The Discourse of Classroom Interaction in Kenyan Primary Schools

ERIC Educational Resources Information Center

Pontefract, Caroline; Hardman, Frank

2005-01-01

This paper addresses the role of classroom discourse in supporting children's learning in Kenyan primary schools. The discourse strategies of 27 teachers teaching English, mathematics and science across the primary phase were intensively studied using discourse analysis and semi-structured interviews. A survey questionnaire (n = 359) was also used…

Physicians' perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models.

PubMed

Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D'Elia, Teresa; Hillier, Loretta M

2015-03-01

To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Ontario. Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists(n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16).Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes,promote efficient use of health care resources, and reduce healthcare costs.

Prospecting for Support in a Wild Environment: Investigating a School-to-School Support System for Primary School Leaders

ERIC Educational Resources Information Center

Abbott, Ian; Middlewood, David; Robinson, Susan

2014-01-01

This paper draws on data collected from a series of semi-structured interviews with head teachers and other stakeholders on the impact and effectiveness of the introduction of a Primary School Improvement Group (PSIG) by the Local Authority (LA). The PSIG was introduced as a response to concerns expressed by the Department of Education about the…

Providing Primary Health Care to Children: Integrating Primary Care Services with Health Insurance Principles.

ERIC Educational Resources Information Center

Rosenbaum, Sara

1993-01-01

Examines how health care reform might be structured to provide support for a package of primary care services for children of all socioeconomic strata. An insurance-like financing system, such as the special Medicaid payment system adopted by New York State for public and nonprofit primary health care programs, may be useful as a model for a…

Patient reactance as a moderator of the effect of therapist structure on posttreatment alcohol use.

PubMed

Karno, Mitchell P; Longabaugh, Richard; Herbeck, Diane

2009-11-01

We sought to replicate findings about the effect of therapist-imposed structure on alcoholism-treatment effectiveness for aftercare patients at different levels of interpersonal reactance and to examine if the effect generalizes to patients in a primary phase of treatment. Analyses were based on ex post facto observer ratings combined with outcome data from a randomized clinical trial. Participants had alcohol abuse or dependence (N = 247) and received treatment at either a primary outpatient treatment site (n = 125) or an aftercare site (n = 122) of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Patients' trait reactance and therapist structure were assessed via observer ratings based on videotaped therapy sessions. Dependent variables included percentage days abstinent, percentage heavy-drinking days, time to first drinking day, and time to first heavy-drinking day throughout a 1-year posttreatment period. The results indicated that increased therapist structure during aftercare treatment predicted fewer abstinent days and more heavy-drinking days for persons at a high level of reactance than for persons at a low level of reactance. The effect was a consistent predictor of alcohol use throughout each 3-month interval within the follow-up period. The interaction effect was not supported in the primary outpatient treatment sites, and it was not supported as a predictor of time to first drink or time to first heavy drink in either the aftercare or the outpatient sites. This study successfully replicated the finding that level of patient reactance appears to moderate the effect of therapist structure on alcohol-use outcomes in aftercare treatment settings. The lack of support for this effect in primary outpatient treatment settings suggests that the negative effect of structured treatment may be limited to patients who are further along in the recovery process.

Design Study of an 8 Meter Monolithic Mirror UV/Optical Space Telescope

NASA Technical Reports Server (NTRS)

Stahl, H. Philip

2008-01-01

This paper will review a recent NASA MSFC preliminary study that demonstrated the feasibility of launching a 6 to 8 meter class monolithic primary mirror telescope to Sun-Earth L2 using an Ares V. The study started with the unique capabilities of the Ares V vehicle and examined the feasibility of launching a large aperture low cost low risk telescope based on a conventional ground based glass primary mirror. Specific technical areas studied included optical design; structural design/analysis including primary mirror support structure, sun shade and secondary mirror support structure; thermal analysis; launch vehicle performance and trajectory; spacecraft including structure, propulsion, GN & C, avionics, power systems and reaction wheels; operations & servicing, mass budget and system cost. The study telescope was an on-axis three-mirror anastigmatic design with a fine steering mirror. The observatory has a 100 arc-minute (8.4 X 12 arc-minutes) of diffraction limited field of view at a wavelength les than 500 nm. The study assumed that the primary mirror would be fabricated from an existing Schott Zerodur residual VLT blank edged to 6.2 meters, 175 mm thick at the edge with a mass of 11,000 kg. The entire mass budget for the observatory including primary mirror, structure, light baffle tube, instruments, space craft, avionics, etc. is less than 40,000 kg - a 33% mass margin on the Ares V's 60,000 kg Sun-Earth L2 capability. An 8 meter class observatory would have a total mass of less than 60,000 kg of which the primary mirror is the largest contributor.

Textile technology development

NASA Technical Reports Server (NTRS)

Shah, Bharat M.

1995-01-01

The objectives of this report were to evaluate and select resin systems for Resin Transfer Molding (RTM) and Powder Towpreg Material, to develop and evaluate advanced textile processes by comparing 2-D and 3-D braiding for fuselage frame applications and develop window belt and side panel structural design concepts, to evaluate textile material properties, and to develop low cost manufacturing and tooling processes for the automated manufacturing of fuselage primary structures. This research was in support of the NASA and Langley Research Center (LaRc) Advanced Composite Structural Concepts and Materials Technologies for Primary Aircraft Structures program.

Physicians’ perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models

PubMed Central

Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D’Elia, Teresa; Hillier, Loretta M.

2015-01-01

Abstract Objective To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Design Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Setting Ontario. Participants Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Methods Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists (n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16). Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Main findings Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. Conclusion The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes, promote efficient use of health care resources, and reduce health care costs. PMID:25932482

An 8 Meter Monolithic UV/Optical Space Telescope

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Postman, Marc

2008-01-01

The planned Ares V launch vehicle with its 10 meter fairing and at least 55,600 kg capacity to Earth Sun L2 enables entirely new classes of space telescopes. A consortium from NASA, Space Telescope Science Institute, and aerospace industry are studying an 8-meter monolithic primary mirror UV/optical/NIR space telescope to enable new astrophysical research that is not feasible with existing or near-term missions, either space or ground. This paper briefly reviews the science case for such a mission and presents the results of an on-going technical feasibility study, including: optical design; structural design/analysis including primary mirror support structure, sun shade and secondary mirror support structure; thermal analysis; launch vehicle performance and trajectory; spacecraft including structure, propulsion, GN&C, avionics, power systems and reaction wheels; operations & servicing; mass budget and cost.

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

PubMed Central

2013-01-01

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

Supporting Teachers in Structuring Mathematics Lessons Involving Challenging Tasks

ERIC Educational Resources Information Center

Sullivan, Peter; Askew, Mike; Cheeseman, Jill; Clarke, Doug; Mornane, Angela; Roche, Anne; Walker, Nadia

2015-01-01

The following is a report on an investigation into ways of supporting teachers in converting challenging mathematics tasks into classroom lessons and supporting students in engaging with those tasks. Groups of primary and secondary teachers, respectively, were provided with documentation of ten lessons built around challenging tasks. Teachers…

Metabolic and structural integrity of magnetic nanoparticle-loaded primary endothelial cells for targeted cell therapy.

PubMed

Orynbayeva, Zulfiya; Sensenig, Richard; Polyak, Boris

2015-05-01

To successfully translate magnetically mediated cell targeting from bench to bedside, there is a need to systematically assess the potential adverse effects of magnetic nanoparticles (MNPs) interacting with 'therapeutic' cells. Here, we examined in detail the effects of internalized polymeric MNPs on primary rat endothelial cells' structural intactness, metabolic integrity and proliferation potential. The intactness of cytoskeleton and organelles was studied by fluorescent confocal microscopy, flow cytometry and high-resolution respirometry. MNP-loaded primary endothelial cells preserve intact cytoskeleton and organelles, maintain normal rate of proliferation, calcium signaling and mitochondria energy metabolism. This study provides supportive evidence that MNPs at doses necessary for targeting did not induce significant adverse effects on structural integrity and functionality of primary endothelial cells - potential cell therapy vectors.

Statistical loads data for MD-82/83 aircraft in commercial operations

DOT National Transportation Integrated Search

1999-02-01

The University of Dayton is supporting Federal Aviation Administration (FAA) research on the structural integrity requirements for the US commercial transport aircraft fleet. The primary objective of this research is to support the FAA Airborne Data ...

End-user support for primary care electronic medical records: a qualitative case study of users’ needs, expectations and realities

PubMed Central

Shachak, Aviv; Montgomery, Catherine; Dow, Rustam; Barnsley, Jan; Tu, Karen; Jadad, Alejandro R.; Lemieux-Charles, Louise

2015-01-01

Support is considered an important factor for realizing the benefits of health information technology (HIT) but there is a dearth of research on the topic of support, especially in primary care. We conducted a qualitative multiple case study of 4 family health teams (FHTs) and one family health organization (FHO) in Ontario, Canada in an attempt to gain insight into users’ expectations and needs, and the realities of end-user support for primary care electronic medical records (EMRs). Data were collected by semi-structured interviews, documents review, and observation of training sessions. The analysis highlights the important role of on-site information technology (IT) staff and super-users in liaising with various stakeholders to solve technical problems and providing hardware and functional (‘how to’) support; the local development of data support practices to ensure consistent documentation; and the gaps that exist in users’ and support personnel’s understanding of each other’s work processes. PMID:26225209

33 CFR 323.4 - Discharges not requiring permits.

Code of Federal Regulations, 2013 CFR

2013-07-01

... discrete structures and the installation of support facilities necessary for construction and utilization... construction of any canal, ditch, dike or other waterway or structure which drains or otherwise significantly... construction of any such structure or waterway requires a permit. (D) Plowing means all forms of primary...

33 CFR 323.4 - Discharges not requiring permits.

Code of Federal Regulations, 2011 CFR

2011-07-01

... discrete structures and the installation of support facilities necessary for construction and utilization... construction of any canal, ditch, dike or other waterway or structure which drains or otherwise significantly... construction of any such structure or waterway requires a permit. (D) Plowing means all forms of primary...

33 CFR 323.4 - Discharges not requiring permits.

Code of Federal Regulations, 2014 CFR

2014-07-01

... discrete structures and the installation of support facilities necessary for construction and utilization... construction of any canal, ditch, dike or other waterway or structure which drains or otherwise significantly... construction of any such structure or waterway requires a permit. (D) Plowing means all forms of primary...

33 CFR 323.4 - Discharges not requiring permits.

Code of Federal Regulations, 2012 CFR

2012-07-01

... discrete structures and the installation of support facilities necessary for construction and utilization... construction of any canal, ditch, dike or other waterway or structure which drains or otherwise significantly... construction of any such structure or waterway requires a permit. (D) Plowing means all forms of primary...

Structure of the Social Support Network of Patients with Severe and Persistent Psychiatric Disorders in Follow-Ups to Primary Health Care.

PubMed

de Souza, Jacqueline; de Almeida, Letícia Yamawaka; Moll, Marciana Fernandes; Silva, Lucas Duarte; Ventura, Carla Aparecida Arena

2016-02-01

The objective of this study is to analyze the characteristics of social support networks of patients with psychiatric disorders at follow-up to primary care. This is a cross-sectional qualitative research study. Forty-five interviews were held with patients and their supporters. The results showed small and dense networks, with a strong emphasis on the bonds with formal supporters and a scant network of informal supporters. It is recommended to develop strategies to improve social support networks and use this as an outcome indicator related to social integration of these patients and to the quality of services involved with outpatient healthcare. Copyright © 2015 Elsevier Inc. All rights reserved.

Statistical loads data for B-767-200ER aircraft in commercial operations

DOT National Transportation Integrated Search

2000-03-01

The University of Dayton is supporting Federal Aviation Administration (FAA) research on the structural integrity requirements for the U.S. commercial transport airplane fleet. The primary objective of this research is to support the FAA Airborne Dat...

LDR structural experiment definition

NASA Technical Reports Server (NTRS)

Russell, Richard A.; Gates, Richard M.

1988-01-01

A study was performed to develop the definition of a structural flight experiment for a large precision segmented reflector that would utilize the Space Station. The objective of the study was to use the Large Deployable Reflector (LDR) baseline configuration for focusing on experiment definition activity which would identify the Space Station accommodation requirements and interface constraints. Results of the study defined three Space Station based experiments to demonstrate the technologies needed for an LDR type structure. The basic experiment configurations are the same as the JPL baseline except that the primary mirror truss is 10 meters in diameter instead of 20. The primary objectives of the first experiment are to construct the primary mirror support truss and to determine its structural and thermal characteristics. Addition of the optical bench, thermal shield and primary mirror segments and alignment of the optical components occur on the second experiment. The structure will then be moved to the payload pointing system for pointing, optical control and scientific optical measurement for the third experiment.

Patient Reactance as a Moderator of the Effect of Therapist Structure on Posttreatment Alcohol Use*

PubMed Central

Karno, Mitchell P.; Longabaugh, Richard; Herbeck, Diane

2009-01-01

Objective: We sought to replicate findings about the effect of therapist-imposed structure on alcoholism-treatment effectiveness for aftercare patients at different levels of interpersonal reactance and to examine if the effect generalizes to patients in a primary phase of treatment. Method: Analyses were based on ex post facto observer ratings combined with outcome data from a randomized clinical trial. Participants had alcohol abuse or dependence (N = 247) and received treatment at either a primary outpatient treatment site (n = 125) or an aftercare site (n = 122) of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Patients' trait reactance and therapist structure were assessed via observer ratings based on videotaped therapy sessions. Dependent variables included percentage days abstinent, percentage heavy-drinking days, time to first drinking day, and time to first heavy-drinking day throughout a 1-year posttreatment period. Results: The results indicated that increased therapist structure during aftercare treatment predicted fewer abstinent days and more heavy-drinking days for persons at a high level of reactance than for persons at a low level of reactance. The effect was a consistent predictor of alcohol use throughout each 3-month interval within the follow-up period. The interaction effect was not supported in the primary outpatient treatment sites, and it was not supported as a predictor of time to first drink or time to first heavy drink in either the aftercare or the outpatient sites. Conclusions: This study successfully replicated the finding that level of patient reactance appears to moderate the effect of therapist structure on alcohol-use outcomes in aftercare treatment settings. The lack of support for this effect in primary outpatient treatment settings suggests that the negative effect of structured treatment may be limited to patients who are further along in the recovery process. PMID:19895770

JWST testbed telescope: a functionally accurate scaled version of the flight optical telescope element used to develop the flight wavefront sensing and control algorithm

NASA Astrophysics Data System (ADS)

Kingsbury, Lana K.; Atcheson, Paul D.

2004-10-01

The Northrop-Grumman/Ball/Kodak team is building the JWST observatory that will be launched in 2011. To develop the flight wavefront sensing and control (WFS&C) algorithms and software, Ball is designing and building a 1 meter diameter, functionally accurate version of the JWST optical telescope element (OTE). This testbed telescope (TBT) will incorporate the same optical element control capability as the flight OTE. The secondary mirror will be controlled by a 6 degree of freedom (dof) hexapod and each of the 18 segmented primary mirror assemblies will have 6 dof hexapod control as well as radius of curvature adjustment capability. In addition to the highly adjustable primary and secondary mirrors, the TBT will include a rigid tertiary mirror, 2 fold mirrors (to direct light into the TBT) and a very stable supporting structure. The total telescope system configured residual wavefront error will be better than 175 nm RMS double pass. The primary and secondary mirror hexapod assemblies enable 5 nm piston resolution, 0.0014 arcsec tilt resolution, 100 nm translation resolution, and 0.04497 arcsec clocking resolution. The supporting structure (specifically the secondary mirror support structure) is designed to ensure that the primary mirror segments will not change their despace position relative to the secondary mirror (spaced > 1 meter apart) by greater than 500 nm within a one hour period of ambient clean room operation.

Vaginal type-II mucosa is an inductive site for primary CD8+ T-cell mucosal immunity

PubMed Central

Wang, Yichuan; Sui, Yongjun; Kato, Shingo; Hogg, Alison E.; Steel, Jason C.; Morris, John C.; Berzofsky, Jay A.

2014-01-01

The structured lymphoid tissues are considered the only inductive sites where primary T cell immune responses occur. The naïve T cells in structured lymphoid tissues, once being primed by antigen -bearing dendritic cells, differentiate into memory T cells and traffic back to the mucosal sites through the bloodstream. Contrary to this belief, here we show that the vaginal type-II mucosa itself, despite lack of structured lymphoid tissues, can act as an inductive site during primary CD8+ T cell immune responses. We provide evidence that the vaginal mucosa supports both the local immune priming of naïve CD8+ T cells and the local expansion of antigen-specific CD8+ T cells, thereby demonstrating a different paradigm for primary mucosal T cell immune induction. PMID:25600442

Formation and nitrile hydrogenation performance of Ru nanoparticles on a K-doped Al2O3 surface.

PubMed

Muratsugu, Satoshi; Kityakarn, Sutasinee; Wang, Fei; Ishiguro, Nozomu; Kamachi, Takashi; Yoshizawa, Kazunari; Sekizawa, Oki; Uruga, Tomoya; Tada, Mizuki

2015-10-14

Decarbonylation-promoted Ru nanoparticle formation from Ru3(CO)12 on a basic K-doped Al2O3 surface was investigated by in situ FT-IR and in situ XAFS. Supported Ru3(CO)12 clusters on K-doped Al2O3 were converted stepwise to Ru nanoparticles, which catalyzed the selective hydrogenation of nitriles to the corresponding primary amines via initial decarbonylation, the nucleation of the Ru cluster core, and the growth of metallic Ru nanoparticles on the surface. As a result, small Ru nanoparticles, with an average diameter of less than 2 nm, were formed on the support and acted as efficient catalysts for nitrile hydrogenation at 343 K under hydrogen at atmospheric pressure. The structure and catalytic performance of Ru catalysts depended strongly on the type of oxide support, and the K-doped Al2O3 support acted as a good oxide for the selective nitrile hydrogenation without basic additives like ammonia. The activation of nitriles on the modelled Ru catalyst was also investigated by DFT calculations, and the adsorption structure of a nitrene-like intermediate, which was favourable for high primary amine selectivity, was the most stable structure on Ru compared with other intermediate structures.

Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

PubMed

Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support were critical. In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination

PubMed Central

2013-01-01

Background Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination. The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care. The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary - hospital care continuum. Methods This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results. Results The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships. Conclusion Care pathways across the primary-hospital care continuum enhance the components of care coordination. PMID:23919518

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination.

PubMed

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

2013-08-06

Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination.The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care.The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary-hospital care continuum. This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results. The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other's roles, expectations and competences and building qualitative relationships. Care pathways across the primary-hospital care continuum enhance the components of care coordination.

Terminator assembly for a floating structure

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

Chiu, H.; Hall, J.E.

1987-10-20

A terminator assembly is described for use in mooring a floating surface to the floor of a body of water. The floating structure has has an upper support and a lower support, comprising: a hawsepipe extending downwardly from adjacent the upper support and supported by the lower support, a tension member extending downwardly from adjacent the upper support through the hawsepipe and the lower support. The tension member has a lower end adapted for connection to the floor of the body of water. Locking means connected to an upper portion of the tension member for maintaining the tension member inmore » tension by acting upon an upper portion of the hawsepipe without transferring primary tension load forces to the upper support.« less

Unibody Composite Pressurized Structure (UCPS) for In-Space Propulsion

NASA Technical Reports Server (NTRS)

Rufer, Markus

2015-01-01

Microcosm, Inc., in conjunction with the Scorpius Space Launch Company, is developing a UCPS (Unibody Composite Pressurized Structure )for in-space propulsion. This innovative approach constitutes a clean break from traditional spacecraft design by combining what were traditionally separate primary and secondary support structures and metal propellant tanks into a single unit.

The emergence of family medicine in Kyrgyzstan.

PubMed

Hardison, Charles; Fonken, Paul; Chew, Tom; Smith, Barton

2007-10-01

In post-Soviet Central Asia, Kyrgyzstan has emerged as the leader in family medicine reform. This paper examines the factors that have allowed family medicine to become the foundation of primary care and the rationale for retraining specialists in primary care. Critical elements of successful family medicine reform have included national policy, international cooperation, training programs, support structures, and quality measures. The national policy has contributed to an environment that has allowed many international organizations to participate in the process of reforming the health care system. The 9-year training process was a momentous nationwide development task that was supported by various structures, organizations, and events and included the implementation of quality measures. Various reports, studies, and evaluations support the positive impact family medicine has had on patient satisfaction, physician attitude, and scope of practice. Further, one study indicates improved health outcomes in terms of decreased years of potential life lost. The national policy of reform that is in favor of family medicine, and international donor agencies-supported training, produced the following results: a group of family medicine teachers, 98% (2,691) of the country's primary care doctors retrained in family medicine, and there were 372 family medicine resident graduates. To ensure quality, objective structured clinical exams were implemented in all levels of training. It will take many more years to fully establish family medicine in the medical culture of Kyrgyzstan and reap its full benefits, but already it is contributing toward improvements in the quality of patient care.

Professional Vision of Classroom Management and Learning Support in Science Classrooms--Does Professional Vision Differ across General and Content-Specific Classroom Interactions?

ERIC Educational Resources Information Center

Steffensky, Mirjam; Gold, Bernadette; Holdynski, Manfred; Möller, Kornelia

2015-01-01

The present study investigates the internal structure of professional vision of in-service teachers and student teachers with respect to classroom management and learning support in primary science lessons. Classroom management (including monitoring, managing momentum, and rules and routines) and learning support (including cognitive activation…

Dynamic analysis of the large deployable reflector

NASA Technical Reports Server (NTRS)

Calleson, Robert E.; Scott, A. Don

1987-01-01

The Large Deployable Reflector (LDR) is to be an astronomical observatory orbiting above Earth's obscuring atmosphere and operating in the spectral range between 30 microns and 1000 microns wavelength. The LDR will be used to study such astronomical phenomena as stellar and galactic formation, cosmology, and planetary atmospheres. The LDR will be the first observatory to be erected and assembled in space. This distinction brings with it several major technological challenges such as the development of ultra-lightweight deployable mirrors, advanced mirror fabrication techniques, advanced structures, and control of vibrations due to various sources of excitation. The purpose of this analysis is to provide an assessment of the vibrational response due to secondary mirror chopping and LDR slewing. The dynamic response of two 20-m LDR configurations was studied. Two mirror support configurations were investigated for the Ames concept, the first employs a six-strut secondary mirror support structure, while the second uses a triple-bipod support design. All three configurations were modeled using a tetrahedral truss design for the primary mirror support structure. Response resulting from secondary mirror chopping was obtained for the two Ames configurations, and the response of the primary mirror from slewing was obtained for all three configurations.

Structures with three dimensional nanofences comprising single crystal segments

DOEpatents

Goyal, Amit; Wee, Sung-Hun

2013-08-27

An article includes a substrate having a surface and a nanofence supported by the surface. The nanofence includes a multiplicity of primary nanorods and branch nanorods, each of the primary nanorods being attached to said substrate, and each of the branch nanorods being attached to a primary nanorods and/or another branch nanorod. The primary and branch nanorods are arranged in a three-dimensional, interconnected, interpenetrating, grid-like network defining interstices within the nanofence. The article further includes an enveloping layer supported by the nanofence, disposed in the interstices, and forming a coating on the primary and branch nanorods. The enveloping layer has a different composition from that of the nanofence and includes a radial p-n single junction solar cell photovoltaic material and/or a radial p-n multiple junction solar cell photovoltaic material.

Understanding the implementation and adoption of an information technology intervention to support medicine optimisation in primary care: qualitative study using strong structuration theory.

PubMed

Jeffries, Mark; Phipps, Denham; Howard, Rachel L; Avery, Anthony; Rodgers, Sarah; Ashcroft, Darren

2017-05-10

Using strong structuration theory, we aimed to understand the adoption and implementation of an electronic clinical audit and feedback tool to support medicine optimisation for patients in primary care. This is a qualitative study informed by strong structuration theory. The analysis was thematic, using a template approach. An a priori set of thematic codes, based on strong structuration theory, was developed from the literature and applied to the transcripts. The coding template was then modified through successive readings of the data. Clinical commissioning group in the south of England. Four focus groups and five semi-structured interviews were conducted with 18 participants purposively sampled from a range of stakeholder groups (general practitioners, pharmacists, patients and commissioners). Using the system could lead to improved medication safety, but use was determined by broad institutional contexts; by the perceptions, dispositions and skills of users; and by the structures embedded within the technology. These included perceptions of the system as new and requiring technical competence and skill; the adoption of the system for information gathering; and interactions and relationships that involved individual, shared or collective use. The dynamics between these external, internal and technological structures affected the adoption and implementation of the system. Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mechanical and thermal disturbances of the PSR Moderate Focus-Mission Structure

NASA Technical Reports Server (NTRS)

Shih, Choon-Foo; Lou, Michael C.

1991-01-01

The primary objective of this paper is to evaluate the optical pointing performance of the PSR Moderate Focus-Mission Structure when subjected to both mechanical and thermal disturbances. The mechanical disturbances are based on secondary mirror chopping. Results indicate that dynamic responses of the primary reflector and the secondary reflector subjected to chopping disturbances of the secondary reflector about its center of mass are within the figure maintenance control capabilities. The effects of modal damping, truss-type secondary support, interface boundary constraints, and alternate configurations, are also evaluated in the analysis. Thermal distortions of the structure were also evaluated based on the on-orbit temperature profiles derived from the submillimeter telescope missions. Results from thermal deformation analysis indicate that figure initialization control is needed for the PSR Moderate Focus-Mission. However, a figure maintenance system may not be required if adequate thermal isolation is incorporated into the support truss design for the PSR Moderate Focus-Mission Structure.

Polymer Basics: Classroom Activities Manipulating Paper Clips to Introduce the Structures and Properties of Polymers

ERIC Educational Resources Information Center

Umar, Yunusa

2014-01-01

A simple and effective hands-on classroom activity designed to illustrate basic polymer concepts is presented. In this activity, students build primary structures of homopolymers and different arrangements of monomers in copolymer using paper clips as monomers. The activity supports formation of a basic understanding of polymer structures,…

Summary of LSST systems analysis and integration task for SPS flight test articles

NASA Astrophysics Data System (ADS)

Greenberg, H. S.

1981-02-01

The structural and equipment requirements for two solar power satellite (SPS) test articles are defined. The first SPS concept uses a hexagonal frame structure to stabilize the array of primary tension cables configured to support a Mills Cross antenna containing 17,925 subarrays composed of dipole radiating elements and solid state power amplifier modules. The second test article consists of a microwave antenna and its power source, a 20 by 200 m array of solar cell blankets, both of which are supported by the solar blanket array support structure. The test article structure, a ladder, is comprised of two longitudinal beams (215 m long) spaced 10 m apart and interconnected by six lateral beams. The system control module structure and bridge fitting provide bending and torsional stiffness, and supplement the in plane Vierendeel structure behavior. Mission descriptions, construction, and structure interfaces are addressed.

Elderly demand for family-based care and support: evidence from a social intervention strategy.

PubMed

Aboagye, Emmanuel; Agyemang, Otuo Serebour; Tjerbo, Trond

2013-12-06

This paper examines the influence of the national health insurance scheme on elderly demand for family-based care and support. It contributes to the growing concern on the rapid increase in the elderly population globally using micro-level social theory to examine the influence the health insurance has on elderly demand for family support. A qualitative case study approach is applied to construct a comprehensive and thick description of how the national health insurance scheme influences the elderly in their demand for family support.Through focused interviews and direct observation of six selected cases, in-depth information on primary carers, living arrangement and the interaction between the health insurance as structure and elders as agents are analyzed. The study highlights that the interaction between the elderly and the national health insurance scheme has produced a new stratum of relationship between the elderly and their primary carers. Consequently, this has created equilibrium between the elderly demand for support and support made available by their primary carers. As the demand of the elderly for support is declining, supply of support by family members for the elderly is also on the decline.

Elderly Demand for Family-based Care and Support: Evidence from a Social Intervention Strategy

PubMed Central

Aboagye, Emmanuel; Agyemang, Otuo Serebour; Tjerbo, Trond

2014-01-01

This paper examines the influence of the national health insurance scheme on elderly demand for family-based care and support. It contributes to the growing concern on the rapid increase in the elderly population globally using micro-level social theory to examine the influence the health insurance has on elderly demand for family support. A qualitative case study approach is applied to construct a comprehensive and thick description of how the national health insurance scheme influences the elderly in their demand for family support. Through focused interviews and direct observation of six selected cases, in-depth information on primary carers, living arrangement and the interaction between the health insurance as structure and elders as agents are analyzed. The study highlights that the interaction between the elderly and the national health insurance scheme has produced a new stratum of relationship between the elderly and their primary carers. Consequently, this has created equilibrium between the elderly demand for support and support made available by their primary carers. As the demand of the elderly for support is declining, supply of support by family members for the elderly is also on the decline. PMID:24576369

Design development of graphite primary structures enables SSTO success

NASA Astrophysics Data System (ADS)

Biagiotti, V. A.; Yahiro, J. S.; Suh, Daniel E.; Hodges, Eric R.; Prior, Donald J.

1997-01-01

This paper describes the development of a graphite composite wing and a graphite composite intertank primary structure for application toward Single-Stage to Orbit space vehicles such as those under development in NASA's X-33/Reusable Launch Vehicle (RLV) Program. The trade study and designs are based on a Rockwell vertical take-off and horizontal landing (VTHL) wing-body RLV vehicle. Northrop Grumman's approach using a building block development technique is described. Composite Graphite/Bismaleimide (Gr/BMI) material characterization test results are presented. Unique intertank and wing composite subcomponent test article designs are described and test results to date are presented. Wing and intertank Full Scale Section Test Article (FSTA) objectives and designs are outlined. Trade studies, supporting building block testing, and FSTA demonstrations combine to develop graphite primary structure composite technology that enables developing X-33/RLV design programs to meet critical SSTO structural weight and operations performance criteria.

The Renewed Primary School in Belgium: Analysis of the Local Innovation Policy.

ERIC Educational Resources Information Center

Vandenberghe, Roland

The Renewed Primary School project in Belgium is analyzed in this paper in terms of organizational response to a large-scale innovation, which is characterized by its multidimensionality, by the large number of participating schools, and by a complex support structure. Section 2 of the report presents an elaborated description of these…

The Latent Structure of Secure Base Script Knowledge

ERIC Educational Resources Information Center

Waters, Theodore E. A.; Fraley, R. Chris; Groh, Ashley M.; Steele, Ryan D.; Vaughn, Brian E.; Bost, Kelly K.; Veríssimo, Manuela; Coppola, Gabrielle; Roisman, Glenn I.

2015-01-01

There is increasing evidence that attachment representations abstracted from childhood experiences with primary caregivers are organized as a cognitive script describing secure base use and support (i.e., the "secure base script"). To date, however, the latent structure of secure base script knowledge has gone unexamined--this despite…

Internal and external relationships of the Cnidaria: implications of primary and predicted secondary structure of the 5'-end of the 23S-like rDNA.

PubMed Central

Odorico, D M; Miller, D J

1997-01-01

Since both internal (class-level) and external relationships of the Cnidaria remain unclear on the basis of analyses of 18S and (partial) 16S rDNA sequence data, we examined the informativeness of the 5'-end of the 23S-like rDNA. Here we describe analyses of both primary and predicted secondary structure data for this region from the ctenophore Bolinopsis sp., the placozoan Trichoplax adhaerens, the sponge Hymeniacidon heliophila, and representatives of all four cnidarian classes. Primary sequence analyses clearly resolved the Cnidaria from other lower Metazoa, supported sister group relationships between the Scyphozoa and Cubozoa and between the Ctenophora and the Placozoa, and confirmed the basal status of the Anthozoa within the Cnidaria. Additionally, in the ctenophore, placozoan and sponge, non-canonical base pairing is required to maintain the secondary structure of the B12 region, whereas amongst the Cnidaria this is not the case. Although the phylogenetic significance of this molecular character is unclear, our analyses do not support the close relationship between Cnidaria and Placozoa suggested by previous studies. PMID:9061962

Analysis of large space structures assembly: Man/machine assembly analysis

NASA Technical Reports Server (NTRS)

1983-01-01

Procedures for analyzing large space structures assembly via three primary modes: manual, remote and automated are outlined. Data bases on each of the assembly modes and a general data base on the shuttle capabilities to support structures assembly are presented. Task element times and structure assembly component costs are given to provide a basis for determining the comparative economics of assembly alternatives. The lessons learned from simulations of space structures assembly are detailed.

Extension of research data repository system to support direct compute access to biomedical datasets: enhancing Dataverse to support large datasets

PubMed Central

McKinney, Bill; Meyer, Peter A.; Crosas, Mercè; Sliz, Piotr

2016-01-01

Access to experimental X-ray diffraction image data is important for validation and reproduction of macromolecular models and indispensable for the development of structural biology processing methods. In response to the evolving needs of the structural biology community, we recently established a diffraction data publication system, the Structural Biology Data Grid (SBDG, data.sbgrid.org), to preserve primary experimental datasets supporting scientific publications. All datasets published through the SBDG are freely available to the research community under a public domain dedication license, with metadata compliant with the DataCite Schema (schema.datacite.org). A proof-of-concept study demonstrated community interest and utility. Publication of large datasets is a challenge shared by several fields, and the SBDG has begun collaborating with the Institute for Quantitative Social Science at Harvard University to extend the Dataverse (dataverse.org) open-source data repository system to structural biology datasets. Several extensions are necessary to support the size and metadata requirements for structural biology datasets. In this paper, we describe one such extension—functionality supporting preservation of filesystem structure within Dataverse—which is essential for both in-place computation and supporting non-http data transfers. PMID:27862010

Ethics support for GPs: what should it look like?

PubMed

Clark-Grill, Monika

2016-03-01

INTRODUCTION Ethics support services for hospital clinicians have become increasingly common globally but not as yet in New Zealand. However, an initiative to change this is gathering momentum. Its slogan 'Clinical ethics is everyone's business' indicates that the aim is to encompass all of health care, not just the hospital sector. General Practitioners (GPs) deal with ethical issues on a daily basis. These issues are often quite different from ethical issues in hospitals. To make future ethics support relevant for primary care, local GPs were interviewed to find out how they might envisage ethics support services that could be useful to them. METHODS A focus group interview with six GPs and semi-structured individual interviews with three GPs were conducted. Questions included how they made decisions on ethical issues at present, what they perceived as obstacles to ethical reflection and decision-making, and what support might be helpful. FINDINGS Three areas of ethics support were considered potentially useful: Formal ethics education during GP training, access to an ethicist for assistance with analysing an ethical issue, and professional guidance with structured ethics conversations in peer groups. CONCLUSION The complex nature of general practice requires GPs to be well educated and supported for handling ethical issues. The findings from this study could serve as input to the development of ethics support services. KEYWORDS General practice; primary care; ethics; support; education.

Primary care practice organization influences colorectal cancer screening performance.

PubMed

Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

2007-06-01

To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001). Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

Promoting physical activity among older people in primary care using peer mentors.

PubMed

Stevens, Zoe; Barlow, Cate; Iliffe, Steve

2015-04-01

The home-based Otago Exercise Programme has been shown to increase sustained physical-activity levels in older people recruited through primary care, when supported by health professionals. The ProAct65+ trial is testing this programme using volunteer peer mentors to support behaviour change. This qualitative study explored how these peer mentors experienced their role. Ten peer mentors from the ProAct65+ trial were interviewed. Semi-structured interviews were audio-recorded, transcribed verbatim and thematically analysed. Peer mentors reported positive experiences including meeting new people, watching mentees progress, developing friendships and being shown gratitude for their support. Key barriers and facilitators to the mentoring process included the home and telephone as settings for support, geography and making contact with mentees. Findings from this study can help the development of peer mentor programmes in primary care for older people. Future programmes should recruit peer mentors who are local to where mentoring is needed to reduce travel difficulties.

GPs' experiences of children with anxiety disorders in primary care: a qualitative study.

PubMed

O'Brien, Doireann; Harvey, Kate; Young, Bridget; Reardon, Tessa; Creswell, Cathy

2017-12-01

Anxiety disorders have a median age of onset of 11 years and are the most common emotional disorders in childhood; however, a significant proportion of those affected do not access professional support. In the UK, GPs are often the first medical professional that families see so are in a prime position to support children with anxiety disorders; however, currently there is little research available on GPs' perspectives on and experiences of supporting children with these disorders. To explore the experiences of GPs in relation to identification, management, and access to specialist services for children (<12 years) with anxiety disorders. Twenty semi-structured interviews were conducted with GPs in primary care throughout England. GPs reflected a diverse group in relation to the ethnic and socioeconomic profile of registered patients, GP age, sex, professional status, previous engagement with research, and practice size and location. Purposive sampling was used to recruit GPs until theoretical saturation was reached. Data were analysed using a constant comparative method of thematic analysis. Data from 20 semi-structured interviews were organised into three themes: decision making, responsibility, and emotional response, with an overarching theme of GPs feeling ill equipped. These themes were retrospectively analysed to illustrate their role at different stages in the primary care process (identification, management, and access to specialist services). GPs feel ill equipped to manage and support childhood anxiety disorders, demonstrating a need for medical training to include greater emphasis on children's mental health, as well as potential for greater collaboration between primary and specialist services. © British Journal of General Practice 2017.

GPs’ experiences of children with anxiety disorders in primary care: a qualitative study

PubMed Central

O’Brien, Doireann; Harvey, Kate; Young, Bridget; Reardon, Tessa; Creswell, Cathy

2017-01-01

Background Anxiety disorders have a median age of onset of 11 years and are the most common emotional disorders in childhood; however, a significant proportion of those affected do not access professional support. In the UK, GPs are often the first medical professional that families see so are in a prime position to support children with anxiety disorders; however, currently there is little research available on GPs’ perspectives on and experiences of supporting children with these disorders. Aim To explore the experiences of GPs in relation to identification, management, and access to specialist services for children (<12 years) with anxiety disorders. Design and setting Twenty semi-structured interviews were conducted with GPs in primary care throughout England. Method GPs reflected a diverse group in relation to the ethnic and socioeconomic profile of registered patients, GP age, sex, professional status, previous engagement with research, and practice size and location. Purposive sampling was used to recruit GPs until theoretical saturation was reached. Data were analysed using a constant comparative method of thematic analysis. Results Data from 20 semi-structured interviews were organised into three themes: decision making, responsibility, and emotional response, with an overarching theme of GPs feeling ill equipped. These themes were retrospectively analysed to illustrate their role at different stages in the primary care process (identification, management, and access to specialist services). Conclusion GPs feel ill equipped to manage and support childhood anxiety disorders, demonstrating a need for medical training to include greater emphasis on children’s mental health, as well as potential for greater collaboration between primary and specialist services. PMID:29061716

Clinical managers in the primary care sector: do the benefits stack up?

PubMed

O'Riordan, Chris; McDermott, Aoife

2012-01-01

The purpose of this paper is to explore the nature and value of the clinical management role undertaken by primary care doctors in Ireland. To date, a majority of research has focused on clinical management roles in the acute sector. The paper presents a sub-set of data from a mixed methods study. In total, 14 semi-structured interviews are drawn upon to identify the nature and value of the clinical management role in primary care. Comparison with acute sector research identifies considerable differences in the nature of the clinical management role across sectors--and in the associated value proposition. Structural and role-related contingencies affecting the potential value of clinical management roles in Irish primary care are discussed. Structural influences include the private ownership structure, low complexity and limited requirement for cross-professional coordination. Role-related influences include the primacy of the clinical identity, time constraints and lack of managerial training. The findings provide a limited basis for generalisation, premised on 14 interviews in one national context. However, given the international shift towards the provision of health services in primary care, they provide a research agenda for an important healthcare context. The findings draw attention to the need for policy consideration of the value of the clinical manager role in primary care; how policy can support effective primary care management; and the need for specialised management training, which takes account of the small-firm context. The paper identifies that primary-care clinical-management roles focus on operational management and oversight and discusses the structural and role-related factors which affect their efficacy.

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

NASA Technical Reports Server (NTRS)

Jenkins, Jerald M.; DeAngelis, V. Michael

1997-01-01

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

Innovative approach to patient-centered care coordination in primary care practices.

PubMed

Clarke, Robin; Bharmal, Nazleen; Di Capua, Paul; Tseng, Chi-Hong; Mangione, Carol M; Mittman, Brian; Skootsky, Samuel A

2015-09-01

Although care coordination is an essential component of the patient-centered medical home structure, current case manager models have limited usefulness to population health because they typically serve a small group of patients defined based on disease or utilization. Our objective was to support our health system's population health by implementing and evaluating a program that embedded nonlicensed coordinators within our primary care practices to support physicians in executing care plans and communicating with patients. Matched case-control differences-in-differences. Comprehensive care coordinators (CCC) were introduced into 14 of the system's 28 practice sites in 2 waves. After a structured training program, CCCs identified, engaged, and intervened among patients within the practice in conjunction with practice primary care providers. We counted and broadly coded CCC activities that were documented in the intervention database. We examined the impact of CCC intervention on emergency department (ED) utilization at the practice level using a negative binomial multivariate regression model controlling for age, gender, and medical complexity. CCCs touched 10,500 unique patients over a 1-year period. CCC interventions included execution of care (38%), coordination of transitions (32%), self-management support/link to community resources (15%), monitor and follow-up (10%), and patient assessment (1%). The CCC intervention group had a 20% greater reduction in its prepost ED visit rate compared with the control group (P < .0001). Our CCC intervention demonstrated a significant reduction in ED visits by focusing on the centrality of the primary care provider and practice. Our model may serve as a cost-effective and scalable alternative for care coordination in primary care.

Factor structure of parent and teacher ratings of the ODD symptoms for Malaysian primary school children.

PubMed

Gomez, Rapson

2017-02-01

This present study used confirmatory factor analysis (CFA) to examine the applicability of one-, two- three- and second order Oppositional Defiant Disorder (ODD) factor models, proposed in previous studies, in a group of Malaysian primary school children. These models were primarily based on parent reports. In the current study, parent and teacher ratings of the ODD symptoms were obtained for 934 children. For both groups of respondents, the findings showing some support for all models examined, with most support for a second order model with Burke et al. (2010) three factors (oppositional, antagonistic, and negative affect) as the primary factors. The diagnostic implications of the findings are discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

Social support, marital adjustment, and psychological distress among women with primary infertility in Pakistan.

PubMed

Qadir, Farah; Khalid, Amna; Medhin, Girmay

2015-01-01

This study aimed to identify prevalence rates of psychological distress among Pakistani women seeking help for primary infertility. The associations of social support, marital adjustment, and sociodemographic factors with psychological distress were also examined. A total of 177 women with primary infertility were interviewed from one hospital in Islamabad using a Self-Reporting Questionnaire, the Multidimensional Scale of Perceived Social Support, and the Locke-Wallace Marital Adjustment Test. The data were collected between November 2012 and March 2013. The prevalence of psychological distress was 37.3 percent. The results of the logistic regression suggested that marital adjustment and social support were significantly negatively associated with psychological distress in this sample. These associations were not confounded by any of the demographic variables controlled in the multivariable regression models. The role of perceived social support and adjustment in marriage among women experiencing primary infertility are important factors in understanding their psychological distress. The results of this small-scale effort highlight the need for social and familial awareness to help tackle the psychological distress related to infertility. Future research needs to focus on the way the experience of infertility is conditioned by social structural realities. New ways need to be developed to better take into account the process and nature of the infertility experience.

Women's experiences of social support during the first year following primary breast cancer surgery.

PubMed

Drageset, Sigrunn; Lindstrøm, Torill Christine; Giske, Tove; Underlid, Kjell

2016-06-01

The aim of this qualitative follow-up study was to describe women's individual experiences of social support during their first year after primary breast cancer surgery. Individual semi-structured interviews with 10 women 1 year after surgery analysed by Kvales' meaning condensation method. Sharing experiences, being understood as an individual, continuity, and information and explanations were themes identified. Sharing mutual experiences increased the women's knowledge regarding cancer, increased experience of support and minimised rumination. After 1 year, the women felt that the network around them had 'normalised' and was less supportive. Being seen as a person, not as 'a diagnosis being treated', and continuity of professional support were important, giving feelings of security and trust. The women felt uncertainty after loss of professional support post-treatment. Information and explanations regarding treatment and treatment-related problems were essential. Mutual sharing of experiences is an important part of social support. Continuity, availability, information and respect were essential aspects of experienced professional support. © 2015 Nordic College of Caring Science.

Design of a flexure mount for optics in dynamic and cryogenic environments

NASA Technical Reports Server (NTRS)

Pollard, Lloyd Wayne

1989-01-01

The design of a flexure mount for a mirror operating in a cryogenic environment is presented. This structure represents a design effort recently submitted to NASA Ames for the support of the primary mirror of the Space Infrared Telescope Facility (SIRTF). The support structure must passively accommodate the differential thermal contraction between the glass mirror and the aluminium structure of the telescope during cryogenic cooldown. Further, it must support the one meter diameter, 116 kilogram (258 pound) primary mirror during a severe launch to orbit without exceeding the micro-yield of the material anywhere in the flexure mount. Procedures used to establish the maximum allowable radial stiffness of the flexural mount, based on the finite element program NASTRAN and the optical program FRINGE, are discussed. Early design concepts were evaluated using a parametric design program, and the development of that program is presented. Dynamic loading analyses performed with NASTRAN are discussed. Methods of combining modal responses resulting from a displacement response spectrum analysis are discussed, and a combination scheme called MRSS, modified root of sum of squares, is presented. Model combination schemes using MRSS, SRSS, and ABS are compared to the results of the modal frequency response analysis performed with NASTRAN.

Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions.

PubMed

Solberg, Hilde Strøm; Steinsbekk, Aslak; Solbjør, Marit; Granbo, Randi; Garåsen, Helge

2014-11-08

Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users' and health professionals' perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients' every-day life situations. The user informants' perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals' competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.

Space Station truss structures and construction considerations

NASA Technical Reports Server (NTRS)

Mikulas, M. M., Jr.; Croomes, S. D.; Schneider, W.; Bush, H. G.; Nagy, K.; Pelischek, T.; Lake, M. S.; Wesselski, C.

1985-01-01

Although a specific configuration has not been selected for the Space Station, a gravity gradient stabilized station as a basis upon which to compare various structural and construction concepts is considered. The Space Station primary truss support structure is described in detail. Three approaches (see sketch A) which are believed to be representative of the major techniques for constructing large structures in space are also described in detail so that salient differences can be highlighted.

Managing professional work: three models of control for health organizations.

PubMed Central

Scott, W R

1982-01-01

Three arrangements for structuring the work of professional participants in professional organizations are described, contrasted and evaluated. Arguments are illustrated by application to the organization of physicians within hospitals. The primary rationale, the support structures that have fostered its development, the key structural features and the advantages and disadvantages of each arrangement are described. The effect on these arrangements of structures and forces external to any particular professional organization is emphasized. PMID:6749761

JPRS Report, East Europe

DTIC Science & Technology

1987-11-24

of the assortment of manufactured parts for partial and complete frames, as well as abutments , support walls, and bridgehead construction...Uniform Series II Generation based on anticipated spans; and • Increased effectiveness of prefabrication for steel and masonry bridge construction...support structures and abutments . Parallel to and on an equal par with standard primary construction trades already cited, the scientific-technical

[Construction of the work process of the Family Health Support Nucleus: the experience of pharmacists in a city in the south of Brazil].

PubMed

Nakamura, Carina Akemi; Leite, Silvana Nair

2016-05-01

The Family Health Support Nucleus (NASF) was created in 2008 with the objective of broadening the range and scope of primary healthcare. The insertion of pharmacists in this multi-professional context represents an opportunity to enhance the working process and the rational access and use of medicines. The working processes of pharmacists in a city NASF was investigated. Field research was conducted using a qualitative approach with participant observation and semi-structured interviews. Two analytic dialectic categories emerged. The first was the pharmacists' dilemma in the construction of their working process as promoters of primary healthcare, while at the same time facing the need to deal with managerial functions mostly to cater to operational demand. The second was the reality experienced with guidelines and coordination of their work, where pharmacists can be free to structure their work as supporters, although at the same time it limits them due to lack of acknowledgment of their previously established working process. The lack of planning and a clear objective for work in the NASF, besides the deficiency of pharmaceutical services in primary healthcare make the development of any type of pharmacist activity important and essential even if it does not fully attend the NASF proposal.

Exploring informal workplace learning in primary healthcare for continuous professional development.

PubMed

Joynes, Viktoria; Kerr, Micky; Treasure-Jones, Tamsin

2017-07-01

All health and social care professionals learn on the job through both formal and informal learning processes, which contributes to continuous professional development (CPD). This study explored workplace learning in General Practices, specifically looking at the role of informal learning and the workplace practices that appear to support or restrict that learning, as well as how technology was integrated into these learning processes. Three focus groups with general practitioners, practice nurses, managerial and administrative staff were conducted followed by twelve individual semi-structured interviews with participants drawn from the focus groups. Three observations of multi-disciplinary team meetings were used to establish potential team-based learning activities. Triggers for informal workplace learning included patients presenting challenging or unusual conditions; exposure to others' professional practice; and policy driven changes through revised guidance and protocols. By exploring how these triggers were acted upon, we identified mechanisms through which the primary care workplace supports or restricts informal learning through working practices, existing technologies and inter-professional structures. Informal workplace learning was identified as arising from both opportunistic encounters and more planned activities, which are both supported and restricted through a variety of mechanisms. Maximising informal learning opportunities and removing barriers to doing so should be a priority for primary care practitioners, managers and educators.

Public health and primary care: struggling to "win friends and influence people".

PubMed

Mayes, Rick; McKenna, Sean

2011-01-01

Why are the goals of public health and primary care less politically popular and financially supported than those of curative medicine? A major part of the answer to this question lies in the fact that humans often worry wrongly by assessing risk poorly. This reality is a significant obstacle to the adequate promotion of and investment in public health, primary care, and prevention. Also, public health's tendency to infringe on personal privacy-as well as to call for difficult behavioral change-often sparks intense controversy and interest group opposition that discourage broader political support. Finally, in contrast to curative medicine, both the cost-benefit structure of public health (costs now, benefits later) and the way in which the profession operates make it largely invisible to and, thus, underappreciated by the general public. When curative medicine works well, most everybody notices. When public health and primary care work well, virtually nobody notices.

The Use of Radio in an In-service Teacher-Training Project.

ERIC Educational Resources Information Center

Ahrens, Patricia; Ghodiwala, Adam

1987-01-01

Describes the background and structure of an inservice project which offered primary school teachers in India support in the teaching of English as a foreign language through radio broadcasts. (Author/CB)

Anticipating students' reasoning and planning prompts in structured problem-solving lessons

NASA Astrophysics Data System (ADS)

Vale, Colleen; Widjaja, Wanty; Doig, Brian; Groves, Susie

2018-02-01

Structured problem-solving lessons are used to explore mathematical concepts such as pattern and relationships in early algebra, and regularly used in Japanese Lesson Study research lessons. However, enactment of structured problem-solving lessons which involves detailed planning, anticipation of student solutions and orchestration of whole-class discussion of solutions is an ongoing challenge for many teachers. Moreover, primary teachers have limited experience in teaching early algebra or mathematical reasoning actions such as generalising. In this study, the critical factors of enacting the structured problem-solving lessons used in Japanese Lesson Study to elicit and develop primary students' capacity to generalise are explored. Teachers from three primary schools participated in two Japanese Lesson Study teams for this study. The lesson plans and video recordings of teaching and post-lesson discussion of the two research lessons along with students' responses and learning are compared to identify critical factors. The anticipation of students' reasoning together with preparation of supporting and challenging prompts was critical for scaffolding students' capacity to grasp and communicate generality.

Design development of graphite primary structures enables SSTO success

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

Biagiotti, V.A.; Yahiro, J.S.; Suh, D.E.

1997-01-01

This paper describes the development of a graphite composite wing and a graphite composite intertank primary structure for application toward Single-Stage to Orbit space vehicles such as those under development in NASA{close_quote}s X-33/Reusable Launch Vehicle (RLV) Program. The trade study and designs are based on a Rockwell vertical take-off and horizontal landing (VTHL) wing-body RLV vehicle. Northrop Grumman{close_quote}s approach using a building block development technique is described. Composite Graphite/Bismaleimide (Gr/BMI) material characterization test results are presented. Unique intertank and wing composite subcomponent test article designs are described and test results to date are presented. Wing and intertank Full Scale Sectionmore » Test Article (FSTA) objectives and designs are outlined. Trade studies, supporting building block testing, and FSTA demonstrations combine to develop graphite primary structure composite technology that enables developing X-33/RLV design programs to meet critical SSTO structural weight and operations performance criteria. {copyright} {ital 1997 American Institute of Physics.}« less

HANFORD DST THERMAL & SEISMIC PROJECT ANSYS BENCHMARK ANALYSIS OF SEISMIC INDUCED FLUID STRUCTURE INTERACTION IN A HANFORD DOUBLE SHELL PRIMARY TANK

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

MACKEY, T.C.

M&D Professional Services, Inc. (M&D) is under subcontract to Pacific Northwest National Laboratories (PNNL) to perform seismic analysis of the Hanford Site Double-Shell Tanks (DSTs) in support of a project entitled ''Double-Shell Tank (DSV Integrity Project-DST Thermal and Seismic Analyses)''. The overall scope of the project is to complete an up-to-date comprehensive analysis of record of the DST System at Hanford in support of Tri-Party Agreement Milestone M-48-14. The work described herein was performed in support of the seismic analysis of the DSTs. The thermal and operating loads analysis of the DSTs is documented in Rinker et al. (2004). Themore » overall seismic analysis of the DSTs is being performed with the general-purpose finite element code ANSYS. The overall model used for the seismic analysis of the DSTs includes the DST structure, the contained waste, and the surrounding soil. The seismic analysis of the DSTs must address the fluid-structure interaction behavior and sloshing response of the primary tank and contained liquid. ANSYS has demonstrated capabilities for structural analysis, but the capabilities and limitations of ANSYS to perform fluid-structure interaction are less well understood. The purpose of this study is to demonstrate the capabilities and investigate the limitations of ANSYS for performing a fluid-structure interaction analysis of the primary tank and contained waste. To this end, the ANSYS solutions are benchmarked against theoretical solutions appearing in BNL 1995, when such theoretical solutions exist. When theoretical solutions were not available, comparisons were made to theoretical solutions of similar problems and to the results from Dytran simulations. The capabilities and limitations of the finite element code Dytran for performing a fluid-structure interaction analysis of the primary tank and contained waste were explored in a parallel investigation (Abatt 2006). In conjunction with the results of the global ANSYS analysis reported in Carpenter et al. (2006), the results of the two investigations will be compared to help determine if a more refined sub-model of the primary tank is necessary to capture the important fluid-structure interaction effects in the tank and if so, how to best utilize a refined sub-model of the primary tank. Both rigid tank and flexible tank configurations were analyzed with ANSYS. The response parameters of interest are total hydrodynamic reaction forces, impulsive and convective mode frequencies, waste pressures, and slosh heights. To a limited extent: tank stresses are also reported. The results of this study demonstrate that the ANSYS model has the capability to adequately predict global responses such as frequencies and overall reaction forces. Thus, the model is suitable for predicting the global response of the tank and contained waste. On the other hand, while the ANSYS model is capable of adequately predicting waste pressures and primary tank stresses in a large portion of the waste tank, the model does not accurately capture the convective behavior of the waste near the free surface, nor did the model give accurate predictions of slosh heights. Based on the ability of the ANSYS benchmark model to accurately predict frequencies and global reaction forces and on the results presented in Abatt, et al. (2006), the global ANSYS model described in Carpenter et al. (2006) is sufficient for the seismic evaluation of all tank components except for local areas of the primary tank. Due to the limitations of the ANSYS model in predicting the convective response of the waste, the evaluation of primary tank stresses near the waste free surface should be supplemented by results from an ANSYS sub-model of the primary tank that incorporates pressures from theoretical solutions or from Dytran solutions. However, the primary tank is expected to have low demand to capacity ratios in the upper wall. Moreover, due to the less than desired mesh resolution in the primary tank knuckle of the global ANSYS model, the evaluation of the primary tank stresses in the lower knuckle should be supplemented by results from a more refined ANSYS sub-model of the primary tank that incorporates pressures from theoretical solutions or from Dytran solutions.« less

Extension of research data repository system to support direct compute access to biomedical datasets: enhancing Dataverse to support large datasets.

PubMed

McKinney, Bill; Meyer, Peter A; Crosas, Mercè; Sliz, Piotr

2017-01-01

Access to experimental X-ray diffraction image data is important for validation and reproduction of macromolecular models and indispensable for the development of structural biology processing methods. In response to the evolving needs of the structural biology community, we recently established a diffraction data publication system, the Structural Biology Data Grid (SBDG, data.sbgrid.org), to preserve primary experimental datasets supporting scientific publications. All datasets published through the SBDG are freely available to the research community under a public domain dedication license, with metadata compliant with the DataCite Schema (schema.datacite.org). A proof-of-concept study demonstrated community interest and utility. Publication of large datasets is a challenge shared by several fields, and the SBDG has begun collaborating with the Institute for Quantitative Social Science at Harvard University to extend the Dataverse (dataverse.org) open-source data repository system to structural biology datasets. Several extensions are necessary to support the size and metadata requirements for structural biology datasets. In this paper, we describe one such extension-functionality supporting preservation of file system structure within Dataverse-which is essential for both in-place computation and supporting non-HTTP data transfers. © 2016 New York Academy of Sciences.

A preliminary structural analysis of space-base living quarters modules to verify a weight-estimating technique

NASA Technical Reports Server (NTRS)

Grissom, D. S.; Schneider, W. C.

1971-01-01

The determination of a base line (minimum weight) design for the primary structure of the living quarters modules in an earth-orbiting space base was investigated. Although the design is preliminary in nature, the supporting analysis is sufficiently thorough to provide a reasonably accurate weight estimate of the major components that are considered to comprise the structural weight of the space base.

Prevention of hospital-acquired thrombosis from a primary care perspective: a qualitative study

PubMed Central

Litchfield, Ian; Fitzmaurice, David; Apenteng, Patricia; Harrison, Sian; Heneghan, Carl; Ward, Alison; Greenfield, Sheila

2016-01-01

Background Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge. Aim To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed. Design and setting Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England. Method Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location. Results A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding. Conclusion The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources. PMID:27266864

Teachers' Perceptions about the Barriers and Catalysts for Effective Practices with ICT in Primary Schools

NASA Astrophysics Data System (ADS)

Dakich, Eva

This paper presents perceptions of four primary school teachers from two Victorian government primary schools about the barriers and catalyst for effective practices with ICT. Findings of the semi-structured qualitative interviews confirm results of previous studies indicating that access to reliable infrastructure, adequate technical support, and time pressures are still considered to be some of the most significant barriers to successful ICT integration in public schools. Teacher interviews however also reveal that the challenges of integrating ICT in teaching and learning can be counterbalanced by a number of variables, which include: owning a laptop, having access to ongoing professional learning, sharing effective practices, drawing on student expertise and being supported by a whole-school approach to teaching and learning with ICT.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.

PubMed

Campbell, S M; Sheaff, R; Sibbald, B; Marshall, M N; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M O

2002-03-01

To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Qualitative case studies using semi-structured interviews and documentation review. Twelve purposively sampled PCG/Ts in England. Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Participants' perceptions of the role of clinical governance in PCG/Ts. PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

Pastor and Lay Leader Perceptions of Barriers and Supports to HIV Ministry Maintenance in an African American Church

PubMed Central

2013-01-01

Abstract Clergy and lay leaders have a pivotal role in the development and maintenance of HIV Ministries within the African American church. However, little is known about the actual roles these men and women have, the barriers they face and the supports they have found in the development and maintenance of an HIV Ministry. The purpose of this study is to examine the role, barriers and supports clergy and lay leaders experienced in the development of a long-standing HIV ministry in an African American church. These data were gathered from a larger ethnographic study, which examined the role of religious culture in the development, implementation and maintenance of an HIV ministry. Data for this study were collected through in-depth semi-structured interviews. Results revealed that the primary role of clergy and lay leaders involved dispelling myths surrounding HIV and ensuring congregational support. The primary barrier to the development and maintenance was views regarding sexuality. The primary support was their relationships with congregants that lived with HIV and AIDS. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries. PMID:22870846

Pastor and lay leader perceptions of barriers and supports to HIV ministry maintenance in an African American church.

PubMed

Stewart, Jennifer M

2014-04-01

Clergy and lay leaders have a pivotal role in the development and maintenance of HIV Ministries within the African American church. However, little is known about the actual roles these men and women have, the barriers they face and the supports they have found in the development and maintenance of an HIV Ministry. The purpose of this study is to examine the role, barriers and supports clergy and lay leaders experienced in the development of a long-standing HIV ministry in an African American church. These data were gathered from a larger ethnographic study, which examined the role of religious culture in the development, implementation and maintenance of an HIV ministry. Data for this study were collected through in-depth semi-structured interviews. Results revealed that the primary role of clergy and lay leaders involved dispelling myths surrounding HIV and ensuring congregational support. The primary barrier to the development and maintenance was views regarding sexuality. The primary support was their relationships with congregants that lived with HIV and AIDS. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries.

The effects of Web site structure: the role of personal difference.

PubMed

Chung, Hwiman; Ahn, Euijin

2007-12-01

This study examined the effects of Web site structures in terms of advertising effectiveness- memory, attitude, and behavioral intentions. The primary research question for this study is, What type of Web site (Web ad) structure is most effective? In the pilot study, we tested the difference between two Web site structures, linear and interactive, in terms of traditional advertising effectiveness. Results from the pilot study did not support our research expectations. However, differences in terms of memory were noted between the two structures. After re-creating the Web site based on subjects' comments, in the final experiment, we examined the differences between the two structures and the moderating role of personality difference on the effects of Web site structure. The results confirm that participants' attitude, memory, and behavioral intentions were affected differently by the different Web site structures. However, some research hypotheses were not supported by the current data.

Optimizing psychosocial support during office-based buprenorphine treatment in primary care: patients’ experiences and preferences

PubMed Central

Fox, Aaron D.; Masyukova, Mariya; Cunningham, Chinazo O.

2015-01-01

Background Buprenorphine maintenance treatment is effective and has been successfully integrated into HIV and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable. Methods We conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes. Results Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care. Conclusions Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining non-judgmental attitudes and shared decision making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise. PMID:26566712

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

Tumor-stroma interactions a trademark for metastasis.

PubMed

Morales, Monica; Planet, Evarist; Arnal-Estape, Anna; Pavlovic, Milica; Tarragona, Maria; Gomis, Roger R

2011-10-01

We aimed to unravel genes that are significantly associated with metastasis in order to identify functions that support disseminated disease. We identify genes associated with metastasis and verify its clinical correlations using publicly available primary tumor expression profile data sets. We used facilities in R and Bioconductor (GSEA). Specific data structures and functions were imported. Our results show that genes associated with metastasis in primary tumor enriched for pathways associated with immune infiltration or cytokine-cytokine receptor interaction. As an example, we focus on the enrichment of TGFBR2 and TGF|X A set of communication tools capital for tumor-stroma interactions that define metastasis to the lung and support bone colonization. We showed that tumor-stroma communication through cytokine-cytokine receptor interaction pathway is selected in primary tumors with high risk of relapse. High levels of these factors support systemic instigation of the far metastatic nest as well as local metastatic-specific functions that provide solid ground for metastatic development. Copyright © 2011 Elsevier Ltd. All rights reserved.

'I am stronger, I'm no longer afraid…', an evaluation of a home-visiting mentor mother support programme for abused women in primary care.

PubMed

Prosman, Gert-Jan; Lo Fo Wong, Sylvie H; Römkens, Renée; Lagro-Janssen, Antoine L M

2014-12-01

We aimed to investigate which factors make a mentor mother support programme for abused women successful. We used semi-structured interviews with abused women and focus group discussions with the mentor mothers to evaluate their experiences and needs within a mentor support programme (MeMoSA). Fourteen abused women were interviewed 6 months after the support programme ended. Mentor mothers participated in two focus group discussions. Abused women emphasised that nonjudgmental listening, equivalence, involvement and bonding are important factors for successful support. Mentor mothers described that empathy, availability, persistence and advocacy fitted the needs of women best to empower them and help them to cope with their violent situation at home. A safe place to meet each other was also an important factor. A good relationship, tailored support provided by home visiting, advocacy and safety are required to effectively help abused women. MeMoSA, a home-visiting support programme, is a promising valuable new support programme in primary care for abused women. © 2013 Nordic College of Caring Science.

Space Tug Point Design Study. Volume 3: Design Definition. Part 2: Insulation, Meteoroid Protection, Structures, Mass Properties, GSE, Reliability and Safety

NASA Technical Reports Server (NTRS)

1973-01-01

A study was conducted to determine the configuration and performance of a space tug. Detailed descriptions of the insulation, meteoroid protection, primary structure, and ground support equipment are presented. Technical assessments leading to the concept selection are analyzed. The tug mass properties, reliability, and safety assessments are included.

3D printing of layered brain-like structures using peptide modified gellan gum substrates.

PubMed

Lozano, Rodrigo; Stevens, Leo; Thompson, Brianna C; Gilmore, Kerry J; Gorkin, Robert; Stewart, Elise M; in het Panhuis, Marc; Romero-Ortega, Mario; Wallace, Gordon G

2015-10-01

The brain is an enormously complex organ structured into various regions of layered tissue. Researchers have attempted to study the brain by modeling the architecture using two dimensional (2D) in vitro cell culturing methods. While those platforms attempt to mimic the in vivo environment, they do not truly resemble the three dimensional (3D) microstructure of neuronal tissues. Development of an accurate in vitro model of the brain remains a significant obstacle to our understanding of the functioning of the brain at the tissue or organ level. To address these obstacles, we demonstrate a new method to bioprint 3D brain-like structures consisting of discrete layers of primary neural cells encapsulated in hydrogels. Brain-like structures were constructed using a bio-ink consisting of a novel peptide-modified biopolymer, gellan gum-RGD (RGD-GG), combined with primary cortical neurons. The ink was optimized for a modified reactive printing process and developed for use in traditional cell culturing facilities without the need for extensive bioprinting equipment. Furthermore the peptide modification of the gellan gum hydrogel was found to have a profound positive effect on primary cell proliferation and network formation. The neural cell viability combined with the support of neural network formation demonstrated the cell supportive nature of the matrix. The facile ability to form discrete cell-containing layers validates the application of this novel printing technique to form complex, layered and viable 3D cell structures. These brain-like structures offer the opportunity to reproduce more accurate 3D in vitro microstructures with applications ranging from cell behavior studies to improving our understanding of brain injuries and neurodegenerative diseases. Copyright © 2015 Elsevier Ltd. All rights reserved.

Health coaching in primary care: a feasibility model for diabetes care.

PubMed

Liddy, Clare; Johnston, Sharon; Nash, Kate; Ward, Natalie; Irving, Hannah

2014-04-03

Health coaching is a new intervention offering a one-on-one focused self-management support program. This study implemented a health coaching pilot in primary care clinics in Eastern Ontario, Canada to evaluate the feasibility and acceptability of integrating health coaching into primary care for patients who were either at risk for or diagnosed with diabetes. We implemented health coaching in three primary care practices. Patients with diabetes were offered six months of support from their health coach, including an initial face-to-face meeting and follow-up by email, telephone, or face-to-face according to patient preference. Feasibility was assessed through provider focus groups and qualitative data analysis methods. All three sites were able to implement the program. A number of themes emerged from the focus groups, including the importance of physician buy-in, wide variation in understanding and implementing of the health coach role, the significant impact of different systems of team communication, and the significant effect of organizational structure and patient readiness on Health coaches' capacity to perform their role. It is feasible to implement health coaching as an integrated program within small primary care clinics in Canada without adding additional resources into the daily practice. Practices should review their organizational and communication processes to ensure optimal support for health coaches if considering implementing this intervention.

Expanding Primary Care at William Beaumont Army Medical Center to Support an Increased Beneficiary Population Resulting from the 2005 Base Realignment and Closure Commission Report

DTIC Science & Technology

2006-07-01

the Army Health Facility Planning Agency (HFPA). F HFPA Bl s B CCSIMakhldr PA& E ecision MECOM anpowe Support GPRMS SuthWest egion - IM CTRI WEIST (DcI 4...providers or resources. Finally, is there potential for consolidation of staff support areas such as lounges , locker rooms or conference areas (DoD Medical...Organization and Equipment for the ist AD (see appendix I). Utilizing this identified structure, the Army Force Management Support Agency web portal

Exploration of the contexts surrounding the implementation of an intervention supporting return-to-work after breast cancer in a primary care setting: starting point for an intervention development.

PubMed

Bilodeau, Karine; Tremblay, Dominique; Durand, Marie-José

2018-01-01

Many recommendations have been made regarding survivorship care provided by teams of primary care professionals. However, the nature of that follow-up, including support for return-to-work (RTW) after cancer, remains largely undefined. As implementation problems are frequently context-related, a pilot study was conducted to describe the contexts, according to Grol and Wensing, in which a new intervention is to be implemented. This pilot study is the first of three steps in intervention development planning. In-depth semi-structured interviews (n=6) were carried out with stakeholders selected for their knowledgeable perspective of various settings, such as hospitals, primary care, employers, and community-based organizations. Interviews focused on participants' perceptions of key contextual facilitators and barriers to consider for the deployment of an RTW intervention in a primary care setting. Data from interviews were transcribed and analyzed. A content analysis was performed based on an iterative process. An intervention supporting the process of RTW in primary care makes sense for participants. Results suggest that important levers are present in organizational, professional, and social settings. However, many barriers, mainly related to organizational settings, have been identified, eg, distribution of tasks for survivor follow-up, continuity of information, and coordination of care between specialized oncology care and general primary care. To develop and deploy the intervention, recommendations that emerged from this pilot study for overcoming barriers were identified, eg, training (professionals, survivors, and employers), the use of communication tools, and adopting a practice guide for survivor care. The results were also helpful in focusing on the relevance of an intervention supporting the RTW process as a component of primary care for survivors.

A structural equation modeling of executive functions, IQ and mathematical skills in primary students: Differential effects on number production, mental calculus and arithmetical problems.

PubMed

Arán Filippetti, Vanessa; Richaud, María Cristina

2017-10-01

Though the relationship between executive functions (EFs) and mathematical skills has been well documented, little is known about how both EFs and IQ differentially support diverse math domains in primary students. Inconsistency of results may be due to the statistical techniques employed, specifically, if the analysis is conducted with observed variables, i.e., regression analysis, or at the latent level, i.e., structural equation modeling (SEM). The current study explores the contribution of both EFs and IQ in mathematics through an SEM approach. A total of 118 8- to 12-year-olds were administered measures of EFs, crystallized (Gc) and fluid (Gf) intelligence, and math abilities (i.e., number production, mental calculus and arithmetical problem-solving). Confirmatory factor analysis (CFA) offered support for the three-factor solution of EFs: (1) working memory (WM), (2) shifting, and (3) inhibition. Regarding the relationship among EFs, IQ and math abilities, the results of the SEM analysis showed that (i) WM and age predict number production and mental calculus, and (ii) shifting and sex predict arithmetical problem-solving. In all of the SEM models, EFs partially or totally mediated the relationship between IQ, age and math achievement. These results suggest that EFs differentially supports math abilities in primary-school children and is a more significant predictor of math achievement than IQ level.

Effect of comfort pads and incubator design on neonatal radiography.

PubMed

Jiang, Xia; Baad, Michael; Reiser, Ingrid; Feinstein, Kate A; Lu, Zhengfeng

2016-01-01

There has been increasing interest in patient dose reduction in neonatal intensive care units. Removing comfort pads for radiography has been identified as a potential means to decrease patient dose. To assess the effect of comfort pads and support trays on detector entrance exposure (DEE) and image quality for neonatal radiography, and its implication for patient dose. Comfort pads and support trays from three incubator and warmer systems were examined. The attenuation of the primary beam by these structures was measured using a narrow beam geometry. Their effect on DEE and image quality was then assessed using typical neonatal chest radiography techniques with three configurations: 1) both the comfort pad and support included in the beam, 2) only the support tray included and 3) both the comfort pad and support tray removed. Comfort pads and support trays were found to attenuate the primary beam by 6-15%. Eliminating these structures from the X-ray beam's path was found to increase the detector entrance exposure by 28-36% and increase contrast-to-noise ratio by more than 21%, suggesting room for patient dose reduction when the same image quality is maintained. Comfort pads and tray support devices can have a considerable effect on DEE and image quality, with large variations among different incubator designs. Positioning the image detector directly underneath neonatal patients for radiography is a potential means for patient dose reduction. However, such benefit should be weighed against the risks of moving the patient.

NASA James Webb Space Telescope Engineering of the Primary Mirror Segment Assemblies (PMSA) and the Primary Mirror Backplane Support Structure (PMBSS)

NASA Technical Reports Server (NTRS)

Cohen, Lester M.

2015-01-01

The design, engineering tests of the PMSAs PMBSS show that we have a robust system that not only meets but exceeds (better than) the design requirements for these components. In the next 2 years the Telescope Observatory will be subjected to a simulated launch environment (sine vibeacoustics) and operations tests at cryogenic temperatures. Launch is schedule for the last quarter of 2018.

Graft Utilization in the Augmentation of Large-to-Massive Rotator Cuff Repairs: A Systematic Review.

PubMed

Ferguson, Devin P; Lewington, Matthew R; Smith, T Duncan; Wong, Ivan H

2016-11-01

Current treatment options for symptomatic large-to-massive rotator cuff tears can reduce pain, but failure rates remain high. Surgeons have incorporated synthetic and biologic grafts to augment these repairs, with promising results. Multiple reviews exist that summarize these products; however, no systematic review has investigated the grafts' ability to maintain structural integrity after augmentation of large-to-massive rotator cuff repairs. To systematically review and evaluate the effectiveness of grafts in the augmentation of large-to-massive rotator cuff repairs. Systematic review. A comprehensive search of 4 reputable databases was completed. Inclusion criteria were (1) large-to-massive rotator cuff tear, (2) graft augmentation of primary repairs ± primary repair control group, and (3) minimum clinical and radiologic follow-up of 12 months. Two reviewers screened the titles, abstracts, and full articles and extracted the data from eligible studies. Results were summarized into evidence tables stratified by graft origin and level of evidence. Ten studies fit the inclusion criteria. Allograft augmentation was functionally and structurally superior to primary repair controls, with intact repairs in 85% versus 40% of patients (P < .01). This was supported by observational study data. Xenograft augmentation failed to demonstrate superiority to primary repair controls, with worse structural healing rates (27% vs 60%; P =.11). Both comparative studies supported this finding. There have also been many reports of inflammatory reactions with xenograft use. Polypropylene patches are associated with improved structural (83% vs 59% and 49%; P < .01) and functional outcomes when compared with controls and xenograft augmentation; however, randomized data are lacking. Augmentation of large-to-massive rotator cuff repairs with human dermal allografts is associated with superior functional and structural outcome when compared with conventional primary repair. Xenograft augmentation failed to demonstrate a statistically significant difference and may be associated with worse rerupture rates and occasional severe inflammatory reactions. Polypropylene patches have initial promising results. Research in this field is limited; future researchers should continue to develop prospective, randomized controlled trials to establish clear recommendations. © 2016 The Author(s).

Identification of a common language describing paediatric physiotherapy practice for children with additional support needs, to support communication with those outside the physiotherapy profession.

PubMed

Hunter, Cathleen; Maciver, Donald; Howden, Stella; Forsyth, Kirsty; Adamson, Amanda; Bremner, Lynne

2013-03-01

Children with additional support needs (ASNs) often require physiotherapy intervention to help maximise their participation within the primary school setting. The aim of this research was to investigate paediatric physiotherapy practice in supporting primary school aged children with ASNs, in order to identify a language to describe this, which could be used to support communication with teachers, parents and others outside the profession. Using a qualitative research multiple methods design, 2 focus groups and 5 structured interviews were held to investigate physiotherapy practice for this group. Senior paediatric physiotherapists (n=13) from a range of specialities, with experience of supporting primary school aged children with ASNs. Focus groups and interviews were digitally recorded, transcribed verbatim and analysed to establish links and patterns: followed by a cyclical process of respondent validation, and expert review. Eight targets for physiotherapy intervention and twelve technique headings were synthesised from the data. The language used for labelling and description of these was aimed to be easily understood by colleagues outside the profession. The findings clearly identified the role of the paediatric physiotherapist as being to support primary school aged children with ASNs to acquire aspects of postural control, mobility and cardio-respiratory function. By grouping the data into eight areas of challenge as the focus of intervention, and twelve commonly used techniques, the researchers generated a language which can be used by paediatric physiotherapists to support communication with teachers, parents and others outside the profession, when describing their intent and interactions regarding these children. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Progress in the Fabrication and Testing of Telescope Mirrors for The James Webb Space Telescope

NASA Astrophysics Data System (ADS)

Bowers, Charles W.; Clampin, M.; Feinberg, L.; Keski-Kuha, R.; McKay, A.; Chaney, D.; Gallagher, B.; Ha, K.

2012-01-01

The telescope of the James Webb Space Telescope (JWST) is an f/20, three mirror anastigmat design, passively cooled (40K) in an L2 orbit. The design provides diffraction limited performance (Strehl ≥ 0.8) at λ=2μm. To fit within the launch vehicle envelope (Arianne V), the 6.6 meter primary mirror and the secondary mirror support structure are folded for launch, then deployed and aligned in space. The primary mirror is composed of 18 individual, 1.3 meter (flat:flat) hexagonal segments, each adjustable in seven degrees of freedom (six rigid body + radius of curvature) provided by a set of high precision actuators. The actuated secondary mirror ( 0.74m) is similarly positioned in six degrees of rigid body motion. The .70x.51m, fixed tertiary and 0.17m, flat fine steering mirror complete the telescope mirror complement. The telescope is supported by a composite structure optimized for performance at cryogenic temperatures. All telescope mirrors are made of Be with substantial lightweighting (21kg for each 1.3M primary segment). Additional Be mounting and supporting structure for the high precision ( 10nm steps) actuators are attached to the primary segments and secondary mirror. All mirrors undergo a process of thermal stabilization to reduce stress. An extensive series of interferometric measurements guide each step of the polishing process. Final polishing must account for any deformation between the ambient temperature of polishing and the cryogenic, operational temperature. This is accomplished by producing highly precise, cryo deformation target maps of each surface which are incorporated into the final polishing cycle. All flight mirrors have now completed polishing, coating with protected Au and final cryo testing, and the telescope is on track to meet all system requirements. We here review the measured performance of the component mirrors and the predicted performance of the flight telescope.

District nursing renascent as Wales adopts safe staffing levels.

PubMed

Labourne, Paul

2018-05-02

This article reflects on the history of the NHS in Wales and how this has led to its current structure. How this structure supports integrated working across primary, community and secondary care and how further integration with social care is moving forward and its direct effects on district nursing are explored. This article describes how district nursing is meeting these challenges. Support for district nurses as part of integrated multiprofessional teams is being developed to promote appropriately staffed teams centred on meeting the requirements of people within a designated area and ensuring that home is the best and first place of care.

Parents' asthma information needs and preferences for school-based asthma support.

PubMed

Al Aloola, Noha Abdullah; Nissen, Lisa; Alewairdhi, Huda Abdullaziz; Al Faryan, Nawaf; Saini, Bandana

2017-11-01

This study sought to investigate parents' needs and preferences for school-based asthma support in Saudi Arabian primary schools. Semi-structured qualitative interviews were conducted in the period between November 2015 and February 2016, with a convenience sample that comprised Saudi parents and carers of children with asthma. Recruitment of participants was primarily driven through Saudi primary schools; passive snowballing and social networks were used to boost participation rates further. Interviews were audio-recorded, transcribed verbatim, translated and data were thematically organised using a latent content analysis approach. Twenty interviews were conducted. Six themes emerged from the interviews and were grouped into three major categories: (1) general asthma management issues; (2) school-based asthma management issues; and (3) communication dissatisfaction. Participants expressed concern at schools' social and physical environments and a lack of confidence in the ability of schools to manage their child's asthma, especially when their child was ill. Most of the participants advocated for staff training and school community engagement to improve the management of asthma in Saudi primary schools. This research clearly describes a need for school-based asthma support, including asthma-related policies, procedures and education on asthma and first aid in Saudi primary schools.

Role of amine structure on carbon dioxide adsorption from ultradilute gas streams such as ambient air.

PubMed

Didas, Stephanie A; Kulkarni, Ambarish R; Sholl, David S; Jones, Christopher W

2012-10-01

A fundamental study on the adsorption properties of primary, secondary, and tertiary amine materials is used to evaluate what amine type(s) are best suited for ultradilute CO(2) capture applications. A series of comparable materials comprised of primary, secondary, or tertiary amines ligated to a mesoporous silica support via a propyl linker are used to systematically assess the role of amine type. Both CO(2) and water adsorption isotherms are presented for these materials in the range relevant to CO(2) capture from ambient air and it is demonstrated that primary amines are the best candidates for CO(2) capture from air. Primary amines possess both the highest amine efficiency for CO(2) adsorption as well as enhanced water affinity compared to other amine types or the bare silica support. The results suggest that the rational design of amine adsorbents for the extraction of CO(2) from ambient air should focus on adsorbents rich in primary amines. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance

PubMed Central

Campbell, S; Sheaff, R; Sibbald, B; Marshall, M; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M

2002-01-01

Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Design: Qualitative case studies using semi-structured interviews and documentation review. Setting: Twelve purposively sampled PCG/Ts in England. Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts. Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance. PMID:12078380

Structural design of a large deformable primary mirror for a space telescope

NASA Astrophysics Data System (ADS)

Hansen, J. G. R.

A 4 meter aperture deformable primary mirror is designed with the mirror and its supports integrated into a single structure. The integrated active mirror's minimal weight makes it desirable for a space telescope as well as a terrestrial application. Utilizing displacement actuators, the active controls at the mirror's surface include position control and slope control in both the radial and tangential directions at each of the 40 control points. Influence functions for each of the controls are nearly independent, reducing the complexity of the control system. Experiments with breadboard models verify the structural concept and the techniques used in the finite element method of computer structural analysis. The majority of this paper is a description of finite element analysis results. Localization of influence functions is exhaustively treated. For gravity loads, a thermal gradient through the mirror thickness, and a uniform thermal soak, diffraction limited performance of the 4m design is evaluated. Loads are applied to defocus the mirror and to cause fourth-order astigmatism. Mirror scallop, instigated by a focus shift, has been virtually eliminated with the 40-actuator design. The structural concept is so effective that it should be considered for uncontrolled primary mirrors as well as active mirrors.

Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system.

PubMed

Bengtsson, Ulrika; Kjellgren, Karin; Hallberg, Inger; Lundin, Mona; Mäkitalo, Åsa

2018-03-01

This paper reports on how the clinical consultation in primary care is performed under the new premises of patients' daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients' contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system. A qualitative, explorative study design was used, examining 20 audio- (n = 10) and video-recorded (n = 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301. Four primary health care centers in Sweden. Patients with hypertension (n = 20) and their health care professional (n = 7). The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients' contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities. Patients' contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients' and health care professionals' equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management Key points   The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style. This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations. Self-reporting combined with increased patient-health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life. These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.

Behavioural health consultants in integrated primary care teams: a model for future care.

PubMed

Dale, Hannah; Lee, Alyssa

2016-07-29

Significant challenges exist within primary care services in the United Kingdom (UK). These include meeting current demand, financial pressures, an aging population and an increase in multi-morbidity. Psychological services also struggle to meet waiting time targets and to ensure increased access to psychological therapies. Innovative ways of delivering effective primary care and psychological services are needed to improve health outcomes. In this article we argue that integrated care models that incorporate behavioural health care are part of the solution, which has seldom been argued in relation to UK primary care. Integrated care involves structural and systemic changes to the delivery of services, including the co-location of multi-disciplinary primary care teams. Evidence from models of integrated primary care in the United States of America (USA) and other higher-income countries suggest that embedding continuity of care and collaborative practice within integrated care teams can be effective in improving health outcomes. The Behavioural Health Consultant (BHC) role is integral to this, working psychologically to support the team to improve collaborative working, and supporting patients to make changes to improve their health across management of long-term conditions, prevention and mental wellbeing. Patients' needs for higher-intensity interventions to enable changes in behaviour and self-management are, therefore, more fully met within primary care. The role also increases accessibility of psychological services, delivers earlier interventions and reduces stigma, since psychological staff are seen as part of the core primary care service. Although the UK has trialled a range of approaches to integrated care, these fall short of the highest level of integration. A single short pilot of integrated care in the UK showed positive results. Larger pilots with robust evaluation, as well as research trials are required. There are clearly challenges in adopting such an approach, especially for staff who must adapt to working more collaboratively with each other and patients. Strong leadership is needed to assist in this, particularly to support organisations to adopt the shift in values and attitudes towards collaborative working. Integrated primary care services that embed behavioural health as part of a multi-disciplinary team may be part of the solution to significant modern day health challenges. However, developing this model is unlikely to be straight-forward given current primary care structures and ways of working. The discussion, developed in this article, adds to our understanding of what the BHC role might consist off and how integrated care may be supported by such behavioural health expertise. Further work is needed to develop this model in the UK, and to evaluate its impact on health outcomes and health care utilisation, and test robustly through research trials.

Link between orientation and retinotopic maps in primary visual cortex

PubMed Central

Paik, Se-Bum; Ringach, Dario L.

2012-01-01

Maps representing the preference of neurons for the location and orientation of a stimulus on the visual field are a hallmark of primary visual cortex. It is not yet known how these maps develop and what function they play in visual processing. One hypothesis postulates that orientation maps are initially seeded by the spatial interference of ON- and OFF-center retinal receptive field mosaics. Here we show that such a mechanism predicts a link between the layout of orientation preferences around singularities of different signs and the cardinal axes of the retinotopic map. Moreover, we confirm the predicted relationship holds in tree shrew primary visual cortex. These findings provide additional support for the notion that spatially structured input from the retina may provide a blueprint for the early development of cortical maps and receptive fields. More broadly, it raises the possibility that spatially structured input from the periphery may shape the organization of primary sensory cortex of other modalities as well. PMID:22509015

Design of a radiator shade for testing in a simulated lunar environment

NASA Technical Reports Server (NTRS)

Huff, Jaimi; Remington, Randy; Tang, Toan

1992-01-01

The National Aeronautics and Space Administration (NASA) and The Universities Space Research Association (USRA) have chosen the parabolic/catenary concept from their sponsored Fall 1991 lunar radiation shade project for further testing and development. NASA asked the design team to build a shading device and support structure for testing in a vacuum chamber. Besides the support structure for the catenary shading device, the design team was asked to develop a system for varying the shade shape so that the device can be tested at different focal lengths. The design team developed concept variants and combined the concept variants to form overall designs. Using a decision matrix, an overall design was selected by the team from several overall design alternatives. Concept variants were developed for three primary functions. The three functions were structural support, shape adjustments, and end shielding. The shade adjustment function was divided into two sub-functions, arc length adjustment, and width adjustment.

Data publication with the structural biology data grid supports live analysis

DOE PAGES

Meyer, Peter A.; Socias, Stephanie; Key, Jason; ...

2016-03-07

Access to experimental X-ray diffraction image data is fundamental for validation and reproduction of macromolecular models and indispensable for development of structural biology processing methods. Here, we established a diffraction data publication and dissemination system, Structural Biology Data Grid (SBDG; data.sbgrid.org), to preserve primary experimental data sets that support scientific publications. Data sets are accessible to researchers through a community driven data grid, which facilitates global data access. Our analysis of a pilot collection of crystallographic data sets demonstrates that the information archived by SBDG is sufficient to reprocess data to statistics that meet or exceed the quality of themore » original published structures. SBDG has extended its services to the entire community and is used to develop support for other types of biomedical data sets. In conclusion, it is anticipated that access to the experimental data sets will enhance the paradigm shift in the community towards a much more dynamic body of continuously improving data analysis.« less

Data publication with the structural biology data grid supports live analysis

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

Meyer, Peter A.; Socias, Stephanie; Key, Jason

Access to experimental X-ray diffraction image data is fundamental for validation and reproduction of macromolecular models and indispensable for development of structural biology processing methods. Here, we established a diffraction data publication and dissemination system, Structural Biology Data Grid (SBDG; data.sbgrid.org), to preserve primary experimental data sets that support scientific publications. Data sets are accessible to researchers through a community driven data grid, which facilitates global data access. Our analysis of a pilot collection of crystallographic data sets demonstrates that the information archived by SBDG is sufficient to reprocess data to statistics that meet or exceed the quality of themore » original published structures. SBDG has extended its services to the entire community and is used to develop support for other types of biomedical data sets. In conclusion, it is anticipated that access to the experimental data sets will enhance the paradigm shift in the community towards a much more dynamic body of continuously improving data analysis.« less

Data publication with the structural biology data grid supports live analysis.

PubMed

Meyer, Peter A; Socias, Stephanie; Key, Jason; Ransey, Elizabeth; Tjon, Emily C; Buschiazzo, Alejandro; Lei, Ming; Botka, Chris; Withrow, James; Neau, David; Rajashankar, Kanagalaghatta; Anderson, Karen S; Baxter, Richard H; Blacklow, Stephen C; Boggon, Titus J; Bonvin, Alexandre M J J; Borek, Dominika; Brett, Tom J; Caflisch, Amedeo; Chang, Chung-I; Chazin, Walter J; Corbett, Kevin D; Cosgrove, Michael S; Crosson, Sean; Dhe-Paganon, Sirano; Di Cera, Enrico; Drennan, Catherine L; Eck, Michael J; Eichman, Brandt F; Fan, Qing R; Ferré-D'Amaré, Adrian R; Fromme, J Christopher; Garcia, K Christopher; Gaudet, Rachelle; Gong, Peng; Harrison, Stephen C; Heldwein, Ekaterina E; Jia, Zongchao; Keenan, Robert J; Kruse, Andrew C; Kvansakul, Marc; McLellan, Jason S; Modis, Yorgo; Nam, Yunsun; Otwinowski, Zbyszek; Pai, Emil F; Pereira, Pedro José Barbosa; Petosa, Carlo; Raman, C S; Rapoport, Tom A; Roll-Mecak, Antonina; Rosen, Michael K; Rudenko, Gabby; Schlessinger, Joseph; Schwartz, Thomas U; Shamoo, Yousif; Sondermann, Holger; Tao, Yizhi J; Tolia, Niraj H; Tsodikov, Oleg V; Westover, Kenneth D; Wu, Hao; Foster, Ian; Fraser, James S; Maia, Filipe R N C; Gonen, Tamir; Kirchhausen, Tom; Diederichs, Kay; Crosas, Mercè; Sliz, Piotr

2016-03-07

Access to experimental X-ray diffraction image data is fundamental for validation and reproduction of macromolecular models and indispensable for development of structural biology processing methods. Here, we established a diffraction data publication and dissemination system, Structural Biology Data Grid (SBDG; data.sbgrid.org), to preserve primary experimental data sets that support scientific publications. Data sets are accessible to researchers through a community driven data grid, which facilitates global data access. Our analysis of a pilot collection of crystallographic data sets demonstrates that the information archived by SBDG is sufficient to reprocess data to statistics that meet or exceed the quality of the original published structures. SBDG has extended its services to the entire community and is used to develop support for other types of biomedical data sets. It is anticipated that access to the experimental data sets will enhance the paradigm shift in the community towards a much more dynamic body of continuously improving data analysis.

Data publication with the structural biology data grid supports live analysis

PubMed Central

Meyer, Peter A.; Socias, Stephanie; Key, Jason; Ransey, Elizabeth; Tjon, Emily C.; Buschiazzo, Alejandro; Lei, Ming; Botka, Chris; Withrow, James; Neau, David; Rajashankar, Kanagalaghatta; Anderson, Karen S.; Baxter, Richard H.; Blacklow, Stephen C.; Boggon, Titus J.; Bonvin, Alexandre M. J. J.; Borek, Dominika; Brett, Tom J.; Caflisch, Amedeo; Chang, Chung-I; Chazin, Walter J.; Corbett, Kevin D.; Cosgrove, Michael S.; Crosson, Sean; Dhe-Paganon, Sirano; Di Cera, Enrico; Drennan, Catherine L.; Eck, Michael J.; Eichman, Brandt F.; Fan, Qing R.; Ferré-D'Amaré, Adrian R.; Christopher Fromme, J.; Garcia, K. Christopher; Gaudet, Rachelle; Gong, Peng; Harrison, Stephen C.; Heldwein, Ekaterina E.; Jia, Zongchao; Keenan, Robert J.; Kruse, Andrew C.; Kvansakul, Marc; McLellan, Jason S.; Modis, Yorgo; Nam, Yunsun; Otwinowski, Zbyszek; Pai, Emil F.; Pereira, Pedro José Barbosa; Petosa, Carlo; Raman, C. S.; Rapoport, Tom A.; Roll-Mecak, Antonina; Rosen, Michael K.; Rudenko, Gabby; Schlessinger, Joseph; Schwartz, Thomas U.; Shamoo, Yousif; Sondermann, Holger; Tao, Yizhi J.; Tolia, Niraj H.; Tsodikov, Oleg V.; Westover, Kenneth D.; Wu, Hao; Foster, Ian; Fraser, James S.; Maia, Filipe R. N C.; Gonen, Tamir; Kirchhausen, Tom; Diederichs, Kay; Crosas, Mercè; Sliz, Piotr

2016-01-01

Access to experimental X-ray diffraction image data is fundamental for validation and reproduction of macromolecular models and indispensable for development of structural biology processing methods. Here, we established a diffraction data publication and dissemination system, Structural Biology Data Grid (SBDG; data.sbgrid.org), to preserve primary experimental data sets that support scientific publications. Data sets are accessible to researchers through a community driven data grid, which facilitates global data access. Our analysis of a pilot collection of crystallographic data sets demonstrates that the information archived by SBDG is sufficient to reprocess data to statistics that meet or exceed the quality of the original published structures. SBDG has extended its services to the entire community and is used to develop support for other types of biomedical data sets. It is anticipated that access to the experimental data sets will enhance the paradigm shift in the community towards a much more dynamic body of continuously improving data analysis. PMID:26947396

Manual Override For Electromechanical Latch

NASA Technical Reports Server (NTRS)

Scott, Richard

1992-01-01

Override mechanism enables user to operate electromechanical latching mechanism manually if primary mechanism fails. Release/Engage Mechanism (REM) moves pin receivers to confine pins on object to be held. Clutch disengages electrically driven latch normally used. Used to latch and unlatch large, heavy objects from fixed support structure.

Seismic vulnerability of existing bridge substructures supporting the I-55 undercrossing at MS-302 (Goodman Road).

DOT National Transportation Integrated Search

2002-10-01

As part of a work assignment issued by the Mississippi Department of Transportation, : Bridge Division, the following report has been prepared to document results of an : investigation of seismic vulnerability of the primary structural elements suppo...

Structural Concepts and Materials for Lunar Exploration Habitats

NASA Technical Reports Server (NTRS)

Belvin, W. Keith; Watson, Judith J.; Singhal, Surendra N.

2006-01-01

A new project within the Exploration Systems Mission Directorate s Technology Development Program at NASA involves development of lightweight structures and low temperature mechanisms for Lunar and Mars missions. The Structures and Mechanisms project is to develop advanced structure technology for the primary structure of various pressurized elements needed to implement the Vision for Space Exploration. The goals are to significantly enhance structural systems for man-rated pressurized structures by 1) lowering mass and/or improving efficient volume for reduced launch costs, 2) improving performance to reduce risk and extend life, and 3) improving manufacturing and processing to reduce costs. The targeted application of the technology is to provide for the primary structure of the pressurized elements of the lunar lander for both sortie and outpost missions, and surface habitats for the outpost missions. The paper presents concepts for habitats that support six month (and longer) lunar outpost missions. Both rigid and flexible habitat wall systems are discussed. The challenges of achieving a multi-functional habitat that provides micro-meteoroid, radiation, and thermal protection for explorers are identified.

Challenges in health visitor prescribing in a London primary care trust.

PubMed

Thurtle, Val

2007-11-01

In this primary care trust there was limited health visitor prescribing. A case study approach sought to identify reasons for this, to lead to recommendations and changes to develop health visitor prescribing. The situation was examined using qualitative methods to consider the opportunities and challenges in health visitor prescribing. Semi-structured interviews with eighteen health visitors and managers explored their views of health visitor prescribing and its position within the PCT. The findings demonstrated only three health visitors prescribed; yet the majority were positive about prescribing, both for clients and health visitor development. Practitioners recognised their difficult working context and felt that organisational systems were not supportive of prescribing. A culture of prescribing was not felt to be in evidence, but was seen as a realistic possibility. Recommendations for change focused on the organisation and practitioners, with improved communication and structures supportive of prescribing. There was a need for practitioners to be active in learning so that they could share knowledge, experience and commitment to prescribing in locally based groups.

The 5As team patient study: patient perspectives on the role of primary care in obesity management.

PubMed

Torti, Jacqueline; Luig, Thea; Borowitz, Michelle; Johnson, Jeffrey A; Sharma, Arya M; Campbell-Scherer, Denise L

2017-02-08

Over 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients' perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this perspective, and more effective management strategies. Qualitative study employing semi-structured interviews and thematic analysis, with a sample of 28 patients from a cohort of 255 patients living with obesity and receiving care to support their weight management in a large Primary Care Network of family practices in Alberta. Four illustrative themes emerged: (1) the patient-physician relationship plays an important role in the adequacy of obesity management; (2) patients have clear expectations of substantive conversations with their primary care team; (3) complex conditions affect weight and patients require assistance tailored to individual obesity drivers; (4) current services provide support in important ways (accessibility, availability, accountability, affordability, consistency of messaging), but are not yet meeting patient needs for individual plans, advanced education, and follow-up opportunities. Patients have clear expectations that their primary care physician asks them about weight within a supportive therapeutic relationship. They see obesity as a complex phenomenon with multiple drivers. They want their healthcare providers to assess and address their root causes - not simplistic advice to "eat less, move more". Patients felt that the current services were positive resources, but expressed needs for tailored weight management plans, and longer-term follow-up.

General practice and the New Zealand health reforms – lessons for Australia?

PubMed Central

McAvoy, Brian R; Coster, Gregor D

2005-01-01

New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy 2. Inadequate management funding and support 3. Inconsistency and variations in contracting processes 4. Lack of publicity and advice around enrolment issues 5. Workforce and workload issues 6. Financial risks On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: • the need for a national primary health care strategy • active engagement of general practitioners and their professional organisations • recognition of implementation costs • the need for infrastructural support, including information technology and quality systems • robust management and governance arrangements • issues related to critical mass and population/distance trade offs in service delivery models PMID:16262908

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

NASA Technical Reports Server (NTRS)

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

1974-01-01

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

The impact of mentor mother programs on PMTCT service uptake and retention-in-care at primary health care facilities in Nigeria: a prospective cohort study (MoMent Nigeria).

PubMed

Sam-Agudu, Nadia A; Cornelius, Llewellyn J; Okundaye, Joshua N; Adeyemi, Olusegun A; Isah, Haroun O; Wiwa, Owens M; Adejuyigbe, Ebun; Galadanci, Hadiza; Afe, Abayomi J; Jolaoso, Ibidun; Bassey, Emem; Charurat, Manhattan E

2014-11-01

Nigeria is a key target country in the global effort toward elimination of mother-to-child transmission of HIV. Low coverage of prevention of mother-to-child transmission (PMTCT) interventions, adherence, and retention-in-care rates in HIV-positive pregnant women are contributing factors to high mother-to-child transmission of HIV (MTCT) rates. In Nigeria, rural areas, served largely by primary health care facilities, have particularly poor indicators of PMTCT coverage. Mentor Mothers are HIV-positive women who serve as peer counselors for PMTCT clients, provide guidance, and support in keeping appointments and promoting antiretroviral adherence and retention-in-care. The Mother Mentor (MoMent) study aims to investigate the impact of structured Mentor Mother programs on PMTCT outcomes in rural Nigeria. A prospective cohort study will compare rates of retention-in-care among PMTCT clients who are supported by formally-trained supervised Mentor Mothers versus clients who receive standard-of-care, informal peer support. Study sites are 20 primary health care centers (10 intervention, 10 control) in rural North-Central Nigeria. The study population is HIV-positive mothers and exposed infant pairs (MIPs) (N = 480; 240 MIPs per study arm). Primary outcome measures are the proportion of exposed infants receiving early HIV testing by age 2 months, and the proportion of MIPs retained in care at 6 months postpartum. Secondary outcome measures examine antiretroviral adherence, 12-month postpartum MIP retention, and MTCT rates. This article presents details of the study design, the structured Mentor Mother programs, and how their impact on PMTCT outcomes will be assessed.

Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience.

PubMed

Takach, Mary

2016-10-01

Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes-all core attributes of a medical home. This qualitative study looked at 4 different PHCO models-3 from the United States and 1 from Australia-with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system.

Health coaching in primary care: a feasibility model for diabetes care

PubMed Central

2014-01-01

Background Health coaching is a new intervention offering a one-on-one focused self-management support program. This study implemented a health coaching pilot in primary care clinics in Eastern Ontario, Canada to evaluate the feasibility and acceptability of integrating health coaching into primary care for patients who were either at risk for or diagnosed with diabetes. Methods We implemented health coaching in three primary care practices. Patients with diabetes were offered six months of support from their health coach, including an initial face-to-face meeting and follow-up by email, telephone, or face-to-face according to patient preference. Feasibility was assessed through provider focus groups and qualitative data analysis methods. Results All three sites were able to implement the program. A number of themes emerged from the focus groups, including the importance of physician buy-in, wide variation in understanding and implementing of the health coach role, the significant impact of different systems of team communication, and the significant effect of organizational structure and patient readiness on Health coaches’ capacity to perform their role. Conclusions It is feasible to implement health coaching as an integrated program within small primary care clinics in Canada without adding additional resources into the daily practice. Practices should review their organizational and communication processes to ensure optimal support for health coaches if considering implementing this intervention. PMID:24708783

[Specialized outpatient care in the Unified Health System: how to fill a void].

PubMed

Tesser, Charles Dalcanale; Poli, Paulo

2017-03-01

The structuring of specialized outpatient care is a bottleneck in the operation of the Unified Health System. Based on a brief discussion about this void in an organizational model, we propose the federal induction of a format of specialized services from the experiences of Centers of Support for Family Health (NASF). They adapted matrix operations and constitute an excellent prototype for the organization of specialized outpatient care. It allows for equal access and maximum proximity to the specialized care of the reality of primary care users, the personal relationship and the close relationship between the family health teams and medical and non-medical specialists, enabling mutual lifelong learning, negotiated regulation and increased efficacy of primary care. Municipal experiences of Florianopolis and Curitiba are synthesized as partial examples of the proposal. the structure of care in mental health of Florianópolis, all organized as a matrix support is briefly described; and we focus on the change in the action of the support teams of Curitiba, which gradually began to engage, involve and mediate the relationship between basic and specialized care. This format can be expanded to most medical specialties.

Lightweight Deployable Mirrors with Tensegrity Supports

NASA Technical Reports Server (NTRS)

Zeiders, Glenn W.; Bradford, Larry J.; Cleve, Richard C.

2004-01-01

The upper part of Figure 1 shows a small-scale prototype of a developmental class of lightweight, deployable structures that would support panels in precise alignments. In this case, the panel is hexagonal and supports disks that represent segments of a primary mirror of a large telescope. The lower part of Figure 1 shows a complete conceptual structure containing multiple hexagonal panels that hold mirror segments. The structures of this class are of the tensegrity type, which was invented five decades ago by artist Kenneth Snelson. A tensegrity structure consists of momentfree compression members (struts) and tension members (cables). The structures of this particular developmental class are intended primarily as means to erect large segmented primary mirrors of astronomical telescopes or large radio antennas in outer space. Other classes of tensegrity structures could also be designed for terrestrial use as towers, masts, and supports for general structural panels. An important product of the present development effort is the engineering practice of building a lightweight, deployable structure as an assembly of tensegrity modules like the one shown in Figure 2. This module comprises two octahedral tensegrity subunits that are mirror images of each other joined at their plane of mirror symmetry. In this case, the plane of mirror symmetry is both the upper plane of the lower subunit and the lower plane of the upper subunit, and is delineated by the midheight triangle in Figure 2. In the configuration assumed by the module to balance static forces under mild loading, the upper and lower planes of each sub-unit are rotated about 30 , relative to each other, about the long (vertical) axis of the structure. Larger structures can be assembled by joining multiple modules like this one at their sides or ends. When the module is compressed axially (vertically), the first-order effect is an increase in the rotation angle, but by virtue of the mirror arrangement, the net first-order rotation between the uppermost and lowermost planes is zero. The need to have zero net rotation between these planes under all loading conditions in a typical practical structure is what prompts the use of the mirror configuration. Force and moment loadings other than simple axial compression produce only second-order deformations through strains in the struts and cables.

Primary care team working in Ireland: a qualitative exploration of team members' experiences in a new primary care service.

PubMed

Kennedy, Norelee; Armstrong, Claire; Woodward, Oonagh; Cullen, Walter

2015-07-01

Team working is an integral aspect of primary care, but barriers to effective team working can limit the effectiveness of a primary care team (PCT). The establishment of new PCTs in Ireland provides an excellent opportunity to explore team working in action. The aim of this qualitative study was to explore the experiences of team members working in a PCT. Team members (n = 19) from two PCTs were interviewed from May to June 2010 using a semi-structured interview guide. All interviews were audio-recorded and transcribed. Data were analysed using NVivo (version 8). Thematic analysis was used to explore the data. We identified five main themes that described the experiences of the team members. The themes were support for primary care, managing change, communication, evolution of roles and benefits of team working. Team members were generally supportive of primary care and had experienced benefits to their practice and to the care of their patients from participation in the team. Regular team meetings enabled communication and discussion of complex cases. Despite the significant scope for role conflict due to the varied employment arrangements of the team members, neither role nor interpersonal conflict was evident in the teams studied. In addition, despite the unusual team structure in Irish PCTs - where there is no formally appointed team leader or manager - general issues around team working and its benefits and challenges were very similar to those found in other international studies. This suggests, in contrast to some studies, that some aspects of the leadership role may not be as important in successful PCT functioning as previously thought. Nonetheless, team leadership was identified as an important issue in the further development of the teams. © 2014 John Wiley & Sons Ltd.

Opto-mechanical design of small infrared cloud measuring device

NASA Astrophysics Data System (ADS)

Zhang, Jiao; Yu, Xun; Tao, Yu; Jiang, Xu

2018-01-01

In order to make small infrared cloud measuring device can be well in a wide temperature range and day-night environment, a design idea using catadioptric infrared panoramic imaging optical system and simple mechanical structure for realizing observation clode under all-weather conditions was proposed. Firstly, the optical system of cloud measuring device was designed. An easy-to-use numerical method was proposed to acquire the profile of a catadioptric mirror, which brought the property of equidistance projection and played the most important role in a catadioptric panoramic lens. Secondly, the mechanical structure was studied in detail. Overcoming the limitations of traditional primary mirror support structure, integrative design was used for refractor and mirror support structure. Lastly, temperature adaptability and modes of the mirror support structure were analyzed. Results show that the observation range of the cloud measuring device is wide and the structure is simple, the fundamental frequency of the structure is greater than 100 Hz, the surface precision of the system reflector reaches PV of λ/10 and RMS of λ/40under the load of temperature range - 40 60°C, it can meet the needs of existing meteorological observation.

KSC-08pd3868

NASA Image and Video Library

2008-11-07

CAPE CANAVERAL, Fla. -- In Building 1555 at Vandenberg Air Force Base in California, workers do a fit check on the mating of the Stage 1 to Stage 2 motors for the Taurus XL rocket that will launch NASA's Orbiting Carbon Observatory, or OCO, spacecraft. At right can be seen the avionics shelf. The avionics skirt, a graphite/epoxy structure, supports the avionics shelf and carries the primary structural loads from the fairing and payload cone. The aluminum avionics shelf supports the third stage avionics. The OCO is a new Earth-orbiting mission sponsored by NASA's Earth System Science Pathfinder Program. The launch of OCO is targeted for January. Photo credit: NASA/Randy Beaudoin, VAFB

[A network to promote health systems based on primary health care in the Region of the Americas].

PubMed

Herrera Vázquez, María Magdalena; Rodríguez Avila, Nuria; Nebot Adell, Carme; Montenegro, Hernán

2007-05-01

To identify the relational components of an international network of organizations that provide technical and financial assistance to promote the development of health systems based on primary health care in the countries of the Region of the Americas; to analyze the linkages that would allow the collaborating partners of the Pan American Health Organization (PAHO) to work together on health issues; and to determine the basic theoretical elements that can help to develop action strategies that support advocacy efforts by a network. This was a qualitative and quantitative cross-sectional study based on identifying key informants and on analyzing social networks. Ethnographic and relational information from 46 international organizations was collected through a self-administered semistructured questionnaire. From 46 international health cooperation organizations, 29 decision makers from 29 organizations participated (63.0% response rate). The structure and the strength of the network was evaluated in terms of density, closeness, clustering, and centralization. The statistical analysis was done using computer programs that included UCINET, Pajek, and Microsoft Access. We found a structurally centralized theoretical network, whose nodes were clustered into four central subgroups linked by a shared vision. The leadership, influence, and political interests reflected the formal and technical-cooperation linkages, the formal support for health systems based on primary health care, and the flow of resources being more often technical ones than financial ones. The interorganizational relational components and the social-action ties that were identified could help in the development and consolidation of a thematic network for advocacy and for the management of technical and financial assistance that supports primary health care in the Americas. The linkages for joint action that were identified could advance international cooperation in developing health systems based on primary health care, once PAHO formulates clear implementation strategies and takes a leadership position in mobilizing financial resources and in creating informal and interpersonal linkages for action.

Predicting primary progressive aphasias with support vector machine approaches in structural MRI data.

PubMed

Bisenius, Sandrine; Mueller, Karsten; Diehl-Schmid, Janine; Fassbender, Klaus; Grimmer, Timo; Jessen, Frank; Kassubek, Jan; Kornhuber, Johannes; Landwehrmeyer, Bernhard; Ludolph, Albert; Schneider, Anja; Anderl-Straub, Sarah; Stuke, Katharina; Danek, Adrian; Otto, Markus; Schroeter, Matthias L

2017-01-01

Primary progressive aphasia (PPA) encompasses the three subtypes nonfluent/agrammatic variant PPA, semantic variant PPA, and the logopenic variant PPA, which are characterized by distinct patterns of language difficulties and regional brain atrophy. To validate the potential of structural magnetic resonance imaging data for early individual diagnosis, we used support vector machine classification on grey matter density maps obtained by voxel-based morphometry analysis to discriminate PPA subtypes (44 patients: 16 nonfluent/agrammatic variant PPA, 17 semantic variant PPA, 11 logopenic variant PPA) from 20 healthy controls (matched for sample size, age, and gender) in the cohort of the multi-center study of the German consortium for frontotemporal lobar degeneration. Here, we compared a whole-brain with a meta-analysis-based disease-specific regions-of-interest approach for support vector machine classification. We also used support vector machine classification to discriminate the three PPA subtypes from each other. Whole brain support vector machine classification enabled a very high accuracy between 91 and 97% for identifying specific PPA subtypes vs. healthy controls, and 78/95% for the discrimination between semantic variant vs. nonfluent/agrammatic or logopenic PPA variants. Only for the discrimination between nonfluent/agrammatic and logopenic PPA variants accuracy was low with 55%. Interestingly, the regions that contributed the most to the support vector machine classification of patients corresponded largely to the regions that were atrophic in these patients as revealed by group comparisons. Although the whole brain approach took also into account regions that were not covered in the regions-of-interest approach, both approaches showed similar accuracies due to the disease-specificity of the selected networks. Conclusion, support vector machine classification of multi-center structural magnetic resonance imaging data enables prediction of PPA subtypes with a very high accuracy paving the road for its application in clinical settings.

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.

A Study to Develop an Improved Organizational Structure for the Provision of Administrative Support for the Delivery of Health Care at Fitzsimons Army Medical Center

DTIC Science & Technology

1978-05-01

responsibility over their activities. The branch is comprised of an officer and a civilian clerk- steno - grapher. Major activities supervised include the...obtained during interviews with the following department chiefs: Colonel (Dr.) Nicholas C. Bethlenfalvay, MC, Department of Primary Care and Com- munity...January 1978. 121nterview with Colonel (Dr.) Nicholas C. Bethlenfalvay, MC, Chief, Department of Primary Care and Community Medicine, Fitzsimons Army

Structure and work process in primary care and hospitalizations for sensitive conditions

PubMed Central

Araujo, Waleska Regina Machado; Queiroz, Rejane Christine de Sousa; Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Thumé, Elaine; Tomasi, Elaine; Facchini, Luiz Augusto; Thomaz, Erika Barbara Abreu Fonseca

2017-01-01

ABSTRACT OBJECTIVE The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. METHODS In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%). RESULTS In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001) and private insurance (β = -0.01) had a negative association, and the human development index (β = 1.13), the proportion of older adults (β = 0.05) and children under the age of five (β = 0.05), and the coverage of the Community Health Agent Strategy (β = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14) and availability of vaccines (β = -0.16) showed a negative association, and availability of medications showed a positive association (β = 0.16). In the proximal level, only the variable of matrix support (β = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. CONCLUSIONS The characteristics of the structure of primary health units and the work process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities. PMID:28832757

Problem solving as a core strategy in the prevention of schizophrenia and other mental disorders.

PubMed

Falloon, I R

2000-11-01

To outline the rationale for implementing training in structured problem solving as a primary prevention strategy for major mental disorders. The evidence that training people in a structured method of solving their personal problems is an effective strategy in the treatment of established cases of schizophrenic and major mood disorders, is selectively reviewed. Most of the relevant research focused on the prevention of major recurrent episodes of psychosis. There is some evidence to support the hypothesis that this strategy may assist many people to achieve a full and sustained recovery from the clinical and social impairments of these disorders, especially when patients are taught to use structured problem solving with members of their personal resource groups, and they continue to take optimal doses of psychoactive medication. There is support for the hypothesis that the key therapeutic factor associated with these benefits is the improved efficiency of the management of life stress. The simplicity of problem solving, the educational methods used, and the widespread application to a person's lifestyle would appear to make this a possible candidate for a primary prevention program for major mental disorders. Guidebooks and teaching aids have been developed and show excellent consumer acceptance.

"You're naked, you're vulnerable": Sexual well-being and body image of women with lower limb lymphedema.

PubMed

Winch, Caleb J; Sherman, Kerry A; Smith, Katriona M; Koelmeyer, Louise A; Mackie, Helen; Boyages, John

2016-09-01

Lower-limb lymphedema is an incurable illness manifesting as visible swelling enlarging the leg(s) and/or feet, buttocks, and genitals. This study used semi-structured interviews and thematic analysis to explore sexual well-being among women with primary (congenital) lymphedema (n=11) or secondary lymphedema associated with gynecological cancer (n=8). Five themes (subthemes) summarized women's responses, with Attractiveness and Confidence (Publicly Unattractive, Privately Unconfident, Lymphedema or Aging?) describing women's central concern. These body image-related concerns accounted for sexual well-being in association with Partner Support (Availability of Support, Languages of Support, Fears About Support) and the degree of Functional Interruptions (Lymphedema in Context, Enduring Impacts, Overcoming Interruptions). Successful Lymphedema Coping (Control, Acceptance) and self-perceived ability to fulfill a valued Sexual Role also affected sexual well-being. Few differences between women with primary versus secondary lymphedema were evident. Lymphedema clinicians should screen for sexual concerns and have referral options available. Copyright © 2016 Elsevier Ltd. All rights reserved.

Exploring the impact of the care sport connector in the Netherlands.

PubMed

Leenaars, Karlijn E F; Smit, Eva; Wagemakers, Annemarie; Molleman, Gerard R M; Koelen, Maria A

2017-10-16

Regular physical activity (PA) is deemed to contribute to the primary and secondary prevention of several chronic diseases, like diabetes mellitus, cancer, cardiovascular diseases, and osteoporosis. In 2012, Care Sport Connectors (CSC), to whom a broker has been ascribed, were introduced in the Netherlands to stimulate PA and guide primary care patients towards local sport facilities. The aim of this study was to explore which structural embedding is the most promising for CSCs' work. In three rounds of interviews, 13 CSCs were followed for 2 years in their work. In these interviews, a network survey was used to identify organisations in the CSCs' network, whether they collaborated with these organisations, and the role of the organisations in the connection. Data from the network survey were analysed using the RE-AIM framework and disaggregated into how CSCs were structurally embedded (Type A: only PA sector; Type B: different sectors; Type C: partnership). A related samples Wilcoxon signed rank test was performed to study how the CSCs' network developed between 2014 and 2016. All CSCs established a connection between the primary care and the PA sector in which the average number of organisations with which CSCs collaborated increased significantly between 2014 (8.3) and 2016 (19.8) (p = 0.002). However, differences were identified in the way CSCs were structurally embedded and in the way they established the connection. Type A CSCs established the connection mostly around their own activities, supported PA organisations with their activities, and collaborated with primary care and welfare professionals around their own activities. Type B and Type C CSCs established the connection by organising, supporting, and implementing different kinds of activities targeting different kinds of audiences, and collaborated mostly with primary care professionals around the referral of professionals' patients. The results of this study suggest that adopting an integral approach (Type B and C) for the structural embedding of the CSC is more promising for reaching the desired outcomes. Whether CSCs really improve the target groups' PA level and health needs to be further studied. Dutch Trial Register NTR4986 . Registered 14 December 2014.

Psychological skills training to support diabetes self-management: Qualitative assessment of nurses' experiences.

PubMed

Graves, Helen; Garrett, Christopher; Amiel, Stephanie A; Ismail, Khalida; Winkley, Kirsty

2016-10-01

Evidence for the efficacy of psychological skills training as a method of supporting patients' self-management is growing, but there is a shortage of mental health providers with specialist diabetes knowledge to deliver them. Primary care nurses are now increasingly expected to learn and use these techniques. This study explores nurse experience of training in six psychological skills to support patients' self-management of type 2 diabetes. Semi-structured interviews elicited themes relating to nurses' experiences of participating in a trial of a psychological intervention, the Diabetes-6 study (D-6). Nurses were employed in GP surgeries in 5 South London boroughs. Thematic framework analysis was used to compare and contrast themes across participants. Nine nurses delivering the intervention (n=11), and 7 from the control intervention (n=12, no psychological element) were interviewed. Three key themes were identified: (i) positive and negative impact of D6 on nurses' practice: positives included patient empowerment; negatives included patients' capacity to engage; (ii) professional boundaries including concerns about over-stepping role as a nurse and (iii) concerns about degree of support from physicians at participating practices in integrating psychological and diabetes care. Primary care nurses report that psychological skills training can have a positive impact on patient care. Significant role adjustment is required, which may be aided by additional support from the practice team. Qualitative evaluation of effectiveness of psychological interventions may reveal processes that hinder or contribute to efficacy and translation. Appropriate support is necessary for primary care nurses to deliver psychological therapies with confidence. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

STS-49 Astronaut By Mission Peculiar Equipment Support Structure (MPESS)

NASA Technical Reports Server (NTRS)

1992-01-01

STS-49, the first flight of the Space Shuttle Orbiter Endeavour, lifted off from launch pad 39B on May 7, 1992 at 6:40 pm CDT. The STS-49 mission was the first U.S. orbital flight to feature 4 extravehicular activities (EVAs), and the first flight to involve 3 crew members working simultaneously outside of the spacecraft. The primary objective was the capture and redeployment of the INTELSAT VI (F-3), a communication satellite for the International Telecommunication Satellite organization, which was stranded in an unusable orbit since its launch aboard the Titan rocket in March 1990. In this onboard photo, astronaut Thomas Akers is positioned near the Mission Peculiar Equipment Support Structure (MPESS) in the cargo bay. The MPESS, developed by Marshall Space Flight Center, was used to support experiments.

Exploring GPs' experiences of using diagnostic tools for cancer: a qualitative study in primary care.

PubMed

Green, Trish; Martins, Tanimola; Hamilton, William; Rubin, Greg; Elliott, Kathy; Macleod, Una

2015-02-01

The UK has an estimated 5-10000 extra cancer deaths each year when compared to other European countries and diagnostic delays are thought to make a significant contribution to this. One of the initiatives in England intended to support primary care professionals has been the development of cancer risk assessment tools (RATs). These tools assist in identifying and quantifying the risk of cancer in symptomatic primary care patients. To explore GPs' experiences of incorporating the RATs for lung and bowel cancers into their clinical practice and in so doing, identify constraints and facilitators to the wider dissemination of the tools in primary care. We conducted semi-structured interviews over the telephone with 11 project managers who implemented the study and 23 GPs who used the tool. The interviews were digitally recorded, professionally transcribed verbatim and analysed through the construction of a 'thematic framework'. The training and support package was fundamental to the successful integration of the RATs into GPs' daily routines. Ongoing support from cancer networks alongside acknowledgement of the clinical expertize of the GPs by those implementing the study enhanced GPs' uptake of the tool in practice. Findings suggest that the embedding of clinical decision support tools into clinical practice is more likely to be achieved when they are perceived to support but not supersede the clinical judgement of their users. This element of our findings is a focal point of this article. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Task Integration Facilitates Multitasking.

PubMed

de Oliveira, Rita F; Raab, Markus; Hegele, Mathias; Schorer, Jörg

2017-01-01

The aim of this study was to investigate multi-task integration in a continuous tracking task. We were particularly interested in how manipulating task structure in a dual-task situation affects learning of a constant segment embedded in a pursuit-tracking task. Importantly, we examined if dual-task effects could be attributed to task integration by varying the structural similarity and difficulty of the primary and secondary tasks. In Experiment 1 participants performed a pursuit tracking task while counting high-pitched tones and ignoring low-pitched tones. The tones were either presented randomly or structurally 250 ms before each tracking turn. Experiment 2 increased the motor load of the secondary tasks by asking participants to tap their feet to the tones. Experiment 3 further increased motor load of the primary task by increasing its speed and having participants tracking with their non-dominant hand. The results show that dual-task interference can be moderated by secondary task conditions that match the structure of the primary task. Therefore our results support proposals of task integration in continuous tracking paradigms. We conclude that multi-tasking is not always detrimental for motor learning but can be facilitated through task-integration.

The place of information and communication technology-mediated consultations in primary care: GPs' perspectives.

PubMed

Hanna, Lisa; May, Carl; Fairhurst, Karen

2012-06-01

New information and communication technologies such as email and text messaging have been shown to be useful in some aspects of primary care service delivery. Little is known about Scottish GPs' attitudes towards the adoption of these technologies as routine consultation tools. To explore GPs' perceptions of the potential place of new non-face-to-face consultation technologies in the routine delivery of primary care; to explore GPs' perceived barriers to the introduction of these technologies and to identify the processes by which GPs feel that new consultation technologies could be incorporated into routine primary care. Qualitative interview study: 20 in-depth semi-structured interviews carried out with maximum variation sample of GPs across Scotland. Whilst the face-to-face consultation was seen as central to much of the clinical and diagnostic work of primary care, many GPs were conditionally willing to consider using new technologies in the future, particularly to carry out administrative or less complex tasks and therefore maximize practice efficiency and patient convenience. Key considerations were access to appropriate training, IT support and medico-legal guidance. GPs are conditionally willing to use new consultation media if clinically appropriate and if medico-legal and technical support is available.

The Organization of Mental Health Services in Cuba.

ERIC Educational Resources Information Center

Camayd-Freixas, Yohel; Uriarte, Miren

1980-01-01

Reviews the status and organization of the Cuban mental health system. Focuses on the deliberate and systematic interdependence of mental health, public health, and socio-political structures; inpatient treatment modes and rehabilitation programs; use of social networks to support discharged patients; community-based care; and primary to tertiary…

Supporting Mathematics Teachers' Development through Higher Education

ERIC Educational Resources Information Center

Prendergast, Mark; Roche, Joseph

2017-01-01

Mathematics education, both nationally and internationally, is facing a number of challenges with significant on-going shifts in the structure, content, and core principles of mathematics curricula in countries around the world. For example, in Ireland there was an ambitious reform of the post-primary mathematics curricula in 2010 with further…

Potential climate change impacts on tidal wetland plant and algal assemblages in the Pacific Northwest

EPA Science Inventory

Tidal wetlands along the coast of the Pacific Northwest provide wildlife habitat and support important ecosystem functions such as primary productivity. The future structure and function of these ecosystems may be altered by sea-level rise (SLR) or other climate change effects. W...

Environmentally Sustainable Practices among College Outdoor Programs and Their Association with Organizational Support Structures

ERIC Educational Resources Information Center

Frauman, Eric

2017-01-01

Sustainability has gained increasing importance amongst both academic research and organizational practice over the past two decades (Davis & Challenger, 2014). The primary purpose of this study was to examine environmentally sustainable practices among college outdoor programs, while also examining how college level policy and infrastructural…

Children's Perspectives on Coping and Support Following Parental Separation

ERIC Educational Resources Information Center

Halpenny, Ann Marie; Greene, Sheila; Hogan, Diane

2008-01-01

Families represent the primary setting in which most children's lives are shaped and determined. Increasingly, children experience ongoing change in family formation and structure, and such fluctuation may threaten or diminish their feelings of security with regard to established family roles, relationships and routines. A number of studies have…

Basic Understanding of Earth Tunneling by Melting : Volume 2. Earth Structure and Design Solutions.

DOT National Transportation Integrated Search

1974-07-01

A novel technique, which employs the melting of rocks and soils as a means of excavating or tunneling while simultaneously generating a glass tunnel lining and/or primary support, was studied. The object of the study was to produce a good basic under...

Teachers' Use of Psycho-Educational Reports in Mainstream Classrooms

ERIC Educational Resources Information Center

Lindelauf, Joanne; Reupert, Andrea; Jacobs, Kate E.

2018-01-01

This study investigated how teachers who support children with learning difficulties utilise psychologists' reports in their teaching practice. Previous research has examined teachers' preferences for how reports should be written, rather than how they might be used. Semi-structured, qualitative interviews with 12 teachers (seven primary, four…

Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs

ERIC Educational Resources Information Center

Finch, Andrew J.; Moberg, D. Paul; Krupp, Amanda Lawton

2014-01-01

Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance…

"They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults: a multicenter qualitative study.

PubMed

Johnson, Heather M; Warner, Ryan C; Bartels, Christie M; LaMantia, Jamie N

2017-01-03

Young adults (18-39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers' perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care. Primary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed. Primary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation. Tailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the "health identity" of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.

Active member vibration control for a 4 meter primary reflector support structure

NASA Technical Reports Server (NTRS)

Umland, J. W.; Chen, G.-S.

1992-01-01

The design and testing of a new low voltage piezoelectric active member with integrated load cell and displacement sensor is described. This active member is intended for micron level vibration and structural shape control of the Precision Segmented Reflector test-bed. The test-bed is an erectable 4 meter diameter backup support truss for a 2.4 meter focal length parabolic reflector. Active damping of the test-bed is then demonstrated using the newly developed active members. The control technique used is referred to as bridge feedback. With this technique the internal sensors are used in a local feedback loop to match the active member's input impedance to the structure's load impedance, which then maximizes vibrational energy dissipation. The active damping effectiveness is then evaluated from closed loop frequency responses.

Unimodal primary sensory cortices are directly connected by long-range horizontal projections in the rat sensory cortex.

PubMed

Stehberg, Jimmy; Dang, Phat T; Frostig, Ron D

2014-01-01

Research based on functional imaging and neuronal recordings in the barrel cortex subdivision of primary somatosensory cortex (SI) of the adult rat has revealed novel aspects of structure-function relationships in this cortex. Specifically, it has demonstrated that single whisker stimulation evokes subthreshold neuronal activity that spreads symmetrically within gray matter from the appropriate barrel area, crosses cytoarchitectural borders of SI and reaches deeply into other unimodal primary cortices such as primary auditory (AI) and primary visual (VI). It was further demonstrated that this spread is supported by a spatially matching underlying diffuse network of border-crossing, long-range projections that could also reach deeply into AI and VI. Here we seek to determine whether such a network of border-crossing, long-range projections is unique to barrel cortex or characterizes also other primary, unimodal sensory cortices and therefore could directly connect them. Using anterograde (BDA) and retrograde (CTb) tract-tracing techniques, we demonstrate that such diffuse horizontal networks directly and mutually connect VI, AI and SI. These findings suggest that diffuse, border-crossing axonal projections connecting directly primary cortices are an important organizational motif common to all major primary sensory cortices in the rat. Potential implications of these findings for topics including cortical structure-function relationships, multisensory integration, functional imaging, and cortical parcellation are discussed.

Unimodal primary sensory cortices are directly connected by long-range horizontal projections in the rat sensory cortex

PubMed Central

Stehberg, Jimmy; Dang, Phat T.; Frostig, Ron D.

2014-01-01

Research based on functional imaging and neuronal recordings in the barrel cortex subdivision of primary somatosensory cortex (SI) of the adult rat has revealed novel aspects of structure-function relationships in this cortex. Specifically, it has demonstrated that single whisker stimulation evokes subthreshold neuronal activity that spreads symmetrically within gray matter from the appropriate barrel area, crosses cytoarchitectural borders of SI and reaches deeply into other unimodal primary cortices such as primary auditory (AI) and primary visual (VI). It was further demonstrated that this spread is supported by a spatially matching underlying diffuse network of border-crossing, long-range projections that could also reach deeply into AI and VI. Here we seek to determine whether such a network of border-crossing, long-range projections is unique to barrel cortex or characterizes also other primary, unimodal sensory cortices and therefore could directly connect them. Using anterograde (BDA) and retrograde (CTb) tract-tracing techniques, we demonstrate that such diffuse horizontal networks directly and mutually connect VI, AI and SI. These findings suggest that diffuse, border-crossing axonal projections connecting directly primary cortices are an important organizational motif common to all major primary sensory cortices in the rat. Potential implications of these findings for topics including cortical structure-function relationships, multisensory integration, functional imaging, and cortical parcellation are discussed. PMID:25309339

Raman structural studies of the nickel electrode

NASA Technical Reports Server (NTRS)

Cornilsen, Bahne C.

1994-01-01

The objectives of this investigation have been to define the structures of charged active mass, discharged active mass, and related precursor materials (alpha-phases), with the purpose of better understanding the chemical and electrochemical reactions, including failure mechanisms and cobalt incorporation, so that the nickel electrode may be improved. Although our primary tool has been Raman spectroscopy, the structural conclusions drawn from the Raman data have been supported and augmented by three other analysis methods: infrared spectroscopy, powder X-ray Diffraction (XRD), and x-ray absorption spectroscopy (in particular EXAFS, Extended X-ray Absorption Fine Structure spectroscopy).

Aircraft empennage structural detail design

NASA Technical Reports Server (NTRS)

Meholic, Greg; Brown, Rhonda; Hall, Melissa; Harvey, Robert; Singer, Michael; Tella, Gustavo

1993-01-01

This project involved the detailed design of the aft fuselage and empennage structure, vertical stabilizer, rudder, horizontal stabilizer, and elevator for the Triton primary flight trainer. The main design goals under consideration were to illustrate the integration of the control systems devices used in the tail surfaces and their necessary structural supports as well as the elevator trim, navigational lighting system, electrical systems, tail-located ground tie, and fuselage/cabin interface structure. Accommodations for maintenance, lubrication, adjustment, and repairability were devised. Weight, fabrication, and (sub)assembly goals were addressed. All designs were in accordance with the FAR Part 23 stipulations for a normal category aircraft.

Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

PubMed Central

Whitford, David L; Hickey, Anne; Horgan, Frances; O'Sullivan, Bernadette; McGee, Hannah; O'Neill, Desmond

2009-01-01

Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care. PMID:19402908

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.

PEPFAR support of alcohol-HIV prevention activities in Namibia and Botswana: a framework for investigation, implementation and evaluation.

PubMed

Glenshaw, M; Deluca, N; Adams, R; Parry, C; Fritz, K; Du Preez, V; Voetsch, K; Lekone, P; Seth, P; Bachanas, P; Grillo, M; Kresina, T F; Pick, B; Ryan, C; Bock, N

2016-01-01

The association between harmful use of alcohol and HIV infection is well documented. To address this dual epidemic, the US President's Emergency Plan for AIDS Relief (PEPFAR) developed and implemented a multi-pronged approach primarily in Namibia and Botswana. We present the approach and preliminary results of the public health investigative and programmatic activities designed, initiated and supported by PEPFAR to combat the harmful use of alcohol and its association as a driver of HIV morbidity and mortality from 2008 to 2013. PEPFAR supported comprehensive alcohol programming using a matrix model approach that combined the socio-ecological framework and the Alcohol Misuse Prevention and Intervention Continuum. This structure enabled seven component objectives: (1) to quantify harmful use of alcohol through rapid assessments; (2) to develop and evaluate alcohol-based interventions; (3) to promote screening programs and alcohol abuse resource services; (4) to support stakeholder networks; (5) to support policy interventions and (6) structural interventions; and (7) to institutionalize universal prevention messages. Targeted PEPFAR support for alcohol activities resulted in several projects to address harmful alcohol use and HIV. Components are graphically conceptualized within the matrix model, demonstrating the intersections between primary, secondary and tertiary prevention activities and individual, interpersonal, community, and societal factors. Key initiative successes included leveraging alcohol harm prevention activities that enabled projects to be piloted in healthcare settings, schools, communities, and alcohol outlets. Primary challenges included the complexity of multi-sectorial programming, varying degrees of political will, and difficulties monitoring outcomes over the short duration of the program.

District nurses' prescribing practice and its link to structural conditions.

PubMed

Blanck, Susanne; Engström, Maria

2015-10-01

To describe district nurses' (DNs') prescribing practice and examine associations between DNs' self-reported prescribing frequency, opinions about prescribing, and structural conditions/empowerment. A cross-sectional and correlational design was employed. Data were collected during 2012 using questionnaires and a prescribing register. A random sample of 150 DNs from 32 primary care centers in Sweden was invited. DNs' ability to prescribe is used to a relatively small extent and access to "opportunities" and "informal power" seems to be the most important structural empowerment conditions for increased prescribing frequency and positive opinions about prescribing. The results support Kanter's theory of structural empowerment. This article regarding restricted prescribing shows how important structural conditions/empowerment is to DNs' prescribing and employers have to enhance nurses' access to especially the structures "opportunities" and "informal power" to increase nurse prescribing. More targeted support and training are needed in different prescribing areas to make use of DNs' prescription qualification to a greater extent. ©2015 American Association of Nurse Practitioners.

Preventing Acute Kidney Injury: a qualitative study exploring 'sick day rules' implementation in primary care.

PubMed

Morris, Rebecca L; Ashcroft, Darren; Phipps, Denham; Bower, Peter; O'Donoghue, Donal; Roderick, Paul; Harding, Sarah; Lewington, Andrew; Blakeman, Thomas

2016-07-22

In response to growing demand for urgent care services there is a need to implement more effective strategies in primary care to support patients with complex care needs. Improving primary care management of kidney health through the implementation of 'sick day rules' (i.e. temporary cessation of medicines) to prevent Acute Kidney Injury (AKI) has the potential to address a major patient safety issue and reduce unplanned hospital admissions. The aim of this study is to examine processes that may enable or constrain the implementation of 'sick day rules' for AKI prevention into routine care delivery in primary care. Forty semi-structured interviews were conducted with patients with stage 3 chronic kidney disease and purposefully sampled, general practitioners, practice nurses and community pharmacists who either had, or had not, implemented a 'sick day rule'. Normalisation Process Theory was used as a framework for data collection and analysis. Participants tended to express initial enthusiasm for sick day rules to prevent AKI, which fitted with the delivery of comprehensive care. However, interest tended to diminish with consideration of factors influencing their implementation. These included engagement within and across services; consistency of clinical message; and resources available for implementation. Participants identified that supporting patients with multiple conditions, particularly with chronic heart failure, made tailoring initiatives complex. Implementation of AKI initiatives into routine practice requires appropriate resourcing as well as training support for both patients and clinicians tailored at a local level to support system redesign.

Study on TCM Syndrome Differentiation of Primary Liver Cancer Based on the Analysis of Latent Structural Model.

PubMed

Gu, Zhan; Qi, Xiuzhong; Zhai, Xiaofeng; Lang, Qingbo; Lu, Jianying; Ma, Changping; Liu, Long; Yue, Xiaoqiang

2015-01-01

Primary liver cancer (PLC) is one of the most common malignant tumors because of its high incidence and high mortality. Traditional Chinese medicine (TCM) plays an active role in the treatment of PLC. As the most important part in the TCM system, syndrome differentiation based on the clinical manifestations from traditional four diagnostic methods has met great challenges and questions with the lack of statistical validation support. In this study, we provided evidences for TCM syndrome differentiation of PLC using the method of analysis of latent structural model from clinic data, thus providing basis for establishing TCM syndrome criteria. And also we obtain the common syndromes of PLC as well as their typical clinical manifestations, respectively.

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

PubMed

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Family physicians' attitude and practice of infertility management at primary care--Suez Canal University, Egypt.

PubMed

Eldein, Hebatallah Nour

2013-01-01

The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians' attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians' practice. Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management.

Family physicians’ attitude and practice of infertility management at primary care - Suez Canal University, Egypt

PubMed Central

Eldein, Hebatallah Nour

2013-01-01

Introduction The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. The aim of the work: to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. Methods This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Results Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians′ attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians′ practice. Conclusion Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management. PMID:24244792

Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience

PubMed Central

2016-01-01

Abstract Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes—all core attributes of a medical home. This qualitative study looked at 4 different PHCO models—3 from the United States and 1 from Australia—with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system. PMID:26636485

A human factors systems approach to understanding team-based primary care: a qualitative analysis

PubMed Central

Mundt, Marlon P.; Swedlund, Matthew P.

2016-01-01

Background. Research shows that high-functioning teams improve patient outcomes in primary care. However, there is no consensus on a conceptual model of team-based primary care that can be used to guide measurement and performance evaluation of teams. Objective. To qualitatively understand whether the Systems Engineering Initiative for Patient Safety (SEIPS) model could serve as a framework for creating and evaluating team-based primary care. Methods. We evaluated qualitative interview data from 19 clinicians and staff members from 6 primary care clinics associated with a large Midwestern university. All health care clinicians and staff in the study clinics completed a survey of their communication connections to team members. Social network analysis identified key informants for interviews by selecting the respondents with the highest frequency of communication ties as reported by their teammates. Semi-structured interviews focused on communication patterns, team climate and teamwork. Results. Themes derived from the interviews lent support to the SEIPS model components, such as the work system (Team, Tools and Technology, Physical Environment, Tasks and Organization), team processes and team outcomes. Conclusions. Our qualitative data support the SEIPS model as a promising conceptual framework for creating and evaluating primary care teams. Future studies of team-based care may benefit from using the SEIPS model to shift clinical practice to high functioning team-based primary care. PMID:27578837

Alignment and assembly process for primary mirror subsystem of a spaceborne telescope

NASA Astrophysics Data System (ADS)

Lin, Wei-Cheng; Chang, Shenq-Tsong; Chang, Sheng-Hsiung; Chang, Chen-Peng; Lin, Yu-Chuan; Chin, Chi-Chieh; Pan, Hsu-Pin; Huang, Ting-Ming

2015-11-01

In this study, a multispectral spaceborne Cassegrain telescope was developed. The telescope was equipped with a primary mirror with a 450-mm clear aperture composed of Zerodur and lightweighted at a ratio of approximately 50% to meet both thermal and mass requirements. Reducing the astigmatism was critical for this mirror. The astigmatism is caused by gravity effects, the bonding process, and deformation from mounting the main structure of the telescope (main plate). This article presents the primary mirror alignment, mechanical ground-supported equipment (MGSE), assembly process, and optical performance test used to assemble the primary mirror. A mechanical compensated shim is used as the interface between the bipod flexure and main plate. The shim was used to compensate for manufacturer errors found in components and differences between local coplanarity errors to prevent stress while the bipod flexure was screwed to the main plate. After primary mirror assembly, an optical performance test method called a bench test with an algorithm was used to analyze the astigmatism caused by the gravity effect and deformation from the mounting or supporter. The tolerance conditions for the primary mirror assembly require the astigmatism caused by gravity and mounting force deformation to be less than P-V 0.02 λ at 632.8 nm. The results demonstrated that the designed MGSE used in the alignment and assembly processes met the critical requirements for the primary mirror assembly of the telescope.

Primary care models for treating opioid use disorders: What actually works? A systematic review

PubMed Central

Klasa, Katarzyna; Bush, Christopher; Heisler, Michele; Chopra, Vineet; Bohnert, Amy

2017-01-01

Background Primary care-based models for Medication-Assisted Treatment (MAT) have been shown to reduce mortality for Opioid Use Disorder (OUD) and have equivalent efficacy to MAT in specialty substance treatment facilities. Objective The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings. Data sources PubMed, EMBASE, CINAHL, and PsychInfo. Methods We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework. Results We included 35 interventions (10 RCTs and 25 quasi-experimental interventions) that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care) and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists) as clinical care managers, incorporating patient “agreements,” and using home inductions to make treatment more convenient for patients and providers. Conclusions The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed. PMID:29040331

Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda.

PubMed

Tsai, Alexander C; Bangsberg, David R; Frongillo, Edward A; Hunt, Peter W; Muzoora, Conrad; Martin, Jeffrey N; Weiser, Sheri D

2012-06-01

Depression is common among people living with HIV/AIDS and contributes to a wide range of worsened HIV-related outcomes, including AIDS-related mortality. Targeting modifiable causes of depression, either through primary or secondary prevention, may reduce suffering as well as improve HIV-related outcomes. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support. Quarterly data were collected by structured interviews and blood draws. The primary outcome was depression symptom severity, measured by a modified Hopkins Symptom Checklist for Depression. The primary explanatory variables were food insecurity, measured with the Household Food Insecurity Access Scale, and social support, measured with a modified version of the Functional Social Support Questionnaire. We found that food insecurity was associated with depression symptom severity among women but not men, and that social support buffered the impacts of food insecurity on depression. We also found that instrumental support had a greater buffering influence than emotional social support. Interventions aimed at improving food security and strengthening instrumental social support may have synergistic beneficial effects on both mental health and HIV outcomes among PLWHA in resource-limited settings. Copyright © 2012 Elsevier Ltd. All rights reserved.

Benchmarks for effective primary care-based nursing services for adults with depression: a Delphi study.

PubMed

McIlrath, Carole; Keeney, Sinead; McKenna, Hugh; McLaughlin, Derek

2010-02-01

This paper is a report of a study conducted to identify and gain consensus on appropriate benchmarks for effective primary care-based nursing services for adults with depression. Worldwide evidence suggests that between 5% and 16% of the population have a diagnosis of depression. Most of their care and treatment takes place in primary care. In recent years, primary care nurses, including community mental health nurses, have become more involved in the identification and management of patients with depression; however, there are no appropriate benchmarks to guide, develop and support their practice. In 2006, a three-round electronic Delphi survey was completed by a United Kingdom multi-professional expert panel (n = 67). Round 1 generated 1216 statements relating to structures (such as training and protocols), processes (such as access and screening) and outcomes (such as patient satisfaction and treatments). Content analysis was used to collapse statements into 140 benchmarks. Seventy-three benchmarks achieved consensus during subsequent rounds. Of these, 45 (61%) were related to structures, 18 (25%) to processes and 10 (14%) to outcomes. Multi-professional primary care staff have similar views about the appropriate benchmarks for care of adults with depression. These benchmarks could serve as a foundation for depression improvement initiatives in primary care and ongoing research into depression management by nurses.

Measuring mechanisms for quality assurance in primary care systems in transition: test of a new instrument in Slovenia and Uzbekistan.

PubMed

Kringos, Dionne Sofia; Boerma, Wienke; Pellny, Martina

2009-01-01

This World Health Organization (WHO) study aimed to develop and field test an instrument to assess the availability of structures and mechanisms for managing quality in primary care in countries in transition. The instrument is based on a literature study, consensus meetings with experts, and observations in these countries. It consists of three parts: a semi-structured questionnaire on national policies and mechanisms; a structured questionnaire for general practitioners (GPs); and a structured questionnaire for use with managers of primary care facilities. The instrument has been field tested in 2007 in Slovenia and Uzbekistan. In Slovenia, leadership on quality improvement was weak and local managers reported few incentives and resources to control quality. There was a lack of external support for quality improvement activities. Availability and use of clinical guidelines for GPs were not optimal. GPs found teamwork and communication with patients inadequate. In Uzbekistan, primary care quality and standards in health centres were extensively regulated and laid down in numerous manuals, instructions and other documents. Managers, however, indicated the need for more financial and non-financial levers for quality improvement and they wanted to know more about modern healthcare management. GPs reported strong involvement in activities such as peer review and clinical audit, and reported frequent use of clinical guidelines. Overall, the information gathered with the provisional instrument has resulted in policy recommendations. At the same time, the pilot resulted in improvements to the instrument. Application of the instrument helps decision makers to identify improvement areas in the infrastructure for managing the quality of primary care.

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.

Solar dynamic power systems for space station

NASA Technical Reports Server (NTRS)

Irvine, Thomas B.; Nall, Marsha M.; Seidel, Robert C.

1986-01-01

The Parabolic Offset Linearly Actuated Reflector (POLAR) solar dynamic module was selected as the baseline design for a solar dynamic power system aboard the space station. The POLAR concept was chosen over other candidate designs after extensive trade studies. The primary advantages of the POLAR concept are the low mass moment of inertia of the module about the transverse boom and the compactness of the stowed module which enables packaging of two complete modules in the Shuttle orbiter payload bay. The fine pointing control system required for the solar dynamic module has been studied and initial results indicate that if disturbances from the station are allowed to back drive the rotary alpha joint, pointing errors caused by transient loads on the space station can be minimized. This would allow pointing controls to operate in bandwidths near system structural frequencies. The incorporation of the fine pointing control system into the solar dynamic module is fairly straightforward for the three strut concentrator support structure. However, results of structural analyses indicate that this three strut support is not optimum. Incorporation of a vernier pointing system into the proposed six strut support structure is being studied.

Lightweight composite reflectors for space optics

NASA Astrophysics Data System (ADS)

Williams, Brian E.; McNeal, Shawn R.; Ono, Russell M.

1998-01-01

The primary goal of this work was to advance the state of the art in lightweight, high optical quality reflectors for space- and Earth-based telescopes. This was accomplished through the combination of a precision silicon carbide (SiC) reflector surface and a high specific strength, low-mass SiC structural support. Reducing the mass of components launched into space can lead to substantial cost savings, but an even greater benefit of lightweight reflectors for both space- and Earth-based optics applications is the fact that they require far less complex and less expensive positioning systems. While Ultramet is not the first company to produce SiC by chemical vapor deposition (CVD) for reflector surfaces, it is the first to propose and demonstrate a lightweight, open-cell SiC structural foam that can support a thin layer of the highly desirable polished SiC reflector material. SiC foam provides a substantial structural and mass advantage over conventional honeycomb supports and alternative finned structures. The result is a reflector component that meets or exceeds the optical properties of current high-quality glass, ceramic, and metal reflectors while maintaining a substantially lower areal density.

EPA DSSTox and ToxCast Project Updates: Generating New ...

EPA Pesticide Factsheets

EPA’s National Center for Computational Toxicology is generating data and capabilities to support a new paradigm for toxicity screening and prediction. The DSSTox project is improving public access to quality structure-annotated chemical toxicity information in less summarized forms than traditionally employed in SAR modeling, and in ways that facilitate data-mining and data read-across. The DSSTox Structure-Browser provides structure searchability across the full published DSSTox toxicity-related inventory, enables linkages to and from previously isolated toxicity data resources (soon to include public microarray resources GEO, ArrayExpress, and CEBS), and provides link-outs to cross-indexed public resources such as PubChem, ChemSpider, and ACToR. The published DSSTox inventory and bioassay information also have been integrated into PubChem allowing a user to take full advantage of PubChem structure-activity and bioassay clustering features. Phase I of the ToxCastTM project has generated high-throughput screening (HTS) data from several hundred biochemical and cell-based assays for a set of 320 chemicals, mostly pesticide actives, with rich toxicology profiles. DSSTox and ACToR are providing the primary cheminformatics support for ToxCastTM and collaborative efforts with the National Toxicology Program’s HTS Program and the NIH Chemical Genomics Center. DSSTox will also be a primary vehicle for publishing ToxCastTM ToxRef summarized bioassay data for use

Developing an electronic health record (EHR) for methadone treatment recording and decision support

PubMed Central

2011-01-01

Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. PMID:21284849

The Effect of Outdoor Learning Activities on the Development of Preschool Children

ERIC Educational Resources Information Center

Yildirim, Günseli; Özyilmaz Akamca, Güzin

2017-01-01

Learning ought to be supported by both in class activities and outdoor activities contributing to structuring knowledge. Outdoor activities allow children to actively participate and to learn by doing. Learning requires a lot of work and activities. These activities, which provide primary experiences, help children to change theoretical knowledge…

33 CFR 155.1035 - Response plan requirements for manned vessels carrying oil as a primary cargo.

Code of Federal Regulations, 2014 CFR

2014-07-01

... be used to manage the response actions. This structure must include the following functional areas and must further include information for key components within each functional area: (i) Command and... operations; (vi) Planning; (vii) Logistics support; and (viii) Finance. (5) The responsibilities of, duties...

33 CFR 155.1035 - Response plan requirements for manned vessels carrying oil as a primary cargo.

Code of Federal Regulations, 2013 CFR

2013-07-01

... be used to manage the response actions. This structure must include the following functional areas and must further include information for key components within each functional area: (i) Command and... operations; (vi) Planning; (vii) Logistics support; and (viii) Finance. (5) The responsibilities of, duties...

33 CFR 155.1035 - Response plan requirements for manned vessels carrying oil as a primary cargo.

Code of Federal Regulations, 2011 CFR

2011-07-01

... be used to manage the response actions. This structure must include the following functional areas and must further include information for key components within each functional area: (i) Command and... operations; (vi) Planning; (vii) Logistics support; and (viii) Finance. (5) The responsibilities of, duties...

33 CFR 155.1035 - Response plan requirements for manned vessels carrying oil as a primary cargo.

Code of Federal Regulations, 2012 CFR

2012-07-01

... be used to manage the response actions. This structure must include the following functional areas and must further include information for key components within each functional area: (i) Command and... operations; (vi) Planning; (vii) Logistics support; and (viii) Finance. (5) The responsibilities of, duties...

A School Council's Experience with School Improvement: A Saskatchewan Case Study

ERIC Educational Resources Information Center

Preston, Jane P.

2012-01-01

Based on a qualitative case study conducted within one Saskatchewan (Canada) rural community, the purpose of this article is to describe the challenges a school council faced when supporting a school improvement plan. The primary data for the study were 35 semi-structured individual interviews conducted with school council members, teachers, and…

Cricital Thinking Abilities That Support Scientific Skills. Workshop.

ERIC Educational Resources Information Center

Pallas, Stella

Science is suggested as an excellent content area for teaching primary students the creative and critical thinking skills that can help them become better problem solvers. J. P. Guilford's Structure of Intellect model and Benjamin Bloom's Taxonomy of Educational Objectives serve as the basis for developing exercises which lead to improvement of…

Success for All: Evaluation Report and Executive Summary

ERIC Educational Resources Information Center

Miller, Sarah; Biggart, Andy; Sloan, Seaneen; O'Hare, Liam

2017-01-01

Success for All (SfA) is a whole-school approach to improving literacy in primary schools. Teachers receive training in areas including group learning strategies, phonics, and assessment, and are provided with structured daily lesson plans and teaching materials. There is also support for school leadership in areas such as data management, ability…

Storytelling, Technology and Children's Literacy Development.

ERIC Educational Resources Information Center

Amaro, Ana Carla; Moreira, Antonio

This paper reports on a project started November 1999, which aims at understanding the storytelling structuring processes put into action by children at primary education level. The ultimate goal of this study is to draft a script for a computer tool to support story telling. For this purpose it identifies narrative scheme as the main organizing…

Inductive Reasoning in Zambia, Turkey, and the Netherlands Establishing Cross-Cultural Equivalence.

ERIC Educational Resources Information Center

van de Vijver, Fons J. R.

2002-01-01

Administered tasks of inductive reasoning to 704 Zambian, 877 Turkish, and 632 Dutch students from the highest 2 grades of primary and the lowest 2 grades of secondary school. Results show strong evidence for structural equivalence and partial evidence for measurement unit equivalence, but did not support full score equivalence. (SLD)

Thermal Design and Analysis of the Optical Telescope Assembly for the Gondola for High Altitude Planetary Science

NASA Technical Reports Server (NTRS)

O'Connor, Brian; Brooks, Thomas

2017-01-01

The NASA Gondola for High Altitude Planetary Science (GHAPS) project is an effort to design, build, and fly a balloon-borne platform for planetary science missions. GHAPS observations will be in the 300 nm to 5 micron wavelength region covering UV, visible, and near-mid IR. The primary element of the project is the Optical Telescope Assembly (OTA). It is a one meter aperture narrow-field-of-view telescope that contains the primary and secondary mirrors, the support system/metering structure, a secondary mirror focusing system, baffles, and insulation. This paper presents the thermal design and analysis that has been done to support the design of the OTA. A major part of the thermal analysis was bounding the flight environment for the six potential Columbia Scientific Balloon Facility launch sites. These analyses were used to give input into the Structural Thermal Optical Performance (STOP) analysis of the telescope. Also the analysis was used to select heater sizes for the few OTA associated electronic components. Currently the telescope is scheduled to have its first flight in 2019.

Monodispersed bimetallic PdAg nanoparticles with twinned structures: Formation and enhancement for the methanol oxidation

PubMed Central

Yin, Zhen; Zhang, Yining; Chen, Kai; Li, Jing; Li, Wenjing; Tang, Pei; Zhao, Huabo; Zhu, Qingjun; Bao, Xinhe; Ma, Ding

2014-01-01

Monodispersed bimetallic PdAg nanoparticles can be fabricated through the emulsion-assisted ethylene glycol (EG) ternary system. Different compositions of bimetallic PdAg nanoparticles, Pd80Ag20, Pd65Ag35 and Pd46Ag54 can be obtained via adjusting the reaction parameters. For the formation process of the bimetallic PdAg nanoparticles, there have two-stage growth processes: firstly, nucleation and growth of the primary nanoclusters; secondly, formation of the secondary nanoparticles with the size-selection and relax process via the coalescence or aggregation of the primary nanoclusters. The as-prepared PdAg can be supported on the carbon black without any post-treatment, which exhibited high electro-oxidation activity towards methanol oxidation under alkaline media. More importantly, carbon-supported Pd80Ag20 nanoparticles reveal distinctly superior activities for the methanol oxidation, even if compared with commercial Pt/C electro-catalyst. It is concluded that the enhanced activity is dependant on the unique twinning structure with heterogeneous phase due to the dominating coalescence growth in EG ternary system. PMID:24608736

A systemic identification approach for primary transcription start site of Arabidopsis miRNAs from multidimensional omics data.

PubMed

You, Qi; Yan, Hengyu; Liu, Yue; Yi, Xin; Zhang, Kang; Xu, Wenying; Su, Zhen

2017-05-01

The 22-nucleotide non-coding microRNAs (miRNAs) are mostly transcribed by RNA polymerase II and are similar to protein-coding genes. Unlike the clear process from stem-loop precursors to mature miRNAs, the primary transcriptional regulation of miRNA, especially in plants, still needs to be further clarified, including the original transcription start site, functional cis-elements and primary transcript structures. Due to several well-characterized transcription signals in the promoter region, we proposed a systemic approach integrating multidimensional "omics" (including genomics, transcriptomics, and epigenomics) data to improve the genome-wide identification of primary miRNA transcripts. Here, we used the model plant Arabidopsis thaliana to improve the ability to identify candidate promoter locations in intergenic miRNAs and to determine rules for identifying primary transcription start sites of miRNAs by integrating high-throughput omics data, such as the DNase I hypersensitive sites, chromatin immunoprecipitation-sequencing of polymerase II and H3K4me3, as well as high throughput transcriptomic data. As a result, 93% of refined primary transcripts could be confirmed by the primer pairs from a previous study. Cis-element and secondary structure analyses also supported the feasibility of our results. This work will contribute to the primary transcriptional regulatory analysis of miRNAs, and the conserved regulatory pattern may be a suitable miRNA characteristic in other plant species.

Environmentally Preferable Coatings for Structural Steel Project

NASA Technical Reports Server (NTRS)

Lewis, Pattie L. (Editor)

2014-01-01

The Ground Systems Development and Operations (GSDO) Program at NASA John F. Kennedy Space Center (KSC) has the primary objective of modernizing and transforming the launch and range complex at KSC to benefit current and future NASA programs along with other emerging users. Described a the "launch support and infrastructure modernization program" in the NASA Authorization Act of 2010, the GSDO Program will develop and implement shared infrastructure and process improvements to provide more flexible, affordable, and responsive capabilities to a multi-user community. In support of the GSDO Program, the objective of this project is to determine the feasibility of environmentally friendly corrosion resistant coatings for launch facilities and ground support equipment. The focus of the project is corrosion resistance and survivability with the goal to reduce the amount of maintenance required to preserve the performance of launch facilities while reducing mission risk. Number of facilities/structures with metallic structural and non-structural components in a highly corrosive environment. Metals require periodic maintenance activity to guard against the insidious effects of corrosion and thus ensure that structures meet or exceed design or performance life. The standard practice for protecting metallic substrates in atmospheric environments is the application of corrosion protective coating system.

Developing Tomorrow's Integrated Community Health Systems: A Leadership Challenge for Public Health and Primary Care

PubMed Central

Welton, William E.; Kantner, Theodore A.; Katz, Sheila Moriber

1997-01-01

As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health. PMID:9184684

Explaining the amount and consistency of medical care and self-management support in asthma: a survey of primary care providers in France and the United Kingdom.

PubMed

de Bruin, Marijn; Dima, Alexandra L; Texier, Nathalie; van Ganse, Eric

2018-05-09

The quality of asthma primary care may vary between countries, health care practices, and health care professionals (HCPs). Identifying and explaining such differences is critical for health services improvement. To examine the quality of asthma primary care in France and United Kingdom, and identify within-country and between-country predictors amenable to intervention. An online questionnaire to capture asthma medical care and self-management support, practice characteristics, and psychosocial determinants, was completed by 276 HCPs. Mokken Scaling analyses were used to examine item structure and consistency. Hierarchical regression analyses were used to identify predictors of the amount (number of asthma care activities HCPs delivered) and consistency (the degree to which HCPs deliver similar care) of asthma medical care and self-management support. On average, HCPs reported delivering 74,2% of guideline-recommended care. Consistency of medical care and self-management support was lower among HCPs delivering a lower amount of care (r=.58 and r=.57, p<.001). UK HCPs provided more and more consistent asthma self-management support -but not medical care- than French HCPs, which was explained by the presence of practice nurses in the UK. More training, positive social norms, and higher behavioural control explained better quality of care across all HCPs. Using carefully-developed questionnaires and advanced psychometric analyses, this study suggests that involving practice nurses, making social expectations visible, and providing more training to enhance skills and confidence in asthma care delivery could enhance the amount and consistency of asthma primary care. This needs to be corroborated in a future intervention trial. Copyright © 2018. Published by Elsevier Inc.

KSC-08pd3866

NASA Image and Video Library

2008-11-07

CAPE CANAVERAL, Fla. -- In Building 1555 at Vandenberg Air Force Base in California, ssembly is underway for the Taurus XL rocket that will launch NASA's Orbiting Carbon Observatory, or OCO, spacecraft. Lined up left to right are the Stage 1 and Stage 2 motors, the boattail, the avionics shelf and the Stage 3 motor. The graphite/epoxy boattail structure provides the transition from the smaller diameter of the Stage 2 motor to the larger diameter of the avionics skirt. The avionics skirt, also a graphite/epoxy structure, supports the avionics shelf and carries the primary structural loads from the fairing and payload cone. The aluminum avionics shelf supports the third stage avionics. The OCO is a new Earth-orbiting mission sponsored by NASA's Earth System Science Pathfinder Program. The launch of OCO is targeted for January. Photo credit: NASA/Randy Beaudoin, VAFB

Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience".

PubMed

Sunaert, Patricia; Bastiaens, Hilde; Feyen, Luc; Snauwaert, Boris; Nobels, Frank; Wens, Johan; Vermeire, Etienne; Van Royen, Paul; De Maeseneer, Jan; De Sutter, An; Willems, Sara

2009-08-23

Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Process evaluation of an action research project (2003-2007) guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC). A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. The overall ACIC score improved from 1.45 (limited support) at the start of the study to 5.5 (basic support) at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care delivery in a primary care system with limited structure. The study succeeded in achieving a considerable improvement of the overall support for diabetes patients but further improvement requires a shift towards system thinking among policy makers. Currently primary care providers lack the opportunities to take up full responsibility for chronic care. ClinicalTrials.gov Identifier: NCT00824499.

Decellularized extracellular matrices produced from immortal cell lines derived from different parts of the placenta support primary mesenchymal stem cell expansion

PubMed Central

Kusuma, Gina D.; Brennecke, Shaun P.; O’Connor, Andrea J.; Kalionis, Bill

2017-01-01

Mesenchymal stem/stromal cells (MSCs) exhibit undesired phenotypic changes during ex vivo expansion, limiting production of the large quantities of high quality primary MSCs needed for both basic research and cell therapies. Primary MSCs retain many desired MSC properties including proliferative capacity and differentiation potential when expanded on decellularized extracellular matrix (dECM) prepared from primary MSCs. However, the need to use low passage number primary MSCs (passage 3 or lower) to produce the dECM drastically limits the utility and impact of this technology. Here, we report that primary MSCs expanded on dECM prepared from high passage number (passage 25) human telomerase reverse transcriptase (hTERT) transduced immortal MSC cell lines also exhibit increased proliferation and osteogenic differentiation. Two hTERT-transduced placenta-derived MSC cell lines, CMSC29 and DMSC23 [derived from placental chorionic villi (CMSCs) and decidua basalis (DMSCs), respectively], were used to prepare dECM-coated substrates. These dECM substrates showed structural and biochemical differences. Primary DMSCs cultured on dECM-DMSC23 showed a three-fold increase in cell number after 14 days expansion in culture and increased osteogenic differentiation compared with controls. Primary CMSCs cultured on the dECM-DMSC23 exhibited a two-fold increase in cell number and increased osteogenic differentiation. We conclude that immortal MSC cell lines derived from different parts of the placenta produce dECM with varying abilities for supporting increased primary MSC expansion while maintaining important primary MSC properties. Additionally, this is the first demonstration of using high passage number cells to produce dECM that can promote primary MSC expansion, and this advancement greatly increases the feasibility and applicability of dECM-based technologies. PMID:28152107

Decellularized extracellular matrices produced from immortal cell lines derived from different parts of the placenta support primary mesenchymal stem cell expansion.

PubMed

Kusuma, Gina D; Brennecke, Shaun P; O'Connor, Andrea J; Kalionis, Bill; Heath, Daniel E

2017-01-01

Mesenchymal stem/stromal cells (MSCs) exhibit undesired phenotypic changes during ex vivo expansion, limiting production of the large quantities of high quality primary MSCs needed for both basic research and cell therapies. Primary MSCs retain many desired MSC properties including proliferative capacity and differentiation potential when expanded on decellularized extracellular matrix (dECM) prepared from primary MSCs. However, the need to use low passage number primary MSCs (passage 3 or lower) to produce the dECM drastically limits the utility and impact of this technology. Here, we report that primary MSCs expanded on dECM prepared from high passage number (passage 25) human telomerase reverse transcriptase (hTERT) transduced immortal MSC cell lines also exhibit increased proliferation and osteogenic differentiation. Two hTERT-transduced placenta-derived MSC cell lines, CMSC29 and DMSC23 [derived from placental chorionic villi (CMSCs) and decidua basalis (DMSCs), respectively], were used to prepare dECM-coated substrates. These dECM substrates showed structural and biochemical differences. Primary DMSCs cultured on dECM-DMSC23 showed a three-fold increase in cell number after 14 days expansion in culture and increased osteogenic differentiation compared with controls. Primary CMSCs cultured on the dECM-DMSC23 exhibited a two-fold increase in cell number and increased osteogenic differentiation. We conclude that immortal MSC cell lines derived from different parts of the placenta produce dECM with varying abilities for supporting increased primary MSC expansion while maintaining important primary MSC properties. Additionally, this is the first demonstration of using high passage number cells to produce dECM that can promote primary MSC expansion, and this advancement greatly increases the feasibility and applicability of dECM-based technologies.

Acyl carrier protein structural classification and normal mode analysis

PubMed Central

Cantu, David C; Forrester, Michael J; Charov, Katherine; Reilly, Peter J

2012-01-01

All acyl carrier protein primary and tertiary structures were gathered into the ThYme database. They are classified into 16 families by amino acid sequence similarity, with members of the different families having sequences with statistically highly significant differences. These classifications are supported by tertiary structure superposition analysis. Tertiary structures from a number of families are very similar, suggesting that these families may come from a single distant ancestor. Normal vibrational mode analysis was conducted on experimentally determined freestanding structures, showing greater fluctuations at chain termini and loops than in most helices. Their modes overlap more so within families than between different families. The tertiary structures of three acyl carrier protein families that lacked any known structures were predicted as well. PMID:22374859

Use of graphite epoxy composites in the Solar-A Soft X-Ray Telescope

NASA Technical Reports Server (NTRS)

Jurcevich, B. K.; Bruner, M. E.

1990-01-01

This paper describes the use of composite materials in the Soft X-Ray Telescope (SXT). One of the primary structural members of the telescope is a graphite epoxy metering tube. The metering tube maintains the structural stability of the telescope during launch as well as the focal length through various environmental conditions. The graphite epoxy metering tube is designed to have a negative coefficient of thermal expansion to compensate for the positive expansion of titanium structural supports. The focus is maintained to + or - 0.001 inch by matching the CTE of the composite tube to the remaining structural elements.

Transfer of label from /sup 3/H-glucose in Digitaria eriantha leaves to the rust fungus Puccinia digitariae Pole Evans

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

Rey, M.E.; Garnett, H.M.

1985-08-01

Digitaria eriantha pentzii was fed /sup 3/H-glucose prior to inoculation with uredospores of Puccinia digitariae Pole Evans. Twenty-one hours after inoculation, uptake of label from /sup 3/H-glucose by the primary infection structures of P. digitariae was demonstrated employing autoradiography. These results indicate that an exchange of nutrients between host and pathogen occurs very early on in the infection process, during the formation of the primary infection structures. Despite contrary reports that obligate parasites receive no nutrition before establishment of haustoria, this study supports the work of Andrews, who demonstrated uptake of /sup 3/H-glucose label from lettuce cotyledons into the primarymore » and secondary infection vesicles, appressoria, and germ tubes of Bremia lactucae.« less

Space ten-meter telescope (STMT) - Structural and thermal feasibility study of the primary mirror

NASA Technical Reports Server (NTRS)

Bely, Pierre Y.; Bolton, John F.; Neeck, Steven P.; Tulkoff, Philip J.

1987-01-01

The structural and thermal behavior of a ten-meter primary mirror for a space optical/near-IR telescope in geosynchronous orbit is studied. The glass-type lightweighted mirror is monolithic, of the double arch type, and is supported at only three points. The computer programs SSPTA (thermal), NASTRAN (finite element), and ACCOS V (optical) are used in sequence to determine the temperature, deformation, and optical performance of the mirror. A mirror temperature of 130 K or less appears to be obtainable by purely passive means. With a fused silica or standard Zerodur blank, thermally-induced deformation is unacceptable and cannot be fully corrected by an active secondary mirror over the desired field. Either active thermal control or a blank of lower thermal expansion coefficient would be required.

An Assessment of the Effectiveness of the AGATE Program Management Model

NASA Technical Reports Server (NTRS)

Warner, Timothy P. (Technical Monitor); Masson, Paul

2005-01-01

This report describes the collaborative program model chosen to implement an aeronautics research and technology program from 1994 through 2001: the Advanced General Aviation Transport Experiments (AGATE) Program. The Program had one primary objective: to improve the ability of the General Aviation industry to adopt technology as a solution to fulfill public benefit objectives. The primary objective of this report is to assess the program s ability to meet a combination of "effectiveness measures" from multiple stakeholders. The "effectiveness" of any model forms the foundation of legitimate questions for policy makers and professional federal managers. The participants rated AGATE as achieving its primary objectives and rating well on effectiveness in most areas, with high measures for relevance, cost, speed and public benefit, but lower measures for institutional fit and flexibility at dealing with the larger NASA organizational structure. This pattern mirrors private sector surveys and represents a tradeoff between the benefits of tailoring a program using partnering, versus the changes necessary within the institutional structure to support such tailoring.

Design Study for the Asteroid Redirect Vehicle (ARV) Composite Primary Bulkhead

NASA Technical Reports Server (NTRS)

Cressman, Thomas O.; Paddock, David A.

2017-01-01

A design study was undertaken of a carbon fiber primary bulkhead for a large solar electric propulsion (SEP) spacecraft. The bulkhead design, supporting up to 16 t of xenon propellant, progressed from one consisting of many simple parts with many complex joints, to one consisting of a few complex parts with a few simple joints. The unique capabilities of composites led to a topology that transitioned loads from bending to in-plane tension and shear, with low part count. This significantly improved bulkhead manufacturability, cost, and mass. The stiffness-driven structure utilized high-modulus M55J fiber unidirectional prepregs. A full-scale engineering demonstration unit (EDU) of the concept was used to demonstrate manufacturability of the concept. Actual labor data was obtained, which could be extrapolated to a full bulkhead. The effort demonstrated the practicality of using high-modulus fiber (HMF) composites for unique shape topologies that minimize mass and cost. The lessons are applicable to primary and secondary aerospace structures that are stiffness driven.

The Alcohol Relapse Situation Appraisal Questionnaire: Development and Validation

PubMed Central

Martin, Rosemarie A.; MacKinnon, Selene M.; Johnson, Jennifer E.; Myers, Mark G.; Cook, Travis A. R.; Rohsenow, Damaris J.

2011-01-01

Background The role of cognitive appraisal of the threat of alcohol relapse has received little attention. A previous instrument, the Relapse Situation Appraisal Questionnaire (RSAQ), was developed to assess cocaine users’ primary appraisal of the threat of situations posing a high risk for cocaine relapse. The purpose of the present study was to modify the RSAQ in order to measure primary appraisal in situations involving a high risk for alcohol relapse. Methods The development and psychometric properties of this instrument, the Alcohol Relapse Situation Appraisal Questionnaire (A-RSAQ), were examined with two samples of abstinent adults with alcohol abuse or dependence. Factor structure and validity were examined in Study 1 (N=104). Confirmation of the factor structure and predictive validity were assessed in Study 2 (N=161). Results Results demonstrated construct, discriminant and predictive validity and reliability of the A-RSAQ. Discussion Results support the important role of primary appraisal of degree of risk in alcohol relapse situations. PMID:21237586

Study on light weight design of truss structures of spacecrafts

NASA Astrophysics Data System (ADS)

Zeng, Fuming; Yang, Jianzhong; Wang, Jian

2015-08-01

Truss structure is usually adopted as the main structure form for spacecrafts due to its high efficiency in supporting concentrated loads. Light-weight design is now becoming the primary concern during conceptual design of spacecrafts. Implementation of light-weight design on truss structure always goes through three processes: topology optimization, size optimization and composites optimization. During each optimization process, appropriate algorithm such as the traditional optimality criterion method, mathematical programming method and the intelligent algorithms which simulate the growth and evolution processes in nature will be selected. According to the practical processes and algorithms, combined with engineering practice and commercial software, summary is made for the implementation of light-weight design on truss structure for spacecrafts.

A human factors systems approach to understanding team-based primary care: a qualitative analysis.

PubMed

Mundt, Marlon P; Swedlund, Matthew P

2016-12-01

Research shows that high-functioning teams improve patient outcomes in primary care. However, there is no consensus on a conceptual model of team-based primary care that can be used to guide measurement and performance evaluation of teams. To qualitatively understand whether the Systems Engineering Initiative for Patient Safety (SEIPS) model could serve as a framework for creating and evaluating team-based primary care. We evaluated qualitative interview data from 19 clinicians and staff members from 6 primary care clinics associated with a large Midwestern university. All health care clinicians and staff in the study clinics completed a survey of their communication connections to team members. Social network analysis identified key informants for interviews by selecting the respondents with the highest frequency of communication ties as reported by their teammates. Semi-structured interviews focused on communication patterns, team climate and teamwork. Themes derived from the interviews lent support to the SEIPS model components, such as the work system (Team, Tools and Technology, Physical Environment, Tasks and Organization), team processes and team outcomes. Our qualitative data support the SEIPS model as a promising conceptual framework for creating and evaluating primary care teams. Future studies of team-based care may benefit from using the SEIPS model to shift clinical practice to high functioning team-based primary care. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care.

PubMed

Hedrick, Susan C; Chaney, Edmund F; Felker, Bradford; Liu, Chuan-Fen; Hasenberg, Nicole; Heagerty, Patrick; Buchanan, Jan; Bagala, Rocco; Greenberg, Diane; Paden, Grady; Fihn, Stephan D; Katon, Wayne

2003-01-01

To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic. Patients were randomly assigned to treatment model by clinic firm. VA primary care clinic. One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia. Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale. Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months. Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.

Feasibility study of a clinical decision support system for the management of multimorbid seniors in primary care: study protocol.

PubMed

Weltermann, Birgitta; Kersting, Christine

2016-01-01

Care for seniors is complex because patients often have more than one disease, one medication, and one physician. It is a key challenge for primary care physicians to structure the various aspects of each patient's care, to integrate each patient's preferences, and to maintain a long-term overview. This article describes the design for the development and feasibility testing of the clinical decision support system (CDSS) eCare*Seniors© which is electronic health record (EHR)-based allowing for a long-term, comprehensive, evidence-based, and patient preference-oriented management of multimorbid seniors. This mixed-methods study is designed in three steps. First, focus groups and practice observations will be conducted to develop criteria for software design from a physicians' and practice assistants' perspective. Second, based on these criteria, a CDSS prototype will be developed. Third, the prototype's feasibility will be tested by five primary care practices in the care of 30 multimorbid seniors. Primary outcome is the usability of the software measured by the validated system usability scale (SUS) after 3 months. Secondary outcomes are the (a) willingness to routinely use the CDSS, (b) degree of utilization of the CDSS, (c) acceptance of the CDSS, (d) willingness of the physicians to purchase the CDSS, and (e) willingness of the practice assistants to use the CDSS in the long term. These outcomes will be measured using semi-structured interviews and software usage data. If the SUS score reaches ≥70 %, feasibility testing will be judged successful. Otherwise, the CDSS prototype will be refined according to the users' needs and retested by the physicians and practice assistants until it is fully adapted to their requirements and reaches a usability score ≥70 %. The study will support the development of a CDSS which is primary care-defined, user-friendly, easy-to-comprehend, workflow-oriented, and comprehensive. The software will assist physicians and practices in their long-term, individualized care for multimorbid seniors. German Clinical Trials Register, DRKS00008777.

Growing community: the impact of the Stephanie Alexander Kitchen Garden Program on the social and learning environment in primary schools.

PubMed

Block, Karen; Gibbs, Lisa; Staiger, Petra K; Gold, Lisa; Johnson, Britt; Macfarlane, Susie; Long, Caroline; Townsend, Mardie

2012-08-01

This article presents results from a mixed-method evaluation of a structured cooking and gardening program in Australian primary schools, focusing on program impacts on the social and learning environment of the school. In particular, we address the Stephanie Alexander Kitchen Garden Program objective of providing a pleasurable experience that has a positive impact on student engagement, social connections, and confidence within and beyond the school gates. Primary evidence for the research question came from qualitative data collected from students, parents, teachers, volunteers, school principals, and specialist staff through interviews, focus groups, and participant observations. This was supported by analyses of quantitative data on child quality of life, cooperative behaviors, teacher perceptions of the school environment, and school-level educational outcome and absenteeism data. Results showed that some of the program attributes valued most highly by study participants included increased student engagement and confidence, opportunities for experiential and integrated learning, teamwork, building social skills, and connections and links between schools and their communities. In this analysis, quantitative findings failed to support findings from the primary analysis. Limitations as well as benefits of a mixed-methods approach to evaluation of complex community interventions are discussed.

Overview and status of the Giant Magellan Telescope Project

NASA Astrophysics Data System (ADS)

McCarthy, Patrick J.; Fanson, James; Bernstein, Rebecca; Ashby, David; Bigelow, Bruce; Boyadjian, Nune; Bouchez, Antonin; Chauvin, Eric; Donoso, Eduardo; Filgueira, Jose; Goodrich, Robert; Groark, Frank; Jacoby, George; Pearce, Eric

2016-08-01

The Giant Magellan Telescope Project is in the construction phase. Production of the primary mirror segments is underway with four of the seven required 8.4m mirrors at various stages of completion and materials purchased for segments five and six. Development of the infrastructure at the GMT site at Las Campanas is nearing completion. Power, water, and data connections sufficient to support the construction of the telescope and enclosure are in place and roads to the summit have been widened and graded to support transportation of large and heavy loads. Construction pads for the support buildings have been graded and the construction residence is being installed. A small number of issues need to be resolved before the final design of the telescope structure and enclosure can proceed and the GMT team is collecting the required inputs to the decision making process. Prototyping activities targeted at the active and adaptive optics systems are allowing us to finalize designs before large scale production of components begins. Our technically driven schedule calls for the telescope to be assembled on site in 2022 and to be ready to receive a subset of the primary and secondary mirror optics late in the year. The end date for the project is coupled to the delivery of the final primary mirror segments and the adaptive secondary mirrors that support adaptive optics operations.

Knowing Your Limits: A Qualitative Study of Physician and Nurse Practitioner Perspectives on NP Independence in Primary Care.

PubMed

Kraus, Elena; DuBois, James M

2017-03-01

The shortage of primary care providers and the provisions of the Affordable Care Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and independence of primary care nurse practitioners (NPs). Such discussions in the media and among professional organizations may insinuate that changes to the laws governing NP practice will engender acrimony between practicing physicians and NPs. However, we lack empirical, descriptive data on how practicing professionals view NP independence in primary care. The aim of the present study was to explore and describe the attitudes about NP independence among physicians and NPs working in primary care. A qualitative study based on the principles of grounded theory. Thirty primary care professionals in Missouri, USA, including 15 primary care physicians and 15 primary care NPs. Semi-structured, in-depth interviews, with data analysis guided by grounded theory. Participants had perspectives that were not well represented by professional organizations or the media. Physicians were supportive of a wide variety of NP roles and comfortable with high levels of NP independence and autonomy. Physicians and NPs described prerequisites to NP independence that were complementary. Physicians generally believed that NPs needed some association with physicians for patient safety, and NPs preferred having a physician readily accessible as needed. The theme "knowing your limits" was important to both NPs and physicians regarding NP independence, and has not been described previously in the literature. NP and physician views about NP practice in primary care are not as divergent as their representative professional organizations and the news media would suggest. The significant agreement among NPs and physicians, and some of the nuances of their perspectives, supports recommendations that may reduce the perceived acrimony surrounding discussions of NP independent practice in primary care.

Design and verification for front mirror-body structure of on-axis three mirror anastigmatic space camera

NASA Astrophysics Data System (ADS)

Wang, Xiaoyong; Guo, Chongling; Hu, Yongli; He, Hongyan

2017-11-01

The primary and secondary mirrors of onaxis three mirror anastigmatic (TMA) space camera are connected and supported by its front mirror-body structure, which affects both imaging performance and stability of the camera. In this paper, the carbon fiber reinforced plastics (CFRP) thin-walled cylinder and titanium alloy connecting rod have been used for the front mirror-body opto-mechanical structure of the long-focus on-axis and TMA space camera optical system. The front mirror-body component structure has then been optimized by finite element analysis (FEA) computing. Each performance of the front mirror-body structure has been tested by mechanics and vacuum experiments in order to verify the validity of such structure engineering design.

The Relationships among Taiwanese Adolescents' Perceived Classroom Environment, Academic Coping, and Burnout

ERIC Educational Resources Information Center

Shih, Shu-Shen

2015-01-01

Although academic pressures are regarded as a primary source of stress among students in Asian countries, there has been paucity of research on the effects of classroom settings providing structure and peer support on Asian adolescents' use of coping strategies and academic burnout. The present study was intended to address this issue. Three…

Teachers' Continuing Professional Development in Primary Physical Education: Lessons from Present and Past to Inform the Future

ERIC Educational Resources Information Center

Armour, Kathleen M.; Duncombe, Rebecca

2004-01-01

There is a growing recognition that teachers' learning, and effective policies and structures to support it, should be at the heart of government polices to improve standards in education (Day, 1999). In England, the continuing professional development (CPD) landscape for teachers is changing; and professional development in physical education…

Tokamak experimental power reactor conceptual design. Volume II

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

Not Available

1976-08-01

Volume II contains the following appendices: (1) summary of EPR design parameters, (2) impurity control, (3) plasma computational models, (4) structural support system, (5) materials considerations for the primary energy conversion system, (6) magnetics, (7) neutronics penetration analysis, (8) first wall stress analysis, (9) enrichment of isotopes of hydrogen by cryogenic distillation, and (10) noncircular plasma considerations. (MOW)

Use of satellite image data to identify changes in hemlock health over space and time

Treesearch

Laurent R. Bonneau; Kathleen S. Shields; Daniel L. Civco; David R. Mikus

2000-01-01

Eastern hemlock (Tsuga canadensis (L.) Carriere), is an important component of ecosystems in the northeastern United States and is the primary coniferous species in southern Connecticut. Hemlocks play a unique role in the region by providing spatial and structural habitat diversity that supports many wildlife and fish populations. Widespread damage...

School-Based Clinics: A Guide for Advocates. Developing Policy Statements, Educating Decision Makers, Enlisting Local Support.

ERIC Educational Resources Information Center

Center for Population Options, Washington, DC.

School-based clinics (SBCs) are comprehensive primary health care facilities located within or on the grounds of middle, junior, or senior high schools. Varying in size and organizational structure, SBCs have emerged as an effective model for advancing adolescent health. They have gained attention because of their potential for treating problems…

The Factor Structure of ADHD in a General Population of Primary School Children

ERIC Educational Resources Information Center

Ullebo, Anne Karin; Breivik, Kyrre; Gillberg, Christopher; Lundervold, Astri J.; Posserud, Maj-Britt

2012-01-01

Objective: To examine whether a bifactor model with a general ADHD factor and domain specific factors of inattention, hyperactivity and impulsivity was supported in a large general population sample of children. We also explored the utility of forming subscales based on the domain-specific factors. Methods: Child mental health questionnaires were…

Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

PubMed

McDonald, Julie; Powell Davies, Gawaine; Jayasuriya, Rohan; Fort Harris, Mark

2011-07-01

Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.

Effectiveness of an online social support intervention for caregivers of people with dementia: the study protocol of a randomised controlled trial.

PubMed

Dam, Alieske E H; de Vugt, Marjolein E; van Boxtel, Martin P J; Verhey, Frans R J

2017-08-29

Caregivers of people with dementia (PwD) face burden, feelings of loneliness, and social isolation. Previous studies have shown promising effects of online e-health interventions. Using social media may facilitate support for dementia caregiver networks. In an iterative step-wise approach, a social support tool entitled "Inlife" was developed. This paper describes the design of a study evaluating the effects of Inlife and its process characteristics. A mixed-method, randomised controlled trial with 122 caregivers of PwD will be conducted. Participants will be assigned to either the Inlife social support intervention or a waiting-list control group. After 16 weeks, the control group will obtain access to the Inlife environment. Data will be collected at baseline (T 0 ) and at 8-week (T 1 ), 16-week (T 2 ) and 42-week follow up (T 3 ). The 16-week follow-up assessment (T 2 ) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. The primary outcomes include feelings of caregiver competence and perceived social support. The secondary outcomes include received support, feelings of loneliness, psychological complaints (e.g., anxiety, stress), and quality of life. A process evaluation, including semi-structured interviews, will be conducted to examine the internal and external validity of the intervention. Using a mixed-method design, our study will provide valuable insights into the usability, effectiveness, and factors related to implementation of the Inlife intervention. Our study results will indicate whether Inlife could be a valuable social support resource in future routine dementia care. Dutch trial register, NTR6131 . Registered on 20 October 2016.

Moving Beyond the Household: Innovations in Data Collection on Kinship

PubMed Central

Madhavan, Sangeetha; Clark, Shelley; Beguy, Donatien; Kabiru, Caroline W.; Gross, Mark

2017-01-01

Across settings, it has been shown that the co-residential household is an insufficient measure of family structure and support. However, it continues to be the primary means of population data collection. To address this problem, we have developed a new instrument – Kinship Support Tree (KST) – to collect kinship structure and support data on residential and non-residential kin and tested it on a sample of 462 single mothers and their children in a slum community in Nairobi, Kenya. This instrument is unique in four important ways: 1) it is not limited to the co-residential household; 2) it distinguishes potential from functional kin; 3) it incorporates multiple geospatial measures; and 4) it collects data on kin relationships from the perspective of children. In this paper, we describe the KST instrument, assess the data collected in comparison to data from household rosters, and consider the challenges and feasibility of administration of the KST. PMID:28139166

Moving beyond the household: Innovations in data collection on kinship.

PubMed

Madhavan, Sangeetha; Clark, Shelley; Beguy, Donatien; Kabiru, Caroline W; Gross, Mark

2017-03-01

Across settings, it has been shown that the co-residential household is an insufficient measure of family structure and support. However, it continues to be the primary means of population data collection. To address this problem, we developed a new instrument, the Kinship Support Tree (KST), to collect kinship structure and support data on co-residential and non-residential kin and tested it on a sample of 462 single mothers and their children in a slum community in Nairobi, Kenya. This instrument is unique in four important ways: (1) it is not limited to the co-residential household; (2) it distinguishes potential from functional kin; (3) it incorporates multiple geospatial measures; and (4) it collects data on kin relationships specifically for children. In this paper, we describe the KST instrument, assess the data collected in comparison to data from household rosters, and consider the challenges and feasibility of administration of the KST.

Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects.

PubMed

Francis, Caitlin F; Feyer, Anne-Marie; Smith, Ben J

2007-11-01

The evaluation of the Sharing Health Care Initiative addressed the translation of different models of chronic disease self-management into health and community service contexts in Australia. Across seven projects, four intervention models were adopted: (1) the Stanford Chronic Disease Self Management course; (2) generic disease management planning, training and support; (3) tailored disease management planning, training and support, and; (4) telephone coaching. Targeted recruitment through support groups and patient lists was most successful for reaching high-needs clients. Projects with well developed organisational structures and health system networks demonstrated more effective implementation. Engagement of GPs in recruitment and client support was limited. Future self-management programs will require flexible delivery methods in the primary health care setting, involving practice nurses or the equivalent. After 12 months there was little evidence of potential sustainability, although structures such as consumer resource centres and client support clubs were established in some locations. Only one project was able to use Medicare chronic disease-related items to integrate self-management support into routine general practice. Participants in all projects showed improvements in self-management practices, but those receiving Model 3, flexible and tailored support, and Model 4, telephone coaching, reported the greatest benefits.

[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.

Morphology of the ampullae of Lorenzini in juvenile freshwater Carcharhinus leucas.

PubMed

Whitehead, Darryl L; Gauthier, Arnault R G; Mu, Erica W H; Bennett, Mike B; Tibbetts, Ian R

2015-05-01

Ampullae of Lorenzini were examined from juvenile Carcharhinus leucas (831-1,045 mm total length) captured from freshwater regions of the Brisbane River. The ampullary organ structure differs from all other previously described ampullae in the canal wall structure, the general shape of the ampullary canal, and the apically nucleated supportive cells. Ampullary pores of 140-205 µm in diameter are distributed over the surface of the head region with 2,681 and 2,913 pores present in two sharks that were studied in detail. The primary variation of the ampullary organs appears in the canal epithelial cells which occur as either flattened squamous epithelial cells or a second form of pseudostratified contour-ridged epithelial cells; both cell types appear to release material into the ampullary lumen. Secondarily, this ampullary canal varies due to involuted walls that form a clover-like canal wall structure. At the proximal end of the canal, contour-ridged cells abut a narrow region of cuboidal epithelial cells that verge on the constant, six alveolar sacs of the ampulla. The alveolar sacs contain numerous receptor and supportive cells bound by tight junctions and desmosomes. Pear-shaped receptor cells that possess a single apical kinocilium are connected basally by unmyelinated neural boutons. Opposed to previously described ampullae of Lorenzini, the supportive cells have an apical nucleus, possess a low number of microvilli, and form a unique, jagged alveolar wall. A centrally positioned centrum cap of cuboidal epithelial cells overlies a primary afferent lateral line nerve. © 2014 Wiley Periodicals, Inc.

RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care.

PubMed

Engel, Charles C; Oxman, Thomas; Yamamoto, Christopher; Gould, Darin; Barry, Sheila; Stewart, Patrice; Kroenke, Kurt; Williams, John W; Dietrich, Allen J

2008-10-01

U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and significant structural barriers to mental health services. Improvements in primary care may help address these issues, and evidence supports the effectiveness of a systems-level collaborative care approach. To test the feasibility of systems-level collaborative care for PTSD and depression in military primary care. We named our collaborative care model "Re-Engineering Systems of Primary Care for PTSD and Depression in the Military" (RESPECT-Mil). Key elements of RESPECT-Mil care include universal primary care screening for PTSD and depression, brief standardized primary care diagnostic assessment for those who screen positive, and use of a nurse "care facilitator" to ensure continuity of care for those with unmet depression and PTSD treatment needs. The care facilitator assists primary care providers with follow-up, symptom monitoring, and treatment adjustment and enhances the primary care interface with specialty mental health services. We report assessments of feasibility of RESPECT-Mil implementation in a busy primary care clinic supporting Army units undergoing frequent Iraq, Afghanistan, and other deployments. Thirty primary care providers (family physicians, physician assistants, and nurse practitioners) were trained in the model and in the care of depression and PTSD. The clinic screened 4,159 primary care active duty patient visits: 404 screens (9.7%) were positive for depression, PTSD, or both. Sixty-nine patients participated in collaborative care for 6 weeks or longer, and the majority of these patients experienced clinically important improvement in PTSD and depression. Even although RESPECT-Mil participation was voluntary for providers, only one refused participation. No serious adverse events were noted. Collaborative care is an evidence-based approach to improving the quality of primary care treatment of anxiety and depression. Our version of collaborative care for PTSD and depression, RESPECT-Mil, is feasible, safe, and acceptable to military primary care providers and patients, and participating patients frequently showed clinical improvements. Efforts to implement and evaluate collaborative care approaches for mental disorders in populations at high risk for psychiatric complications of military service are warranted.

KSC-08pd3867

NASA Image and Video Library

2008-11-07

CAPE CANAVERAL, Fla. -- In Building 1555 at Vandenberg Air Force Base in California, assembly is underway for the Taurus XL rocket that will launch NASA's Orbiting Carbon Observatory, or OCO, spacecraft. In the foreground at left is the boattail; behind it is the Stage 0 Castor 120 motor. At right near the wall (from left) are the Stage 1 and Stage 2 motors, the avionics shelf and the Stage 3 motor. The graphite/epoxy boattail structure provides the transition from the smaller diameter of the Stage 2 motor to the larger diameter of the avionics skirt. The avionics skirt, also a graphite/epoxy structure, supports the avionics shelf and carries the primary structural loads from the fairing and payload cone. The aluminum avionics shelf supports the third stage avionics. The OCO is a new Earth-orbiting mission sponsored by NASA's Earth System Science Pathfinder Program. The launch of OCO is targeted for January. Photo credit: NASA/Randy Beaudoin, VAFB

LUTE primary mirror materials and design study report

NASA Astrophysics Data System (ADS)

Ruthven, Greg

1993-02-01

The major objective of the Lunar Ultraviolet Telescope Experiment (LUTE) Primary Mirror Materials and Design Study is to investigate the feasibility of the LUTE telescope primary mirror. A systematic approach to accomplish this key goal was taken by first understanding the optical, thermal, and structural requirements and then deriving the critical primary mirror-level requirements for ground testing, launch, and lunar operations. After summarizing the results in those requirements which drove the selection of material and the design for the primary mirror are discussed. Most important of these are the optical design which was assumed to be the MSFC baseline (i.e. 3 mirror optical system), telescope wavefront error (WFE) allocations, the telescope weight budget, and the LUTE operational temperature ranges. Mechanical load levels, reflectance and microroughness issues, and options for the LUTE metering structure were discussed and an outline for the LUTE telescope sub-system design specification was initiated. The primary mirror analysis and results are presented. The six material substrate candidates are discussed and four distinct mirror geometries which are considered are shown. With these materials and configurations together with varying the location of the mirror support points, a total of 42 possible primary mirror designs resulted. The polishability of each substrate candidate was investigated and a usage history of 0.5 meter and larger precision cryogenic mirrors (the operational low end LUTE temperature of 60 K is the reason we feel a survey of cryogenic mirrors is appropriate) that were flown or tested are presented.

LUTE primary mirror materials and design study report

NASA Technical Reports Server (NTRS)

Ruthven, Greg

1993-01-01

The major objective of the Lunar Ultraviolet Telescope Experiment (LUTE) Primary Mirror Materials and Design Study is to investigate the feasibility of the LUTE telescope primary mirror. A systematic approach to accomplish this key goal was taken by first understanding the optical, thermal, and structural requirements and then deriving the critical primary mirror-level requirements for ground testing, launch, and lunar operations. After summarizing the results in those requirements which drove the selection of material and the design for the primary mirror are discussed. Most important of these are the optical design which was assumed to be the MSFC baseline (i.e. 3 mirror optical system), telescope wavefront error (WFE) allocations, the telescope weight budget, and the LUTE operational temperature ranges. Mechanical load levels, reflectance and microroughness issues, and options for the LUTE metering structure were discussed and an outline for the LUTE telescope sub-system design specification was initiated. The primary mirror analysis and results are presented. The six material substrate candidates are discussed and four distinct mirror geometries which are considered are shown. With these materials and configurations together with varying the location of the mirror support points, a total of 42 possible primary mirror designs resulted. The polishability of each substrate candidate was investigated and a usage history of 0.5 meter and larger precision cryogenic mirrors (the operational low end LUTE temperature of 60 K is the reason we feel a survey of cryogenic mirrors is appropriate) that were flown or tested are presented.

ATLAST-8 Mission Concept Study for 8-Meter Monolithic UV/Optical Space Telescope

NASA Technical Reports Server (NTRS)

Stahl, H. Philip; Postman, Marc; Arnold, William R., Sr.; Hopkins, Randall C.; Hornsby, Linda; Mosier, Gary E.; Pasquale, Bert A.

2010-01-01

ATLAST-8m is an 8-meter monolithic UV/optical/NIR space observatory which could be placed in orbit at Sun-Earth L2 by a heavily lift launch vehicle. Two development study cycles have resulted in a detailed concept including a dual foci optical design; several primary mirror launch support and secondary mirror support structural designs; spacecraft propulsion, power and pointing control design; and thermal design. ATLAST-8m is designed to yield never before achieved performance to obtain fundamental astronomical breakthroughs

Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care.

PubMed

Holtrop, Jodi Summers; Ruland, Sandra; Diaz, Stephanie; Morrato, Elaine H; Jones, Eric

2018-05-01

Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.

Environmental and genetic factors support the dissociation between α-synuclein aggregation and toxicity.

PubMed

Villar-Piqué, Anna; Lopes da Fonseca, Tomás; Sant'Anna, Ricardo; Szegö, Éva Mónika; Fonseca-Ornelas, Luis; Pinho, Raquel; Carija, Anita; Gerhardt, Ellen; Masaracchia, Caterina; Abad Gonzalez, Enrique; Rossetti, Giulia; Carloni, Paolo; Fernández, Claudio O; Foguel, Debora; Milosevic, Ira; Zweckstetter, Markus; Ventura, Salvador; Outeiro, Tiago Fleming

2016-10-18

Synucleinopathies are a group of progressive disorders characterized by the abnormal aggregation and accumulation of α-synuclein (aSyn), an abundant neuronal protein that can adopt different conformations and biological properties. Recently, aSyn pathology was shown to spread between neurons in a prion-like manner. Proteins like aSyn that exhibit self-propagating capacity appear to be able to adopt different stable conformational states, known as protein strains, which can be modulated both by environmental and by protein-intrinsic factors. Here, we analyzed these factors and found that the unique combination of the neurodegeneration-related metal copper and the pathological H50Q aSyn mutation induces a significant alteration in the aggregation properties of aSyn. We compared the aggregation of WT and H50Q aSyn with and without copper, and assessed the effects of the resultant protein species when applied to primary neuronal cultures. The presence of copper induces the formation of structurally different and less-damaging aSyn aggregates. Interestingly, these aggregates exhibit a stronger capacity to induce aSyn inclusion formation in recipient cells, which demonstrates that the structural features of aSyn species determine their effect in neuronal cells and supports a lack of correlation between toxicity and inclusion formation. In total, our study provides strong support in favor of the hypothesis that protein aggregation is not a primary cause of cytotoxicity.

Environmental and genetic factors support the dissociation between α-synuclein aggregation and toxicity

PubMed Central

Villar-Piqué, Anna; Lopes da Fonseca, Tomás; Sant’Anna, Ricardo; Szegö, Éva Mónika; Fonseca-Ornelas, Luis; Pinho, Raquel; Carija, Anita; Gerhardt, Ellen; Masaracchia, Caterina; Abad Gonzalez, Enrique; Rossetti, Giulia; Carloni, Paolo; Fernández, Claudio O.; Foguel, Debora; Milosevic, Ira; Zweckstetter, Markus; Ventura, Salvador; Outeiro, Tiago Fleming

2016-01-01

Synucleinopathies are a group of progressive disorders characterized by the abnormal aggregation and accumulation of α-synuclein (aSyn), an abundant neuronal protein that can adopt different conformations and biological properties. Recently, aSyn pathology was shown to spread between neurons in a prion-like manner. Proteins like aSyn that exhibit self-propagating capacity appear to be able to adopt different stable conformational states, known as protein strains, which can be modulated both by environmental and by protein-intrinsic factors. Here, we analyzed these factors and found that the unique combination of the neurodegeneration-related metal copper and the pathological H50Q aSyn mutation induces a significant alteration in the aggregation properties of aSyn. We compared the aggregation of WT and H50Q aSyn with and without copper, and assessed the effects of the resultant protein species when applied to primary neuronal cultures. The presence of copper induces the formation of structurally different and less-damaging aSyn aggregates. Interestingly, these aggregates exhibit a stronger capacity to induce aSyn inclusion formation in recipient cells, which demonstrates that the structural features of aSyn species determine their effect in neuronal cells and supports a lack of correlation between toxicity and inclusion formation. In total, our study provides strong support in favor of the hypothesis that protein aggregation is not a primary cause of cytotoxicity. PMID:27708160

Mobile Devices and Apps as Scaffolds to Science Learning in the Primary Classroom

NASA Astrophysics Data System (ADS)

Falloon, Garry

2017-12-01

Considerable work over many years has explored the contribution technology can make to science learning, at all levels of education. In the school sector, historically this has focused on the use of fixed, desktop-based or semi-mobile laptop systems for purposes such as experiment data collection or analysis, or as a means of engaging or motivating interest in science. However, the advent of mobile devices such as iPads supported by a huge array of low or no cost apps, means that new opportunities are becoming available for teachers to explore how these resources may be useful for supporting `hands on' science learning. This article reports outcomes from a study of primary (elementary) school students' use of a series of apps integrated with practical science activities, in a topic exploring Energy concepts. It used an innovative display capture tool to examine how the students used the apps and features of their iPads to scaffold their practical work at different stages during the experiments. Results identify device functions and app-based scaffolds that assisted these students to structure their experiments, understand procedures, think about the influence of variables and communicate and share outcomes. However, they also discovered limitations in the apps' ability to support conceptual knowledge development, identifying the critical role of teachers and the importance of task structure and design to ensuring conceptual knowledge objectives are met.

Dentists with extended skills: the challenge of innovation.

PubMed

Al-Haboubi, M; Eliyas, S; Briggs, P F A; Jones, E; Rayan, R R; Gallagher, J E

2014-08-01

The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided. A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists. Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice. This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed.

Hearing loss in older adults affects neural systems supporting speech comprehension.

PubMed

Peelle, Jonathan E; Troiani, Vanessa; Grossman, Murray; Wingfield, Arthur

2011-08-31

Hearing loss is one of the most common complaints in adults over the age of 60 and a major contributor to difficulties in speech comprehension. To examine the effects of hearing ability on the neural processes supporting spoken language processing in humans, we used functional magnetic resonance imaging to monitor brain activity while older adults with age-normal hearing listened to sentences that varied in their linguistic demands. Individual differences in hearing ability predicted the degree of language-driven neural recruitment during auditory sentence comprehension in bilateral superior temporal gyri (including primary auditory cortex), thalamus, and brainstem. In a second experiment, we examined the relationship of hearing ability to cortical structural integrity using voxel-based morphometry, demonstrating a significant linear relationship between hearing ability and gray matter volume in primary auditory cortex. Together, these results suggest that even moderate declines in peripheral auditory acuity lead to a systematic downregulation of neural activity during the processing of higher-level aspects of speech, and may also contribute to loss of gray matter volume in primary auditory cortex. More generally, these findings support a resource-allocation framework in which individual differences in sensory ability help define the degree to which brain regions are recruited in service of a particular task.

Hearing loss in older adults affects neural systems supporting speech comprehension

PubMed Central

Peelle, Jonathan E.; Troiani, Vanessa; Grossman, Murray; Wingfield, Arthur

2011-01-01

Hearing loss is one of the most common complaints in adults over the age of 60 and a major contributor to difficulties in speech comprehension. To examine the effects of hearing ability on the neural processes supporting spoken language processing in humans, we used functional magnetic resonance imaging (fMRI) to monitor brain activity while older adults with age-normal hearing listened to sentences that varied in their linguistic demands. Individual differences in hearing ability predicted the degree of language-driven neural recruitment during auditory sentence comprehension in bilateral superior temporal gyri (including primary auditory cortex), thalamus, and brainstem. In a second experiment we examined the relationship of hearing ability to cortical structural integrity using voxel-based morphometry (VBM), demonstrating a significant linear relationship between hearing ability and gray matter volume in primary auditory cortex. Together, these results suggest that even moderate declines in peripheral auditory acuity lead to a systematic downregulation of neural activity during the processing of higher-level aspects of speech, and may also contribute to loss of gray matter volume in primary auditory cortex. More generally these findings support a resource-allocation framework in which individual differences in sensory ability help define the degree to which brain regions are recruited in service of a particular task. PMID:21880924

Optimization of lightweight structure and supporting bipod flexure for a space mirror.

PubMed

Chen, Yi-Cheng; Huang, Bo-Kai; You, Zhen-Ting; Chan, Chia-Yen; Huang, Ting-Ming

2016-12-20

This article presents an optimization process for integrated optomechanical design. The proposed optimization process for integrated optomechanical design comprises computer-aided drafting, finite element analysis (FEA), optomechanical transfer codes, and an optimization solver. The FEA was conducted to determine mirror surface deformation; then, deformed surface nodal data were transferred into Zernike polynomials through MATLAB optomechanical transfer codes to calculate the resulting optical path difference (OPD) and optical aberrations. To achieve an optimum design, the optimization iterations of the FEA, optomechanical transfer codes, and optimization solver were automatically connected through a self-developed Tcl script. Two examples of optimization design were illustrated in this research, namely, an optimum lightweight design of a Zerodur primary mirror with an outer diameter of 566 mm that is used in a spaceborne telescope and an optimum bipod flexure design that supports the optimum lightweight primary mirror. Finally, optimum designs were successfully accomplished in both examples, achieving a minimum peak-to-valley (PV) value for the OPD of the deformed optical surface. The simulated optimization results showed that (1) the lightweight ratio of the primary mirror increased from 56% to 66%; and (2) the PV value of the mirror supported by optimum bipod flexures in the horizontal position effectively decreased from 228 to 61 nm.

Intact coding region of the serotonin transporter gene in obsessive-compulsive disorder

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

Altemus, M.; Murphy, D.L.; Greenberg, B.

1996-07-26

Epidemiologic studies indicate that obsessive-compulsive disorder is genetically transmitted in some families, although no genetic abnormalities have been identified in individuals with this disorder. The selective response of obsessive-compulsive disorder to treatment with agents which block serotonin reuptake suggests the gene coding for the serotonin transporter as a candidate gene. The primary structure of the serotonin-transporter coding region was sequenced in 22 patients with obsessive-compulsive disorder, using direct PCR sequencing of cDNA synthesized from platelet serotonin-transporter mRNA. No variations in amino acid sequence were found among the obsessive-compulsive disorder patients or healthy controls. These results do not support a rolemore » for alteration in the primary structure of the coding region of the serotonin-transporter gene in the pathogenesis of obsessive-compulsive disorder. 27 refs.« less

Power in telephone-advice nursing.

PubMed

Leppänen, Vesa

2010-03-01

Power is a central aspect of nursing, especially in telephone-advice nursing, where nurses assess callers' medical problems and decide what measures that need to be taken. This article presents a framework for understanding how power operates in social interaction between nurses and callers in telephone-advice nursing in primary care in Sweden. Power is analysed as the result of nurses and callers being oriented to five social structures that are relevant to their actions in this context, namely the organization of telephone-advice nursing, the social stock of medical knowledge, the professional division of labour between nurses and doctors, structures of social interaction and structures of emotions. While structural constraints govern some actions to a high degree, calls take place in an organizational free room that give nurses more leeway for acting more creatively. The discussion focuses on the introduction of new technologies of control, for instance computerized decision support systems and audio recording of calls, and on how they reduce the free room. Empirical data consist of 276 audio-recorded telephone calls to 13 nurses at six primary-care centres and of qualitative interviews with 18 nurses.

Trade study plan for Graphite Composite Primary Structure (GCPS)

NASA Technical Reports Server (NTRS)

Greenberg, H. S.

1994-01-01

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

A comparison of performance of lightweight mirrors

NASA Technical Reports Server (NTRS)

Cho, Myung K.; Richard, Ralph M.; Hileman, Edward A.

1990-01-01

Four lightweight solid contoured back mirror shapes (a double arch, a single arch, a modified single arch, and a double concave mirror) and a cellular sandwich lightweight meniscus mirror, have been considered for the primary mirror of the Space Infrared Telescope Facility (SIRTF). A parametric design study using these shapes for the SIRTF 40 inch primary mirror with a focal ratio f/2 is presented. Evaluations of the optical performance and fundamental frequency analyses are performed to compare relative merits of each mirror configuration. Included in these are structural, optical, and frequency analyses for (1) different back contour shapes, (2) different number and location of the support points, and (3) two gravity orientations (ZENITH and HORIZON positions). The finite element program NASTRAN is used to obtain the structural deflections of the optical surface. For wavefront error analysis, FRINGE and PCFRINGE programs are used to evaluate the optical performance. A scaling law relating the optical and structural performance for various mirror contoured back shapes is developed.

A synchronous increase in hydraulic conductive capacity and mechanical support in conifers with relatively uniform xylem structure.

PubMed

Jagels, Richard; Visscher, George E

2006-02-01

The dual function provided by longitudinal tracheids in conifers has led to a generally held trade-off concept that increasing wall thickness and/or volume of latewood tracheids improves mechanical support, while increasing cell diameter and/or volume of earlywood tracheids enhances conductive potential. Yet, some conifers have either uniform cell structure across the growth ring or, at most, a small amount of latewood. How do these trees accomplish the needs for increasing support and conduction with height growth? We examined Metasequoia glyptostroboides, a species that we previously demonstrated improves its mechanical properties with increasing age without a change in specific gravity or secondary wall microfibril angle. In this paper, we showed that lignin and extractive contents are not contributing factors, and through composite structure analysis, we eliminated a role for tracheid length. Using micromorphometric analysis, we demonstrated that as cell diameter increases, total primary wall decreases, secondary wall increases, and strength and conductive capacity increase with no change in specific gravity. Meta-analysis using other species of Cupressaceae, Podocarpaceae, and Araucariaceae provided strong corroborative evidence for this design strategy.

A decision-supported outpatient practice system.

PubMed Central

Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.

1996-01-01

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774

First results of the wind evaluation breadboard for ELT primary mirror design

NASA Astrophysics Data System (ADS)

Reyes García-Talavera, Marcos; Viera, Teodora; Núñez, Miguel

2010-07-01

The Wind Evaluation Breadboard (WEB) is a primary mirror and telescope simulator formed by seven aluminium segments, including position sensors, electromechanical support systems and support structures. WEB has been developed to evaluate technologies for primary mirror wavefront control and to evaluate the performance of the control of wind buffeting disturbance on ELT segmented mirrors. For this purpose WEB electro-mechanical set-up simulates the real operational constrains applied to large segmented mirrors. This paper describes the WEB assembly, integration and verification, the instrument characterisation and close loop control design, including the dynamical characterization of the instrument and the control architecture. The performance of the new technologies developed for position sensing, acting and controlling is evaluated. The integration of the instrument in the observatory and the results of the first experiments are summarised, with different wind conditions, elevation and azimuth angles of incidence. Conclusions are extracted with respect the wind rejection performance and the control strategy for an ELT. WEB has been designed and developed by IAC, ESO, ALTRAN and JUPASA, with the integration of subsystems of FOGALE and TNO.

Reliability Analysis of RSG-GAS Primary Cooling System to Support Aging Management Program

NASA Astrophysics Data System (ADS)

Deswandri; Subekti, M.; Sunaryo, Geni Rina

2018-02-01

Multipurpose Research Reactor G.A. Siwabessy (RSG-GAS) which has been operating since 1987 is one of the main facilities on supporting research, development and application of nuclear energy programs in BATAN. Until now, the RSG-GAS research reactor has been successfully operated safely and securely. However, because it has been operating for nearly 30 years, the structures, systems and components (SSCs) from the reactor would have started experiencing an aging phase. The process of aging certainly causes a decrease in reliability and safe performances of the reactor, therefore the aging management program is needed to resolve the issues. One of the programs in the aging management is to evaluate the safety and reliability of the system and also screening the critical components to be managed.One method that can be used for such purposes is the Fault Tree Analysis (FTA). In this papers FTA method is used to screening the critical components in the RSG-GAS Primary Cooling System. The evaluation results showed that the primary isolation valves are the basic events which are dominant against the system failure.

Caring for an adolescent with a chronic illness.

PubMed

Buhlmann, U; Fitzpatrick, S B

1987-03-01

Although early, mid, and late adolescence are transient psychological periods, the teenager must master these three phases to complete the psychological stages and tasks of adolescence. Because chronic disease delays or alters these phases, it becomes imperative for the primary care physician to reassess psychological development periodically for appropriate and intensive counseling. With the advantage of continuous contact with the family and the understanding of the family's structure and interpersonal relationships, the primary care physician may be able to: alleviate struggles for control that may seriously impede care, encourage the teenager to accomplish the psychological tasks of adolescence, both during hospitalization and in follow-up outpatient care visits, promote the adolescent's participation in his or her own health care, and ultimately enhance both the family's and the teenager's adaptation to a chronic illness. Finally, during the terminal phase of an illness, the primary care physician will be able to help the adolescent find meaning in his or her short life, provide the support to help the teenager to disengage from life with dignity, and provide a supportive relationship to the parents and siblings.

Valued aspects of primary palliative care: content analysis of bereaved carers' descriptions.

PubMed

Grande, Gunn E; Farquhar, Morag C; Barclay, Stephen Ig; Todd, Chris J

2004-10-01

Informal carers provide the bulk of palliative home care. They largely rely on general practitioners (GPs) and district nurses to support them in this role, yet little is known about what carers themselves consider important in this support. To identify what informal carers valued in the palliative support provided by GPs and district nurses by using carers' own descriptions of such support. Retrospective interviews. Primary care in Cambridgeshire. Semi-structured interviews with bereaved carers of 48 patients with cancer and 12 patients with non-cancer diagnoses. Content analysis of carers' evaluative descriptions of GP and district nurse support. The accessibility of the GP and district nurse emerged as the most important aspect of support. Enlistment of help from other agencies was also extensively mentioned, together with provision of equipment. Attitude or approach during interactions, and relationship with the professional were important, particularly regarding GP support, whereas support for the carer, information, and symptom control were mentioned less often. Data suggested that support was not as good for older patients (> or =75 years), but this finding requires further investigation. Results largely confirmed findings of previous, quantitative research and the importance of a patient-centred approach. What emerged most strongly, however, was the central importance of accessibility of support services for lay carers responsible for end-of-life home care. This mainly concerned GP and district nurse support, but accessibility of additional care and equipment were also important. In short, carers' main focus was the basic support that enabled them to sustain care in the home.

Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review.

PubMed

Wändell, Per E; de Waard, Anne-Karien M; Holzmann, Martin J; Gornitzki, Carl; Lionis, Christos; de Wit, Niek; Søndergaard, Jens; Sønderlund, Anders L; Kral, Norbert; Seifert, Bohumil; Korevaar, Joke C; Schellevis, François G; Carlsson, Axel C

2018-01-29

The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Challenges of Developing Disciplinary Knowledge and Making Links across the Disciplines in Early Years and Primary Humanities

ERIC Educational Resources Information Center

Swift, Diane

2017-01-01

This article argues that an understanding of disciplinary knowledge production helps to underpin a conceptual structure for the humanities curriculum. This is important as a conceptual curriculum more overtly supports knowledge production for both pupils and teachers than one that is solely focused on propositional knowledge. It can mean the…

Helping Young Children to See What Is Relevant and Why: Supporting Cognitive Change in Earth Science Using Analogy. Research Report

ERIC Educational Resources Information Center

Blake, Anthony

2004-01-01

This experimental study explores how 60 primary-age children's (9-11 years old) understanding of rocks was effected by instruction that used the conceptual structure of the rock cycle together with the analogy of aluminium can recycling. Using a combination of probes into children's understanding, including concept maps and semi-structured…

The Evaluation of Enhanced Academic Instruction in After-School Programs: Final Report. NCEE 2009-4077

ERIC Educational Resources Information Center

Black, Alison Rebeck; Somers, Marie-Andree; Doolittle, Fred; Unterman, Rebecca; Grossman, Jean Baldwin

2009-01-01

The primary purpose of this study is to determine whether providing structured academic instruction in reading or math to students in grades two to five during their afterschool hours--instead of the less formal academic supports offered in regular after-school programs-- improves their academic performance in the subject. This is the second and…

Structural insights into the interaction of IL-33 with its receptors.

PubMed

Liu, Xi; Hammel, Michal; He, Yanfeng; Tainer, John A; Jeng, U-Ser; Zhang, Linqi; Wang, Shuying; Wang, Xinquan

2013-09-10

Interleukin (IL)-33 is an important member of the IL-1 family that has pleiotropic activities in innate and adaptive immune responses in host defense and disease. It signals through its ligand-binding primary receptor ST2 and IL-1 receptor accessory protein (IL-1RAcP), both of which are members of the IL-1 receptor family. To clarify the interaction of IL-33 with its receptors, we determined the crystal structure of IL-33 in complex with the ectodomain of ST2 at a resolution of 3.27 Å. Coupled with structure-based mutagenesis and binding assay, the structural results define the molecular mechanism by which ST2 specifically recognizes IL-33. Structural comparison with other ligand-receptor complexes in the IL-1 family indicates that surface-charge complementarity is critical in determining ligand-binding specificity of IL-1 primary receptors. Combined crystallography and small-angle X-ray-scattering studies reveal that ST2 possesses hinge flexibility between the D3 domain and D1D2 module, whereas IL-1RAcP exhibits a rigid conformation in the unbound state in solution. The molecular flexibility of ST2 provides structural insights into domain-level conformational change of IL-1 primary receptors upon ligand binding, and the rigidity of IL-1RAcP explains its inability to bind ligands directly. The solution architecture of IL-33-ST2-IL-1RAcP complex from small-angle X-ray-scattering analysis resembles IL-1β-IL-1RII-IL-1RAcP and IL-1β-IL-1RI-IL-1RAcP crystal structures. The collective results confer IL-33 structure-function relationships, supporting and extending a general model for ligand-receptor assembly and activation in the IL-1 family.

Nurses' participation in audit: a regional study.

PubMed

Cheater, F M; Keane, M

1998-03-01

To find out to what extent nurses were perceived to be participating in audit, to identify factors thought to impede their involvement, and to assess progress towards multidisciplinary audit. Qualitative. Focus groups and interviews. Chairs of audit groups and audit support staff in hospital, community and primary health care and audit leads in health authorities in the North West Region. In total 99 audit leads/support staff in the region participated representing 89% of the primary health care audit groups, 80% of acute hospitals, 73% of community health services, and 59% of purchasers. Many audit groups remain medically dominated despite recent changes to their structure and organisation. The quality of interprofessional relations, the leadership style of the audit chair, and nurses' level of seniority, audit knowledge, and experience influenced whether groups reflected a multidisciplinary, rather than a doctor centred approach. Nurses were perceived to be enthusiastic supporters of audit, although their active participation in the process was considered substantially less than for doctors in acute and community health services. Practice nurses were increasingly being seen as the local audit enthusiasts in primary health care. Reported obstacles to nurses' participation in audit included hierarchical nurse and doctor relationships, lack of commitment from senior doctors and managers, poor organisational links between departments of quality and audit, work load pressures and lack of protected time, availability of practical support, and lack of knowledge and skills. Progress towards multidisciplinary audit was highly variable. The undisciplinary approach to audit was still common, particularly in acute services. Multidisciplinary audit was more successfully established in areas already predisposed towards teamworking or where nurses had high involvement in decision making. Audit support staff were viewed as having a key role in helping teams to adopt a collaborative approach to audit. Although nurses were undertaking audit, and some were leading developments in their settings, a range of structural and organisational, interprofessional and intraprofessional factors was still impeding progress. If the ultimate goal of audit is to improve patient care, the obstacles that make it difficult for nurses to contribute actively to the process must be acknowledged and considered.

Behavioral control in at-risk toddlers: the influence of the family check-up.

PubMed

Shelleby, Elizabeth C; Shaw, Daniel S; Cheong, Jeewon; Chang, Hyein; Gardner, Frances; Dishion, Thomas J; Wilson, Melvin N

2012-01-01

This study examines the role of one component of emotion regulation, behavioral control, in the growth of children's early behavior problems by examining whether increases in parental positive behavior support brought about by a family-centered intervention were associated with greater child behavioral control, and whether greater behavioral control at age 3 mediated the association between improvements in aspects of positive behavior support from ages 2 to 3 and decreases in growth of behavior problems from ages 2 to 4. The sample included 713 at-risk children (50% female) and their primary caregivers (50% European American, 28% African American, 13% biracial, 9% other) who were randomly assigned to the intervention or control group. Children had a mean age of 29.91 months at the initial assessment. Data were collected through home visits at child ages 2 to 4, which involved questionnaires for primary caregivers and structured and unstructured play activities for children with primary and alternative caregivers and siblings. Results indicated that the intervention improved parental positive behavior support and reduced growth of child behavior problems. One dimension of positive behavior support, proactive parenting, was modestly associated with behavioral control at age 3, which in turn was significantly associated with growth in behavior problems from ages 2 to 4, with greater behavioral control related to lower levels of growth in behavior problems. Results provide support for the notion that proactive parenting is an important factor in the development of children's behavioral control and that behavioral control plays an important role in the growth of behavior problems.

Altered regional cortical thickness and subcortical volume in women with primary dysmenorrhoea.

PubMed

Liu, P; Yang, J; Wang, G; Liu, Y; Liu, X; Jin, L; Liang, F; Qin, W; Calhoun, V D

2016-04-01

There is emerging evidence that primary dysmenorrhoea (PDM) is associated with altered brain function and structure. However, few studies have investigated changes in regional cortical thickness and subcortical volumes in PDM patients. The purpose of this study was to characterize differences in both cortical thickness and subcortical volumes between PDM patients and healthy controls (HCs). T1-weighted magnetic resonance images were obtained from 44 PDM patients and 32 HCs matched for age and handedness. Cortical thickness was compared in multiple locations across the continuous cortical surface, and subcortical volumes were compared on a structure-by-structure basis. Correlation analysis was then used to evaluate relationships between the clinical symptoms and abnormal brain structure in PDM. PDM patients had significantly increased cortical thickness in the orbitofrontal cortex (OFC), insula (IN), primary/secondary sensory area (SI/SII), superior temporal cortex (STC), precuneus (pCUN) and posterior cingulate cortex (PCC). Meanwhile, significantly decreased subcortical volumes of the caudate, thalamus and amygdala were found in PDM patients. Moreover, there were significant positive correlations between the PDM-related duration and the OFC, SFC, STC and IN. The MPQ scores were positively correlated with the pCUN. These findings provide further evidence for grey matter changes in patients with PDM, and in addition, the results support relationships between the structural abnormalities and their role in symptom production. All these results are likely to be potential valuable to provide us with direct information about the neural basis of PDM. © 2015 European Pain Federation - EFIC®

Alignment positioning mechanism

NASA Technical Reports Server (NTRS)

Fantasia, Peter M. (Inventor)

1991-01-01

An alignment positioning mechanism for correcting and compensating for misalignment of structures to be coupled is disclosed. The mechanism comprises a power screw with a base portion and a threaded shank portion. A mounting fixture is provided for rigidly coupling said base portion to the mounting interface of a supporting structure with the axis of the screw perpendicular thereto. A traveling ball nut threaded on the power screw is formed with an external annular arcuate surface configured in the form of a spherical segment and enclosed by a ball nut housing with a conforming arcuate surface for permitting gimballed motion thereon. The ball nut housing is provided with a mounting surface which is positionable in cooperable engagement with the mounting interface of a primary structure to be coupled to the supporting structure. Cooperative means are provided on the ball nut and ball nut housing, respectively, for positioning the ball nut and ball nut housing in relative gimballed position within a predetermined range of relative angular relationship whereby severe structural stresses due to unequal loadings and undesirable bending moments on the mechanism are avoided.

Aquarius main structure configuration

NASA Astrophysics Data System (ADS)

Eremenko, A.

The Aquarius/SAC-D Observatory is a joint US-Argentine mission to map the salinity at the ocean surface. This information is critical to improving our understanding of two major components of Earth's climate system - the water cycle and ocean circulation. By measuring ocean salinity from space, the Aquarius/SAC-D Mission will provide new insights into how the massive natural exchange of freshwater between the ocean, atmosphere and sea ice influences ocean circulation, weather and climate. Aquarius is the primary instrument on the SAC-D spacecraft. It consists of a Passive Microwave Radiometer to detect the surface emission that is used to obtain salinity and an Active Scatterometer to measure the ocean waves that affect the precision of the salinity measurement. The Aquarius Primary Structure houses instrument electronics, feed assemblies, and supports a deployable boom with a 2.5 m Reflector, and provides the structural interface to the SAC-D Spacecraft. The key challenge for the Aquarius main structure configuration is to satisfy the needs of component accommodations, ensuring that the instrument can meet all operational, pointing, environmental, and launch vehicle requirements. This paper describes the evolution of the Aquarius main structure configuration, the challenges of balancing the conflicting requirements, and the major configuration driving decisions and compromises.

Aquarius Main Structure Configuration

NASA Technical Reports Server (NTRS)

Eremenko, Alexander

2012-01-01

The Aquarius/SAC-D Observatory is a joint US-Argentine mission to map the salinity at the ocean surface. This information is critical to improving our understanding of two major components of Earth's climate system - the water cycle and ocean circulation. By measuring ocean salinity from space, the Aquarius/SAC-D Mission will provide new insights into how the massive natural exchange of freshwater between the ocean, atmosphere and sea ice influences ocean circulation, weather and climate. Aquarius is the primary instrument on the SAC-D spacecraft. It consists of a Passive Microwave Radiometer to detect the surface emission that is used to obtain salinity and an Active Scatterometer to measure the ocean waves that affect the precision of the salinity measurement. The Aquarius Primary Structure houses instrument electronics, feed assemblies, and supports a deployable boom with a 2.5 m Reflector, and provides the structural interface to the SAC-D Spacecraft. The key challenge for the Aquarius main structure configuration is to satisfy the needs of component accommodations, ensuring that the instrument can meet all operational, pointing, environmental, and launch vehicle requirements. This paper describes the evolution of the Aquarius main structure configuration, the challenges of balancing the conflicting requirements, and the major configuration driving decisions and compromises.

Collaborative modeling of an implementation strategy: a case study to integrate health promotion in primary and community care.

PubMed

Grandes, Gonzalo; Sanchez, Alvaro; Cortada, Josep M; Pombo, Haizea; Martinez, Catalina; Balagué, Laura; Corrales, Mary Helen; de la Peña, Enrique; Mugica, Justo; Gorostiza, Esther

2017-12-06

Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care. Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A's evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records. Collaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.

[Strengthening primary health care: a strategy to maximize coordination of care].

PubMed

de Almeida, Patty Fidelis; Fausto, Márcia Cristina Rodrigues; Giovanella, Lígia

2011-02-01

To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil. Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions. The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumer driven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed.

Receiver subsystem analysis report (RADL Item 4-1). The 10-MWe solar thermal central-receiver pilot plant: Solar-facilities design integration

NASA Astrophysics Data System (ADS)

1982-04-01

The results of thermal hydraulic, design for the stress analyses which are required to demonstrate that the receiver design for the Barstow Solar Pilot Plant satisfies the general design and performance requirements during the plant's design life are presented. Recommendations are made for receiver operation. The analyses are limited to receiver subsystem major structural parts (primary tower, receiver unit core support structure), pressure parts (absorber panels, feedwater, condensate and steam piping/components, flash tank, and steam mainfold) and shielding.

Development of immobilized ligands for actinide separations. Final report, June 1991--May 1994

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

Paine, R.T.

1994-06-01

Primary goals during this grant period were to (1) synthesize new bifunctional chelating ligands, (2) characterize the structural features of the Ln and An coordination complexes formed by these ligands, (3) use structural data to iteratively design new classes of multifunctional ligands, and (4) explore additional routes for attachment of key ligands to solid supports that could be useful for chromatographic separations. Some highlights of recently published work as well as a summary of submitted, unpublished and/or still in progress research are outlined.

Coronagraph for astronomical imaging and spectrophotometry

NASA Technical Reports Server (NTRS)

Vilas, Faith; Smith, Bradford A.

1987-01-01

A coronagraph designed to minimize scattered light in astronomical observations caused by the structure of the primary mirror, secondary mirror, and secondary support structure of a Cassegrainian telescope is described. Direct (1:1) and reducing (2.7:1) imaging of astronomical fields are possible. High-quality images are produced. The coronagraph can be used with either a two-dimensional charge-coupled device or photographic film camera. The addition of transmission dispersing optics converts the coronagraph into a low-resolution spectrograph. The instrument is modular and portable for transport to different observatories.

Qualitative evaluation of general practices developing training for a range of health disciplines.

PubMed

Hughes, Lesley A

2014-01-01

This study adopted an interpretative approach, using focus groups and face-to-face interviews to evaluate the development of a five-year pilot project within general practice. The aim of the project is for these practices to offer training to a range of health disciplines from varying academic levels, develop capacity and provide interprofessional education as part of the learning ethos. Eight consortia are involved in the project, which is funded by the workforce and education directorate and the Deanery of the Yorkshire and Humber Strategic Health Authority. The evaluation was undertaken 18 months into the project, to understand the views and experiences of primary care practitioners and university educationalists, in order to identify achievements and barriers to the project's development. The study revealed positive attitudes towards the project, and that steps are being taken to engage in dialogue with universities to increase student numbers, but progress is slow. Early experiences of student nurses taking up placements in the practices reveal incompatible learning outcomes between what is expected for curriculum and learning opportunities within primary care. A common concern is the impact increased students may pose on existing support structures, and that this may compromise student learning. Concern is evident over self-belief and competencies to teach across professions, and the ambiguity over the learning outcomes for IPE and the training required to support this. It is recommended that a systems theory be adopted to provide strategic planning across clinical and education organisations to ensure that structures of communication, leadership and training adequately meet the aims of the project. The paper will be of interest to practitioners in primary care who may be considering expanding services and training, and to educationalists seeking to allocate students to placements in primary care.

Market structure and the role of consumer information in the physician services industry: an empirical test.

PubMed

Wong, H S

1996-04-01

This paper applies Panzar and Rosse's (1987) econometric test of market structure to examine two long-debated issues: What is the market structure for physician services? Do more physicians in a market area raise the search cost of obtaining consumer information and increase prices (Satterthwaite, 1979, 1985)? For primary care and general and family practice physicians, the monopolistically competitive model prevailed over the competing hypotheses--monopoly, perfect competition, and monopolistic competition characterized by consumer informational confusion. Although less conclisive, there is some evidence to support the monopolistically competitive model for surgeons and the consumer informational confusion model for internal medicine physicians.

Realization and testing of a deployable space telescope based on tape springs

NASA Astrophysics Data System (ADS)

Lei, Wang; Li, Chuang; Zhong, Peifeng; Chong, Yaqin; Jing, Nan

2017-08-01

For its compact size and light weight, space telescope with deployable support structure for its secondary mirror is very suitable as an optical payload for a nanosatellite or a cubesat. Firstly the realization of a prototype deployable space telescope based on tape springs is introduced in this paper. The deployable telescope is composed of primary mirror assembly, secondary mirror assembly, 6 foldable tape springs to support the secondary mirror assembly, deployable baffle, aft optic components, and a set of lock-released devices based on shape memory alloy, etc. Then the deployment errors of the secondary mirror are measured with three-coordinate measuring machine to examine the alignment accuracy between the primary mirror and the deployed secondary mirror. Finally modal identification is completed for the telescope in deployment state to investigate its dynamic behavior with impact hammer testing. The results of the experimental modal identification agree with those from finite element analysis well.

Marital crises in oncology patients. An approach to initial intervention by primary clinicians.

PubMed

Peteet, J; Greenberg, B

1995-05-01

Life-threatening illnesses such as cancer may precipitate marital crises in vulnerable relationships, and oncology clinicians often feel uncertain about how to approach them. This paper presents a framework for initial intervention based on the nature of the principal threat to the relationship. Immature relationships need distance and support for their identity as a couple; hostile dependent couples need to find consensus in order to structure communication; physically abusive relationships require monitoring in order to promote safety; and estranged couples need help in understanding their disappointment and identifying available support. Clinicians working in oncology can help couples in crisis by promoting a realistic balance of independence and dependence, clarifying the complexity of factors contributing to the crisis, considering referral for couples treatment, communicating with the team while respecting patients' confidences, and by choosing clear and compatible clinical roles. Primary clinicians can stabilize and treat marital crises, but need access to medically knowledgeable couples' therapists.

Primary care providers and medical homes for individuals with spina bifida.

PubMed

Walker, William O

2008-01-01

The contributions of primary care providers to the successful care of children with spina bifida cannot be underestimated. Overcoming systemic barriers to their integration into a comprehensive care system is essential. By providing routine and disability specific care through the structure of a Medical Home, they are often the first line resource and support for individuals and their families. The Medical Home model encourages primary care providers to facilitate discussions on topics as varied as education and employment. Knowledge of specific medical issues unique to this population allows the primary care provider to complement the efforts of other specialty clinics and providers in often neglected areas such as sexual health, obesity and latex sensitization. As individuals with spina bifida live into adulthood, and access to traditional multidisciplinary care models evolves, these skills will take on increasing importance within the scope of providing comprehensive and coordinated care.

Structural verification for GAS experiments

NASA Technical Reports Server (NTRS)

Peden, Mark Daniel

1992-01-01

The purpose of this paper is to assist the Get Away Special (GAS) experimenter in conducting a thorough structural verification of its experiment structural configuration, thus expediting the structural review/approval process and the safety process in general. Material selection for structural subsystems will be covered with an emphasis on fasteners (GSFC fastener integrity requirements) and primary support structures (Stress Corrosion Cracking requirements and National Space Transportation System (NSTS) requirements). Different approaches to structural verifications (tests and analyses) will be outlined especially those stemming from lessons learned on load and fundamental frequency verification. In addition, fracture control will be covered for those payloads that utilize a door assembly or modify the containment provided by the standard GAS Experiment Mounting Plate (EMP). Structural hazard assessment and the preparation of structural hazard reports will be reviewed to form a summation of structural safety issues for inclusion in the safety data package.

Effect of human patient plasma ex vivo treatment on gene expression and progenitor cell activation of primary human liver cells in multi-compartment 3D perfusion bioreactors for extra-corporeal liver support.

PubMed

Schmelzer, Eva; Mutig, Kerim; Schrade, Petra; Bachmann, Sebastian; Gerlach, Jörg C; Zeilinger, Katrin

2009-07-01

Cultivation of primary human liver cells in innovative 3D perfusion multi-compartment capillary membrane bioreactors using decentralized mass exchange and integral oxygenation provides in vitro conditions close to the physiologic environment in vivo. While a few scale-up bioreactors were used clinically, inoculated liver progenitors in these bioreactors were not investigated. Therefore, we characterized regenerative processes and expression patterns of auto- and paracrine mediators involved in liver regeneration in bioreactors after patient treatment. Primary human liver cells containing parenchymal and non-parenchymal cells co-cultivated in bioreactors were used for clinical extra-corporeal liver support to bridge to liver transplantation. 3D tissue re-structuring in bioreactors was studied; expression of proteins and genes related to regenerative processes and hepatic progenitors was analyzed. Formation of multiple bile ductular networks and colonies of putative progenitors were observed within parenchymal cell aggregates. HGF was detected in scattered cells located close to vascular-like structures, expression of HGFA and c-Met was assigned to biliary cells and hepatocytes. Increased expression of genes associated to hepatic progenitors was detected following clinical application. The results confirm auto- and paracrine interactions between co-cultured cells in the bioreactor. The 3D bioreactor provides a valuable tool to study mechanisms of progenitor activation and hepatic regeneration ex vivo under patient plasma treatment. (c) 2009 Wiley Periodicals, Inc.

TREAT Neutronics Analysis and Design Support, Part I: Multi-SERTTA

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

Bess, John D.; Woolstenhulme, Nicolas E.; Hill, Connie M.

2016-08-01

Experiment vehicle design is necessary in preparation for Transient Reactor Test (TREAT) facility restart and the resumption of transient testing to support Accident Tolerant Fuel (ATF) characterization and other future fuels testing requirements. Currently the most mature vehicle design is the Multi-SERTTA (Static Environments Rodlet Transient Test Apparatuses), which can accommodate up to four concurrent rodlet-sized specimens under separate environmental conditions. Robust test vehicle design requires neutronics analyses to support design development, optimization of the power coupling factor (PCF) to efficiently maximize energy generation in the test fuel rodlets, and experiment safety analyses. Calculations were performed to support analysis ofmore » a near-final design of the Multi-SERTTA vehicle, the design process for future TREAT test vehicles, and establish analytical practices for upcoming transient test experiments. Models of the Multi-SERTTA vehicle containing typical PWR-fuel rodlets were prepared and neutronics calculations were performed using MCNP6.1 with ENDF/B-VII.1 nuclear data libraries. Calculation of the PCF for reference conditions of a PWR fuel rodlet in clean water at operational temperature and pressure provided results between 1.10 and 1.74 W/g-MW depending on the location of the four Multi-SERTTA units with the stack. Basic changes to the Multi-SERTTA secondary vessel containment and support have minimal impact on PCF; using materials with less neutron absorption can improve expected PCF values, especially in the primary containment. An optimized balance is needed between structural integrity, experiment safety, and energy deposition in the experiment. Type of medium and environmental conditions within the primary vessel surrounding the fuel rodlet can also have a significant impact on resultant PCF values. The estimated reactivity insertion worth into the TREAT core is impacted more by the primary and secondary Multi-SERTTA vehicle structure with the experiment content and contained environment having a near negligible impact on overall system reactivity. Additional calculations were performed to evaluate the peak-to-average assembly powers throughout the TREAT core, as well as the nuclear heat generation for the various structural components of the Multi-SERTTA assembly. Future efforts include the evaluation of flux collars to shape the PCF for individual Multi-SERTTA units during an experiment such as to achieve uniformity in test unit environmental conditions impacted by the non-uniform axial flux/power profile of TREAT. Upon resumption of transient testing, experimental results from both the Multi-SERTTA and Multi-SERTTA-CAL will be compared against calculational results and methods for further optimization and design strategies.« less

Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation.

PubMed

Keith, Rosalind E; Crosson, Jesse C; O'Malley, Ann S; Cromp, DeAnn; Taylor, Erin Fries

2017-02-10

Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner. To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components. Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts. The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data. NCT02318108.

Internal versus external motivation in referral of primary care patients with depression to an internet support group: randomized controlled trial.

PubMed

Van Voorhees, Benjamin W; Hsiung, Robert C; Marko-Holguin, Monika; Houston, Thomas K; Fogel, Joshua; Lee, Royce; Ford, Daniel E

2013-03-12

Depressive disorders and symptoms affect more than one-third of primary care patients, many of whom do not receive or do not complete treatment. Internet-based social support from peers could sustain depression treatment engagement and adherence. We do not know whether primary care patients will accept referral to such websites nor do we know which methods of referral would be most effective. We conducted a randomized clinical trial to determine whether (1) a simple generic referral card (control), (2) a patient-oriented brochure that provided examples of online postings and experience (internal motivation), or (3) a physician letter of recommendation (external motivation) would generate the greatest participation in a primary care Internet depression treatment support portal focused around an Internet support group (ISG). We used 3 offline methods to identify potential participants who had not used an ISG in the past 6 months. Eligibility was determined in part by a brief structured psychiatric interview based on the Patient Health Questionnaire-9 (PHQ-9). After consent and enrollment, participants were randomly assigned to 1 of 3 groups (control, internal motivation, or external motivation). We constructed a portal to connect primary care patients to both fact-based information and an established ISG (Psycho-Babble). The ISG allowed participants to view messages and then decide if they actually wished to register there. Participation in the portal and the ISG was assessed via automated activity tracking. Fifty participants were assigned to the 3 groups: a motivation-neutral control group (n=18), an internal motivation group (n=19), and an external motivation group (n=13). Of these participants, 31 (62%) visited the portal; 27 (54%) visited the ISG itself. The internal motivation group showed significantly greater participation than the control group on several measures. The external motivation group spent significantly less time logged onto the portal than the control group. The internal motivation group showed significantly greater participation than the external motivation group on several measures. Referral of primary care patients with depressive disorders and symptoms to an ISG is feasible even if they have never previously used one. This may best be accomplished by enhancing their internal motivation.

The role of mixotrophic protists in the biological carbon pump

NASA Astrophysics Data System (ADS)

Mitra, A.; Flynn, K. J.; Burkholder, J. M.; Berge, T.; Calbet, A.; Raven, J. A.; Granéli, E.; Glibert, P. M.; Hansen, P. J.; Stoecker, D. K.; Thingstad, F.; Tillmann, U.; Våge, S.; Wilken, S.; Zubkov, M. V.

2013-08-01

The traditional view of the planktonic foodweb describes consumption of inorganic nutrients by photo-autotrophic phytoplankton, which in turn supports zooplankton and ultimately higher trophic levels. Pathways centred on bacteria provide mechanisms for nutrient recycling. This structure lies at the foundation of most models used to explore biogeochemical cycling, functioning of the biological pump, and the impact of climate change on these processes. We suggest an alternative paradigm, which sees the bulk of the base of this foodweb supported by protist plankton (phytoplankton and microzooplankton) communities that are mixotrophic - combining phototrophy and phagotrophy within a~single cell. The photoautotrophic eukaryotic plankton and their heterotrophic microzooplankton grazers dominate only within immature environments (e.g., spring bloom in temperate systems). With their flexible nutrition, mixotrophic protists dominate in more mature systems (e.g., temperate summer, established eutrophic systems and oligotrophic systems); the more stable water columns suggested under climate change may also be expected to favour these mixotrophs. We explore how such a predominantly mixotrophic structure affects microbial trophic dynamics and the biological pump. The mixotroph dominated structure differs fundamentally in its flow of energy and nutrients, with a shortened and potentially more efficient chain from nutrient regeneration to primary production. Furthermore, mixotrophy enables a direct conduit for the support of primary production from bacterial production. We show how the exclusion of an explicit mixotrophic component in studies of the pelagic microbial communities leads to a failure to capture the true dynamics of the carbon flow. In order to prevent a misinterpretation of the full implications of climate change upon biogeochemical cycling and the functioning of the biological pump, we recommend inclusion of multi-nutrient mixotroph models within ecosystem studies.

The role of mixotrophic protists in the biological carbon pump

NASA Astrophysics Data System (ADS)

Mitra, A.; Flynn, K. J.; Burkholder, J. M.; Berge, T.; Calbet, A.; Raven, J. A.; Granéli, E.; Glibert, P. M.; Hansen, P. J.; Stoecker, D. K.; Thingstad, F.; Tillmann, U.; Våge, S.; Wilken, S.; Zubkov, M. V.

2014-02-01

The traditional view of the planktonic food web describes consumption of inorganic nutrients by photoautotrophic phytoplankton, which in turn supports zooplankton and ultimately higher trophic levels. Pathways centred on bacteria provide mechanisms for nutrient recycling. This structure lies at the foundation of most models used to explore biogeochemical cycling, functioning of the biological pump, and the impact of climate change on these processes. We suggest an alternative new paradigm, which sees the bulk of the base of this food web supported by protist plankton communities that are mixotrophic - combining phototrophy and phagotrophy within a single cell. The photoautotrophic eukaryotic plankton and their heterotrophic microzooplankton grazers dominate only during the developmental phases of ecosystems (e.g. spring bloom in temperate systems). With their flexible nutrition, mixotrophic protists dominate in more-mature systems (e.g. temperate summer, established eutrophic systems and oligotrophic systems); the more-stable water columns suggested under climate change may also be expected to favour these mixotrophs. We explore how such a predominantly mixotrophic structure affects microbial trophic dynamics and the biological pump. The mixotroph-dominated structure differs fundamentally in its flow of energy and nutrients, with a shortened and potentially more efficient chain from nutrient regeneration to primary production. Furthermore, mixotrophy enables a direct conduit for the support of primary production from bacterial production. We show how the exclusion of an explicit mixotrophic component in studies of the pelagic microbial communities leads to a failure to capture the true dynamics of the carbon flow. In order to prevent a misinterpretation of the full implications of climate change upon biogeochemical cycling and the functioning of the biological pump, we recommend inclusion of multi-nutrient mixotroph models within ecosystem studies.

Patient generated "frequently asked questions": identifying informational needs in a RCT of peer support in type 2 diabetes.

PubMed

Whitford, David L; Paul, Gillian; Smith, Susan M

2013-07-01

The purpose of this study is to discuss the use of a system of patient generated "frequently asked questions" (FAQs) in order to gain insight into the information needs of participants. FAQs generated during group meetings taking place in a randomized controlled trial of peer support in type 2 diabetes are described in terms of their frequencies and topic areas. Data from focus groups and semi-structured interviews concerning the FAQs was subjected to content analysis. 59/182 (33%) of the FAQs were directly related to the topic area of the scheduled peer support meeting with foot care, eyes and kidneys generating the most specific questions. The FAQs addressed mainly knowledge and concerns. The FAQs appeared to enhance peer support and also enabled participants to ask questions to experts that they may not have asked in a clinic situation. The use of FAQs to support peer supporters proved beneficial in a randomized controlled trial and may be usefully added to the tools used within a peer support framework. The use of FAQs provided valuable insight into the informal information needs of people with diabetes. Means of providing a similar structure in routine clinical care should be explored. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

A qualitative study of sign-out processes between primary and on-call residents: relationships in information exchange, responsibility and accountability.

PubMed

Lee, Soo-Hoon; Fisher, Dale A; Mah, Heidi; Goh, Wei-Ping; Phan, Phillip H

2017-10-01

To review a quality improvement event on the process of sign-outs between the primary and on-call residents. A retrospective qualitative study using semi-structured interviews. A tertiary academic medical center in Singapore with 283 inpatient Medicine beds served by 28 consultants, 29 registrars, 45 residents and 30 interns during the day but 5 residents and 3 interns at night. Residents, registrars and consultants. Quality improvement event on sign-out. Effectiveness of sign-out comprises exchange of patient information, professional responsibility and task accountability. The following process of sign-outs was noted. Primary teams were accountable to the on-call resident by selecting at-risk patients and preparing contingency plans for sign-out. Structured information exchanged included patient history, active problems and plans of care. On-call residents took ownership of at-risk patients by actively asking questions during sign-out and reporting back the agreed care plan. On-call residents were accountable to the primary team by reporting back at-risk patients the next day. A structured information exchange at sign-out increased the on-call resident's ability to care for at-risk patients when it was supported by two-way transfers of responsibility and accountability. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Functional Specialization of Cellulose Synthase Isoforms in a Moss Shows Parallels with Seed Plants1[OPEN

PubMed Central

Li, Xingxing; Huang, Shixin; Van de Meene, Allison M.L.; Tran, Mai L.; Killeavy, Erin; Mercure, Danielle; Burton, Rachel A.

2017-01-01

The secondary cell walls of tracheary elements and fibers are rich in cellulose microfibrils that are helically oriented and laterally aggregated. Support cells within the leaf midribs of mosses deposit cellulose-rich secondary cell walls, but their biosynthesis and microfibril organization have not been examined. Although the Cellulose Synthase (CESA) gene families of mosses and seed plants diversified independently, CESA knockout analysis in the moss Physcomitrella patens revealed parallels with Arabidopsis (Arabidopsis thaliana) in CESA functional specialization, with roles for both subfunctionalization and neofunctionalization. The similarities include regulatory uncoupling of the CESAs that synthesize primary and secondary cell walls, a requirement for two or more functionally distinct CESA isoforms for secondary cell wall synthesis, interchangeability of some primary and secondary CESAs, and some CESA redundancy. The cellulose-deficient midribs of ppcesa3/8 knockouts provided negative controls for the structural characterization of stereid secondary cell walls in wild type P. patens. Sum frequency generation spectra collected from midribs were consistent with cellulose microfibril aggregation, and polarization microscopy revealed helical microfibril orientation only in wild type leaves. Thus, stereid secondary walls are structurally distinct from primary cell walls, and they share structural characteristics with the secondary walls of tracheary elements and fibers. We propose a mechanism for the convergent evolution of secondary walls in which the deposition of aggregated and helically oriented microfibrils is coupled to rapid and highly localized cellulose synthesis enabled by regulatory uncoupling from primary wall synthesis. PMID:28768816

Integrating disease management into the outpatient delivery system during and after managed care.

PubMed

Villagra, Victor G

2004-01-01

Managed care introduced disease management as a replacement strategy to utilization management. The focus changed from influencing treatment decisions to supporting self-care and compliance. Disease management rendered operational many elements of the chronic care model, but it did so outside the delivery system, thus escaping the financial limitations, cultural barriers, and inertia inherent in effecting radical change from within. Medical management "after managed care" should include the functional and structural integration of disease management with primary care clinics. Such integration would supply the infrastructure that primary care physicians need to coordinate the care of chronically ill patients more effectively.

Social support for diabetes illness management: supporting adolescents and caregivers.

PubMed

Idalski Carcone, April; Ellis, Deborah A; Weisz, Arlene; Naar-King, Sylvie

2011-10-01

The aim of this research study was to examine the relationship between 4 sources of social support (support for the adolescent from family, support for the adolescent from friends, support for the caregiver from another adult, and support to the family from the health care provider) and adolescents' diabetes outcomes (illness management behavior and health status) using a diverse sample of urban adolescents. One hundred forty-one adolescents with insulin-managed diabetes and their primary caregivers completed questionnaires assessing social support and illness management behavior. Glucose meters were downloaded and hemoglobin A1c assays were obtained. Structural equation modeling was used to test a model social support informed by social ecological theory. The results of the structural equation modeling indicated that support for the caregiver from another adult was directly and positively related to support for the adolescent from family and indirectly related to better illness management. Support for the adolescent from family was directly related to better diabetes management and, through better management, to better diabetes health. Support to the family from the health care provider was not related to support for the adolescent and support to the adolescent from friends was not related to illness management, as hypothesized. This study identifies a novel target for social support intervention to improve adolescents' illness management behavior-the caregivers of adolescents with diabetes. By enhancing the social support caregivers receive from other adults in their lives, caregivers' ability to support their adolescent children with diabetes might also be improved which, in turn, improves adolescents' illness outcomes.

The Relative Roles Played by Structural and Pragmatic Language Skills in Relation to Behaviour in a Population of Primary School Children from Socially Disadvantaged Backgrounds

ERIC Educational Resources Information Center

Law, J.; Rush, R.; McBean, K.

2014-01-01

Considerable evidence supports the association between language learning difficulties and behaviour in young children and this is likely to be particularly true of children raised in social disadvantage. Less is known about the way that different aspects of language, specifically pragmatics, interact with behaviour. This study examines the extent…

Work satisfaction and future career intentions of experienced nurses transitioning to primary health care employment.

PubMed

Ashley, Christine; Peters, Kath; Brown, Angela; Halcomb, Elizabeth

2018-02-12

To explore registered nurses' reflections on transitioning from acute to primary health care employment, and future career intentions. Reforms in primary health care have resulted in increasing demands for a skilled primary health care nursing workforce. To meet shortfalls, acute care nurses are being recruited to primary health care employment, yet little is known about levels of satisfaction and future career intentions. A sequential mixed methods study consisting of a survey and semi-structured interviews with nurses who transition to primary health care. Most reported positive experiences, valuing work/life balance, role diversity and patient/family interactions. Limited orientation and support, loss of acute skills and inequitable remuneration were reported negatively. Many respondents indicated an intention to stay in primary health care (87.3%) and nursing (92.6%) for the foreseeable future, whilst others indicated they may leave primary health care as soon as convenient (29.6%). Our findings provide guidance to managers in seeking strategies to recruit and retain nurses in primary health care employment. To maximize recruitment and retention, managers must consider factors influencing job satisfaction amongst transitioning nurses, and the impact that nurses' past experiences may have on future career intentions in primary health care. © 2018 John Wiley & Sons Ltd.

How Game Location Affects Soccer Performance: T-Pattern Analysis of Attack Actions in Home and Away Matches.

PubMed

Diana, Barbara; Zurloni, Valentino; Elia, Massimiliano; Cavalera, Cesare M; Jonsson, Gudberg K; Anguera, M Teresa

2017-01-01

The influence of game location on performance has been widely examined in sport contexts. Concerning soccer, game-location affects positively the secondary and tertiary level of performance; however, there are fewer evidences about its effect on game structure (primary level of performance). This study aimed to detect the effect of game location on a primary level of performance in soccer. In particular, the objective was to reveal the hidden structures underlying the attack actions, in both home and away matches played by a top club (Serie A 2012/2013-First Leg). The methodological approach was based on systematic observation, supported by digital recordings and T-pattern analysis. Data were analyzed with THEME 6.0 software. A quantitative analysis, with nonparametric Mann-Whitney test and descriptive statistics, was carried out to test the hypotheses. A qualitative analysis on complex patterns was performed to get in-depth information on the game structure. This study showed that game tactics were significantly different, with home matches characterized by a more structured and varied game than away matches. In particular, a higher number of different patterns, with a higher level of complexity and including more unique behaviors was detected in home matches than in the away ones. No significant differences were found in the number of events coded per game between the two conditions. THEME software, and the corresponding T-pattern detection algorithm, enhance research opportunities by going further than frequency-based analyses, making this method an effective tool in supporting sport performance analysis and training.

The Primary Mechanism of Cellular Internalization for a Short Cell- Penetrating Peptide as a Nano-Scale Delivery System.

PubMed

Liu, Betty R; Huang, Yue-Wern; Korivi, Mallikarjuna; Lo, Shih-Yen; Aronstam, Robert S; Lee, Han-Jung

2017-01-01

Development of effective drug delivery systems (DDS) is a critical issue in health care and medicine. Advances in molecular biology and nanotechnology have allowed the introduction of nanomaterial-based drug delivery systems. Cell-penetrating peptides (CPPs) can form the basis of drug delivery systems by virtue of their ability to support the transport of cargoes into the cell. Potential cargoes include proteins, DNA, RNA, liposomes, and nanomaterials. These cargoes generally retain their bioactivities upon entering cells. In the present study, the smallest, fully-active lactoferricin-derived CPP, L5a is used to demonstrate the primary contributor of cellular internalization. The secondary helical structure of L5a encompasses symmetrical positive charges around the periphery. The contributions of cell-specificity, peptide length, concentration, zeta potential, particle size, and spatial structure of the peptides were examined, but only zeta potential and spatial structure affected protein transduction efficiency. FITC-labeled L5a appeared to enter cells via direct membrane translocation insofar as endocytic modulators did not block FITC-L5a entry. This is the same mechanism of protein transduction active in Cy5 labeled DNA delivery mediated by FITC-L5a. A significant reduction of transduction efficiency was observed with structurally incomplete FITC-L5a formed by tryptic destruction, in which case the mechanism of internalization switched to a classical energydependent endocytosis pathway. These results support the continued development of the non-cytotoxic L5a as an efficient tool for drug delivery. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

How Game Location Affects Soccer Performance: T-Pattern Analysis of Attack Actions in Home and Away Matches

PubMed Central

Diana, Barbara; Zurloni, Valentino; Elia, Massimiliano; Cavalera, Cesare M.; Jonsson, Gudberg K.; Anguera, M. Teresa

2017-01-01

The influence of game location on performance has been widely examined in sport contexts. Concerning soccer, game-location affects positively the secondary and tertiary level of performance; however, there are fewer evidences about its effect on game structure (primary level of performance). This study aimed to detect the effect of game location on a primary level of performance in soccer. In particular, the objective was to reveal the hidden structures underlying the attack actions, in both home and away matches played by a top club (Serie A 2012/2013—First Leg). The methodological approach was based on systematic observation, supported by digital recordings and T-pattern analysis. Data were analyzed with THEME 6.0 software. A quantitative analysis, with nonparametric Mann–Whitney test and descriptive statistics, was carried out to test the hypotheses. A qualitative analysis on complex patterns was performed to get in-depth information on the game structure. This study showed that game tactics were significantly different, with home matches characterized by a more structured and varied game than away matches. In particular, a higher number of different patterns, with a higher level of complexity and including more unique behaviors was detected in home matches than in the away ones. No significant differences were found in the number of events coded per game between the two conditions. THEME software, and the corresponding T-pattern detection algorithm, enhance research opportunities by going further than frequency-based analyses, making this method an effective tool in supporting sport performance analysis and training. PMID:28878712

Pleistocene and ecological effects on continental-scale genetic differentiation in the bobcat (Lynx rufus).

PubMed

Reding, Dawn M; Bronikowski, Anne M; Johnson, Warren E; Clark, William R

2012-06-01

The potential for widespread, mobile species to exhibit genetic structure without clear geographic barriers is a topic of growing interest. Yet the patterns and mechanisms of structure--particularly over broad spatial scales--remain largely unexplored for these species. Bobcats occur across North America and possess many characteristics expected to promote gene flow. To test whether historical, topographic or ecological factors have influenced genetic differentiation in this species, we analysed 1 kb mtDNA sequence and 15 microsatellite loci from over 1700 samples collected across its range. The primary signature in both marker types involved a longitudinal cline with a sharp transition, or suture zone, occurring along the Great Plains. Thus, the data distinguished bobcats in the eastern USA from those in the western half, with no obvious physical barrier to gene flow. Demographic analyses supported a scenario of expansion from separate Pleistocene refugia, with the Great Plains representing a zone of secondary contact. Substructure within the two main lineages likely reflected founder effects, ecological factors, anthropogenic/topographic effects or a combination of these forces. Two prominent topographic features, the Mississippi River and Rocky Mountains, were not supported as significant genetic barriers. Ecological regions and environmental correlates explained a small but significant proportion of genetic variation. Overall, results implicate historical processes as the primary cause of broad-scale genetic differentiation, but contemporary forces seem to also play a role in promoting and maintaining structure. Despite the bobcat's mobility and broad niche, large-scale landscape changes have contributed to significant and complex patterns of genetic structure. © 2012 Blackwell Publishing Ltd.

Cajal-body formation correlates with differential coilin phosphorylation in primary and transformed cell lines.

PubMed

Hearst, Scoty M; Gilder, Andrew S; Negi, Sandeep S; Davis, Misty D; George, Eric M; Whittom, Angela A; Toyota, Cory G; Husedzinovic, Alma; Gruss, Oliver J; Hebert, Michael D

2009-06-01

Cajal bodies (CBs) are nuclear structures that are thought to have diverse functions, including small nuclear ribonucleoprotein (snRNP) biogenesis. The phosphorylation status of coilin, the CB marker protein, might impact CB formation. We hypothesize that primary cells, which lack CBs, contain different phosphoisoforms of coilin compared with that found in transformed cells, which have CBs. Localization, self-association and fluorescence recovery after photobleaching (FRAP) studies on coilin phosphomutants all suggest this modification impacts the function of coilin and may thus contribute towards CB formation. Two-dimensional gel electrophoresis demonstrates that coilin is hyperphosphorylated in primary cells compared with transformed cells. mRNA levels of the nuclear phosphatase PPM1G are significantly reduced in primary cells and expression of PPM1G in primary cells induces CBs. Additionally, PPM1G can dephosphorylate coilin in vitro. Surprisingly, however, expression of green fluorescent protein alone is sufficient to form CBs in primary cells. Taken together, our data support a model whereby coilin is the target of an uncharacterized signal transduction cascade that responds to the increased transcription and snRNP demands found in transformed cells.

Primary structure of the hemoglobin alpha-chain of rose-ringed parakeet (Psittacula krameri).

PubMed

Islam, A; Beg, O U; Persson, B; Zaidi, Z H; Jörnvall, H

1988-10-01

The structure of the hemoglobin alpha-chain of Rose-ringed Parakeet was determined by sequence degradations of the intact subunit, the CNBr fragments, and peptides obtained by digestion with staphylococcal Glu-specific protease and trypsin. Using this analysis, the complete alpha-chain structure of 21 avian species is known, permitting comparisons of the protein structure and of avian relationships. The structure exhibits differences from previously established avian alpha-chains at a total of 61 positions, five of which have residues unique to those of the parakeet (Ser-12, Gly-65, Ser-67, Ala-121, and Leu-134). The analysis defines hemoglobin variation within an additional avian order (Psittaciformes), demonstrates distant patterns for evaluation of relationships within other avian orders, and lends support to taxonomic conclusions from molecular data.

Structural investigation of the Grenville Province by radar and other imaging and nonimaging sensors

NASA Technical Reports Server (NTRS)

Lowman, P. D., Jr.; Blodget, H. W.; Webster, W. J., Jr.; Paia, S.; Singhroy, V. H.; Slaney, V. R.

1984-01-01

The structural investigation of the Canadian Shield by orbital radar and LANDSAT, is outlined. The area includes parts of the central metasedimentary belt and the Ontario gneiss belt, and major structures as well-expressed topographically. The primary objective is to apply SIR-B data to the mapping of this key part of the Grenville orogen, specifically ductile fold structures and associated features, and igneous, metamorphic, and sedimentary rock (including glacial and recent sediments). Secondary objectives are to support the Canadian RADARSAT project by evaluating the baseline parameters of a Canadian imaging radar satellite planned for late in the decade. The baseline parameters include optimum incidence and azimuth angles. The experiment is to develop techniques for the use of multiple data sets.

Duct flow nonuniformities: Effect of struts in SSME HGM 2+

NASA Technical Reports Server (NTRS)

Burke, Roger

1988-01-01

This study consists of an analysis of flow through the Space Shuttle Main Engine (SSME) Hot Gas Manifold (HGM) for the purpose of understanding and quantifying the flow environment and, in particular, the flow through a region of structural supports located between the inner and outer walls of the HGM. The primary task of the study, as defined by NASA-MSFC, is to assess and develop the computational capability for analyzing detailed three-dimensional flow through the HGM support strut region to be incorporated into a full fuelside HGM analysis. Secondarily, computed results are to be compared with available experimental results.

How primary health care staff working in rural and remote areas access skill development and expertise to support health promotion practice.

PubMed

McFarlane, Kathryn A; Judd, Jenni; Wapau, Hylda; Nichols, Nina; Watt, Kerrianne; Devine, Sue

2018-05-01

Health promotion is a key component of comprehensive primary health care. Health promotion approaches complement healthcare management by enabling individuals to increase control over their health. Many primary healthcare staff have a role to play in health promotion practice, but their ability to integrate health promotion into practice is influenced by their previous training and experience. For primary healthcare staff working in rural and remote locations, access to professional development can be limited by what is locally available and prohibitive in terms of cost for travel and accommodation. This study provides insight into how staff at a large north Queensland Aboriginal community controlled health service access skill development and health promotion expertise to support their work. A qualitative exploratory study was conducted. Small group and individual semi-structured interviews were conducted with staff at Apunipima Cape York Health Council (n=9). A purposive sampling method was used to recruit participants from a number of primary healthcare teams that were more likely to be involved in health promotion work. Both on-the-ground staff and managers were interviewed. All participants were asked how they access skill development and expertise in health promotion practice and what approaches they prefer for ongoing health promotion support. The interviews were transcribed verbatim and analysed thematically. All participants valued access to skill development, advice and support that would assist their health promotion practice. Skill development and expertise in health promotion was accessed from a variety of sources: conferences, workshops, mentoring or shared learning from internal and external colleagues, and access to online information and resources. With limited funds and limited access to professional development locally, participants fostered external and internal organisational relationships to seek in-kind advice and support. Irrespective of where the advice came from, it needed to be applicable to work with Aboriginal and Torres Strait Islander remote communities. To improve health outcomes in rural and remote communities, the focus on health promotion and prevention approaches must be strengthened. Primary healthcare staff require ongoing access to health promotion skill development and expertise to increase their capacity to deliver comprehensive primary health care. Practice-based evidence from staff working in the field provides a greater understanding of how skill development and advice are accessed. Many of these strategies can be formalised through organisational plans and systems, which would ensure that a skilled health promotion workforce is sustained.

I-motif DNA structures are formed in the nuclei of human cells

NASA Astrophysics Data System (ADS)

Zeraati, Mahdi; Langley, David B.; Schofield, Peter; Moye, Aaron L.; Rouet, Romain; Hughes, William E.; Bryan, Tracy M.; Dinger, Marcel E.; Christ, Daniel

2018-06-01

Human genome function is underpinned by the primary storage of genetic information in canonical B-form DNA, with a second layer of DNA structure providing regulatory control. I-motif structures are thought to form in cytosine-rich regions of the genome and to have regulatory functions; however, in vivo evidence for the existence of such structures has so far remained elusive. Here we report the generation and characterization of an antibody fragment (iMab) that recognizes i-motif structures with high selectivity and affinity, enabling the detection of i-motifs in the nuclei of human cells. We demonstrate that the in vivo formation of such structures is cell-cycle and pH dependent. Furthermore, we provide evidence that i-motif structures are formed in regulatory regions of the human genome, including promoters and telomeric regions. Our results support the notion that i-motif structures provide key regulatory roles in the genome.

Exploring the relationships among performance-based functional ability, self-rated disability, perceived instrumental support, and depression: a structural equation model analysis.

PubMed

Weil, Joyce; Hutchinson, Susan R; Traxler, Karen

2014-11-01

Data from the Women's Health and Aging Study were used to test a model of factors explaining depressive symptomology. The primary purpose of the study was to explore the association between performance-based measures of functional ability and depression and to examine the role of self-rated physical difficulties and perceived instrumental support in mediating the relationship between performance-based functioning and depression. The inclusion of performance-based measures allows for the testing of functional ability as a clinical precursor to disability and depression: a critical, but rarely examined, association in the disablement process. Structural equation modeling supported the overall fit of the model and found an indirect relationship between performance-based functioning and depression, with perceived physical difficulties serving as a significant mediator. Our results highlight the complementary nature of performance-based and self-rated measures and the importance of including perception of self-rated physical difficulties when examining depression in older persons. © The Author(s) 2014.

Assessing a five factor model of PTSD: is dysphoric arousal a unique PTSD construct showing differential relationships with anxiety and depression?

PubMed

Armour, Cherie; Elhai, Jon D; Richardson, Don; Ractliffe, Kendra; Wang, Li; Elklit, Ask

2012-03-01

Posttraumatic stress disorder's (PTSD) latent structure has been widely debated. To date, two four-factor models (Numbing and Dysphoria) have received the majority of factor analytic support. Recently, Elhai et al. (2011) proposed and supported a revised (five-factor) Dysphoric Arousal model. Data were gathered from two separate samples; War veterans and Primary Care medical patients. The three models were compared and the resultant factors of the Dysphoric Arousal model were validated against external constructs of depression and anxiety. The Dysphoric Arousal model provided significantly better fit than the Numbing and Dysphoria models across both samples. When differentiating between factors, the current results support the idea that Dysphoric Arousal can be differentiated from Anxious Arousal but not from Emotional Numbing when correlated with depression. In conclusion, the Dysphoria model may be a more parsimonious representation of PTSD's latent structure in these trauma populations despite superior fit of the Dysphoric Arousal model. Copyright © 2011 Elsevier Ltd. All rights reserved.

Factors associated with physical violence against pregnant women from São Luís, Maranhão State, Brazil: an approach using structural equation modeling.

PubMed

Costa, Danielle Cristina Silva; Ribeiro, Marizélia Rodrigues Costa; Batista, Rosângela Fernandes Lucena; Valente, Camila Maia; Ribeiro, João Victor Fonseca; Almeida, Laysa Andrade; Costa, Ludmilla Emilia Martins; Alves, Maria Teresa Seabra Soares de Britto E; Silva, Antônio Augusto Moura da

2017-01-23

The factors associated with physical violence against pregnant women were analyzed in a cross-sectional study of 1,446 pregnant women from a prenatal cohort who were interviewed in 2010 and 2011 in São Luís, Brazil. In the initial model, socioeconomic status occupied the most distal position, determining sociodemographic factors, social support and the behavioral factors that ultimately determined physical violence, which was investigated as a latent variable. Structural equation modeling was used in the analysis. Pregnant women who were from more disadvantaged backgrounds (p = 0.027), did not reside with intimate partners (p = 0.005), had low social support (p < 0.001) and had a high number of lifetime intimate partners (p = 0.001) reported more episodes of physical violence. Low social support was the primary mediator of the effect of socioeconomic status on physical violence. The effect of marital status was mainly mediated by a high number of lifetime intimate partners.

The PKI collector

NASA Astrophysics Data System (ADS)

Rice, M. P.

1982-07-01

The design and manufacturing of a solar thermal collector is discussed. The collector has three primary subsystems: concentrator, receiver/fluid loop, and controls. Identical curved reflective columns are utilized in a faceted Fresnel design to support 864 one foot square flat inexpensive second-surface, silvered glass mirrors. The columns are ganged together and rotated through their centers of gravity to provide elevation tracking. The concentrator is supported by a lightweight spaceframe structure which distributes all wind and gravity loads to the base supports. The base of the structure is a track which rotates on wheels mounted on concrete piers. A parallel tube steel heat exchanger is mounted at the concentrator focal area in a well insulated, galvanized steel housing. Two rows of vertical close-packed, staggered tubes connect a mud header and a steam header. Automatic two axis tracking and operational control is provided with a microprocessor based package. Concentrator-mounted shadowbands are the basis for active tracking. A software program provides azimuthal tracking during cloudy periods.

The PKI collector

NASA Technical Reports Server (NTRS)

Rice, M. P.

1982-01-01

The design and manufacturing of a solar thermal collector is discussed. The collector has three primary subsystems: concentrator, receiver/fluid loop, and controls. Identical curved reflective columns are utilized in a faceted Fresnel design to support 864 one foot square flat inexpensive second-surface, silvered glass mirrors. The columns are ganged together and rotated through their centers of gravity to provide elevation tracking. The concentrator is supported by a lightweight spaceframe structure which distributes all wind and gravity loads to the base supports. The base of the structure is a track which rotates on wheels mounted on concrete piers. A parallel tube steel heat exchanger is mounted at the concentrator focal area in a well insulated, galvanized steel housing. Two rows of vertical close-packed, staggered tubes connect a mud header and a steam header. Automatic two axis tracking and operational control is provided with a microprocessor based package. Concentrator-mounted shadowbands are the basis for active tracking. A software program provides azimuthal tracking during cloudy periods.

Reconstruction of Ares I-X Integrated Vehicle Rollout Loads

NASA Technical Reports Server (NTRS)

Chamberlain, Matthew K.; Hahn, Steven R.

2011-01-01

The measurements taken during the Ares I-X test flight provided a unique opportunity to assess the accuracy of the models and methods used to analyze the loads and accelerations present in the planned Ares I vehicle. During the rollout of the integrated vehicle from the Vehicle Assembly Building (VAB) to the launch pad, the vehicle and its supporting structure are subjected to wind loads and the vibrations produced by the crawler-transporter (CT) that is carrying it. While the loads induced on the vehicle during this period are generally low relative to those experienced in flight, the rollout is a period of operation of primary interest to those designing both the ground support equipment and the interfaces between the launch vehicle and its supporting structure. In this paper, the methods used for reconstructing the loads during the rollout phase are described. The results generated are compared to measured values, leading to insight into the accuracy of the Ares I assessment techniques.

Increasing Capacity for Innovation in Bureaucratic Primary Care Organizations: A Whole System Participatory Action Research Project

PubMed Central

Thomas, Paul; McDonnell, Juliet; McCulloch, Janette; While, Alison; Bosanquet, Nick; Ferlie, Ewan

2005-01-01

PURPOSE We wanted to identify what organizational features support innovation in Primary Care Groups (PCGs). METHODS Our study used a whole system participatory action research model. Four research teams provided complementary insights. Four case study PCGs were analyzed. Two had an intervention to help local facilitators reflect on their work. Data included 70 key informant interviews, observations of clinical governance interventions and committee meetings, analysis of written materials, surveys and telephone interviews of London Primary Care Organizations, interviews with 20 nurses, and interviews with 6 finance directors. A broad range of stakeholders reviewed data at annual conferences and formed conclusions about trustworthy principles. Sequential research phases were refocused in the light of these conclusions and in response to the changing political context. RESULTS Five features were associated with increased organizational capacity for innovation: (1) clear structures and a vision for corporate and clinical governance; (2) multiple opportunities for people to reflect and learn at all levels of the organization, and connections between these “learning spaces”; (3) both clinicians and managers in leadership roles that encourage participation; (4) the right timing for an initiative and its adaptation to the local context; and (5) external facilitation that provides opportunities for people to make sense of their experiences. Low morale was commonly attributed to 3 features: (1) overwhelming pace of reform, (2) inadequate staff experience and supportive infrastructure, and (3) financial deficits. CONCLUSIONS These features together may support innovation in other primary care bureaucracies. The research methodology enabled people from different backgrounds to make sense of diverse research insights. PMID:16046563

Increasing capacity for innovation in bureaucratic primary care organizations: a whole system participatory action research project.

PubMed

Thomas, Paul; McDonnell, Juliet; McCulloch, Janette; While, Alison; Bosanquet, Nick; Ferlie, Ewan

2005-01-01

We wanted to identify what organizational features support innovation in Primary Care Groups (PCGs). Our study used a whole system participatory action research model. Four research teams provided complementary insights. Four case study PCGs were analyzed. Two had an intervention to help local facilitators reflect on their work. Data included 70 key informant interviews, observations of clinical governance interventions and committee meetings, analysis of written materials, surveys and telephone interviews of London Primary Care Organizations, interviews with 20 nurses, and interviews with 6 finance directors. A broad range of stakeholders reviewed data at annual conferences and formed conclusions about trustworthy principles. Sequential research phases were refocused in the light of these conclusions and in response to the changing political context. Five features were associated with increased organizational capacity for innovation: (1) clear structures and a vision for corporate and clinical governance; (2) multiple opportunities for people to reflect and learn at all levels of the organization, and connections between these "learning spaces"; (3) both clinicians and managers in leadership roles that encourage participation; (4) the right timing for an initiative and its adaptation to the local context; and (5) external facilitation that provides opportunities for people to make sense of their experiences. Low morale was commonly attributed to 3 features: (1) overwhelming pace of reform, (2) inadequate staff experience and supportive infrastructure, and (3) financial deficits. These features together may support innovation in other primary care bureaucracies. The research methodology enabled people from different backgrounds to make sense of diverse research insights.

Effects of vacancies on atom displacement threshold energy calculations through Molecular Dynamics Methods in BaTiO3

NASA Astrophysics Data System (ADS)

Gonzalez Lazo, Eduardo; Cruz Inclán, Carlos M.; Rodríguez Rodríguez, Arturo; Guzmán Martínez, Fernando; Abreu Alfonso, Yamiel; Piñera Hernández, Ibrahin; Leyva Fabelo, Antonio

2017-09-01

A primary approach for evaluating the influence of point defects like vacancies on atom displacement threshold energies values Td in BaTiO3 is attempted. For this purpose Molecular Dynamics Methods, MD, were applied based on previous Td calculations on an ideal tetragonal crystalline structure. It is an important issue in achieving more realistic simulations of radiation damage effects in BaTiO3 ceramic materials. It also involves irradiated samples under severe radiation damage effects due to high fluency expositions. In addition to the above mentioned atom displacement events supported by a single primary knock-on atom, PKA, a new mechanism was introduced. It corresponds to the simultaneous excitation of two close primary knock-on atoms in BaTiO3, which might take place under a high flux irradiation. Therefore, two different BaTiO3 Td MD calculation trials were accomplished. Firstly, single PKA excitations in a defective BaTiO3 tetragonal crystalline structure, consisting in a 2×2×2 BaTiO3 perovskite like super cell, were considered. It contains vacancies on Ba and O atomic positions under the requirements of electrical charge balance. Alternatively, double PKA excitations in a perfect BaTiO3 tetragonal unit cell were also simulated. On this basis, the corresponding primary knock-on atom (PKA) defect formation probability functions were calculated at principal crystal directions, and compared with the previous one we calculated and reported at an ideal BaTiO3 tetrahedral crystal structure. As a general result, a diminution of Td values arises in present calculations in comparison with those calculated for single PKA excitation in an ideal BaTiO3 crystal structure.

The Experimental Breeder Reactor II seismic probabilistic risk assessment

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

Roglans, J; Hill, D J

1994-02-01

The Experimental Breeder Reactor II (EBR-II) is a US Department of Energy (DOE) Category A research reactor located at Argonne National Laboratory (ANL)-West in Idaho. EBR-II is a 62.5 MW-thermal Liquid Metal Reactor (LMR) that started operation in 1964 and it is currently being used as a testbed in the Integral Fast Reactor (IFR) Program. ANL has completed a Level 1 Probabilistic Risk Assessment (PRA) for EBR-II. The Level 1 PRA for internal events and most external events was completed in June 1991. The seismic PRA for EBR-H has recently been completed. The EBR-II reactor building contains the reactor, themore » primary system, and the decay heat removal systems. The reactor vessel, which contains the core, and the primary system, consisting of two primary pumps and an intermediate heat exchanger, are immersed in the sodium-filled primary tank, which is suspended by six hangers from a beam support structure. Three systems or functions in EBR-II were identified as the most significant from the standpoint of risk of seismic-induced fuel damage: (1) the reactor shutdown system, (2) the structural integrity of the passive decay heat removal systems, and (3) the integrity of major structures, like the primary tank containing the reactor that could threaten both the reactivity control and decay heat removal functions. As part of the seismic PRA, efforts were concentrated in studying these three functions or systems. The passive safety response of EBR-II reactor -- both passive reactivity shutdown and passive decay heat removal, demonstrated in a series of tests in 1986 -- was explicitly accounted for in the seismic PRA as it had been included in the internal events assessment.« less

Financing Opportunities for Renewable Energy Development in Alaska

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

Ardani, K.; Hillman, D.; Busche, S.

2013-04-01

This technical report provides an overview of existing and potential financing structures for renewable energy project development in Alaska with a focus on four primary sources of project funding: government financed or supported (the most commonly used structure in Alaska today), developer equity capital, commercial debt, and third-party tax-equity investment. While privately funded options currently have limited application in Alaska, their implementation is theoretically possible based on successful execution in similar circumstances elsewhere. This report concludes that while tax status is a key consideration in determining appropriate financing structure, there are opportunities for both taxable and tax-exempt entities to participatemore » in renewable energy project development.« less

The structure of evaluative anxiety among children differing in socioeconomic status, ethnicity, and sex.

PubMed

Rhine, W R; Spaner, S D

1983-11-01

Following Anastasi and Thurstone, the factor structure of evaluative anxiety was examined among six groups of primary age boys and girls (N = 8064). A factor matching technique was used to study hypotheses about the effects of group differences in socioeconomic status (SES), ethnicity, and sex on the pattern of the children's responses to the Test Anxiety Scale for Children (TASC). Hypotheses about the congruence of factor patterns were based on both demographic differences and results of developmental research. The hypothesis of an SES X ethnicity X sex interaction was strongly supported. Implications for comparing factor structures, measuring evaluative anxiety, and future research of evaluative anxiety are discussed.

Telehealth in Rio Grande do Sul, Brazil: Bridging the Gaps.

PubMed

Harzheim, Erno; Gonçalves, Marcelo Rodrigues; Umpierre, Roberto Nunes; da Silva Siqueira, Ana Célia; Katz, Natan; Agostinho, Milena R; Oliveira, Elise B; Basso, Josué; Roman, Rudi; Dal Moro, Rafael G; Pilz, Carlos; Heinzelmann, Ricardo S; Schmitz, Carlos André Aita; Hauser, Lisiane; Mengue, Sotero Serrate

2016-11-01

In 1988, Brazil adopted a universal healthcare model in which access is mediated by the primary care level. However, difficulties have emerged in the coordination of care between the primary and specialized levels. Telehealth was thus proposed as a means to overcome this challenge. This article describes initiatives developed by a large Brazilian program, TelessaúdeRS/UFRGS, in the fields of teleconsultation, telediagnosis, tele-education, and information technology development to support the public healthcare system. TelessaúdeRS/UFRGS was established in 2010 to develop a telehealth platform and a support system for primary care teams with a special focus on optimizing the flow between primary and specialized levels of care. To define priorities, TelessaúdeRS analyzes the health needs of the Brazilian population and the most common inquiries it receives from primary care health professionals. This information is then combined with the best available scientific evidence for development of services. Since 2010, over 50,000 clinical consultations have been provided. More than 15,000 healthcare professionals have benefited from teleconsultations and from telediagnosis and tele-education activities. All services were provided using information technology solutions developed by the Telessaúde team, including smartphone apps and a Web-based National Telehealth Platform. The case of TelessaúdeRS/UFRGS shows that even in the presence of structural limitations, telemedicine is potentially useful to improve the quality of care and streamline the flow between different levels of care.

Histological evidence for a supraspinous ligament in sauropod dinosaurs

PubMed Central

Cerda, Ignacio A.; Casal, Gabriel A.; Martinez, Rubén D.; Ibiricu, Lucio M.

2015-01-01

Supraspinous ossified rods have been reported in the sacra of some derived sauropod dinosaurs. Although different hypotheses have been proposed to explain the origin of this structure, histological evidence has never been provided to support or reject any of them. In order to establish its origin, we analyse and characterize the microstructure of the supraspinous rod of two sauropod dinosaurs from the Upper Cretaceous of Argentina. The supraspinous ossified rod is almost entirely formed by dense Haversian bone. Remains of primary bone consist entirely of an avascular tissue composed of two types of fibre-like structures, which are coarse and longitudinally (parallel to the main axis of the element) oriented. These structures are differentiated on the basis of their optical properties under polarized light. Very thin fibrous strands are also observed in some regions. These small fibres are all oriented parallel to one another but perpendicular to the element main axis. Histological features of the primary bone tissue indicate that the sacral supraspinous rod corresponds to an ossified supraspinous ligament. The formation of this structure appears to have been a non-pathological metaplastic ossification, possibly induced by the continuous tensile forces applied to the element. PMID:26587248

Performance characterization of active fiber-composite actuators for helicopter rotor blade applications

NASA Astrophysics Data System (ADS)

Wickramasinghe, Viresh K.; Hagood, Nesbitt W.

2002-07-01

The primary objective of this work was to characterize the performance of the Active Fiber Composite (AFC) actuator material system for the Boeing Active Material Rotor (AMR) blade application. The AFCs were a new structural actuator system consisting of piezoceramic fibers embedded in an epoxy matrix and sandwiched between interdigitated electrodes to orient the driving electric field in the fiber direction to use the primary piezoelectric effect. These actuators were integrated directly into the blade spar laminate as active plies within the composite structure to perform structural actuation for vibration control in helicopters. Therefore, it was necessary to conduct extensive electromechanical material characterization to evaluate AFCs both as actuators and as structural components of the rotor blade. The characterization tests designed to extract important electromechanical properties under simulated blade operating conditions included stress-strain tests, free strain tests and actuation under tensile load tests. This paper presents the test results as well as the comprehensive testing process developed to evaluate the relevant AFC material properties. The results from this comprehensive performance characterization of the AFC material system supported the design and operation of the Boeing AMR blade scheduled for hover and forward flight wind tunnel tests.

The structure and photochemical transformation of cyclopropylacetylene radical cation as revealed by matrix EPR and quantum chemical study

NASA Astrophysics Data System (ADS)

Shiryaeva, Ekaterina S.; Tyurin, Daniil A.; Feldman, Vladimir I.

2012-05-01

The primary radical cation of cyclopropylacetylene was first characterized by EPR spectroscopy in low-temperature freon matrices. The assignment was confirmed by specific deuteration and quantum-chemical calculations at PBE0 and CCSD(T) levels. Photolysis with visible light led to irreversible transformation of the initial species to a ring-open structure. Detailed computational analysis of energy and magnetic resonance parameters of possible reaction products justified formation of pent-3-en-1-yne radical cation (presumably, a (Z)-isomer). This conclusion was also supported by the effect of specific deuteration.

A study on the utilization of advanced composites in commercial aircraft wing structure: Executive summary

NASA Technical Reports Server (NTRS)

Watts, D. J.

1978-01-01

The overall wing study objectives are to study and plan the effort by commercial transport aircraft manufacturers to accomplish the transition from current conventional materials and practices to extensive use of advanced composites in wings of aircraft that will enter service in the 1985-1990 time period. Specific wing study objectives are to define the technology and data needed to support an aircraft manufacturer's commitment to utilize composites primary wing structure in future production aircraft and to develop plans for a composite wing technology program which will provide the needed technology and data.

LDEF mechanical systems

NASA Technical Reports Server (NTRS)

Spear, Steve; Dursch, Harry

1991-01-01

Following the Long Duration Exposure Facility (LDEF), the Systems Special Investigation Group (SIG) was involved in a considerable amount of testing of mechanical hardware flown on the LDEF. The primary objectives were to determine the effects of the long term exposure on: (1) mechanisms employed both on the LDEF or as part of individual experiments; (2) structural components; and (3) fasteners. Results of testing the following LDEF hardware are presented: LDEF structure, fasteners, trunnions, end support beam, environment exposure control cannisters, motors, and lubricants. A limited discussion of PI test results is included. The lessons learned are discussed along with the future activities of the System SIG.

Conceptual design studies for large free-flying solar-reflector spacecraft

NASA Technical Reports Server (NTRS)

Hedgepeth, J. M.; Miller, R. K.; Knapp, K. P. W.

1981-01-01

The 1 km diameter reflecting film surface is supported by a lightweight structure which may be automatically deployed after launch in the Space Shuttle. A twin rotor, control moment gyroscope, with deployable rotors, is included as a primary control actuator. The vehicle has a total specific mass of less than 12 g/sq m including allowances for all required subsystems. The structural elements were sized to accommodate the loads of a typical SOLARES type mission where a swam of these free flying satellites is employed to concentrate sunlight on a number of energy conversion stations on the ground.

Implementing care programmes for frail older people: a project management perspective.

PubMed

Bindels, Jill; Cox, Karen; Abma, Tineke A; van Schayck, Onno C P; Widdershoven, Guy

2015-01-01

To examine the issues that influenced the implementation of programmes designed to identify and support frail older people in the community in the Netherlands. Qualitative research methods were used to investigate the perspectives of project leaders, project members and members of the steering committee responsible for the implementation of the programmes. Interviews were conducted in 2009 (n = 10) and in 2012 (n = 13) and a focus group was organised in 2012 (n = 5). The interviews revealed that the implementation was influenced by the extent and quality of collaboration between organisations, adaptation to existing structures, future funding for the programmes and project leadership. A good relationship between participating organisations and professionals is required for successful implementation. A lack of clear project leadership and structural funding hampers the implementation of complex programmes in primary care settings. The findings of this study are useful for organisations and professionals who are planning to implement complex programmes. Identifying barriers concerning institutional collaboration, adaptation to existing structures, leadership and continuation of financial support at an early stage of the implementation process can support practitioners in overcoming them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

Chukwu, Emeka; Garg, Lalit; Eze, Godson

2016-05-17

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

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

PubMed Central

Garg, Lalit; Eze, Godson

2016-01-01

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

Brief encounters: what do primary care professionals contribute to peoples' self-care support network for long-term conditions? A mixed methods study.

PubMed

Rogers, Anne; Vassilev, Ivaylo; Brooks, Helen; Kennedy, Anne; Blickem, Christian

2016-02-17

Primary care professionals are presumed to play a central role in delivering long-term condition management. However the value of their contribution relative to other sources of support in the life worlds of patients has been less acknowledged. Here we explore the value of primary care professionals in people's personal communities of support for long-term condition management. A mixed methods survey with nested qualitative study designed to identify relationships and social network member's (SNM) contributions to the support work of managing a long-term condition conducted in 2010 in the North West of England. Through engagement with a concentric circles diagram three hundred participants identified 2544 network members who contributed to illness management. The results demonstrated how primary care professionals are involved relative to others in ongoing self-care management. Primary care professionals constituted 15.5 % of overall network members involved in chronic illness work. Their contribution was identified as being related to illness specific work providing less in terms of emotional work than close family members or pets and little to everyday work. The qualitative accounts suggested that primary care professionals are valued mainly for access to medication and nurses for informational and monitoring activities. Overall primary care is perceived as providing less input in terms of extended self-management support than the current literature on policy and practice suggests. Thus primary care professionals can be described as providing 'minimally provided support'. This sense of a 'minimally' provided input reinforces limited expectations and value about what primary care professionals can provide in terms of support for long-term condition management. Primary care was perceived as having an essential but limited role in making a contribution to support work for long-term conditions. This coalesces with evidence of a restricted capacity of primary care to take on the work load of self-management support work. There is a need to prioritise exploring the means by which extended self-care support could be enhanced out-with primary care. Central to this is building a system capable of engaging network capacity to mobilise resources for self-management support from open settings and the broader community.

LIST/BMI Turbines Instrumentation and Infrastructure

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

JONES,PERRY L.; SUTHERLAND,HERBERT J.; NEAL,BYRON A.

2001-06-01

In support of two major SNL programs, the Long-term Inflow and Structural Test (LIST) program and the Blade Manufacturing Initiative (BMI), three Micon 65/13M wind turbines have been erected at the USDA Agriculture Research Service (ARS) center in Bushland, Texas. The inflow and structural response of these turbines are being monitored with an array of 60 instruments: 34 to characterize the inflow, 19 to characterize structural response and 7 to characterize the time-varying state of the turbine. The primary characterization of the inflow into the LIST turbine relies upon an array of five sonic anemometers. Primary characterization of the structuralmore » response of the turbine uses several sets of strain gauges to measure bending loads on the blades and the tower and two accelerometers to measure the motion of the nacelle. Data are sampled at a rate of 30 Hz using a newly developed data acquisition system. The system features a time-synchronized continuous data stream and telemetered data from the turbine rotor. This paper documents the instruments and infrastructure that have been developed to monitor these turbines and their inflow.« less

Heuristic Programming Project: October 1979-September 1982

DTIC Science & Technology

1985-03-27

the research on ROGET focused on acquiring the initial conceptual structure needed to design the knowedge base in the first place. ROGET’s special...the user in constructing and specifying the details of the components. A component is a collection of functions and variables that support conceptual ...other framwork , called the Backchain framework, is for building programs that use backward-chaind production rules as the primary mechanism of generating

Medical Group Structural Integration May Not Ensure That Care Is Integrated, From The Patient's Perspective.

PubMed

Kerrissey, Michaela J; Clark, Jonathan R; Friedberg, Mark W; Jiang, Wei; Fryer, Ashley K; Frean, Molly; Shortell, Stephen M; Ramsay, Patricia P; Casalino, Lawrence P; Singer, Sara J

2017-05-01

Structural integration is increasing among medical groups, but whether these changes yield care that is more integrated remains unclear. We explored the relationships between structural integration characteristics of 144 medical groups and perceptions of integrated care among their patients. Patients' perceptions were measured by a validated national survey of 3,067 Medicare beneficiaries with multiple chronic conditions across six domains that reflect knowledge and support of, and communication with, the patient. Medical groups' structural characteristics were taken from the National Study of Physician Organizations and included practice size, specialty mix, technological capabilities, and care management processes. Patients' survey responses were most favorable for the domain of test result communication and least favorable for the domain of provider support for medication and home health management. Medical groups' characteristics were not consistently associated with patients' perceptions of integrated care. However, compared to patients of primary care groups, patients of multispecialty groups had strong favorable perceptions of medical group staff knowledge of patients' medical histories. Opportunities exist to improve patient care, but structural integration of medical groups might not be sufficient for delivering care that patients perceive as integrated. Project HOPE—The People-to-People Health Foundation, Inc.

Sustainability of the integrated chronic disease management model at primary care clinics in South Africa.

PubMed

Mahomed, Ozayr H; Asmall, Shaidah; Voce, Anna

2016-11-17

An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes. The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation. The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa. The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability. Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70-79.89) followed by West Rand Health District (70.25 (95% CI: 63.96-76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17-77.83)). Four facilities (11%) had an overall sustainability score of less than 55. The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model.

"Preventing the pain" when working with family and sexual violence in primary care.

PubMed

Coles, Jan; Dartnall, Elizabeth; Astbury, Jill

2013-01-01

Primary care professionals (PCPs) are increasingly being expected to identify and respond to family and sexual violence as the chronic nature and severity of the long-term health impacts are increasingly recognized. This discussion paper reports the authors' expert opinion from their experiences running international workshops to prevent trauma among those who work and research sexual violence. It describes the burnout and secondary traumatic stress literature which provides the evidence supporting their work. Implications for practicing basic training in response to trauma and ongoing education are a key area for responding to family violence and preventing professional stress. A professional culture that supports and values caring well for those who have experienced family violence as well as "caring for the carer" is needed. Working in teams and having more support systems in place are likely to protect PCPs from secondary traumatic stress and burnout. Undergraduate and postgraduate training of PCPs to develop trauma knowledge and the skills to ask about and respond to family violence safely are essential. In addition, the healthcare system, workplace, and the individual practitioner support structures need to be in place to enable PCPs to provide safe and effective long-term care and access to other appropriate services for those who have experienced family violence.

Models of Metabolic Community Structure in Martian Habitable Environments: Constraints from a Terrestrial Analog Acid-Sulfate Fumarole Environment, Cerro Negro Volcano, Nicaragua

NASA Astrophysics Data System (ADS)

Rogers, K. L.; McCollom, T. M.; Hynek, B. M.

2014-12-01

Microbial habitability in extreme environments on Earth is described by microscale geochemical conditions that constrain metabolic niches in concert with long-term habitat stability that is governed by dynamic geologic processes. Using terrestrial analogs to identify habitable martian environments requires correlating microscale geochemical constraints with reconstructions of past martian environments that are based on global-scale observations. While past martian environments can be characterized by primary parameters (e.g. pH, redox, mineralogy, thermal history), microbial habitability on Earth is a complex function of both primary and derived parameters (e.g. metabolic reaction energetics, chemical & thermal gradients, flow dynamics). In recent years we have been investigating acid-sulfate fumaroles at the Mars analog site, Cerro Negro Volcano, Nicaragua, where habitability is constrained by steep thermal gradients, spatially- and temporally-variable vent dynamics, and limited water and nutrient availability. The most common niche identified thus far is found in fumaroles that host mixed photosynthetic and chemosynthetic endolithic microbial communities. One such endolith is dominated by acidic red algae (Cyanidiales), aerobic bacterial heterotrophs (Ktedonobacteria), and archaeal thermoacidophiles (Hyperthermus, Caldisphaera, and Thermofilum). An analysis of the metabolic structure suggests that primary production by the red algae supports the growth of heterotrophic thermoacidophiles. Diversification among the chemoheterotrophs with respect to temperature and oxygen tolerance suggests community adaptation to environmental gradients or variable venting dynamics. Furthermore, individual cells within the endolith are silica-encrusted, providing the possibility for biosignature formation and preservation. Putative hydrothermal environments on early Mars with similar conditions could have supported endolithic communities with comparable metabolic strategies. Even on a generally cold and dry Mars, volcanic craters likely provided long-lived warm and wet conditions that could have supported diverse assemblages of thermoacidophilic organisms with various metabolic strategies adapted to environmental conditions of acid-sulfate fumaroles.

Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study.

PubMed

Athié, Karen; Menezes, Alice Lopes do Amaral; da Silva, Angela Machado; Campos, Monica; Delgado, Pedro Gabriel; Fortes, Sandra; Dowrick, Christopher

2016-09-30

Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health. In this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals' (Mann-Whitney non-parametric test) and health managers' perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis. Firstly, health managers and professionals' perceptions converged in all components, except the health record system. Secondly, managers' perceptions in traditional services contrasted with managers' perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked. There is a gap between health managers' and professionals' understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes.

Coexistence of a two-states organization for a cell-penetrating peptide in lipid bilayer.

PubMed

Plénat, Thomas; Boichot, Sylvie; Dosset, Patrice; Milhiet, Pierre-Emmanuel; Le Grimellec, Christian

2005-12-01

Primary amphipathic cell-penetrating peptides transport cargoes across cell membranes with high efficiency and low lytic activity. These primary amphipathic peptides were previously shown to form aggregates or supramolecular structures in mixed lipid-peptide monolayers, but their behavior in lipid bilayers remains to be characterized. Using atomic force microscopy, we have examined the interactions of P(alpha), a primary amphipathic cell-penetrating peptide which remains alpha-helical whatever the environment, with dipalmitoylphosphatidylcholine (DPPC) bilayers. Addition of P(alpha) at concentrations up to 5 mol % markedly modified the supported bilayers topography. Long and thin filaments lying flat at the membrane surface coexisted with deeply embedded peptides which induced a local thinning of the bilayer. On the other hand, addition of P(alpha) only exerted very limited effects on the corresponding liposome's bilayer physical state, as estimated from differential scanning calorimetry and diphenylhexatriene fluorescence anisotropy experiments. The use of a gel-fluid phase separated supported bilayers made of a dioleoylphosphatidylcholine/dipalmitoylphosphatidylcholine mixture confirmed both the existence of long filaments, which at low peptide concentration were preferentially localized in the fluid phase domains and the membrane disorganizing effects of 5 mol % P(alpha). The simultaneous two-states organization of P(alpha), at the membrane surface and deeply embedded in the bilayer, may be involved in the transmembrane carrier function of this primary amphipathic peptide.

Development and Validation of the Primary Care Team Dynamics Survey

PubMed Central

Song, Hummy; Chien, Alyna T; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Hacker, Karen; Rosenthal, Meredith B; Singer, Sara J

2015-01-01

Objective To develop and validate a survey instrument designed to measure team dynamics in primary care. Data Sources/Study Setting We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. Study Design We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. Data Collection We administered the survey between September 2012 and March 2013. Principal Findings Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71–0.91), and discriminant validity (average factor correlations: 0.49). Conclusions It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes). PMID:25423886

Development and validation of the primary care team dynamics survey.

PubMed

Song, Hummy; Chien, Alyna T; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Hacker, Karen; Rosenthal, Meredith B; Singer, Sara J

2015-06-01

To develop and validate a survey instrument designed to measure team dynamics in primary care. We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. We administered the survey between September 2012 and March 2013. Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49). It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes). © Health Research and Educational Trust.

[Virtual clinical diagnosis support system of degenerative stenosis of the lumbar spinal canal].

PubMed

Shevelev, I N; Konovalov, N A; Cherkashov, A M; Molodchenkov, A A; Sharamko, T G; Asiutin, D S; Nazarenko, A G

2013-01-01

The aim of the study was to develop a virtual clinical diagnostic support system of degenerative lumbar spinal stenosis on database of spine registry. Choice of criteria's for diagnostic system was made on symptom analysis of 298 patients with lumbar spinal stenosis. Also was analysed a group of patient with disc herniation's for sensitivity and specify assessment of developed diagnostic support system. Represented clinical diagnostic support system allows identifying patients with degenerative lumbar spinal stenosis on stage of patient's primary visit. System sensitivity and specify are 90 and 71% respectively. "Online" mode of diagnostic system in structure of spine registry provides maximal availability for specialists, regardless of their locations. Development of tools "medicine 2.0" is the actual direction for carrying out further researches with which carrying out the centralized baea collection by means of specialized registers helps.

Temporal patterns of diversity: Assessing the biotic and abiotic controls on ant assemblages

USGS Publications Warehouse

Dunn, R.R.; Parker, C.R.; Sanders, N.J.

2007-01-01

In this study, we use 12 months of data from 11 ant assemblages to test whether seasonal variation in ant diversity is governed by either the structuring influences of interspecific competition or environmental conditions. Because the importance of competition might vary along environmental gradients, we also test whether the signature of competition depends on elevation. We find little evidence that competition structures the seasonal patterns of activity in the ant assemblages considered, but find support for the effects of temperature on seasonal patterns of diversity, especially at low-elevation sites. Although, in general, both competition and the environment interact to structure ant assemblages, our results suggest that environmental conditions are the primary force structuring the seasonal activity of the ant assemblages studied here. ?? 2007 The Linnean Society of London.

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

PubMed Central

Murray, Scott A

2013-01-01

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

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

PubMed

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

2013-06-01

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

Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings.

PubMed

Bailie, Jodie; Matthews, Veronica; Laycock, Alison; Schultz, Rosalie; Burgess, Christopher P; Peiris, David; Larkins, Sarah; Bailie, Ross

2017-07-14

Like other colonised populations, Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Preventable chronic disease is the largest contributor to the health differential between Indigenous and non-Indigenous Australians, but recommended best-practice preventive care is not consistently provided to Indigenous Australians. Significant improvement in health care delivery could be achieved through identifying and minimising evidence-practice gaps. Our objective was to use clinical audit data to create a framework of the priority evidence-practice gaps, strategies to address them, and drivers to support these strategies in the delivery of recommended preventive care. De-identified preventive health clinical audit data from 137 primary health care (PHC) centres in five jurisdictions were analysed (n = 17,108 audited records of well adults with no documented major chronic disease; 367 system assessments; 2005-2014), together with stakeholder survey data relating to interpretation of these data, using a mixed-methods approach (n = 152 responses collated in 2015-16). Stakeholders surveyed included clinicians, managers, policy officers, continuous quality improvement (CQI) facilitators and academics. Priority evidence-practice gaps and associated barriers, enablers and strategies to address the gaps were identified and reported back through two-stages of consultation. Further analysis and interpretation of these data were used to develop a framework of strategies and drivers for health service improvement. Stakeholder identified priorities were: following-up abnormal test results; completing cardiovascular risk assessments; timely recording of results; recording enquiries about living conditions, family relationships and substance use; providing support for clients identified with emotional wellbeing risk; enhancing systems to enable team function and continuity of care. Drivers identified for improving care in these areas included: strong Indigenous participation in the PHC service; appropriate team structure and function to support preventive care; meaningful use of data to support quality of care and CQI; and corporate support functions and structures. The framework should be useful for guiding development and implementation of barrier-driven, tailored interventions for primary health care service delivery and policy contexts, and for guiding further research. While specific strategies to improve the quality of preventive care need to be tailored to local context, these findings reinforce the requirement for multi-level action across the system. The framework and findings may be useful for similar purposes in other parts of the world, with appropriate attention to context in different locations.

Linking Silica Support Morphology to the Dynamics of Aminopolymers in Composites

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

Carrillo, Jan-Michael Y.; Potter, Matthew E.; Sakwa-Novak, Miles A.

A combined computational and experimental approach is used to elucidate the effect of silica support morphology on polymer dynamics and CO 2 adsorption capacities in aminopolymer/silica composites. Furthermore, simulations are based on coarse-grained molecular dynamics simulations of aminopolymer composites where a branched aminopolymer, representing poly(ethylenimine) (PEI), is impregnated into different silica mesoporous supports. The morphology of the mesoporous supports varies from hexagonally packed cylindrical pores representing SBA-15, double gyroids representing KIT-6 and MCM-48, and cagelike structures representing SBA-16. In parallel, composites of PEI and the silica supports SBA-15, KIT-6, MCM-48, and SBA-16 are synthesized and characterized, including measuring their COmore » 2 uptake. Simulations predict that a 3D pore morphology, such as those of KIT-6, MCM-48, and SBA-16, will have faster segmental mobility and have lower probability of primary amine and surface silanol associations, which should translate to higher CO 2 uptake in comparison to a 2D pore morphology such as that of SBA-15. We found that KIT-6 has higher CO 2 uptake than SBA-15 at equivalent PEI loading, even though both supports have similar surface area and pore volume. But, this is not the case for the MCM-48 support, which has smaller pores, and SBA-16, whose pore structure rapidly degrades after PEI impregnation.« less

Wind tower service lift

DOEpatents

Oliphant, David; Quilter, Jared; Andersen, Todd; Conroy, Thomas

2011-09-13

An apparatus used for maintaining a wind tower structure wherein the wind tower structure may have a plurality of legs and may be configured to support a wind turbine above the ground in a better position to interface with winds. The lift structure may be configured for carrying objects and have a guide system and drive system for mechanically communicating with a primary cable, rail or other first elongate member attached to the wind tower structure. The drive system and guide system may transmit forces that move the lift relative to the cable and thereby relative to the wind tower structure. A control interface may be included for controlling the amount and direction of the power into the guide system and drive system thereby causing the guide system and drive system to move the lift relative to said first elongate member such that said lift moves relative to said wind tower structure.

Convergence of an iterative procedure for large-scale static analysis of structural components

NASA Technical Reports Server (NTRS)

Austin, F.; Ojalvo, I. U.

1976-01-01

The paper proves convergence of an iterative procedure for calculating the deflections of built-up component structures which can be represented as consisting of a dominant, relatively stiff primary structure and a less stiff secondary structure, which may be composed of one or more substructures that are not connected to one another but are all connected to the primary structure. The iteration consists in estimating the deformation of the primary structure in the absence of the secondary structure on the assumption that all mechanical loads are applied directly to the primary structure. The j-th iterate primary structure deflections at the interface are imposed on the secondary structure, and the boundary loads required to produce these deflections are computed. The cycle is completed by applying the interface reaction to the primary structure and computing its updated deflections. It is shown that the mathematical condition for convergence of this procedure is that the maximum eigenvalue of the equation relating primary-structure deflection to imposed secondary-structure deflection be less than unity, which is shown to correspond with the physical requirement that the secondary structure be more flexible at the interface boundary.

Operations and support cost modeling of conceptual space vehicles

NASA Technical Reports Server (NTRS)

Ebeling, Charles

1994-01-01

The University of Dayton is pleased to submit this annual report to the National Aeronautics and Space Administration (NASA) Langley Research Center which documents the development of an operations and support (O&S) cost model as part of a larger life cycle cost (LCC) structure. It is intended for use during the conceptual design of new launch vehicles and spacecraft. This research is being conducted under NASA Research Grant NAG-1-1327. This research effort changes the focus from that of the first two years in which a reliability and maintainability model was developed to the initial development of an operations and support life cycle cost model. Cost categories were initially patterned after NASA's three axis work breakdown structure consisting of a configuration axis (vehicle), a function axis, and a cost axis. A revised cost element structure (CES), which is currently under study by NASA, was used to established the basic cost elements used in the model. While the focus of the effort was on operations and maintenance costs and other recurring costs, the computerized model allowed for other cost categories such as RDT&E and production costs to be addressed. Secondary tasks performed concurrent with the development of the costing model included support and upgrades to the reliability and maintainability (R&M) model. The primary result of the current research has been a methodology and a computer implementation of the methodology to provide for timely operations and support cost analysis during the conceptual design activities.

Optomechanical stability design of space optical mapping camera

NASA Astrophysics Data System (ADS)

Li, Fuqiang; Cai, Weijun; Zhang, Fengqin; Li, Na; Fan, Junjie

2018-01-01

According to the interior orientation elements and imaging quality requirements of mapping application to mapping camera and combined with off-axis three-mirror anastigmat(TMA) system, high optomechanical stability design of a space optical mapping camera is introduced in this paper. The configuration is a coaxial TMA system used in off-axis situation. Firstly, the overall optical arrangement is described., and an overview of the optomechanical packaging is provided. Zerodurglass, carbon fiber composite and carbon-fiber reinforced silicon carbon (C/SiC) are widely used in the optomechanical structure, because their low coefficient of thermal expansion (CTE) can reduce the thermal sensitivity of the mirrors and focal plane. Flexible and unloading support are used in reflector and camera supporting structure. Epoxy structural adhesives is used for bonding optics to metal structure is also introduced in this paper. The primary mirror is mounted by means of three-point ball joint flexures system, which is attach to the back of the mirror. Then, In order to predict flexural displacements due to gravity, static finite element analysis (FEA) is performed on the primary mirror. The optical performance peak-to-valley (PV) and root-mean-square (RMS) wavefront errors are detected before and after assemble. Also, the dynamic finite element analysis(FEA) of the whole optical arrangement is carried out as to investigate the performance of optomechanical. Finally, in order to evaluate the stability of the design, the thermal vacuum test and vibration test are carried out and the Modulation Transfer Function (MTF) and elements of interior orientation are presented as the evaluation index. Before and after the thermal vacuum test and vibration test, the MTF, focal distance and position of the principal point of optical system are measured and the result is as expected.

Associations Between Secondary Caregivers' Supportive Behavior and Psychological Distress of Primary Spousal Caregivers of Cognitively Intact and Impaired Elders.

PubMed

Lou, Vivian W Q; Kwan, Chi Wai; Chong, Ming Lin Alice; Chi, Iris

2015-08-01

This study examined associations between the availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. A sample of 8,087 assessments using the validated Chinese version of the Minimum Data Set-Home Care of individuals applying for government-subsidized long-term care services from 2006 to 2009 in Hong Kong were selected based on inclusion criteria. More than 70% of primary caregivers had secondary caregivers; the rate was slightly lower for those caring for moderately or severely cognitively impaired spouses. More than half of the primary spousal caregivers had secondary caregivers who provided both emotional and instrumental support. Emotional support provided by secondary caregivers had a negative association with primary caregivers' psychological distress when their care recipients were cognitively intact. When secondary caregivers provided both instrumental and emotional support, primary caregivers had a higher likelihood of psychological distress when care recipients had greater negative mood symptoms as compared to those who had less negative mood symptoms. This is the first study that examined the association between availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. The findings suggest a need to provide services that enhance the provision of emotional support from both secondary and primary caregivers to cognitively intact elders and support primary spousal caregivers to seek appropriate help according to the mood of care recipients. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs

PubMed Central

Finch, Andrew J.; Moberg, D. Paul; Krupp, Amanda Lawton

2014-01-01

Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance abuse, recovery schools appear to successfully function as continuing care providers reinforcing and sustaining therapeutic benefits gained from treatment. Small size and therapeutic programming allow for a potentially broader continuum of services than currently exists in most of the schools. Recovery schools thus provide a useful design for continuing care warranting further study and policy support. PMID:24591808

The BepiColombo Spacecraft: The Mercury Transfer Module Structure Qualification Test Campaign Description

NASA Astrophysics Data System (ADS)

Martin Zurdo, M. J.

2012-07-01

The BepiColombo is a space mission to Mercury (ESA in cooperation with Japan Aerospace Exploration Agency). The spacecraft consist of three different structures: two orbiters responsible for the scientific mission (MPO and MMO) and one service module, Mercury Transfer Module (MTM), which provides propulsion and services during the journey to Mercury. Taking into account only the MTM structure, the companies involved are ASTRIUM GERMANY acting as the prime contractor and ASTRIUM UK acting as the co- prime contractor company. EADS CASA Espacio (ECE) in Spain is the company responsible for the final design, manufacturing and qualification of the MTM structure. The test campaign specimen is the MTM core structure, which corresponds to the central cone with the structure floors, shear panels and tank support structure. This test campaign qualifies the primary load path and its primary interfaces; the rest of the MTM structure is qualified by system level vibration test. In order to qualify the MTM structure, three different kinds of qualification tests have been performed: stiffness test, global strength test and local tests in different specific areas. The most relevant test during the campaign is the global strength test case, in which several external loads are introduced (different interfaces) simulating the load introduction for a selected critical flight case. There are two important items in the qualification test campaign: 1. The instrumentation of the structure, with two main functions: to control the specimen under test loads, and to demonstrate the qualification of the structure. 2. The set-up structure, designed by ECE to allow the correct load introduction on each testing case during the whole test campaign. This paper describes the MTM structure test campaign from the definition of the loads applied in each test to the qualification of the complete structure.

Understanding Implementation of Complex Interventions in Primary Care Teams.

PubMed

Luig, Thea; Asselin, Jodie; Sharma, Arya M; Campbell-Scherer, Denise L

2018-01-01

The implementation of interventions to support practice change in primary care settings is complex. Pragmatic strategies, grounded in empiric data, are needed to navigate real-world challenges and unanticipated interactions with context that can impact implementation and outcomes. This article uses the example of the "5As Team" randomized control trial to explore implementation strategies to promote knowledge transfer, capacity building, and practice integration, and their interaction within the context of an interdisciplinary primary care team. We performed a qualitative evaluation of the implementation process of the 5As Team intervention study, a randomized control trial of a complex intervention in primary care. We conducted thematic analysis of field notes of intervention sessions, log books of the practice facilitation team members, and semistructured interviews with 29 interdisciplinary clinician participants. We used and further developed the Interactive Systems Framework for dissemination and implementation to interpret and structure findings. Three themes emerged that illuminate interactions between implementation processes, context, and outcomes: (1) facilitating team communication supported collective and individual sense-making and adoption of the innovation, (2) iterative evaluation of the implementation process and real-time feedback-driven adaptions of the intervention proved crucial for sustainable, context-appropriate intervention impact, (3) stakeholder engagement led to both knowledge exchange that contributes to local problem solving and to shaping a clinical context that is supportive to practice change. Our findings contribute pragmatic strategies that can help practitioners and researchers to navigate interactions between context, intervention, and implementation factors to increase implementation success. We further developed an implementation framework that includes sustained engagement with stakeholders, facilitation of team sense-making, and dynamic evaluation and intervention design as integral parts of complex intervention implementation. NCT01967797. 18 October 2013. © Copyright 2018 by the American Board of Family Medicine.

"It's not just about walking.....it's the practice nurse that makes it work": a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care.

PubMed

Beighton, Carole; Victor, Christina; Normansell, Rebecca; Cook, Derek; Kerry, Sally; Iliffe, Steve; Ussher, Michael; Whincup, Peter; Fox-Rushby, Julia; Woodcock, Alison; Harris, Tess

2015-12-12

Physical activity (PA) is important for physical and mental health in adults and older adults. Interventions incorporating theory-based behaviour change techniques (BCTs) can be useful in helping people to increase their PA levels and can be delivered by practice nurses in primary care. We undertook two primary care based complex walking interventions among adults and older adults. Both interventions were underpinned by BCTs and delivered by practice nurses and we sought their views and experiences of delivering over 1400 complex PA consultations. Semi structured interviews with two practice nurse groups (n = 4 and n = 5) and two individual interviews (total n = 11) were conducted by independent facilitators; audio-recorded, transcribed verbatim and analysed using thematic analysis. Five key themes emerged as enablers and/or barriers to delivering the intervention: preparation and training; initial and ongoing support; adherence to the protocol; the use of materials and equipment; and engagement of participants. The themes were organised into a framework of 'pre-trial' and 'delivery of the intervention'. Two additional 'post-trial' themes were identified; changed practice and the future feasibility of the intervention. Nurses believed that taking part in the trial, especially the BCT training, enhanced the quality and delivery of advice and support they provided within routine consultations, although the lack of time available routinely makes this challenging. Delivering an effective behaviour change intervention in primary care requires adequate training and support for practice nurses both initially and throughout the trial as well as adequate consultation time. Enhanced skills from participating in such trials can lead to long-term changes, including more patient-centred consulting. PACE-Lift ISRCTN 42122561 , PACE-UP ISRCTN 98538934 .

Primary Health Care: care coordinator in regionalized networks?

PubMed Central

de Almeida, Patty Fidelis; dos Santos, Adriano Maia

2016-01-01

RESUMO OBJECTIVE To analyze the breadth of care coordination by Primary Health Care in three health regions. METHODS This is a quantitative and qualitative case study. Thirty-one semi-structured interviews with municipal, regional and state managers were carried out, besides a cross-sectional survey with the administration of questionnaires to physicians (74), nurses (127), and a representative sample of users (1,590) of Estratégia Saúde da Família (Family Health Strategy) in three municipal centers of health regions in the state of Bahia. RESULTS Primary Health Care as first contact of preference faced strong competition from hospital outpatient and emergency services outside the network. Issues related to access to and provision of specialized care were aggravated by dependence on the private sector in the regions, despite progress observed in institutionalizing flows starting out from Primary Health Care. The counter-referral system was deficient and interprofessional communication was scarce, especially concerning services provided by the contracted network. CONCLUSIONS Coordination capacity is affected both by the fragmentation of the regional network and intrinsic problems in Primary Health Care, which poorly supported in its essential attributes. Although the health regions have common problems, Primary Health Care remains a subject confined to municipal boundaries. PMID:28099663

Part 2: Screening, Brief Intervention and Referral to Treatment Plus Recovery Management: A Proposed Model for Recovery-Oriented Primary Care.

PubMed

Fornili, Katherine S

2016-01-01

Part 1 of this two-part series (The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in the Primary Care) explored the theoretical foundations for evidence-based substance Screening, Brief Intervention and Referral to Treatment (SBIRT) services. The aim was to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for individuals who have more serious substance use disorders, including drug use and alcohol/drug dependence. Building on that analysis, through meaningful application of recovery management (RM) concepts within an integrated primary care/behavioral health context, a new, theory-based, recovery-oriented framework for primary care SBIRT is now introduced in Part 2. The proposed SBIRT Plus Recovery Management (SBIRT + RM) model moves traditional SBIRT from its original, limited, and narrow focus only on substance detection, brief intervention, and referral to its rightful, structured placement within a comprehensive, multidimensional, recovery-oriented system of care clinical practice environment. SBIRT+RM describes relevant strategies for improving recovery outcomes for individuals identified through primary care substance screening and defines primary care provider roles and responsibilities for sustained recovery support and long-term recovery maintenance.

Cajal-body formation correlates with differential coilin phosphorylation in primary and transformed cell lines

PubMed Central

Hearst, Scoty M.; Gilder, Andrew S.; Negi, Sandeep S.; Davis, Misty D.; George, Eric M.; Whittom, Angela A.; Toyota, Cory G.; Husedzinovic, Alma; Gruss, Oliver J.; Hebert, Michael D.

2009-01-01

Summary Cajal bodies (CBs) are nuclear structures that are thought to have diverse functions, including small nuclear ribonucleoprotein (snRNP) biogenesis. The phosphorylation status of coilin, the CB marker protein, might impact CB formation. We hypothesize that primary cells, which lack CBs, contain different phosphoisoforms of coilin compared with that found in transformed cells, which have CBs. Localization, self-association and fluorescence recovery after photobleaching (FRAP) studies on coilin phosphomutants all suggest this modification impacts the function of coilin and may thus contribute towards CB formation. Two-dimensional gel electrophoresis demonstrates that coilin is hyperphosphorylated in primary cells compared with transformed cells. mRNA levels of the nuclear phosphatase PPM1G are significantly reduced in primary cells and expression of PPM1G in primary cells induces CBs. Additionally, PPM1G can dephosphorylate coilin in vitro. Surprisingly, however, expression of green fluorescent protein alone is sufficient to form CBs in primary cells. Taken together, our data support a model whereby coilin is the target of an uncharacterized signal transduction cascade that responds to the increased transcription and snRNP demands found in transformed cells. PMID:19435804

[Stakeholder representations of the role of the intermediate level of the DRC health system].

PubMed

Mbeva, Jean Bosco Kahindo; Karemere, Hermès; Schirvel, Carole; Porignon, Denis

2014-01-01

Intermediate health care structures in the DRC were designed during the setting-up of primary health care in a perspective of health district support. This study was designed to describe stakeholder representations of the intermediate level of the DRC health system during the first 30 years of the primary health care system. This case study was based on inductive analysis of data from 27 key informant interviews.. The intermediate level of the health system, lacking sufficient expertise and funding during the 1980s, was confined to inspection and control functions, answering to the central level of the Ministry of health and provincial authorities. Since the 1990s, faced with the pressing demand for support from health district teams, whose self-management had to deal with humanitarian emergencies, the need to integrate vertical programmes, and cope with the logistics of many different actors, the intermediate heath system developed methods and tools to support heath districts. This resulted in a subsidiary model of the intermediate level, the perceived efficacy of which varies according to the province over recent years. The "subsidiary" model of the intermediary health system level seems a good alternative to the "control" model in DRC.

Supercomputer Environments

DTIC Science & Technology

1990-01-09

data structures can easily be presented to the user interface. An emphasis of the Graph Browser was the realization of graph views and graph animation ... animation of the graph. Anima- tion of the graph includes changing node shapes, changing node and arc colors, changing node and arc text, and making...many graphs tend to be tree-like. Animtion of a graph is a useful feature. One of the primary goals of GMB was to support animated graphs. For animation

A descriptive qualitative study of the roles of family members in older men’s depression treatment from the perspectives of older men and primary care providers

PubMed Central

Hinton, Ladson; Apesoa-Varano, Ester Carolina; Unutzer, Jurgen; Dwight-Johnson, Megan; Park, Mijung; Barker, Judith C.

2014-01-01

OBJECTIVE To describe the roles of family members in older men’s depression treatment from the perspectives of older men and primary care physicians (PCPs). METHODS Cross-sectional, descriptive qualitative study conducted from 2008–2011 in primary care clinics in an academic medical center and a safety-net county teaching hospital in California’s Central Valley. Participants in this study were 1) 77 age ≥ 60, non-institutionalized men with a one-year history of clinical depression and/or depression treatment who were identified through screening in primary care clinics and 2) a convenience sample of 15 PCPs from same recruitment sites. Semi-structured, in-depth qualitative interviews were conducted and audiotaped, then transcribed and analyzed thematically. RESULTS Treatment-promoting roles of family included providing an emotionally supportive home environment, promoting depression self-management and facilitating communication about depression during primary care visits. Treatment impeding roles of family included triggering or worsening men’s depression, hindering depression care during primary care visits, discouraging depression treatment and being unavailable to assist men with their depression care. Overall, more than 90% of the men and the PCPs described one or more treatment-promoting roles of family and over 75% of men and PCPs described one or more treatment-impeding roles of family. CONCLUSIONS Families play important roles in older men’s depression treatment with the potential to promote as well as impede care. Interventions and services need to carefully assess the ongoing roles and attitudes of family members and to tailor treatment approaches to build on the positive aspects and mitigate the negative aspects of family support. PMID:25131709

A descriptive qualitative study of the roles of family members in older men's depression treatment from the perspectives of older men and primary care providers.

PubMed

Hinton, Ladson; Apesoa-Varano, Ester Carolina; Unützer, Jürgen; Dwight-Johnson, Megan; Park, Mijung; Barker, Judith C

2015-05-01

The aim of this study is to describe the roles of family members in older men's depression treatment from the perspectives of older men and primary care physicians (PCPs). Cross-sectional, descriptive qualitative study conducted from 2008-2011 in primary care clinics in an academic medical center and a safety-net county teaching hospital in California's Central Valley. Participants in this study were the following: (1) 77 age ≥ 60, noninstitutionalized men with a 1-year history of clinical depression and/or depression treatment who were identified through screening in primary care clinics and (2) a convenience sample of 15 PCPs from the same recruitment sites. Semi-structured and in-depth qualitative interviews were conducted and audiotaped then transcribed and analyzed thematically. Treatment-promoting roles of family included providing an emotionally supportive home environment, promoting depression self-management and facilitating communication about depression during primary care visits. Treatment-impeding roles of family included triggering or worsening men's depression, hindering depression care during primary care visits, discouraging depression treatment and being unavailable to assist men with their depression care. Overall, more than 90% of the men and the PCPs described one or more treatment-promoting roles of family and over 75% of men and PCPs described one or more treatment-impeding roles of family. Families play important roles in older men's depression treatment with the potential to promote as well as impede care. Interventions and services need to carefully assess the ongoing roles and attitudes of family members and to tailor treatment approaches to build on the positive aspects and mitigate the negative aspects of family support. Copyright © 2014 John Wiley & Sons, Ltd.

Using the Knowledge, Process, Practice (KPP) model for driving the design and development of online postgraduate medical education.

PubMed

Shaw, Tim; Barnet, Stewart; Mcgregor, Deborah; Avery, Jennifer

2015-01-01

Online learning is a primary delivery method for continuing health education programs. It is critical that programs have curricula objectives linked to educational models that support learning. Using a proven educational modelling process ensures that curricula objectives are met and a solid basis for learning and assessment is achieved. To develop an educational design model that produces an educationally sound program development plan for use by anyone involved in online course development. We have described the development of a generic educational model designed for continuing health education programs. The Knowledge, Process, Practice (KPP) model is founded on recognised educational theory and online education practice. This paper presents a step-by-step guide on using this model for program development that encases reliable learning and evaluation. The model supports a three-step approach, KPP, based on learning outcomes and supporting appropriate assessment activities. It provides a program structure for online or blended learning that is explicit, educationally defensible, and supports multiple assessment points for health professionals. The KPP model is based on best practice educational design using a structure that can be adapted for a variety of online or flexibly delivered postgraduate medical education programs.

The development of poly(vinyl chloride) [PVC] extrusions for a 14,000-ton self-supporting structure for the detection of neutrinos

DOE PAGES

Grudzinski, James J.; Talaga, Richard L.; Pla-Dalmau, Anna; ...

2014-12-16

The NOvA Neutrino Experiment has built a one of a kind self-supporting plastic structure, potentially the largest ever built. The PVC structure serves as a neutrino detector and is composed of 28 individual blocks that measure 15.5 m (51 feet) high by 15.5 m (51 feet) wide by 2.1 m (7 feet) deep. The primary parts in the detector construction are 15.5m (51 foot), 15-cell PVC extrusions. These extrusions from the basis of the detector modules which are laminated together in a crossed pattern to form the individual blocks and then filled with mineral oil based liquid scintillator. The self-supportingmore » nature of the detector places important structural requirements on both the PVC formulation and the extrusions. Block assembly requirements impose narrow geometric tolerances. Due to the method of detecting neutrinos, the extrusions must possess exceptionally high reflectivity over a particular wavelength range. The requirement places additional restrictions on the components of the PVC formulation. Altogether, the PVC extrusions have to maintain important reflectivity characteristics, provide structural support to the detector, and meet relatively tight geometric requirements for assembly. In order to meet these constraints, a custom PVC formulation had to be created and extruded. Here, we describe the purpose and requirements of the NOvA detector leading to the production of our unique PVC extrusion, summarize the R&D process, and discuss the lessons learned.« less

Design-Load Basis for LANL Structures, Systems, and Components

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

I. Cuesta

2004-09-01

This document supports the recommendations in the Los Alamos National Laboratory (LANL) Engineering Standard Manual (ESM), Chapter 5--Structural providing the basis for the loads, analysis procedures, and codes to be used in the ESM. It also provides the justification for eliminating the loads to be considered in design, and evidence that the design basis loads are appropriate and consistent with the graded approach required by the Department of Energy (DOE) Code of Federal Regulation Nuclear Safety Management, 10, Part 830. This document focuses on (1) the primary and secondary natural phenomena hazards listed in DOE-G-420.1-2, Appendix C, (2) additional loadsmore » not related to natural phenomena hazards, and (3) the design loads on structures during construction.« less

Learning of goal-relevant and -irrelevant complex visual sequences in human V1.

PubMed

Rosenthal, Clive R; Mallik, Indira; Caballero-Gaudes, Cesar; Sereno, Martin I; Soto, David

2018-06-12

Learning and memory are supported by a network involving the medial temporal lobe and linked neocortical regions. Emerging evidence indicates that primary visual cortex (i.e., V1) may contribute to recognition memory, but this has been tested only with a single visuospatial sequence as the target memorandum. The present study used functional magnetic resonance imaging to investigate whether human V1 can support the learning of multiple, concurrent complex visual sequences involving discontinous (second-order) associations. Two peripheral, goal-irrelevant but structured sequences of orientated gratings appeared simultaneously in fixed locations of the right and left visual fields alongside a central, goal-relevant sequence that was in the focus of spatial attention. Pseudorandom sequences were introduced at multiple intervals during the presentation of the three structured visual sequences to provide an online measure of sequence-specific knowledge at each retinotopic location. We found that a network involving the precuneus and V1 was involved in learning the structured sequence presented at central fixation, whereas right V1 was modulated by repeated exposure to the concurrent structured sequence presented in the left visual field. The same result was not found in left V1. These results indicate for the first time that human V1 can support the learning of multiple concurrent sequences involving complex discontinuous inter-item associations, even peripheral sequences that are goal-irrelevant. Copyright © 2018. Published by Elsevier Inc.

Parents' information needs, self-efficacy and influences on consulting for childhood respiratory tract infections: a qualitative study.

PubMed

Ingram, Jenny; Cabral, Christie; Hay, Alastair D; Lucas, Patricia J; Horwood, Jeremy

2013-07-28

Acute respiratory tract infection (RTI) is the most common reason why parents consult primary care in the UK. Little is known about parents' perceptions of what may help them to make an appropriate decision to consult when their child is ill and how to improve self-care.Using qualitative methods, this study aimed to explore parents' views on support and information needs prior to consulting when children have RTIs with cough, and identify the triggers and barriers to consulting primary care. 7 focus groups and 30 semi-structured interviews were held with 60 parents (with children aged 5 months - 17 years) from a range of socio-economic backgrounds. Topics discussed were informed by the Health Belief Model, and explored parents' concerns and beliefs about susceptibility and severity of RTIs, beliefs about the triggers and barriers to consulting, and information and support seeking behaviour undertaken before consulting primary care. Discussions were audio-recorded, transcribed and analysed using thematic methods. Parents from all socio-economic backgrounds sought information from a wide range of sources about RTIs in children in order to identify which of their child's symptoms should be of concern and trigger a visit to the doctor. The perception of threat to a child of RTI (with cough) was increased with more severe illness and by perceived susceptibility to illness of a particular child; whilst experience with other children increased parental efficacy to cope with childhood cough at home. Psychological models of health behaviour informed the understanding of cultural beliefs and attitudes that underpin health related behaviours. A wide range of perceptions influence the likelihood that parents will seek help from primary care for a child with cough; these perceptions are similar across socio-economic groups. Parents' experience, confidence and efficacy influence the likelihood of consulting primary care for their child's RTI. Parents would value consistent advice from a trusted source that addresses common concerns and supports home care and decision making about help seeking.

Segment Alignment Maintenance System for the Hobby-Eberly Telescope

NASA Technical Reports Server (NTRS)

Rakoczy, John; Burdine, Robert (Technical Monitor)

2001-01-01

NASA's Marshall Space Flight Center, in collaboration with Blue Line Engineering of Colorado Springs, Colorado, is developing a Segment Alignment Maintenance System (SAMS) for McDonald Observatory's Hobby-Eberly Telescope (HET). The SAMS shall sense motions of the 91 primary mirror segments and send corrections to HET's primary mirror controller as the mirror segments misalign due to thermo -elastic deformations of the mirror support structure. The SAMS consists of inductive edge sensors. All measurements are sent to the SAMS computer where mirror motion corrections are calculated. In October 2000, a prototype SAMS was installed on a seven-segment cluster of the HET. Subsequent testing has shown that the SAMS concept and architecture are a viable practical approach to maintaining HET's primary mirror figure, or the figure of any large segmented telescope. This paper gives a functional description of the SAMS sub-array components and presents test data to characterize the performance of the subarray SAMS.

SOFIA primary mirror fabrication and testing

NASA Astrophysics Data System (ADS)

Geyl, Roland; Tarreau, Michel; Plainchamp, Patrick

2001-12-01

The Stratospheric Observatory for Infrared Astronomy (SOFIA) is a joint American-German project dedicated to performing IR astronomy on board a Boeing Aircraft, in near space condition. First flight of the Observatory is planned for 2003. The REOSC Products Unit of SAGEM SA (France) has been contracted by Kayser Threde (Germany) for the design and fabrication of the 2.7-meter diameter, F/1.19 parabolic lightweight SOFIA primary mirror as well as the M3 dichroic and folding mirror assembly. This paper will report the design, fabrication and test of the lightweight primary mirror. The mirror structure has been obtained by machining it out from a solid Zerodur blank. It is the world's largest of this type today. Axial and lateral mirror support system has been conceptually designed and engineered by SAGEM-REOSC engineers in relation with Kayser Threde team. The optical surface is an F/1.19 parabola polished to a high level of quality.

Managing physical and mental health conditions: Consumer perspectives on integrated care.

PubMed

Rollins, Angela L; Wright-Berryman, Jennifer; Henry, Nancy H; Quash, Alicia M; Benbow, Kyle; Bonfils, Kelsey A; Hedrick, Heidi; Miller, Alex P; Firmin, Ruthie; Salyers, Michelle P

2017-01-01

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.

Teacher perspectives on implementing and sustaining a handwashing promotion intervention in Western Kenyan primary schools.

PubMed

Graves, Janessa M; Finsness, Erica D; Quick, Robert; Nyando Integrated Child Health And Education Project Niche Study Team; Harris, Julie R; Daniell, William E

School-based handwashing programs are challenging to establish and sustain, especially in low-resource settings. This qualitative study described teacher perspectives associated with implementing and sustaining a handwashing program in primary schools participating in the Nyando Integrated Child Health and Education (NICHE) project. Structured key informant interviews were conducted with teachers. Prevalent concepts and themes were grouped into themes and topic areas using an iterative, open coding approach. Forty-one teacher respondents reported favorable expectations and benefits of handwashing programs. The importance of available resources (e.g., reliable water) was cited as a primary concern. Other challenges included time and personal or institutional financial commitment necessary to ensure program sustainability. Handwashing programs in low-income, rural schools, where infrastructure is lacking and "student ambassadors" extend the intervention to the surrounding community, hold great promise to improve community health. Teachers must have adequate support and resources to implement and sustain the programs.

Practice context affects efforts to improve diabetes care for primary care patients: a pragmatic cluster randomized trial.

PubMed

Dickinson, L Miriam; Dickinson, W Perry; Nutting, Paul A; Fisher, Lawrence; Harbrecht, Marjie; Crabtree, Benjamin F; Glasgow, Russell E; West, David R

2015-04-01

Efforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes. To examine practice contextual features that moderate intervention effectiveness. Secondary analysis of data from a cluster randomized trial of three approaches for implementing the Chronic Care Model to improve diabetes care. Forty small to mid-sized primary care practices participated, with 522 clinician and staff member surveys. Outcomes were assessed for 822 established patients with a diagnosis of type 2 diabetes who had at least one visit to the practice in the 18 months following enrollment. The primary outcome was a composite measure of diabetes process of care, ascertained by chart audit, regarding nine quality measures from the American Diabetes Association Physician Recognition Program: HgA1c, foot exam, blood pressure, dilated eye exam, cholesterol, nephropathy screen, flu shot, nutrition counseling, and self-management support. Data from practices included structural and demographic characteristics and Practice Culture Assessment survey subscales (Change Culture, Work Culture, Chaos). Across the three implementation approaches, demographic/structural characteristics (rural vs. urban + .70(p = .006), +2.44(p < .001), -.75(p = .004)); Medicaid: < 20 % vs. ≥ 20 % (-.20(p = .48), +.75 (p = .08), +.60(p = .02)); practice size: < 4 clinicians vs. ≥ 4 clinicians (+.56(p = .02), +1.96(p < .001), +.02(p = .91)); practice Change Culture (high vs. low: -.86(p = .048), +1.71(p = .005), +.34(p = .22)), Work Culture (high vs. low: -.67(p = .18), +2.41(p < .001), +.67(p = .005)) and variability in practice Change Culture (high vs. low: -.24(p = .006), -.20(p = .0771), -.44(p = .0019) and Work Culture (high vs. low: +.56(p = .3160), -1.0(p = .008), -.25 (p = .0216) were associated with trajectories of change in diabetes process of care, either directly or differentially by study arm. This study supports the need for broader use of methodological approaches to better examine contextual effects on implementation and effectiveness of quality improvement interventions in primary care settings.

Impact of health literacy, accessibility and coordination of care on patient's satisfaction with primary care in Germany.

PubMed

Altin, Sibel Vildan; Stock, Stephanie

2015-10-22

Although health policy makers call for the transformation of health care organizations to health literacy responsive ones, there is limited evidence on the care experiences of patients with limited health literacy skills (HL) in respect to health care quality. We explored if HL and patient-reported experiences regarding access to care and support in care-coordination in primary care organizations (PCO) have an impact on patients satisfaction with the care received by their personal general practitioner (GP). A nationwide representative survey was administered in a random sample of 1125 German adults. Binary logistic regression analyses were performed to determine whether HL and perceived access to and coordination of care were associated with satisfaction with care received in primary care adjusting for demographics and health status. In the unadjusted as well as adjusted model, better accessibility of the primary care practice (β= 1.858; 2.032 p < 0.001) frequent support in care coordination by the general practitioner (β = 2.680; 2.820 p < 0.001) as well as sufficient HL (β = 0.888; 1.228 p < 0.05) were independent predictors of a higher satisfaction with care received in the general practice. German adults with sufficient HL and positive experiences regarding care coordination and access to care are more satisfied with care received by their personal general practitioner. This result is from major importance for primary care organizations intending to transform their processes and structures to respond to the health literacy needs of their patients more effectively.

Dynamic amphiphile libraries to screen for the "fragrant" delivery of siRNA into HeLa cells and human primary fibroblasts.

PubMed

Gehin, Charlotte; Montenegro, Javier; Bang, Eun-Kyoung; Cajaraville, Ana; Takayama, Shota; Hirose, Hisaaki; Futaki, Shiroh; Matile, Stefan; Riezman, Howard

2013-06-26

Dynamic amphiphiles are amphiphiles with dynamic covalent bridges between their hydrophilic heads and their hydrophobic tails. Their usefulness to activate ion transporters, for odorant release, and for differential sensing of odorants and perfumes, has been demonstrated recently. Here, we report that the same "fragrant" dynamic amphiphiles are ideal to screen for new siRNA transfection agents. The advantages of this approach include rapid access to fairly large libraries of complex structures, and possible transformation en route to assist uptake and minimize toxicity. We report single-component systems that exceed the best commercially available multicomponent cocktails with regard to both efficiency and velocity of EGFP knockdown in HeLa cells. In human primary fibroblasts, siRNA-mediated enzyme knockdown nearly doubled from >30% for Lipofectamine to >60% for our best hit. The identified structures were predictable neither from literature nor from results in fluorogenic vesicles and thus support the importance of conceptually innovative screening approaches.

Validating Female Psychopathy Subtypes: Differences in Personality, Antisocial and Violent Behavior, Substance Abuse, Trauma, and Mental Health

PubMed Central

Hicks, Brian M.; Vaidyanathan, Uma; Patrick, Christopher J.

2010-01-01

Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems including symptoms of post-traumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to non-violent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities. PMID:20582155

A knowledge-based patient assessment system: conceptual and technical design.

PubMed Central

Reilly, C. A.; Zielstorff, R. D.; Fox, R. L.; O'Connell, E. M.; Carroll, D. L.; Conley, K. A.; Fitzgerald, P.; Eng, T. K.; Martin, A.; Zidik, C. M.; Segal, M.

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring. PMID:11079970

A knowledge-based patient assessment system: conceptual and technical design.

PubMed

Reilly, C A; Zielstorff, R D; Fox, R L; O'Connell, E M; Carroll, D L; Conley, K A; Fitzgerald, P; Eng, T K; Martin, A; Zidik, C M; Segal, M

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring.

Software engineering capability for Ada (GRASP/Ada Tool)

NASA Technical Reports Server (NTRS)

Cross, James H., II

1995-01-01

The GRASP/Ada project (Graphical Representations of Algorithms, Structures, and Processes for Ada) has successfully created and prototyped a new algorithmic level graphical representation for Ada software, the Control Structure Diagram (CSD). The primary impetus for creation of the CSD was to improve the comprehension efficiency of Ada software and, as a result, improve reliability and reduce costs. The emphasis has been on the automatic generation of the CSD from Ada PDL or source code to support reverse engineering and maintenance. The CSD has the potential to replace traditional prettyprinted Ada Source code. A new Motif compliant graphical user interface has been developed for the GRASP/Ada prototype.

Sedimentary textures formed by aqueous processes, Erebus crater Meridiani Planum, Mars

USGS Publications Warehouse

Grotzinger, J.; Bell, J.; Herkenhoff, K.; Johnson, J.; Knoll, A.; McCartney, E.; McLennan, S.; Metz, J.; Moore, J.; Squyres, S.; Sullivan, R.; Ahronson, O.; Arvidson, R.; Joliff, B.; Golombek, M.; Lewis, K.; Parker, T.; Soderblom, J.

2006-01-01

New observations at Erebus crater (Olympia outcrop) by the Mars Exploration Rover Opportunity between sols 671 and 735 (a sol is a martian day) indicate that a diverse suite of primary and penecontemporaneous sedimentary structures is preserved in sulfate-rich bedrock. Centimeter-scale trough (festoon) cross-lamination is abundant, and is better expressed and thicker than previously described examples. Postdepositional shrinkage cracks in the same outcrop are interpreted to have formed in response to desiccation. Considered collectively, this suite of sedimentary structures provides strong support for the involvement of liquid water during accumulation of sedimentary rocks at Meridiani Planum. ?? 2006 Geological Society of America.

Helping Families Improve: An Evaluation of Two Primary Care Approaches to Parenting Support in the Netherlands

ERIC Educational Resources Information Center

de Graaf, Ireen; Onrust, Simone; Haverman, Merel; Janssens, Jan

2009-01-01

The present study evaluated two primary care parenting interventions. First, we evaluated the most widely used Dutch practices for primary care parenting support. Second, we assessed the applicability of the Primary Care Triple P approach, which is now being utilized in a wide variety of primary care settings. Both interventions target parents of…

Effects of Support on the Attitude of the Primary Caregiver of a Child with Down Syndrome.

ERIC Educational Resources Information Center

Heritage, Jeannette G.; And Others

Parents of children with mental or physical handicaps often experience overwhelming feelings of stress and anxiety. Research indicates that support for the primary caregiver can help alleviate some stressors involved in raising a child with a handicap. This study examined how level of support affects feelings of satisfaction the primary caregiver…

A Self-Study Guide for Managers and Staff of Primary Support Programs for Young People.

ERIC Educational Resources Information Center

Costello, Joan; Barker, Gary; Pickens, Lisa Marie; Cassaniga, Neide; Merry, Sheila; Falcon, Adrienne

Identifying the voluntary activities, programs, and services that children and families use during students' out-of-school time as primary supports, this self-study guide provides a framework for developing primary support programs that allow school-aged children and adolescents to develop physical, cognitive, social, and emotional skills. The…

[Dysfunctionality of the primary family as a supportive factor for the development of polytoxicomany in young people].

PubMed

Nenadović, Milutin M; Šapić, Rosa; Nenadović, Nenad

2012-01-01

Dependent behaviour represents a strong homeostasis of the family of an addict. The aim of our research is to record and explore irregularities during the addicts' growth, as well as the specific type of family relations in the addicts' family. For research purposes a general questionnaire was used on growth and development, and GRADIR questionnaire on the assessment of family relationships. Our results indicate that delinquent behaviour is often found with the addicts before the occurrence of abuse. A significant dysfunctional family of addicts was detected. Families with an addict were not substantially damaged or altered in terms of emotional exchange, but in their structure that enhanced dysfunction leading to addictive behaviour. Emotional investments without control, prohibitions and penalties, contribute to a lack of consciousness that disturbs the process of socialization. Due to the apparent control and the apparent support, the addicts do not have structured organization and socialization. Emotional stimuli without obligation for polytoxicomanes to maintain a reciprocal relationship with their parents influence the parental support of egoistic style of behaviour.

METAShield: Hot Metallic Aeroshell Concept for RLV/SOV

NASA Technical Reports Server (NTRS)

Scotti, Stephen J.; Poteet, Carl C.; Daryabeigi, Kamran; Nowak, Robert J.; Hsu, Su-Yuen; Schmidt, Irvin H.; Ku, Shih-Huei P.

2003-01-01

An innovative fuselage design approach that combines many desirable operational features with a simple and efficient structural approach is being developed by NASA. The approach, named METAShield for MEtallic TransAtmospheric Shield, utilizes lightly loaded, hot aeroshell structures surrounding integral propellant tanks that carry the primary structural loads. The aeroshells are designed to withstand the local pressure loads, transmitting them to the tanks with minimal restraint of thermal growth. No additional thermal protection system protects the METAShield, and a fibrous or multilayer insulation blanket, located in the space between the aeroshell and the tanks, serves as both high temperature and cryogenic insulation for the tanks. The concept is described in detail, and the performance and operational features are highlighted. Initial design results and analyses of the structural, thermal, and thermal-structural performance are described. Computational results evaluating resistance to hypervelocity impact damage, as well as some supporting aerothermal wind tunnel results. are also presented. Future development needs are summarized.

Factor structure of the CES-D and measurement invariance across gender in Mainland Chinese adolescents.

PubMed

Wang, Mengcheng; Armour, Cherie; Wu, Yan; Ren, Fen; Zhu, Xiongzhao; Yao, Shuqiao

2013-09-01

The primary aim was to examine the depressive symptom structure of Mainland China adolescents using the Center for Epidemiologic Studies Depression Scale (CES-D). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were simultaneously conducted to determine the structure of the CES-D in a large scale, representative adolescent samples recruited from Mainland China. Multigroup CFA (N = 5059, 48% boys, mean = 16.55±1.06) was utilized to test the factorial invariance of the depressive symptom structure, which was generated by EFA and confirmed by CFA across gender. The CES-D can be interpreted in terms of 3 symptom dimensions. Additionally, factorial invariance of the new proposed model across gender was supported at all assuming different degrees of invariance. Mainland Chinese adolescents have specific depressive symptom structure, which is consistent across gender. © 2013 Wiley Periodicals, Inc.

Computational analysis of human and mouse CREB3L4 Protein

PubMed Central

Velpula, Kiran Kumar; Rehman, Azeem Abdul; Chigurupati, Soumya; Sanam, Ramadevi; Inampudi, Krishna Kishore; Akila, Chandra Sekhar

2012-01-01

CREB3L4 is a member of the CREB/ATF transcription factor family, characterized by their regulation of gene expression through the cAMP-responsive element. Previous studies identified this protein in mice and humans. Whereas CREB3L4 in mice (referred to as Tisp40) is found in the testes and functions in spermatogenesis, human CREB3L4 is primarily detected in the prostate and has been implicated in cancer. We conducted computational analyses to compare the structural homology between murine Tisp40α human CREB3L4. Our results reveal that the primary and secondary structures of the two proteins contain high similarity. Additionally, predicted helical transmembrane structure reveals that the proteins likely have similar structure and function. This study offers preliminary findings that support the translation of mouse Tisp40α findings into human models, based on structural homology. PMID:22829733

A mixed methods evaluation of peer support in Bristol, UK: mothers', midwives' and peer supporters' views and the effects on breastfeeding.

PubMed

Ingram, Jenny

2013-10-20

International studies suggest that breastfeeding interventions in primary care are more effective than usual care in increasing short and long term breastfeeding rates. Interventions that combine pre- and postnatal components have larger effects than either alone, and those that including lay support in a multicomponent intervention may be more beneficial. Despite the mixed reports of the effectiveness of breastfeeding peer support in the UK, targeted peer support services are being established in many areas of the UK. In 2010, NHS Bristol Primary Care Trust commissioned a targeted breastfeeding peer support service for mothers in 12 lower socio-economic areas of the city, with one antenatal visit and postnatal contact for up to 2 weeks. Mothers receiving the peer support service were invited to complete an on-line survey covering infant feeding; breastfeeding support; and confidence in breastfeeding (using the Breastfeeding Self-Efficacy Scale). Semi-structured interviews and a focus group explored perceptions of mothers, midwives and peer supporters. The effects of the service on breastfeeding rates were documented and compared. 163 mothers completed the on-line survey; 25 participants were interviewed (14 mothers, 7 peer supporters and 4 maternity health professionals); exclusive and total breastfeeding rates for initiation and at 8 weeks were compared for 12 months before and after the service started.The targeted peer support service was associated with small non-significant increases in breastfeeding rates, (particularly exclusive breastfeeding), compared to the rest of the city. The service was very positively evaluated by mothers, health professionals and peer supporters. Mothers felt that peer support increased their confidence to breastfeed; peer supporters found the contacts rewarding, enjoyable and important for mothers; midwives and maternity support workers were positive about the continuity of an antenatal visit and postnatal support from the same local supporter. The introduction of a targeted peer support service was associated with psycho-social benefits for mothers, health professionals and peer supporters. Continuity of peer support with an antenatal visit and postnatal support from the same local supporter was also thought to be beneficial.

Just the Right Amount of Reinforcement

NASA Technical Reports Server (NTRS)

Walton, Greg

1998-01-01

Lockheed Martin Skunk Works, is taking the next step towards economical low-Earth-orbit (LEO) operations with NASA's X-33 technology demonstrator, that uses composite tanks for liquid hydrogen (LH sub2) fuel storage and structural support, The X-33 is a 53% scale model of the VentureStar single-stage-to-orbit (SSTO) reusable launch vehicle(RLV) projected to orbit payloads at a rate, of $1,000 per pound beginning in 2004 In order to make VentureStar completely reusable and economical engineers are using composite materials throughout the spacecrafts structure. The first test of the design comes in 1999 on the X-33 technology demonstrator. Two of the primary structures that engineers will be evaluating are the carbon fiber/epoxy LH2 fuel tanks. The 29-ft long by 18-ft wide tanks, which fill two-thirds of the X-33's interior, serve a dual purpose carrying fuel and providing structural support to the walls of the spacecraft. Fiber placement makes it possible to build the fuel tanks, large, light and strong enough to satisfy X33's requirements. Lockheed Martin choose the fabrication technology to produce the eight sections of each tank because of fiber placement's ability to handle complex surfaces, speed and repeatability.

Decoding the future from past experience: learning shapes predictions in early visual cortex.

PubMed

Luft, Caroline D B; Meeson, Alan; Welchman, Andrew E; Kourtzi, Zoe

2015-05-01

Learning the structure of the environment is critical for interpreting the current scene and predicting upcoming events. However, the brain mechanisms that support our ability to translate knowledge about scene statistics to sensory predictions remain largely unknown. Here we provide evidence that learning of temporal regularities shapes representations in early visual cortex that relate to our ability to predict sensory events. We tested the participants' ability to predict the orientation of a test stimulus after exposure to sequences of leftward- or rightward-oriented gratings. Using fMRI decoding, we identified brain patterns related to the observers' visual predictions rather than stimulus-driven activity. Decoding of predicted orientations following structured sequences was enhanced after training, while decoding of cued orientations following exposure to random sequences did not change. These predictive representations appear to be driven by the same large-scale neural populations that encode actual stimulus orientation and to be specific to the learned sequence structure. Thus our findings provide evidence that learning temporal structures supports our ability to predict future events by reactivating selective sensory representations as early as in primary visual cortex. Copyright © 2015 the American Physiological Society.

Mould design and manufacturing considerations of honeycomb biocomposites with transverse fibre direction for aerospace application

NASA Astrophysics Data System (ADS)

Manan, N. H.; Majid, D. L.; Romli, F. I.

2016-10-01

Sandwich structures with honeycomb core are known to significantly improve stiffness at lower weight and possess high flexural rigidity. They have found wide applications in aerospace as part of the primary structures, as well as the interior paneling and floors. High performance aluminum and aramid are the typical materials used for the purpose of honeycomb core whereas in other industries, materials such as fibre glass, carbon fibre, Nomex and also Kevlar reinforced with polymer are used. Recently, growing interest in developing composite structures with natural fibre reinforcement has also spurred research in natural fibre honeycomb material. The majority of the researches done, however, have generally emphasized on the usage of random chopped fibre and only a few are reported on development of honeycomb structure using unidirectional fibre as the reinforcement. This is mainly due to its processing difficulties, which often involve several stages to account for the arrangement of fibres and curing. Since the use of unidirectional fibre supports greater strength compared to random chopped fibre, a single-stage process in conjunction with vacuum infusion is suggested with a mould design that supports fibre arrangement in the direction of honeycomb loading.

Thermo-mechanical evaluation of carbon-carbon primary structure for SSTO vehicles

NASA Astrophysics Data System (ADS)

Croop, Harold C.; Lowndes, Holland B.; Hahn, Steven E.; Barthel, Chris A.

1998-01-01

An advanced development program to demonstrate carbon-carbon composite structure for use as primary load carrying structure has entered the experimental validation phase. The component being evaluated is a wing torque box section for a single-stage-to-orbit (SSTO) vehicle. The validation or demonstration component features an advanced carbon-carbon design incorporating 3D woven graphite preforms, integral spars, oxidation inhibited matrix, chemical vapor deposited (CVD) oxidation protection coating, and ceramic matrix composite fasteners. The validation component represents the culmination of a four phase design and fabrication development effort. Extensive developmental testing was performed to verify material properties and integrity of basic design features before committing to fabrication of the full scale box. The wing box component is now being set up for testing in the Air Force Research Laboratory Structural Test Facility at Wright-Patterson Air Force Base, Ohio. One of the important developmental tests performed in support of the design and planned testing of the full scale box was the fabrication and test of a skin/spar trial subcomponent. The trial subcomponent incorporated critical features of the full scale wing box design. This paper discusses the results of the trial subcomponent test which served as a pathfinder for the upcoming full scale box test.

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

PubMed Central

2013-01-01

Background The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Methods Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. Results While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services’ responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse “dilemmatic space” in their work. Conclusions The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health’s recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value of community control of PHC services and the types of policy, resource and managerial environments that support action on social determinants is warranted by this study’s findings. PMID:23663304

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints.

PubMed

Baum, Frances E; Legge, David G; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Jolley, Gwyneth M

2013-05-10

The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services' responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse "dilemmatic space" in their work. The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health's recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value of community control of PHC services and the types of policy, resource and managerial environments that support action on social determinants is warranted by this study's findings.

Review: An Australian model of care for co-morbid diabetes and chronic kidney disease.

PubMed

Lo, Clement; Zimbudzi, Edward; Teede, Helena; Cass, Alan; Fulcher, Greg; Gallagher, Martin; Kerr, Peter G; Jan, Stephen; Johnson, Greg; Mathew, Tim; Polkinghorne, Kevan; Russell, Grant; Usherwood, Tim; Walker, Rowan; Zoungas, Sophia

2018-02-05

Diabetes and chronic kidney disease (CKD) are two of the most prevalent co-morbid chronic diseases in Australia. The increasing complexity of multi-morbidity, and current gaps in health-care delivery for people with co-morbid diabetes and CKD, emphasise the need for better models of care for this population. Previously, proposed published models of care for co-morbid diabetes and CKD have not been co-designed with stake-holders or formally evaluated. Particular components of health-care shown to be effective in this population are interventions that: are structured, intensive and multifaceted (treating diabetes and multiple cardiovascular risk factors); involve multiple medical disciplines; improve self-management by the patient; and upskill primary health-care. Here we present an integrated patient-centred model of health-care delivery incorporating these components and co-designed with key stake-holders including specialist health professionals, general practitioners and Diabetes and Kidney Health Australia. The development of the model of care was informed by focus groups of patients and health-professionals; and semi-structured interviews of care-givers and health professionals. Other distinctives of this model of care are routine screening for psychological morbidity; patient-support through a phone advice line; and focused primary health-care support in the management of diabetes and CKD. Additionally, the model of care integrates with the patient-centred health-care home currently being rolled out by the Australian Department of Health. This model of care will be evaluated after implementation across two tertiary health services and their primary care catchment areas. Copyright © 2018 John Wiley & Sons, Ltd. This article is protected by copyright. All rights reserved.

Comparative testing of nondestructive examination techniques for concrete structures

NASA Astrophysics Data System (ADS)

Clayton, Dwight A.; Smith, Cyrus M.

2014-03-01

A multitude of concrete-based structures are typically part of a light water reactor (LWR) plant to provide foundation, support, shielding, and containment functions. Concrete has been used in the construction of nuclear power plants (NPPs) because of three primary properties, its inexpensiveness, its structural strength, and its ability to shield radiation. Examples of concrete structures important to the safety of LWR plants include containment building, spent fuel pool, and cooling towers. Comparative testing of the various NDE concrete measurement techniques requires concrete samples with known material properties, voids, internal microstructure flaws, and reinforcement locations. These samples can be artificially created under laboratory conditions where the various properties can be controlled. Other than NPPs, there are not many applications where critical concrete structures are as thick and reinforced. Therefore, there are not many industries other than the nuclear power plant or power plant industry that are interested in performing NDE on thick and reinforced concrete structures. This leads to the lack of readily available samples of thick and heavily reinforced concrete for performing NDE evaluations, research, and training. The industry that typically performs the most NDE on concrete structures is the bridge and roadway industry. While bridge and roadway structures are thinner and less reinforced, they have a good base of NDE research to support their field NDE programs to detect, identify, and repair concrete failures. This paper will summarize the initial comparative testing of two concrete samples with an emphasis on how these techniques could perform on NPP concrete structures.

PRomotion Of Physical activity through structured Education with differing Levels of ongoing Support for people at high risk of type 2 diabetes (PROPELS): study protocol for a randomized controlled trial.

PubMed

Yates, Tom; Griffin, Simon; Bodicoat, Danielle H; Brierly, Gwen; Dallosso, Helen; Davies, Melanie J; Eborall, Helen; Edwardson, Charlotte; Gillett, Mike; Gray, Laura; Hardeman, Wendy; Hill, Sian; Morton, Katie; Sutton, Stephen; Troughton, Jacqui; Khunti, Kamlesh

2015-07-02

The prevention of type 2 diabetes is recognised as a health care priority. Lifestyle change has proven effective at reducing the risk of type 2 diabetes, but limitations in the current evidence have been identified in: the promotion of physical activity; availability of interventions that are suitable for commissioning and implementation; availability of evidence-based interventions using new technologies; and physical activity promotion among ethnic minorities. We aim to investigate whether a structured education programme with differing levels of ongoing support, including text-messaging, can increase physical activity over a 4 year period in a multi-ethnic population at high risk of diabetes. A multi-centre randomised controlled trial, with follow-up at 12 and 48 months. The primary outcome is change in ambulatory activity at 48 months. Secondary outcomes include changes to markers of metabolic, cardiovascular, anthropometric and psychological health along with cost-effectiveness. Participants aged 40-74 years for White European, or 25-74 years for South Asians, with an HbA1c value of between 6.0 and < 6.4% (42 and 47 mmol/mol) or with a previously recorded plasma glucose level or HbA1c value within the high risk (prediabetes) range within the last five years, are invited to take part in the trial. Participants are identified through primary care, using an automated diabetes risk score within their practice database, or from a database of previous research participants. Participants are randomly assigned to either: 1) the control group who receive a detailed advice leaflet; 2) the Walking Away group, who receive the same leaflet and attend a 3 hour structured education programme with annual maintenance sessions delivered in groups; or 3) the Walking Away Plus group, who receive the leaflet, attend the structured education programme with annual maintenance sessions, plus receive follow-on support through highly-tailored text-messaging and telephone calls to help to aid pedometer use and behaviour change. This study will provide new evidence for the long-term effectiveness of a structured education programme focused on physical activity, conducted within routine care in a multi-ethnic population in the UK. It will also investigate the impact of different levels of ongoing support and the cost-effectiveness of each intervention. ISRCTN83465245 Trial registration date: 14/06/2012.

How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis

PubMed Central

Moran, Valerie; Allen, Pauline; Checkland, Kath; Warwick-Giles, Lynsey; Gore, Oz; Bramwell, Donna; Coleman, Anna

2017-01-01

Objectives From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services. Design We carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs). Setting/participants We conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning. Results Conflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein. Conclusions Devolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs. PMID:29122801

[Social support versus chosen health status indicators in primary care patients].

PubMed

Kurpas, Donata; Piotrowski, Patryk; Marciniak, Doininik; Kasprzak, Maja; MroczekS, Bożena; Nitsch-Osuchi, Aneta; Kasssolik, Krzysztof; Karakiewicz, Beata; Bielska, Dorota; Kiejna, Andrzej

2014-01-01

The purposes of our study were to determine the level of total social support, informational support, instrumental support, appraisal support and emotional support received by patients of primary care as well as factors related to this level with reference to health status and sociodemographic variables. The sample for current analysis included 516 patients of primary care clinics in Poland cooperating with medical universities. Questionnaires: STAI (State-Trait Anxiety Inventory), SCL-90 (Symptom Checklist-90), EPQ-R (Eysenck Personality Questionnaire-Revised), GHQ (General Health Questionnaire)and SSS (Social Support Scale)were used in the study. Results from last two questionnaires are presented in the paper. The highest mean levels were obtained for instrumental support, while the lowest levels were observed for emotional support. The highest means were indicated in the GHQ-28-social dysfunction, the lowest-GHQ-severe depression. Statistically significant relation was found between the level of social support and gender. Less subjectively evaluated total social support as well as instrumental and appraisal support were obtained by women. The highest Spearman score was found in the case of total GHQ-28 score, somatic symptoms, anxiety and insomnia, severe depression and total support. Taking into account the ANOVA findings, it was observed that an increasing GHQ score was associated with intensively increasing emotional support, informative support, appraisal support and the most- instrumental support. The results display the underestimated role of emotional, informational and appraisal support and the overestimated role of instrumental support in primary care. The consequence may be a more frequent using health care accompanied by low level of patients' satisfaction, severity of social dysfunction disorders, particularly in patients with chronic diseases, who constitute an increasingly large group of primary health care.

Medical home implementation: a sensemaking taxonomy of hard and soft best practices.

PubMed

Hoff, Timothy

2013-12-01

The patient-centered medical home (PCMH) model of care is currently a central focus of U.S. health system reform, but less is known about the model's implementation in the practice of everyday primary care. Understanding its implementation is key to ensuring the approach's continued support and success nationally. This article addresses this gap through a qualitative examination of the best practices associated with PCMH implementation for older adult patients in primary care. I used a multicase, comparative study design that relied on a sensemaking approach and fifty-one in-depth interviews with physicians, nurses, and clinic support staff working in six accredited medical homes located in various geographic areas. My emphasis was on gaining descriptive insights into the staff's experiences delivering medical home care to older adult patients in particular and then analyzing how these experiences shaped the staff's thinking, learning, and future actions in implementing medical home care. I found two distinct taxonomies of implementation best practices, which I labeled "hard" and "soft" because of their differing emphasis and content. Hard implementation practices are normative activities and structural interventions that align well with existing national standards for medical home care. Soft best practices are more relational in nature and derive from the existing practice social structure and everyday interactions between staff and patients. Currently, external stakeholders are less apt to recognize, encourage, or incentivize soft best practices. The results suggest that there may be no standardized, one-size-fits-all approach to making medical home implementation work, particularly for special patient populations such as the elderly. My study also raises the issue of broadening current PCMH assessments and reward systems to include implementation practices that contain heavy social and relational components of care, in addition to the emphasis now placed on building structural supports for medical home work. Further study of these softer implementation practices and a continued call for qualitative methodological approaches that gain insight into everyday practice behavior are warranted. © 2013 Milbank Memorial Fund.

The factor structure of the Spanish version of the Work-Family Culture Scale in a sample of workers from the advertising sector.

PubMed

Beléndez Vázquez, Marina; Martín Llaguno, Marta; Hernández Ruiz, Alejandra

2013-01-01

The Work-Family Culture Scale (WFCS) was designed to assess employee perceptions of the extent to which their organizations facilitates a work-family balance. The WFCS comprises three dimensions: Oorganizational time demands, Managerial support and Negative career consequences. The primary purpose of the present study was to analyze the factor structure and reliability of the Spanish version of the Work-Family Culture Scale in a sample of 795 employees (447 females and 348 males) working for twenty-three firms in the Spanish advertising sector. Both EFA and CFA using split-half data sets yielded an 11-item three-factor model (Managerial support, Career consequences and Organizational time demands) that fits the data very well. The findings for structural equation modeling were as follows: χ(2) (41) = 63.85; CFI = .99; GFI = .97; and RMSEA = .038. Internal consistency for the WFCS factors proved adequate. The results of the analysis indicate that this three-factor model confirms previous exploratory analyses of the original scale.

Space Shuttle Solid Rocket Booster Debris Assessment

NASA Technical Reports Server (NTRS)

Kendall, Kristin; Kanner, Howard; Yu, Weiping

2006-01-01

The Space Shuttle Columbia Accident revealed a fundamental problem of the Space Shuttle Program regarding debris. Prior to the tragedy, the Space Shuttle requirement stated that no debris should be liberated that would jeopardize the flight crew and/or mission success. When the accident investigation determined that a large piece of foam debris was the primary cause of the loss of the shuttle and crew, it became apparent that the risk and scope of - damage that could be caused by certain types of debris, especially - ice and foam, were not fully understood. There was no clear understanding of the materials that could become debris, the path the debris might take during flight, the structures the debris might impact or the damage the impact might cause. In addition to supporting the primary NASA and USA goal of returning the Space Shuttle to flight by understanding the SRB debris environment and capability to withstand that environment, the SRB debris assessment project was divided into four primary tasks that were required to be completed to support the RTF goal. These tasks were (1) debris environment definition, (2) impact testing, (3) model correlation and (4) hardware evaluation. Additionally, the project aligned with USA's corporate goals of safety, customer satisfaction, professional development and fiscal accountability.

Group therapy techniques for sexually abused preteen girls.

PubMed

Berman, P

1990-01-01

This article describes an open-ended, structured, highly intensive therapy group for sexually abused preteen girls that was the primary mode of treatment for 11 girls from multiproblem, low-income, rural, white families. The active support of Child Protective Service workers was important in maintaining the girls in treatment in the face of strong parental opposition. Unique features of the group included simultaneous group goals and individualized goals. A case description illustrates the makeup and functioning of the program.

"...he was excluded for the kind of behaviour that we thought he needed support with…" A Qualitative Analysis of the Experiences and Perspectives of Parents Whose Children Have Been Excluded from School

ERIC Educational Resources Information Center

Parker, Claire; Paget, Amelia; Ford, Tamsin; Gwernan-Jones, Ruth

2016-01-01

Exclusion from school is associated with adverse outcomes for young people. There is limited research that explores parents' perspectives, particularly in relation to the exclusion of primary school aged children. The present study used semi-structured interviews with 35 parents of 37 children aged 5-12 years from the Southwest of England. Parents…

Good Seeing: Best Practices for Sustainable Operations at the Air Force Maui Optical and Supercomputing Site

DTIC Science & Technology

2016-01-01

supportive of this work from the start . This research would not have been possible without the contributions made by a number of individuals throughout...and funding structures. We started with these questions in particular based on the primary concerns at AMOS identified in the results of Phase I...from the start . Keck maintains connections with a series of other sites within a remote observing network. Remote observing from the mainland

Repair of Bonded Primary Structure

DTIC Science & Technology

1978-06-01

of the body 2. Operational Items a. lard Landings * Damage to the wheel well area and in proximity of’ the lanuing gear beams b. Foreign Object...their main problems with the C-1 30 are to the ramp hinge support bulkhead and landing gear wheel well area. Lockheed has repair kits for each of these...MAC). The wheel well area is quite .ttsceptible to damage from hard landings. E’xcess runway water causes damage to the wheel well doors. Other

Development and testing of shingle-type solar cell molecules

NASA Technical Reports Server (NTRS)

Shepard, N. F.

1978-01-01

The details of a shingle module design which produces in excess of 97 watts/sq m of module area at 1 kW/sq m insolation and at 60 C are reported. This selected design employs a tempered glass coverplate to provide the primary solar cell structural support. The fabrication and testing of a preproduction module of this design has demonstrated that this selected approach will meet the environmental testing requirements imposed by the contract.

Patients requests and needs for culturally and individually adapted supportive care in type 2 diabetes patients: A comparative study between Nordic and non-Nordic patients in a social economical vulnerable area of Linköping, Sweden.

PubMed

Staff, Angelica; Garvin, Peter; Wiréhn, Ann-Britt; Yngman-Uhlin, Pia

2017-12-01

This study sought to determine and compare the metabolic control of type 2 diabetes mellitus (T2DM) in non-Nordic immigrants and native Nordics. The aim was also to describe and compare the request of supportive care between these two groups. One hundred and eighty-four patients (n=184) coming to a routine check-up in a primary healthcare setting (PHC), were consecutively enrolled to the study during a period of one year. Data on therapeutic interventions, clinical measurements, healthcare consumption, and adherence to standard diabetes healthcare program were extracted from the patientś medical record. Structured interviews on supportive care were conducted by diabetes trained nurses. If needed, a qualified interpreter was used. Comparisons were made between Nordic patients (n=151) and non-Nordic patients (n=33). Among T2DM patients in a setting of PHC, there was a difference in meeting the metabolic target HbA1c, between native Nordics and non-Nordic immigrants. There was also a difference in request on supportive care. The non-Nordic group significantly requested more and different supportive care. They also attended the standard diabetes program to a lesser degree. Culturally/individually adapted prevention is not only medically warranted but also requested by the patients themselves. Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

A Conceptual Model of Natural and Anthropogenic Drivers and Their Influence on the Prince William Sound, Alaska, Ecosystem

PubMed Central

Harwell, Mark A.; Gentile, John H.; Cummins, Kenneth W.; Highsmith, Raymond C.; Hilborn, Ray; McRoy, C. Peter; Parrish, Julia; Weingartner, Thomas

2010-01-01

Prince William Sound (PWS) is a semi-enclosed fjord estuary on the coast of Alaska adjoining the northern Gulf of Alaska (GOA). PWS is highly productive and diverse, with primary productivity strongly coupled to nutrient dynamics driven by variability in the climate and oceanography of the GOA and North Pacific Ocean. The pelagic and nearshore primary productivity supports a complex and diverse trophic structure, including large populations of forage and large fish that support many species of marine birds and mammals. High intra-annual, inter-annual, and interdecadal variability in climatic and oceanographic processes as drives high variability in the biological populations. A risk-based conceptual ecosystem model (CEM) is presented describing the natural processes, anthropogenic drivers, and resultant stressors that affect PWS, including stressors caused by the Great Alaska Earthquake of 1964 and the Exxon Valdez oil spill of 1989. A trophodynamic model incorporating PWS valued ecosystem components is integrated into the CEM. By representing the relative strengths of driver/stressors/effects, the CEM graphically demonstrates the fundamental dynamics of the PWS ecosystem, the natural forces that control the ecological condition of the Sound, and the relative contribution of natural processes and human activities to the health of the ecosystem. The CEM illustrates the dominance of natural processes in shaping the structure and functioning of the GOA and PWS ecosystems. PMID:20862192

A Conceptual Model of Natural and Anthropogenic Drivers and Their Influence on the Prince William Sound, Alaska, Ecosystem.

PubMed

Harwell, Mark A; Gentile, John H; Cummins, Kenneth W; Highsmith, Raymond C; Hilborn, Ray; McRoy, C Peter; Parrish, Julia; Weingartner, Thomas

2010-07-01

Prince William Sound (PWS) is a semi-enclosed fjord estuary on the coast of Alaska adjoining the northern Gulf of Alaska (GOA). PWS is highly productive and diverse, with primary productivity strongly coupled to nutrient dynamics driven by variability in the climate and oceanography of the GOA and North Pacific Ocean. The pelagic and nearshore primary productivity supports a complex and diverse trophic structure, including large populations of forage and large fish that support many species of marine birds and mammals. High intra-annual, inter-annual, and interdecadal variability in climatic and oceanographic processes as drives high variability in the biological populations. A risk-based conceptual ecosystem model (CEM) is presented describing the natural processes, anthropogenic drivers, and resultant stressors that affect PWS, including stressors caused by the Great Alaska Earthquake of 1964 and the Exxon Valdez oil spill of 1989. A trophodynamic model incorporating PWS valued ecosystem components is integrated into the CEM. By representing the relative strengths of driver/stressors/effects, the CEM graphically demonstrates the fundamental dynamics of the PWS ecosystem, the natural forces that control the ecological condition of the Sound, and the relative contribution of natural processes and human activities to the health of the ecosystem. The CEM illustrates the dominance of natural processes in shaping the structure and functioning of the GOA and PWS ecosystems.

Applying Exploratory Structural Equation Modeling to Examine the Student-Teacher Relationship Scale in a Representative Greek Sample.

PubMed

Tsigilis, Nikolaos; Gregoriadis, Athanasios; Grammatikopoulos, Vasilis; Zachopoulou, Evridiki

2018-01-01

Teacher-child relationships in early childhood are a fundamental prerequisite for children's social, emotional, and academic development. The Student-Teacher Relationship Scale (STRS) is one of the most widely accepted and used instruments that evaluate the quality of teacher-child relationships. STRS is a 28-item questionnaire that assess three relational dimensions, Closeness, Conflict, and Dependency. The relevant literature has shown a pattern regarding the difficulty to support the STRS factor structure with CFA, while it is well-documented with EFA. Recently, a new statistical technique was proposed to combine the best of the CFA and EFA namely, the Exploratory Structural Equation Modeling (ESEM). The purpose of this study was (a) to examine the factor structure of the STRS in a Greek national sample. Toward this end, the ESEM framework was applied in order to overcome the limitations of EFA and CFA, (b) to confirm previous findings about the cultural influence in teacher-child relationship patterns, and (c) to examine the invariance of STRS across gender and age. Early educators from a representative Greek sample size of 535 child care and kindergarten centers completed the STRS for 4,158 children. CFA as well as ESEM procedures were implemented. Results showed that ESEM provided better fit to the data than CFA in both groups, supporting the argument that CFA is an overly restrictive approach in comparison to ESEM for the study of STRS. All primary loadings were statistically significant and were associated with their respective latent factors. Contrary to the existing literature conducted in USA and northern Europe, the association between Closeness and Dependency yielded a positive correlation. This finding is in line with previous studies conducted in Greece and confirm the existence of cultural differences in teacher-child relationships. In addition, findings supported the configural, metric, scalar, and variance/covariance equivalence of the STRS between males and females and between preschoolers (3-5 years) and early primary years (5-7 years). Latent factor means comparisons showed that females seem to have a warmer and more dependent relationship with their teachers and are less conflictual in comparison to males.

Applying Exploratory Structural Equation Modeling to Examine the Student-Teacher Relationship Scale in a Representative Greek Sample

PubMed Central

Tsigilis, Nikolaos; Gregoriadis, Athanasios; Grammatikopoulos, Vasilis; Zachopoulou, Evridiki

2018-01-01

Teacher-child relationships in early childhood are a fundamental prerequisite for children's social, emotional, and academic development. The Student-Teacher Relationship Scale (STRS) is one of the most widely accepted and used instruments that evaluate the quality of teacher-child relationships. STRS is a 28-item questionnaire that assess three relational dimensions, Closeness, Conflict, and Dependency. The relevant literature has shown a pattern regarding the difficulty to support the STRS factor structure with CFA, while it is well-documented with EFA. Recently, a new statistical technique was proposed to combine the best of the CFA and EFA namely, the Exploratory Structural Equation Modeling (ESEM). The purpose of this study was (a) to examine the factor structure of the STRS in a Greek national sample. Toward this end, the ESEM framework was applied in order to overcome the limitations of EFA and CFA, (b) to confirm previous findings about the cultural influence in teacher-child relationship patterns, and (c) to examine the invariance of STRS across gender and age. Early educators from a representative Greek sample size of 535 child care and kindergarten centers completed the STRS for 4,158 children. CFA as well as ESEM procedures were implemented. Results showed that ESEM provided better fit to the data than CFA in both groups, supporting the argument that CFA is an overly restrictive approach in comparison to ESEM for the study of STRS. All primary loadings were statistically significant and were associated with their respective latent factors. Contrary to the existing literature conducted in USA and northern Europe, the association between Closeness and Dependency yielded a positive correlation. This finding is in line with previous studies conducted in Greece and confirm the existence of cultural differences in teacher-child relationships. In addition, findings supported the configural, metric, scalar, and variance/covariance equivalence of the STRS between males and females and between preschoolers (3–5 years) and early primary years (5–7 years). Latent factor means comparisons showed that females seem to have a warmer and more dependent relationship with their teachers and are less conflictual in comparison to males. PMID:29867688

Positive influences of home food environment on primary-school children's diet and weight status: a structural equation model approach.

PubMed

Ong, Jia Xin; Ullah, Shahid; Magarey, Anthea; Leslie, Eva

2016-10-01

The mechanism by which the home food environment (HFE) influences childhood obesity is unclear. The present study aimed to investigate the relationship between HFE and childhood obesity as mediated by diet in primary-school children. Cross-sectional data collected from parents and primary-school children participating in the Obesity Prevention and Lifestyle Evaluation Project. Only children aged 9-11 years participated in the study. Matched parent/child data (n 3323) were analysed. Exploratory factor analysis underlined components of twenty-one HFE items; these were linked to child diet (meeting guidelines for fruit, vegetable and non-core food intakes) and measured child BMI, in structural equation modelling, adjusting for confounders. Twenty geographically bounded metropolitan and regional South Australian communities. School children and their parents from primary schools in selected communities. In the initial exploratory factor analysis, nineteen items remaining extracted eight factors with eigenvalues >1·0 (72·4 % of total variance). A five-factor structure incorporating ten items described HFE. After adjusting for age, gender, socio-economic status and physical activity all associations in the model were significant (P<0·05), explaining 9·3 % and 4·5 % of the variance in child diet and BMI, respectively. A more positive HFE was directly and indirectly associated with a lower BMI in children through child diet. The robust statistical methodology used in the present study provides support for a model of direct and indirect dynamics between the HFE and childhood obesity. The model can be tested in future longitudinal and intervention studies to identify the most effective components of the HFE to target in childhood obesity prevention efforts.

A snapshot of the organization and provision of primary care in Turkey

PubMed Central

2011-01-01

Background This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. Methods The WHO Primary Care Evaluation Tool was implemented in two provinces (Bolu and Eskişehir) in Turkey in 2007/08. The Tool consists of three parts: a national questionnaire concerning the organisation and financing of primary care; a questionnaire for family doctors; and a questionnaire for patients who visit a family health centre. Results Primary care has just recently become an official health policy priority with the introduction of a family medicine scheme. Although the supply of family doctors (FDs) has improved, they are geographically uneven distributed, and nationwide shortages of primary care staff remain. Coordination of care could be improved and quality control mechanisms were lacking. However, patients were very satisfied with the treatment by FDs. Conclusions The study provides an overview of the current state of PC in Turkey for two provinces with newly introduced family medicine, by using a structured approach to evaluate the essential functions of PC, including governance, financing, resource generation, as well as the characteristics of a "good" service delivery system (as being accessible, comprehensive, coordinated and continuous). PMID:21542904

Extraction, integration and analysis of alternative splicing and protein structure distributed information

PubMed Central

D'Antonio, Matteo; Masseroli, Marco

2009-01-01

Background Alternative splicing has been demonstrated to affect most of human genes; different isoforms from the same gene encode for proteins which differ for a limited number of residues, thus yielding similar structures. This suggests possible correlations between alternative splicing and protein structure. In order to support the investigation of such relationships, we have developed the Alternative Splicing and Protein Structure Scrutinizer (PASS), a Web application to automatically extract, integrate and analyze human alternative splicing and protein structure data sparsely available in the Alternative Splicing Database, Ensembl databank and Protein Data Bank. Primary data from these databases have been integrated and analyzed using the Protein Identifier Cross-Reference, BLAST, CLUSTALW and FeatureMap3D software tools. Results A database has been developed to store the considered primary data and the results from their analysis; a system of Perl scripts has been implemented to automatically create and update the database and analyze the integrated data; a Web interface has been implemented to make the analyses easily accessible; a database has been created to manage user accesses to the PASS Web application and store user's data and searches. Conclusion PASS automatically integrates data from the Alternative Splicing Database with protein structure data from the Protein Data Bank. Additionally, it comprehensively analyzes the integrated data with publicly available well-known bioinformatics tools in order to generate structural information of isoform pairs. Further analysis of such valuable information might reveal interesting relationships between alternative splicing and protein structure differences, which may be significantly associated with different functions. PMID:19828075

The Impact of Personal Background and School Contextual Factors on Academic Competence and Mental Health Functioning across the Primary-Secondary School Transition

PubMed Central

Vaz, Sharmila; Parsons, Richard; Falkmer, Torbjörn; Passmore, Anne Elizabeth; Falkmer, Marita

2014-01-01

Students negotiate the transition to secondary school in different ways. While some thrive on the opportunity, others are challenged. A prospective longitudinal design was used to determine the contribution of personal background and school contextual factors on academic competence (AC) and mental health functioning (MHF) of 266 students, 6-months before and after the transition to secondary school. Data from 197 typically developing students and 69 students with a disability were analysed using hierarchical linear regression modelling. Both in primary and secondary school, students with a disability and from socially disadvantaged backgrounds gained poorer scores for AC and MHF than their typically developing and more affluent counterparts. Students who attended independent and mid-range sized primary schools had the highest concurrent AC. Those from independent primary schools had the lowest MHF. The primary school organisational model significantly influenced post-transition AC scores; with students from Kindergarten - Year 7 schools reporting the lowest scores, while those from the Kindergarten - Year 12 structure without middle school having the highest scores. Attending a school which used the Kindergarten - Year 12 with middle school structure was associated with a reduction in AC scores across the transition. Personal background factors accounted for the majority of the variability in post-transition AC and MHF. The contribution of school contextual factors was relatively minor. There is a potential opportunity for schools to provide support to disadvantaged students before the transition to secondary school, as they continue to be at a disadvantage after the transition. PMID:24608366

The impact of personal background and school contextual factors on academic competence and mental health functioning across the primary-secondary school transition.

PubMed

Vaz, Sharmila; Parsons, Richard; Falkmer, Torbjörn; Passmore, Anne Elizabeth; Falkmer, Marita

2014-01-01

Students negotiate the transition to secondary school in different ways. While some thrive on the opportunity, others are challenged. A prospective longitudinal design was used to determine the contribution of personal background and school contextual factors on academic competence (AC) and mental health functioning (MHF) of 266 students, 6-months before and after the transition to secondary school. Data from 197 typically developing students and 69 students with a disability were analysed using hierarchical linear regression modelling. Both in primary and secondary school, students with a disability and from socially disadvantaged backgrounds gained poorer scores for AC and MHF than their typically developing and more affluent counterparts. Students who attended independent and mid-range sized primary schools had the highest concurrent AC. Those from independent primary schools had the lowest MHF. The primary school organisational model significantly influenced post-transition AC scores; with students from Kindergarten--Year 7 schools reporting the lowest scores, while those from the Kindergarten--Year 12 structure without middle school having the highest scores. Attending a school which used the Kindergarten--Year 12 with middle school structure was associated with a reduction in AC scores across the transition. Personal background factors accounted for the majority of the variability in post-transition AC and MHF. The contribution of school contextual factors was relatively minor. There is a potential opportunity for schools to provide support to disadvantaged students before the transition to secondary school, as they continue to be at a disadvantage after the transition.

Correlation of the Care by Design primary care practice redesign model and the principles of the patient-centered medical home.

PubMed

Egger, Marlene J; Day, Julie; Scammon, Debra L; Li, Yao; Wilson, Andrew; Magill, Michael K

2012-01-01

Health care reform requires major changes in the organization and delivery of primary care. In 2003, the University of Utah Community Clinics began developing Care by Design (CBD), a primary care model emphasizing access, care teams, and planned care. In 2007, leading primary care organizations published joint principles of the patient-centered medical home (PCMH), the basis for recognition of practices as PCMHs by the National Committee for Quality Assurance (NCQA). The objective of this study was to compare CBD and PCMH metrics conceptually and statistically. This was an observational study in 10 urban and rural primary care clinics including 56 providers. A self-evaluation included the CBD Extent of Use survey and self-estimated PCMH values. The main and secondary outcome measures were CBD scores and PCMH values, respectively. CBD and PCMH principles share common themes such as appropriate access, team-based care, the use of an augmented electronic medical record, planned care, and self-management support. CBD focuses more on the process of practice transformation. The NCQA PCMH standards focus more on structure, including policy, capacity, and populated electronic medical record fields. The Community Clinics' clinic-level PCMH/CBD correlations were low (P > .05.) Practice redesign requires an ability to assess uptake of the redesign as a transformation progresses. The correlation of CBD and PCMH is substantial conceptually but low statistically. PCMH and CBD focus on complementary aspects of redesign: PCMH on structure and CBD on process. Both domains should be addressed in practice reform. Both metrics are works in progress.

Fatigue as a cause, not a consequence of depression and daytime sleepiness: a cross-lagged analysis.

PubMed

Schönberger, Michael; Herrberg, Marlene; Ponsford, Jennie

2014-01-01

To examine the temporal relation between fatigue, depression, and daytime sleepiness after traumatic brain injury. Fatigue is a frequent and disabling consequence of traumatic brain injury (TBI). However, it is unclear whether fatigue is a primary consequence of the structural brain injury or a secondary consequence of injury-related sequelae such as depression and daytime sleepiness. Eighty-eight adults with complicated mild-severe TBI (69% male). Fatigue Severity Scale; depression subscale of the Hospital Anxiety and Depression Scale; Epworth Sleepiness scale at baseline and 6-month follow-up. A cross-lagged path analysis computed within a structural equation modeling framework revealed that fatigue was predictive of depression (β = .20, P < .05) and sleepiness (β = .25, P < .05). However, depression and sleepiness did not predict fatigue (P > .05). The results support the view of fatigue after TBI as "primary fatigue"-that is, a consequence of the structural brain injury rather than a secondary consequence of depression or daytime sleepiness. A rehabilitation approach that assists individuals with brain injury in learning to cope with their neuropsychological and physical limitations in everyday life might attenuate their experience with fatigue.

Identifying clinical and support-service resources and network practices for cancer patients and survivors in southern Puerto Rico

PubMed Central

Castro, Eida M.; Jiménez, Julio C.; Quinn, Gwendolyn; García, Myra; Colón, Yesenia; Ramos, Axel; Brandon, Thomas; Simmons, Vani; Gwede, Clement; Vadaparampil, Susan; Nazario, Cruz María

2015-01-01

Objective The objectives of this study were to identify cancer-related health care services and to explore the presence of inter-organizational interactions among clinical and support oncology services in southern Puerto Rico. Methods From January through July of 2010, a survey was completed by 54 health care organizations offering clinical, supportive, or both services to cancer patients/survivors (CPS) in southern PR. Survey data were compiled and descriptive analyses performed using the software Statistical Package for a Social Science (SPSS), version 18.0. Results The distribution of the primary services provided by the participating organizations was the following: 26 had clinical services, 16 had support services, and 12 offered a combination of clinical and support services. Only 24% of the surveyed organizations offered their services exclusively to patients diagnosed with cancer. In terms of referral practices, 61% of the responses were for medical specialists, 43% were for mental health services, and 37% were referrals for primary care services. The most common reason for interacting (n = 27) was to provide a given patient both an referral and information. Conclusion Findings suggest gaps in both the availability of oncology services and the delivery of integrated health care. Lack of communication among clinical and support organizations (for cancer patients, specifically) could negatively impact the quality of the services that they offer. Further network analysis studies are needed to confirm these gaps. Until systemic, structural changes occur, more efforts are needed to facilitate communication and collaboration among these kinds of organization. PMID:25249352

Sustainability of the integrated chronic disease management model at primary care clinics in South Africa

PubMed Central

Asmall, Shaidah

2016-01-01

Background An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes. Aim The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation. Setting The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa. Methods The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability. Results Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70–79.89) followed by West Rand Health District (70.25 (95% CI: 63.96–76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17–77.83)). Four facilities (11%) had an overall sustainability score of less than 55. Conclusion The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model. PMID:28155314

Standard versus prosocial online support groups for distressed breast cancer survivors: a randomized controlled trial.

PubMed

Lepore, Stephen J; Buzaglo, Joanne S; Lieberman, Morton A; Golant, Mitch; Davey, Adam

2011-08-25

The Internet can increase access to psychosocial care for breast cancer survivors through online support groups. This study will test a novel prosocial online group that emphasizes both opportunities for getting and giving help. Based on the helper therapy principle, it is hypothesized that the addition of structured helping opportunities and coaching on how to help others online will increase the psychological benefits of a standard online group. A two-armed randomized controlled trial with pretest and posttest. Non-metastatic breast cancer survivors with elevated psychological distress will be randomized to either a standard facilitated online group or to a prosocial facilitated online group, which combines online exchanges of support with structured helping opportunities (blogging, breast cancer outreach) and coaching on how best to give support to others. Validated and reliable measures will be administered to women approximately one month before and after the interventions. Self-esteem, positive affect, and sense of belonging will be tested as potential mediators of the primary outcomes of depressive/anxious symptoms and sense of purpose in life. This study will test an innovative approach to maximizing the psychological benefits of cancer online support groups. The theory-based prosocial online support group intervention model is sustainable, because it can be implemented by private non-profit or other organizations, such as cancer centers, which mostly offer face-to-face support groups with limited patient reach. ClinicalTrials.gov: NCT01396174.

Evaluation of the quality of care of a multi-disciplinary Risk Factor Assessment and Management Programme for Hypertension (RAMP-HT).

PubMed

Yu, Esther Yee Tak; Wan, Eric Yuk Fai; Chan, Karina Hiu Yen; Wong, Carlos King Ho; Kwok, Ruby Lai Ping; Fong, Daniel Yee Tak; Lam, Cindy Lo Kuen

2015-06-19

There is some evidence to support a risk-stratified, multi-disciplinary approach to manage patients with hypertension in primary care. The aim of this study is to evaluate the quality of care (QOC) of a multi-disciplinary Risk Assessment and Management Programme for Hypertension (RAMP-HT) for hypertensive patients in busy government-funded primary care clinics in Hong Kong. The objectives are to develop an evidence-based, structured and comprehensive evaluation framework on quality of care, to enhance the QOC of the RAMP-HT through an audit spiral of two evaluation cycles and to determine the effectiveness of the programme in reducing cardiovascular disease (CVD) risk. A longitudinal study is conducted using the Action Learning and Audit Spiral methodologies to measure whether pre-set target standards of care intended by the RAMP-HT are achieved. A structured evaluation framework on the quality of structure, process and outcomes of care has been developed based on the programme objectives and literature review in collaboration with the programme workgroup and health service providers. Each participating clinic is invited to complete a structure of care evaluation questionnaire in each evaluation cycle. The data of all patients who have enrolled into the RAMP-HT in the pre-defined evaluation periods are used for the evaluation of the process and outcomes of care in each evaluation cycle. For evaluation of the effectiveness of RAMP-HT, the primary outcomes including blood pressure (both systolic and diastolic), low-density lipoprotein cholesterol and estimated 10-year CVD risk of RAMP-HT participants are compared to those of hypertensive patients in usual care without RAMP-HT. The QOC and effectiveness of the RAMP-HT in improving clinical and patient-reported outcomes for patients with hypertension in normal primary care will be determined. Possible areas for quality enhancement and standards of good practice will be established to inform service planning and policy decision making.

Advanced solar concentrator: Preliminary and detailed design

NASA Technical Reports Server (NTRS)

Bell, D. M.; Maraschin, R. A.; Matsushita, M. T.; Erskine, D.; Carlton, R.; Jakovcevic, A.; Yasuda, A. K.

1981-01-01

A single reflection point focusing two-axis tracking paraboloidal dish with a reflector aperture diameter of approximately 11 m has a reflective surface made up of 64 independent, optical quality gores. Each gore is a composite of a thin backsilvered mirror glass face sheet continuously bonded to a contoured substrate of lightweight, rigid cellular glass. The use of largely self-supporting gores allows a significant reduction in the weight of the steel support structure as compared to alternate design concepts. Primary emphasis in the preliminary design package for the low-cost, low-weight, mass producible concentrator was placed on the design of the higher cost subsystems. The outer gore element was sufficiently designed to allow fabrication of prototype gores.

Two-axis tracking solar collector mechanism

DOEpatents

Johnson, Kenneth C.

1992-01-01

This invention is a novel solar tracking mechanism incorporating a number of practical features that give it superior environmental resilience and exceptional tracking accuracy. The mechanism comprises a lightweight space-frame assembly supporting an array of point-focus Fresnel lenses in a two-axis tracking structure. The system is enclosed under a glass cover which isolates it from environmental exposure and enhances tracking accuracy by eliminating wind loading. Tracking accuracy is also enhanced by the system's broad-based tracking support. The system's primary intended application would be to focus highly concentrated sunlight into optical fibers for transmission to core building illumination zones, and the system may also have potential for photovoltaic or photothermal solar energy conversion.

Two-axis tracking solar collector mechanism

DOEpatents

Johnson, Kenneth C.

1990-01-01

This invention is a novel solar tracking mechanism incorporating a number of practical features that give it superior environmental resilience and exceptional tracking accuracy. The mechanism comprises a lightweight space-frame assembly supporting an array of point-focus Fresnel lenses in a two-axis tracking structure. The system is enclosed under a glass cover which isolates it from environmental exposure and enhances tracking accuracy by eliminating wind loading. Tracking accuracy is also enhanced by the system's broad-based tracking support. The system's primary intended application would be to focus highly concentrated sunlight into optical fibers for transmission to core building illumination zones, and the system may also have potential for photovoltaic or photothermal solar energy conversion.

Two-axis tracking solar collector mechanism

DOEpatents

Johnson, K.C.

1992-12-08

This invention is a novel solar tracking mechanism incorporating a number of practical features that give it superior environmental resilience and exceptional tracking accuracy. The mechanism comprises a lightweight space-frame assembly supporting an array of point-focus Fresnel lenses in a two-axis tracking structure. The system is enclosed under a glass cover which isolates it from environmental exposure and enhances tracking accuracy by eliminating wind loading. Tracking accuracy is also enhanced by the system's broad-based tracking support. The system's primary intended application would be to focus highly concentrated sunlight into optical fibers for transmission to core building illumination zones, and the system may also have potential for photovoltaic or photothermal solar energy conversion. 16 figs.

The role of organizational context in the implementation of a statewide initiative to integrate mental health services into pediatric primary care.

PubMed

King, Melissa A; Wissow, Lawrence S; Baum, Rebecca A

Although there is evidence that mental health services can be delivered in pediatric primary care with good outcomes, few changes in service delivery have been seen over the past decade. Practices face a number of barriers, making interventions that address determinants of change at multiple levels a promising solution. However, these interventions may need appropriate organizational contexts in place to be successfully implemented. The objective of this study was to test whether organizational context (culture, climate, structures/processes, and technologies) influenced uptake of a complex intervention to implement mental health services in pediatric primary care. We incorporated our research into the implementation and evaluation of Ohio Building Mental Wellness Wave 3, a learning collaborative with on-site trainings and technical assistance supporting key drivers of mental health care implementation. Simple linear regression was used to test the effects of organizational context and external or fixed organizational characteristics on program uptake. Culture, structure/processes, and technologies scores indicating a more positive organizational context for mental health at the project's start, as well as general cultural values that were more group/developmental, were positively associated with uptake. Patient-centered medical home certification and use of electronic medical records were also associated with greater uptake. Changes in context over the course of Building Mental Wellness did not influence uptake. Organizational culture, structures/processes, and technologies are important determinants of the uptake of activities to implement mental health services in pediatric primary care. Interventions may be able to change these aspects of context to make them more favorable to integration, but baseline characteristics more heavily influence the more proximal uptake of program activities. Pediatric primary care practices would benefit from assessing their organizational context and taking steps to address it prior to or in a phased approach with mental health service implementation.

New families of human regulatory RNA structures identified by comparative analysis of vertebrate genomes.

PubMed

Parker, Brian J; Moltke, Ida; Roth, Adam; Washietl, Stefan; Wen, Jiayu; Kellis, Manolis; Breaker, Ronald; Pedersen, Jakob Skou

2011-11-01

Regulatory RNA structures are often members of families with multiple paralogous instances across the genome. Family members share functional and structural properties, which allow them to be studied as a whole, facilitating both bioinformatic and experimental characterization. We have developed a comparative method, EvoFam, for genome-wide identification of families of regulatory RNA structures, based on primary sequence and secondary structure similarity. We apply EvoFam to a 41-way genomic vertebrate alignment. Genome-wide, we identify 220 human, high-confidence families outside protein-coding regions comprising 725 individual structures, including 48 families with known structural RNA elements. Known families identified include both noncoding RNAs, e.g., miRNAs and the recently identified MALAT1/MEN β lincRNA family; and cis-regulatory structures, e.g., iron-responsive elements. We also identify tens of new families supported by strong evolutionary evidence and other statistical evidence, such as GO term enrichments. For some of these, detailed analysis has led to the formulation of specific functional hypotheses. Examples include two hypothesized auto-regulatory feedback mechanisms: one involving six long hairpins in the 3'-UTR of MAT2A, a key metabolic gene that produces the primary human methyl donor S-adenosylmethionine; the other involving a tRNA-like structure in the intron of the tRNA maturation gene POP1. We experimentally validate the predicted MAT2A structures. Finally, we identify potential new regulatory networks, including large families of short hairpins enriched in immunity-related genes, e.g., TNF, FOS, and CTLA4, which include known transcript destabilizing elements. Our findings exemplify the diversity of post-transcriptional regulation and provide a resource for further characterization of new regulatory mechanisms and families of noncoding RNAs.

Structural Model of the Bilitranslocase Transmembrane Domain Supported by NMR and FRET Data.

PubMed

Roy Choudhury, Amrita; Sikorska, Emilia; van den Boom, Johannes; Bayer, Peter; Popenda, Łukasz; Szutkowski, Kosma; Jurga, Stefan; Bonomi, Massimiliano; Sali, Andrej; Zhukov, Igor; Passamonti, Sabina; Novič, Marjana

2015-01-01

We present a 3D model of the four transmembrane (TM) helical regions of bilitranslocase (BTL), a structurally uncharacterized protein that transports organic anions across the cell membrane. The model was computed by considering helix-helix interactions as primary constraints, using Monte Carlo simulations. The interactions between the TM2 and TM3 segments have been confirmed by Förster resonance energy transfer (FRET) spectroscopy and nuclear magnetic resonance (NMR) spectroscopy, increasing our confidence in the model. Several insights into the BTL transport mechanism were obtained by analyzing the model. For example, the observed cis-trans Leu-Pro peptide bond isomerization in the TM3 fragment may indicate a key conformational change during anion transport by BTL. Our structural model of BTL may facilitate further studies, including drug discovery.

Motivational interviewing: experiences of primary care nurses trained in the method.

PubMed

Östlund, Ann-Sofi; Wadensten, Barbro; Kristofferzon, Marja-Leena; Häggström, Elisabeth

2015-03-01

Motivational interviewing is a person-centered counseling style used to promote behavioral change regarding a wide variety of lifestyle problems. Use of motivational interview is growing worldwide and among many different healthcare professions, including primary care nursing. The study aim was to describe motivational interview trained nurses' experiences of motivational interviewing in primary care settings. The study had a qualitative descriptive design. It was carried out in Swedish primary care settings in two county council districts, with 20 primary care nurses trained in motivational interviewing. Half of them used the method in their work, half did not. Qualitative semi-structured interviews were used. Data were analyzed using qualitative content analysis. The nurses experienced that openness to the approach and an encouraging working climate are required to overcome internal resistance and to increase use of motivational interviewing. They also experienced mutual benefit: motivational interviewing elicits and develops abilities in both nurses and patients. For the nurses using it, motivational interviewing is perceived to facilitate work with patients in need of lifestyle change. Lack of training/education, support, interest and appropriate work tasks/patients are reasons for not using motivational interviewing.

Review of behavioral health integration in primary care at Baylor Scott and White Healthcare, Central Region

PubMed Central

Fluet, Norman R.; Reis, Michael D.; Stern, Charles H.; Thompson, Alexander W.; Jolly, Gillian A.

2016-01-01

The integration of behavioral health services in primary care has been referred to in many ways, but ultimately refers to common structures and processes. Behavioral health is integrated into primary care because it increases the effectiveness and efficiency of providing care and reduces costs in the care of primary care patients. Reimbursement is one factor, if not the main factor, that determines the level of integration that can be achieved. The federal health reform agenda supports changes that will eventually permit behavioral health to be fully integrated and will allow the health of the population to be the primary target of intervention. In an effort to develop more integrated services at Baylor Scott and White Healthcare, models of integration are reviewed and the advantages and disadvantages of each model are discussed. Recommendations to increase integration include adopting a disease management model with care management, planned guideline-based stepped care, follow-up, and treatment monitoring. Population-based interventions can be completed at the pace of the development of alternative reimbursement methods. The program should be based upon patient-centered medical home standards, and research is needed throughout the program development process. PMID:27034543

Health care provider experiences in primary care memory clinics: a phenomenological study.

PubMed

Sheiban, Linda; Stolee, Paul; McAiney, Carrie; Boscart, Veronique

2018-05-19

There is a growing need for community-based services for persons with Alzheimer's disease and related dementias (ADRD). Memory clinic (MC) teams in primary care settings have been established to provide care to people with ADRD. To consider wider adoption of these MC teams, insight is needed into the experiences of practitioners working in these models. The purpose of the current study is to explore the experiences of health care providers (HCPs) who work in primary care Memory Clinic (MC) teams to provide care to persons with Alzheimer's disease and related dementias (ADRD). This study utilized a phenomenological methodology to explore experiences of 12 HCPs in two primary care MCs. Semi-structured interviews were completed with each HCP. Interviews were recorded and transcribed verbatim. Colaizzi's steps for analyzing phenomenological data was utilized by the authors. Three themes emerged from the analysis to describe HCP experiences: supporting patients and family members during ADRD diagnosis and treatment, working in a team setting, and personal and professional rewards of caring for people with ADRD and their family members. Findings provide insight into current practices in primary care MCs and on the motivation of HCPs working with persons with ADRD.

Is change in environmental supportiveness between primary and secondary school associated with a decline in children׳s physical activity levels?

PubMed

Coombes, Emma; Jones, Andy; Page, Angie; Cooper, Ashley R

2014-09-01

Using a sample of English schoolchildren, we evaluate whether a change in school local area environmental supportiveness between primary and secondary school is associated with changes in active travel behaviours and physical activity levels. Participant׳s activity levels and travel behaviours were recorded for a week during their primary school final year and secondary school first year. Environmental supportiveness was evaluated using a Geographical Information System. Children attending both a primary and secondary school with a more supportive local environment were more likely to maintain active travel behaviours than those with less supportive environments. However, no trends were apparent with change in school supportiveness and change in physical activity. Policies that focus on the maintenance and uptake of active travel behaviours may help maintain children׳s physical activity levels into adolescence. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Measurement and Analysis of Structural Integrity of Reactor Core Support Structure in Pressurized Water Reactor (PWR) Plant

NASA Astrophysics Data System (ADS)

Ansari, Saleem A.; Haroon, Muhammad; Rashid, Atif; Kazmi, Zafar

2017-02-01

Extensive calculation and measurements of flow-induced vibrations (FIV) of reactor internals were made in a PWR plant to assess the structural integrity of reactor core support structure against coolant flow. The work was done to meet the requirements of the Fukushima Response Action Plan (FRAP) for enhancement of reactor safety, and the regulatory guide RG-1.20. For the core surveillance measurements the Reactor Internals Vibration Monitoring System (IVMS) has been developed based on detailed neutron noise analysis of the flux signals from the four ex-core neutron detectors. The natural frequencies, displacement and mode shapes of the reactor core barrel (CB) motion were determined with the help of IVMS. The random pressure fluctuations in reactor coolant flow due to turbulence force have been identified as the predominant cause of beam-mode deflection of CB. The dynamic FIV calculations were also made to supplement the core surveillance measurements. The calculational package employed the computational fluid dynamics, mode shape analysis, calculation of power spectral densities of flow & pressure fields and the structural response to random flow excitation forces. The dynamic loads and stiffness of the Hold-Down Spring that keeps the core structure in position against upward coolant thrust were also determined by noise measurements. Also, the boron concentration in primary coolant at any time of the core cycle has been determined with the IVMS.

A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review

PubMed Central

2013-01-01

Background Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. Methods A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006–2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006–2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Results Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement – using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. Conclusions All examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements described in this paper, and there appears to be agreement that multiple elements are required to ensure successful and sustained integration efforts. Whilst no one model fits all systems these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings. PMID:24359610

A governance model for integrated primary/secondary care for the health-reforming first world - results of a systematic review.

PubMed

Nicholson, Caroline; Jackson, Claire; Marley, John

2013-12-20

Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006-2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006-2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement - using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. All examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements described in this paper, and there appears to be agreement that multiple elements are required to ensure successful and sustained integration efforts. Whilst no one model fits all systems these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings.

Design, Analysis and Fabrication of Secondary Structural Components for the Habitat Demonstration Unit-Deep Space Habitat

NASA Technical Reports Server (NTRS)

Smith, Russell W.; Langford, William M.

2012-01-01

In support of NASA s Habitat Demonstration Unit - Deep Space Habitat Prototype, a number of evolved structural sections were designed, fabricated, analyzed and installed in the 5 meter diameter prototype. The hardware consisted of three principal structural sections, and included the development of novel fastener insert concepts. The articles developed consisted of: 1) 1/8th of the primary flooring section, 2) an inner radius floor beam support which interfaced with, and supported (1), 3) two upper hatch section prototypes, and 4) novel insert designs for mechanical fastener attachments. Advanced manufacturing approaches were utilized in the fabrication of the components. The structural components were developed using current commercial aircraft constructions as a baseline (for both the flooring components and their associated mechanical fastener inserts). The structural sections utilized honeycomb sandwich panels. The core section consisted of 1/8th inch cell size Nomex, at 9 lbs/cu ft, and which was 0.66 inches thick. The facesheets had 3 plys each, with a thickness of 0.010 inches per ply, made from woven E-glass with epoxy reinforcement. Analysis activities consisted of both analytical models, as well as initial closed form calculations. Testing was conducted to help verify analysis model inputs, as well as to facilitate correlation between testing and analysis. Test activities consisted of both 4 point bending tests as well as compressive core crush sequences. This paper presents an overview of this activity, and discusses issues encountered during the various phases of the applied research effort, and its relevance to future space based habitats.

[Primary care: A definition of the field to develop research].

PubMed

Verga-Gérard, A

2018-03-01

Research in the field of primary care has dramatically increased in France in recent years, especially since 2013 with the introduction of primary care as a thematic priority for research proposals launched by the Ministry of Health (Direction générale de l'offre de soins). The RECaP (Research in Clinical Epidemiology and Public Health) network is a French research network supported by Inserm, which recently implemented a specific working group focusing on research in primary care, based on a multidisciplinary approach. Researchers from different specialties participate in this group. The first aim of the group was to reach a common definition of the perimeter and of the panel of healthcare professionals and structures potentially involved in the field of primary care. For this purpose, a selection of different data sets of sources defining primary care was analyzed by the group, each participant collecting a set of sources, from which a synthesis was made and discussed. A definition of primary care at different levels (international, European and French) was summarized. A special attention was given to the French context in order to adapt the perimeter to the characteristics of the French healthcare system, notably by illustrating the different key elements of the definition with the inclusion of primary care actors and the type of practice premises. In conclusion, this work illustrates the diversity of primary care in France and the potential offered for research purposes. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

User-centered design to improve clinical decision support in primary care.

PubMed

Brunner, Julian; Chuang, Emmeline; Goldzweig, Caroline; Cain, Cindy L; Sugar, Catherine; Yano, Elizabeth M

2017-08-01

A growing literature has demonstrated the ability of user-centered design to make clinical decision support systems more effective and easier to use. However, studies of user-centered design have rarely examined more than a handful of sites at a time, and have frequently neglected the implementation climate and organizational resources that influence clinical decision support. The inclusion of such factors was identified by a systematic review as "the most important improvement that can be made in health IT evaluations." (1) Identify the prevalence of four user-centered design practices at United States Veterans Affairs (VA) primary care clinics and assess the perceived utility of clinical decision support at those clinics; (2) Evaluate the association between those user-centered design practices and the perceived utility of clinical decision support. We analyzed clinic-level survey data collected in 2006-2007 from 170 VA primary care clinics. We examined four user-centered design practices: 1) pilot testing, 2) provider satisfaction assessment, 3) formal usability assessment, and 4) analysis of impact on performance improvement. We used a regression model to evaluate the association between user-centered design practices and the perceived utility of clinical decision support, while accounting for other important factors at those clinics, including implementation climate, available resources, and structural characteristics. We also examined associations separately at community-based clinics and at hospital-based clinics. User-centered design practices for clinical decision support varied across clinics: 74% conducted pilot testing, 62% conducted provider satisfaction assessment, 36% conducted a formal usability assessment, and 79% conducted an analysis of impact on performance improvement. Overall perceived utility of clinical decision support was high, with a mean rating of 4.17 (±.67) out of 5 on a composite measure. "Analysis of impact on performance improvement" was the only user-centered design practice significantly associated with perceived utility of clinical decision support, b=.47 (p<.001). This association was present in hospital-based clinics, b=.34 (p<.05), but was stronger at community-based clinics, b=.61 (p<.001). Our findings are highly supportive of the practice of analyzing the impact of clinical decision support on performance metrics. This was the most common user-centered design practice in our study, and was the practice associated with higher perceived utility of clinical decision support. This practice may be particularly helpful at community-based clinics, which are typically less connected to VA medical center resources. Published by Elsevier B.V.

The Cambridge Structural Database

PubMed Central

Groom, Colin R.; Bruno, Ian J.; Lightfoot, Matthew P.; Ward, Suzanna C.

2016-01-01

The Cambridge Structural Database (CSD) contains a complete record of all published organic and metal–organic small-molecule crystal structures. The database has been in operation for over 50 years and continues to be the primary means of sharing structural chemistry data and knowledge across disciplines. As well as structures that are made public to support scientific articles, it includes many structures published directly as CSD Communications. All structures are processed both computationally and by expert structural chemistry editors prior to entering the database. A key component of this processing is the reliable association of the chemical identity of the structure studied with the experimental data. This important step helps ensure that data is widely discoverable and readily reusable. Content is further enriched through selective inclusion of additional experimental data. Entries are available to anyone through free CSD community web services. Linking services developed and maintained by the CCDC, combined with the use of standard identifiers, facilitate discovery from other resources. Data can also be accessed through CCDC and third party software applications and through an application programming interface. PMID:27048719

The Cambridge Structural Database.

PubMed

Groom, Colin R; Bruno, Ian J; Lightfoot, Matthew P; Ward, Suzanna C

2016-04-01

The Cambridge Structural Database (CSD) contains a complete record of all published organic and metal-organic small-molecule crystal structures. The database has been in operation for over 50 years and continues to be the primary means of sharing structural chemistry data and knowledge across disciplines. As well as structures that are made public to support scientific articles, it includes many structures published directly as CSD Communications. All structures are processed both computationally and by expert structural chemistry editors prior to entering the database. A key component of this processing is the reliable association of the chemical identity of the structure studied with the experimental data. This important step helps ensure that data is widely discoverable and readily reusable. Content is further enriched through selective inclusion of additional experimental data. Entries are available to anyone through free CSD community web services. Linking services developed and maintained by the CCDC, combined with the use of standard identifiers, facilitate discovery from other resources. Data can also be accessed through CCDC and third party software applications and through an application programming interface.

Toward A Scalable, Patient-Centered Community Health Worker Model: Adapting the IMPaCT Intervention for Use in the Outpatient Setting.

PubMed

Kangovi, Shreya; Carter, Tamala; Charles, Dorothy; Smith, Robyn A; Glanz, Karen; Long, Judith A; Grande, David

2016-12-01

Community health worker (CHW) programs are an increasingly popular strategy for patient-centered care. Many health care organizations are building CHW programs through trial and error, rather than implementing or adapting evidence-based interventions. This study used a qualitative design-mapping process to adapt an evidence-based CHW intervention, originally developed and tested in the hospital setting, for use among outpatients with multiple chronic conditions. The study involved qualitative in-depth, semi-structured interviews with chronically ill, uninsured, or Medicaid outpatients from low-income zip codes (n = 21) and their primary care practice staff (n = 30). Three key themes informed adaptation of the original intervention for outpatients with multiple conditions. First, outpatients were overwhelmed by their multiple conditions and wished they could focus on 1 at a time. Thus, the first major revision was to design a low-literacy decision aid that patients and providers could use to select a condition to focus on during the intervention. Second, motivation for health behavior change was a more prominent theme than in the original intervention. It was decided that in addition to providing tailored social support as in the original intervention, CHWs would help patients track progress toward their chronic disease management goals to motivate health behavior change. Third, patients were already connected to primary care; yet they still needed additional support to navigate their clinic once the intervention ended. The intervention was revised to include a weekly clinic-based support group. Structured adaptation using qualitative design mapping may allow for rapid adaptation and scale-up of evidence-based CHW interventions across new settings and populations.

Community structure and trophic ecology of megabenthic fauna from the deep basins in the Interior Sea of Chiloé, Chile (41-43° S)

NASA Astrophysics Data System (ADS)

Zapata-Hernández, Germán; Sellanes, Javier; Thiel, Martin; Henríquez, Camila; Hernández, Sebastián; Fernández, Julio C. C.; Hajdu, Eduardo

2016-11-01

Estuarine environments are complex ecological systems, which depend on multiple inputs of organic sources that could support their benthic communities. The deep-water megabenthic communities of the Interior Sea of Chiloé (ISCh, northern part of the fjord region of Chile) were studied to characterize their taxonomic composition and to trace the energy pathways supporting them by using stable isotope analysis (SIA). Megabenthic and demersal organisms as well as sunken macroalgal debris and terrestrial organic matter (TOM: wood, leaves, branches) were obtained by bottom trawling along an estuarine gradient covering 100-460 m water depth. Additionally, particulate organic matter (POM) and the sedimentary organic matter (SOM) were sampled and carbon (δ13C) and nitrogen (δ15N) isotope ratios were determined for all these organisms and potential food sources. A total of 140 taxa were obtained, including invertebrates (e.g. polychaetes, mollusks, crustaceans and echinoderms) bony fishes, rays and sharks. Based on the stable isotope values it was possible to infer a strong dependence on primary production derived from phytoplankton which is exported to the benthos. A potentially important contribution from sunken macroalgae to megabenthic consumers was established only for some invertebrates, such as the irregular echinoid Tripylaster philippii and the decapod Eurypodius latreillii. The trophic structure metrics suggest a similar isotopic niche width, trophic diversity and species packaging in the food webs among the major basins in the ISCh. It is thus concluded that the benthic food webs are supported principally by surface primary production, but macroalgal subsidies could be exploited by selected invertebrate taxa (e.g. detritivores) and terrestrial carbon pathways are important for certain specialized taxa (e.g. Xylophaga dorsalis).

Structural barriers to coping with type 1 diabetes mellitus in Ghana: experiences of diabetic youth and their families.

PubMed

Kratzer, J

2012-06-01

To explore the structural barriers faced by families coping with type 1 diabetes mellitus (T1DM) in Ghana, and to provide insight for policy development. Qualitative study conducted with families with a child with T1DM, receiving care in the greater Accra area. Total of 17 individuals were interviewed using individual and dyadic approaches: 7 youth with T1DM, 9 parents of children with T1DM, and one medical doctor. 5 key barriers emerged from the data: primary care, schools, financial burden, lack of formal support, and access to information. Participants expressed concern over the misdiagnosis of T1DM at primary care facilities, resulting in some of the children going into a diabetic coma before receiving proper care. Children and parents noted discrimination and poor care at school. Financial burden was due to the high costs of medications and appliances needed for proper diabetes management. A lack of formal support was credited by participants to be the result of the lethargy of advocacy groups or resource centers. Finally, there was a lack of readily available and accessible information for children and parents on T1DM. Awareness of T1DM needs to be increased, by incorporating lessons on recognition into already existing campaigns for type 2 diabetes mellitus (T2DM). Schools need to be more engaged with their responsibility for children with diabetes. Pressuring policy makers and pharmaceutical companies to make diabetes supplies more affordable and accessible could ease the financial burden. Social support networks need to be explored and strengthened. Study into the experiences of youth with T1DM in rural settings and other parts of Ghana, as well as, youth from low socioeconomic backgrounds is necessary.

Dependency-based Siamese long short-term memory network for learning sentence representations

PubMed Central

Zhu, Wenhao; Ni, Jianyue; Wei, Baogang; Lu, Zhiguo

2018-01-01

Textual representations play an important role in the field of natural language processing (NLP). The efficiency of NLP tasks, such as text comprehension and information extraction, can be significantly improved with proper textual representations. As neural networks are gradually applied to learn the representation of words and phrases, fairly efficient models of learning short text representations have been developed, such as the continuous bag of words (CBOW) and skip-gram models, and they have been extensively employed in a variety of NLP tasks. Because of the complex structure generated by the longer text lengths, such as sentences, algorithms appropriate for learning short textual representations are not applicable for learning long textual representations. One method of learning long textual representations is the Long Short-Term Memory (LSTM) network, which is suitable for processing sequences. However, the standard LSTM does not adequately address the primary sentence structure (subject, predicate and object), which is an important factor for producing appropriate sentence representations. To resolve this issue, this paper proposes the dependency-based LSTM model (D-LSTM). The D-LSTM divides a sentence representation into two parts: a basic component and a supporting component. The D-LSTM uses a pre-trained dependency parser to obtain the primary sentence information and generate supporting components, and it also uses a standard LSTM model to generate the basic sentence components. A weight factor that can adjust the ratio of the basic and supporting components in a sentence is introduced to generate the sentence representation. Compared with the representation learned by the standard LSTM, the sentence representation learned by the D-LSTM contains a greater amount of useful information. The experimental results show that the D-LSTM is superior to the standard LSTM for sentences involving compositional knowledge (SICK) data. PMID:29513748

A Framework for Developing a Curriculum Regarding Autism Spectrum Disorders for Primary Care Providers

PubMed Central

Lillystone, David; Dossetor, David; Wilkinson, Helen; Kefford, Carolyn; Eastwood, John; Liaw, Siaw Teng

2015-01-01

Introduction The prevalence of Autism Spectrum Disorders (ASDs) has increased and varies across age groups. Thus there is an increasing need for educational opportunities for General Practitioners (GPs) and other Primary Care providers to help in early identification and referral to specialist services. An earlier survey of GPs in New South Wales (Australia) demonstrated two broad domains for educational activities: (1) a general knowledge (important for early identification and referral) and (2) surveillance (important for ongoing management). Aim To seek further evidence to these domains and synthesize the important contents for educational programs for GPs. Materials and Methods We conducted a (1) Confirmatory Factor Analysis (CFA) on our original survey data and (2) systematic review of the literature to identify important educational topics, using a life cycle approach. Results CFA and literature review support theoretical framework of two domains. Alerts and red flags for ASDs, knowledge of simple surveillance tools, communication of diagnosis with parents, referral pathways particularly to speech pathologists before a formal diagnosis is confirmed, and appreciation of vulnerabilities for identifying supports were important in the general knowledge domain, while supporting the families through transition points such as from pre-school to school entry, secondary school and adolescence, role of psychopharmacology such as medications for sleep issues, and for common co-morbidities of anxiety were important in the surveillance dimension. Conclusion GP supervisors and medical and nursing educators can use findings from this paper for developing structured learning activities for training primary health care workforce regarding ASD’s. PMID:26557583

Diagenetic Microcrystalline Opal Varieties from the Monterey Formation, CA: HRTEM Study of Structures and Phase Transformation Mechanisms

NASA Technical Reports Server (NTRS)

Cady, Sherry L.; Wenk, H.-R.; DeVincenzi, Don (Technical Monitor)

1994-01-01

Microcrystalline opal varieties form as intermediary precipitates during the diagenetic transformation of biogenically precipitated non-crystalline opal (opal-A) to microquartz. With regard to the Monterey Formation of California, X-ray powder diffraction studies have shown that a decrease in the primary d-spacing of opal-CT toward that of cristobalite occurs with increasing diagenesis. The initial timing of opal-CT/quartz formation and the value of the primary opal-CT d-spacing, are influenced by the sediment. lithology. Transmission electron microscopy methods (CTEM/HRTEM) were used to investigate the structure of the diagenetic phases and establish transformation mechanisms between the varieties of microcrystalline opals in charts and porcelanites from the Monterey Formation. HRTEM images revealed that the most common fibrous varieties of microcrystalline opals contain varying amounts of structural disorder. Finite lamellar units of cristobalite-and tridymite-type. layer sequences were found to be randomly stacked in a direction perpendicular to the fiber axis. Disordered and ordered fibers were found to have coprecipitated within the same radial fiber bundles that formed within the matrix of the Most siliceous samples. HRTEM images, which reveal that the fibers within radial and lepispheric fiber bundles branch non-crystallographically, support an earlier proposal that microspheres in chert grow via a spherulitic growth mechanism. A less common variety of opal-CT was found to be characterized by non-parallel (low-angle) stacking sequences that often contain twinned lamellae. Tabular-shaped crystals of orthorhombic tridymite (PO-2) were also identified in the porcelanite samples. A shift in the primary d-spacing of opal-CT has been interpreted as an indication of solid-state ordering g toward a predominantly cristobalite structure, (opal-C). Domains of opal-C were identified as topotactically-oriented overgrowths on discrete Sections of opal-CT fibers and as lamellar domains within relict opal-CT fibers. These findings indicate that the type of transformation mechanism depends upon the primary structural characteristics of the authigenic opaline. varieties that are in turn influenced by the sediment lithology.

The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness.

PubMed

Chin, Weng Yee; Choi, Edmond P H; Chan, Kit T Y; Wong, Carlos K H

2015-01-01

The Center for Epidemiologic Studies Depression Scale (CES-D) is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness. The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9) and the Short Form-12 Health Survey (version 2) Mental Component Summary (SF-12 v2 MCS). The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78) and SF-12 v2 MCS (coefficient: -0.75). Internal consistency was assessed by McDonald's omega hierarchical (ωH). The ωH value for the general depression factor was 0.855. The ωH values for "somatic", "depressed affect", "positive affect" and "interpersonal problems" were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value <0.01 and all effect size statistics >0.2). The CES-D was externally responsive, with the AUC>0.7. The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original four-factor and bi-factor structure, the CES-D is supported for cross-cultural comparisons of depression in multi-center studies.

Shifting plant species composition in response to climate change stabilizes grassland primary production.

PubMed

Liu, Huiying; Mi, Zhaorong; Lin, Li; Wang, Yonghui; Zhang, Zhenhua; Zhang, Fawei; Wang, Hao; Liu, Lingli; Zhu, Biao; Cao, Guangmin; Zhao, Xinquan; Sanders, Nathan J; Classen, Aimée T; Reich, Peter B; He, Jin-Sheng

2018-04-17

The structure and function of alpine grassland ecosystems, including their extensive soil carbon stocks, are largely shaped by temperature. The Tibetan Plateau in particular has experienced significant warming over the past 50 y, and this warming trend is projected to intensify in the future. Such climate change will likely alter plant species composition and net primary production (NPP). Here we combined 32 y of observations and monitoring with a manipulative experiment of temperature and precipitation to explore the effects of changing climate on plant community structure and ecosystem function. First, long-term climate warming from 1983 to 2014, which occurred without systematic changes in precipitation, led to higher grass abundance and lower sedge abundance, but did not affect aboveground NPP. Second, an experimental warming experiment conducted over 4 y had no effects on any aspect of NPP, whereas drought manipulation (reducing precipitation by 50%), shifted NPP allocation belowground without affecting total NPP. Third, both experimental warming and drought treatments, supported by a meta-analysis at nine sites across the plateau, increased grass abundance at the expense of biomass of sedges and forbs. This shift in functional group composition led to deeper root systems, which may have enabled plant communities to acquire more water and thus stabilize ecosystem primary production even with a changing climate. Overall, our study demonstrates that shifting plant species composition in response to climate change may have stabilized primary production in this high-elevation ecosystem, but it also caused a shift from aboveground to belowground productivity.

Use of Social Support during Communication about Sickle Cell Carrier Status

PubMed Central

Bradford, Lisa; Roedl, Sara J.; Christopher, Stephanie A.; Farrell, Michael H.

2012-01-01

Objective To examine the use of social support behaviors by primary care providers during delivery of positive newborn screening results for Sickle Cell Anemia carrier status. Methods Transcripts from 125 primary care providers who conveyed Sickle Cell Anemia carrier status to standardized parents were content analyzed using categories derived from Cutrona and Suhr’s social support taxonomy. Frequencies and cross-tabulation matrices were calculated to study providers’ social support utilization. Results Results showed most primary care providers (80%) incorporate social support behaviors into delivery of Sickle Cell Anemia carrier results and most frequently employed social network (61.6%) and informational support (38.4%) behaviors. Providers used tangible aid (8%), esteem (1.6%), and emotional support (9.6%) behaviors less frequently. Conclusion Cutrona and Suhr’s taxonomy may be a useful tool for assessing supportive communication during the delivery of Sickle Cell Anemia carrier status and could be incorporated into population scale assessments of communication quality assurance. Practice Implications Primary care providers may need training in how to adapt supportive behaviors to parents’ needs during communication of Sickle Cell Anemia carrier status. They also may benefit from specific training about how to use esteem and emotional support. PMID:22658247

Pathways from Maternal Effortful Control to Child Self-Regulation: The Role of Maternal Emotional Support

PubMed Central

Zeytinoglu, Selin; Calkins, Susan D.; Swingler, Margaret M.; Leerkes, Esther M.

2016-01-01

This study examined the direct and indirect pathways from maternal effortful control to two aspects of children’s self-regulation – executive functioning and behavioral regulation – via maternal emotional support. Two hundred and seventy eight children and their primary caregivers (96% mothers) participated in laboratory visits when children were 4 and 5 years, and teachers reported on children’s behavior at kindergarten. At the 4-year assessment, maternal effortful control was measured using the Adult Temperament Questionnaire (ATQ; Evans & Rothbart, 2007) and maternal emotional support was observed during a semi-structured mother-child problem-solving task. At the 5-year assessment, children’s executive functioning was measured using laboratory tasks designed to assess updating/working memory, inhibitory control, and cognitive flexibility, whereas behavioral regulation was assessed via teacher-report questionnaires on children’s attention control, discipline and persistence, and work habits. Results from structural equation modeling indicated that, after controlling for child gender and minority status, and maternal education, maternal effortful control was indirectly associated with both child executive functioning and behavioral regulation through maternal emotional support. Maternal effortful control had a direct association with children’s teacher-reported behavioral regulation but not observed executive functioning. These findings suggest that maternal effortful control may be a key contributing factor to the development of children’s self-regulatory competencies through its impact on maternal emotional support. PMID:27929315

Aeroelastic Optimization of Generalized Tube and Wing Aircraft Concepts Using HCDstruct Version 2.0

NASA Technical Reports Server (NTRS)

Quinlan, Jesse R.; Gern, Frank H.

2017-01-01

Major enhancements were made to the Higher-fidelity Conceptual Design and structural optimization (HCDstruct) tool developed at NASA Langley Research Center (LaRC). Whereas previous versions were limited to hybrid wing body (HWB) configurations, the current version of HCDstruct now supports the analysis of generalized tube and wing (TW) aircraft concepts. Along with significantly enhanced user input options for all air- craft configurations, these enhancements represent HCDstruct version 2.0. Validation was performed using a Boeing 737-200 aircraft model, for which primary structure weight estimates agreed well with available data. Additionally, preliminary analysis of the NASA D8 (ND8) aircraft concept was performed, highlighting several new features of the tool.

Evaluating ecological equivalence of created marshes: comparing structural indicators with stable isotope indicators of blue crab trophic support

USGS Publications Warehouse

Llewellyn, Chris; LaPeyre, Megan K.

2010-01-01

This study sought to examine ecological equivalence of created marshes of different ages using traditional structural measures of equivalence, and tested a relatively novel approach using stable isotopes as a measure of functional equivalence. We compared soil properties, vegetation, nekton communities, and δ13C and δ15N isotope values of blue crab muscle and hepatopancreas tissue and primary producers at created (5-24 years old) and paired reference marshes in SW Louisiana. Paired contrasts indicated that created and reference marshes supported equivalent plant and nekton communities, but differed in soil characteristics. Stable isotope indicators examining blue crab food web support found that the older marshes (8 years+) were characterized by comparable trophic diversity and breadth compared to their reference marshes. Interpretation of results for the youngest site was confounded by the fact that the paired reference, which represented the desired end goal of restoration, contained a greater diversity of basal resources. Stable isotope techniques may give coastal managers an additional tool to assess functional equivalency of created marshes, as measured by trophic support, but may be limited to comparisons of marshes with similar vegetative communities and basal resources, or require the development of robust standardization techniques.

Three-meter balloon-borne telescope

NASA Technical Reports Server (NTRS)

Hoffmann, William F.; Fazio, G. G.; Harper, D. A.

1988-01-01

The Three-Meter Balloon-Borne Telescope is planned as a general purpose facility for making far-infrared and submillimeter astronomical observations from the stratosphere. It will operate throughout the spectral range 30 microns to 1 millimeter which is largely obscurred from the ground. The design is an f/13.5 Cassegrain telescope with an f/1.33 3-meter primary mirror supported with a 3-axis gimbal and stabilization system. The overall structure is 8.0 m high by 5.5 m in width by 4.0 m in depth and weighs 2000 kg. This low weight is achieved through the use of an ultra lightweight primary mirror of composite construction. Pointing and stabilization are achieved with television monitoring of the star field, flex-pivot bearing supports, gyroscopes, and magnetically levitated reaction wheels. Two instruments will be carried on each flight; generally a photometric camera and a spectrometer. A 64-element bolometer array photometric camera operating from 30 to 300 microns is planned as part of the facility. Additional instruments will be derived from KAO and other development programs.

Spectroscopic Results From Blue Hills Observatory of the 2009-2011 Eclipse of epsilon Aurigae

NASA Astrophysics Data System (ADS)

Gorodenski, S. A.

2012-02-01

The purpose of this paper is to report spectroscopic results of epsilon Aurigae during the 2009-2011 eclipse. Spectra of the sodium D lines and an absorption line occurring at approximately 5853Å were taken from February 13, 2010, to October 10, 2011, with an LHIRES III spectrograph and a 16-inch Meade telescope at Blue Hills Observatory in Dewey, Arizona. Equivalent width and radial velocity data support the presence of a void or ring structure within the eclipsing disk, and they support a central disk clearing around an unseen primary central object. The results also indicate the disk does not end at fourth contact but continues for a significant distance. Analysis of radial velocities demonstrated the profile of the 5853Å line has a disk component in addition to the primary F0 star component. A split line at this location was observed. From the equivalent width profile of the 5853Å line the duration of the split line event was estimated to be 101 days. Other lesser results are presented and discussed.

Primary prevention of type 2 diabetes: integrative public health and primary care opportunities, challenges and strategies

PubMed Central

Green, Lawrence W; Brancati, Frederick L; Albright, Ann

2012-01-01

Type 2 diabetes imposes a large and growing burden on the public’s health. This burden, combined with the growing evidence for primary prevention from randomized controlled trials of structured lifestyle programs leads to recommendations to include caloric reduction, increased physical activity and specific assistance to patients in problem solving to achieve modest weight loss as well as pharmacotherapy. These recommendations demand exploration of new ways to implement such primary prevention strategies through more integrated community organization, medical practice and policy. The US experience with control of tobacco use and high blood pressure offers valuable lessons for policy, such as taxation on products, and for practice in a variety of settings, such as coordination of referrals for lifestyle supports. We acknowledge also some notable exceptions to their generalizability. This paper presents possible actions proposed by an expert panel, summarized in Table 1 as recommendations for immediate action, strategic action and research. The collaboration of primary care and public health systems will be required to make many of these recommendations a reality. This paper also provides information on the progress made in recent years by the Division of Diabetes Translation at the US Centers for Disease Control and Prevention (CDC) to implement or facilitate such integration of primary care and public health for primary prevention. PMID:22399542

A shared computer-based problem-oriented patient record for the primary care team.

PubMed

Linnarsson, R; Nordgren, K

1995-01-01

1. INTRODUCTION. A computer-based patient record (CPR) system, Swedestar, has been developed for use in primary health care. The principal aim of the system is to support continuous quality improvement through improved information handling, improved decision-making, and improved procedures for quality assurance. The Swedestar system has evolved during a ten-year period beginning in 1984. 2. SYSTEM DESIGN. The design philosophy is based on the following key factors: a shared, problem-oriented patient record; structured data entry based on an extensive controlled vocabulary; advanced search and query functions, where the query language has the most important role; integrated decision support for drug prescribing and care protocols and guidelines; integrated procedures for quality assurance. 3. A SHARED PROBLEM-ORIENTED PATIENT RECORD. The core of the CPR system is the problem-oriented patient record. All problems of one patient, recorded by different members of the care team, are displayed on the problem list. Starting from this list, a problem follow-up can be made, one problem at a time or for several problems simultaneously. Thus, it is possible to get an integrated view, across provider categories, of those problems of one patient that belong together. This shared problem-oriented patient record provides an important basis for the primary care team work. 4. INTEGRATED DECISION SUPPORT. The decision support of the system includes a drug prescribing module and a care protocol module. The drug prescribing module is integrated with the patient records and includes an on-line check of the patient's medication list for potential interactions and data-driven reminders concerning major drug problems. Care protocols have been developed for the most common chronic diseases, such as asthma, diabetes, and hypertension. The patient records can be automatically checked according to the care protocols. 5. PRACTICAL EXPERIENCE. The Swedestar system has been implemented in a primary care area with 30,000 inhabitants. It is being used by all the primary care team members: 15 general practitioners, 25 district nurses, and 10 physiotherapists. Several years of practical experience of the CPR system shows that it has a positive impact on quality of care on four levels: 1) improved clinical follow-up of individual patients; 2) facilitated follow-up of aggregated data such as practice activity analysis, annual reports, and clinical indicators; 3) automated medical audit; and 4) concurrent audit. Within that primary care area, quality of care has improved substantially in several aspects due to the use of the CPR system [1].

Differential Effects of Carbohydrates on Arabidopsis Pollen Germination.

PubMed

Hirsche, Jörg; García Fernández, José M; Stabentheiner, Edith; Großkinsky, Dominik K; Roitsch, Thomas

2017-04-01

Pollen germination as a crucial process in plant development strongly depends on the accessibility of carbon as energy source. Carbohydrates, however, function not only as a primary energy source, but also as important signaling components. In a comprehensive study, we analyzed various aspects of the impact of 32 different sugars on in vitro germination of Arabidopsis pollen comprising about 150 variations of individual sugars and combinations. Twenty-six structurally different mono-, di- and oligosaccharides, and sugar analogs were initially tested for their ability to support pollen germination. Whereas several di- and oligosaccharides supported pollen germination, hexoses such as glucose, fructose and mannose did not support and even considerably inhibited pollen germination when added to germination-supporting medium. Complementary experiments using glucose analogs with varying functional features, the hexokinase inhibitor mannoheptulose and the glucose-insensitive hexokinase-deficient Arabidopsis mutant gin2-1 suggested that mannose- and glucose-mediated inhibition of sucrose-supported pollen germination depends partially on hexokinase signaling. The results suggest that, in addition to their role as energy source, sugars act as signaling molecules differentially regulating the complex process of pollen germination depending on their structural properties. Thus, a sugar-dependent multilayer regulation of Arabidopsis pollen germination is supported, which makes this approach a valuable experimental system for future studies addressing sugar sensing and signaling. © The Author 2017. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension.

PubMed

Ono, Sarah S; Crabtree, Benjamin F; Hemler, Jennifer R; Balasubramanian, Bijal A; Edwards, Samuel T; Green, Larry A; Kaufman, Arthur; Solberg, Leif I; Miller, William L; Woodson, Tanisha Tate; Sweeney, Shannon M; Cohen, Deborah J

2018-02-01

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality improvement support, practice capacity building, and linking with community resources-to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services.

Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

PubMed Central

Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.

2018-01-01

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality improvement support, practice capacity building, and linking with community resources—to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services. PMID:29401016

Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care

PubMed Central

2014-01-01

Background There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial. Methods This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures. Results All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients. Conclusions This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context. Trial registration Current Controlled Trials ISRCTN31685626. PMID:24886516

Reassembly of adult human testicular cells: can testis cord-like structures be created in vitro?

PubMed

Mincheva, M; Sandhowe-Klaverkamp, R; Wistuba, J; Redmann, K; Stukenborg, J-B; Kliesch, S; Schlatt, S

2018-02-01

Can enzymatically dispersed testicular cells from adult men reassemble into seminiferous cord-like structures in vitro? Adult human testicular somatic cells reassembled into testicular cord-like structures via dynamic interactions of Sertoli and peritubular cells. In vitro approaches using dispersed single cell suspensions of human testes to generate seminiferous tubule structures and to initiate their functionality have as yet shown only limited success. Testes from 15 adult gender dysphoria patients (mean ± standard deviation age 35 ± 9.3 years) showing spermatogonial arrest became available for this study after sex-reassignment surgery. In vitro primary testicular somatic cell cultures were generated to explore the self-organizing ability of testicular somatic cells to form testis cords over a 2-week period. Morphological phenotype, protein marker expression and temporal dynamics of cell reassembly were analyzed. Cell suspensions obtained by two-step enzymatic digestion were plated onto glass coverslips in 24-well plates. To obtain adherent somatic cells, the supernatant was discarded on Day 2. The culture of the attached cell population was continued. Reassembly into cord-like structures was analyzed daily by microscopic observations. Endpoints were qualitative changes in morphology. Cell types were characterized by phase-contrast microscopy and immunohistochemistry. Dynamics of cord formation were recorded by time-lapse microscopy. Primary adult human testicular cells underwent sequential morphological changes including compaction and reaggregation resulting in round or elongated cord-like structures. Time-lapse video recordings within the first 4 days of culture revealed highly dynamic processes of migration and coalescence of reaggregated cells. The cellular movements were mediated by peritubular cells. Immunohistochemical analysis showed that both SRY-related high mobility box 9-positive Sertoli and α-smooth muscle actin-positive peritubular myoid cells interacted and contributed to cord-like structure formation. Not applicable. Owing to scarcity of normal human testicular tissue, testes from gender dysphoria patients were used in the study. The regressed status might influence the experimental responses of primary cells. We observed basic morphological features resembling in vivo testicular cords, however, the proof of functionality (e.g. support of germ cells) will need further studies. The proposed in vitro culture system may open opportunities for examination of testicular cell interactions during testicular tubulogenesis. Further refinement of our approach may enable initiation of ex vivo spermatogenesis. The work was supported by EU-FP7-PEOPLE-2013-ITN 603568: 'Growsperm'. No conflict of interests is declared. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

A systematic review of structured versus non-structured breastfeeding programmes to support the initiation and duration of exclusive breastfeeding in acute and primary healthcare settings.

PubMed

Beake, Sarah; Pellowe, Carol; Dykes, Fiona; Schmied, Virginia; Bick, Debra

2011-01-01

Background: Breastfeeding has many important health benefits for the woman and her baby. Despite evidence of benefit from a large number of well conducted studies, breastfeeding uptake and the duration of exclusive breastfeeding remain low in many countries. In order to improve breastfeeding rates, policy and guidelines at global, individual country level and in local healthcare settings have recommended that structured programmes to support breastfeeding should be introduced. The objective of this review was to consider the evidence of outcomes of structured compared with non-structured breastfeeding programmes in acute maternity care settings to support initiation and duration of exclusive breastfeeding. The definition of structured programme used included a multi-faceted or single intervention approach to support breastfeeding; definition of non-structured included support offered within standard care. The review considered quantitative and qualitative studies which addressed outcomes following the introduction of a structured programme in acute healthcare settings to support breastfeeding compared with no programme. The primary outcomes of interest were uptake of breastfeeding and duration of exclusive breastfeeding (only breast milk, including milk expressed). Studies which only considered community based interventions were not included. A search of the literature published between 1992 and 2010 was conducted, which followed a four step process. After a limited search of MEDLINE and CINAHL to identify key words contained in the title or abstract and index terms to describe relevant interventions, a second extensive search was undertaken using identified key words and index terms. The third step included a search of reference lists and bibliographies of relevant articles and the fourth step included a search of grey and unpublished literature and national databasesMethodological quality: Methodological quality was assessed using checklists developed by the Joanna Briggs Institute. Two independent reviewers conducted critical appraisal and data extraction. Twenty-six articles were included; one randomised controlled trial, two non randomised trials, one cross-sectional study, five systematic reviews, 15 cohort studies and two descriptive studies. Due to the poor quality of evidence presented and clinical and methodological heterogeneity of study designs, including definitions of breastfeeding and duration of follow-up, it was not possible to combine studies or individual outcomes in meta-analyses, therefore findings are presented in a narrative form.In most studies the structured programme of interest reflected some or all of the Baby Friendly Hospital Initiative 'Ten Steps'. Most studies found a statistically significant improvement in initiation of breastfeeding following introduction of a structured breastfeeding programme, although effect sizes varied widely.The impact of introducing a structured programme on the duration of exclusive breastfeeding and duration of any breastfeeding was also evident, although not all studies found statistically significant differences. At hospital discharge or within the first week post-birth, implementation of a structured programme appeared to increase duration of exclusive breastfeeding and the duration of any breastfeeding compared with usual care. After hospital discharge and up to six months post-birth, use of structured programmes also appeared to support continued duration of exclusive and any breastfeeding although differences in outcomes were not reported across all included studies. At six months, three of five studies which included data on longer-term outcomes showed women were statistically significantly more likely to be exclusively breastfeeding. Only one of these studies compared outcomes following implementation of BFHI. Despite the poor overall quality of studies, structured programmes, regardless of content, compared with standard care appear to influence the uptake and duration of exclusive breastfeeding and any breastfeeding. In healthcare settings with low breastfeeding uptake and duration rates, structured programmes may have a greater benefit. In countries where breastfeeding uptake is already high, the benefit is less apparent. The extent to which structured programmes in different maternity acute care settings have a significant effect on the duration of exclusive breastfeeding at six months is less clear. Most of the recommendations of this review were based on observational studies and retrospective data collection. Few studies controlled for any potential confounding factors and the impact of bias has to be considered. Acute maternity care settings should implement structured programmes to support breastfeeding as part of routine maternity care. Programmes can replicate an existing programme, such as the BFHI, in full or in part, or be specifically developed to support implementation of evidence to reflect the needs and demands of the local healthcare organisation. In healthcare settings which have a high uptake of breastfeeding, resources may be better directed at improving support for duration of exclusive breastfeeding in the community. Further high quality RCTs are needed which address the impact of introduction of structured programmes on women's experiences of infant feeding, on the role of the relevant healthcare professionals and on short and longer-term health outcomes. Prospective data capture to inform economic analyses should also be undertaken. Trial interventions need to be well defined and implementation processes described to inform reproducibility across different locations and different country settings. Research is also needed to address the issue of which elements of a structured programme are likely to lead to the most clinical and cost effective use of healthcare resources and to address how sustainable these interventions are in health systems facing increased economic pressures.

New Horizons Observations of the Atmospheres of Pluto and Charon

NASA Astrophysics Data System (ADS)

Gladstone, G. R.; Stern, S. A.; Weaver, H. A.; Young, L. A.; Ennico, K. A.; Olkin, C. B.; Cheng, A. F.; Greathouse, T. K.; Hinson, D. P.; Kammer, J. A.; Linscott, I. R.; Parker, A. H.; Parker, J. Wm.; Retherford, K. D.; Schindhelm, E.; Singer, K. N.; Steffl, A. J.; Strobel, D. F.; Summers, M. E.; Tsang, C. C. C.; Tyler, G. L.; Versteeg, M. H.; Woods, W. W.; Cunningham, N.; Curdt, W.

2015-11-01

Major goals of the New Horizons (NH) mission are to explore and characterize the structure and composition of Pluto’s atmosphere, and to establish whether Charon has a measurable atmosphere of its own. The primary instruments onboard NH which contribute to these goals are the REX instrument, through uplink X-band radio occultations, the Alice instrument, through extreme- and far-ultraviolet solar occultations, and the LORRI panchromatic imager, through high-phase-angle imaging. The associated datasets were obtained following closest approach of NH to Pluto. Pressure and temperature profiles of the lower atmosphere are derived from the REX data, the composition and structure of the extended atmosphere are derived from the Alice data (supported by approach observations of reflected ultraviolet sunlight), and the distribution and properties of Pluto’s hazes are derived from the LORRI data. In this talk an overview of the early atmosphere science results will be presented.This work was supported by NASA's New Horizons project.

Simulation Study of Structure and Properties of Plasma Liners for the PLX- α Project

NASA Astrophysics Data System (ADS)

Samulyak, Roman; Shih, Wen; Hsu, Scott; PLX-Alpha Team

2017-10-01

Detailed numerical studies of the propagation and merger of high-Mach-number plasma jets and the formation and implosion of plasma liners have been performed using the FronTier code in support of the Plasma Liner Experiment-ALPHA (PLX- α) project. Physics models include radiation, physical diffusion, plasma-EOS models, and an anisotropic diffusion model that mimics deviations from fully collisional hydrodynamics in outer layers of plasma jets. Detailed structure and non-uniformity of plasma liners of due to primary and secondary shock waves have been studies as well as averaged quantities of ram pressure and Mach number. Synthetic data from simulations have been compared with available experimental data from a multi-chord interferometer and survey and high-resolution spectrometers. Numerical studies of the sensitivity of liner properties to experimental errors in the initial masses of jets and the synchronization of plasma gun valves have also been performed. Supported by the ARPA-E ALPHA program.

Shuttle Experimental Radar for Geological Exploration (SERGE); antenna and integration concept definition study

NASA Technical Reports Server (NTRS)

Kierein, J. W.

1977-01-01

The baseline configuration defined has the SERGE antenna panel array mounted on the OFT-2 pallet sufficiently high in the bay that negligible amounts of radiation from the beam are reflected from orbiter surfaces into the shuttle payload bay. The array is symmetrically mounted to the pallet along the array long dimension with the pallet at the center. It utilizes a graphite epoxy trusswork support structure. The antenna panels are of SEASAT engineering model design and construction. The antenna array has 7 panels and a 7-way naturally tapered coax corporate feed system. The performance of the system is predicted to exceed 33 db gain, have -15 db sidelobes in the E-plane and even lower in the H-plane, and have and E-plane beamwidth less than 2.2 deg, all within performance specification. The primary support structure is predicted to exceed the specified greater than 25 hertz fundamental frequency, although individual panels will have hertz fundamental frequency.

Influences on water-hammer wave shape: an experimental study

NASA Astrophysics Data System (ADS)

Traudt, T.; Bombardieri, C.; Manfletti, C.

2016-09-01

Water-hammer phenomena are of strong interest in a number of different industrial fields, amongst which the space industry. Here the priming of feedlines during start-up of an engine as well as the rapid closing of valves upon shutdown may lead to pressure peaks symptomatic of a water-hammer wave. Test benches used to conduct tests on future as well as current engines are also sensitive to water-hammer waves traveling along their feedlines. To enhance the understanding of water-hammer, we investigated different configurations and their influence on the wave shape in the frequency domain. The configurations feature a coiled pipe setup with a support structure and without a support structure. Two other phenomena will be presented. We found a beat phenomenon which is likely to be the so called Poisson-coupling beat. Finally we will show that the second water-hammer peak can reach pressures a lot higher than the first peak by additive interference of the primary and secondary water-hammer wave.

Social networks of patients with chronic skin lesions: nursing care.

PubMed

Bandeira, Luciana Alves; Santos, Maxuel Cruz Dos; Duarte, Êrica Rosalba Mallmann; Bandeira, Andrea Gonçalves; Riquinho, Deise Lisboa; Vieira, Letícia Becker

2018-01-01

To describe the social networks of patients with chronic skin damages. A qualitative study conducted through semi-structured interviews with nine subjects with chronic skin lesions from June 2016 to March 2017; we used the theoretical-methodological framework of Lia Sanicola's Social Network. The analysis of the relational maps revealed that the primary network was formed mainly by relatives and neighbors; its characteristics, such as: reduced size, low density and few exchanges/relationships, configures fragility in these links. The secondary network was essentially described by health services, and the nurse was cited as a linker in the therapeutic process. Faced with the fragility of the links and social isolation, the primary health care professionals are fundamental foundations for the construction of networks of social support and care for patients with chronic skin lesions.

Large Deployable Reflector (LDR) system concept and technology definition study. Volume 2: Technology assessment and technology development plan

NASA Technical Reports Server (NTRS)

Agnew, Donald L.; Jones, Peter A.

1989-01-01

A study was conducted to define reasonable and representative LDR system concepts for the purpose of defining a technology development program aimed at providing the requisite technological capability necessary to start LDR development by the end of 1991. This volume presents thirteen technology assessments and technology development plans, as well as an overview and summary of the LDR concepts. Twenty-two proposed augmentation projects are described (selected from more than 30 candidates). The five LDR technology areas most in need of supplementary support are: cryogenic cooling; astronaut assembly of the optically precise LDR in space; active segmented primary mirror; dynamic structural control; and primary mirror contamination control. Three broad, time-phased, five-year programs were synthesized from the 22 projects, scheduled, and funding requirements estimated.

Bolstering the pipeline for primary care: a proposal from stakeholders in medical education

PubMed Central

Shi, Hanyuan; Lee, Kevin C.

2016-01-01

The Association of American Medical Colleges reports an impending shortage of over 90,000 primary care physicians by the year 2025. An aging and increasingly insured population demands a larger provider workforce. Unfortunately, the supply of US-trained medical students entering primary care residencies is also dwindling, and without a redesign in this country's undergraduate and graduate medical education structure, there will be significant problems in the coming decades. As an institution producing fewer and fewer trainees in primary care for one of the poorest states in the United States, we propose this curriculum to tackle the issue of the national primary care physician shortage. The aim is to promote more recruitment of medical students into family medicine through an integrated 3-year medical school education and a direct entry into a local or state primary care residency without compromising clinical experience. Using the national primary care deficit figures, we calculated that each state medical school should reserve 20–30 primary care (family medicine) residency spots, allowing students to bypass the traditional match after successfully completing a series of rigorous externships, pre-internships, core clerkships, and board exams. Robust support, advising, and personal mentoring are also incorporated to ensure adequate preparation of students. The nation's health is at risk. With full implementation in allopathic medical schools in 50 states, we propose a long-term solution that will serve to provide more than 1,000–2,700 new primary care providers annually. Ultimately, we will produce happy, experienced, and empathetic doctors to advance our nation's primary care system. PMID:27389607

Design and development status of the University of Tokyo Atacama Observatory 6.5m telescope

NASA Astrophysics Data System (ADS)

Morokuma, Tomoki; Aoki, Tsutomu; Doi, Mamoru; Handa, Toshihiro; Kamizuka, Takafumi; Kato, Natsuko; Kawara, Kimiaki; Kohno, Kotaro; Konishi, Masahiro; Koshida, Shintaro; Minezaki, Takeo; Miyata, Takashi; Motohara, Kentaro; Sako, Shigeyuki; Soyano, Takao; Takahashi, Hidenori; Tamura, Yoichi; Tanabe, Toshihiko; Tanaka, Masuo; Tarusawa, Ken'ichi; Yoshii, Yuzuru

2014-07-01

We here summarize the design and the current fabrication status for the University of Tokyo Atacama Observatory (TAO) 6.5-m telescope. The TAO telescope is operated at one of the best sites for infrared observations, at the summit of Co. Chajnantor in Chile, and is optimized for infrared observations. The telescope mount, mirrors, and mirror support systems are now at the final design phase. The mechanical and optical designs are done by following and referring to those of the Magellan telescopes, MMT, and Large Binocular Telescope. The final focal ratio is 12.2. The field-of-view is as wide as 25 arcmin in diameter and the plate scale is 2.75 arcsec mm-1. The F/1.25 light-weighted borosilicate (Ohara E6) honeycomb primary mirror is adopted and being fabricated by the Steward Observatory Mirror Laboratory. The primary mirror is supported by 104 loadspreaders bonded to the back surface of the mirror and 6 adjustable hardpoints. The mirror is actively controlled by adjusting the actuator forces based on the realtime wavefront measurement. The actuators are optimized for operation at high altitude of the site, 5640-m above the sea level, by considering the low temperature and low air pressure. The mirror is held in the primary mirror cell which is used as a part of the vacuum chamber when the mirror surface is aluminized without being detached from the cell. The pupil is set at the secondary mirror to minimize infrared radiation into instruments. The telescope has two Nasmyth foci for near-infrared and mid-infrared facility instruments (SWIMS and MIMIZUKU, respectively) and one folded-Caseggrain focus for carry-in instruments. At each focus, autoguider and wavefront measurement systems are attached to achieve seeing-limited image quality. The telescope mount is designed as a tripod-disk type alt-azimuth mount. Both the azimuthal and elevation axes are supported by and run on the hydrostatic bearings. Friction drives are selected for these axis drives. The telescope mount structure and primary mirror support as well as the mirrors are under thermal control and maintained at ambient air temperature to minimize the mirror seeing.

Development of Bonded Joint Technology for a Rigidizable-Inflatable Deployable Truss

NASA Technical Reports Server (NTRS)

Smeltzer, Stanley S., III

2006-01-01

Microwave and Synthetic Aperture Radar antenna systems have been developed as instrument systems using truss structures as their primary support and deployment mechanism for over a decade. NASA Langley Research Center has been investigating fabrication, modular assembly, and deployment methods of lightweight rigidizable/inflatable linear truss structures during that time for large spacecraft systems. The primary goal of the research at Langley Research Center is to advance these existing state-of-the-art joining and deployment concepts to achieve prototype system performance in a relevant space environment. During 2005, the development, fabrication, and testing of a 6.7 meter multi-bay, deployable linear truss was conducted at Langley Research Center to demonstrate functional and precision metrics of a rigidizable/inflatable truss structure. The present paper is intended to summarize aspects of bonded joint technology developed for the 6.7 meter deployable linear truss structure while providing a brief overview of the entire truss fabrication, assembly, and deployment methodology. A description of the basic joint design, surface preparation investigations, and experimental joint testing of component joint test articles will be described. Specifically, the performance of two room temperature adhesives were investigated to obtain qualitative data related to tube folding testing and quantitative data related to tensile shear strength testing. It was determined from the testing that a polyurethane-based adhesive best met the rigidizable/inflatable truss project requirements.

The logic of relations and the logic of management.

PubMed

Buntinx, W

2008-07-01

Increasing emphasis on financial and administrative control processes is affecting service culture in support organisations for persons with intellectual disability. This phenomenon is currently obvious in Dutch service organisations that find themselves in transition towards more community care and at the same time under pressure from new administrative and funding managerial bureaucracy. As a result, the logic of management is becoming more dominant in direct support settings and risk to overshadow the logic of relationships between staff and clients. The article presents a reflection on this phenomenon, starting from a description of service team characteristics as found in the literature. Next, findings about direct support staff (DSS) continuity are summarised from four Dutch studies. Following up these findings, the concept of 'microsystems' is explored as a possible answer to the organisational challenges demonstrated in the studies. Team characteristics, especially team size and membership continuity for DSS, appear relevant factors for assuring supportive relationships and service quality in direct support teams. The structure of the primary support team shows to be of special interest. The organisational concept of 'microsystems' is explored with respect to transcending the present conflict between bureaucratic managerial pressure and the need for supportive relationships. Service organisations need to create structural conditions for the efficacy of direct support teams in terms of client relationships and relevant client outcomes. At the same time, the need for administrative and control processes can not be denied. The concept of 'microsystems', application of a Quality of Life framework and the use of new instruments, such as the Supports Intensity Scale, can contribute to an organisational solution for the present conflicting logic of relations and management.

Social support, family functioning and parenting competence in adolescent parents.

PubMed

Angley, Meghan; Divney, Anna; Magriples, Urania; Kershaw, Trace

2015-01-01

Depression is known to mediate the association between low social support and parenting competence in adult mothers, but this relationship is rarely assessed in adolescent mothers and fathers. The primary aim of this study was to identify the association between social support, family functioning and social capital on parenting competence, including self-efficacy and satisfaction in adolescent mothers and their partners. Secondary aims included identifying potential partner effects (e.g. whether a partner's social support influenced the respondent's parenting efficacy). Data was obtained from a subset of participants from a longitudinal study of pregnant adolescent females and their partners. Couples completed individual structured interviews via audio computer-assisted self-interview during pregnancy and at 6 months postpartum. To measure the influence of support on parenting outcomes, multi-level modeling was used to assess the Actor-Partner Interdependence model, which examines responses from both members of a dyad in a single analysis. Greater social support was associated with increased parenting self-efficacy (B = 0.062, p = 0.006) and parenting satisfaction (B = 0.111, p < 0.001). Higher family functioning was also associated with greater parenting satisfaction (B = 0.05, p = 0.035). Greater partner family functioning was associated with higher parenting satisfaction (B = 0.047, p = 0.026). This study found the importance of a strong support structure during pregnancy on perceived parenting competence in the early postpartum period for young mothers and fathers. Both social support and family functioning during pregnancy were associated with a greater sense of parenting competence, and these associations were mediated by parental depression. The results of this study underscore the importance of providing social support for young expectant fathers as well as mothers.

Differences in the Perception of Social Support Among Rural Area Seniors-A Cross-Sectional Survey of Polish Population.

PubMed

Chruściel, Paweł; Kulik, Teresa; Jakubowska, Klaudia; Nalepa, Dorota

2018-06-19

Introduction and objective : Social support constitutes an important determinant of an elderly person’s health and of functioning in his or her living environment. It depends on available support networks and the type of help received. Measurement of social support should encompass both its structure and the functions it fulfills, which enables detailed assessment of the phenomenon. The aim of the study was to compare the perception of social support among rural area seniors provided with institutional care with those living in a home setting. Material and method : Using the diagnostic survey method and the technique of the distribution of a direct questionnaire, 364 respondents from rural areas were examined: those living in an institutional environment ( n = 190) and those living in their home (natural) environment ( n = 174). The respondents were selected on the basis of a combined sampling method: proportionate, stratified, and systematic. Variables were measured with the following questionnaires: Courage Social Network Index (CSNI) and Social Support Scale (SSS). Results : The living environment has been proved to differentiate average values of support both in the structural and functional dimensions in a statistically significant way ( p < 0.001). An untypical phenomenon was higher average values pertaining to emotional bonds, frequency of direct contacts, and help received in the group of respondents living in an institutional environment. Conclusions : The living environment and demographic variables affect the perception of social support among elderly people. Full-time institutional care of a senior citizen leads to the deterioration of social support; therefore, keeping an elderly person in a home environment should be one of the primary goals of the senior policy.

Exploring the use of Motivational Interviewing with a disengaged primary-aged child

PubMed Central

Cryer, Sarah; Atkinson, Cathy

2015-01-01

Research suggests motivational interviewing (MI) techniques are both widely-used by educational psychologists (EPs) and effective in supporting young people of secondary age. To date, there has been no published research investigating the use of MI with primary-aged children. This study details the use of a short MI-based intervention with a primary-aged pupil identified as disengaged. A case-based approach was employed, using pupil and teacher interviews and observational fieldnotes to assess the usefulness of the intervention. Data were analysed using thematic analysis and the intervention checked for adherence to the MI spirit and principles. Here the process, structure and outcomes of the intervention are exemplified through an illustrative case study with a nine-year-old boy. Results indicate that the adapted intervention had a significant impact on learning motivation and classroom behaviour. The implications of the findings are discussed in relation to the use of school-based therapeutic interventions by EPs. PMID:26339113

Developmentally and Culturally Appropriate Screening in Primary Care: Development of the Behavioral Health Checklist

PubMed Central

Koshy, Anson J.; Watkins, Marley W.; Cassano, Michael C.; Wahlberg, Andrea C.; Mautone, Jennifer A.; Blum, Nathan J.

2013-01-01

Objective To evaluate the construct validity of the Behavioral Health Checklist (BHCL) for children aged from 4 to 12 years from diverse backgrounds. Method The parents of 4–12-year-old children completed the BHCL in urban and suburban primary care practices affiliated with a tertiary-care children’s hospital. Across practices, 1,702 were eligible and 1,406 (82.6%) provided consent. Children of participating parents were primarily non-Hispanic black/African American and white/Caucasian from low- to middle-income groups. Confirmatory factor analyses examined model fit for the total sample and subsamples defined by demographic characteristics. Results The findings supported the hypothesized 3-factor structure: Internalizing Problems, Externalizing Problems, and Inattention/Hyperactivity. The model demonstrated adequate to good fit across age-groups, gender, races, income groups, and suburban versus urban practices. Conclusion The findings provide strong evidence of the construct validity, developmental appropriateness, and cultural sensitivity of the BHCL when used for screening in primary care. PMID:23978505

Secondary and compound concentrators for parabolic dish solar thermal power systems

NASA Technical Reports Server (NTRS)

Jaffe, L. D.; Poon, P. T.

1981-01-01

A secondary optical element may be added to a parabolic dish solar concentrator to increase the geometric concentration ratio attainable at a given intercept factor. This secondary may be a Fresnel lens or a mirror, such as a compound elliptic concentrator or a hyperbolic trumpet. At a fixed intercept factor, higher overall geometric concentration may be obtainable with a long focal length primary and a suitable secondary matched to it. Use of a secondary to increase the geometric concentration ratio is more likely to e worthwhile if the receiver temperature is high and if errors in the primary are large. Folding the optical path with a secondary may reduce cost by locating the receiver and power conversion equipment closer to the ground and by eliminating the heavy structure needed to support this equipment at the primary focus. Promising folded-path configurations include the Ritchey-Chretien and perhaps some three element geometries. Folding the optical path may be most useful in systems that provide process heat.

Demonstration of a Segment Alignment Maintenance System on a Seven-Segment Sub-Array of the Hobby-Eberly Telescope

NASA Technical Reports Server (NTRS)

Rakoczy, John; Whitaker, Ann F. (Technical Monitor)

2001-01-01

NASA's Marshall Space Flight Center, in collaboration with Blue Line Engineering of Colorado Springs, Colorado, is developing a Segment Alignment Maintenance System (SAMS) for McDonald Observatory's Hobby-Eberly Telescope (HET). The SAMS shall sense motions of the 91 primary mirror segments and send corrections to HET's primary mirror controller as the mirror segments misalign due to thermo-elastic deformations of the mirror support structure. The SAMS consists of inductive edge sensors supplemented by inclinometers for global radius of curvature sensing. All measurements are sent to the SAMS computer where mirror motion corrections are calculated. In October 2000, a prototype SAMS was installed on a seven-segment cluster of the HET. Subsequent testing has shown that the SAMS concept and architecture are a viable practical approach to maintaining HET's primary mirror figure, or the figure of any large segmented telescope. This paper gives a functional description of the SAMS sub-array components and presents test data to characterize the performance of the sub-array SAMS.

Biocompatibility of cluster-assembled nanostructured TiO2 with primary and cancer cells.

PubMed

Carbone, Roberta; Marangi, Ida; Zanardi, Andrea; Giorgetti, Luca; Chierici, Elisabetta; Berlanda, Giuseppe; Podestà, Alessandro; Fiorentini, Francesca; Bongiorno, Gero; Piseri, Paolo; Pelicci, Pier Giuseppe; Milani, Paolo

2006-06-01

We have characterized the biocompatibility of nanostructured TiO2 films produced by the deposition of a supersonic beam of TiOx clusters. Physical analysis shows that these films possess, at the nanoscale, a granularity and porosity mimicking those of typical extracellular matrix structures and adsorption properties that could allow surface functionalization with different macromolecules such as DNA, proteins, and peptides. To explore the biocompatibility of this novel nanostructured surface, different cancer and primary cells were analyzed in terms of morphological appearance (by bright field microscopy and immunofluorescence) and growth properties, with the aim to evaluate cluster-assembled TiO2 films as substrates for cell-based and tissue-based applications. Our results strongly suggest that this new biomaterial supports normal growth and adhesion of primary and cancer cells with no need for coating with ECM proteins; we thus propose this new material as an optimal substrate for different applications in cell-based assays, biosensors or microfabricated medical devices.

Alignment between Chronic Disease Policy and Practice: Case Study at a Primary Care Facility

PubMed Central

Draper, Claire A.; Draper, Catherine E.; Bresick, Graham F.

2014-01-01

Background Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. Methods One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. Results The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Conclusions Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting. PMID:25141191

Alignment between chronic disease policy and practice: case study at a primary care facility.

PubMed

Draper, Claire A; Draper, Catherine E; Bresick, Graham F

2014-01-01

Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting.

The McCanse Readiness for Death Instrument (MRDI): a reliable and valid measure for hospice care.

PubMed

McCanse, R P

1995-01-01

The purpose of this study was to establish whether or not readiness for death, as an indicator of healthy dying, is a measurable concept. Review of relevant literature revealed consensus regarding the universality of a human need for healthy dying. A theory of healthy dying was derived from the Rogerian paradigm. The McCanse Readiness for Death Instrument (MRDI) was constructed, which included indicators of physiological, psychological, sociological, and spiritual aspects of "healthy" field pattern as death is developmentally approached. The MRDI was a 26-item structured interview questionnaire which generated interval-ratio data through a visual analog scale. A pretest was conducted with a sample of 9 volunteer patients drawn from a small suburban outpatient hospice. The MRDI was concurrently administered to dying individuals, their primary caregivers, and their primary hospice nurses. Correlations between dying individuals' scores and their primary caregivers' estimates of patient death readiness as well as between patients and their primary hospice nurses were very encouraging. Cronbach's coefficient alpha for internal consistency reliability was .59. Content validity was supported by consensus of an expert panel of practicing hospice nurses. Construct validity was demonstrated through legitimate placement of the concept, healthy death readiness, within the theoretical web which supported it. The MRDI was then administered to a sample of 31 terminally-ill individuals, their primary caregivers, and their primary hospice nurses drawn from larger, urban hospice populations in three geographic areas of the United States. The MRDI was also administered to a contrast group of 39 cardiac-impaired individuals who were not terminally-ill. Overall internal consistency of the MRDI was found to be quite favorable (alpha = .76). Debilitating illness and actual mortality in the study sample precluded and/or confounded estimates of test-retest reliability. Convergent validity of the MRDI was indicated by significant correlations between patients' scores and primary caregivers' estimates (r = .35, p < .05) and between patients' scores and primary hospice nurses' estimates (r = .53, p < .01). Discriminant validity of the MRDI was demonstrated by a significant mean difference between the group of terminally-ill patients and the group of non-terminal, cardiac-impaired patients (t = 1.76, p < .01).

Women with spontaneous 46,XX primary ovarian insufficiency (hypergonadotropic hypogonadism) have lower perceived social support than control women

PubMed Central

Orshan, Susan A.; Ventura, June L.; Covington, Sharon N.; Vanderhoof, Vien H.; Troendle, James F.; Nelson, Lawrence M.

2009-01-01

Objective To test the hypothesis that women with spontaneous primary ovarian insufficiency differ from control women with regard to perceived social support and to investigate the relationship between perceived social support and self-esteem. Design Cross-sectional Setting Mark O. Hatfield Clinical Research Center, National Institutes of Health. Patient(s) Women diagnosed with spontaneous primary ovarian insufficiency (N=154) at a mean age of 27 years and healthy control women (N=63). Intervention(s) Administration of validated self-reporting instruments. Main Outcome Measure(s) Personal Resource Questionnaire-85 (PRQ85), Rosenberg Self-Esteem Scale Result(s) Women with primary ovarian insufficiency had significantly lower scores than controls on the perceived social support scale and the self-esteem scale. The findings remained significant after modeling with multivariate regression for differences in age, marital status, and having children. In patients there was a significant positive correlation between self-esteem scores and perceived social support. We found no significant differences in perceived social support or self-esteem related to marital status, whether or not they had children, or time since diagnosis. Conclusion(s) This evidence supports the need for prospective controlled studies. Strategies to improve social support and self-esteem might provide a therapeutic approach to reduce the emotional suffering that accompanies the life-altering diagnosis of spontaneous primary ovarian insufficiency. PMID:18829005

[The Jena Anxiety Monitoring List (JAMoL) - a tool for the evidence-based treatment of panic disorder with or without agoraphobia in primary care].

PubMed

Hiller, Thomas Stephan; Freytag, Antje; Breitbart, Jörg; Teismann, Tobias; Schöne, Elisabeth; Blank, Wolfgang; Schelle, Mercedes; Vollmar, Horst Christian; Margraf, Jürgen; Gensichen, Jochen

2018-04-01

Behavior therapy-oriented methods are recommended for treating anxiety disorders in primary care. The treatment of patients with long-term conditions can be improved by case management and structured clinical monitoring. The present paper describes the rationale, design and application of the 'Jena Anxiety Monitoring List' (JAMoL), a monitoring tool for the treatment of patients with panic disorder, with or without agoraphobia, in primary care. JAMoL's design was based on established clinical measures, the rationale of exposure-based anxiety treatment, and research on family practice-based case management. After piloting, the JAMoL was used in the clinical study 'Jena-PARADISE' (ISRCTN64669297), where non-physician practice staff monitored patients with panic disorder by telephone. Using semi-structured interviews in concomitant studies, study participants were asked about the instrument's functionality. The JAMoL assesses the severity of anxiety symptoms (6 items) as well as the patient's adherence to therapy (4 items) and fosters the case management-related information exchange (3 items). An integrated traffic light scheme facilitates the evaluation of monitoring results. Within the clinical study, non-physician practice staff carried out a total of 1,525 JAMoL-supported monitoring calls on 177 patients from 30 primary care practices (median calls per patient: 10 [interquartile range, 9-10]). Qualitative analyses revealed that most practice teams and patients rated the JAMoL as a practicable and treatment-relevant tool. The JAMoL enables primary care practice teams to continuously monitor anxiety symptoms and treatment adherence in patients with panic disorder with or without agoraphobia. Within the behavior therapy-oriented treatment program 'Jena-PARADISE', the JAMoL constitutes an important case management tool. Copyright © 2018. Published by Elsevier GmbH.

Health for Life in Primary Schools Program, United Kingdom: a Program Impact Pathways (PIP) analysis.

PubMed

Passmore, Sandra; Donovan, Martin

2014-09-01

The Health for Life in Primary Schools Program helps schools promote healthy, active lifestyles through curriculum support related to healthy eating and cooking, growing food, physical activity, and family involvement. These interrelated strands are shown to have the greatest impact on healthy lifestyles, and the Health for Life in Primary Schools Program seeks to make these not one-off lessons, but a sustainable part of a school's culture. Each school involved with the program develops its own Action Plan in order to achieve program goals. Each school is assessed by an audit of facilities, skills, and curriculum at baseline and follow-up, and the pupils complete an on-line questionnaire at baseline and follow-up. Other impact measures are individual to the school and relate to its own Action Plan. Health for Life in Primary Schools sought to assess the cohesiveness and strength of the program using the Program Impact Pathways (PIP) model. The program was deconstructed to its individual parts, with each part assessed in terms of its contribution to the overall program and constraints upon its effectiveness. The PIP analysis helped clarify the logic and structure of the program, whether its objectives can be achieved, the Critical Quality Control Points (CCPs), and the impact measures required to demonstrate success. The core indicators identified for impact evaluation were knowledge, attitudes, and behaviors of pupils around healthy eating cooking, growing food, and physical activity. The PIP model confirmed that the Health for Life in Primary Schools Program is well structured and is well suited to achieve its goals. The findings were presented at the Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation.

Improving Interlaminar Shear Strength

NASA Technical Reports Server (NTRS)

Jackson, Justin

2015-01-01

To achieve NASA's mission of space exploration, innovative manufacturing processes are being applied to the fabrication of complex propulsion elements.1 Use of fiber-reinforced, polymeric composite tanks are known to reduce weight while increasing performance of propulsion vehicles. Maximizing the performance of these materials is needed to reduce the hardware weight to result in increased performance in support of NASA's missions. NASA has partnered with the Mississippi State University (MSU) to utilize a unique scalable approach of locally improving the critical properties needed for composite structures. MSU is responsible for the primary development of the concept with material and engineering support provided by NASA. The all-composite tank shown in figure 1 is fabricated using a prepreg system of IM7 carbon fiber/CYCOM 5320-1 epoxy resin. This is a resin system developed for out-of-autoclave applications. This new technology is needed to support the fabrication of large, all composite structures and is currently being evaluated on a joint project with Boeing for the Space Launch System (SLS) program. In initial efforts to form an all composite pressure vessel using this prepreg system, a 60% decrease in properties was observed in scarf joint regions. Inspection of these areas identified interlaminar failure in the adjacent laminated structure as the main failure mechanism. This project seeks to improve the interlaminar shear strength (ILSS) within the prepreg layup by locally modifying the interply region shown in figure 2.2

Collateral benefits of the family check-up in early childhood: primary caregivers' social support and relationship satisfaction.

PubMed

McEachern, Amber D; Fosco, Gregory M; Dishion, Thomas J; Shaw, Daniel S; Wilson, Melvin N; Gardner, Frances

2013-04-01

This research investigated potential collateral benefits of the Family Check-Up (FCU) intervention, namely, primary caregivers' perceived social support and couple relationship satisfaction. A subsample of 435 low-income families with a 2-year-old child was recruited to participate in a randomized controlled trial assessing preventative effects of the FCU. Longitudinal growth models were used to evaluate intention-to-treat effects of the FCU on increases in primary caregivers' ratings of social support satisfaction with perceived social support and significant-other relationships, and indirect effects on primary caregivers through improvements in children's behavior problems. Support was found for a model in which reductions in child problem behavior from ages 2 to 4 predicted positive change in caregiver-rated social support and relationship satisfaction over a 3-year period. This indirect effects model is discussed with respect to implications for early childhood prevention research focused on improving family functioning. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Collateral Benefits of the Family Check-Up in Early Childhood: Primary Caregivers’ Social Support and Relationship Satisfaction

PubMed Central

McEachern, Amber D.; Dishion, Thomas J.; Wilson, Melvin N.; Fosco, Gregory M.; Shaw, Daniel S.; Gardner, Frances

2013-01-01

This research investigated potential collateral benefits of the Family Check-Up (FCU) intervention, namely, primary caregivers’ perceived social support and couple relationship satisfaction. A subsample of 435 low-income families with a 2-year-old child was recruited to participate in a randomized controlled trial assessing preventative effects of the FCU. Longitudinal growth models were used to evaluate intention-to-treat effects of the FCU on increases in primary caregivers’ ratings of social support satisfaction with perceived social support and significant-other relationships, and indirect effects on primary caregivers through improvements in children's behavior problems. Support was found for a model in which reductions in child problem behavior from ages 2 to 4 predicted positive change in caregiver-rated social support and relationship satisfaction over a 3-year period. This indirect effects model is discussed with respect to implications for early childhood prevention research focused on improving family functioning. PMID:23458695

A model for the electronic support of practice-based research networks.

PubMed

Peterson, Kevin A; Delaney, Brendan C; Arvanitis, Theodoros N; Taweel, Adel; Sandberg, Elisabeth A; Speedie, Stuart; Richard Hobbs, F D

2012-01-01

The principal goal of the electronic Primary Care Research Network (ePCRN) is to enable the development of an electronic infrastructure to support clinical research activities in primary care practice-based research networks (PBRNs). We describe the model that the ePCRN developed to enhance the growth and to expand the reach of PBRN research. Use cases and activity diagrams were developed from interviews with key informants from 11 PBRNs from the United States and United Kingdom. Discrete functions were identified and aggregated into logical components. Interaction diagrams were created, and an overall composite diagram was constructed describing the proposed software behavior. Software for each component was written and aggregated, and the resulting prototype application was pilot tested for feasibility. A practical model was then created by separating application activities into distinct software packages based on existing PBRN business rules, hardware requirements, network requirements, and security concerns. We present an information architecture that provides for essential interactions, activities, data flows, and structural elements necessary for providing support for PBRN translational research activities. The model describes research information exchange between investigators and clusters of independent data sites supported by a contracted research director. The model was designed to support recruitment for clinical trials, collection of aggregated anonymous data, and retrieval of identifiable data from previously consented patients across hundreds of practices. The proposed model advances our understanding of the fundamental roles and activities of PBRNs and defines the information exchange commonly used by PBRNs to successfully engage community health care clinicians in translational research activities. By describing the network architecture in a language familiar to that used by software developers, the model provides an important foundation for the development of electronic support for essential PBRN research activities.

Alignment and testing of critical interface fixtures for the James Webb Space Telescope

NASA Astrophysics Data System (ADS)

McLean, Kyle; Bagdanove, Paul; Berrier, Joshua; Cofie, Emmanuel; Glassman, Tiffany; Hadjimichael, Theodore; Johnson, Eric; Levi, Joshua; Lo, Amy; McMann, Joseph; Ohl, Raymond; Osgood, Dean; Parker, James; Redman, Kevin; Roberts, Vicki; Stephens, Matthew; Sutton, Adam; Wenzel, Greg; Young, Jerrod

2017-08-01

NASA's James Webb Space Telescope (JWST) is a 6.5m diameter, segmented, deployable telescope for cryogenic IR space astronomy. The JWST Observatory architecture includes the Primary Mirror Backplane Support Structure (PMBSS) and Integrated Science Instrument Module (ISIM) Electronics Compartment (IEC) which is designed to integrate to the spacecraft bus via six cup/cone interfaces. Prior to integration to the spacecraft bus, the JWST observatory must undergo environmental testing, handling, and transportation. Multiple fixtures were developed to support these tasks including the vibration fixture and handling and integration fixture (HIF). This work reports on the development of the nominal alignment of the six interfaces and metrology operations performed for the JWST observatory to safely integrate them for successful environmental testing.

Alignment and Testing of Critical Interface Fixtures for the James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Mclean, Kyle; Bagdanove, Paul; Berrier, Joshua; Cofie, Emmanuel; Glassman, Tiffany; Hadjimichael, Theodore; Johnson, Eric; Levi, Joshua; Lo, Amy; McMann, Joseph;

Alignment and Testing of Critical Interface Fixtures for the James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Mclean, Kyle; Bagdanove, Paul; Berrier, Joshua; Cofie, Emmanuel; Glassman, Tiffany; Hadjimichael, Theodore; Johnson, Eric; Levi, Joshua; Lo, Amy; McMann, Joseph;

Achieving Value in Primary Care: The Primary Care Value Model.

PubMed

Rollow, William; Cucchiara, Peter

2016-03-01

The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation. © 2016 Annals of Family Medicine, Inc.

Supporting the use of theory in cross-country health services research: a participatory qualitative approach using Normalisation Process Theory as an example

PubMed Central

Mair, Frances S; Dowrick, Christopher; Brún, Mary O’Reilly-de; de Brún, Tomas; Burns, Nicola; Lionis, Christos; Saridaki, Aristoula; Papadakaki, Maria; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; Gravenhorst, Katja; Cooper, Lucy; Princz, Christine; Teunissen, Erik; Mareeuw, Francine van den Driessen; Vlahadi, Maria; Spiegel, Wolfgang; MacFarlane, Anne

2017-01-01

Objectives To describe and reflect on the process of designing and delivering a training programme supporting the use of theory, in this case Normalisation Process Theory (NPT), in a multisite cross-country health services research study. Design Participatory research approach using qualitative methods. Setting Six European primary care settings involving research teams from Austria, England, Greece, Ireland, The Netherlands and Scotland. Participants RESTORE research team consisting of 8 project applicants, all senior primary care academics, and 10 researchers. Professional backgrounds included general practitioners/family doctors, social/cultural anthropologists, sociologists and health services/primary care researchers. Primary outcome measures Views of all research team members (n=18) were assessed using qualitative evaluation methods, analysed qualitatively by the trainers after each session. Results Most of the team had no experience of using NPT and many had not applied theory to prospective, qualitative research projects. Early training proved didactic and overloaded participants with information. Drawing on RESTORE’s methodological approach of Participatory Learning and Action, workshops using role play, experiential interactive exercises and light-hearted examples not directly related to the study subject matter were developed. Evaluation showed the study team quickly grew in knowledge and confidence in applying theory to fieldwork. Recommendations applicable to other studies include: accepting that theory application is not a linear process, that time is needed to address researcher concerns with the process, and that experiential, interactive learning is a key device in building conceptual and practical knowledge. An unanticipated benefit was the smooth transition to cross-country qualitative coding of study data. Conclusion A structured programme of training enhanced and supported the prospective application of a theory, NPT, to our work but raised challenges. These were not unique to NPT but could arise with the application of any theory, especially in large multisite, international projects. The lessons learnt are applicable to other theoretically informed studies. PMID:28827231

A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

PubMed

Cohen, Deborah J; Balasubramanian, Bijal A; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I; Crabtree, Benjamin F; Stange, Kurt C; Davis, Melinda; Miller, William L; Damschroder, Laura J; McConnell, K John; Creswell, John

2016-06-29

The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. ESCALATES is a national evaluation of an ambitious large-scale dissemination and implementation effort focused on transforming smaller primary care practices. Insights will help to inform the design of national health care practice extension systems aimed at supporting practice transformation efforts in the USA. NCT02560428 (09/21/15).

Clinical decision making in a high-risk primary care environment: a qualitative study in the UK.

PubMed

Balla, John; Heneghan, Carl; Thompson, Matthew; Balla, Margaret

2012-01-01

Examine clinical reasoning and decision making in an out of hours (OOH) primary care setting to gain insights into how general practitioners (GPs) make clinical decisions and manage risk in this environment. Semi-structured interviews using open-ended questions. A 2-month qualitative interview study conducted in Oxfordshire, UK. 21 GPs working in OOH primary care. The most powerful themes to emerge related to dealing with urgent potentially high-risk cases, keeping patients safe and responding to their needs, while trying to keep patients out of hospital and the concept of 'fire fighting'. There were a number of well-defined characteristics that GPs reported making presentations easy or difficult to deal with. Severely ill patients were straightforward, while the older people, with complex multisystem diseases, were often difficult. GPs stopped collecting clinical information and came to clinical decisions when high-risk disease and severe illness requiring hospital attention has been excluded; they had responded directly to the patient's needs and there was a reliable safety net in place. Learning points that GPs identified as important for trainees in the OOH setting included the importance of developing rapport in spite of time pressures, learning to deal with uncertainty and learning about common presentations with a focus on critical cues to exclude severe illness. The findings support suggestions that improvements in primary care OOH could be achieved by including automated and regular timely feedback system for GPs and individual peer and expert clinician support for GPs with regular meetings to discuss recent cases. In addition, trainee support and mentoring to focus on clinical skills, knowledge and risk management issues specific to OOH is currently required. Investigating the stopping rules used for diagnostic closure may provide new insights into the root causes of clinical error in such a high-risk setting.

HELP for behaviours that challenge in adults with intellectual and developmental disabilities

PubMed Central

Green, Laurie; McNeil, Karen; Korossy, Marika; Boyd, Kerry; Grier, Elizabeth; Ketchell, MacKenzie; Loh, Alvin; Lunsky, Yona; McMillan, Shirley; Sawyer, Amanda; Thakur, Anupam; Bradley, Elspeth

2018-01-01

Abstract Objective To provide primary care physicians with an understanding of the causes of behaviours that challenge (BTC) in adults with intellectual and developmental disabilities (IDD), as presented in the 2018 Canadian consensus guidelines for primary care of adults with IDD; to offer a systematic approach to the assessment and treatment of such behaviours; and to link to tools to support these assessments. Sources of information This review elaborates upon guidelines 26 to 29 in the mental health section of the 2018 Canadian consensus guidelines. Several of the authors participated in the development of these guidelines, which were based on literature searches and interdisciplinary input. Main message Most adults with IDD are followed by primary care providers but they comprise a small proportion of primary care practices. Unique ways of communicating needs, diagnostic queries, and BTC are common in this population. This complexity can lead to missed diagnoses and inappropriate antipsychotic medication use with attendant risks. This article presents a systematic approach, HELP, to the assessment and treatment of factors of Health, Environment, Lived experience, and Psychiatric conditions that can lead to BTC and includes tools to support these assessments. Conclusion A structured approach to the assessment and treatment of BTC in adults with IDD helps family physicians provide guideline-directed, individualized care to this population. This includes a systematic evaluation using the HELP framework that takes place over multiple visits. A team of health professionals might be needed for optimal care, but these resources are not routinely available across Canada. PMID:29650741

Provision of mental health care within primary care in Peru: A qualitative study exploring the perspectives of psychologists, primary health care providers, and patients

PubMed Central

Cavero, Victoria; Diez-Canseco, Francisco; Toyama, Mauricio; Flórez Salcedo, Gustavo; Ipince, Alessandra; Araya, Ricardo; Miranda, J. Jaime

2018-01-01

Background: This study aimed to understand the offer of mental health care at the primary care level, collecting the views of psychologists, primary health care providers (PHCPs), and patients, with a focus on health services in which patients attend regularly and who present a higher prevalence of mental disorders. Methods: A qualitative study was conducted in antenatal care, tuberculosis, HIV/AIDS, and chronic diseases services from six primary health care centers. Semi-structured interviews were conducted with psychologists, PHCPs, and patients working in or attending the selected facilities.  Results: A total of 4 psychologists, 22 PHCPs, and 37 patients were interviewed. A high perceived need for mental health care was noted. PHCPs acknowledged the emotional impact physical health conditions have on their patients and mentioned that referral to psychologists was reserved only for serious problems. Their approach to emotional problems was providing emotional support (includes listening, talk about their patients’ feelings, provide advice). PHCPs identified system-level barriers about the specialized mental health care, including a shortage of psychologists and an overwhelming demand, which results in brief consultations and lack in continuity of care. Psychologists focus their work on individual consultations; however, consultations were brief, did not follow a standardized model of care, and most patients attend only once. Psychologists also mentioned the lack of collaborative work among other healthcare providers. Despite these limitations, interviewed patients declared that they were willing to seek specialized care if advised and considered the psychologist's care provided as helpful; however, they recognized the stigmatization related to seeking mental health care. Conclusions: There is a perceived need of mental health care for primary care patients. To attend these needs, PHCPs provide emotional support and refer to psychology the most severe cases, while psychologists provide one-to-one consultations. Significant limitations in the care provided are discussed. PMID:29623297

COPD self-management supportive care: chaos and complexity theory.

PubMed

Cornforth, Amber

This paper uses the emergent theories of chaos and complexity to explore the self-management supportive care of chronic obstructive pulmonary disease (COPD) patients within the evolving primary care setting. It discusses the concept of self-management support, the complexity of the primary care context and consultations, smoking cessation, and the impact of acute exacerbations and action planning. The author hopes that this paper will enable the acquisition of new insight and better understanding in this clinical area, as well as support meaningful learning and facilitate more thoughtful, effective and high quality patient-centred care within the context of primary care.

Structural Design of a 4-Meter Off-Axis Space Telescope for the Habitable-Zone Exoplanet Direct Imaging Mission

NASA Technical Reports Server (NTRS)

Arnold, William, Sr.; Stahl, H Philip

2017-01-01

This design study was conducted to support the HABEX project. There are a number of companion papers at this conference which go into detail on what all the HABEX goals are. The objective of this paper is to establish a baseline primary mirror design which satisfies the following structural related requirements. The designs in this study have a high TRL (Technology Readiness Level), realistic manufacturing limits and performance in line with the HABEX mission. A secondary goal of the study was to evaluate a number competing criteria for the selection. Questions such as differences in the on axis versus off axis static and dynamic response to disturbances. This study concentrates on the structural behavior, companion papers cover thermal and long term stability aspects of the problem.

LDEF mechanical systems

NASA Technical Reports Server (NTRS)

Spear, W. Steve; Dursch, Harry W.

1992-01-01

Following LDEF retrieval, a number of studies were made of mechanical hardware and structure flown on the LDEF. The primary objectives are to determine the effects of long term space exposure on (1) mechanisms either used on LDEF or as part of individual experiments; (2) LDEF structural components; and (3) fasteners. Results from examination and testing of LDEF structure, fasteners, LDEF end support beam, environment exposure control canisters, experiment tray clamps, LDEF grapple fixtures, and viscous damper are presented. The most significant finding is the absence of space exposure related cold welding. The instances of seizure or removal difficulties initially attributed to cold welding were shown to have resulted from installation galling damage or improper removal techniques. Widespread difficulties encountered with removal of stainless steel fasteners underscore the need for effective thread lubrication schemes to ensure successful application of proposed orbital replacement units onboard Space Station Freedom.

Structural basis of membrane disruption and cellular toxicity by α-synuclein oligomers.

PubMed

Fusco, Giuliana; Chen, Serene W; Williamson, Philip T F; Cascella, Roberta; Perni, Michele; Jarvis, James A; Cecchi, Cristina; Vendruscolo, Michele; Chiti, Fabrizio; Cremades, Nunilo; Ying, Liming; Dobson, Christopher M; De Simone, Alfonso

2017-12-15

Oligomeric species populated during the aggregation process of α-synuclein have been linked to neuronal impairment in Parkinson's disease and related neurodegenerative disorders. By using solution and solid-state nuclear magnetic resonance techniques in conjunction with other structural methods, we identified the fundamental characteristics that enable toxic α-synuclein oligomers to perturb biological membranes and disrupt cellular function; these include a highly lipophilic element that promotes strong membrane interactions and a structured region that inserts into lipid bilayers and disrupts their integrity. In support of these conclusions, mutations that target the region that promotes strong membrane interactions by α-synuclein oligomers suppressed their toxicity in neuroblastoma cells and primary cortical neurons. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.