Integrated Work Management: Overview, Course 31881

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

Simpson, Lewis Edward

Integrated work management (IWM) is the process used for formally implementing the five-step process associated with integrated safety management (ISM) and integrated safeguards and security management (ISSM) at Los Alamos National Laboratory (LANL). IWM also directly supports the LANL Environmental Management System (EMS). IWM helps all workers and managers perform work safely and securely and in a manner that protects people, the environment, property, and the security of the nation. The IWM process applies to all work activities at LANL, from working in the office to designing experiments to assembling and detonating explosives. The primary LANL document that establishes andmore » describes IWM requirements is Procedure (P) 300, Integrated Work Management.« less

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

PubMed

Gevers, Aník; Dartnall, Elizabeth

2014-01-01

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

Neural Anatomy of Primary Visual Cortex Limits Visual Working Memory.

PubMed

Bergmann, Johanna; Genç, Erhan; Kohler, Axel; Singer, Wolf; Pearson, Joel

2016-01-01

Despite the immense processing power of the human brain, working memory storage is severely limited, and the neuroanatomical basis of these limitations has remained elusive. Here, we show that the stable storage limits of visual working memory for over 9 s are bound by the precise gray matter volume of primary visual cortex (V1), defined by fMRI retinotopic mapping. Individuals with a bigger V1 tended to have greater visual working memory storage. This relationship was present independently for both surface size and thickness of V1 but absent in V2, V3 and for non-visual working memory measures. Additional whole-brain analyses confirmed the specificity of the relationship to V1. Our findings indicate that the size of primary visual cortex plays a critical role in limiting what we can hold in mind, acting like a gatekeeper in constraining the richness of working mental function. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Bilateral primary malignant lymphoma of the breast.

PubMed

Shpitz, B; Witz, M; Kaufman, Z; Griffel, B; Manor, Y; Dinbar, A

1985-08-01

A rare case of bilateral primary malignant lymphoma of breast in a 76 year old woman is presented. The lesion was examined by electron microscopy and immunochemistry. The diagnosis of primary malignant lymphoma remains a diagnosis by exclusion and requires extensive work-up to exclude widespread malignant process. The behaviour of this malignancy tends to be an aggressive one and the prognosis is generally poor.

Primary care teams in Ireland: a qualitative mapping review of Irish grey and published literature.

PubMed

O'Sullivan, M; Cullen, W; MacFarlane, A

2015-03-01

The Irish government published its primary care strategy, Primary Care: A New Direction in 2001. Progress with the implementation of Primary care teams is modest. The aim of this paper is to map the Irish grey literature and peer-reviewed publications to determine what research has been carried out in relation to primary care teams, the reform process and interdisciplinary working in primary care in Ireland. This scoping review employed three methods: a review of Web of Science, Medline and Embase databases, an email survey of researchers across academic institutions, the HSE and independent researchers and a review of Lenus and the Health Well repository. N = 123 outputs were identified. N = 14 were selected for inclusion. A thematic analysis was undertaken. Common themes identified were resources, GP participation, leadership, clarity regarding roles in primary care teams, skills and knowledge for primary care team working, communication and community. There is evidence of significant problems that disrupt team formation and functioning that warrants more comprehensive research.

Enthalpy restoration in geothermal energy processing system

DOEpatents

Matthews, Hugh B.

1983-01-01

A geothermal deep well energy extraction system is provided of the general type in which solute-bearing hot water is pumped to the earth's surface from a relatively low temperature geothermal source by transferring thermal energy from the hot water to a working fluid for driving a primary turbine-motor and a primary electrical generator at the earth's surface. The superheated expanded exhaust from the primary turbine motor is conducted to a bubble tank where it bubbles through a layer of sub-cooled working fluid that has been condensed. The superheat and latent heat from the expanded exhaust of the turbine transfers thermal energy to the sub-cooled condensate. The desuperheated exhaust is then conducted to the condenser where it is condensed and sub-cooled, whereupon it is conducted back to the bubble tank via a barometric storage tank. The novel condensing process of this invention makes it possible to exploit geothermal sources which might otherwise be non-exploitable.

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study

PubMed Central

2014-01-01

Background In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Methods Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. Results The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an ‘active’ job profile (high job demands and high levels of job control combined) according to Karasek’s demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Conclusions Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland’s GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care. PMID:25103861

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study.

PubMed

Kuusio, Hannamaria; Lämsä, Riikka; Aalto, Anna-Mari; Manderbacka, Kristiina; Keskimäki, Ilmo; Elovainio, Marko

2014-08-07

In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs' experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an 'active' job profile (high job demands and high levels of job control combined) according to Karasek's demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland's GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care.

Working Memory Tasks in Relation to Phonological Processes of Arab Dyslexics in the State of Kuwait

ERIC Educational Resources Information Center

Al-dyiar, Mosaad Abo; Salem, Ashraf Atta M. S.

2013-01-01

The current study investigated the relationship between the working memory tasks and the phonological processes of Arab dyslexics in the primary stage in the State of Kuwait. The researchers used the descriptive research design. The sample of the study consists of 500 pupils (250 males and 250 females), their ages range from (9.05 ± 0.49) years…

Work Hope: Development and Initial Validation of a Measure

ERIC Educational Resources Information Center

Juntunen, Cindy L.; Wettersten, Kara Brita

2006-01-01

Hope is a core construct of positive psychology that has received only minimal application to work and vocational situations. C. R. Snyder (2000) conceptualized hope as a cognitive process with 3 primary components: goals, agency, and pathways. This article presents the development and validation of the Work Hope Scale (WHS), which was rationally…

Primary process and peer consultation: an experiential model to work through countertransference.

PubMed

Markus, Howard E; Cross, Wendi F; Halewski, Paula G; Quallo, Hope; Smith, Sherrie; Sullivan, Marilyn; Sullivan, Peter; Tantillo, Mary

2003-01-01

Various models exist for peer supervision and consultation of group therapy. This article documents the authors' experience using an experiential group consultation of group therapy model that relies on primary process to overcome countertransference dilemmas. A review of group therapy supervision and consultation models is followed by vignettes from the authors' experience. Discussion of the vignettes highlight critical issues in group consultation and expound upon the strengths and challenges of using an experiential model.

Learning How Scientists Work: Experiential Research Projects to Promote Cell Biology Learning and Scientific Process Skills

PubMed Central

2002-01-01

Facilitating not only the mastery of sophisticated subject matter, but also the development of process skills is an ongoing challenge in teaching any introductory undergraduate course. To accomplish this goal in a sophomore-level introductory cell biology course, I require students to work in groups and complete several mock experiential research projects that imitate the professional activities of the scientific community. I designed these projects as a way to promote process skill development within content-rich pedagogy and to connect text-based and laboratory-based learning with the world of contemporary research. First, students become familiar with one primary article from a leading peer-reviewed journal, which they discuss by means of PowerPoint-based journal clubs and journalism reports highlighting public relevance. Second, relying mostly on primary articles, they investigate the molecular basis of a disease, compose reviews for an in-house journal, and present seminars in a public symposium. Last, students author primary articles detailing investigative experiments conducted in the lab. This curriculum has been successful in both quarter-based and semester-based institutions. Student attitudes toward their learning were assessed quantitatively with course surveys. Students consistently reported that these projects significantly lowered barriers to primary literature, improved research-associated skills, strengthened traditional pedagogy, and helped accomplish course objectives. Such approaches are widely suited for instructors seeking to integrate process with content in their courses. PMID:12669101

Learning how scientists work: experiential research projects to promote cell biology learning and scientific process skills.

PubMed

DebBurman, Shubhik K

2002-01-01

Facilitating not only the mastery of sophisticated subject matter, but also the development of process skills is an ongoing challenge in teaching any introductory undergraduate course. To accomplish this goal in a sophomore-level introductory cell biology course, I require students to work in groups and complete several mock experiential research projects that imitate the professional activities of the scientific community. I designed these projects as a way to promote process skill development within content-rich pedagogy and to connect text-based and laboratory-based learning with the world of contemporary research. First, students become familiar with one primary article from a leading peer-reviewed journal, which they discuss by means of PowerPoint-based journal clubs and journalism reports highlighting public relevance. Second, relying mostly on primary articles, they investigate the molecular basis of a disease, compose reviews for an in-house journal, and present seminars in a public symposium. Last, students author primary articles detailing investigative experiments conducted in the lab. This curriculum has been successful in both quarter-based and semester-based institutions. Student attitudes toward their learning were assessed quantitatively with course surveys. Students consistently reported that these projects significantly lowered barriers to primary literature, improved research-associated skills, strengthened traditional pedagogy, and helped accomplish course objectives. Such approaches are widely suited for instructors seeking to integrate process with content in their courses.

Bilateral primary malignant lymphoma of the breast.

PubMed Central

Shpitz, B.; Witz, M.; Kaufman, Z.; Griffel, B.; Manor, Y.; Dinbar, A.

1985-01-01

A rare case of bilateral primary malignant lymphoma of breast in a 76 year old woman is presented. The lesion was examined by electron microscopy and immunochemistry. The diagnosis of primary malignant lymphoma remains a diagnosis by exclusion and requires extensive work-up to exclude widespread malignant process. The behaviour of this malignancy tends to be an aggressive one and the prognosis is generally poor. Images Figure 1 Figure 2 PMID:4034464

The influence of levels of processing on recall from working memory and delayed recall tasks.

PubMed

Loaiza, Vanessa M; McCabe, David P; Youngblood, Jessie L; Rose, Nathan S; Myerson, Joel

2011-09-01

Recent research in working memory has highlighted the similarities involved in retrieval from complex span tasks and episodic memory tasks, suggesting that these tasks are influenced by similar memory processes. In the present article, the authors manipulated the level of processing engaged when studying to-be-remembered words during a reading span task (Experiment 1) and an operation span task (Experiment 2) in order to assess the role of retrieval from secondary memory during complex span tasks. Immediate recall from both span tasks was greater for items studied under deep processing instructions compared with items studied under shallow processing instructions regardless of trial length. Recall was better for deep than for shallow levels of processing on delayed recall tests as well. These data are consistent with the primary-secondary memory framework, which suggests that to-be-remembered items are displaced from primary memory (i.e., the focus of attention) during the processing phases of complex span tasks and therefore must be retrieved from secondary memory. (c) 2011 APA, all rights reserved.

‘In the Moment’: An Analysis of Facilitator Impact During a Quality Improvement Process

PubMed Central

Shaw, Erik; Looney, Anna; Chase, Sabrina; Navalekar, Rohini; Stello, Brian; Lontok, Oliver; Crabtree, Benjamin

2010-01-01

Facilitators frequently act ‘in the moment’ – deciding if, when and how to intervene into group process discussions. This paper offers a unique look at how facilitators impacted eleven primary care teams engaged in a 12-week quality improvement (QI) process. Participating in a federally funded QI trial, primary care practices in New Jersey and Pennsylvania formed practice-based teams comprised of physicians, nurses, administrative staff, and patients. External facilitators met with each team to help them identify and implement changes aimed at improving the organization, work relationships, office functions, and patient care. Audio-recordings of the meetings and descriptive field notes were collected. These qualitative data provided information on how facilitators acted ‘in the moment’ and how their interventions impacted group processes over time. Our findings reveal that facilitators impacted groups in multiple ways throughout the QI process, rather than through a linear progression of stages or events. We present five case examples that show what acting ‘in the moment’ looked like during the QI meetings and how these facilitator actions/interventions impacted the primary care teams. These accounts provide practical lessons learned and insights into effective facilitation that may encourage others in their own facilitation work and offer beneficial strategies to facilitators in other contexts. PMID:22557936

Electronic working length determination in primary teeth by ProPex and Digital Signal Processing.

PubMed

Nelson-Filho, Paulo; Lucisano, Marcela Pacífico; Leonardo, Mário Roberto; da Silva, Raquel Assed Bezerra; da Silva, Léa Assed Bezerra

2010-12-01

The purpose of this study was to evaluate the accuracy of electronic apex locators Digital Signal Processing (DSP) and ProPex, for root canal length determination in primary teeth. Fifteen primary molars (a total of 34 root canals) were divided into two groups: Group I - without physiological resorption (n = 16); and Group II - with physiological resorption (n = 18). The length of each canal was measured by introducing a file until its tip was visible and then it was retracted 1 mm. For electronic measurement, the devices were set to 1 mm short of the apical resorption. The data were analysed statistically using the intraclass correlation coefficient (ICC). Results showed that the ICC was high for both electronic apex locators in all situations - with (ICC: DSP = 0.82 and Propex = 0.89) or without resorption (ICC: DSP = 0.92 and Propex = 0.90). Both apex locators were extremely accurate in determining the working length in primary teeth, both with or without physiological resorption. © 2010 The Authors. Australian Endodontic Journal © 2010 Australian Society of Endodontology.

KSC-07pd0306

NASA Image and Video Library

2007-02-06

KENNEDY SPACE CENTER, FLA. -- On the floor of the Space Station Processing Facility, astronauts Dan Tani (left) and Peggy Whitson practice working with a cover, something they may handle during an upcoming shuttle flight. With construction of the Space Station the primary focus of future shuttle missions, astronaut crews will be working with one or more of the elements and hardware already being processed in the SSPF. Photo credit: NASA/Kim Shiflett

Acute physical exercise affected processing efficiency in an auditory attention task more than processing effectiveness.

PubMed

Dutke, Stephan; Jaitner, Thomas; Berse, Timo; Barenberg, Jonathan

2014-02-01

Research on effects of acute physical exercise on performance in a concurrent cognitive task has generated equivocal evidence. Processing efficiency theory predicts that concurrent physical exercise can increase resource requirements for sustaining cognitive performance even when the level of performance is unaffected. This hypothesis was tested in a dual-task experiment. Sixty young adults worked on a primary auditory attention task and a secondary interval production task while cycling on a bicycle ergometer. Physical load (cycling) and cognitive load of the primary task were manipulated. Neither physical nor cognitive load affected primary task performance, but both factors interacted on secondary task performance. Sustaining primary task performance under increased physical and/or cognitive load increased resource consumption as indicated by decreased secondary task performance. Results demonstrated that physical exercise effects on cognition might be underestimated when only single task performance is the focus.

The Primary Physical Education Curriculum Process: More Complex That You Might Think!!

ERIC Educational Resources Information Center

Jess, Mike; Carse, Nicola; Keay, Jeanne

2016-01-01

In this paper, we present the curriculum development process as a complex, iterative and integrated phenomenon. Building on the early work of Stenhouse [1975, "An Introduction to Curriculum Research and Development". London: Heinemann Educational], we position the teacher at the heart of this process and extend his ideas by exploring how…

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.

The environment of professional practice and Burnout in nurses in primary healthcare

PubMed Central

Lorenz, Vera Regina; Guirardello, Edinêis de Brito

2014-01-01

OBJECTIVES: to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. METHOD: cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. RESULTS: the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. CONCLUSION: the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas. PMID:25517928

Considerations of Dance Transmission Processes: Adapting Bharata Natyam in a Singapore Primary School

ERIC Educational Resources Information Center

Lum, Chee Hoo; Gonda, Donn Emmanuel

2014-01-01

This qualitative case study has, for its purpose, an examination of the pedagogies and practices of a master Bharata Natyam dance instructor working within a Singapore primary school context. It explores the instructor's adaptation within an after-school weekly activity of the South Indian traditional classical dance form. Considerations of dance…

Educators and the Quality of Their Work Environment: An Analysis of the Organisational Climate in Primary Schools

ERIC Educational Resources Information Center

Vos, D.; van der Westhuizen, Philip C.; Mentz, P. J.; Ellis, S. M.

2012-01-01

The prevalent organisational climate in primary schools in the North West Province was determined in order to formulate management strategies to increase the organisational climate. For this purpose, a quantitative research method, founded in post-positivistic points of departure, was applied. In the process, the Organizational Climate Description…

A Model of Comparative Ethics Education for Social Workers

ERIC Educational Resources Information Center

Pugh, Greg L.

2017-01-01

Social work ethics education models have not effectively engaged social workers in practice in formal ethical reasoning processes, potentially allowing personal bias to affect ethical decisions. Using two of the primary ethical models from medicine, a new social work ethics model for education and practical application is proposed. The strengths…

Student Research: Documentaries Made in the Community

ERIC Educational Resources Information Center

Morris, Ronald V.

2018-01-01

Middle school students learned about their community when they created documentaries as part of a state bicentennial celebration. Students gathered multiple primary and secondary resources and worked with community members to interview them for their perspectives through video presentations as part of the inquiry process. Students work with local…

Improving primary treatment of urban wastewater with lime-induced coagulation.

PubMed

Marani, Dario; Ramadori, Roberto; Braguglia, Camilla Maria

2004-01-01

The enhancement of primary treatment efficiency through the coagulation process may yield several advantages, including lower aeration energy in the subsequent biological unit and higher recovery of biogas from sludge digestion. In this work sewage coagulation with lime was studied at pilot plant level, using degritted sewage from the city of Rome. The work aimed at optimising the operating conditions (coagulant dosage or treatment pH, and mixing conditions in the coagulation and flocculation tanks), in order to maximise the efficiency of suspended Chemical Oxygen Demand (COD) removal and to minimise sludge production. Lime dosage optimisation resulted in an optimal treatment pH of 9. Lime addition up to pH 9 may increase COD removal rate in the primary treatment from typical 30-35% of plain sedimentation up to 55-70%. Within the velocity gradients experimented in this work (314-795 s(-1) for the coagulation tank and 13-46 s(-1) for the flocculation tank), mixing conditions did not significantly affect the lime-enhanced process, which seems to be controlled by slow lime dissolution. Sludge produced in the lime-enhanced process settled and compacted easily, inducing an average 36% decrease in sludge volume with respect to plain settling. However excess sludge was produced, which was not accounted for by the amount of suspended solids removed. This is probably due to incomplete dissolution of lime, which may be partially incorporated in the sludge.

Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim".

PubMed

Koslov, Steven; Trowbridge, Elizabeth; Kamnetz, Sandra; Kraft, Sally; Grossman, Jeffrey; Pandhi, Nancy

2016-09-01

Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing. Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability. Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes. The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation. Copyright © 2015 Elsevier Inc. All rights reserved.

Across the Divide: “Primary Care Departments Working Together to Redesign Care to Achieve the Triple Aim”

PubMed Central

Koslov, Steven; Trowbridge, Elizabeth; Kamnetz, Sandra; Kraft, Sally; Grossman, Jeffrey; Pandhi, Nancy

2016-01-01

Background Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. Methods As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing. Results Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability. Conclusions Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes. Implications The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation. PMID:27637827

Serial recall of visuospatial and verbal information with and without material-specific interference: implications for contemporary models of working memory.

PubMed

Davis, Lynne C; Rane, Shruti; Hiscock, Merrill

2013-01-01

A longstanding question in working memory (WM) research concerns the fractionation of verbal and nonverbal processing. Although some contemporary models include both domain-specific and general-purpose mechanisms, the necessity to postulate differential processing of verbal and nonverbal material remains unclear. In the present two-experiment series we revisit the order reconstruction paradigm that Jones, Farrand, Stuart, and Morris (1995) used to support a unitary model of WM. Goals were to assess (1) whether serial position curves for dot positions differ from curves for letter names; and (2) whether selective interference can be demonstrated. Although we replicated Jones et al.'s finding of similar serial position curves for the two tasks, this similarity could reflect the demands of the order reconstruction paradigm rather than undifferentiated processing of verbal and nonverbal stimuli. Both generalised and material-specific interference was found, which can be attributed to competition between primary and secondary tasks for attentional resources. As performance levels for the combined primary and secondary tasks exceed active WM capacity limits, primary task items apparently are removed from active memory during processing of the secondary list and held temporarily in maintenance storage. We conclude that active WM is multimodal but maintenance stores may be domain specific.

Northern nursing practice in a primary health care setting.

PubMed

Vukic, Adele; Keddy, Barbara

2002-12-01

This paper explicates the nature of outpost nursing work, and/or the day-to-day realities of northern nursing practice in a primary health care setting in Canada. The study was carried out to systematically explore the work of nurses in an indigenous setting. Institutional ethnography, pioneered by Dorothy Smith was the methodology used to guide this research. The theoretical perspective of this methodology does not seek causes or links but intends to explicate visible practices. It is intended to explicate the social organization of specific discourses that inform work processes of nurses working in remote indigenous communities. The data originated from various sources including spending 2 weeks in a northern remote community shadowing experienced nurses, taking field notes and audio taping interviews with these nurses. One of the two researchers was a northern practice nurse for many years and has had taught in an outpost nursing programme. As part of the process, texts were obtained from the site as data to be incorporated in the analysis. The lived experiences have added to the analytical understanding of the work of nurses in remote areas. Data uncovered documentary practices inherent to the work setting which were then analysed along with the transcribed interviews and field notes derived from the on-site visit. Identifying disjuncture in the discourse of northern nursing and the lived experience of the nurses in this study was central to the research process. The results indicated that the social organization of northern community nursing work required a broad generalist knowledge base for decision making to work effectively within this primary health care setting. The nurse as 'other' and the invisibility of nurses' work of building a trusting relationship with the community is not reflected in the discourse of northern nursing. Trust cannot be quantified or measured yet it is fundamental to working effectively with the community. The nurses in this study saw building trust to promote health and well-being in communities as very important, yet very difficult to achieve. The difficulty in part stems from the constraining, structural, administrative, historical, cultural and political contextual realities that have shaped northern community nursing.

Panel management, team culture, and worklife experience.

PubMed

Willard-Grace, Rachel; Dubé, Kate; Hessler, Danielle; O'Brien, Bridget; Earnest, Gillian; Gupta, Reena; Shunk, Rebecca; Grumbach, Kevin

2015-09-01

Burnout and professional dissatisfaction are threats to the primary care workforce. We investigated the relationship between panel management capability, team culture, cynicism, and perceived "do-ability" of primary care among primary care providers (PCPs) and staff in primary care practices. We surveyed 326 PCPs and 142 staff members in 10 county-administered, 6 university-run, and 3 Veterans Affairs primary care clinics in a large urban area in 2013. Predictor variables included capability for performing panel management and perception of team culture. Outcome variables included 2 work experience measures--the Maslach Burnout Inventory cynicism scale and a 1-item measure of the "do-ability" of primary care this year compared with last year. Generalized Estimation Equation (GEE) models were used to account for clustering at the clinic level. Greater panel management capability and higher team culture were associated with lower cynicism among PCPs and staff and higher reported "do-ability" of primary care among PCPs. Panel management capability and team culture interacted to predict the 2 work experience outcomes. Among PCPs and staff reporting high team culture, there was little association between panel management capability and the outcomes, which were uniformly positive. However, there was a strong relationship between greater panel management capability and improved work experience outcomes for PCPs and staff reporting low team culture. Team-based processes of care such as panel management may be an important strategy to protect against cynicism and dissatisfaction in primary care, particularly in settings that are still working to improve their team culture. (c) 2015 APA, all rights reserved).

Teaching the process of science: faculty perceptions and an effective methodology.

PubMed

Coil, David; Wenderoth, Mary Pat; Cunningham, Matthew; Dirks, Clarissa

2010-01-01

Most scientific endeavors require science process skills such as data interpretation, problem solving, experimental design, scientific writing, oral communication, collaborative work, and critical analysis of primary literature. These are the fundamental skills upon which the conceptual framework of scientific expertise is built. Unfortunately, most college science departments lack a formalized curriculum for teaching undergraduates science process skills. However, evidence strongly suggests that explicitly teaching undergraduates skills early in their education may enhance their understanding of science content. Our research reveals that faculty overwhelming support teaching undergraduates science process skills but typically do not spend enough time teaching skills due to the perceived need to cover content. To encourage faculty to address this issue, we provide our pedagogical philosophies, methods, and materials for teaching science process skills to freshman pursuing life science majors. We build upon previous work, showing student learning gains in both reading primary literature and scientific writing, and share student perspectives about a course where teaching the process of science, not content, was the focus. We recommend a wider implementation of courses that teach undergraduates science process skills early in their studies with the goals of improving student success and retention in the sciences and enhancing general science literacy.

Teaching the Process of Science: Faculty Perceptions and an Effective Methodology

PubMed Central

Coil, David; Wenderoth, Mary Pat; Cunningham, Matthew

2010-01-01

Most scientific endeavors require science process skills such as data interpretation, problem solving, experimental design, scientific writing, oral communication, collaborative work, and critical analysis of primary literature. These are the fundamental skills upon which the conceptual framework of scientific expertise is built. Unfortunately, most college science departments lack a formalized curriculum for teaching undergraduates science process skills. However, evidence strongly suggests that explicitly teaching undergraduates skills early in their education may enhance their understanding of science content. Our research reveals that faculty overwhelming support teaching undergraduates science process skills but typically do not spend enough time teaching skills due to the perceived need to cover content. To encourage faculty to address this issue, we provide our pedagogical philosophies, methods, and materials for teaching science process skills to freshman pursuing life science majors. We build upon previous work, showing student learning gains in both reading primary literature and scientific writing, and share student perspectives about a course where teaching the process of science, not content, was the focus. We recommend a wider implementation of courses that teach undergraduates science process skills early in their studies with the goals of improving student success and retention in the sciences and enhancing general science literacy. PMID:21123699

Use of a computerized decision support system for primary and secondary prevention of work-related MSD disability.

PubMed

Womack, Sarah K; Armstrong, Thomas J

2005-09-01

The present study evaluates the effectiveness of a decision support system used to evaluate and control physical job stresses and prevent re-injury of workers who have experienced or are concerned about work-related musculoskeletal disorders. The software program is a database that stores detailed job information such as standardized work data, videos, and upper-extremity physical stress ratings for over 400 jobs in the plant. Additionally, the database users were able to record comments about the jobs and related control issues. The researchers investigated the utility and effectiveness of the software by analyzing its use over a 20-month period. Of the 197 comments entered by the users, 25% pertained to primary prevention, 75% pertained to secondary prevention, and 94 comments (47.7%) described ergonomic interventions. Use of the software tool improved primary and secondary prevention by improving the quality and efficiency of the ergonomic job analysis process.

Work motivation among healthcare professionals.

PubMed

Kjellström, Sofia; Avby, Gunilla; Areskoug-Josefsson, Kristina; Andersson Gäre, Boel; Andersson Bäck, Monica

2017-06-19

Purpose The purpose of this paper is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. In total, 43 interviews were completed with different medical professions and qualitative deductive content analysis was conducted. Findings Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers' positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematic quality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications Leaders need to consistently translate and integrate reforms with the professionals' drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications The design of the reforms and leadership are essential preconditions for work motivation. Originality/value The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.

Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory.

PubMed

Volker, Nerida; Williams, Lauren T; Davey, Rachel C; Cochrane, Thomas; Clancy, Tanya

2017-02-24

The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a 'hard sell', is going to rely on improving the value proposition for all stakeholders. The study provided a detailed understanding of the work required to implement a complex cardiovascular disease prevention intervention within general practice. The findings highlighted the need for multiple strategies that engage all stakeholders. Normalisation process theory was a useful framework for guiding change implementation.

Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

PubMed

Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo

2015-06-01

To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

A Process Model for Assessing Adolescent Risk for Suicide.

ERIC Educational Resources Information Center

Stoelb, Matt; Chiriboga, Jennifer

1998-01-01

This comprehensive assessment process model includes primary, secondary, and situational risk factors and their combined implications and significance in determining an adolescent's level or risk for suicide. Empirical data and clinical intuition are integrated to form a working client model that guides the professional in continuously reassessing…

The Role of Nitrogen-Fixing Symbionts in Primary Succession on the Juneau Icefield

NASA Astrophysics Data System (ADS)

Walker-Andrews, T.; Cooley, S.; Veitz, M.; White, C.

2017-12-01

The glaciers of the Juneau icefield will likely continue to retreat in the coming years, leaving behind a rocky landscape. As this land is exposed, colonizing organisms will begin the process of primary succession and soil formation. As student researchers with the Juneau Icefield Research Program, we are studying the relationship between abundance and diversity of nitrogen-fixing symbionts on the Juneau Icefield and the rate of primary succession and soil development on recently deglaciated areas. We will survey three representative plots in a variety of vegetation zones at various sample sites; collecting data on soil profiles, as well as abundance and diversity of plants and lichens. We expect to find a positive correlation between the diversity of plants and lichens­- especially of nitrogen-fixing symbionts - and the level of soil development. The data will improve understanding of plant diversity on the Juneau Icefield and how the processes of primary succession transform the new environment. This work will contribute to on-going research on the process of primary succession on the Juneau Icefield.

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory.

PubMed

Tierney, Edel; McEvoy, Rachel; O'Reilly-de Brún, Mary; de Brún, Tomas; Okonkwo, Ekaterina; Rooney, Michelle; Dowrick, Chris; Rogers, Anne; MacFarlane, Anne

2016-06-01

There have been recent important advances in conceptualizing and operationalizing involvement in health research and health-care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine - normalized - way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization - definition, enrolment, enactment and appraisal. Ours was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory. Twenty-six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co-governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals. To improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co-governance and dissemination of research processes and findings. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Quality indicators and specifications for strategic and support processes in laboratory medicine.

PubMed

Ricós, Carmen; Biosca, Carme; Ibarz, Mercè; Minchinela, Joana; Llopis, Maantonia; Perich, Carmen; Alsina, Jesus; Alvarez, Virtudes; Doménech, Vicenta; Pastor, Rosa Ma; Sansalvador, Mireia; Isern, Gloria Trujillo; Navarro, Conrad Vilanova

2008-01-01

This work is the second part of a study regarding indicators and quality specifications for the non-analytical processes in laboratory medicine. Five primary care and five hospital laboratories agreed on the indicators for two strategic processes (quality planning and project development) and various support processes (client relationships, instrument and infrastructure maintenance, safety and risk prevention, purchases and storage, personnel training). In the majority of cases, the median values recorded over 1 year is considered to be the state-of-the-art in our setting and proposed as the quality specification for the indicators stated. Values have been stratified according to primary care and hospital laboratory for referred tests and group of personnel for training. In some cases, the specifications have been set equal to zero events, such as serious incidents in the infrastructure maintenance process and number of work accidents in the safety and risk prevention process. In light of this study, an effort is needed to optimize decisions regarding corrective actions and to move from a subjective individual criterion to systematic and comparative management. This preliminary study provides a comprehensive vision of a subject that could motivate further research and advances in the quality of laboratory services.

Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention.

PubMed

Reeve, Joanne; Cooper, Lucy; Harrington, Sean; Rosbottom, Peter; Watkins, Jane

2016-09-06

Health services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area in to quality improvement changes on the ground. BounceBack was a service development innovation project which sought to examine this issue through the implementation and evaluation in a primary care setting of a novel complex intervention. The project was a collaboration between a local mental health charity, an academic unit, and GP practices. The aim was to translate the charity's model of care into practice-based evidence describing delivery and impact. Normalisation Process Theory (NPT) was used to support the implementation of the new model of primary mental health care into six GP practices. An integrated process evaluation evaluated the process and impact of care. Implementation quickly stalled as we identified problems with the described model of care when applied in a changing and variable primary care context. The team therefore switched to using the NPT framework to support the systematic identification and modification of the components of the complex intervention: including the core components that made it distinct (the consultation approach) and the variable components (organisational issues) that made it work in practice. The extra work significantly reduced the time available for outcome evaluation. However findings demonstrated moderately successful implementation of the model and a suggestion of hypothesised changes in outcomes. The BounceBack project demonstrates the development of a complex intervention from practice. It highlights the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention; and describes the use of the research process in the generation of practice-based evidence. Implications for future translational complex intervention research supporting practice change through scholarship are discussed.

Horizontal tuning for faces originates in high-level Fusiform Face Area.

PubMed

Goffaux, Valerie; Duecker, Felix; Hausfeld, Lars; Schiltz, Christine; Goebel, Rainer

2016-01-29

Recent work indicates that the specialization of face visual perception relies on the privileged processing of horizontal angles of facial information. This suggests that stimulus properties assumed to be fully resolved in primary visual cortex (V1; e.g., orientation) in fact determine human vision until high-level stages of processing. To address this hypothesis, the present fMRI study explored the orientation sensitivity of V1 and high-level face-specialized ventral regions such as the Occipital Face Area (OFA) and Fusiform Face Area (FFA) to different angles of face information. Participants viewed face images filtered to retain information at horizontal, vertical or oblique angles. Filtered images were viewed upright, inverted and (phase-)scrambled. FFA responded most strongly to the horizontal range of upright face information; its activation pattern reliably separated horizontal from oblique ranges, but only when faces were upright. Moreover, activation patterns induced in the right FFA and the OFA by upright and inverted faces could only be separated based on horizontal information. This indicates that the specialized processing of upright face information in the OFA and FFA essentially relies on the encoding of horizontal facial cues. This pattern was not passively inherited from V1, which was found to respond less strongly to horizontal than other orientations likely due to adaptive whitening. Moreover, we found that orientation decoding accuracy in V1 was impaired for stimuli containing no meaningful shape. By showing that primary coding in V1 is influenced by high-order stimulus structure and that high-level processing is tuned to selective ranges of primary information, the present work suggests that primary and high-level levels of the visual system interact in order to modulate the processing of certain ranges of primary information depending on their relevance with respect to the stimulus and task at hand. Copyright © 2015 Elsevier Ltd. All rights reserved.

Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study.

PubMed

Tierney, E; O'Sullivan, M; Hickey, L; Hannigan, A; May, C; Cullen, W; Kennedy, N; Kineen, L; MacFarlane, A

2016-11-22

Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals' views of this process. This study compares Primary Healthcare Professionals' perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland. Design and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests. There were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by GPs but not by nurses or clinical therapists. PCPs and GPs agree there is limited PCT implementation. GPs are most negative about this implementation. There is some disagreement about which resources are most important for effective PCT working. These findings provide valuable data for clinicians and policy makers about implementation of interdisciplinary teams in primary care.

Recrystallization characteristics of oxide dispersion strengthened nickel-base alloys

NASA Technical Reports Server (NTRS)

Hotzler, R. K.; Glasgow, T. K.

1980-01-01

Electron microscopy was employed to study the process of recrystallization in two oxide dispersion strengthened (ODS) mechanically alloyed nickel-base alloys, MA 754 and MA 6000E. MA 754 contained both fine, uniformly dispersed particles and coarser oxides aligned along the working direction. Hot rolled MA 754 had a grain size of 0.5 microns and high dislocation densities. After partial primary recrystallization, the fine grains transformed to large elongated grains via secondary (or abnormal) grain growth. Extruded and rolled MA 6000E contained equiaxed grains of 0.2 micron diameter. Primary recrystallization occurring during working eliminated virtually all dislocations. Conversion from fine to coarse grains was triggered by gamma prime dissolution; this was also a process of secondary or abnormal grain growth. Comparisons were made to conventional and oxide dispersion strengthened nickel-base alloys.

Shielding cognition from nociception with working memory.

PubMed

Legrain, Valéry; Crombez, Geert; Plaghki, Léon; Mouraux, André

2013-01-01

Because pain often signals the occurrence of potential tissue damage, nociceptive stimuli have the capacity to capture attention and interfere with ongoing cognitive activities. Working memory is known to guide the orientation of attention by maintaining goal priorities active during the achievement of a task. This study investigated whether the cortical processing of nociceptive stimuli and their ability to capture attention are under the control of working memory. Event-related brain potentials (ERPs) were recorded while participants performed primary tasks on visual targets that required or did not require rehearsal in working memory (1-back vs 0-back conditions). The visual targets were shortly preceded by task-irrelevant tactile stimuli. Occasionally, in order to distract the participants, the tactile stimuli were replaced by novel nociceptive stimuli. In the 0-back conditions, task performance was disrupted by the occurrence of the nociceptive distracters, as reflected by the increased reaction times in trials with novel nociceptive distracters as compared to trials with standard tactile distracters. In the 1-back conditions, such a difference disappeared suggesting that attentional capture and task disruption induced by nociceptive distracters were suppressed by working memory, regardless of task demands. Most importantly, in the conditions involving working memory, the magnitude of nociceptive ERPs, including ERP components at early latency, were significantly reduced. This indicates that working memory is able to modulate the cortical processing of nociceptive input already at its earliest stages, and could explain why working memory reduces consequently ability of nociceptive stimuli to capture attention and disrupt performance of the primary task. It is concluded that protecting cognitive processing against pain interference is best guaranteed by keeping out of working memory pain-related information. Copyright © 2012 Elsevier Ltd. All rights reserved.

Projection methods

Treesearch

Michael E. Goerndt; W. Keith Moser; Patrick D. Miles; Dave Wear; Ryan D. DeSantis; Robert J. Huggett; Stephen R. Shifley; Francisco X. Aguilar; Kenneth E. Skog

2016-01-01

One purpose of the Northern Forest Futures Project is to predict change in future forest attributes across the 20 States in the U.S. North for the period that extends from 2010 to 2060. The forest attributes of primary interest are the 54 indicators of forest sustainability identified in the Montreal Process Criteria and Indicators (Montreal Process Working Group, n.d...

Tracking the Muse: The Writing Processes of Poets.

ERIC Educational Resources Information Center

Armstrong, Cherryl

Focusing on the nature of revision in lyric poetry, a study investigated poets' writing processes. Primary data sources included poets' commentary, letters, recorded conversations, interviews, and essays. Two case studies were also conducted--an evaluation of two poets at work (one a novice and one an experienced poet) and a textual analysis of…

The critical role of social workers in home-based primary care.

PubMed

Reckrey, Jennifer M; Gettenberg, Gabrielle; Ross, Helena; Kopke, Victoria; Soriano, Theresa; Ornstein, Katherine

2014-01-01

The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

Working Memory and Processing Efficiency in Children's Reasoning.

ERIC Educational Resources Information Center

Halford, Graeme S.; And Others

A series of studies was conducted to determine whether children's reasoning is capacity-limited and whether any such capacity, if it exists, is based on the working memory system. An N-term series (transitive inference) was used as the primary task in an interference paradigm. A concurrent short-term memory load was employed as the secondary task.…

Problem-Solving Strategies for Career Planning.

ERIC Educational Resources Information Center

McBryde, Merry J.; Karr-Kidwell, PJ

The need for new expertise in problem solving in the work setting has emerged as a woman's issue because work outside the home has become a primary means for personal goal attainment for about half the women in the United States and because traditional career patterns and norms are ineffective. Career planning is the process of individual career…

STS-99 Atlantis, Shuttle Radar Topography Mission (SRTM) in the MPPF with Technicians working

NASA Technical Reports Server (NTRS)

1999-01-01

The primary objective of the STS-99 mission was to complete high resolution mapping of large sections of the Earth's surface using the Shuttle Radar Topography Mission (SRTM), a specially modified radar system. This videotape shows technicians in clean room suits working on the SRTM in the Multi-Payload Processing Facility (MPPF).

Courses offered by the Minas Health Channel: perception of primary care workers.

PubMed

Pereira, Lizziane D' Ávila; Sena, Roseni Rosângela de

2016-06-01

To analyse how primary healthcare workers perceive the impact of the Health Channel Mines courses in their work process. This is a descriptive exploratory qualitative study conducted with 38 professionals working in primary health care units of three municipalities in the state of Minas Gerais, Brazil. Data were collected in 2014 by means of semi-structured interviews and subjected to thematic content analysis. Data analysis revealed the following three categories: interest in training and its contribution to professional practice; factors that alter professional practices; and proposals for improvement. The study data demonstrated that the Mines Health Channel courses cannot single-handedly change professional practices. Continued and refresher education resources that enable the exchange and articulation of knowledge between the various specialities are needed to transform professional practices.

Building health promotion capacity in a primary health care workforce in the Northern Territory: some lessons from practice.

PubMed

Judd, Jenni; Keleher, Helen

2013-12-01

Reorientation of the workforce in primary health care is a complex process and requires specific strategies and interventions. Primary health care providers are a key health care workforce that is expected to deliver tangible outcomes from disease prevention and health promotion strategies. This paper describes a training intervention that occurred as part of a broader participatory action research process for building health promotion capacity in the primary health care workforce. Participatory action research (PAR) was conducted over six action and reflection cycles in a two-year period (2001-02) in an urban community health setting in the Northern Territory. One of the PAR cycles was a training intervention that was identified as a need from a survey in the first action and reflection cycle. This training was facilitated by a health promotion specialist, face-to-face and comprised five 3.5-h sessions over a 5-month period. A pre-post questionnaire was used to measure the knowledge and skills components of the training intervention. The results reinforced the importance of using a participatory approach that involved the primary health care providers themselves. Multiple strategies such as workforce development within capacity building frameworks assisted in shifting work practice more upstream. Additionally, these strategies encouraged more reflective practice and built social capital within the primary health care workforce. Lessons from practice reinforce that workforce development influenced work practice change and is an important element in building the health promotion capacity of primary health care centres. SO WHAT?: Workforce development is critical for reorienting health services. Health promotion specialists play an important role in reorienting practice, which is only effective when combined with other strategies, and driven and led by the primary health care workforce.

Macroergonomic study of food sector company distribution centres.

PubMed

García Acosta, Gabriel; Lange Morales, Karen

2008-07-01

This study focussed on the work system design to be used by a Colombian food sector company for distributing products. It considered the concept of participative ergonomics, where people from the commercial, logistics, operation, occupational health areas worked in conjunction with the industrial designers, ergonomists who methodologically led the project. As a whole, the project was conceived as having five phases: outline, diagnosis, modelling the process, scalability, instrumentation. The results of the project translate into procedures for selecting, projecting a new distribution centre, the operational process model, a description of ergonomic systems that will enable specific work stations to be designed, the procedure for adapting existing warehouses. Strategically, this work helped optimise the company's processes and ensure that knowledge would be transferred within it. In turn, it became a primary prevention strategy in the field of health, aimed at reducing occupational risks, improving the quality of life at work.

Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis.

PubMed

Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Gómez-Urquiza, Jose L; Albendín-García, Luis; Aguayo, Raimundo; Cañadas-De la Fuente, Guillermo A

2018-05-10

burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses. We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017. After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment. Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.

Weighting Primary Care Patient Panel Size: A Novel Electronic Health Record-Derived Measure Using Machine Learning.

PubMed

Rajkomar, Alvin; Yim, Joanne Wing Lan; Grumbach, Kevin; Parekh, Ami

2016-10-14

Characterizing patient complexity using granular electronic health record (EHR) data regularly available to health systems is necessary to optimize primary care processes at scale. To characterize the utilization patterns of primary care patients and create weighted panel sizes for providers based on work required to care for patients with different patterns. We used EHR data over a 2-year period from patients empaneled to primary care clinicians in a single academic health system, including their in-person encounter history and virtual encounters such as telephonic visits, electronic messaging, and care coordination with specialists. Using a combination of decision rules and k-means clustering, we identified clusters of patients with similar health care system activity. Phenotypes with basic demographic information were used to predict future health care utilization using log-linear models. Phenotypes were also used to calculate weighted panel sizes. We identified 7 primary care utilization phenotypes, which were characterized by various combinations of primary care and specialty usage and were deemed clinically distinct by primary care physicians. These phenotypes, combined with age-sex and primary payer variables, predicted future primary care utilization with R 2 of .394 and were used to create weighted panel sizes. Individual patients' health care utilization may be useful for classifying patients by primary care work effort and for predicting future primary care usage.

What is a good general practitioner (GP)? The development and evaluation of a multi-source feedback instrument for GP appraisal.

PubMed

Shepherd, Annabel; Lough, Murray

2010-05-01

Although multi-source feedback (MSF) has been used in primary healthcare, the development of an MSF instrument specific to this setting in the UK has not been previously described. The aims of this study were to develop and evaluate an MSF instrument for GPs in Scotland taking part in appraisal. The members of ten primary healthcare teams in the west of Scotland were asked to provide comments in answer to the question, 'What is a good GP?'. The data were reduced and coded by two researchers and questions were devised. Following content validity testing the MSF process was evaluated with volunteers using face-to-face interviews and a postal survey. Thirty-seven statements covering the six domains of communication skills, professional values, clinical care, working with colleagues, personality issues and duties and responsibilities were accepted as relevant by ten primary healthcare teams using a standard of 80 percent agreement. The evaluation found the MSF process to be feasible and acceptable and participants provided some evidence of educational impact. An MSF instrument for GPs has been developed based on the concept of 'the good GP' as described by the primary healthcare team. The evaluation of the resultant MSF process illustrates the potential of MSF, when delivered in the supportive environment of GP appraisal, to provide feedback which has the possibility of improving working relationships between GPs and their colleagues.

As Ye Sow, So Shall Ye Reap: From Consultant to Collaborator in the Development of a Teacher Preparation Program in Lesotho.

ERIC Educational Resources Information Center

Rothenberg, Julia Johnson

This paper reports on the author's 4-week consultation with faculty of the Lesotho National Teachers College as part of the Primary Education Project which provided technical assistance with issues of primary age schooling in the Kingdom of Lesotho. The consultant worked with 12 faculty members of the National Teachers College in a process that…

Interrelations in the Development of Primary School Learners' Creative Imagination and Creative Activity When Depicting a Portrait in Visual Art Lessons

ERIC Educational Resources Information Center

Šlahova, Aleksandra; Volonte, Ilze; Cacka, Maris

2017-01-01

Creative imagination is a psychic process of creating a new original image, idea or art work based on the acquired knowledge, skills, and abilities as well as on the experience of creative activity. The best of all primary school learners' creative imagination develops at the lessons of visual art, aimed at teaching them to understand what is…

Innovations in Primary Health Care: the use of communications technology and information tools to support local management.

PubMed

Pinto, Luiz Felipe; Rocha, Cristianne Maria Famer

2016-05-01

Social media has been used in different contexts as a way to streamline the flow of data and information for decision making. This has contributed to the issue of knowledge production in networks and the expansion of communication channels so that there is greater access to health services. This article describes the results of research done on 16 Information Technology and Communications Observatories in Health Care - OTICS Network in Rio - covering the Municipal Health Secretariat in Rio de Janeiro which supported the integration of primary health care and promoted the monitoring of health. It is a descriptive case study. The results relate to the support given to employees in training covering the dissemination of information, communication, training and information management in primary health care. This innovative means of communication in public health, with very little cost to the Unified Health System (SUS), allowed for a weekly registering of work processes for teams that worked in 193 primary health care units (APS) using blogs, whose total accesses reached the seven million mark in mid-2015. In the future there is a possibility that distance learning tools could be used to assist in training processes and in the continuing education of professionals in family health teams.

[Play therapy in social work with children].

PubMed

Dvarionas, Dziugas

2002-01-01

This article introduces the results of scientific research performed in 1995-1997 in Kaunas primary school with 1st and 2nd grade children exhibiting behavioral disorders. Play therapy, a quite novel method in the country, seeks better improvement and an achievement of a better relationship for disadvantaged children in educational process. Play group counseling, or play media counseling, is shown as an important method in working with early primary grade children, especially those who present behavioral problems in the classroom. Another important aspect of group play therapy is the concentrated relationship with the counselor. Primary school children, especially those who are disadvantaged respond more to warmth than to praise for being right and doing well. Data analysis allow us to assume that behavioral difficulties of primary school children are connected with a low rate of self-esteem and dissatisfaction with their vital activities. Main conclusions to correspond with hypothesis held for the research are: a) children exhibiting behavioral problems are less active in educational process; b) by means of systematic use of play group counseling method in school, problematic children are able to solve their difficulties and to optimize their academic improvement; c) there is a complementary relationship between child's self-esteem and his/her satisfaction with his/her vital activity.

Teachers' work ability: a study of relationships between collective efficacy and self-efficacy beliefs.

PubMed

Guidetti, Gloria; Viotti, Sara; Bruno, Andreina; Converso, Daniela

2018-01-01

Work ability constitutes one of the most studied well-being indicators related to work. Past research highlighted the relationship with work-related resources and demands, and personal resources. However, no studies highlight the role of collective and self-efficacy beliefs in sustaining work ability. The purpose of this study was to examine whether and by which mechanism work ability is linked with individual and collective efficacies in a sample of primary and middle school teachers. Using a dataset consisting of 415 primary and middle school Italian teachers, the analysis tested for the mediating role of self-efficacy between collective efficacy and work ability. Mediational analysis highlights that teachers' self-efficacy totally mediates the relationship between collective efficacy and perceived work ability. Results of this study enhance the theoretical knowledge and empirical evidence regarding the link between teachers' collective efficacy and self-efficacy, giving further emphasis to the concept of collective efficacy in school contexts. Moreover, the results contribute to the study of well-being in the teaching profession, highlighting a process that sustains and promotes levels of work ability through both collective and personal resources.

Profiles of mental health care professionals based on work role performance.

PubMed

Markon, Marie-Pierre; Bamvita, Jean-Marie; Chiocchio, François; Fleury, Marie-Josée

2017-12-01

The worldwide burden of mental disorders is considerable, and on the rise, putting pressure on health care systems. Current reforms aim to improve the efficiency of mental health care systems by increasing service integration in communities and strengthening primary mental health care. In this context, mental health care professionals (MHPs) are increasingly required to work on interdisciplinary teams in a variety of settings. Little is known, however, about the profiles of MHPs in relation to their perceived work role performance. MHPs in Quebec (N = 315) from four local service networks completed a self-administered questionnaire eliciting information on individual and team characteristics, as well as team processes and states. Profiles of MHPs were created using a two-step cluster analysis. Five profiles were generated. MHPs belonging to profiles labelled senior medical outpatient specialized care MHPs and senior psychosocial outpatient specialized care MHPs perceived themselves as more performing than MHPs in other profiles. The profile labelled low-collaborators was significantly less performing than all other groups. Two other profiles were identified, positioned between the aforementioned groups in terms of the perceived performance of MHPs: the junior primary care MHPs and the diversified specialized care MHPs. Seniority within the team, delivering specialized type of care, and positive team processes were all features associated with profiles where perceived work performance was high. Overall, this study supports the case for initiatives aimed at improving stability and interdisciplinary collaboration in health teams, especially in primary care.

Association Between Sluggish Cognitive Tempo Symptoms and Attentional Network and Working Memory in Primary Schoolchildren.

PubMed

Camprodon-Rosanas, E; Ribas-Fitó, N; Batlle, S; Persavento, C; Alvarez-Pedrerol, M; Sunyer, J; Forns, J

2017-04-01

Few consistent data are available in relation to the cognitive and neuropsychological processes involved in sluggish cognitive tempo (SCT) symptoms. The objective of this study was to determine the association of working memory and attentional networks with SCT symptoms in primary schoolchildren. The participants were schoolchildren aged 7 to 10 years ( n = 183) from primary schools in Catalonia (Spain). All the participants completed a working memory task (n-back) and an attentional network task (ANT). Their parents completed an SCT-Child Behavior Checklist self-report and a questionnaire concerning sociodemographic variables. Teachers of the participants provided information on ADHD symptoms and learning determinants. SCT symptoms were correlated with lower scores in both the n-back and ANT. In multivariate regression analysis, SCT symptoms were associated with slower hit reaction times from the ANT. Our results suggest that SCT symptoms are associated with a neuropsychological profile that is different from the classical ADHD profile and characterized by slower reaction times.

How personal and standardized coordination impact implementation of integrated care.

PubMed

Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

2015-10-02

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.

Developing the Scale of Teacher Self-Efficacy in Teaching Process

ERIC Educational Resources Information Center

Korkmaz, Fahrettin; Unsal, Serkan

2016-01-01

The purpose of this study is to develop a reliable and valid measurement tool which will reveal teachers' self-competence in education process. Participants of the study are 300 teachers working at state primary schools in the province of Gaziantep. Results of the exploratory factor analysis administered to the scale in order to determine its…

When Creativity Met Transfer: Increasing Creativity and Transfer by Controlling the Styles of Processing

ERIC Educational Resources Information Center

Kaniel, Shlomo

2013-01-01

The primary purpose of this article is to combine both transfer of learning (hereafter, transfer) and creativity into similar processes that can increase the products of transfer and creativity. Both transfer and creativity operate within reciprocal relationships between memory storage and working memory. Moreover, they are also based on moving…

Second and Fourth Graders' Copying Ability: From Graphical to Linguistic Processing

ERIC Educational Resources Information Center

Grabowski, Joachim; Weinzierl, Christian; Schmitt, Markus

2010-01-01

Particularly in primary school, good performance on copy tasks is an important working technique. With respect to writing skills, copying is a very basic process on which more complex writing abilities are based. We studied the copying ability of second and fourth graders across four types of symbols which vary with respect to their semantic and…

Analyzing the Interprofessional Working of a Home-Based Primary Care Team.

PubMed

Smith-Carrier, Tracy; Neysmith, Sheila

2014-09-01

Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients' homes), as well the negotiation of external relationships in the HBPC field, require further investigation.

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

PubMed

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

2018-06-01

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

Examining Power Struggles as a Signifier of Successful Partnership Working: A Case Study of Partnership Dynamics

ERIC Educational Resources Information Center

Derkzen, Petra; Franklin, Alex; Bock, Bettina

2008-01-01

In Britain, and Wales particularly, inclusion and equal opportunities for all became key principles guiding the work of the many partnerships that were established at the beginning of this century. A primary objective of this paper is to develop a greater understanding of the politics and processes within "partnership" as a widely used…

Thermal Management in Friction-Stir Welding of Precipitation-Hardened Aluminum Alloys

NASA Astrophysics Data System (ADS)

Upadhyay, Piyush; Reynolds, Anthony P.

2015-05-01

Process design and implementation in friction-stir welding (FSW) is mostly dependent on empirical information. Basic science of FSW and processing can only be complete when fundamental interrelationships between the process control parameters and response variables and the resulting weld microstructure and properties are established to a reasonable extent. It is known that primary process control parameters such as tool rotation, translation rates, and forge axis force have complicated and interactive relationships to process-response variables such as peak temperature and time at temperature. Of primary influence on the other process-response parameters are temperature and its gradient in the deformation and heat-affected zones. Through a review of pertinent works in the literature and results from boundary condition experiments performed in precipitation-hardening aluminum alloys, this article partially elucidates the nature and effects of temperature transients caused by variation of thermal boundaries in FSW.

Novel Binders and Methods for Agglomeration of Ore

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

S. K. Kawatra; T. C. Eisele; J. A. Gurtler

2004-03-31

Many metal extraction operations, such as leaching of copper, leaching of precious metals, and reduction of metal oxides to metal in high-temperature furnaces, require agglomeration of ore to ensure that reactive liquids or gases are evenly distributed throughout the ore being processed. Agglomeration of ore into coarse, porous masses achieves this even distribution of fluids by preventing fine particles from migrating and clogging the spaces and channels between the larger ore particles. Binders are critically necessary to produce agglomerates that will not break down during processing. However, for many important metal extraction processes there are no binders known that willmore » work satisfactorily. A primary example of this is copper heap leaching, where there are no binders that will work in the acidic environment encountered in this process. As a result, operators of acidic heap-leach facilities see a large loss of process efficiency due to their inability to take advantage of agglomeration. The large quantities of ore that must be handled in metal extraction processes also means that the binder must be inexpensive and useful at low dosages to be economical. The acid-resistant binders and agglomeration procedures developed in this project will also be adapted for use in improving the energy efficiency and performance of other agglomeration applications, particularly advanced primary ironmaking.« less

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

PubMed

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

2017-06-01

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

Decision Making Processes and Outcomes

PubMed Central

Hicks Patrick, Julie; Steele, Jenessa C.; Spencer, S. Melinda

2013-01-01

The primary aim of this study was to examine the contributions of individual characteristics and strategic processing to the prediction of decision quality. Data were provided by 176 adults, ages 18 to 93 years, who completed computerized decision-making vignettes and a battery of demographic and cognitive measures. We examined the relations among age, domain-specific experience, working memory, and three measures of strategic information search to the prediction of solution quality using a 4-step hierarchical linear regression analysis. Working memory and two measures of strategic processing uniquely contributed to the variance explained. Results are discussed in terms of potential advances to both theory and intervention efforts. PMID:24282638

Exemplars in the use of technology for management of depression in primary care.

PubMed

Serrano, Neftali; Molander, Rachel; Monden, Kimberley; Grosshans, Ashley; Krahn, Dean D

2012-06-01

Depression care management as part of larger efforts to integrate behavioral health care into primary care has been shown to be effective in helping patients and primary care clinicians achieve improved outcomes within the primary care environment. Central to care management systems is the use of registries which enable effective clinic population management. The aim of this article is to detail the methods and utility of technology in depression care management processes while also highlighting the real-world variations and barriers that exist in different clinical environments, namely a federally qualified health center and a Veterans Administration clinic. We analyzed descriptive data from the registries of Access Community Health Centers and the William S. Middleton Veterans Administration clinics along with historical reviews of their respective care management processes. Both registry reviews showed trend data indicating improvement in scores of depression and provided baseline data on important system variables, such as the number of patients who are not making progress, the percentage of patients who are unreachable by phone, and the kind of actions needed to ensure evidence-based and efficient care. Both sites also highlighted systemic technical barriers to more complete implementation of care management processes. Care management processes are an effective and efficient part of population-based care for depression in primary care. Implementation depends on available resources including hardware, software, and clinical personnel. Additionally, care management processes and technology have evolved over time based on local needs and are part of an integrated method to support the work of primary care clinicians in providing care for patients with depression.

Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and patients.

PubMed

Kennedy, Anne; Rogers, Anne; Chew-Graham, Carolyn; Blakeman, Thomas; Bowen, Robert; Gardner, Caroline; Lee, Victoria; Morris, Rebecca; Protheroe, Joanne

2014-10-21

Implementation of long-term condition management interventions rests on the notion of whole systems re-design, where incorporating wider elements of health care systems are integral to embedding effective and integrated solutions. However, most self-management support (SMS) evaluations still focus on particular elements or outcomes of a sub-system. A randomised controlled trial of a SMS intervention (WISE-Whole System Informing Self-management Engagement) implemented in primary care showed no effect on patient-level outcomes. This paper reports on a parallel process evaluation to ascertain influences affecting WISE implementation at patient, clinical and organisational levels. Normalisation Process Theory (NPT) provided a sensitising background and analytical framework. A multi-method approach using surveys and interviews with organisational stakeholders, practice staff and trial participants about impact of training and use of tools developed for WISE. Analysis was sensitised by NPT (coherence, cognitive participation, collective action and reflective monitoring). The aim was to identify what worked and what did not work for who and in what context. Interviews with organisation stakeholders emphasised top-down initiation of WISE by managers who supported innovation in self-management. Staff from 31 practices indicated engagement with training but patchy adoption of WISE tools; SMS was neither prioritised by practices nor fitted with a biomedically focussed ethos, so little effort was invested in WISE techniques. Interviews with 24 patients indicated no awareness of any changes following the training of practice staff; furthermore, they did not view primary care as an appropriate place for SMS. The results contribute to understanding why SMS is not routinely adopted and implemented in primary care. WISE was not embedded because of the perceived lack of relevance and fit to the ethos and existing work. Enacting SMS within primary care practice was not viewed as a legitimate activity or a professional priority. There was failure to, in principle, engage with and identify patients' support needs. Policy presumptions concerning SMS appear to be misplaced. Implementation of SMS within the health service does not currently account for patient circumstances. Primary care priorities and support for SMS could be enhanced if they link to patients' broader systems of implementation networks and resources.

Implementation of innovative attitudes and behaviour in primary health care by means of strategic communication: a 7-year follow-up.

PubMed

Morténius, Helena; Marklund, Bertil; Palm, Lars; Björkelund, Cecilia; Baigi, Amir

2012-06-01

To bridge the gap between theory and practice, methods are needed that promote a positive attitude to change among health care professionals and facilitate the incorporation of new research findings. In this context, communication plays a significant role. The aim of this study was to analyse primary care staff members' readiness to adopt new ways of thinking and willingness to change their work practices by means of strategic communication. An evaluative design was used to study a primary care staff cohort for 7 years. The study population comprised all primary care staff in a region of Sweden (n = 1206). The strategic communication encompassed managerial impact, planning and implementation of reflexive communication processes, in addition to activities in three established communication channels (oral, written and digital). A questionnaire was used, and bivariate and multivariate statistical analyses were performed. A total of 846 individuals participated in the evaluation (70%). Strategic communication had a significant effect on staff members' new way of thinking (61%) and willingness to change daily work practices (33%). The communication channels had a significant synergy effect on the adoption of new ideas and willingness to change attitudes. Oral and digital communication had a significant impact on staff members' readiness to change. Strategic communication plays an important role in the process of creating innovative attitudes and behaviour among primary care professionals. The willingness to change attitudes enhances primary care staff's readiness to change everyday practices, thus facilitating the implementation of evidence-based care. © 2011 Blackwell Publishing Ltd.

Exploring interprofessional collaboration during the integration of diabetes teams into primary care.

PubMed

Gucciardi, Enza; Espin, Sherry; Morganti, Antonia; Dorado, Linda

2016-02-01

Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes. This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work. Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators' reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software. Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange. Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.

Transmitted light microscopy for visualizing the turbulent primary breakup of a microscale liquid jet

NASA Astrophysics Data System (ADS)

Reddemann, Manuel A.; Mathieu, Florian; Kneer, Reinhold

2013-11-01

Aiming at a maximum spatial resolution and a minimum motion blur, a new simple double-imaging transmitted light microscopy technique is developed in this work enabling a fundamental investigation of primary breakup of a microscale liquid jet. Contrary to conventional far-field visualization techniques, the working distance is minimized to increase the numerical aperture. The resulting images provide information about shapes, length scales and velocities of primary liquid structures. The method is applied to an optically dense spray leaving a 109-μm diesel nozzle at various injection pressures under atmospheric conditions. A phenomenological study on the temporal spray evolution is done with focus on droplet and ligament formation. Different breakup processes are identified and described. It is found that the jet is characterized by long ligaments parallel or angular to the inner jet region. These ligaments result from collapsing films developing at the spray edge. A significant influence of outlet velocity variation on shape and velocity of these ligaments is observed. The experimental results prove that a transmitted light microscopy technique with reduced working distance is an appropriate tool for a better understanding of primary breakup for small-scaled diesel nozzles and a valuable complement to highly complex measurement techniques.

Working memory capacity and task goals modulate error-related ERPs.

PubMed

Coleman, James R; Watson, Jason M; Strayer, David L

2018-03-01

The present study investigated individual differences in information processing following errant behavior. Participants were initially classified as high or as low working memory capacity using the Operation Span Task. In a subsequent session, they then performed a high congruency version of the flanker task under both speed and accuracy stress. We recorded ERPs and behavioral measures of accuracy and response time in the flanker task with a primary focus on processing following an error. The error-related negativity was larger for the high working memory capacity group than for the low working memory capacity group. The positivity following an error (Pe) was modulated to a greater extent by speed-accuracy instruction for the high working memory capacity group than for the low working memory capacity group. These data help to explicate the neural bases of individual differences in working memory capacity and cognitive control. © 2017 Society for Psychophysiological Research.

Analysis of haptic information in the cerebral cortex

PubMed Central

2016-01-01

Haptic sensing of objects acquires information about a number of properties. This review summarizes current understanding about how these properties are processed in the cerebral cortex of macaques and humans. Nonnoxious somatosensory inputs, after initial processing in primary somatosensory cortex, are partially segregated into different pathways. A ventrally directed pathway carries information about surface texture into parietal opercular cortex and thence to medial occipital cortex. A dorsally directed pathway transmits information regarding the location of features on objects to the intraparietal sulcus and frontal eye fields. Shape processing occurs mainly in the intraparietal sulcus and lateral occipital complex, while orientation processing is distributed across primary somatosensory cortex, the parietal operculum, the anterior intraparietal sulcus, and a parieto-occipital region. For each of these properties, the respective areas outside primary somatosensory cortex also process corresponding visual information and are thus multisensory. Consistent with the distributed neural processing of haptic object properties, tactile spatial acuity depends on interaction between bottom-up tactile inputs and top-down attentional signals in a distributed neural network. Future work should clarify the roles of the various brain regions and how they interact at the network level. PMID:27440247

Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach.

PubMed

Steele Gray, Carolyn; Khan, Anum Irfan; Kuluski, Kerry; McKillop, Ian; Sharpe, Sarah; Bierman, Arlene S; Lyons, Renee F; Cott, Cheryl

2016-02-18

Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD. This paper describes the design and development approach, specifically the process of incorporating qualitative research methods into user-centered design approaches to create the ePRO tool. Key lessons learned are offered as a guide for other eHealth and mHealth research and technology developers working with complex patient populations and their primary health care providers. Guided by user-centered design principles, interpretive descriptive qualitative research methods were adopted to capture user experiences through interviews and working groups. Consistent with interpretive descriptive methods, an iterative analysis technique was used to generate findings, which were then organized in relation to the tool design and function to help systematically inform modifications to the tool. User feedback captured and analyzed through this method was used to challenge the design and inform the iterative development of the tool. Interviews with primary health care providers (n=7) and content experts (n=6), and four focus groups with patients and carers (n=14) along with a PICK analysis-Possible, Implementable, (to be) Challenged, (to be) Killed-guided development of the first prototype. The initial prototype was presented in three design working groups with patients/carers (n=5), providers (n=6), and experts (n=5). Working group findings were broken down into categories of what works and what does not work to inform modifications to the prototype. This latter phase led to a major shift in the purpose and design of the prototype, validating the importance of using iterative codesign processes. Interpretive descriptive methods allow for an understanding of user experiences of patients with CCDD, their carers, and primary care providers. Qualitative methods help to capture and interpret user needs, and identify contextual barriers and enablers to tool adoption, informing a redesign to better suit the needs of this diverse user group. This study illustrates the value of adopting interpretive descriptive methods into user-centered mHealth tool design and can also serve to inform the design of other eHealth technologies. Our approach is particularly useful in requirements determination when developing for a complex user group and their health care providers.

Orbital transfer vehicle launch operations study. Processing flows. Volume 3

NASA Technical Reports Server (NTRS)

1986-01-01

The Orbit Transfer Vehicle (OTV) processing flow and Resource Identification Sheets (RISs) for the ground based orbit transfer vehicle and for the space based orbit transfer vehicle are the primary source of information for the rest of the Kennedy Space Center (KSC) OTV Launch Operations Study. Work is presented which identifies KSC facility requirements for the OTV Program, simplifies or automates either flow though the application technology, revises test practices and identifies crew sizes or skills used. These flows were used as the primary point of departure from current operations and practices. Analyses results were documented by revising the appropriate RIS page.

An educational process to strengthen primary care nursing practices in São Paulo, Brazil.

PubMed

Chiesa, A M; Fracolli, L A

2007-12-01

To describe the experience of a registered nurse (RN) training process related to the Family Health Program (FHP) developed in the city of São Paulo, Brazil. The FHP is a national, government strategy to restructure primary care services. It focuses on the family in order to understand its physical and social structure in regards to the health-illness process. In the FHP, the RN is a member of a team with the same number as medical doctors - an unprecedented situation. The FHP requires a discussion of the RNs' practice, by qualifying and empowering them with tools and knowledge. The training process was based on Freire's approach founded on critical pedagogy in order to address the fundamental problem of inequalities in health. The first phase included workshops and the second one included a course. The workshops identified the following problems related to the RN's work: lack of tools to identify the population's needs; overload of work due to the accumulation of management and assistance activities; difficulties regarding teamwork; lack of tools to evaluate the impact of nursing interventions; lack of tools to improve the participation of the community. The course was organized to tackle these problems under five thematic headings. The RN's training process allowed the group to reflect deeply on its work. This experience led to the need for the construction of tools to intervene in the reality, mainly against social exclusion, rescuing and adapting of the knowledge accumulated in the healthcare practice, identifying settings which demand institutional solutions and engaging the RN in research groups in order to develop projects according to the complexity of the primary care services. The application of the concept of equity in the health sector represented a reaction against the processes of social exclusion, starting from performance at a local level to become a reality in the accomplishments achieved by the Brazilian National Health System. This training process allowed us to evaluate that partnership, which has produced many concrete results in addressing both parts of the Inequalities in Health dilemma and which is a productive way of building up a new model of health.

The Relations between Children's Reading Comprehension, Working Memory, Language Skills and Components of Reading Decoding in a Normal Sample

ERIC Educational Resources Information Center

Goff, Deborah A.; Pratt, Chris; Ong, Ben

2005-01-01

The primary aim of the current study was to identify the strongest independent predictors of reading comprehension using word reading, language and memory variables in a normal sample of 180 children in grades 3-5, with a range of word reading skills. It was hypothesized that orthographic processing, receptive vocabulary and verbal working memory…

Shallow Water Reverberation Measurement and Prediction

DTIC Science & Technology

1994-06-01

tool . The temporal signal processing consisted of a short-time Fourier transform spectral estimation method applied to data from a single hydrophone...The three-dimensional Hamiltonian Acoustic Ray-tracing Program for the Ocean (HARPO) was used as the primary propagation modeling tool . The temporal...summarizes the work completed and discusses lessons learned . Advice regarding future work to refine the present study will be provided. 6 our poiut source

Work process related to cerebral palsy of neurological rehabilitation centers.

PubMed

Mendonça, Ana Paula; Castro, Shamyr Sulyvan; Stone, John Henry; Andrade, Peterson M O

2015-01-01

To evaluate the work process for CP cases in different rehabilitation centers according to Brazilian health policies and recommendations from the "World Report on Disability". A questionnaire - Evaluation Process of Rehabilitation of Children with CP was applied to the Coordinators of 13 services. This instrument has a maximum score of 108 points. The results of the questionnaire varied from 28 to 64 points. The mean and SD were 43.5 and 10.9, respectively. The main administrative difficulties were: (a) presence of unmet demand, (b) patient absenteeism, (c) referral to primary care services, (d) inadequate physical facilities, (e) the scarce provision of prosthetics and orthotics, (f) insufficient financial resources, (g) human resources training, (h) difficulties with the use of the information system and (i) transportation difficulties for patients. Administrative and clinical guidelines are needed for uniformity of the work process of the rehabilitation centers.

Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders.

PubMed

Kredo, Tamara; Abrams, Amber; Young, Taryn; Louw, Quinette; Volmink, Jimmy; Daniels, Karen

2017-08-29

Clinical practice guidelines (CPGs) are common tools in policy and clinical practice informing clinical decisions at the bedside, governance of health facilities, health insurer and government spending, and patient choices. South Africa's health sector is transitioning to a national health insurance system, aiming to build on other primary health care initiatives to transform the previously segregated, inequitable services. Within these plans CPGs are an integral tool for delivering standardised and cost effective care. Currently, there is no accepted standard approach to developing, adapting or implementing CPGs efficiently or effectively in South Africa. We explored the current players; drivers; and the context and processes of primary care CPG development from the perspective of stakeholders operating at national level. We used a qualitative approach. Sampling was initially purposeful, followed by snowballing and further sampling to reach representivity of primary care service providers. Individual in-depth interviews were recorded and transcribed verbatim. We used thematic content analysis to analyse the data. We conducted 37 in-depth interviews from June 2014-July 2015. We found CPG development and implementation were hampered by lack of human and funding resources for technical and methodological work; fragmentation between groups, and between national and provincial health sectors; and lack of agreed systems for CPG development and implementation. Some CPG contributors steadfastly work to improve processes aiming to enhance communication, use of evidence, and transparency to ensure credible guidance is produced. Many interviewed had shared values, and were driven to address inequity, however, resource gaps were perceived to create an enabling environment for commercial interests or personal agendas to drive the CPG development process. Our findings identified strengths and gaps in CPG development processes, and a need for national standards to guide CPG development and implementation. Based on our findings and suggestions from participants, a possible way forward would be for South Africa to have a centrally coordinated CPG unit to address these needs and aspects of fragmentation by devising processes that support collaboration, transparency and credibility across sectors and disciplines. Such an initiative will require adequate resourcing to build capacity and ensure support for the delivery of high quality CPGs for South African primary care.

Humanization policy in primary health care: a systematic review

PubMed Central

Nora, Carlise Rigon Dalla; Junges, José Roque

2013-01-01

OBJECTIVE To analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy. METHODS A systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis. RESULTS Among the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users. CONCLUSIONS Although many practices were cited as humanizing they do not produce changes in the health services because of the lack of more profound analysis of the work processes and ongoing education in the health care services. PMID:24626556

Developing effective child psychiatry collaboration with primary care: leadership and management strategies.

PubMed

Sarvet, Barry D; Wegner, Lynn

2010-01-01

By working in collaboration with pediatric primary care providers, child and adolescent psychiatrists have the opportunity to address significant levels of unmet need for the majority of children and teenagers with serious mental health problems who have been unable to gain access to care. Effective collaboration with primary care represents a significant change from practice-as-usual for many child and adolescent psychiatrists. Implementation of progressive levels of collaborative practice, from the improvement of provider communication through the development of comprehensive collaborative systems, may be possible with sustained management efforts and application of process improvement methodology.

Discrete-Time Demodulator Architectures for Free-Space Broadband Optical Pulse-Position Modulation

NASA Technical Reports Server (NTRS)

Gray, A. A.; Lee, C.

2004-01-01

The objective of this work is to develop discrete-time demodulator architectures for broadband optical pulse-position modulation (PPM) that are capable of processing Nyquist or near-Nyquist data rates. These architectures are motivated by the numerous advantages of realizing communications demodulators in digital very large scale integrated (VLSI) circuits. The architectures are developed within a framework that encompasses a large body of work in optical communications, synchronization, and multirate discrete-time signal processing and are constrained by the limitations of the state of the art in digital hardware. This work attempts to create a bridge between theoretical communication algorithms and analysis for deep-space optical PPM and modern digital VLSI. The primary focus of this work is on the synthesis of discrete-time processing architectures for accomplishing the most fundamental functions required in PPM demodulators, post-detection filtering, synchronization, and decision processing. The architectures derived are capable of closely approximating the theoretical performance of the continuous-time algorithms from which they are derived. The work concludes with an outline of the development path that leads to hardware.

Secondary aerosol production from agricultural gas precursors

USDA-ARS?s Scientific Manuscript database

Studies of air quality indicate that agricultural emissions may impact particulate mass concentrations through both primary and secondary processes. Increasing evidence from both laboratory and field work suggests that not only does ammonia produce secondary particulate matter, but some volatile org...

Developing a programme theory to explain how primary health care teams learn to respond to intimate partner violence: a realist case-study.

PubMed

Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel; Vives-Cases, Carmen; Marchal, Bruno

2015-06-09

Despite the progress made on policies and programmes to strengthen primary health care teams' response to Intimate Partner Violence, the literature shows that encounters between women exposed to IPV and health-care providers are not always satisfactory, and a number of barriers that prevent individual health-care providers from responding to IPV have been identified. We carried out a realist case study, for which we developed and tested a programme theory that seeks to explain how, why and under which circumstances a primary health care team in Spain learned to respond to IPV. A realist case study design was chosen to allow for an in-depth exploration of the linkages between context, intervention, mechanisms and outcomes as they happen in their natural setting. The first author collected data at the primary health care center La Virgen (pseudonym) through the review of documents, observation and interviews with health systems' managers, team members, women patients, and members of external services. The quality of the IPV case management was assessed with the PREMIS tool. This study found that the health care team at La Virgen has managed 1) to engage a number of staff members in actively responding to IPV, 2) to establish good coordination, mutual support and continuous learning processes related to IPV, 3) to establish adequate internal referrals within La Virgen, and 4) to establish good coordination and referral systems with other services. Team and individual level factors have triggered the capacity and interest in creating spaces for team leaning, team work and therapeutic responses to IPV in La Virgen, although individual motivation strongly affected this mechanism. Regional interventions did not trigger individual and/ or team responses but legitimated the workings of motivated professionals. The primary health care team of La Virgen is involved in a continuous learning process, even as participation in the process varies between professionals. This process has been supported, but not caused, by a favourable policy for integration of a health care response to IPV. Specific contextual factors of La Virgen facilitated the uptake of the policy. To some extent, the performance of La Virgen has the potential to shape the IPV learning processes of other primary health care teams in Murcia.

Mechanisms behind overshoots in mean cluster size profiles in aggregation-breakup processes.

PubMed

Sadegh-Vaziri, Ramiar; Ludwig, Kristin; Sundmacher, Kai; Babler, Matthaus U

2018-05-26

Aggregation and breakup of small particles in stirred suspensions often shows an overshoot in the time evolution of the mean cluster size: Starting from a suspension of primary particles the mean cluster size first increases before going through a maximum beyond which a slow relaxation sets in. Such behavior was observed in various systems, including polymeric latices, inorganic colloids, asphaltenes, proteins, and, as shown by independent experiments in this work, in the flocculation of microalgae. This work aims at investigating possible mechanism to explain this phenomenon using detailed population balance modeling that incorporates refined rate models for aggregation and breakup of small particles in turbulence. Four mechanisms are considered: (1) restructuring, (2) decay of aggregate strength, (3) deposition of large clusters, and (4) primary particle aggregation where only aggregation events between clusters and primary particles are permitted. We show that all four mechanisms can lead to an overshoot in the mean size profile, while in contrast, aggregation and breakup alone lead to a monotonic, "S"-shaped size evolution profile. In order to distinguish between the different mechanisms simple protocols based on variations of the shear rate during the aggregation-breakup process are proposed. Copyright © 2018 Elsevier Inc. All rights reserved.

Preparing skilled labor in industry through production-based curriculum approach in vocational high school

NASA Astrophysics Data System (ADS)

Yoto

2017-09-01

Vocational high school (Sekolah Menengah Kejuruan / SMK) aims to prepare mid-level skilled labors to work in the industry and are able to create self-employment opportunities. For those reasons, the curriculum in SMK should be based on meeting the needs of the industries and is able to prepare learners to master the competence in accordance with the skills program of their choice. Production based curriculum is the curriculum which the learning process is designed together with the production process or using production process as a learning medium. This approach with the primary intention to introduce students with the real working environment and not merely simulations. In the production-based curriculum implementation model, students are directly involved in the industry through the implementation of industrial working practices, do work on production units in school, and do practical work in school by doing the job as done in the industry by using industry standards machines.

Primary healthcare nurses' experiences with motivational interviewing in health promotion practice.

PubMed

Brobeck, Elisabeth; Bergh, Håkan; Odencrants, Sigrid; Hildingh, Cathrine

2011-12-01

The aim of the study was to describe primary healthcare nurses' experiences with motivational interviewing as a method for health promotion practice. A person's lifestyle has a major effect on his or her health. Motivational interviewing is one way of working with lifestyle changes in health promotion practice. The basic plan of motivational interviewing is to help people understand their lifestyle problems and make positive lifestyle changes. Motivational interviewing has been proven to be more effective than conventional methods in increasing patient motivation. This study has a descriptive design and uses a qualitative method. Twenty nurses who worked in primary health care and actively used motivational interviewing in their work were interviewed. Qualitative content analysis was used to process the data. The primary healthcare nurses' experiences with motivational interviewing as a method of health promotion practice demonstrate that motivational interviewing is a demanding, enriching and useful method that promotes awareness and guidance in the care relationship. The results also show that motivational interviewing is a valuable tool for primary healthcare nurses' health promotion practice. This study shows that motivational interviewing places several different demands on nurses who use this method. Those who work with motivational interviewing must make an effort to incorporate this new method to avoid falling back into the former practice of simply giving advice. Maintaining an open mind while implementing motivational interviewing in real healthcare settings is crucial for nurses to increase this method's effectiveness. The nurses in the study had a positive experience with motivational interviewing, which can contribute to the increased use, adaption and development of motivational interviewing among primary healthcare professionals. Increased motivational interviewing knowledge and skills would also contribute to promotion of health lifestyle practices. © 2011 Blackwell Publishing Ltd.

Optimizing Transitions of Care - Hospital to Community.

PubMed

Sheridan, Emily; Thompson, Christine; Pinheiro, Tania; Robinson, Nicole; Davies, Karen; Whitmore, Nancy

2017-01-01

Discharging patients from the hospital is a complex process, and preventing avoidable readmissions has the potential to improve both the quality of life for patients and the financial sustainability of the healthcare system (Alper et al. 2016). Improving the discharge process is one method to mitigate readmission to the hospital. Historically, St. Thomas Elgin General Hospital (STEGH) consistently experienced higher-than-expected readmission rates, and only 41% of discharge summaries were sent from the hospital to the community primary care within 48 hours. In addition, the overall percentage of patients attending a follow-up appointment with a primary care physician within seven days of discharge from hospital was lower than the provincial average. Through engagement with primary care providers (PCPs) and clinical associates (CAs) and with the use of standard work and monitoring organizational metrics, STEGH has achieved significant improvements.

Translating 10 lessons from lean six sigma project in paper-based training site to electronic health record-based primary care practice: challenges and opportunities.

PubMed

Aleem, Sohaib

2013-01-01

Lean Six Sigma is a well-proven methodology to enhance the performance of any business, including health care. The strategy focuses on cutting out waste and variation from the processes to improve the value and efficiency of work. This article walks through the journey of "green belt" training using a Lean Six Sigma approach and the implementation of a process improvement project that focused on wait time for patients to be examined in an urban academic primary care clinic without requiring added resources. Experiences of the training and the project at an urban paper-based satellite clinic have informed the planning efforts of a data and performance team, including implementing a 15-minute nurse "pre-visit" at primary care sites of an accountable care organization.

Site planning and integration fiscal year 1999 multi-year work plan (MYWP) update for WBS 1.8.2.1

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

SCHULTZ, E.A.

The primary mission of the Site Planning and Integration (SP and I) project is to assist Fluor Daniel Project Direction to ensure that all work performed under the Project Hanford Management Contract (PHMC) is adequately planned, executed, controlled, and that performance is measured and reported in an integrated fashion. Furthermore, SP and I is responsible for the development, implementation, and management of systems and processes that integrate technical, schedule, and cost baselines for PHMC work.

The Relationships of Working Memory, Secondary Memory, and General Fluid Intelligence: Working Memory is Special

PubMed Central

Shelton, Jill Talley; Elliott, Emily M.; Matthews, Russell A.; Hill, B. D.; Gouvier, Wm. Drew

2010-01-01

Recent efforts have been made to elucidate the commonly observed link between working memory and reasoning ability. The results have been inconsistent, with some work suggesting the emphasis placed on retrieval from secondary memory by working memory tests is the driving force behind this association (Mogle, Lovett, Stawski, & Sliwinski, 2008), while other research suggests retrieval from secondary memory is only partly responsible for the observed link between working memory and reasoning (Unsworth & Engle, 2006, 2007b). The present study investigates the relationship between processing speed, working memory, secondary memory, primary memory, and fluid intelligence. Although our findings show all constructs are significantly correlated with fluid intelligence, working memory, but not secondary memory, accounts for significant unique variance in fluid intelligence. Our data support predictions made by Unsworth and Engle, and suggest that the combined need for maintenance and retrieval processes present in working memory tests makes them “special” in their prediction of higher-order cognition. PMID:20438278

B827 Chemical Synthhesis Project - Industrial Control System Integration - Statement of Work & Specification with Attachments 1-14

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

Wade, F. E.

The Chemical Synthesis Pilot Process at the Lawrence Livermore National Laboratory (LLNL) Site 300 827 Complex will be used to synthesize small quantities of material to support research and development. The project will modernize and increase current capabilities for chemical synthesis at LLNL. The primary objective of this project is the conversion of a non-automated hands-on process to a remoteoperation process, while providing enhanced batch process step control, stored recipe-specific parameter sets, process variable visibility, monitoring, alarm and warning handling, and comprehensive batch record data logging. This Statement of Work and Specification provides the industrial-grade process control requirements for themore » chemical synthesis batching control system, hereafter referred to as the “Control System” to be delivered by the System Integrator.« less

Using robotics construction kits as metacognitive tools: a research in an Italian primary school.

PubMed

La Paglia, Filippo; Caci, Barbara; La Barbera, Daniele; Cardaci, Maurizio

2010-01-01

The present paper is aimed at analyzing the process of building and programming robots as a metacognitive tool. Quantitative data and qualitative observations from a research performed in a sample of children attending an Italian primary school are described in this work. Results showed that robotics activities may be intended as a new metacognitive environment that allows children to monitor themselves and control their learning actions in an autonomous and self-centered way.

Transition to family practice in Turkey.

PubMed

Güneş, Evrim Didem; Yaman, Hakan

2008-01-01

Turkey's primary health care (PHC) system was established in the beginning of the 1960s and provides preventive and curative basic medical services to the population. This article describes the experience of the Turkish health system, as it tries to adapt to the European health system. It describes the current organization of primary health care and the family medicine model that is in the process of implementation and discusses implications of the transition for family physicians and the challenges faced in meeting the needs for health care staff. In Turkey a trend toward urbanization is evident and more staff positions in rural PHC centers are vacant. Shortages of physicians and an ineffective distribution of doctors are seen as a major problem. Family medicine gained popularity at the beginning of the 1990s, as a specialty with a 3-year postgraduate training program. Medical practitioners who are graduates of a 6-year medical training program and are already working in the PHC system are offered retraining courses. Better working conditions and higher salaries may be important incentives for medical practitioners to sign a contract with the social security institution of Turkey. The lack of well-trained primary care staff is an ongoing challenge. Attempts to retrain medical practitioners to act as family physicians show promising results. Shortness of physician and health professionals and lack of time and resources in primary health care are problems to overcome during this process.

Teachers’ work ability: a study of relationships between collective efficacy and self-efficacy beliefs

PubMed Central

Guidetti, Gloria; Viotti, Sara; Bruno, Andreina; Converso, Daniela

2018-01-01

Introduction Work ability constitutes one of the most studied well-being indicators related to work. Past research highlighted the relationship with work-related resources and demands, and personal resources. However, no studies highlight the role of collective and self-efficacy beliefs in sustaining work ability. Purpose The purpose of this study was to examine whether and by which mechanism work ability is linked with individual and collective efficacies in a sample of primary and middle school teachers. Materials and methods Using a dataset consisting of 415 primary and middle school Italian teachers, the analysis tested for the mediating role of self-efficacy between collective efficacy and work ability. Results Mediational analysis highlights that teachers’ self-efficacy totally mediates the relationship between collective efficacy and perceived work ability. Conclusion Results of this study enhance the theoretical knowledge and empirical evidence regarding the link between teachers’ collective efficacy and self-efficacy, giving further emphasis to the concept of collective efficacy in school contexts. Moreover, the results contribute to the study of well-being in the teaching profession, highlighting a process that sustains and promotes levels of work ability through both collective and personal resources. PMID:29861646

Motivation related to work: A century of progress.

PubMed

Kanfer, Ruth; Frese, Michael; Johnson, Russell E

2017-03-01

Work motivation is a topic of crucial importance to the success of organizations and societies and the well-being of individuals. We organize the work motivation literature over the last century using a meta-framework that clusters theories, findings, and advances in the field according to their primary focus on (a) motives, traits, and motivation orientations (content); (b) features of the job, work role, and broader environment (context); or (c) the mechanisms and processes involved in choice and striving (process). Our integrative review reveals major achievements in the field, including more precise mapping of the psychological inputs and operations involved in motivation and broadened conceptions of the work environment. Cross-cutting trends over the last century include the primacy of goals, the importance of goal striving processes, and a more nuanced conceptualization of work motivation as a dynamic, goal-directed, resource allocation process that unfolds over the related variables of time, experience, and place. Across the field, advances in methodology and measurement have improved the match between theory and research. Ten promising directions for future research are described and field experiments are suggested as a useful means of bridging the research-practice gap. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Understanding chemistry behind secondary aerosol production from nitrogen and sulfur compounds from agriculture

USDA-ARS?s Scientific Manuscript database

Agricultural emissions impact particulate mass concentrations through both primary and secondary processes. Evidence from laboratory and field work suggest that not only does ammonia produce secondary particulate matter, but nitrogen and sulfur containing volatile organic compounds also contribute. ...

48 CFR 927.300 - General.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 927.300 Federal Acquisition Regulations System DEPARTMENT OF ENERGY GENERAL CONTRACTING REQUIREMENTS... primary missions of the Department of Energy is the use of its procurement process to ensure the conduct... sources of energy. To accomplish its mission, DOE must work in cooperation with industry in the...

48 CFR 927.300 - General.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 927.300 Federal Acquisition Regulations System DEPARTMENT OF ENERGY GENERAL CONTRACTING REQUIREMENTS... primary missions of the Department of Energy is the use of its procurement process to ensure the conduct... sources of energy. To accomplish its mission, DOE must work in cooperation with industry in the...

48 CFR 927.300 - General.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 927.300 Federal Acquisition Regulations System DEPARTMENT OF ENERGY GENERAL CONTRACTING REQUIREMENTS... primary missions of the Department of Energy is the use of its procurement process to ensure the conduct... sources of energy. To accomplish its mission, DOE must work in cooperation with industry in the...

48 CFR 927.300 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 927.300 Federal Acquisition Regulations System DEPARTMENT OF ENERGY GENERAL CONTRACTING REQUIREMENTS... primary missions of the Department of Energy is the use of its procurement process to ensure the conduct... sources of energy. To accomplish its mission, DOE must work in cooperation with industry in the...

Design, fabrication and characterization of a poly-silicon PN junction

NASA Astrophysics Data System (ADS)

Tower, Jason D.

This thesis details the design, fabrication, and characterization of a PN junction formed from p-type mono-crystalline silicon and n-type poly-crystalline silicon. The primary product of this project was a library of standard operating procedures (SOPs) for the fabrication of such devices, laying the foundations for future work and the development of a class in fabrication processes. The fabricated PN junction was characterized; in particular its current-voltage relationship was measured and fit to models. This characterization was to determine whether or not the fabrication process could produce working PN junctions with acceptable operational parameters.

Operationalizing Space Weather Products - Process and Issues

NASA Astrophysics Data System (ADS)

Scro, K. D.; Quigley, S.

2006-12-01

Developing and transitioning operational products for any customer base is a complicated process. This is the case for operational space weather products and services for the USAF. This presentation will provide information on the current state of affairs regarding the process required to take an idea from the research field to the real-time application of 24-hour space weather operations support. General principles and specific issues are discussed and will include: customer requirements, organizations in-play, funding, product types, acquisition of engineering and validation data, security classification, version control, and various important changes that occur during the process. The author's viewpoint is as an individual developing space environmental system-impact products for the US Air Force: 1) as a member of its primary research organization (Air Force Research Laboratory), 2) working with its primary space environment technology transition organization (Technology Application Division of the Space and Missile Systems Center, SMC/WXT), and 3) delivering to the primary sponsor/customer of such system-impact products (Air Force Space Command). The experience and focus is obviously on specific military operationalization process and issues, but most of the paradigm may apply to other (commercial) enterprises as well.

Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

PubMed

Smith, Patrick D; Boyd, Cynthia; Bellantoni, Julia; Roth, Jill; Becker, Kathleen L; Savage, Jessica; Nkimbeng, Manka; Szanton, Sarah L

2016-02-01

To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote safe and efficient communication. Nurses should empower patients to address concerns directly with providers through use of devices including health passports. © 2016 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.

Computational modeling of colorimetric primary transducer for metrological assurance in additive manufacturing

NASA Astrophysics Data System (ADS)

Skliarov, Volodymyr

2018-03-01

Many additive manufacturing (AM) systems are based on laser technology. The advantage of laser technology is that it provides a high-intensity and high-collimation energy beam that can be controlled. Since AM requires that the material on each layer has to be solid or connected to the previous one, the energy of laser radiation is exactly the needed technical tool for the processing of the material. AM uses two types of laser processing: cutting and heating. One of the most popular (common) types of measurements in the field of laser metrology is the control of the energy parameters of the sources of laser radiation. At present, calorimeters provide the highest accuracy of absolute measurements of laser radiation in the power range from several watts to tens of kilowatts. The main elements that determine the accuracy of reproduction, maintenance and transfer of the unit of laser power are the primary measuring converters (PMCs), which are the part of the equipment of the national primary measurement standards of Ukraine. A significant contribution to the uncertainty budget of the primary measuring calorimetric converter is the unbalanced replacement of laser radiation by the heat flux that calibrates this converter. The heterogeneous internal structure of the calorimetric primary converter, the nonlinearity of processes occurring in it, and the multifactorial process of its calibration substantially complicate the development of primary measuring converters. The purpose of this paper is to simulate the thermal field of the primary converter for maximum reduction of the uncertainty of calibration. The presented research is a part of the scientific work that NSC "Institute of Metrology" carries out under COOMET and EMPIRE projects. The modeling was performed in the academic version of ANSYS.

[Decisive factors relating to workload in a primary healthcare unit].

PubMed

da Silva, Nilson Rogério

2011-08-01

Work-related diseases o either physical or emotional origin have been on the increase in contemporary society in the different work sectors. They have had a profound impact on health professionals, such as physicians, dentists, nurses, nursing assistants and administrative assistants in the primary healthcare units. This study aimed to establish the decisive factors relating to workload, seeking to identify possible relations between the working conditions and their potential impact on worker health. Thirty-one individuals comprised the sample, namely 12 physicians, 3 dentists, 1 nurse, 9 nursing assistants, 3 dental assistants and 3 business assistants at a PHU (Primary Healthcare Unit) in a city in the interior of the State of São Paulo. For the data collection, structured interviews were conducted through meetings with the specific groups of workers, such that a detailed description of the activities performed by each group could be drafted, as well as a survey of the problems and desirable features involved. The results indicated the presence of physical, cognitive and psychological demands; inadequate communication processes; obsolete equipment; excessive number of users and an inefficient structure to deal with absenteeism.

Automated platform for designing multiple robot work cells

NASA Astrophysics Data System (ADS)

Osman, N. S.; Rahman, M. A. A.; Rahman, A. A. Abdul; Kamsani, S. H.; Bali Mohamad, B. M.; Mohamad, E.; Zaini, Z. A.; Rahman, M. F. Ab; Mohamad Hatta, M. N. H.

2017-06-01

Designing the multiple robot work cells is very knowledge-intensive, intricate, and time-consuming process. This paper elaborates the development process of a computer-aided design program for generating the multiple robot work cells which offer a user-friendly interface. The primary purpose of this work is to provide a fast and easy platform for less cost and human involvement with minimum trial and errors adjustments. The automated platform is constructed based on the variant-shaped configuration concept with its mathematical model. A robot work cell layout, system components, and construction procedure of the automated platform are discussed in this paper where integration of these items will be able to automatically provide the optimum robot work cell design according to the information set by the user. This system is implemented on top of CATIA V5 software and utilises its Part Design, Assembly Design, and Macro tool. The current outcomes of this work provide a basis for future investigation in developing a flexible configuration system for the multiple robot work cells.

Methodology trends on gamma and electron radiation damage simulation studies in solids under high fluency irradiation environments

NASA Astrophysics Data System (ADS)

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

2017-09-01

The present work deals with the numerical simulation of gamma and electron radiation damage processes under high brightness and radiation particle fluency on regard to two new radiation induced atom displacement processes, which concern with both, the Monte Carlo Method based numerical simulation of the occurrence of atom displacement process as a result of gamma and electron interactions and transport in a solid matrix and the atom displacement threshold energies calculated by Molecular Dynamic methodologies. The two new radiation damage processes here considered in the framework of high brightness and particle fluency irradiation conditions are: 1) The radiation induced atom displacement processes due to a single primary knockout atom excitation in a defective target crystal matrix increasing its defect concentrations (vacancies, interstitials and Frenkel pairs) as a result of a severe and progressive material radiation damage and 2) The occurrence of atom displacements related to multiple primary knockout atom excitations for the same or different atomic species in an perfect target crystal matrix due to subsequent electron elastic atomic scattering in the same atomic neighborhood during a crystal lattice relaxation time. In the present work a review numeral simulation attempts of these two new radiation damage processes are presented, starting from the former developed algorithms and codes for Monte Carlo simulation of atom displacements induced by electron and gamma in

Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study

PubMed Central

Lionis, Christos; Papadakaki, Maria; Saridaki, Aristoula; Dowrick, Christopher; O'Donnell, Catherine A; Mair, Frances S; van den Muijsenbergh, Maria; Burns, Nicola; de Brún, Tomas; O'Reilly de Brún, Mary; van Weel-Baumgarten, Evelyn; Spiegel, Wolfgang; MacFarlane, Anne

2016-01-01

Objectives Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings. Setting As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands. Participants A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners). Primary and secondary outcome measures We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs. Results The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project. Conclusions This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants. PMID:27449890

Progress in Operational Analysis of Launch Vehicles in Nonstationary Flight

NASA Technical Reports Server (NTRS)

James, George; Kaouk, Mo; Cao, Timothy

2013-01-01

This paper presents recent results in an ongoing effort to understand and develop techniques to process launch vehicle data, which is extremely challenging for modal parameter identification. The primary source of difficulty is due to the nonstationary nature of the situation. The system is changing, the environment is not steady, and there is an active control system operating. Hence, the primary tool for producing clean operational results (significant data lengths and data averaging) is not available to the user. This work reported herein uses a correlation-based two step operational modal analysis approach to process the relevant data sets for understanding and development of processes. A significant drawback for such processing of short time histories is a series of beating phenomena due to the inability to average out random modal excitations. A recursive correlation process coupled to a new convergence metric (designed to mitigate the beating phenomena) is the object of this study. It has been found in limited studies that this process creates clean modal frequency estimates but numerically alters the damping.

Study protocol of a mixed-methods evaluation of a cluster randomized trial to improve the safety of NSAID and antiplatelet prescribing: data-driven quality improvement in primary care.

PubMed

Grant, Aileen; Dreischulte, Tobias; Treweek, Shaun; Guthrie, Bruce

2012-08-28

Trials of complex interventions are criticized for being 'black box', so the UK Medical Research Council recommends carrying out a process evaluation to explain the trial findings. We believe it is good practice to pre-specify and publish process evaluation protocols to set standards and minimize bias. Unlike protocols for trials, little guidance or standards exist for the reporting of process evaluations. This paper presents the mixed-method process evaluation protocol of a cluster randomized trial, drawing on a framework designed by the authors. This mixed-method evaluation is based on four research questions and maps data collection to a logic model of how the data-driven quality improvement in primary care (DQIP) intervention is expected to work. Data collection will be predominately by qualitative case studies in eight to ten of the trial practices, focus groups with patients affected by the intervention and quantitative analysis of routine practice data, trial outcome and questionnaire data and data from the DQIP intervention. We believe that pre-specifying the intentions of a process evaluation can help to minimize bias arising from potentially misleading post-hoc analysis. We recognize it is also important to retain flexibility to examine the unexpected and the unintended. From that perspective, a mixed-methods evaluation allows the combination of exploratory and flexible qualitative work, and more pre-specified quantitative analysis, with each method contributing to the design, implementation and interpretation of the other.As well as strengthening the study the authors hope to stimulate discussion among their academic colleagues about publishing protocols for evaluations of randomized trials of complex interventions. DATA-DRIVEN QUALITY IMPROVEMENT IN PRIMARY CARE TRIAL REGISTRATION: ClinicalTrials.gov: NCT01425502.

Nursing challenges for universal health coverage: a systematic review1

PubMed Central

Schveitzer, Mariana Cabral; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida Maria da Silva

2016-01-01

Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage. PMID:27143536

The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care.

PubMed

Foster, Michele; Burridge, Letitia; Donald, Maria; Zhang, Jianzhen; Jackson, Claire

2016-01-14

Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Small-scale, locally-led service delivery innovation is a valuable source of learning about the complexities of change and the actions of local change agents. This exploratory qualitative study captures the perspectives of clinicians and managers involved in a general practitioner-led integrated diabetes care innovation. Data on these change agents' perspectives on the local innovation and how it works in the local context were collected through focus groups and semi-structured interviews at two primary health care sites. Transcribed data were analysed thematically. Normalization Process Theory provided a framework to explore perspectives on the individual and collective work involved in putting the innovation into practice in local service delivery contexts. Twelve primary health care clinicians, hospital-based medical specialists and practice managers participated in the study, which represented the majority involved in the innovation at the two sites. The thematic analysis highlighted three main themes of local innovation work: 1) trusting and embedding new professional relationships; 2) synchronizing services and resources; and 3) reconciling realities of innovation work. As a whole, the findings show that while locally-led service delivery innovation is designed to respond to local problems, convincing others to trust change and managing the boundary tensions is core to local work, particularly when it challenges taken-for-granted practices and relationships. Despite this, the findings also show that local innovators can and do act in both discretionary and creative ways to progress the innovation. The use of Normalization Process Theory uncovered some critical professional, organizational and structural factors early in the progression of the innovation. The key to local service delivery innovation lies in building coalitions of trust at the point of service delivery and persuading organizational and institutional mindsets to consider the opportunities of locally-led innovation.

Handwriting Fluency and Visuospatial Generativity at Primary School

ERIC Educational Resources Information Center

Stievano, Paolo; Michetti, Silvia; McClintock, Shawn M.; Levi, Gabriel; Scalisi, Teresa Gloria

2016-01-01

Handwriting is a complex activity that involves continuous interaction between lowerlevel perceptual-motor and higher-level cognitive processes. All handwriting models describe involvement of executive functions (EF) in handwriting development. Particular EF domains associated with handwriting include maintenance of information in working memory,…

Differential Processing for Actively Ignored Pictures and Words

PubMed Central

Ciraolo, Margeaux

2017-01-01

Previous work suggests that, when attended, pictures may be processed more readily than words. The current study extends this research to assess potential differences in processing between these stimulus types when they are actively ignored. In a dual-task paradigm, facilitated recognition for previously ignored words was found provided that they appeared frequently with an attended target. When adapting the same paradigm here, previously unattended pictures were recognized at high rates regardless of how they were paired with items during the primary task, whereas unattended words were later recognized at higher rates only if they had previously been aligned with primary task targets. Implicit learning effects obtained by aligning unattended items with attended task-targets may apply only to conceptually abstract stimulus types, such as words. Pictures, on the other hand, may maintain direct access to semantic information, and are therefore processed more readily than words, even when being actively ignored. PMID:28122022

Differential Processing for Actively Ignored Pictures and Words.

PubMed

Walker, Maegen; Ciraolo, Margeaux; Dewald, Andrew; Sinnett, Scott

2017-01-01

Previous work suggests that, when attended, pictures may be processed more readily than words. The current study extends this research to assess potential differences in processing between these stimulus types when they are actively ignored. In a dual-task paradigm, facilitated recognition for previously ignored words was found provided that they appeared frequently with an attended target. When adapting the same paradigm here, previously unattended pictures were recognized at high rates regardless of how they were paired with items during the primary task, whereas unattended words were later recognized at higher rates only if they had previously been aligned with primary task targets. Implicit learning effects obtained by aligning unattended items with attended task-targets may apply only to conceptually abstract stimulus types, such as words. Pictures, on the other hand, may maintain direct access to semantic information, and are therefore processed more readily than words, even when being actively ignored.

Evaluation of dairy powder products implicates thermophilic sporeformers as the primary organisms of interest.

PubMed

Watterson, M J; Kent, D J; Boor, K J; Wiedmann, M; Martin, N H

2014-01-01

Dairy powder products (e.g., sweet whey, nonfat dry milk, acid whey, and whey protein concentrate-80) are of economic interest to the dairy industry. According to the US Dairy Export Council, customers have set strict tolerances (<500 to <1,000/g) for thermophilic and mesophilic spores in dairy powders; therefore, understanding proliferation and survival of sporeforming organisms within dairy powder processing plants is necessary to control and reduce sporeformer counts. Raw, work-in-process, and finished product samples were collected from 4 dairy powder processing facilities in the northeastern United States over a 1-yr period. Two separate spore treatments: (1) 80°C for 12min (to detect sporeformers) and (2) 100°C for 30min (to detect highly heat resistant sporeformers) were applied to samples before microbiological analyses. Raw material, work-in-process, and finished product samples were analyzed for thermophilic, mesophilic, and psychrotolerant sporeformers, with 77.5, 71.0, and 4.6% of samples being positive for those organisms, respectively. Work-in-process and finished product samples were also analyzed for highly heat resistant thermophilic and mesophilic sporeformers, with 63.7 and 42.6% of samples being positive, respectively. Sporeformer prevalence and counts varied considerably by product and plant; sweet whey and nonfat dry milk showed a higher prevalence of thermophilic and mesophilic sporeformers compared with acid whey and whey protein concentrate-80. Unlike previous reports, we found limited evidence for increased spore counts toward the end of processing runs. Our data provide important insight into spore contamination patterns associated with production of different types of dairy powders and support that thermophilic sporeformers are the primary organism of concern in dairy powders. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Investigation of the Work Motivation Levels of Primary School Teachers

ERIC Educational Resources Information Center

Ates, Hatice Kadioglu; Yilmaz, Perihan

2018-01-01

This study was conducted to examine the work motivation levels of primary school teachers working in primary school institutions located in Istanbul province, Kucukcekmece district. The descriptive survey model was used in this study. The population of the study consists of primary school teachers and primary school administrators working in state…

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing

PubMed Central

Dreischulte, Tobias; Guthrie, Bruce

2017-01-01

Objective To explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time. Design Mixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices. Setting Ten (30%) primary care practices participating in the trial from Scotland, UK. Results Four practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability. Conclusions Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the trial. Practices organised their delivery of changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation. Trial registration number NCT01425502. PMID:28283493

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing.

PubMed

Grant, Aileen; Dreischulte, Tobias; Guthrie, Bruce

2017-03-10

To explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time. Mixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices. Ten (30%) primary care practices participating in the trial from Scotland, UK. Four practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability. Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the trial. Practices organised their delivery of changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation. NCT01425502. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Ethical and legal issues in the clinical practice of primary health care.

PubMed

Maestro, Francisco Javier; Martinez-Romero, Marcos; Vazquez-Naya, Jose Manuel; Pereira, Javier; Pazos, Alejandro

2013-01-01

Since it was conceived, the notion of primary care has been a crucial concept in health services. Most health care is provided at this level and primary care clinicians have an essential role, both in terms of disease prevention and disease management. During the last decades, primary health care has evolved from a traditional paternalistic model, in which patients played the role of passive recipient of care, towards a situation in which patients are partners involved in the decision making-process. This new context opened a considerable number of new ethical and legal aspects, which need to be comprehensively analyzed and discussed in order to preserve the quality of primary health care all around the world. This work reviews the most important ethical and legal issues in primary health care. Legislation issues are explained in the context of the Spanish Health Services.

Does the Component Processes Task Assess Text-Based Inferences Important for Reading Comprehension? A Path Analysis in Primary School Children

PubMed Central

Wassenburg, Stephanie I.; de Koning, Björn B.; de Vries, Meinou H.; van der Schoot, Menno

2016-01-01

Using a component processes task (CPT) that differentiates between higher-level cognitive processes of reading comprehension provides important advantages over commonly used general reading comprehension assessments. The present study contributes to further development of the CPT by evaluating the relative contributions of its components (text memory, text inferencing, and knowledge integration) and working memory to general reading comprehension within a single study using path analyses. Participants were 173 third- and fourth-grade children. As hypothesized, knowledge integration was the only component of the CPT that directly contributed to reading comprehension, indicating that the text-inferencing component did not assess inferential processes related to reading comprehension. Working memory was a significant predictor of reading comprehension over and above the component processes. Future research should focus on finding ways to ensure that the text-inferencing component taps into processes important for reading comprehension. PMID:27378989

Research and evaluation in the transformation of primary care.

PubMed

Peek, C J; Cohen, Deborah J; deGruy, Frank V

2014-01-01

Across the United States, primary care practices are engaged in demonstration projects and quality improvement efforts aimed at integrating behavioral health and primary care. Efforts to make sustainable changes at the frontline of care have identified new research and evaluation needs. These efforts enable clinics and larger health care communities to learn from demonstration projects regarding what works and what does not when integrating mental health, substance use, and primary care under realistic circumstances. To do this, implementers need to measure their successes and failures to inform local improvement processes, including the efforts of those working on integration in separate but similar settings. We review how new research approaches, beyond the contributions of traditional controlled trials, are needed to inform integrated behavioral health. Illustrating with research examples from the field, we describe how research traditions can be extended to meet these new research and learning needs of frontline implementers. We further suggest that a shared language and set of definitions for the field (not just for a particular study) are critical for the aggregation of knowledge and learning across practices and for policymaking and business modeling.

Primary health care reform, dilemmatic space and risk of burnout among health workers.

PubMed

Freeman, Toby; Baum, Fran; Labonté, Ronald; Javanparast, Sara; Lawless, Angela

2018-05-01

Health system changes may increase primary health care workers' dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government-managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community-controlled service) during a period of change and examined workers' dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work 'under the radar', undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.

Bibliographic processes and products, and a bibliography of the published primary-source works of B. F. Skinner

PubMed Central

Morris, Edward K.; Smith, Nathaniel G.

2003-01-01

This paper introduces the nature and practice of bibliography (e.g., definition, history, and genres); it reviews the extant B. F. Skinner bibliographies (1958 to 2001); and it describes the methods used in constructing a new, comprehensive, and corrected bibliography of Skinner's primary-source published works. The bibliography includes 291 items from across 16 categories of publications (e.g., books, articles, chapters, monographs, book reviews, manuals, encyclopedia entries, letters to the editor) and lists them in chronological order (1930 to 1999). A discussion section addresses the bibliography's limitations, how it might be enlarged and expanded, its value for qualitative and quantitative historical inquiry, and the beginnings of a “Skinner industry.” PMID:22478394

NOVEL BINDERS AND METHODS FOR AGGLOMERATION OF ORE

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

S.K. Kawatra; T.C. Eisele; J.A. Gurtler

2004-04-01

Many metal extraction operations, such as leaching of copper, leaching of precious metals, and reduction of metal oxides to metal in high-temperature furnaces, require agglomeration of ore to ensure that reactive liquids or gases are evenly distributed throughout the ore being processed. Agglomeration of ore into coarse, porous masses achieves this even distribution of fluids by preventing fine particles from migrating and clogging the spaces and channels between the larger ore particles. Binders are critically necessary to produce agglomerates that will not break down during processing. However, for many important metal extraction processes there are no binders known that willmore » work satisfactorily. Primary examples of this are copper heap leaching, where there are no binders that will work in the acidic environment encountered in this process, and advanced ironmaking processes, where binders must function satisfactorily over an extraordinarily large range of temperatures (from room temperature up to over 1200 C). As a result, operators of many facilities see a large loss of process efficiency due to their inability to take advantage of agglomeration. The large quantities of ore that must be handled in metal extraction processes also means that the binder must be inexpensive and useful at low dosages to be economical. The acid-resistant binders and agglomeration procedures developed in this project will also be adapted for use in improving the energy efficiency and performance of a broad range of mineral agglomeration applications, particularly heap leaching and advanced primary ironmaking.« less

Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach

PubMed Central

Khan, Anum Irfan; Kuluski, Kerry; McKillop, Ian; Sharpe, Sarah; Bierman, Arlene S; Lyons, Renee F; Cott, Cheryl

2016-01-01

Background Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD. Objective This paper describes the design and development approach, specifically the process of incorporating qualitative research methods into user-centered design approaches to create the ePRO tool. Key lessons learned are offered as a guide for other eHealth and mHealth research and technology developers working with complex patient populations and their primary health care providers. Methods Guided by user-centered design principles, interpretive descriptive qualitative research methods were adopted to capture user experiences through interviews and working groups. Consistent with interpretive descriptive methods, an iterative analysis technique was used to generate findings, which were then organized in relation to the tool design and function to help systematically inform modifications to the tool. User feedback captured and analyzed through this method was used to challenge the design and inform the iterative development of the tool. Results Interviews with primary health care providers (n=7) and content experts (n=6), and four focus groups with patients and carers (n=14) along with a PICK analysis—Possible, Implementable, (to be) Challenged, (to be) Killed—guided development of the first prototype. The initial prototype was presented in three design working groups with patients/carers (n=5), providers (n=6), and experts (n=5). Working group findings were broken down into categories of what works and what does not work to inform modifications to the prototype. This latter phase led to a major shift in the purpose and design of the prototype, validating the importance of using iterative codesign processes. Conclusions Interpretive descriptive methods allow for an understanding of user experiences of patients with CCDD, their carers, and primary care providers. Qualitative methods help to capture and interpret user needs, and identify contextual barriers and enablers to tool adoption, informing a redesign to better suit the needs of this diverse user group. This study illustrates the value of adopting interpretive descriptive methods into user-centered mHealth tool design and can also serve to inform the design of other eHealth technologies. Our approach is particularly useful in requirements determination when developing for a complex user group and their health care providers. PMID:26892952

Interagency Exchanges at Military Universities: Do Concerns About Finances, Career Progression and Assignments Affect Foreign Service Officers and Specialists’ Willingness to Participate?

DTIC Science & Technology

2015-06-12

benefits as well as its drawbacks , the results to this partition of the survey are extremely important to answering the primary research question. Are...Responses include: Too political. In my opinion, the assignment process is far from transparent. The assignment’s process sucks and the pendulum has... pendulum has swung back to “who you know”. Experience and prior work history is not taking into consideration when making assignments. And the process

The Principal's Role in the Post-Evaluation Process.--How Does the Principal Engage in the Work Carried out after the Schools Self-Evaluation?

ERIC Educational Resources Information Center

Emstad, Anne Berit

2011-01-01

This article refers to a study on how the school principal engaged in the process after a school self-evaluation. The study examined how two primary schools followed up the evaluation. Although they both used the same evaluation tool, the schools' understanding and application of results differed greatly. This paper describes and discusses the…

Study of Fluid Experiment System (FES)/CAST/Holographic Ground System (HGS)

NASA Technical Reports Server (NTRS)

Workman, Gary L.; Cummings, Rick; Jones, Brian

1992-01-01

The use of holographic and schlieren optical techniques for studying the concentration gradients in solidification processes has been used by several investigators over the years. The HGS facility at MSFC has been primary resource in researching this capability. Consequently, scientific personnel have been able to utilize these techniques in both ground based research and in space experiments. An important event in the scientific utilization of the HGS facilities was the TGS Crystal Growth and the casting and solidification technology (CAST) experiments that were flown on the International Microgravity Laboratory (IML) mission in March of this year. The preparation and processing of these space observations are the primary experiments reported in this work. This project provides some ground-based studies to optimize on the holographic techniques used to acquire information about the crystal growth processes flown on IML. Since the ground-based studies will be compared with the space-based experimental results, it is necessary to conduct sufficient ground based studies to best determine how the experiment worked in space. The current capabilities in computer based systems for image processing and numerical computation have certainly assisted in those efforts. As anticipated, this study has certainly shown that these advanced computing capabilities are helpful in the data analysis of such experiments.

The Impact of Cognitive Dissonance on Learning Work Behavior

ERIC Educational Resources Information Center

Dechawatanapaisal, Decha; Siengthai, Sununta

2006-01-01

Purpose: This research proposes a framework, which identifies the underlying factors that shape learning behavior in the workplace. It takes organizational members' perspectives into consideration to gain better understanding on managing people and their behavior in the organizational learning process. Design/methodology/approach: Primary data…

First and Second Graders Writing Informational Text

ERIC Educational Resources Information Center

Read, Sylvia

2005-01-01

Process approaches to writing instruction in primary-grade classrooms have become widespread due to the influence of Graves (1983), Calkins (1986), Avery (1993), and others. Their work emphasizes expressive writing, particularly personal narrative, more than expository or informational writing. As a consequence, expressive writing is what children…

ASSESSMENT OF SYNAPSE FORMATION IN RAT PRIMARY NEURAL CELL CULTURE USING HIGH CONTENT MICROSCOPY.

EPA Science Inventory

Cell-based assays can model neurodevelopmental processes including neurite growth and synaptogenesis, and may be useful for screening and evaluation of large numbers of chemicals for developmental neurotoxicity. This work describes the use of high content screening (HCS) to dete...

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.

Early identification in primary health care of people at risk for sick leave due to work-related stress - study protocol of a randomized controlled trial (RCT).

PubMed

Holmgren, Kristina; Sandheimer, Christine; Mårdby, Ann-Charlotte; Larsson, Maria E H; Bültmann, Ute; Hange, Dominique; Hensing, Gunnel

2016-11-25

Early identification of persons at risk of sickness absence due to work-related stress is a crucial problem for society in general, and primary health care in particular. Tho date, no established method to do this exists. This project's aim is to evaluate whether systematic early identification of work-related stress can prevent sickness absence. This paper presents the study design, procedure and outcome measurements, as well as allocation and baseline characteristics of the study population. The study is a two-armed randomized controlled trial with follow-up at 3, 6 and 12 months. Non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers (PHCC) were eligible to participate. At baseline work-related stress was measured by the Work Stress Questionnaire (WSQ), combined with feedback at consultation, at PHCC. The preventive intervention included early identification of work-related stress by the WSQ, GP training in the use of WSQ, GP feedback at consultation and finding suitable preventive measures. A process evaluation was used to explore how to facilitate future implementation and structural use of the WSQ at the PHCC. The primary outcome to compare the preventive sick leave intervention by the general practitioner (GP) versus treatment as usual is sick leave data obtained from the Swedish Social Insurance Agency register. Early screening for sick leave due to work-related stress makes it possible not only to identify those at risk for sick leave, but also to put focus on the patient's specific work-related stress problems, which can be helpful in finding suitable preventive measures. This study investigates if use of the WSQ by GPs at PHCCs, combined with feedback at consultation, prevents future sickness absence. ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.

Validating the client-focused considering work model for people living with HIV and quantifying phases of change of commitment to work.

PubMed

Conyers, Liza M; Boomer, K B

2017-06-01

The primary purpose of this study was to validate the client-focused considering work model and to gain a better understanding of the nature of the relationship among the four domains purported to influence the considering work process (medical, psychosocial, financial/legal and vocational). A second goal of the study was to quantify the relationship between these four domains and the phases of considering work (contemplation, preparation, action, resolution). Structural equation modeling was used to analyze data of 1702 diverse (43% Black, 31% White, 19% Latino 7% other) unemployed respondents who were recruited from AIDS Service Organizations (ASO) and networks across the United States to complete the National Working Positive Vocational Development and Employment Needs Survey (NWPC-VDENS). Overall the results of this study supported the validity of the client-focused considering work model and helped to provide a deeper level of understanding of the relationship among the domains of influence and their contribution to the level of commitment to the considering work process. Implications for Rehabilitation This model enables rehabilitation professionals to consider interventions for clients at different phases (contemplation, preparation, action) of considering work. Rehabilitation professionals are encouraged to provide prevocational services to engage people with HIV in the considering work process. When assisting PLWH within the considering work process, it is important to assess not only medical status but also psychosocial, financial and vocational concerns.

Integrated primary care, the collaboration imperative inter-organizational cooperation in the integrated primary care field: a theoretical framework

PubMed Central

Valentijn, Pim P; Bruijnzeels, Marc A; de Leeuw, Rob J; Schrijvers, Guus J.P

2012-01-01

Purpose Capacity problems and political pressures have led to a rapid change in the organization of primary care from mono disciplinary small business to complex inter-organizational relationships. It is assumed that inter-organizational collaboration is the driving force to achieve integrated (primary) care. Despite the importance of collaboration and integration of services in primary care, there is no unambiguous definition for both concepts. The purpose of this study is to examine and link the conceptualisation and validation of the terms inter-organizational collaboration and integrated primary care using a theoretical framework. Theory The theoretical framework is based on the complex collaboration process of negotiation among multiple stakeholder groups in primary care. Methods A literature review of health sciences and business databases, and targeted grey literature sources. Based on the literature review we operationalized the constructs of inter-organizational collaboration and integrated primary care in a theoretical framework. The framework is being validated in an explorative study of 80 primary care projects in the Netherlands. Results and conclusions Integrated primary care is considered as a multidimensional construct based on a continuum of integration, extending from segregation to integration. The synthesis of the current theories and concepts of inter-organizational collaboration is insufficient to deal with the complexity of collaborative issues in primary care. One coherent and integrated theoretical framework was found that could make the complex collaboration process in primary care transparent. This study presented theoretical framework is a first step to understand the patterns of successful collaboration and integration in primary care services. These patterns can give insights in the organization forms needed to create a good working integrated (primary) care system that fits the local needs of a population. Preliminary data of the patterns of collaboration and integration will be presented.

Cooperative processing in primary somatosensory cortex and posterior parietal cortex during tactile working memory.

PubMed

Ku, Yixuan; Zhao, Di; Bodner, Mark; Zhou, Yong-Di

2015-08-01

In the present study, causal roles of both the primary somatosensory cortex (SI) and the posterior parietal cortex (PPC) were investigated in a tactile unimodal working memory (WM) task. Individual magnetic resonance imaging-based single-pulse transcranial magnetic stimulation (spTMS) was applied, respectively, to the left SI (ipsilateral to tactile stimuli), right SI (contralateral to tactile stimuli) and right PPC (contralateral to tactile stimuli), while human participants were performing a tactile-tactile unimodal delayed matching-to-sample task. The time points of spTMS were 300, 600 and 900 ms after the onset of the tactile sample stimulus (duration: 200 ms). Compared with ipsilateral SI, application of spTMS over either contralateral SI or contralateral PPC at those time points significantly impaired the accuracy of task performance. Meanwhile, the deterioration in accuracy did not vary with the stimulating time points. Together, these results indicate that the tactile information is processed cooperatively by SI and PPC in the same hemisphere, starting from the early delay of the tactile unimodal WM task. This pattern of processing of tactile information is different from the pattern in tactile-visual cross-modal WM. In a tactile-visual cross-modal WM task, SI and PPC contribute to the processing sequentially, suggesting a process of sensory information transfer during the early delay between modalities. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

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

Primary and Secondary Variants of Psychopathy in a Volunteer Sample Are Associated With Different Neurocognitive Mechanisms.

PubMed

Sethi, Arjun; McCrory, Eamon; Puetz, Vanessa; Hoffmann, Ferdinand; Knodt, Annchen R; Radtke, Spenser R; Brigidi, Bartholomew D; Hariri, Ahmad R; Viding, Essi

2018-04-12

Recent work has indicated that there at least two distinct subtypes of psychopathy. Primary psychopathy is characterized by low anxiety and thought to result from a genetic predisposition, whereas secondary psychopathy is characterized by high anxiety and thought to develop in response to environmental adversity. Primary psychopathy is robustly associated with reduced neural activation to others' emotions and, in particular, distress. However, it has been proposed that the secondary presentation has different neurocognitive correlates. Primary (n = 50), secondary (n = 100), and comparison (n = 82) groups were drawn from a large volunteer sample (N = 1444) using a quartile-split approach across psychopathic trait (affective-interpersonal) and anxiety measures. Participants performed a widely utilized emotional face processing task during functional magnetic resonance imaging. The primary group showed reduced amygdala and insula activity in response to fear. The secondary group did not differ from the comparison group in these regions. Instead, the secondary group showed reduced activity compared with the comparison group in other areas, including the superior temporal sulcus/inferior parietal lobe, thalamus, pallidum, and substantia nigra. Both psychopathy groups also showed reduced activity in response to fear in the anterior cingulate cortex. During anger processing, the secondary group exhibited reduced activity in the anterior cingulate cortex compared with the primary group. Distinct neural correlates of fear processing characterize individuals with primary and secondary psychopathy. The reduced neural response to fear that characterizes individuals with the primary variant of psychopathic traits is not observed in individuals with the secondary presentation. The neurocognitive mechanisms underpinning secondary psychopathy warrant further systematic investigation. Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Laboratory medicine handoff gaps experienced by primary care practices: A report from the shared networks of collaborative ambulatory practices and partners (SNOCAP).

PubMed

West, David R; James, Katherine A; Fernald, Douglas H; Zelie, Claire; Smith, Maxwell L; Raab, Stephen S

2014-01-01

The majority of errors in laboratory medicine testing are thought to occur in the pre- and postanalytic testing phases, and a large proportion of these errors are secondary to failed handoffs. Because most laboratory tests originate in ambulatory primary care, understanding the gaps in handoff processes within and between laboratories and practices is imperative for patient safety. Therefore, the purpose of this study was to understand, based on information from primary care practice personnel, the perceived gaps in laboratory processes as a precursor to initiating process improvement activities. A survey was used to assess perceptions of clinicians, staff, and management personnel of gaps in handoffs between primary care practices and laboratories working in 21 Colorado primary care practices. Data were analyzed to determine statistically significant associations between categorical variables. In addition, qualitative analysis of responses to open-ended survey questions was conducted. Primary care practices consistently reported challenges and a desire/need to improve their efforts to systematically track laboratory test status, confirm receipt of laboratory results, and report results to patients. Automated tracking systems existed in roughly 61% of practices, and all but one of those had electronic health record-based tracking systems in place. One fourth of these electronic health record-enabled practices expressed sufficient mistrust in these systems to warrant the concurrent operation of an article-based tracking system as backup. Practices also reported 12 different procedures used to notify patients of test results, varying by test result type. The results highlight the lack of standardization and definition of roles in handoffs in primary care laboratory practices for test ordering, monitoring, and receiving and reporting test results. Results also identify high-priority gaps in processes and the perceptions by practice personnel that practice improvement in these areas is needed. Commonalities in these areas warrant the development and support of tools for use in primary care settings. © Copyright 2014 by the American Board of Family Medicine.

Conceptual studies for a mercury target circuit

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

Sigg, B.

1996-06-01

For the now favored target design of the European Spallation Source project, i.e. the version using mercury as target material, a basic concept of the primary system has been worked out. It does not include a detailed design of the various components of the target circuit, but tries to outline a feasible solution for the system. Besides the removal of the thermal power of about 3MW produced in the target by the proton beam, the primary system has to satisfy a number of other requirements related to processing, safety, and operation. The basic proposal uses an electromagnetic pump and amore » mercury-water intermediate heat excanger, but other alternatives are also being discussed. Basic safety requirements, i.e. protection against radiation and toxic mercury vapours, are satisfied by a design using an air-tight primary system containment, double-walled tubes in the intermediate heat exchanger, a fail-safe system for decay heat removal, and a remote handling facility for the active part of the system. Much engineering work has still to be done, because many details of the design of the mercury and gas processing systems remain to be clarified, the thermal-hydraulic components need further optimisation, the system for control and instrumentation is only known in outline and a through safety analysis will be required.« less

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study.

PubMed

Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

2012-04-01

Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. To explore processes underpinning the implementation of CKD management in primary care. Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity.

Yttrium recovery from primary and secondary sources: A review of main hydrometallurgical processes

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

Innocenzi, Valentina, E-mail: valentina.innocenzi1@univaq.it; De Michelis, Ida; Kopacek, Bernd

2014-07-15

Highlights: • Review of the main hydrometallurgical processes to recover yttrium. • Recovery of yttrium from primary sources. • Recovery of yttrium from e-waste and other types of waste. - Abstract: Yttrium is important rare earths (REs) used in numerous fields, mainly in the phosphor powders for low-energy lighting. The uses of these elements, especially for high-tech products are increased in recent years and combined with the scarcity of the resources and the environmental impact of the technologies to extract them from ores make the recycling waste, that contain Y and other RE, a priority. The present review summarized themore » main hydrometallurgical technologies to extract Y from ores, contaminated solutions, WEEE and generic wastes. Before to discuss the works about the treatment of wastes, the processes to retrieval Y from ores are discussed, since the processes are similar and derived from those already developed for the extraction from primary sources. Particular attention was given to the recovery of Y from WEEE because the recycle of them is important not only for economical point of view, considering its value, but also for environmental impact that this could be generated if not properly disposal.« less

Anticipation increases tactile stimulus processing in the ipsilateral primary somatosensory cortex.

PubMed

van Ede, Freek; de Lange, Floris P; Maris, Eric

2014-10-01

Stimulus anticipation improves perception. To account for this improvement, we investigated how stimulus processing is altered by anticipation. In contrast to a large body of previous work, we employed a demanding perceptual task and investigated sensory responses that occur beyond early evoked activity in contralateral primary sensory areas: Stimulus-induced modulations of neural oscillations. For this, we recorded magnetoencephalography in 19 humans while they performed a cued tactile identification task involving the identification of either a proximal or a distal stimulation on the fingertips. We varied the cue-target interval between 0 and 1000 ms such that tactile targets occurred at various degrees of anticipation. This allowed us to investigate the influence of anticipation on stimulus processing in a parametric fashion. We observed that anticipation increases the stimulus-induced response (suppression of beta-band oscillations) originating from the ipsilateral primary somatosensory cortex. This occurs in the period in which the tactile memory trace is analyzed and is correlated with the anticipation-induced improvement in tactile perception. We propose that this ipsilateral response indicates distributed processing across bilateral primary sensory cortices, of which the extent increases with anticipation. This constitutes a new and potentially important mechanism contributing to perception and its improvement following anticipation. © The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Implementing Quality Improvement in Small, Autonomous Primary Care Practices: Implications for the Patient Centered Medical Home

PubMed Central

Arar, Nedal H.; Noel, Polly H.; Leykum, Luci; Zeber, John E.; Romero, Raquel; Parchman, Michael L.

2012-01-01

Background Implementing improvement programs to enhance quality of care within primary care clinics is complex, with limited practical guidance available to help practices during the process. Understanding how improvement strategies can be implemented in primary care is timely given the recent national movement towards transforming primary care into patient-centered medical homes (PCMH). This study examined practice members’ perceptions of the opportunities and challenges associated with implementing changes in their practice. Methods Semi-structured interviews were conducted with a purposive sample of 56 individuals working in 16 small, community-based primary care practices. The interview consisted of open-ended questions focused on participants’ perceptions of: (1) practice vision, (2) perceived need for practice improvement, and (3) barriers that hinder practice improvement. The interviews were conducted at the participating clinics and were tape-recorded, transcribed, and content analyzed. Results Content analysis identified two main domains for practice improvement related to: (1) the process of care, and (2) patients’ involvement in their disease management. Examples of desired process of care changes included improvement in patient tracking/follow-up system, standardization of processes of care, and overall clinic documentations. Changes related to the patients’ involvement in their care included improving (a) health education, and (b) self care management. Among the internal barriers were: staff readiness for change, poor communication, and relationship difficulties among team members. External barriers were: insurance regulations, finances and patient health literacy. Practice Implications Transforming their practices to more patient-centered models of care will be a priority for primary care providers. Identifying opportunities and challenges associated with implementing change is critical for successful improvement programs. Successful strategy for enhancing the adoption and uptake of PCMH elements should leverage areas of concordance between practice members’ perceived needs and planned improvement efforts. PMID:22186171

Decomposing Bias in Different Types of Simple Decisions

ERIC Educational Resources Information Center

White, Corey N.; Poldrack, Russell A.

2014-01-01

The ability to adjust bias, or preference for an option, allows for great behavioral flexibility. Decision bias is also important for understanding cognition as it can provide useful information about underlying cognitive processes. Previous work suggests that bias can be adjusted in 2 primary ways: by adjusting how the stimulus under…

Coalescing a School Community around Total Quality: A Superintendent's Perspective.

ERIC Educational Resources Information Center

Manley, Robert J.

1996-01-01

Inspired by Deming's work, the superintendent of West Babylon (New York) Schools convened his administrative team to build a consensus about the schools' mission. The vision statement outlines four primary functions: protective care, civic training, personality development, and teaching of knowledge. The district's goal-driven process surmounted…

What Are the Humanities?

ERIC Educational Resources Information Center

Broderick, Francis

A working definition of the humanities and characteristics of a liberally educated person are specified. The humanities embrace areas of human knowledge that possess these elements: central concern for human beings rather than for the processes of nature or the structures of society; primary focus on the individual rather than on the group;…

Primary Teachers as Physical Education Curriculum Change Agents

ERIC Educational Resources Information Center

Carse, Nicola

2015-01-01

There has been some exploration of the conceptualisation of teachers as change agents within educational change literature. While this body of work does consider how teachers understand, harness and influence the process of curriculum change, within the policy rhetoric and educational change literature there is limited reference made to how the…

Nonsteady-Flow Thrust Augmenting Ejectors

NASA Technical Reports Server (NTRS)

Foa, J. V.

1979-01-01

Ejector augmenters in which the transfer of mechanical energy from the primary to the secondary flow takes place through the work of interface pressure forces are investigated. Nonsteady flow processes are analyzed from the standpoint of energy transfer efficiency and a comparison of a rotary jet augmenter to an ejector is presented.

Process evaluation in a multisite, primary obesity-prevention trial in American Indian schoolchildren.

PubMed

Helitzer, D L; Davis, S M; Gittelsohn, J; Going, S B; Murray, D M; Snyder, P; Steckler, A B

1999-04-01

We describe the development, implementation, and use of the process evaluation component of a multisite, primary obesity prevention trial for American Indian schoolchildren. We describe the development and pilot testing of the instruments, provide some examples of the criteria for instrument selection, and provide examples of how process evaluation results were used to document and refine intervention components. The theoretical and applied framework of the process evaluation was based on diffusion theory, social learning theory, and the desire for triangulation of multiple modes of data collection. The primary objectives of the process evaluation were to systematically document the training process, content, and implementation of 4 components of the intervention. The process evaluation was developed and implemented collaboratively so that it met the needs of both the evaluators and those who would be implementing the intervention components. Process evaluation results revealed that observation and structured interviews provided the most informative data; however, these methods were the most expensive and time consuming and required the highest level of skill to undertake. Although the literature is full of idealism regarding the uses of process evaluation for formative and summative purposes, in reality, many persons are sensitive to having their work evaluated in such an in-depth, context-based manner as is described. For this reason, use of structured, quantitative, highly objective tools may be more effective than qualitative methods, which appear to be more dependent on the skills and biases of the researcher and the context in which they are used.

Depression screening optimization in an academic rural setting.

PubMed

Aleem, Sohaib; Torrey, William C; Duncan, Mathew S; Hort, Shoshana J; Mecchella, John N

2015-01-01

Primary care plays a critical role in screening and management of depression. The purpose of this paper is to focus on leveraging the electronic health record (EHR) as well as work flow redesign to improve the efficiency and reliability of the process of depression screening in two adult primary care clinics of a rural academic institution in USA. The authors utilized various process improvement tools from lean six sigma methodology including project charter, swim lane process maps, critical to quality tree, process control charts, fishbone diagrams, frequency impact matrix, mistake proofing and monitoring plan in Define-Measure-Analyze-Improve-Control format. Interventions included change in depression screening tool, optimization of data entry in EHR. EHR data entry optimization; follow up of positive screen, staff training and EHR redesign. Depression screening rate for office-based primary care visits improved from 17.0 percent at baseline to 75.9 percent in the post-intervention control phase (p<0.001). Follow up of positive depression screen with Patient History Questionnaire-9 data collection remained above 90 percent. Duplication of depression screening increased from 0.6 percent initially to 11.7 percent and then decreased to 4.7 percent after optimization of data entry by patients and flow staff. Impact of interventions on clinical outcomes could not be evaluated. Successful implementation, sustainability and revision of a process improvement initiative to facilitate screening, follow up and management of depression in primary care requires accounting for voice of the process (performance metrics), system limitations and voice of the customer (staff and patients) to overcome various system, customer and human resource constraints.

Effect of Ga Addition on Morphology and Recovery of Primary Si During Al-Si Alloy Solidification Refining

NASA Astrophysics Data System (ADS)

Li, Jingwei; Bai, Xiaolong; Li, Yanlei; Ban, Boyuan; Chen, Jian

2015-12-01

The effect of Ga addition on alloy macrostructure, morphology and recovery rate of primary Si during the Al-Si-Ga alloy solvent refining process of silicon was studied in this work. The addition of Ga to Al-Si alloy could change the morphology of the primary Si. The average plate thickness of the primary Si increases with increase of Ga content. With the increase of Ga content, the average plate length of the primary Si crystals becomes larger when the Ga content is less than 5% in the Al-30%Si-xGa alloy, but becomes smaller when the Ga content exceeds 5%. Al-Si-Ga alloys consist of three types, primary Si, GaxAl1-x, (α-Al+Si+β-Ga) eutectic. (111) is the preferred growth surface of the plate-like primary Si. The recovery rate of the primary Si increases with the increase of Ga content. When the Ga content increased to 20% in Al-30%Si-xGa alloy, the relative recovery rate of the primary Si increased to 50.41% than that in Al-30%Si alloy.

Negotiating and managing partnership in primary care.

PubMed

Charlesworth, J

2001-09-01

In the UK public service organisations are increasingly working together in new partnerships, networks and alliances, largely stimulated by government legislation, which aims to encourage 'joined-up' policy-making. This is particularly prevalent in health-care where local government, health authorities and trusts, voluntary and community groups are extending existing, and developing new, forms of partnership, particularly around Health Improvement Programmes and new primary care organisations. This paper explores two main aspects of how these new interorganizational relationships are being developed and managed and is based on research conducted in one case study locality. First, the new structures of partnership in primary care are mapped out, together with discussion on why these particular patterns of relationship between statutory and voluntary sector organisations have emerged, exploring both centrally and locally determined influences. Secondly, the paper explores the tensions associated with working within new policy-making and management structures, and how the additional demands of audit, performance measurement and the sheer pace of change, pose a potential threat to the partnership process.

Nursing practices in the primary health care context: a scoping review 1

PubMed Central

Barbiani, Rosangela; Nora, Carlise Rigon Dalla; Schaefer, Rafaela

2016-01-01

ABSTRACT Objective: to identify and categorize the practices performed by nurses working in Primary Health Care and Family Health Strategy Units in light of responsibilities established by the profession's legal and programmatic frameworks and by the Brazilian Unified Health System. Method: a scoping review was conducted in the following databases: LILACS, IBECS, BDENF, CINAHL and MEDLINE, and the Cochrane and SciELO libraries. Original research papers written by nurses addressing nursing practices in the primary health care context were included. Results: the review comprised 30 studies published between 2005 and 2014. Three categories emerged from the analysis: practices in the service; practices in the community; and management and education practices. Conclusion: the challenges faced by nurses are complex, as care should be centered on the population's health needs, which requires actions at other levels of clinical and health responsibility. Brazilian nursing has achieved important advancements since the implementation of policies intended to reorganize work. There is, however, a need to shift work processes from being focused on individual procedures to being focused on patients so that an enlarged clinic is the ethical-political imperative guiding the organization of services and professional intervention. PMID:27579928

Registered nurses' perceptions of conditions for patient education - focusing on organisational, environmental and professional cooperation aspects.

PubMed

Bergh, Anne-Louise; Karlsson, Jan; Persson, Eva; Friberg, Febe

2012-09-01

To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work. © 2012 Blackwell Publishing Ltd.

Modelling and simulating the forming of new dry automated lay-up reinforcements for primary structures

NASA Astrophysics Data System (ADS)

Bouquerel, Laure; Moulin, Nicolas; Drapier, Sylvain; Boisse, Philippe; Beraud, Jean-Marc

2017-10-01

While weight has been so far the main driver for the development of prepreg based-composites solutions for aeronautics, a new weight-cost trade-off tends to drive choices for next-generation aircrafts. As a response, Hexcel has designed a new dry reinforcement type for aircraft primary structures, which combines the benefits of automation, out-of-autoclave process cost-effectiveness, and mechanical performances competitive to prepreg solutions: HiTape® is a unidirectional (UD) dry carbon reinforcement with thermoplastic veil on each side designed for aircraft primary structures [1-3]. One privileged process route for HiTape® in high volume automated processes consists in forming initially flat dry reinforcement stacks, before resin infusion [4] or injection. Simulation of the forming step aims at predicting the geometry and mechanical properties of the formed stack (so-called preform) for process optimisation. Extensive work has been carried out on prepreg and dry woven fabrics forming behaviour and simulation, but the interest for dry non-woven reinforcements has emerged more recently. Some work has been achieved on non crimp fabrics but studies on the forming behaviour of UDs are seldom and deal with UD prepregs only. Tension and bending in the fibre direction, along with inter-ply friction have been identified as the main mechanisms controlling the HiTape® response during forming. Bending has been characterised using a modified Peirce's flexometer [5] and inter-ply friction study is under development. Anisotropic hyperelastic constitutive models have been selected to represent the assumed decoupled deformation mechanisms. Model parameters are then identified from associated experimental results. For forming simulation, a continuous approach at the macroscopic scale has been selected first, and simulation is carried out in the Zset framework [6] using proper shell finite elements.

Development of stitched/RTM primary structures for transport aircraft

NASA Technical Reports Server (NTRS)

Hawley, Arthur V.

1993-01-01

This report covers work accomplished in the Innovative Composite Aircraft Primary Structure (ICAPS) program. An account is given of the design criteria and philosophy that guides the development. Wing and fuselage components used as a baseline for development are described. The major thrust of the program is to achieve a major cost breakthrough through development of stitched dry preforms and resin transfer molding (RTM), and progress on these processes is reported. A full description is provided on the fabrication of the stitched RTM wing panels. Test data are presented.

Project - line interaction implementing projects in JPL's Matrix

NASA Technical Reports Server (NTRS)

Baroff, Lynn E.

2006-01-01

Can programmatic and line organizations really work interdependently, to accomplish their work as a community? Does the matrix produce a culture in which individuals take personal responsibility for both immediate mission success and long-term growth? What is the secret to making a matrix enterprise actually work? This paper will consider those questions, and propose that developing an effective project-line partnership demands primary attention to personal interactions among people. Many potential problems can be addressed by careful definition of roles, responsibilities, and work processes for both parts of the matrix -- and by deliberate and clear communication between project and line organizations and individuals.

Learning to listen to the organisational rhetoric of primary health and social care integration.

PubMed

Warne, T; McAndrew, S; King, M; Holland, K

2007-11-01

The sustained modernisation of the UK primary health care service has resulted in individuals and organisations having to develop more integrated ways of working. This has resulted in changes to the structure and functioning of primary care organisations, changes to the traditional workforce, and an increase in scope of primary care practice. These changes have contributed to what for many staff has become a constantly turbulent organisational and practice environment. Data from a three-year project, commissioned by the North West Development Agency is used to explore how staff involved in these changes dealt with this turbulence. Three hundred and fifty staff working within primary care participated in the study. A multimethods approach was used which facilitated an iterative analysis and data collection process. Thematic analysis revealed a high degree of congruence between the perceptions of all staff groups with evidence of a generally well-articulated, but often rhetorical view of the organisational and professional factors involved in how these changes were experienced. This rhetoric was used by individuals as a way of containing both the good and bad elements of their experience. This paper discusses how these defense mechanisms need to be recognised and understood by managers so that a more supportive organisational culture is developed.

Searching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions.

PubMed

Johnson, Julie K; Farnan, Jeanne M; Barach, Paul; Hesselink, Gijs; Wollersheim, Hub; Pijnenborg, Loes; Kalkman, Cor; Arora, Vineet M

2012-12-01

Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk. Our aim was to demonstrate how process mapping can illustrate current handover practices between ambulatory and inpatient care settings, identify existing barriers and facilitators to effective transitions of care, and highlight potential areas for quality improvement. We conducted focus group interviews to facilitate a process mapping exercise with clinical teams in six academic health centres in the USA, Poland, Sweden, Italy, Spain and the Netherlands. At a high level, the process of patient admission to the hospital through the emergency department, inpatient care, and discharge back in the community were comparable across sites. In addition, the process maps highlighted similar barriers to providing information to primary care physicians, inaccurate or incomplete information on referral and discharge, a lack of time and priority to collaborate with counterpart colleagues, and a lack of feedback to clinicians involved in the handovers. Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care.

PubMed

Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

2016-01-01

The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed.

Suppression of Metastasis by Primary Tumor and Acceleration of Metastasis Following Primary Tumor Resection: A Natural Law?

PubMed

Hanin, Leonid; Rose, Jason

2018-03-01

We study metastatic cancer progression through an extremely general individual-patient mathematical model that is rooted in the contemporary understanding of the underlying biomedical processes yet is essentially free of specific biological assumptions of mechanistic nature. The model accounts for primary tumor growth and resection, shedding of metastases off the primary tumor and their selection, dormancy and growth in a given secondary site. However, functional parameters descriptive of these processes are assumed to be essentially arbitrary. In spite of such generality, the model allows for computing the distribution of site-specific sizes of detectable metastases in closed form. Under the assumption of exponential growth of metastases before and after primary tumor resection, we showed that, regardless of other model parameters and for every set of site-specific volumes of detected metastases, the model-based likelihood-maximizing scenario is always the same: complete suppression of metastatic growth before primary tumor resection followed by an abrupt growth acceleration after surgery. This scenario is commonly observed in clinical practice and is supported by a wealth of experimental and clinical studies conducted over the last 110 years. Furthermore, several biological mechanisms have been identified that could bring about suppression of metastasis by the primary tumor and accelerated vascularization and growth of metastases after primary tumor resection. To the best of our knowledge, the methodology for uncovering general biomedical principles developed in this work is new.

[Primary headache and work: concepts of pathophysiology, occupational risk factors, health monitoring and criteria for judging causation].

PubMed

Taino, Giuseppe; Pucci, Ennio; Imbriani, Paola; Delogu, Alberto; Brevi, Marco; Bruscella, Sara; Imbriani, Marcello

2014-01-01

Primary headaches account for 90% of all the forms of headache. The disease is characterized by high occurrence in the working-age population and by significant impact in countries with high economic and social development. These two epidemiological aspects carry significant economic costs that can be estimated calculating loss of working days due to illness and appreciable loss of labour productivity. In an occupational setting several circumstances are known to cause the onset of attacks in workers who already suffer from primary headache. In this sense, the following factors have an important role: interruption of the circadian sleep-wake rhythm, sleep deprivation, physical/mental distress, not ergonomic postures (mainly those involving the cervical-brachial district), prolonged use of display screen, acoustic discomfort. Among chemicals, in the current conditions of exposure, the olfactory characteristics seem of primary importance rather than the more "conventional" mechanism of toxicity. The main aim of this study is to provide useful information to occupational physicians on the management of workers suffering from primary headache, with regard either to the formulation of the judgement of suitability, or to their auxiliary role in the planning and organization of work. A second aim involves the identification of specific preventive measures in order to reduce the probability of occurrence of a headache attack. This also minimizes the risk of accidents and injuries and ensures workers' efficiency. After these considerations, we suggest guidelines for a flow chart (aimed to understand worker's suitability for his/her specific task). This guarantees not only safety and health of workers who suffer from the illness, but also safeguards any third worker from a possible consequence due to less working capacity and reduction of attention of employees working with a headache attack. In conclusion we also identify three critical factors: the diagnosis of the form of primary headache, the characteristics of the work and the effects due to pharmacological therapy. The study and characterization of these elements are a crucial step for a proper formulation of the judgement of suitability to work. We report a decision process for judgement formulation at the end of this article. It is organized with a hierarchical model, the first steps are the clinical examination and history, the last step, if necessary or advisable, is the neurological visit and a periodic verification of the adherence to treatment prescribed and the follow-up.

Interprofessional primary care in academic family medicine clinics: implications for education and training.

PubMed

Drummond, Neil; Abbott, Karen; Williamson, Tyler; Somji, Behnaz

2012-08-01

To explore the status and processes of interprofessional work environments and the implications for interprofessional education in a sample of family medicine teaching clinics. Focus group interviews using a purposive sampling procedure. Four academic family medicine clinics in Alberta. Seven family physicians, 9 registered nurses, 5 licensed practical nurses, 2 residents, 1 psychologist, 1 informatics specialist, 1 pharmacist, 1 dietitian, 1 nurse practitioner, 1 receptionist, and 1 respiratory therapist. Assessment of clinic status and performance in relation to established principles of interprofessional work and education was explored using semistructured focus group interviews. Our data supported the D'Amour and Oandasan model of successful interprofessional collaborative practice in terms of the model's main "factors" (ie, shared goals and vision, sense of belonging, governance, and the structuring of clinical care) and their constituent "elements." It is reasonable to conclude that the extent to which these factors and elements are both present and positively oriented in academic clinic settings is an important contributory factor to the establishment of interprofessional collaborative practice in primary care. Using this model, 2 of the 4 clinics were rated as expressing substantial progress in relation to interprofessional work, while the other 2 clinics were rated as less successful on that dimension. None of the clinics was identified as having a clear and explicit focus on providing interprofessional education. The key factor in relation to the implementation of interprofessional work in primary care appears to be the existence of clear and explicit leadership in that direction. Substantial scope exists for improvement in the organization, conduct, and promotion of interprofessional education for Canadian primary care.

Automated Analysis of CT Images for the Inspection of Hardwood Logs

Treesearch

Harbin Li; A. Lynn Abbott; Daniel L. Schmoldt

1996-01-01

This paper investigates several classifiers for labeling internal features of hardwood logs using computed tomography (CT) images. A primary motivation is to locate and classify internal defects so that an optimal cutting strategy can be chosen. Previous work has relied on combinations of low-level processing, image segmentation, autoregressive texture modeling, and...

Plants in the Classroom, An Environmental Investigation.

ERIC Educational Resources Information Center

National Wildlife Federation, Washington, DC.

This environmental unit is one of a series designed for integration within the existing curriculum. The unit is self-contained and requires minimal teacher preparation. The philosophy of this series is based on an experience-oriented process that encourages self-paced independent student work. This particular unit, designed for the primary grades,…

STS 31 PAYLOAD HUBBLE SPACE TELESCOPE ENCLOSED IN AN AIR-TIGHT PLASTIC BAG FOR PROTECTION IN VERTICA

NASA Technical Reports Server (NTRS)

1989-01-01

Preparations are made to enclose the Hubble Space Telescope [HST] inside an air-tight plastic bag in the VPF. Processing of the 94- inch primary mirror telescope for launch on the Discovery in March 1990, involves working within strict controls to prevent contamination.

Problem Solving and Emotional Education in Initial Primary Teacher Education

ERIC Educational Resources Information Center

Caballero, Ana; Blanco, Lorenzo J.; Guerrero, Eloisa

2011-01-01

Our work is based on two premises. The first is that affective factors (beliefs, attitudes, and emotions) influence teaching and learning mathematics, and problem solving in particular. The second is that initial teacher education is an important element in the process of improving overall educational practice. On this basis, our research group…

The Hidden Picture: Administrators' Perspectives on Least Restrictive Environment

ERIC Educational Resources Information Center

Garner, Gina Marlene

2009-01-01

This study looks to better understand how administrators make a decision about a least restrictive environment placement recommendation. What decision processes do they engage in when merging information of individual and environment to create a working plan of access that will benefit all involved? It also seeks the factors that are primary in…

The Organizational Communication Process in Schools

ERIC Educational Resources Information Center

Gunbayi, Ilhan

2007-01-01

This study examined the perceptions of teachers on the effectiveness of organizational communication in their schools and whether the perceptions differed between teachers in primary and junior high schools as a function of gender, age, marital status, seniority, and rank. Data were collected from a sample of 334 teachers in 63 schools, working in…

Deposition and Characterization of Improved Hydrogen Getter Materials - Report on FY 14-15 Activities

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

Hubbard, Kevin Mark; Sandoval, Cynthia Wathen

2015-10-15

The goals of this work have been two-fold. First, to perform an initial, quantitative, optimization of getter performance, with the primary variables being DEB/Pd ratio and UV power. Second, to simplify the deposition process to make it more compatible with the DOE production environment.

Effects of Teachers' Organizational Justice Perceptions on Intention to Quit: Mediation Role of Organizational Identification

ERIC Educational Resources Information Center

Basar, Ufuk; Sigri, Ünsal

2015-01-01

This research aims to discover the effects of teachers' organizational justice perceptions on intention to quit as well as the mediation role of teachers' organizational identification in this process. Interactions between research variables were measured using structural equation models. The sample used comprised teachers working at primary and…

Case Study on the Use of Microcomputers in Primary Schools in Bar-le-Duc (France).

ERIC Educational Resources Information Center

Dieschbourg, Robert

1988-01-01

Examines a project which involves the introduction of computer science into elementary schools to create an awareness of data processing as an intellectual, technological, and socio-cultural phenomenon. Concludes that the early computer experience and group work involved in the project enhances student social and psychological development. (GEA)

Advances and challenges in oral health after a decade of the "Smiling Brazil" Program.

PubMed

Scherer, Charleni Inês; Scherer, Magda Duarte dos Anjos

2015-01-01

To analyze oral health work changes in primary health care after Brazil's National Oral Health Policy Guidelines were released. A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people's participation and social control; and intersectorial actions. Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory.

PubMed

Coupe, Nia; Anderson, Emma; Gask, Linda; Sykes, Paul; Richards, David A; Chew-Graham, Carolyn

2014-05-01

Collaborative care (CC) is an organisational framework which facilitates the delivery of a mental health intervention to patients by case managers in collaboration with more senior health professionals (supervisors and GPs), and is effective for the management of depression in primary care. However, there remains limited evidence on how to successfully implement this collaborative approach in UK primary care. This study aimed to explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting. This qualitative study explored perspectives of the 6 case managers (CMs), 5 supervisors (trial research team members) and 15 general practitioners (GPs) from practices participating in a randomised controlled trial of CC for depression. Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial thematic analysis, and a secondary analysis using the Normalisation Process Theory concepts of coherence, cognitive participation, collective action and reflexive monitoring with respect to the implementation of CC in primary care. Supervisors and CMs demonstrated coherence in their understanding of CC, and consequently reported good levels of cognitive participation and collective action regarding delivering and supervising the intervention. GPs interviewed showed limited understanding of the CC framework, and reported limited collaboration with CMs: barriers to collaboration were identified. All participants identified the potential or experienced benefits of a collaborative approach to depression management and were able to discuss ways in which collaboration can be facilitated. Primary care professionals in this study valued the potential for collaboration, but GPs' understanding of CC and organisational barriers hindered opportunities for communication. Further work is needed to address these organisational barriers in order to facilitate collaboration around individual patients with depression, including shared IT systems, facilitating opportunities for informal discussion and building in formal collaboration into the CC framework. ISRCTN32829227 30/9/2008.

Cold worked ferritic alloys and components

DOEpatents

Korenko, Michael K.

1984-01-01

This invention relates to liquid metal fast breeder reactor and steam generator precipitation hardening fully ferritic alloy components which have a microstructure substantially free of the primary precipitation hardening phase while having cells or arrays of dislocations of varying population densities. It also relates to the process by which these components are produced, which entails solution treating the alloy followed by a final cold working step. In this condition, the first significant precipitation hardening of the component occurs during high temperature use.

Binary asteroid orbit evolution due to primary shape deformation

NASA Astrophysics Data System (ADS)

Hirabayashi, Masatoshi; Jacobson, Seth A.; Davis, Alex

2017-10-01

About a sixth of all small asteroid systems are binary [Margot et al., Science, 2002]. Many binary asteroids consist of an elongated synchronous secondary body orbiting a fast-rotating spheroidal primary body with ridges on its equator. The primary in such systems has experienced a long-term spin-up due to the YORP effect [Vokrouhlick'y et al., Asteroid IV, 2015]. This spin-up process can make the primary reach its spin barrier inducing shape deformation processes that ease the structural condition for failure inside the primary [e.g., Holsapple, Icarus, 2010]. Earlier works have shown that structural heterogeneities in the primary such as the shape and density distribution induce asymmetric deformation [Sánchez and Scheeres, Icarus, 2016]. Here, we investigate how asymmetric shape deformation in the primary affects the mutual motion of a binary system. We use a dynamics model for an irregularly shaped binary system that accounts for possible deformation of the primary [Hirabayashi et al., LPSC, 2017]. In this model, we consider asymmetric deformation that occurs based on structural failure in the primary and thus it modifies the location of the center of mass of the system. Using 1999 KW4 as an example, we study a hypothetical case in which the primary is initially identical to the current shape [Ostro et al., Science, 2006] with an aspect ratio (AR) of 0.83 and then suddenly changes its shape to an AR of 0.76. The results show that the asymmetric deformation process and the shift of the center of mass excite the eccentricity of the mutual orbit. Considering that the original mutual orbit has an eccentricity of 0.0004, after the primary shape change the eccentricity reaches values up to 0.15. Also, since the gravity field is modified after deformation, the secondary’s spin is desynchronized from the mutual orbit. Since synchronicity is a requirement for the binary YORP (BYORP) effect, which modifies the semi-major axis of binary asteroids, a primary shape change temporarily pauses the BYORP effect, in effect lengthening the effective BYORP timescale.

Scandium recovery from slags after oxidized nickel ore processing

NASA Astrophysics Data System (ADS)

Smyshlyaev, Denis; Botalov, Maxim; Bunkov, Grigory; Rychkov, Vladimir; Kirillov, Evgeny; Kirillov, Sergey; Semenishchev, Vladimir

2017-09-01

One of the possible sources of scandium production - waste (slags) from processing of oxidized nickel ores, has been considered in present research work. The hydrometallurgical method has been selected as the primary for scandium extraction. Different reagents for leaching of scandium, such as sulfuric acid, various carbonate salts and fluorides, have been tested. Sulfuric acid has been recognized as an optimal leaching reagent. Sulfuric acid concentration of 100 g L-1 allowed recovering up to 97 % of scandium.

Work continues on Leonardo, the Multi-Purpose Logistics Module, in the Space Station Processing Faci

NASA Technical Reports Server (NTRS)

1999-01-01

Workers in the Space Station Processing Facility work on Leonardo, the Multipurpose Logistics Module (MPLM) built by the Agenzia Spaziale Italiana (ASI). The MPLM, a reusable logistics carrier, will be the primary delivery system used to resupply and return International Space Station cargo requiring a pressurized environment. Leonardo is the first of three MPLM carriers for the International Space Station. It is scheduled to be launched on Space Shuttle Mission STS-102, targeted for June 2000. Leonardo shares space in the SSPF with the Shuttle Radar Topography Mission (SRTM), targeted for launch in September 1999, and Destiny, the U.S. Lab module, targeted for mission STS-98 in late April 2000.

Critical factors for the return-to-work process among people with affective disorders: Voices from two vocational approaches.

PubMed

Porter, Susann; Lexén, Annika; Johansson, Suzanne; Bejerholm, Ulrika

2018-05-22

Depression is among the major causes of disability with a negative impact on both daily life and work performance. Whilst depression is the primary cause of sick-leave and unemployment in today's workplace there is a lack of knowledge of the needs of individuals with depression regarding their return-to-work (RTW) process. To explore which factors are of critical importance for people suffering from depression and who also are unemployed in their RTW-process and to explore the impact of two vocational approaches on the service users' experiences. The study included participants in two vocational rehabilitation approaches; Individual Enabling and Support (IES) and Traditional Vocational Rehabilitation (TVR). Qualitative methods were applied to explore critical factors in the RTW-process. Individuals with affective disorders including depression and bipolar disorder were included.RESULTSThree themes emerged as critical factors; Experiencing hope and power, Professionals' positive attitudes, beliefs and behaviours, and Employing a holistic perspective and integrating health and vocational service.CONCLUSIONThis study has demonstrated critical factors for the return-to-work process as experienced by persons with depression. To experience hope and power, to meet professionals that believe "you can work", who use a person-centred and holistic service approach, are such factors necessary for gaining a real job. In particular, professionals in TVR need to embrace this understanding since their services were not experienced as including these elements.

Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil.

PubMed

Silveira, Cássio; Carneiro Junior, Nivaldo; Ribeiro, Manoel Carlos Sampaio de Almeida; Barata, Rita de Cássia Barradas

2013-10-01

Bolivian immigrants in Brazil experience serious social problems: precarious work conditions, lack of documents and insufficient access to health services. The study aimed to investigate inequalities in living conditions and access to health services among Bolivian immigrants living in the central area of São Paulo, Brazil, using a cross-sectional design and semi-structured interviews with 183 adults. According to the data, the immigrants tend to remain in Brazil, thus resulting in an aging process in the group. Per capita income increases the longer the immigrants stay in the country. The majority have secondary schooling. Work status does not vary according to time since arrival in Brazil. The immigrants work and live in garment sweatshops and speak their original languages. Social networks are based on ties with family and friends. Access to health services shows increasing inclusion in primary care. The authors conclude that the immigrants' social exclusion is decreasing due to greater access to documentation, work (although precarious), and the supply of health services from the public primary care system.

KENNEDY SPACE CENTER, FLA. - Technicians in the Space Station Processing Facility work on a Multi-Element Integrated Test (MEIT) of the U.S. Node 2 and the Japanese Experiment Module (JEM). Node 2 attaches to the end of the U.S. Lab on the ISS and provides attach locations for the Japanese laboratory, European laboratory, the Centrifuge Accommodation Module and, eventually, Multipurpose Logistics Modules. It will provide the primary docking location for the Shuttle when a pressurized mating adapter is attached to Node 2. Installation of the module will complete the U.S. Core of the ISS. The JEM, developed by the National Space Development Agency of Japan (NASDA), is Japan's primary contribution to the Station. It will enhance the unique research capabilities of the orbiting complex by providing an additional environment for astronauts to conduct science experiments.

NASA Image and Video Library

2003-09-03

KENNEDY SPACE CENTER, FLA. - Technicians in the Space Station Processing Facility work on a Multi-Element Integrated Test (MEIT) of the U.S. Node 2 and the Japanese Experiment Module (JEM). Node 2 attaches to the end of the U.S. Lab on the ISS and provides attach locations for the Japanese laboratory, European laboratory, the Centrifuge Accommodation Module and, eventually, Multipurpose Logistics Modules. It will provide the primary docking location for the Shuttle when a pressurized mating adapter is attached to Node 2. Installation of the module will complete the U.S. Core of the ISS. The JEM, developed by the National Space Development Agency of Japan (NASDA), is Japan's primary contribution to the Station. It will enhance the unique research capabilities of the orbiting complex by providing an additional environment for astronauts to conduct science experiments.

Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study

PubMed Central

Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

2012-01-01

Background Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. Aim To explore processes underpinning the implementation of CKD management in primary care. Design and setting Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Method Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. Results A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Conclusion Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity. PMID:22520910

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.

Nurse practitioners as attending providers for workers with uncomplicated back injuries: using administrative data to evaluate quality and process of care.

PubMed

Sears, Jeanne M; Wickizer, Thomas M; Franklin, Gary M; Cheadle, Allen D; Berkowitz, Bobbie

2007-08-01

The objectives of this study were 1) to identify quality and process of care indicators available in administrative workers' compensation data and to document their association with work disability outcomes, and 2) to use these indicators to assess whether nurse practitioners (NPs), recently authorized to serve as attending providers for injured workers in Washington State, performed differently than did primary care physicians (PCPs). Quality and process of care indicators for NP and PCP back injury claims from Washington State were compared using direct standardization and logistic regression. This study found little evidence of differences between NP and PCP claims in case mix or quality of care. The process of care indicators that we identified were highly associated with the duration of work disability and have potential for further development to assess and promote quality improvement.

Burnout: Interpreting the Perception of Iranian Primary Rural Health Care Providers from Working and Organizational Conditions

PubMed Central

Keshvari, Mahrokh; Mohammadi, Eesa; Boroujeni, Ali Zargham; Farajzadegan, Ziba

2012-01-01

Objectives: Health care providers in the rural centers offer the primary health services in the form of proficiencies and professions to the most required target population in the health system. These services are provided in certain condition and population with a verity of limitations. This study aimed to describe and interpret the experiences of the employees from their own working condition in the rural health centers. Methods: The present study conducted in a qualitative research approach and content analysis method through individual and group interviews with 26 employed primary health care providers (including 7 family physicians, 7 midwives, and 12 health workers) in the rural health centers in Isfahan in 2009. Sampling was done using purposive sampling method. The data were analyzed using qualitative content analysis as constant comparative basis. Results: During the content analysis process, six themes were obtained; “instability and frequent changes”, “involved in laws and regulations”, “pressure and stress due to unbalanced workload and manpower”, “helplessness in performing the tasks and duties”, “sense of identity threat and low self-concept”, and “deprivation of professional development”. The mentioned themes indicate a main and more important theme called “burnout”. Conclusions: Health services providers in the rural health centers are working in stressful and challenging work conditions and are suffered from deprivation of something for which are responsible to the community. PMID:22826774

The Iron Project

NASA Technical Reports Server (NTRS)

Pradhan, Anil K.

2000-01-01

Recent advances in theoretical atomic physics have enabled large-scale calculation of atomic parameters for a variety of atomic processes with high degree of precision. The development and application of these methods is the aim of the Iron Project. At present the primary focus is on collisional processes for all ions of iron, Fe I - FeXXVI, and other iron-peak elements; new work on radiative processes has also been initiated. Varied applications of the Iron Project work to X-ray astronomy are discussed, and more general applications to other spectral ranges are pointed out. The IP work forms the basis for more specialized projects such as the RmaX Project, and the work on photoionization/recombination, and aims to provide a comprehensive and self-consistent set of accurate collisional and radiative cross sections, and transition probabilities, within the framework of relativistic close coupling formulation using the Breit-Pauli R-Matrix method. An illustrative example is presented of how the IP data may be utilized in the formation of X-ray spectra of the K alpha complex at 6.7 keV from He-like Fe XXV.

Characterizing the primary material sources and dominant erosional processes for post-fire debris-flow initiation in a headwater basin using multi-temporal terrestrial laser scanning data

USGS Publications Warehouse

Staley, Dennis M.; Waslewicz, Thad A.; Kean, Jason W.

2014-01-01

Wildfire dramatically alters the hydrologic response of a watershed such that even modest rainstorms can produce hazardous debris flows. Relative to shallow landslides, the primary sources of material and dominant erosional processes that contribute to post-fire debris-flow initiation are poorly constrained. Improving our understanding of how and where material is eroded from a watershed during a post-fire debris-flow requires (1) precise measurements of topographic change to calculate volumetric measurements of erosion and deposition, and (2) the identification of relevant morphometrically defined process domains to spatially constrain these measurements of erosion and deposition. In this study, we combine the morphometric analysis of a steep, small (0.01 km2) headwater drainage basin with measurements of topographic change using high-resolution (2.5 cm) multi-temporal terrestrial laser scanning data made before and after a post-fire debris flow. The results of the morphometric analysis are used to define four process domains: hillslope-divergent, hillslope-convergent, transitional, and channelized incision. We determine that hillslope-divergent and hillslope-convergent process domains represent the primary sources of material over the period of analysis in the study basin. From these results we conclude that raindrop-impact induced erosion, ravel, surface wash, and rilling are the primary erosional processes contributing to post-fire debris-flow initiation in the small, steep headwater basin. Further work is needed to determine (1) how these results vary with increasing drainage basin size, (2) how these data might scale upward for use with coarser resolution measurements of topography, and (3) how these results change with evolving sediment supply conditions and vegetation recovery.

Process evaluation in a multisite, primary obesity-prevention trial in American Indian schoolchildren1–3

PubMed Central

Helitzer, Deborah L; Davis, Sally M; Gittelsohn, Joel; Going, Scott B; Murray, David M; Snyder, Patricia; Steckler, Allan B

2016-01-01

We describe the development, implementation, and use of the process evaluation component of a multisite, primary obesity prevention trial for American Indian schoolchildren. We describe the development and pilot testing of the instruments, provide some examples of the criteria for instrument selection, and provide examples of how process evaluation results were used to document and refine intervention components. The theoretical and applied framework of the process evaluation was based on diffusion theory, social learning theory, and the desire for triangulation of multiple modes of data collection. The primary objectives of the process evaluation were to systematically document the training process, content, and implementation of 4 components of the intervention. The process evaluation was developed and implemented collaboratively so that it met the needs of both the evaluators and those who would be implementing the intervention components. Process evaluation results revealed that observation and structured interviews provided the most informative data; however, these methods were the most expensive and time consuming and required the highest level of skill to undertake. Although the literature is full of idealism regarding the uses of process evaluation for formative and summative purposes, in reality, many persons are sensitive to having their work evaluated in such an in-depth, context-based manner as is described. For this reason, use of structured, quantitative, highly objective tools may be more effective than qualitative methods, which appear to be more dependent on the skills and biases of the researcher and the context in which they are used. PMID:10195608

Short communication: planning considerations for on-farm dairy processing enterprises.

PubMed

Smith, S M; Chaney, E A; Bewley, J M

2013-07-01

Across the world, more dairy producers are considering on-farm dairy processing to add value to the milk produced on their farms. Dairy producers may bottle milk or process their milk into cheese, ice cream, butter, yogurt, or cream. The primary objective of this research was to establish a series of sound factors or indicators of success for those considering on-farm processing. A survey was employed to collect opinions and advice from managers of on-farm processing enterprises. Surveys were distributed online (n=120), with 31 surveys returned, accounting for a 25.8% response rate. Most (64%) respondents had been involved in on-farm dairy processing for less than 10 yr. Sixty-one percent of respondents attained a positive cash flow in 1 to 3 yr. The primary products manufactured were cheese (69%), milk (59%), ice cream (31%), yogurt (25%), and butter (21%). Factors influencing the decision to start an on-farm dairy processing enterprise included commodity milk prices (61%), desire to work with the public (41%), an opportunity to promote the dairy industry (39%), a desire to maintain or expand a small family operation (29%), and product differentiation (16%). Respondents cited dealing with regulations (26%), product marketing (19%), manufacturing technicalities (19%), and securing funding (17%) as the most difficult parts of starting the business. Open-ended responses provided by the respondents of this survey were also documented to give future dairy producers advice. The most common advice to future on-farm processors was to work on realistic business plans, develop and follow realistic budgets, and observe and use market surveys within the industry. These results provide a useful array of information for future on-farm dairy processing enterprises. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Making on-orbit structural repairs to Space Station

NASA Technical Reports Server (NTRS)

Haber, Harry S.; Quinn, Alberta

1989-01-01

One of the key factors dictating the safety and durability of the proposed U.S. Space Station is the ability to repair structural damage while remaining in orbit. Consequently, studies are conducted to identify the engineering problems associated with accomplishing structural repairs on orbit, due to zero gravity environment and exposure to extreme temperature variations. There are predominant forms of structural failure, depending on the metallic or composite material involved. Aluminum is the primary metallic material used in space vehicle applications. Welding processes on aluminum alloy structures were tested, resulting in final selection of electron beam welding as the primary technique for metallic material repair in Space. Several composite structure repair processes were bench-tested to define their applicability to on-orbit EVA requirements: induction heating prevailed. One of the unique problems identified as inherent in the on-orbit repair process is that of debris containment. The Maintenance Work Station concept provides means to prevent module contamination from repair debris and ensure the creation of a facility for crew members to work easily in a microgravity environment. Different technologies were also examined for application to EVA repair activities, and the concept selected was a spring-loaded, collapsible, box-like Debris Containement and Collection Device with incorporated fold-down tool boards and handholes in the front panel.

[What do pediatricians and pediatric residents think of the rotation into Primary Health Care].

PubMed

García Puga, J M; Villazán Pérez, C; Domínguez Aurrecoechea, B; Ugarte Líbano, R

2009-05-01

Since 2007, on a mandatory, pediatric residents (PR) have been obliged to rotate into primary health care centers for 3 months. On disagreeing with the type of rotation proposed, the teaching group of the Spanish Primary Care Pediatrics Association (AEPap) was raised to find out the views of Hospital Pediatricians (PH), Pediatrics Health Care (PHC) and PR in terms of need, length, year in which it should take place and rotation expectations. Cross-sectional study using a 13 question validated questionnaire, which was distributed to the various AEPap associations, and completed via the website. The data was processed with SPSS 12.0 and analysed using the Chi(2) test. A total of 323 surveys from 13 Autonomous Regions were analysed, of which 56% were answered by PHC, 38.7% by PR and 5.3% by PH, 67.5% of which were women, with two age groups; one under 30 years old and the other between 41-50 years. Of the participants, 99% believed it was necessary to rotate, with a duration of 6 months proposed by the PHC (73.3%) while PR considered 1 or 2 months (56.9%), (P<0001), preferably performed in two periods (65.1% of PHC). Of the PHC, 75.5% believed that the PR who were going to work in Primary Care should work 6 months more in their last year of residency (P<0001). Of the PR, 63,9% hoped to improve their training in the rotation into Primary Health Care. The need to rotate into Primary Health Care was almost unanimous and three months are insufficient for the majority of respondents and PHC believe it should be 6 months. There appears to be two preferences for rotation: in a period in any year of residence or in two periods. Those PR who are thinking of working in a Primary Health Care should rotate 6 months during the fourth year of residency. The PR expect rotation to improve their training.

Effects of interactive metronome training on timing, attention, working memory, and processing speed in children with ADHD: a case study of two children

PubMed Central

Park, Yun-Yi; Choi, Yu-Jin

2017-01-01

[Purpose] The purpose of this study was to present the effects of Interactive metronome (IM) on timing for children with Attention-Deficit Hyperactivity Disorder (ADHD). [Subjects and Methods] The subjects of the present study were 2 children diagnosed with ADHD. Pre- and post-intervention tests were completed by the researcher using Long Form Assessment (LFA) test of IM and K-WPPSI-IV. The subjects were provided with IM for 40 minutes at a time, 2 times per week, for a total of 8 weeks. [Results] The timing decreased after IM intervention. The subjects showed improvement in attention span after IM intervention. Working memory index as well as processing speed index were increased after intervention, as shown by the Korean-Wechsler Preschool and Primary Scale of Intelligence-IV (K-WPPSI-IV). [Conclusion] IM was effective in improving timing, attention, working memory and processing speed in children with ADHD. PMID:29643596

Effects of interactive metronome training on timing, attention, working memory, and processing speed in children with ADHD: a case study of two children.

PubMed

Park, Yun-Yi; Choi, Yu-Jin

2017-12-01

[Purpose] The purpose of this study was to present the effects of Interactive metronome (IM) on timing for children with Attention-Deficit Hyperactivity Disorder (ADHD). [Subjects and Methods] The subjects of the present study were 2 children diagnosed with ADHD. Pre- and post-intervention tests were completed by the researcher using Long Form Assessment (LFA) test of IM and K-WPPSI-IV. The subjects were provided with IM for 40 minutes at a time, 2 times per week, for a total of 8 weeks. [Results] The timing decreased after IM intervention. The subjects showed improvement in attention span after IM intervention. Working memory index as well as processing speed index were increased after intervention, as shown by the Korean-Wechsler Preschool and Primary Scale of Intelligence-IV (K-WPPSI-IV). [Conclusion] IM was effective in improving timing, attention, working memory and processing speed in children with ADHD.

Toluene in sewage and sludge in wastewater treatment plants.

PubMed

Mrowiec, Bozena

2014-01-01

Toluene is a compound that often occurs in municipal wastewater ranging from detectable levels up to 237 μg/L. Before the year 2000, the presence of the aromatic hydrocarbons was assigned only to external sources. The Enhanced Biological Nutrients Removal Processes (EBNRP) work according to many different schemes and technologies. For high-efficiency biological denitrification and dephosphatation processes, the presence of volatile fatty acids (VFAs) in sewage is required. VFAs are the main product of organic matter hydrolysis from sewage sludge. However, no attention has been given to other products of the process. It has been found that in parallel to VFA production, toluene formation occurred. The formation of toluene in municipal anaerobic sludge digestion processes was investigated. Experiments were performed on a laboratory scale using sludge from primary and secondary settling tanks of municipal treatment plants. The concentration of toluene in the digested sludge from primary settling tanks was found to be about 42,000 μg/L. The digested sludge supernatant liquor returned to the biological dephosphatation and denitrification processes for sewage enrichment can contain up to 16,500 μg/L of toluene.

The Integrated Taxonomy of Health Care: Classifying Both Complementary and Biomedical Practices Using a Uniform Classification Protocol

PubMed Central

Porcino, Antony; MacDougall, Colleen

2009-01-01

Background: Since the late 1980s, several taxonomies have been developed to help map and describe the interrelationships of complementary and alternative medicine (CAM) modalities. In these taxonomies, several issues are often incompletely addressed: A simple categorization process that clearly isolates a modality to a single conceptual categoryClear delineation of verticality—that is, a differentiation of scale being observed from individually applied techniques, through modalities (therapies), to whole medical systemsRecognition of CAM as part of the general field of health care Methods: Development of the Integrated Taxonomy of Health Care (ITHC) involved three stages: Development of a precise, uniform health glossaryAnalysis of the extant taxonomiesUse of an iterative process of classifying modalities and medical systems into categories until a failure to singularly classify a modality occurred, requiring a return to the glossary and adjustment of the classifying protocol Results: A full vertical taxonomy was developed that includes and clearly differentiates between techniques, modalities, domains (clusters of similar modalities), systems of health care (coordinated care system involving multiple modalities), and integrative health care. Domains are the classical primary focus of taxonomies. The ITHC has eleven domains: chemical/substance-based work, device-based work, soft tissue–focused manipulation, skeletal manipulation, fitness/movement instruction, mind–body integration/classical somatics work, mental/emotional–based work, bio-energy work based on physical manipulation, bio-energy modulation, spiritual-based work, unique assessments. Modalities are assigned to the domains based on the primary mode of interaction with the client, according the literature of the practitioners. Conclusions: The ITHC has several strengths: little interpretation is used while successfully assigning modalities to single domains; the issue of taxonomic verticality is fully resolved; and the design fully integrates the complementary health care fields of biomedicine and CAM. PMID:21589735

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

PubMed

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

2010-01-01

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

The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature.

PubMed

Hilton, Gillean; Unsworth, Carolyn; Murphy, Gregory

2018-07-01

This review sought to answer the question "What are the barriers and facilitators influencing people's experience of return to work following spinal cord injury?" Studies that met the selection criteria were identified, presented and critically appraised using National Institute for Health and Care Excellence guidelines. Thematic synthesis was completed with studies possessing strong methodological rigor. Synthesis and interpretation involved three stages; coding of primary data; development of descriptive themes reflective of the primary data; and establishment of analytical themes to answer the review question. Data from nine papers were included in the thematic synthesis. Several descriptive themes and three analytical themes were drawn from the data to answer the research question. Analytical themes included: a matrix of personal and environmental factors exists requiring complex navigation in order to create possibilities and opportunities for postinjury employment; the process of seeking or gaining employment shares a reciprocal relationship with the temporal nature of adjustment to spinal cord injury; and there is an intrinsic need for occupational engagement through paid employment. Returning to or gaining employment after spinal cord injury is a fundamentally difficult experience for people. Multiple strategies are required to support the navigation of the process. There is, however, a need in people with spinal cord injury, to be a worker, and with that comes the inherent benefits of being employed. Implications for rehabilitation Returning to work should be a significant focus of spinal cord injury rehabilitation. Employment is both possible and health promoting following spinal cord injury. Multiple strategies are required to support people to navigate the return to work process. It is important to be cognizant of the individual motivations for being a worker and the complexity of the adjustment process. Spinal cord injury centers can provide a consistent and supportive framework and culture of positivity about employment after spinal cord injury.

Scatter correction for x-ray conebeam CT using one-dimensional primary modulation

NASA Astrophysics Data System (ADS)

Zhu, Lei; Gao, Hewei; Bennett, N. Robert; Xing, Lei; Fahrig, Rebecca

2009-02-01

Recently, we developed an efficient scatter correction method for x-ray imaging using primary modulation. A two-dimensional (2D) primary modulator with spatially variant attenuating materials is inserted between the x-ray source and the object to separate primary and scatter signals in the Fourier domain. Due to the high modulation frequency in both directions, the 2D primary modulator has a strong scatter correction capability for objects with arbitrary geometries. However, signal processing on the modulated projection data requires knowledge of the modulator position and attenuation. In practical systems, mainly due to system gantry vibration, beam hardening effects and the ramp-filtering in the reconstruction, the insertion of the 2D primary modulator results in artifacts such as rings in the CT images, if no post-processing is applied. In this work, we eliminate the source of artifacts in the primary modulation method by using a one-dimensional (1D) modulator. The modulator is aligned parallel to the ramp-filtering direction to avoid error magnification, while sufficient primary modulation is still achieved for scatter correction on a quasicylindrical object, such as a human body. The scatter correction algorithm is also greatly simplified for the convenience and stability in practical implementations. The method is evaluated on a clinical CBCT system using the Catphan© 600 phantom. The result shows effective scatter suppression without introducing additional artifacts. In the selected regions of interest, the reconstruction error is reduced from 187.2HU to 10.0HU if the proposed method is used.

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

PubMed

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

2016-05-01

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

A Theoretical Analysis of Thermal Radiation from Neutron Stars

NASA Technical Reports Server (NTRS)

Applegate, James H.

1993-01-01

As soon as it was realized that the direct URCA process is allowed by many modern nuclear equation of state, an analysis of its effect on the cooling of neutron stars was undertaken. A primary study showed that the occurrence of the direct URCA process makes the surface temperature of a neutron star suddenly drop by almost an order of magnitude when the cold wave from the core reaches the surface when the star is a few years old. The results of this study are published in Page and Applegate. As a work in progress, we are presently extending the above work. Improved expressions for the effect of nucleon pairing on the neutrino emissivity and specific heat are now available, and we have incorporated them in a recalculation of rate of the direct URCA process.

Pharmacist provision of primary health care: a modified Delphi validation of pharmacists' competencies.

PubMed

Kennie-Kaulbach, Natalie; Farrell, Barbara; Ward, Natalie; Johnston, Sharon; Gubbels, Ashley; Eguale, Tewodros; Dolovich, Lisa; Jorgenson, Derek; Waite, Nancy; Winslade, Nancy

2012-03-28

Pharmacists have expanded their roles and responsibilities as a result of primary health care reform. There is currently no consensus on the core competencies for pharmacists working in these evolving practices. The aim of this study was to develop and validate competencies for pharmacists' effective performance in these roles, and in so doing, document the perceived contribution of pharmacists providing collaborative primary health care services. Using a modified Delphi process including assessing perception of the frequency and criticality of performing tasks, we validated competencies important to primary health care pharmacists practising across Canada. Ten key informants contributed to competency drafting; thirty-three expert pharmacists replied to a second round survey. The final primary health care pharmacist competencies consisted of 34 elements and 153 sub-elements organized in seven CanMeds-based domains. Highest importance rankings were allocated to the domains of care provider and professional, followed by communicator and collaborator, with the lower importance rankings relatively equally distributed across the manager, advocate and scholar domains. Expert pharmacists working in primary health care estimated their most important responsibilities to be related to direct patient care. Competencies that underlie and are required for successful fulfillment of these patient care responsibilities, such as those related to communication, collaboration and professionalism were also highly ranked. These ranked competencies can be used to help pharmacists understand their potential roles in these evolving practices, to help other health care professionals learn about pharmacists' contributions to primary health care, to establish standards and performance indicators, and to prioritize supports and education to maximize effectiveness in this role.

Pharmacist provision of primary health care: a modified Delphi validation of pharmacists' competencies

PubMed Central

2012-01-01

Background Pharmacists have expanded their roles and responsibilities as a result of primary health care reform. There is currently no consensus on the core competencies for pharmacists working in these evolving practices. The aim of this study was to develop and validate competencies for pharmacists' effective performance in these roles, and in so doing, document the perceived contribution of pharmacists providing collaborative primary health care services. Methods Using a modified Delphi process including assessing perception of the frequency and criticality of performing tasks, we validated competencies important to primary health care pharmacists practising across Canada. Results Ten key informants contributed to competency drafting; thirty-three expert pharmacists replied to a second round survey. The final primary health care pharmacist competencies consisted of 34 elements and 153 sub-elements organized in seven CanMeds-based domains. Highest importance rankings were allocated to the domains of care provider and professional, followed by communicator and collaborator, with the lower importance rankings relatively equally distributed across the manager, advocate and scholar domains. Conclusions Expert pharmacists working in primary health care estimated their most important responsibilities to be related to direct patient care. Competencies that underlie and are required for successful fulfillment of these patient care responsibilities, such as those related to communication, collaboration and professionalism were also highly ranked. These ranked competencies can be used to help pharmacists understand their potential roles in these evolving practices, to help other health care professionals learn about pharmacists' contributions to primary health care, to establish standards and performance indicators, and to prioritize supports and education to maximize effectiveness in this role. PMID:22455482

29 CFR 780.106 - Employment in “primary” agriculture is farming regardless of why or where work is performed.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 3 2014-07-01 2014-07-01 false Employment in âprimaryâ agriculture is farming regardless... DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Exemption...

29 CFR 780.106 - Employment in “primary” agriculture is farming regardless of why or where work is performed.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Employment in âprimaryâ agriculture is farming regardless... DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Exemption...

29 CFR 780.106 - Employment in “primary” agriculture is farming regardless of why or where work is performed.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Employment in âprimaryâ agriculture is farming regardless... DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Exemption...

29 CFR 780.106 - Employment in “primary” agriculture is farming regardless of why or where work is performed.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 3 2012-07-01 2012-07-01 false Employment in âprimaryâ agriculture is farming regardless... DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Exemption...

29 CFR 780.106 - Employment in “primary” agriculture is farming regardless of why or where work is performed.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 3 2013-07-01 2013-07-01 false Employment in âprimaryâ agriculture is farming regardless... DIRECTLY RELATED TO REGULATIONS EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Exemption...

Cognitive Processes and Math Performance: A Study with Children at Third Grade of Basic Education

ERIC Educational Resources Information Center

Campos, Isabel S.; Almeida, Leandro S.; Ferreira, Aristides I.; Martinez, Luis F.; Ramalho, Gloria

2013-01-01

The present study aims to examine the relationship between cognitive factors and mathematical achievement in primary education. Participants were 103 Portuguese third grade students, aged 8 and 9. All participants completed a battery for working memory (WMTB-C), a test of general intelligence (Raven's Progressive Color Matrices), a selective…

Logo Experiences with Young Children: Describing Performance, Problem-Solving and Social Contexts of Learning.

ERIC Educational Resources Information Center

Yelland, Nicola

1995-01-01

Explored the performance of primary school children in Logo programming tasks while they worked in one of three gender pairs (girl, boy, or boy-girl). Found no considerable differences in performance based on gender. Results suggest that what distinguished performance was the application of metastrategic processes--the most effective solutions…

ICT Integration in Primary and Secondary Education in Andalusia, Spain: Curricular and Organizational Implications

ERIC Educational Resources Information Center

Morueta, Ramon Tirado; Igado, Manuel Fandos; Gomez, J. Ignacio Aguaded

2010-01-01

This work, part of the Spanish government's National I + D Plan 2004/07, entitled "Observatics: the implementation of free software in ICT centres in Andalusia: an analysis of its effect on the teaching-learning process", aims to describe the most recent impact of online communication technologies on education in Andalusia (Spain),…

Responsibility, Authority, and Accountability in School-Based and Non-School-Based Management: Principals' Coping Strategies

ERIC Educational Resources Information Center

Grinshtain, Yael; Gibton, Dan

2018-01-01

Purpose: The purpose of this paper is to understand how primary school principals in Israel cope with the gaps between authority and responsibility in their work, deriving from partially implemented decentralization processes, and how this relates to school-based management (SBM) and accountability principles. Design/methodology/approach: Using…

Children, Extracurricular Activities, and Digital Media: The Process of Displacement and School Performance

ERIC Educational Resources Information Center

Mourgela, Vasiliki; Pacurar, Ecaterina

2018-01-01

This work, situated in the Greek sociocultural context, attempts to analyze the time spent by primary school students on digital and traditional extracurricular activities and the impact of these activities on the educational outcome. The first objective was to determine, by means of a quantitative survey, if the children as "digital…

Impact of a Major National Evaluation Study: Israel's Van Leer Report.

ERIC Educational Resources Information Center

Alkin, Marvin C.; Lewy, Arieh

This investigation documents the impact of the Van Leer Study, a large-scale evaluation study of achievement in the primary schools of Israel. It is intended to increase understanding of the process of evaluation utilization, showing how evaluation findings and other kinds of information can work together, over time and in a variety of ways, to…

Improving the Management Style of School Principals: Results from a Randomized Trial

ERIC Educational Resources Information Center

Lassibille, Gérard

2016-01-01

Using information from a randomized experiment carried out over the course of two school years in Madagascar, this paper evaluates the impact of specific actions designed to streamline and tighten the work processes of public primary school directors. The results show that interventions at the school level, reinforced by interventions at the…

Teaching Primary & Secondary Sources: An Earthshaking Collaboration

ERIC Educational Resources Information Center

Gustafson, Chris

2006-01-01

Does history have to be boring and dry? Not if a person takes the familiar and adds an earthshaking twist! To begin the collaborative process, work with a willing teacher. This article talks about a teaching collaboration between the author as a library media specialist and Beth who was interested in literature circle titles for her 6th grade…

Interrater Reliability among Elementary Principals Using the North Carolina Teacher Evaluation Process

ERIC Educational Resources Information Center

Mazurek, Sharon Ann

2012-01-01

Teacher observation remains one of the primary data collection methods for analyzing teaching behaviors. States use various evaluation instruments and current trends across the United States show that more states are working to tie teacher evaluation to student performance. The purpose of this study was to determine to what extent there was…

Examining the Impact of Technology on Primary Students' Revision of Written Work

ERIC Educational Resources Information Center

Lisy, Jennifer Garrette

2015-01-01

Few studies have examined the revision processes of second grade students and even fewer have explored the impact of digital writing on young students' revisions. This study utilized a within subject crossover trial using randomized block assignment (AB | BA) for counterbalancing. This study sought to determine (1) whether revising on paper versus…

Executive Function in Preschool-Age Children: Integrating Measurement, Neurodevelopment, and Translational Research

ERIC Educational Resources Information Center

Griffin, James A., Ed.; McCardle, Peggy, Ed.; Freund, Lisa, Ed.

2016-01-01

A primary aim of the neuropsychological revolution has been the mapping of what has come to be known as executive function (EF). This term encompasses a range of mental processes such as working memory, inhibitory control, and cognitive flexibility that, together, regulate our social behavior, and our emotional and cognitive well-being. In this…

Improving Doctoral Degrees in Education: Focus on Mission, Coherence, and Sustainability

ERIC Educational Resources Information Center

Gallagher, Karen Symms

2013-01-01

This article is a retrospective description of the decisions, strategies, and context of program changes made at the USC Rossier School of Education, related specifically to the education doctorate. The primary purpose is to highlight the change process from the perspective of the academic dean. Drawing on work in systems change and strategic…

Engendering Anthropocentrism: Lessons from Children's Realistic Animal Stories.

ERIC Educational Resources Information Center

Johnson, Kathleen R.

In children's realistic stories about animals a number of wholly and unambiguously anthropocentric assumptions are at work. For instance, in a study most of the books (81%) in one sampling of 50 stories involve a pet or the process of domesticating a wild animal. In most cases the primary animal character is a dog or horse. The predominance of…

Learning Practices of Femininity through Gendered Craft Education in Finland

ERIC Educational Resources Information Center

Kokko, Sirpa

2009-01-01

This paper discusses the processes and practices that link crafts and gender in the upbringing and education of girls. The paper is based on a study conducted among female primary school trainee teachers in Finland. The data are comprised of their experiences with crafts as schoolgirls. The methods of the study were memory work and writing of…

Science of the Brain as a Gateway to Understanding Play: An Interview with Jaak Panksepp

ERIC Educational Resources Information Center

American Journal of Play, 2010

2010-01-01

Jaak Panksepp, known best for his work on animal emotions and coining the term "affective neuroscience," investigates the primary processes of brain and mind that enable and drive emotion. As an undergraduate, he briefly considered a career in electrical engineering but turned instead to psychology, which led to a 1969 University of…

How do nurse practitioners work in primary health care settings? A scoping review.

PubMed

Grant, Julian; Lines, Lauren; Darbyshire, Philip; Parry, Yvonne

2017-10-01

This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes. A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. Data sources included literature identified by a search of electronic databases conducted in September 2015 (CINAHL, Informit, Web of Science, Scopus and Medline) and repeated in July 2016. Additional studies were located through hand searching and authors' knowledge of other relevant studies. 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). The majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to comprehensive models of primary health care. Nurse practitioners predominantly worked with populations defined by an illness with structured protocols for curative and rehabilitative care. Nurse practitioner work that also incorporated promotive activities targeted improving social determinants of health for people rendered vulnerable due to ethnicity, Aboriginal identity, socioeconomic disadvantage, remote location, gender and aging. Interventions were at individual and community levels with outcomes including increased access to care, cost savings and salutogenic characteristics of empowerment for social change. Copyright © 2017 Elsevier Ltd. All rights reserved.

The energetics of the primary proton transfer in bacteriorhodopsin revisited: it is a sequential light-induced charge separation after all.

PubMed

Braun-Sand, Sonja; Sharma, Pankaz K; Chu, Zhen T; Pisliakov, Andrei V; Warshel, Arieh

2008-05-01

The light-induced proton transport in bacteriorhodopsin has been considered as a model for other light-induced proton pumps. However, the exact nature of this process is still unclear. For example, it is not entirely clear what the driving force of the initial proton transfer is and, in particular, whether it reflects electrostatic forces or other effects. The present work simulates the primary proton transfer (PT) by a specialized combination of the EVB and the QCFF/PI methods. This combination allows us to obtain sufficient sampling and a quantitative free energy profile for the PT at different protein configurations. The calculated profiles provide new insight about energetics of the primary PT and its coupling to the protein conformational changes. Our finding confirms the tentative analysis of an earlier work (A. Warshel, Conversion of light energy to electrostatic energy in the proton pump of Halobacterium halobium, Photochem. Photobiol. 30 (1979) 285-290) and determines that the overall PT process is driven by the energetics of the charge separation between the Schiff base and its counterion Asp85. Apparently, the light-induced relaxation of the steric energy of the chromophore leads to an increase in the ion-pair distance, and this drives the PT process. Our use of the linear response approximation allows us to estimate the change in the protein conformational energy and provides the first computational description of the coupling between the protein structural changes and the PT process. It is also found that the PT is not driven by twist-modulated changes of the Schiff base's pKa, changes in the hydrogen bond directionality, or other non-electrostatic effects. Overall, based on a consistent use of structural information as the starting point for converging free energy calculations, we conclude that the primary event should be described as a light-induced formation of an unstable ground state, whose relaxation leads to charge separation and to the destabilization of the ion-pair state. This provides the driving force for the subsequent PT steps.

[The patient's right to information: influence of socio-professional factors in primary care].

PubMed

Pérez-Cárceles, M D; Pereñíguez-Barranco, J E; Osuna-Carrillo de Albornoz, E; Luna-Maldonado, A

2006-02-15

To describe the information provided by primary care doctors to their patients in different phases of the care provision process and to analyse any relationships with socio-professional factors. Descriptive, cross-sectional study based on postal questionnaire. Primary care centres in Murcia, Spain. 227 family physicians. Distribution of a questionnaire which includes: a) socio-professional variables (age, sex, marital status, years in practice, years in present post, work environment, previous training, number of patients on list, number of patients seen daily); b) an evaluation of job satisfaction (Likert scale) related to salary, career choice, immediate superiors and daily surgery; and c) the frequency with which information is provided to patients concerning diagnosis, prognosis, treatment, complementary examinations and personal, professional and family impact. The reply rate was 59%. The percentages of doctors who always provided information concerning diagnosis, prognosis, treatment, complementary examinations and person, professional and family impact was, 23.3%, 7%, 64.3%, 40.5%, and 9.7%, respectively. There was a direct and statistically significant relationship between job satisfaction and the information provided to patients, the doctors feeling most satisfaction providing the most information on the different phases of the care process. On the other hand, there was an inverse and statistically significant relationship between the number of patients on the doctors' lists and the information provided. The degree of fulfillment of the patient's right to information is low. Doctors should realise the practical importance of clinical information in their work. There is a general feeling of discontent amongst family doctors, which has a negative impact on their professional activity. A lighter workload would significantly improve the extent to which doctors provide patients with information and mechanisms should be put in place to improve working conditions to avoid the non-fulfillment of the patient's right to information.

Interprofessional primary care in academic family medicine clinics

PubMed Central

Drummond, Neil; Abbott, Karen; Williamson, Tyler; Somji, Behnaz

2012-01-01

Abstract Objective To explore the status and processes of interprofessional work environments and the implications for interprofessional education in a sample of family medicine teaching clinics. Design Focus group interviews using a purposive sampling procedure. Setting Four academic family medicine clinics in Alberta. Participants Seven family physicians, 9 registered nurses, 5 licensed practical nurses, 2 residents, 1 psychologist, 1 informatics specialist, 1 pharmacist, 1 dietitian, 1 nurse practitioner, 1 receptionist, and 1 respiratory therapist. Methods Assessment of clinic status and performance in relation to established principles of interprofessional work and education was explored using semistructured focus group interviews. Main findings Our data supported the D’Amour and Oandasan model of successful interprofessional collaborative practice in terms of the model’s main “factors” (ie, shared goals and vision, sense of belonging, governance, and the structuring of clinical care) and their constituent “elements.” It is reasonable to conclude that the extent to which these factors and elements are both present and positively oriented in academic clinic settings is an important contributory factor to the establishment of interprofessional collaborative practice in primary care. Using this model, 2 of the 4 clinics were rated as expressing substantial progress in relation to interprofessional work, while the other 2 clinics were rated as less successful on that dimension. None of the clinics was identified as having a clear and explicit focus on providing interprofessional education. Conclusion The key factor in relation to the implementation of interprofessional work in primary care appears to be the existence of clear and explicit leadership in that direction. Substantial scope exists for improvement in the organization, conduct, and promotion of interprofessional education for Canadian primary care. PMID:22893347

Development of a family nursing model for prevention of cancer and other noncommunicable diseases through an appreciative inquiry.

PubMed

Jongudomkarn, Darunee; Macduff, Colin

2014-01-01

Cancer and non-communicable diseases are a major issue not only for the developed but also developing countries. Public health and primary care nursing offer great potential for primary and secondary prevention of these diseases through community and family-based approaches. Within Thailand there are related established educational curricula but less is known about how graduate practitioners enact ideas in practice and how these can influence policy at local levels. The aim of this inquiry was to develop family nursing practice in primary care settings in the Isaan region or Northeastern Thailand and to distill what worked well into a nursing model to guide practice. An appreciative inquiry approach involving analysis of written reports, focus group discussions and individual interviews was used to synthesize what worked well for fourteen family nurses involved in primary care delivery and to build the related model. Three main strategies were seen to offer a basis for optimal care delivery, namely: enacting a participatory action approach mobilizing families' social capital; using family nursing process; and implementing action strategies within communities. These were distilled into a new conceptual model. The model has some features in common with related community partnership models and the World Health Organization Europe Family Health Nurse model, but highlights practical strategies for family nursing enactment. The model offers a basis not only for planning and implementing family care to help prevent cancer and other diseases but also for education of nurses and health care providers working in communities. This articulation of what works in this culture also offers possible transference to different contexts internationally, with related potential to inform health and social care policies, and international development of care models.

Coordinate metrology of a primary surface composite panel from the Large Millimeter Telescope

NASA Astrophysics Data System (ADS)

Gale, David M.; Lucero Álvarez, Maribel; Cabrera Cuevas, Lizeth; Leon-Huerta, Andrea; Arizmendi Reyes, Edgar; Icasio Hernández, Octavio; Castro Santos, David; Hernández Ríos, Emilio; Tecuapetla Sosa, Esteban; Tzile Torres, Carlos; Viliesid Alonso, Miguel

2016-07-01

The Large Millimeter Telescope (LMT) is a single-dish fully-steerable radio telescope presently operating with a 32.5 m parabolic primary reflector, in the process of extension to 50 m. The project is managed by the Instituto Nacional de Astrofísica, Óptica y Electrónica (INAOE) in México, and the University of Massachusetts Amherst, USA. A laminated surface panel from the LMT primary reflector has been subjected to a surface measurement assay at Mexico's National Metrology Center (CENAM). Data obtained using a coordinate measuring machine and laser tracker owned by CENAM is compared with measurements using an identical model laser tracker and the photogrammetry technique, the latter systems owned and operated by the LMT. All measurements were performed within the controlled metrology environment at CENAM. The measurement exercise is intended to prepare the groundwork for converting this spare surface panel into a calibrated work-piece. The establishment of a calibrated work-piece provides quality assurance for metrology through measurement traceability. It also simplifies the evaluation of measurement uncertainty for coordinate metrology procedures used by the LMT project during reflector surface qualification.

What Makes Counsellors Working in Primary Care Distinct from Counsellors Working in Other Settings?

ERIC Educational Resources Information Center

Hudson-Allez, Glyn

2000-01-01

Counseling in primary care can be considered a fast-evolving profession that is distinct from counseling in the private sector. Differences in counselor roles, specifically confidentiality ethics and working hours, are discussed. Referrals and attrition are also discussed. The distinctiveness of primary care counseling versus working in more…

Test results management and distributed cognition in electronic health record-enabled primary care.

PubMed

Smith, Michael W; Hughes, Ashley M; Brown, Charnetta; Russo And, Elise; Giardina, Traber D; Mehta, Praveen; Singh, Hardeep

2018-06-01

Managing abnormal test results in primary care involves coordination across various settings. This study identifies how primary care teams manage test results in a large, computerized healthcare system in order to inform health information technology requirements for test results management and other distributed healthcare services. At five US Veterans Health Administration facilities, we interviewed 37 primary care team members, including 16 primary care providers, 12 registered nurses, and 9 licensed practical nurses. We performed content analysis using a distributed cognition approach, identifying patterns of information transmission across people and artifacts (e.g. electronic health records). Results illustrate challenges (e.g. information overload) as well as strategies used to overcome challenges. Various communication paths were used. Some team members served as intermediaries, processing information before relaying it. Artifacts were used as memory aids. Health information technology should address the risks of distributed work by supporting awareness of team and task status for reliable management of results.

Working with Bangladeshi patients in Britain: perspectives from Primary Health Care.

PubMed

Hawthorne, Kamila; Rahman, Jasmin; Pill, Roisin

2003-04-01

The difficulties of ethnic minority communities in accessing appropriate primary care are well documented, but little is known about the experiences of Primary Health Care Teams (PHCTs) serving these communities, or their strategies to help patients overcome these difficulties. The purpose of the study was to explore the PHCT perspective of working with Bangladeshi patients. Qualitative group discussions with PHCTs were set up by four health centres in the Grangetown area of Cardiff, where a large proportion of the Bangladeshi community lives. Experiences of and attitudes to working with Bangladeshi patients were explored. Discussions were taped and transcribed for independent analysis by two researchers. Comparisons within and between PHCTs were made. PHCTs largely entered into full and frank discussions. Health visitors had made significantly more effort than others to get to know their Bangladeshi patients. This had costs in terms of time and effort, with no reduction in caseload. Cutting across this difference were common themes such as communication and cultural differences, and patients' difficulties in using NHS services appropriately, which caused disruption and frustration. While there was an awareness of the reasons for these difficulties, PHCTs generally were not able to allow for them because of the inflexibility of their workload and systems of working. Group discussions are a useful way to encourage PHCTs to reflect on their practice and share experiences. PHCTs are aware of their patients' needs and keen to explore racial awareness training and new ways of looking at how they work. However, the grind of heavy workloads makes this process unlikely without outside facilitation.

In-vivo quantification of primary microRNA processing by Drosha with a luciferase based system

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

Allegra, Danilo; Cooperation Unit 'Mechanisms of Leukemogenesis', B061, DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg; Mertens, Daniel, E-mail: daniel.mertens@uniklinik-ulm.de

2011-03-25

Research highlights: {yields} Posttranscriptional regulation of miRNA processing is difficult to quantify. {yields} Our in-vivo processing assay can quantify Drosha cleavage in live cells. {yields} It is based on luciferase reporters fused with pri-miRNAs. {yields} The assay validates the processing defect caused by a mutation in pri-16-1. {yields} It is a sensitive method to quantify pri-miRNA cleavage by Drosha in live cells. -- Abstract: The RNAse III Drosha is responsible for the first step of microRNA maturation, the cleavage of primary miRNA to produce the precursor miRNA. Processing by Drosha is finely regulated and influences the amount of mature microRNAmore » in a cell. We describe in the present work a method to quantify Drosha processing activity in-vivo, which is applicable to any microRNA. With respect to other methods for measuring Drosha activity, our system is faster and scalable, can be used with any cellular system and does not require cell sorting or use of radioactive isotopes. This system is useful to study regulation of Drosha activity in physiological and pathological conditions.« less

A process-based framework to guide nurse practitioners integration into primary healthcare teams: results from a logic analysis.

PubMed

Contandriopoulos, Damien; Brousselle, Astrid; Dubois, Carl-Ardy; Perroux, Mélanie; Beaulieu, Marie-Dominique; Brault, Isabelle; Kilpatrick, Kelley; D'Amour, Danielle; Sansgter-Gormley, Esther

2015-02-27

Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- professional collaboration, and team-based work processes that make the best use of the subsidiarity principle. There have been numerous studies on nurse practitioner integration, and the literature provides a comprehensive list of barriers to, and facilitators of, integration. However, this literature is much less prolific in discussing the operational level implications of those barriers and facilitators and in offering practical recommendations. In the context of a large-scale research project on the introduction of nurse practitioners in Quebec (Canada) we relied on a logic-analysis approach based, on the one hand on a realist review of the literature and, on the other hand, on qualitative case-studies in 6 primary healthcare teams in rural and urban area of Quebec. Five core themes that need to be taken into account when integrating nurse practitioners into primary care teams were identified. Those themes are: planning, role definition, practice model, collaboration, and team support. The present paper has two objectives: to present the methods used to develop the themes, and to discuss an integrative model of nurse practitioner integration support centered around these themes. It concludes with a discussion of how this framework contributes to existing knowledge and some ideas for future avenues of study.

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

PubMed Central

Scherer, Charleni Inês; Scherer, Magda Duarte dos Anjos

2016-01-01

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities. PMID:26815162

The protocol and design of a randomised controlled study on training of attention within the first year after acquired brain injury.

PubMed

Bartfai, Aniko; Markovic, Gabriela; Sargenius Landahl, Kristina; Schult, Marie-Louise

2014-05-08

To describe the design of the study aiming to examine intensive targeted cognitive rehabilitation of attention in the acute (<4 months) and subacute rehabilitation phases (4-12 months) after acquired brain injury and to evaluate the effects on function, activity and participation (return to work). Within a prospective, randomised, controlled study 120 consecutive patients with stroke or traumatic brain injury were randomised to 20 hours of intensive attention training by Attention Process Training or by standard, activity based training. Progress was evaluated by Statistical Process Control and by pre and post measurement of functional and activity levels. Return to work was also evaluated in the post-acute phase. Primary endpoints were the changes in the attention measure, Paced Auditory Serial Addition Test and changes in work ability. Secondary endpoints included measurement of cognitive functions, activity and work return. There were 3, 6 and 12-month follow ups focussing on health economics. The study will provide information on rehabilitation of attention in the early phases after ABI; effects on function, activity and return to work. Further, the application of Statistical Process Control might enable closer investigation of the cognitive changes after acquired brain injury and demonstrate the usefulness of process measures in rehabilitation. The study was registered at ClinicalTrials.gov Protocol. NCT02091453, registered: 19 March 2014.

Large Crater Clustering tool

NASA Astrophysics Data System (ADS)

Laura, Jason; Skinner, James A.; Hunter, Marc A.

2017-08-01

In this paper we present the Large Crater Clustering (LCC) tool set, an ArcGIS plugin that supports the quantitative approximation of a primary impact location from user-identified locations of possible secondary impact craters or the long-axes of clustered secondary craters. The identification of primary impact craters directly supports planetary geologic mapping and topical science studies where the chronostratigraphic age of some geologic units may be known, but more distant features have questionable geologic ages. Previous works (e.g., McEwen et al., 2005; Dundas and McEwen, 2007) have shown that the source of secondary impact craters can be estimated from secondary impact craters. This work adapts those methods into a statistically robust tool set. We describe the four individual tools within the LCC tool set to support: (1) processing individually digitized point observations (craters), (2) estimating the directional distribution of a clustered set of craters, back projecting the potential flight paths (crater clusters or linearly approximated catenae or lineaments), (3) intersecting projected paths, and (4) intersecting back-projected trajectories to approximate the local of potential source primary craters. We present two case studies using secondary impact features mapped in two regions of Mars. We demonstrate that the tool is able to quantitatively identify primary impacts and supports the improved qualitative interpretation of potential secondary crater flight trajectories.

Organizational culture: an important context for addressing and improving hospital to community patient discharge.

PubMed

Hesselink, Gijs; Vernooij-Dassen, Myrra; Pijnenborg, Loes; Barach, Paul; Gademan, Petra; Dudzik-Urbaniak, Ewa; Flink, Maria; Orrego, Carola; Toccafondi, Giulio; Johnson, Julie K; Schoonhoven, Lisette; Wollersheim, Hub

2013-01-01

Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown. To explore aspects of organizational culture to develop a deeper understanding of the discharge process. A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data. In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses. Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices. On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.

Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems.

PubMed

Knowles, Sarah E; Chew-Graham, Carolyn; Coupe, Nia; Adeyemi, Isabel; Keyworth, Chris; Thampy, Harish; Coventry, Peter A

2013-09-20

Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting. A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis. Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients. Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.

Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems

PubMed Central

2013-01-01

Background Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting. Methods A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis. Results Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients. Conclusions Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice. PMID:24053257

Primary and secondary fragmentation of crystal-bearing intermediate magma

NASA Astrophysics Data System (ADS)

Jones, Thomas J.; McNamara, Keri; Eychenne, Julia; Rust, Alison C.; Cashman, Katharine V.; Scheu, Bettina; Edwards, Robyn

2016-11-01

Crystal-rich intermediate magmas are subjected to both primary and secondary fragmentation processes, each of which may produce texturally distinct tephra. Of particular interest for volcanic hazards is the extent to which each process contributes ash to volcanic plumes. One way to address this question is by fragmenting pyroclasts under controlled conditions. We fragmented pumice samples from Soufriere Hills Volcano (SHV), Montserrat, by three methods: rapid decompression in a shock tube-like apparatus, impact by a falling piston, and milling in a ball mill. Grain size distributions of the products reveal that all three mechanisms produce fractal breakage patterns, and that the fractal dimension increases from a minimum of 2.1 for decompression fragmentation (primary fragmentation) to a maximum of 2.7 by repeated impact (secondary fragmentation). To assess the details of the fragmentation process, we quantified the shape, texture and components of constituent ash particles. Ash shape analysis shows that the axial ratio increases during milling and that particle convexity increases with repeated impacts. We also quantify the extent to which the matrix is separated from the crystals, which shows that secondary processes efficiently remove adhering matrix from crystals, particularly during milling (abrasion). Furthermore, measurements of crystal size distributions before (using x-ray computed tomography) and after (by componentry of individual grain size classes) decompression-driven fragmentation show not only that crystals influence particular size fractions across the total grain size distribution, but also that free crystals are smaller in the fragmented material than in the original pumice clast. Taken together, our results confirm previous work showing both the control of initial texture on the primary fragmentation process and the contributions of secondary processes to ash formation. Critically, however, our extension of previous analyses to characterisation of shape, texture and componentry provides new analytical tools that can be used to assess contributions of secondary processes to ash deposits of uncertain or mixed origin. We illustrate this application with examples from SHV deposits.

The role of auditory and cognitive factors in understanding speech in noise by normal-hearing older listeners

PubMed Central

Schoof, Tim; Rosen, Stuart

2014-01-01

Normal-hearing older adults often experience increased difficulties understanding speech in noise. In addition, they benefit less from amplitude fluctuations in the masker. These difficulties may be attributed to an age-related auditory temporal processing deficit. However, a decline in cognitive processing likely also plays an important role. This study examined the relative contribution of declines in both auditory and cognitive processing to the speech in noise performance in older adults. Participants included older (60–72 years) and younger (19–29 years) adults with normal hearing. Speech reception thresholds (SRTs) were measured for sentences in steady-state speech-shaped noise (SS), 10-Hz sinusoidally amplitude-modulated speech-shaped noise (AM), and two-talker babble. In addition, auditory temporal processing abilities were assessed by measuring thresholds for gap, amplitude-modulation, and frequency-modulation detection. Measures of processing speed, attention, working memory, Text Reception Threshold (a visual analog of the SRT), and reading ability were also obtained. Of primary interest was the extent to which the various measures correlate with listeners' abilities to perceive speech in noise. SRTs were significantly worse for older adults in the presence of two-talker babble but not SS and AM noise. In addition, older adults showed some cognitive processing declines (working memory and processing speed) although no declines in auditory temporal processing. However, working memory and processing speed did not correlate significantly with SRTs in babble. Despite declines in cognitive processing, normal-hearing older adults do not necessarily have problems understanding speech in noise as SRTs in SS and AM noise did not differ significantly between the two groups. Moreover, while older adults had higher SRTs in two-talker babble, this could not be explained by age-related cognitive declines in working memory or processing speed. PMID:25429266

FINDING A METHOD FOR THE MADNESS: A COMPARATIVE ANALYSIS OF STRATEGIC DESIGN METHODOLOGIES

DTIC Science & Technology

2017-06-01

FINDING A METHOD FOR THE MADNESS: A COMPARATIVE ANALYSIS OF STRATEGIC DESIGN METHODOLOGIES BY AMANDA DONNELLY A THESIS...work develops a comparative model for strategic design methodologies, focusing on the primary elements of vision, time, process, communication and...collaboration, and risk assessment. My analysis dissects and compares three potential design methodologies including, net assessment, scenarios and

Primary Five Pupils' Cooperative Behaviours and Perceptions of the Use of Cooperative Learning in Social Studies Classes in Singapore.

ERIC Educational Resources Information Center

Hing, Tey Sau; Lee, Christine Kim-Eng; Ng, Maureen; Chew, Joy

A study recorded the experiences of elementary school students with cooperative learning in two schools in Singapore. The students worked cooperatively in various assigned social studies tasks through the process of social interaction and sharing with their peers. One school was used as the experimental school while the other served as the…

Student Support Teams: Helping Students Succeed in General Education Classrooms or Working To Place Students in Special Education?

ERIC Educational Resources Information Center

Logan, Kent R.; Hansen, Carol D.; Nieminen, Paul K.; Wright, E. Heath

2001-01-01

A study involving 24 elementary teachers found they were not using Student Support Teams (SST) as designed. Teachers believed the primary purpose of SST was to test and place students into special education, referred students with whom they had not been successful, and believed there was a covert evaluation process. (Contains references.)…

Factor Stability of Primary Scales of the General Organization Questionnaire

DTIC Science & Technology

1980-10-01

leadership , climate , and processes function optimally. The Leadership and Organizational Effectiveness Work Unit re- searches personal, small-group...the Litwin and Stringer (1968) Organizational Climate Questionnaire found a factor structure that was dif- ferent from the a priori structure...number) General Organization Questionnaire (GOQ) Organizational climate Organizational effectiveness 20. ATRACT (Cnm N eriwem7 d Iderntify by block numbst

Considering the Art History of El Mundo Maya: Some Issues Regarding the Inquiry Process.

ERIC Educational Resources Information Center

Labadie, John Antoine

The project sees study of art culture through primary source inquiry as a valuable experience for the art educator. Regardless of the culture, artist, or time period studied, the work of art makes itself known through both intellectual and emotive responses to it. Through description of Mayan culture, society, and artifacts, art as an extension…

Determining the Motor Skills Development of Mentally Retarded Children through the Contribution of Visual Arts

ERIC Educational Resources Information Center

Erim, Gonca; Caferoglu, Müge

2017-01-01

Visual arts education is a process that helps the reflection of inner worlds, socialization via group works and healthier motor skills development of normally developing or handicapped children like the mentally retarded. This study aims to determine the influence of visual art studies on the motor skills development of primary school first grade…

Suggestopedia Based Storytelling Teaching Model for Primary Students in Salatiga

ERIC Educational Resources Information Center

Sunardi; Waluyo, Herman J.; Suudi, Astini; Wardani, Nugraheni Eko

2018-01-01

Teaching and learning speaking skills should be able to engage students in a creative process. Students have to be able to speak in front of the class, create a dialogue, tell a story, and produce the language creatively. The teaching and learning of the speaking skill focusing on story telling ability can work well when supported by the…

Plated wire memory subsystem

NASA Technical Reports Server (NTRS)

Reynolds, L.; Tweed, H.

1972-01-01

The work performed entailed the design, development, construction and testing of a 4000 word by 18 bit random access, NDRO plated wire memory for use in conjunction with a spacecraft imput/output unit and central processing unit. The primary design parameters, in order of importance, were high reliability, low power, volume and weight. A single memory unit, referred to as a qualification model, was delivered.

Defending Identity and Ethos: An Analysis of Teacher Perceptions of School Collaboration in Northern Ireland

ERIC Educational Resources Information Center

Donnelly, Caitlin

2012-01-01

The purpose of this article is to examine the process of collaborative working between teachers located in separate faith-based schools in Northern Ireland. Drawing on theories of intergroup relations, and with reference to in-depth interviews with teachers in post-primary schools, the article shows that despite earlier research which identified a…

[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.

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers confirm the Multi-Purpose Logistics Module Donatello is safely in place on a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello, is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-13

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers confirm the Multi-Purpose Logistics Module Donatello is safely in place on a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello, is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, the Multi-Purpose Logistics Module Donatello is slowly lowered toward a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-13

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, the Multi-Purpose Logistics Module Donatello is slowly lowered toward a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers help the Multi-Purpose Logistics Module Donatello settle onto a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello, is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-13

KENNEDY SPACE CENTER, FLA. - In the Space Station Processing Facility, workers help the Multi-Purpose Logistics Module Donatello settle onto a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello, is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

Psychopathic Personality Traits Associated with Abnormal Selective Attention and Impaired Cognitive Control

PubMed Central

Sadeh, Naomi; Verona, Edelyn

2008-01-01

The current study investigated how mechanisms of attention that have been well-characterized in the cognitive psychology literature (Lavie, Hirst, De Fockert, & Viding, 2004; Maylor & Lavie, 1998) may be differentially associated with psychopathic traits in non-incarcerated men. Previous research on cognition and psychopathy indicates that primary psychopathic traits are associated with over-focused attention and/or reduced processing of information peripheral to the focus of attention. Conversely, deficits in executive functioning, such as working memory and cognitive control, are implicated in secondary psychopathic traits. Results revealed a significant relationship between traits typically associated with primary psychopathy (e.g., low anxiety, social dominance, fearlessness, callousness) and reduced processing of task-irrelevant distractors, suggesting diminished basic attentional capacity among individuals high on these traits. In contrast, some characteristics linked to secondary psychopathy (e.g., social alienation, cynicism) showed a positive relationship with impaired working memory functioning, indicative of deficits in cognitive control, whereas other traits (i.e., self-centeredness, antagonism) did not. These results suggest that psychopathic traits are differentially related to selective impairments in attentional functioning, which may help explain the observed heterogeneity in psychopathic manifestations. PMID:18763886

Embedding effective depression care: using theory for primary care organisational and systems change.

PubMed

Gunn, Jane M; Palmer, Victoria J; Dowrick, Christopher F; Herrman, Helen E; Griffiths, Frances E; Kokanovic, Renata; Blashki, Grant A; Hegarty, Kelsey L; Johnson, Caroline L; Potiriadis, Maria; May, Carl R

2010-08-06

Depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development. Five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences. Ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depression.

Dynamic Modeling of Process Technologies for Closed-Loop Water Recovery Systems

NASA Technical Reports Server (NTRS)

Allada, Rama Kumar; Lange, Kevin; Anderson, Molly

2011-01-01

Detailed chemical process simulations are a useful tool in designing and optimizing complex systems and architectures for human life support. Dynamic and steady-state models of these systems help contrast the interactions of various operating parameters and hardware designs, which become extremely useful in trade-study analyses. NASA s Exploration Life Support technology development project recently made use of such models to compliment a series of tests on different waste water distillation systems. This paper presents dynamic simulations of chemical process for primary processor technologies including: the Cascade Distillation System (CDS), the Vapor Compression Distillation (VCD) system, the Wiped-Film Rotating Disk (WFRD), and post-distillation water polishing processes such as the Volatiles Removal Assembly (VRA) that were developed using the Aspen Custom Modeler and Aspen Plus process simulation tools. The results expand upon previous work for water recovery technology models and emphasize dynamic process modeling and results. The paper discusses system design, modeling details, and model results for each technology and presents some comparisons between the model results and available test data. Following these initial comparisons, some general conclusions and forward work are discussed.

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

PubMed Central

Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

2016-01-01

Background: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. Methods: The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Results: Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Conclusion: Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and inside the clinic for prevention and management of disease. A toolkit of proactive and holistic opportunities for interventions is proposed. PMID:27928502

Tau and Amyloid-β Cerebrospinal Fluid Biomarkers have Differential Relationships with Cognition in Mild Cognitive Impairment.

PubMed

Malpas, Charles B; Saling, Michael M; Velakoulis, Dennis; Desmond, Patricia; O'Brien, Terence J

2015-01-01

Alzheimer's disease (AD) is characterized by two primary pathologies: tau-related neurofibrillary tangles and the extracellular accumulation of amyloid-β (Aβ). The development of these pathologies is topologically distinct early in the disease, with Aβ beginning to accumulate as a diffuse, neocortical pathology, while tau-related pathology begins to form in mesial temporal regions. This study investigated the hypothesis that, by virtue of this distinction, there exist preferential associations between the primary pathologies and aspects of the cognitive phenotype. We investigated the relationship between cerebrospinal fluid (CSF) biomarkers for tau and Aβ pathologies with neurocognitive measures in 191 patients with mild cognitive impairment (MCI). Participants completed cognitive tests of new learning, information processing speed, and working memory. Separate regression models were computed and then followed up with mediation analyses to examine the predictive status of CSF biomarkers. The effect of Aβ on learning was mediated by phospho-tau (p = 0.008). In contrast, Aβ had a direct effect on information processing speed that was not mediated by phospho-tau (p = 0.59). No predictors were significant for working memory. This study provided evidence for a differential relationship of Aβ and phospho-tau pathologies on the neurocognitive phenotype of MCI. This supports the proposition that these primary AD pathologies maximally affect different aspects of cognition, and has potential implications for cognitive assessments and the use of biomarkers in disease-modifyingtherapeutic trials.

The effects of the therapist's disengaged feelings on the in-session process in psychodynamic psychotherapy.

PubMed

Ulberg, Randi; Amlo, Svein; Hersoug, Anne Grete; Dahl, Hanne-Sofie Johnsen; Høglend, Per

2014-05-01

The primary aim of this article was to explore the effects of the therapist's disengaged feelings (i.e., bored, tired of, sleepy, indifferent, aloof) in psychodynamic therapy. The Transference Work Scale was used in combination with the Defense Mechanism Rating Scales and Structural Analyses of Social Behavior to explore the in-session process in 2 therapies with female patients with interpersonal problems. Analyses showed differences in in-session processes (i.e., defense mechanisms; transference work; degree of affiliation and interdependence in the dialogue) and treatment outcome between therapies characterized by a low versus a higher degree of disengaged feelings. Compared to the case with the engaged therapist, the disengaged therapist showed poorer interaction and less response to transference and defense interpretation. When aware of their disengaged feelings, therapists are advised to encourage their patients to discuss the patient-therapist interaction. © 2014 Wiley Periodicals, Inc.

Pharmacology of Vagal Afferent Influences on Disordered Breathing During Sleep

PubMed Central

Carley, David W; Radulovacki, Miodrag

2008-01-01

Sleep related breathing disorders (SRBD) are a significant public health concern, with a prevalence in the US general population of ∼2% of women and ∼4% of men. Although significant strides have been made in our understanding of these disorders with respect to epidemiology, risk factors, pathogenesis and consequences, work to understand these factors in terms of the underlying cellular, molecular and neuromodulatory processes remains in its infancy. Current primary treatments are surgical or mechanical, with no drug treatments available. Basic investigations into the neurochemistry and neuropharmacology of sleep-related changes in respiratory pattern generation and modulation will be essential to clarify the pathogenic processes underlying SRBD and to identify rational and specific pharmacotherapeutic opportunities. Here we summarize emerging work suggesting the importance of vagal afferent feedback systems in sleep related respiratory pattern disturbances and pointing toward a rich but complex array of neurochemical and neuromodulatory processes that may be involved. PMID:18694851

Utilizing Lean Six Sigma Methodology to Improve the Authored Works Command Approval Process at Naval Medical Center San Diego.

PubMed

Valdez, Michelle M; Liwanag, Maureen; Mount, Charles; Rodriguez, Rechell; Avalos-Reyes, Elisea; Smith, Andrew; Collette, David; Starsiak, Michael; Green, Richard

2018-03-14

Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project. Two major outcome metrics were identified: (1) the number of authored works submissions containing all required signatures and (2) customer satisfaction with the authored works process. Primary metric baseline data were gathered utilizing a Clinical Investigations database tracking publications and presentations. Secondary metric baseline data were collected via a customer satisfaction survey to GME faculty and residents. The project team analyzed pre-survey data and utilized LSS tools and methodology including a "gemba" (environment) walk, cause and effect diagram, critical to quality tree, voice of the customer, "muda" (waste) chart, and a pre- and post-event value stream map. The team selected an electronic submission system as the intervention most likely to positively impact the RIE project outcome measures. The number of authored works compliant with all required signatures improved from 52% to 100%. Customer satisfaction rated as "completely or mostly satisfied" improved from 24% to 97%. For both outcomes, signature compliance and customer satisfaction, statistical significance was achieved with a p < 0.0001. This RIE project utilized LSS methodology and tools to improve signature compliance and increase customer satisfaction with the authored works approval process, leading to 100% signature compliance, a comprehensive longitudinal repository of all authored work requests, and a 97% "completely or mostly satisfied" customer rating of the process.

Effect of Thermomechanical Processing on the Microstructure, Properties, and Work Behavior of a Ti50.5 Ni29.5 Pt20 High-Temperature Shape Memory Alloy

NASA Technical Reports Server (NTRS)

Noebe, Ronald; Draper, Susan; Gaydosh, Darrell; Garga, Anita; Lerch, Brad; Penney, Nicholas; Begelow, Glen; Padula, Santo, II; Brown, Jeff

2006-01-01

TiNiPt shape memory alloys are particularly promising for use as solid state actuators in environments up to 300 C, due to a reasonable balance of properties, including acceptable work output. However, one of the challenges to commercializing a viable high-temperature shape memory alloy (HTSMA) is to establish the appropriate primary and secondary processing techniques for fabrication of the material in a required product form such as rod and wire. Consequently, a Ti(50.5)Ni(29.5)Pt20 alloy was processed using several techniques including single-pass high-temperature extrusion, multiple-pass high-temperature extrusion, and cold drawing to produce bar stock, thin rod, and fine wire, respectively. The effects of heat treatment on the hardness, grain size, room temperature tensile properties, and transformation temperatures of hot- and cold-worked material were examined. Basic tensile properties as a function of temperature and the strain-temperature response of the alloy under constant load, for the determination of work output, were also investigated for various forms of the Ti(50.5)Ni(29.5)Pt20 alloy, including fine wire.

[Verbal communication disorders and language disorders in cortical dementias (I). The current state of the art in research].

PubMed

Benedet, M J

This is the first part of a research work into primary and secondary language disorders (LD) in the stages of minimum to mild pathological deterioration in the degenerative process of cortical dementias. AIMS. In this first part, in the light of recent models of symbolic computation of language processing, we review the most significant publications on the subject matter. We begin with an introduction to the historical development of the approaches used to deal with the subject. Following that, we briefly describe the components of the language processing system (LPS) in the light of symbolic computation models. We then analyse the publications dealing with those models. Our aim was to determine whether the LD reported in those publications are the result of a primary involvement of any of the LPS components, or whether they are only the result of disorders affecting other components of the cognitive system. In this case, the supposed LD would be secondary and thus a communication, but not language, disorder. Despite the important variations from one individual to another that have been systematically observed by different authors, it seems that only LD belonging to so called primary progressive aphasia are actually cases of this disorder. In all the other dementias in the above mentioned stages of the development process these disorders are secondary to the involvement of other subsystems of the LPS.

Conceptualizing and Measuring Working Memory and its Relationship to Aphasia

PubMed Central

Wright, Heather Harris; Fergadiotis, Gerasimos

2011-01-01

Background General agreement exists in the literature that individuals with aphasia can exhibit a working memory deficit that contributes to their language processing impairments. Though conceptualized within different working memory frameworks, researchers have suggested that individuals with aphasia have limited working memory capacity, impaired attention-control processes as well as impaired inhibitory mechanisms. However, across studies investigating working memory ability in individuals with aphasia, different measures have been used to quantify their working memory ability and identify the relationship between working memory and language performance. Aims The primary objectives of this article are to (1) review current working memory theoretical frameworks, (2) review tasks used to measure working memory, and (3) discuss findings from studies that have investigated working memory as they relate to language processing in aphasia. Main Contribution Though findings have been consistent across studies investigating working memory ability in individuals with aphasia, discussion of how working memory is conceptualized and defined is often missing, as is discussion of results within a theoretical framework. This is critical, as working memory is conceptualized differently across the different theoretical frameworks. They differ in explaining what limits capacity and the source of individual differences as well as how information is encoded, maintained, and retrieved. When test methods are considered within a theoretical framework, specific hypotheses can be tested and stronger conclusions that are less susceptible to different interpretations can be made. Conclusions Working memory ability has been investigated in numerous studies with individuals with aphasia. To better understand the underlying cognitive constructs that contribute to the language deficits exhibited by individuals with aphasia, future investigations should operationally define the cognitive constructs of interest and discuss findings within theoretical frameworks. PMID:22639480

The Surgical Nosology In Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care

PubMed Central

Gruen, Russell L; Knox, Stephanie; Britt, Helena; Bailie, Ross S

2004-01-01

Background The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties. Methods A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice. Results A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists. Conclusion Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging classification system in the public domain, we invite comment and application in other settings where similar problems might be faced. PMID:15142280

Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors: a mixed-methods study.

PubMed

Doekhie, Kirti D; Buljac-Samardzic, Martina; Strating, Mathilde M H; Paauwe, Jaap

2017-12-28

Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals' perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions? We conducted a mixed-methods study in the Dutch primary care setting. First, a survey study of 152 professionals representing 12 primary care disciplines was conducted, focusing on their perceptions of which disciplines are part of the team and the degree of relational coordination between professionals from different disciplinary backgrounds. Subsequently, we conducted semi-structured interviews with 32 professionals representing 5 primary care disciplines to gain a deeper understanding of the underlying factors influencing their perceptions and the (mis)alignment between these perceptions. Misalignments were found between perceptions regarding which disciplines are members of the team and the relational coordination between disciplines. For example, general practitioners were viewed as part of the team by helping assistants, (district) nurses, occupational therapists and geriatric specialized practice nurses, whereas the general practitioners themselves only considered geriatric specialized practice nurses to be part of their team. Professionals perceive multidisciplinary primary care teams as having multiple inner and outer layers. Three factors influence their perception of being part of a team and acting accordingly: a) knowing the people you work with, b) the necessity for knowledge exchange and c) sharing a holistic view of caregiving. Research and practice should take into account the misalignment between primary care professionals' perceptions of primary care teams, as our study notes variations in the conceptualization of primary care teams. To enhance teamwork between professionals from different disciplinary backgrounds, professionals acknowledge the importance of three underlying conditions: team familiarity, regular and structured knowledge exchange between all professionals involved in the care process and realizing and believing in the added value for patients of working as a team.

Health Information System in Primary Health Care: The Challenges and Barriers from Local Providers’ Perspective of an Area in Iran

PubMed Central

Yazdi-Feyzabadi, Vahid; Emami, Mozhgan; Mehrolhassani, Mohammad Hossein

2015-01-01

Background: Health information system (HIS) has been utilized for collecting, processing, storing, and transferring the required information for planning and decision-making at different levels of health sector to provide quality services. In this study, in order to provide high-quality HIS, primary health care (PHC) providers’ perspective on current challenges and barriers were investigated. Methods: This study was carried out with a qualitative approach using semi-structured audiotaped focus group discussions (FGDs). One FGD was conducted with 13 Behvarz and health technicians as front-line workers and the other with 16 personnel including physicians, statisticians, and health professionals working in health centers of the PHC network in KUMS. The discussions were transcribed and then analyzed using the framework analysis method. Results: The identified organizational challenges were categorized into two groups: HIS structure and the current model of PHC in urban areas. Furthermore, the structural challenges were classified into HIS management structure (information systems resources, including human, supplies, and organizational rules) and information process. Conclusions: The HIS works effectively and efficiently when there are a consistency and integrity between the human, supplies, and process aspects. Hence, multifaceted interventions including strengthening the organizational culture to use the information in decisions, eliminating infrastructural obstacles, appointing qualified staff and more investment for service delivery at urban areas are the most fundamental requirements of high-quality HIS in PHC. PMID:26236444

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.

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

[Study of the work and of working in Family Health Care Support Center].

PubMed

Lancman, Selma; Gonçalves, Rita Maria de Abreu; Cordone, Nicole Guimarães; Barros, Juliana de Oliveira

2013-10-01

To understand the organization of and the working conditions in family health care support centers, as well as subjective experiences related to work in two of these centers. This was a case study carried out during 2011 and 2012 in two family health care support centers in Sao Paulo, Southeastern Brazil. Data were collected and analyzed using two theoretical-methodological references from ergonomics and work psychodynamics influenced, respectively, by ergonomic work analysis, developed based on open observations of a variety of tasks and on interviews and in practice in work psychodynamics, carried out using think tanks about the work. The work of the Family Health Care Support Centers in question is constituted on the bases of complex, diversified actions to be shared among the various professionals and teams involved. Innovative technological tools, which are not often adopted by primary health care professionals, are used and the parameters and productivity measures do not encompass the specificity and the complexity of the work performed. These situations require constant organizational rearrangement, especially between the Family Health Care Support Centers and the Family Health Care Teams, causing difficulties in carrying out the work as well as in constituting the identity of the professionals studied. The study attempts to lend greater visibility to the work processes at the Family Health Care Support Centers in order to contribute to advances in public policy on primary healthcare. It is important to stress that introducing changes at work, which affect both its organization and work conditions, is above all a commitment, which to be effective, must be permanent and must involve the different levels of hierarchy.

Stress corrosion crack initiation of alloy 600 in PWR primary water

DOE PAGES

Zhai, Ziqing; Toloczko, Mychailo B.; Olszta, Matthew J.; ...

2017-04-27

Stress corrosion crack (SCC) initiation of three mill-annealed alloy 600 heats in simulated pressurized water reactor primary water has been investigated using constant load tests equipped with in-situ direct current potential drop (DCPD) measurement capabilities. SCC initiation times were greatly reduced by a small amount of cold work. Shallow intergranular attack and/or cracks were found on most high-energy grain boundaries intersecting the surface with only a small fraction evolving into larger cracks and intergranular SCC growth. Crack depth profiles were measured and related to DCPD-detected initiation response. Lastly, we discuss processes controlling the SCC initiation in mill-annealed alloy 600.

From empower to Green Dot : successful strategies and lessons learned in developing comprehensive sexual violence primary prevention programming.

PubMed

Cook-Craig, Patricia G; Millspaugh, Phyllis H; Recktenwald, Eileen A; Kelly, Natalie C; Hegge, Lea M; Coker, Ann L; Pletcher, Tisha S

2014-10-01

This case study describes Kentucky's partnership with the Centers for Disease Control and Prevention (CDC) EMPOWER (Enhancing and Making Programs Work to End Rape) program to enhance the mission and services of existing rape crisis centers to include comprehensive primary prevention programming to reduce rates of sexual violence perpetration. The planning process and the successful implementation of a statewide, 5-year, randomized control trial study of a bystander prevention program (Green Dot), and its evaluation are described. Lessons learned in generating new questions, seeking funding, building relationships and capacity, and disseminating knowledge are presented. © The Author(s) 2014.

Stress corrosion crack initiation of alloy 600 in PWR primary water

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

Zhai, Ziqing; Toloczko, Mychailo B.; Olszta, Matthew J.

Stress corrosion crack (SCC) initiation of three mill-annealed alloy 600 heats in simulated pressurized water reactor primary water has been investigated using constant load tests equipped with in-situ direct current potential drop (DCPD) measurement capabilities. SCC initiation times were greatly reduced by a small amount of cold work. Shallow intergranular attack and/or cracks were found on most high-energy grain boundaries intersecting the surface with only a small fraction evolving into larger cracks and intergranular SCC growth. Crack depth profiles were measured and related to DCPD-detected initiation response. Lastly, we discuss processes controlling the SCC initiation in mill-annealed alloy 600.

Advanced engineering environment pilot project.

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

Schwegel, Jill; Pomplun, Alan R.; Abernathy, Rusty

2006-10-01

The Advanced Engineering Environment (AEE) is a concurrent engineering concept that enables real-time process tooling design and analysis, collaborative process flow development, automated document creation, and full process traceability throughout a product's life cycle. The AEE will enable NNSA's Design and Production Agencies to collaborate through a singular integrated process. Sandia National Laboratories and Parametric Technology Corporation (PTC) are working together on a prototype AEE pilot project to evaluate PTC's product collaboration tools relative to the needs of the NWC. The primary deliverable for the project is a set of validated criteria for defining a complete commercial off-the-shelf (COTS) solutionmore » to deploy the AEE across the NWC.« less

Cognitive Function, Coping, and Depressive Symptoms in Children and Adolescents with Sickle Cell Disease.

PubMed

Prussien, Kemar V; DeBaun, Michael R; Yarboi, Janet; Bemis, Heather; McNally, Colleen; Williams, Ellen; Compas, Bruce E

2018-06-01

The objective of this study was to investigate the association between cognitive functioning, coping, and depressive symptoms in children and adolescents with sickle cell disease (SCD). Forty-four children (M age = 9.30, SD = 3.08; 56.8% male) with SCD completed cognitive assessments measuring working memory (Wechsler Intelligence Scale for Children-Fourth Edition) and verbal comprehension (Wechsler Abbreviated Scale of Intelligence-Second Edition). Participants' primary caregivers completed questionnaires assessing their child's coping and depressive symptoms. Verbal comprehension was significantly positively associated with secondary control coping (cognitive reappraisal, acceptance, distraction), and both working memory and secondary control coping were negatively associated with depressive symptoms. In partial support of the primary study hypothesis, verbal comprehension had an indirect association with depressive symptoms through secondary control coping, whereas working memory had a direct association with depressive symptoms. The results provide new evidence for the associations between cognitive function and coping, and the association of both of these processes with depressive symptoms in children with SCD. Findings provide potential implications for clinical practice, including interventions to improve children's cognitive functioning to attenuate depressive symptoms.

Applying process mapping and analysis as a quality improvement strategy to increase the adoption of fruit, vegetable, and water breaks in Australian primary schools.

PubMed

Biggs, Janice S; Farrell, Louise; Lawrence, Glenda; Johnson, Julie K

2014-03-01

Over the past decade, public health policy in Australia has prioritized the prevention and control of obesity and invested in programs that promote healthy eating-related behaviors, which includes increasing fruit and vegetable consumption in children. This article reports on a study that used process mapping and analysis as a quality improvement strategy to improve the delivery of a nutrition primary prevention program delivered in primary schools in New South Wales, Australia. Crunch&Sip® has been delivered since 2008. To date, adoption is low with only 25% of schools implementing the program. We investigated the cause of low adoption and propose actions to increase school participation. We conducted semistructured interviews with key stakeholders and analyzed the process of delivering Crunch&Sip to schools. Interviews and process mapping and analysis identified a number of barriers to schools adopting the program. The analyses identified the need to simplify and streamline the process of delivering the program to schools and introduce monitoring and feedback loops to track ongoing participation. The combination of stakeholder interviews and process mapping and analysis provided important practical solutions to improving program delivery and also contributed to building an understanding of factors that help and hinder program adoption. The insight provided by this analysis helped identify usable routine measures of adoption, which were an improvement over those used in the existing program plan. This study contributed toward improving the quality and efficiency of delivering a health promoting program to work toward achieving healthy eating behaviors in children.

Path Analysis of Work Family Conflict, Job Salary and Promotion Satisfaction, Work Engagement to Subjective Well-Being of the Primary and Middle School Principals

ERIC Educational Resources Information Center

Hu, Chun-mei; Cui, Shu-jing; Wang, Lei

2016-01-01

Objective: To investigate the path analysis of work family conflict, job salary and promotion satisfaction, work engagement to subjective well-being of the primary and middle school principals, and provide advice for enhancing their well-being. Methods: Using convenient sampling, totally 300 primary and middle school principals completed the WFC,…

Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women.

PubMed

Lilliehorn, Sara; Hamberg, Katarina; Kero, Anneli; Salander, Pär

2013-06-01

An increasing number of women survive breast cancer and a majority return to work. However, findings based on mean values may conceal individual processes that need to be better understood to discuss meaningful rehabilitation. The purpose of this study is to describe the sick-leave pattern of a group of Swedish women with primary breast cancer but foremost to explore their ideas about what motivates and discourages their return to work. Fifty-six women were repeatedly interviewed over a period of 18-24 months. Interview sections that clearly illustrated the women's experiences and ideas about work were categorized using the comparative similarities-differences technique. The average length of sick leave was 410 days (range 0-942). Six months after the first day of sick leave, 29% worked at least their previous service grade. At 12 months, 55% and at 18 months 57% did so. Those treated with chemotherapy had in average more than twice as large sick leave as those who did not. Three categories emerged. 'Motives for not returning to work' consists of four subcategories: 'I'm still too fragile to return to work'; 'My workplace is a discouraging place'; 'I took an opportunity to pause' and 'I've lost the taste for work'. 'Motives for returning' consists of two sub-categories: 'Work generates and structures my everyday life' and 'I miss my workplace'. Finally, 'Transition in work approach' reflects a changed approach to work. The meaning of work varies over time, but first and foremost work was regarded as an important part of the healing process as it restores the disruption of everyday life. Guidelines cannot be reduced to a linear relationship with biomedical variables but the individual context of everyday life must be considered. © 2012 Nordic College of Caring Science.

The role of the cilium in hereditary tumor predisposition syndromes

PubMed Central

Klasson, Timothy D.; Giles, Rachel H.

2014-01-01

The primary cilium is a highly conserved cell organelle that is closely connected to processes involved in cell patterning and replication. Amongst their many functions, cilia act as “signal towers” through which cell-cell signaling cascades pass. Dysfunction of cilia or the myriad processes that are connected with cilium function can lead to disease. Due to the sheer number of cellular processes that at some point involve the primary cilium, the effects of misregulation are highly heterogeneous between different cell populations. However, because of the importance of primary cilia in the development, growth, patterning and orientation of cells and tissues, a common thread has emerged in which defective cilia can lead to disorganization, which can contribute to the growth of neoplasms, including cancer and pre-cancerous phenotypes. Because cilia are so vital for signaling during cell replication and the cell fate decisions that are important in childhood growth, symptoms often arise early in life. Here we review recent work connecting misregulation of the primary cilium with tumor formation in a variety of tissues in the developing body, with a particular focus on the syndromes in which classic tumor genes are mutated, including von Hippel-Lindau disease (OMIM 193300), adenomatous polyposis coli (OMIM 175100), tuberous sclerosis (OMIM 191100) and Birt-Hogg-Dubé syndrome (OMIM 135150). Timely diagnosis of these syndromes is essential for entry into appropriate screening protocols, which have been shown to effectively prolong life expectancy in these cohorts of patients. PMID:27625869

Excessive workload, uncertain career opportunities and lack of funding are important barriers to recruiting and retaining primary care medical researchers: a qualitative interview study.

PubMed

Thomsen, Janus Laust; Jarbøl, Dorthe; Søndergaard, Jens

2006-10-01

Research activity in primary care has been steadily increasing, but is still insufficient and more researchers are needed. Many initiatives have been launched to recruit and retain primary care researchers, but only little is known about barriers and facilitators to a research career in primary care. To examine barriers and facilitators to recruiting and retaining primary care medical researchers. Semi-structured interviews with 33 primary care medical researchers, all medical doctors. We used a phenomenological approach to analysing the interviews. Important barriers to pursuing a research career in primary care were heavy workload, isolation at work, short-term funding and low salary. Important facilitators to attracting and retaining primary care researchers were the desire and opportunity to improve primary care, the flexible working conditions, the career opportunities, including the possibility of combining university-based research with clinical work and a friendly and competent research environment. Better strategies for recruiting and retaining researchers are a prerequisite for the development of primary care, and in future the main emphasis should be on working conditions, networking and mentoring. Studies including those primary care physicians who have chosen not to do research are highly needed.

Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory.

PubMed

Bamford, Claire; Poole, Marie; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Iliffe, Steve; Manthorpe, Jill; Robinson, Louise

2014-11-08

Case management has been suggested as a way of improving the quality and cost-effectiveness of support for people with dementia. In this study we adapted and implemented a successful United States' model of case management in primary care in England. The results are reported elsewhere, but a key finding was that little case management took place. This paper reports the findings of the process evaluation which used Normalization Process Theory to understand the barriers to implementation. Ethnographic methods were used to explore the views and experiences of case management. Interviews with 49 stakeholders (patients, carers, case managers, health and social care professionals) were supplemented with observation of case managers during meetings and initial assessments with patients. Transcripts and field notes were analysed initially using the constant comparative approach and emerging themes were then mapped onto the framework of Normalization Process Theory. The primary focus during implementation was on the case managers as isolated individuals, with little attention being paid to the social or organizational context within which they worked. Barriers relating to each of the four main constructs of Normalization Process Theory were identified, with a lack of clarity over the scope and boundaries of the intervention (coherence); variable investment in the intervention (cognitive participation); a lack of resources, skills and training to deliver case management (collective action); and limited reflection and feedback on the case manager role (reflexive monitoring). Despite the intuitive appeal of case management to all stakeholders, there were multiple barriers to implementation in primary care in England including: difficulties in embedding case managers within existing well-established community networks; the challenges of protecting time for case management; and case managers' inability to identify, and act on, emerging patient and carer needs (an essential, but previously unrecognised, training need). In the light of these barriers it is unclear whether primary care is the most appropriate setting for case management in England. The process evaluation highlights key aspects of implementation and training to be addressed in future studies of case management for dementia.

The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

PubMed

Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

2018-05-01

Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

The undergraduate research fellows program: a unique model to promote engagement in research.

PubMed

Vessey, Judith A; DeMarco, Rosanna F

2008-01-01

Well-educated nurses with research expertise are needed to advance evidence-based nursing practice. A primary goal of undergraduate nursing curricula is to create meaningful participatory experiences to help students develop a research skill set that articulates with rapid career advancement of gifted, young graduates interested in nursing research and faculty careers. Three research enrichment models-undergraduate honors programs, research assistant work-for-hire programs, and research work/mentorship programs-to be in conjunction with standard research content are reviewed. The development and implementation of one research work/mentorship program, the Boston College undergraduate research fellows program (UGRF), is explicated. This process included surveying previous UGRFs followed by creating a retreat and seminars to address specific research skill sets. The research skill sets included (a) how to develop a research team, (b) accurate data retrieval, (c) ethical considerations, (d) the research process, (e) data management, (f) successful writing of abstracts, and (g) creating effective poster presentations. Outcomes include evidence of involvement in research productivity and valuing of evidenced-based practice through the UGRF mentorship process with faculty partners.

Toxic hepatitis in occupational exposure to solvents

PubMed Central

Malaguarnera, Giulia; Cataudella, Emanuela; Giordano, Maria; Nunnari, Giuseppe; Chisari, Giuseppe; Malaguarnera, Mariano

2012-01-01

The liver is the main organ responsible for the metabolism of drugs and toxic chemicals, and so is the primary target organ for many organic solvents. Work activities with hepatotoxins exposures are numerous and, moreover, organic solvents are used in various industrial processes. Organic solvents used in different industrial processes may be associated with hepatotoxicity. Several factors contribute to liver toxicity; among these are: species differences, nutritional condition, genetic factors, interaction with medications in use, alcohol abuse and interaction, and age. This review addresses the mechanisms of hepatotoxicity. The main pathogenic mechanisms responsible for functional and organic damage caused by solvents are: inflammation, dysfunction of cytochrome P450, mitochondrial dysfunction and oxidative stress. The health impact of exposure to solvents in the workplace remains an interesting and worrying question for professional health work. PMID:22719183

Chronic kidney disease guideline implementation in primary care: a qualitative report from the TRANSLATE CKD study

PubMed Central

Vest, Bonnie M.; York, Trevor R.M.; Sand, Jessica; Fox, Chester H.; Kahn, Linda S.

2016-01-01

Background Primary care physicians (PCPs) are optimally situated to identify and manage early-stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national mixed-methods cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. Methods As part of mixed-methods process evaluation, semi-structured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the four domains of Normalization Process Theory (NPT). Results Identified themes illuminated the complex work undertaken in primary care practices to manage CKD. Barriers to guideline implementation were identified in each of the four NPT domains, including: 1) lack of knowledge and understanding around CKD (coherence), 2) difficulties engaging providers and patients in CKD management (cognitive participation), 3) limited time and competing demands (collective action), and 4) challenges obtaining and utilizing data to monitor progress (reflexive monitoring). Conclusions Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. PMID:26355134

Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study.

PubMed

Vest, Bonnie M; York, Trevor R M; Sand, Jessica; Fox, Chester H; Kahn, Linda S

2015-01-01

Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT). Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring). Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. © Copyright 2015 by the American Board of Family Medicine.

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.

Judgements about fellow professionals and the management of patients receiving palliative care in primary care: a qualitative study.

PubMed

Walshe, Catherine; Todd, Chris; Caress, Ann-Louise; Chew-Graham, Carolyn

2008-04-01

Policies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services. To explore the influences on referrals within general and specialist community palliative care services. Qualitative, multiple-case study. Three primary care trusts in the north-west of England. Multiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals. Judgements -- positive and negative -- about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional "game playing" to achieve professionals' desired outcomes. Palliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care.

International Space Station Payload Training Overview

NASA Technical Reports Server (NTRS)

Underwood, Deborah B.; Noneman, Steven R.; Sanchez, Julie N.

2001-01-01

This paper describes payload crew training-related activities performed by NASA and the U.S. Payload Developer (PD) community for the International Space Station (ISS) Program. It describes how payloads will be trained and the overall training planning and integration process. The overall concept, definition, and template for payload training are described. The roles and responsibilities of individuals, organizations, and groups involved are discussed. The facilities utilized during payload training and the primary processes and activities performed to plan, develop, implement, and administer payload training for ISS crews are briefly described. Areas of improvement to crew training processes that have been achieved or are currently being worked are identified.

The Simplest Chronoscope V: A Theory of Dual Primary and Secondary Reaction Time Systems.

PubMed

Montare, Alberto

2016-12-01

Extending work by Montare, visual simple reaction time, choice reaction time, discriminative reaction time, and overall reaction time scores obtained from college students by the simplest chronoscope (a falling meterstick) method were significantly faster as well as significantly less variable than scores of the same individuals from electromechanical reaction timers (machine method). Results supported the existence of dual reaction time systems: an ancient primary reaction time system theoretically activating the V5 parietal area of the dorsal visual stream that evolved to process significantly faster sensory-motor reactions to sudden stimulations arising from environmental objects in motion, and a secondary reaction time system theoretically activating the V4 temporal area of the ventral visual stream that subsequently evolved to process significantly slower sensory-perceptual-motor reactions to sudden stimulations arising from motionless colored objects. © The Author(s) 2016.

The application of dual-electrode through vial impedance spectroscopy for the determination of ice interface temperatures, primary drying rate and vial heat transfer coefficient in lyophilization process development.

PubMed

Smith, Geoff; Jeeraruangrattana, Yowwares; Ermolina, Irina

2018-06-22

Through vial impedance spectroscopy (TVIS) is a product non-invasive process analytical technology which exploits the frequency dependence of the complex impedance spectrum of a composite object (i.e. the freeze-drying vial and its contents) in order to track the progression of the freeze-drying cycle. This work demonstrates the use of a dual electrode system, attached to the external surface of a type I glass tubing vial (nominal capacity 10 mL) in the prediction of (i) the ice interface temperatures at the sublimation front and at the base of the vial, and (ii) the primary drying rate. A value for the heat transfer coefficient (for a chamber pressure of 270 µbar) was then calculated from these parameters and shown to be comparable to that published by Tchessalov[1]. Copyright © 2018. Published by Elsevier B.V.

Development of children's identity and position processing for letter, digit, and symbol strings: A cross-sectional study of the primary school years.

PubMed

Schubert, Teresa; Badcock, Nicholas; Kohnen, Saskia

2017-10-01

Letter recognition and digit recognition are critical skills for literate adults, yet few studies have considered the development of these skills in children. We conducted a nine-alternative forced-choice (9AFC) partial report task with strings of letters and digits, with typographical symbols (e.g., $, @) as a control, to investigate the development of identity and position processing in children. This task allows for the delineation of identity processing (as overall accuracy) and position coding (as the proportion of position errors). Our participants were students in Grade 1 to Grade 6, allowing us to track the development of these abilities across the primary school years. Our data suggest that although digit processing and letter processing end up with many similarities in adult readers, the developmental trajectories for identity and position processing for the two character types differ. Symbol processing showed little developmental change in terms of identity or position accuracy. We discuss the implications of our results for theories of identity and position coding: modified receptive field, multiple-route model, and lexical tuning. Despite moderate success for some theories, considerable theoretical work is required to explain the developmental trajectories of letter processing and digit processing, which might not be as closely tied in child readers as they are in adult readers. Copyright © 2017 Elsevier Inc. All rights reserved.

Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study.

PubMed

Lionis, Christos; Papadakaki, Maria; Saridaki, Aristoula; Dowrick, Christopher; O'Donnell, Catherine A; Mair, Frances S; van den Muijsenbergh, Maria; Burns, Nicola; de Brún, Tomas; O'Reilly de Brún, Mary; van Weel-Baumgarten, Evelyn; Spiegel, Wolfgang; MacFarlane, Anne

2016-07-22

Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings. As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands. A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners). We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs. The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project. This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

"At Risk of Harm"? An Exploratory Survey of School Counsellors in the UK, Their Perceptions of Confidentiality, Information Sharing and Risk Management

ERIC Educational Resources Information Center

Jenkins, Peter; Palmer, Joanne

2012-01-01

The primary objective of this study was to explore perceptions of UK school counsellors of confidentiality and information sharing in therapeutic work with children and young people, using qualitative methods. The research design employed a two-stage process, using questionnaires and follow-up interviews, with a small, non-random sample of school…

"Teacher, Will You Marry Me?" Integrating Teachers' Stories and Self-Reflective Texts for Exploring Sexuality Discourses in School Settings

ERIC Educational Resources Information Center

Gerouki, Margarita

2011-01-01

This work is based on data collected for a research project aiming to critically investigate issues of primary school sex and relationships education. Teachers are important stakeholders of any educational process, especially when the focus is on sensitive and controversial issues such as the provision of sex education. The aim here is to present…

Cross Curriculum: Awakening and Building Prior Knowledge with Primary Sources: See, Think, Wonder

ERIC Educational Resources Information Center

Fontichiaro, Kristin

2010-01-01

The basics of this lesson can be used with students at different levels, helping them to identify what they already know and to build interest in and curiosity for the inquiry work to come. It also guides them to develop questions about things they are curious about and want to know before they begin the research process. In this activity, the…

The Role of Executive Function in Arithmetic Problem-Solving Processes: A Study of Third Graders

ERIC Educational Resources Information Center

Viterbori, Paola; Traverso, Laura; Usai, M. Carmen

2017-01-01

This study investigated the roles of different executive function (EF) components (inhibition, shifting, and working memory) in 2-step arithmetic word problem solving. A sample of 139 children aged 8 years old and regularly attending the 3rd grade of primary school were tested on 6 EF tasks measuring different EF components, a reading task and a…

Defense AT&L (Volume 35, Number 6, November-December 2006)

DTIC Science & Technology

2006-12-01

our view of reality is inherently unstable. That is, when we realize our current cultural preferences, frame- works, mental models , doctrines...manufacturing rules and procedures (con- trols). IDEF0 function modeling has since been adopted for other applications such as business process... negotiating busy intersections, and avoiding obstacles. The DARPA Grand Challenge Web site <http://www.darpa.mil/grandchallenge>is the primary resource for

Selective Attention is a Primary Determinant of the Relationship between Working Memory and General Learning Ability in Outbred Mice

ERIC Educational Resources Information Center

Kolata, Stefan; Light, Kenneth; Grossman, Henya C.; Hale, Gregory; Matzel, Louis D.

2007-01-01

A single factor (i.e., general intelligence) can account for much of an individuals' performance across a wide variety of cognitive tests. However, despite this factor's robustness, the underlying process is still a matter of debate. To address this question, we developed a novel battery of learning tasks to assess the general learning abilities…

Health benefits of primary care social work for adults with complex health and social needs: a systematic review.

PubMed

McGregor, Jules; Mercer, Stewart W; Harris, Fiona M

2018-01-01

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self-management of long-term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care. © 2016 John Wiley & Sons Ltd.

[Effects of mental workload on work ability in primary and secondary school teachers].

PubMed

Xiao, Yuanmei; Li, Weijuan; Ren, Qingfeng; Ren, Xiaohui; Wang, Zhiming; Wang, Mianzhen; Lan, Yajia

2015-02-01

To investigate the change pattern of primary and secondary school teachers' work ability with the changes in their mental workload. A total of 901 primary and secondary school teachers were selected by random cluster sampling, and then their mental workload and work ability were assessed by National Aeronautics and Space Administration-Task Load Index (NASA-TLX) and Work Ability Index (WAI) questionnaires, whose reliability and validity had been tested. The effects of their mental workload on the work ability were analyzed. Primary and secondary school teachers' work ability reached the highest level at a certain level of mental workload (55.73< mental workload ≤ 64.10). When their mental workload was lower than the level, their work ability had a positive correlation with the mental workload. Their work ability increased or maintained stable with the increasing mental workload. Moreover, the percentage of teachers with good work ability increased, while that of teachers with moderate work ability decreased. But when their mental workload was higher than the level, their work ability had a negative correlation with the mental workload. Their work ability significantly decreased with the increasing mental workload (P < 0.01). Furthermore, the percentage of teachers with good work ability decreased, while that of teachers with moderate work ability increased (P < 0.001). Too high or low mental workload will result in the decline of primary and secondary school teachers' work ability. Moderate mental workload (55.73∼64.10) will benefit the maintaining and stabilization of their work ability.

Accelerating quality improvement within your organization: Applying the Model for Improvement.

PubMed

Crowl, Ashley; Sharma, Anita; Sorge, Lindsay; Sorensen, Todd

2015-01-01

To discuss the fundamentals of the Model for Improvement and how the model can be applied to quality improvement activities associated with medication use, including understanding the three essential questions that guide quality improvement, applying a process for actively testing change within an organization, and measuring the success of these changes on care delivery. PubMed from 1990 through April 2014 using the search terms quality improvement, process improvement, hospitals, and primary care. At the authors' discretion, studies were selected based on their relevance in demonstrating the quality improvement process and tests of change within an organization. Organizations are continuously seeking to enhance quality in patient care services, and much of this work focuses on improving care delivery processes. Yet change in these systems is often slow, which can lead to frustration or apathy among frontline practitioners. Adopting and applying the Model for Improvement as a core strategy for quality improvement efforts can accelerate the process. While the model is frequently well known in hospitals and primary care settings, it is not always familiar to pharmacists. In addition, while some organizations may be familiar with the "plan, do, study, act" (PDSA) cycles-one element of the Model for Improvement-many do not apply it effectively. The goal of the model is to combine a continuous process of small tests of change (PDSA cycles) within an overarching aim with a longitudinal measurement process. This process differs from other forms of improvement work that plan and implement large-scale change over an extended period, followed by months of data collection. In this scenario it may take months or years to determine whether an intervention will have a positive impact. By following the Model for Improvement, frontline practitioners and their organizational leaders quickly identify strategies that make a positive difference and result in a greater degree of success.

Novel Binders and Methods for Agglomeration of Ore

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

S. K. Kawatra; T. C. Eisele; K. A. Lewandowski

2006-12-31

Many metal extraction operations, such as leaching of copper, leaching of precious metals, and reduction of metal oxides to metal in high-temperature furnaces, require agglomeration of ore to ensure that reactive liquids or gases are evenly distributed throughout the ore being processed. Agglomeration of ore into coarse, porous masses achieves this even distribution of fluids by preventing fine particles from migrating and clogging the spaces and channels between the larger ore particles. Binders are critically necessary to produce agglomerates that will not break down during processing. However, for many important metal extraction processes there are no binders known that willmore » work satisfactorily. Primary examples of this are copper heap leaching, where there are no binders that will work in the acidic environment encountered in this process, and advanced ironmaking processes, where binders must function satisfactorily over an extraordinarily large range of temperatures (from room temperature up to over 1200 C). As a result, operators of many facilities see a large loss of process efficiency due to their inability to take advantage of agglomeration. The large quantities of ore that must be handled in metal extraction processes also means that the binder must be inexpensive and useful at low dosages to be economical. The acid-resistant binders and agglomeration procedures developed in this project will also be adapted for use in improving the energy efficiency and performance of a broad range of mineral agglomeration applications, particularly heap leaching and advanced primary ironmaking. This project has identified several acid-resistant binders and agglomeration procedures that can be used for improving the energy efficiency of heap leaching, by preventing the ''ponding'' and ''channeling'' effects that currently cause reduced recovery and extended leaching cycle times. Methods have also been developed for iron ore processing which are intended to improve the performance of pellet binders, and have directly saved energy by increasing filtration rates of the pelletization feed by as much as 23%.« less

Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review.

PubMed

Tsang, Jung Yin; Blakeman, Tom; Hegarty, Janet; Humphreys, John; Harvey, Gill

2016-04-04

Chronic kidney disease (CKD) is common and a significant marker of morbidity and mortality. Its management in primary care is essential for maintenance of cardiovascular health, avoidance of acute kidney injury (AKI) and delay in progression to end-stage renal disease. Although many guidelines and interventions have been established, there is global evidence of an implementation gap, including variable identification rates and low patient communication and awareness. The objective of this study is to understand the factors enabling and constraining the implementation of CKD interventions in primary care. A rapid realist review was conducted that involved a primary literature search of three databases to identify existing CKD interventions in primary care between the years 2000 and 2014. A secondary search was performed as an iterative process and included bibliographic and grey literature searches of reference lists, authors and research groups. A systematic approach to data extraction using Normalisation Process Theory (NPT) illuminated key mechanisms and contextual factors that affected implementation. Our primary search returned 710 articles that were narrowed down to 18 relevant CKD interventions in primary care. Our findings suggested that effective management of resources (encompassing many types) was a significant contextual factor enabling or constraining the functioning of mechanisms. Three key intervention features were identified from the many that contributed to successful implementation. Firstly, it was important to frame CKD interventions appropriately, such as within the context of cardiovascular health and diabetes. This enabled buy-in and facilitated an understanding of the significance of CKD and the need for intervention. Secondly, interventions that were compatible with existing practices or patients' everyday lives were readily accepted. In contrast, new systems that could not be integrated were abandoned as they were viewed as inconvenient, generating more work. Thirdly, ownership of the feedback process allowed users to make individualised improvements to the intervention to suit their needs. Our rapid realist review identified mechanisms that need to be considered in order to optimise the implementation of interventions to improve the management of CKD in primary care. Further research into the factors that enable prolonged sustainability and cost-effectiveness is required for efficient resource utilisation.

Doing Men's Work?: Discipline, Power and the Primary School in Taiwan

ERIC Educational Resources Information Center

Li, Hsiao-jung

2016-01-01

This article examines the masculinization of discipline and its interplay with power in the primary school through an exploration of teachers' gender and disciplinary work and roles by drawing on data from an ethnographic study conducted at a primary school in Taiwan. The research findings suggest that discipline was men's work due to women…

Increasing Working Memory Load Reduces Processing of Cross-Modal Task-Irrelevant Stimuli Even after Controlling for Task Difficulty and Executive Capacity

PubMed Central

Simon, Sharon S.; Tusch, Erich S.; Holcomb, Phillip J.; Daffner, Kirk R.

2016-01-01

The classic account of the load theory (LT) of attention suggests that increasing cognitive load leads to greater processing of task-irrelevant stimuli due to competition for limited executive resource that reduces the ability to actively maintain current processing priorities. Studies testing this hypothesis have yielded widely divergent outcomes. The inconsistent results may, in part, be related to variability in executive capacity (EC) and task difficulty across subjects in different studies. Here, we used a cross-modal paradigm to investigate whether augmented working memory (WM) load leads to increased early distracter processing, and controlled for the potential confounders of EC and task difficulty. Twenty-three young subjects were engaged in a primary visual WM task, under high and low load conditions, while instructed to ignore irrelevant auditory stimuli. Demands of the high load condition were individually titrated to make task difficulty comparable across subjects with differing EC. Event-related potentials (ERPs) were used to measure neural activity in response to stimuli presented in both the task relevant modality (visual) and task-irrelevant modality (auditory). Behavioral results indicate that the load manipulation and titration procedure of the primary visual task were successful. ERPs demonstrated that in response to visual target stimuli, there was a load-related increase in the posterior slow wave, an index of sustained attention and effort. Importantly, under high load, there was a decrease of the auditory N1 in response to distracters, a marker of early auditory processing. These results suggest that increased WM load is associated with enhanced attentional engagement and protection from distraction in a cross-modal setting, even after controlling for task difficulty and EC. Our findings challenge the classic LT and offer support for alternative models. PMID:27536226

Increasing Working Memory Load Reduces Processing of Cross-Modal Task-Irrelevant Stimuli Even after Controlling for Task Difficulty and Executive Capacity.

PubMed

Simon, Sharon S; Tusch, Erich S; Holcomb, Phillip J; Daffner, Kirk R

2016-01-01

The classic account of the load theory (LT) of attention suggests that increasing cognitive load leads to greater processing of task-irrelevant stimuli due to competition for limited executive resource that reduces the ability to actively maintain current processing priorities. Studies testing this hypothesis have yielded widely divergent outcomes. The inconsistent results may, in part, be related to variability in executive capacity (EC) and task difficulty across subjects in different studies. Here, we used a cross-modal paradigm to investigate whether augmented working memory (WM) load leads to increased early distracter processing, and controlled for the potential confounders of EC and task difficulty. Twenty-three young subjects were engaged in a primary visual WM task, under high and low load conditions, while instructed to ignore irrelevant auditory stimuli. Demands of the high load condition were individually titrated to make task difficulty comparable across subjects with differing EC. Event-related potentials (ERPs) were used to measure neural activity in response to stimuli presented in both the task relevant modality (visual) and task-irrelevant modality (auditory). Behavioral results indicate that the load manipulation and titration procedure of the primary visual task were successful. ERPs demonstrated that in response to visual target stimuli, there was a load-related increase in the posterior slow wave, an index of sustained attention and effort. Importantly, under high load, there was a decrease of the auditory N1 in response to distracters, a marker of early auditory processing. These results suggest that increased WM load is associated with enhanced attentional engagement and protection from distraction in a cross-modal setting, even after controlling for task difficulty and EC. Our findings challenge the classic LT and offer support for alternative models.

Implementation of a Transdisciplinary Team for the Transition Support of Medically and Socially Complex Youth.

PubMed

Ciccarelli, Mary R; Gladstone, Erin B; Armstrong Richardson, Eprise A J

2015-01-01

This article reports the ongoing work of a statewide transition support program which serves youth ages 11 to 22 with medically complex conditions and socially complex lives. Seven years of transition support services have led to program evolution demonstrated via a descriptive summary of the patients along with both families' and primary care providers' responses to satisfaction surveys. An illustrative case is used to highlight the types of expertise needed in specialized transition service delivery for patients with significant complexity. The team's analysis of their transdisciplinary work processes further explains the work. Nearly three hundred youth with complex needs are served yearly. Families and primary care providers express high satisfaction with the support of the services. The case example shows the broad array of transition-specific services engaged beyond the usual skill set of pediatric or adult care coordination teams. Transdisciplinary team uses skills in collaboration, support, learning, and compromise within a trusting and respectful environment. They describe the shared responsibility and continuous learning of the whole team. Youth with complex medical conditions and complex social situations are at higher risk for problems during transition. Serving this population with a transdisciplinary model is time consuming and requires advanced expertise but, with those investments, we can meet the expectations of the youth, their families and primary care providers. Successful transdisciplinary teamwork requires sustained and focused investment. Further work is needed to describe the complexity of this service delivery along with distinct transition outcomes and costs comparisons. Copyright © 2015 Elsevier Inc. All rights reserved.

Is Primary-Process Cognition a Feature of Hypnosis?

PubMed

Finn, Michael T; Goldman, Jared I; Lyon, Gyrid B; Nash, Michael R

2017-01-01

The division of cognition into primary and secondary processes is an important part of contemporary psychoanalytic metapsychology. Whereas primary processes are most characteristic of unconscious thought and loose associations, secondary processes generally govern conscious thought and logical reasoning. It has been theorized that an induction into hypnosis is accompanied by a predomination of primary-process cognition over secondary-process cognition. The authors hypothesized that highly hypnotizable individuals would demonstrate more primary-process cognition as measured by a recently developed cognitive-perceptual task. This hypothesis was not supported. In fact, low hypnotizable participants demonstrated higher levels of primary-process cognition. Exploratory analyses suggested a more specific effect: felt connectedness to the hypnotist seemed to promote secondary-process cognition among low hypnotizable participants.

Australian primary health care nurses most and least satisfying aspects of work.

PubMed

Halcomb, Elizabeth; Ashley, Christine

2017-02-01

To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. A cross-sectional online survey. Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care. © 2016 John Wiley & Sons Ltd.

Factors affecting the views and attitudes of Scottish pharmacists to continuing professional development.

PubMed

Power, Ailsa; Grammatiki, Aikaterini; Bates, Ian; Mc Kellar, Susan; Johnson, B Julienne; Diack, H Lesley; Stewart, Derek; Hudson, Steve A

2011-12-01

To explore factors associated with Scottish pharmacists' views and attitudes to continuing professional development (CPD). A retrospective principal component analysis of 552 (22.8%) questionnaires returned from a sample of 2420 Scottish pharmacists randomly selected from the 4300 pharmacists registered with the Royal Pharmaceutical Society of Great Britain and with a Scottish address. Principal component analysis of questionnaire items (n = 19) revealed four factors associated with Scottish pharmacists' views and attitudes to CPD: having positive support in the workplace, having access to resources and meeting learning needs, having confidence in the CPD process and motivation to participate in the CPD process. Community pharmacists were identified as the subgroup of pharmacists that needed most support for CPD regarding all four factors, while pharmacists working in primary care felt that they had most support in the workplace in comparison to other sectors (P < 0.05) and better access to resources and meeting learning needs when compared to community (P < 0.001) and hospital (P = 0.008) colleagues. Pharmacists working in primary care also felt more motivated to participate in the CPD process than those in the community (P < 0.001), and hospital pharmacists reported having more confidence in the CPD process compared to community pharmacists (P < 0.05). Using principal component analysis has identified four factors associated with Scottish pharmacists' views and attitudes to CPD. This may provide an approach to facilitate comparison of CPD views and attitudes with intra and inter professional groupings. Further study may allow identification of good practice and solutions to common CPD issues. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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.

[Collaboration between Medicine and Psychology: Evolving Mentalities in Belgium and Evolution of the Health Care System in Canada].

PubMed

Chomienne, Marie-Hélène; Vanneste, Patrick; Grenier, Jean; Hendrick, Stephan

Objectives 1) To give a portrait of the evolving mentalities prevailing in Belgium on the collaboration between psychologists and general practitioners, and identify the barriers to the development of the collaboration between those two health professionals 2) To report on the primary care reform in Canada, its role in fostering collaborative practice in primary mental health and on the strategies needed to improve collaboration.Methods Literature search using PubMed and Google Scholar.Results Because of the unmet need of psychologists in primary care, general practitioners and psychologists have a propensity to work together. However to facilitate the collaborative process there needs to be system changes and clear definition of scopes of practices. Both countries are at different levels of implementing change. In Belgium for example it is only very recently that the autonomous practice of clinical psychology has been acknowledged. In Canada although the primary care reform has put forward and supported collaborative care, focus on mental health is insufficient. Early reports on collaborative care in the new models of care inconsistently report improved health outcomes. Strategies to improve collaborative care are looking at teaching future health professionals on how to work together by integrating inter-professional education.Conclusion Both the health care system and graduate training need to support foster and teach collaborative care.

Implementation of integration strategies between primary care units and a regional general hospital in Brazil to update and connect health care professionals: a quasi-experimental study protocol.

PubMed

Bracco, Mario Maia; Mafra, Ana Carolina Cintra Nunes; Abdo, Alexandre Hannud; Colugnati, Fernando Antonio Basile; Dalla, Marcello Dala Bernardina; Demarzo, Marcelo Marcos Piva; Abrahamsohn, Ises; Rodrigues, Aline Pacífico; Delgado, Ana Violeta Ferreira de Almeida; Dos Prazeres, Glauber Alves; Teixeira, José Carlos; Possa, Silvio

2016-08-12

Better communication among field health care teams and points of care, together with investments focused on improving teamwork, individual management, and clinical skills, are strategies for achieving better outcomes in patient-oriented care. This research aims to implement and evaluate interventions focused on improving communication and knowledge among health teams based on points of care in a regional public health outreach network, assessing the following hypotheses: 1) A better-working communication process between hospitals and primary health care providers can improve the sharing of information on patients as well as patients' outcomes. 2) A skill-upgrading education tool offered to health providers at their work sites can improve patients' care and outcomes. A quasi-experimental study protocol with a mixed-methods approach (quantitative and qualitative) was developed to evaluate communication tools for health care professionals based in primary care units and in a general hospital in the southern region of São Paulo City, Brazil. The usefulness and implementation processes of the integration strategies will be evaluated, considering: 1) An Internet-based communication platform that facilitates continuity and integrality of care to patients, and 2) A tailored updating distance-learning course on ambulatory care sensitive conditions for clinical skills improvements. The observational study will evaluate a non-randomized cohort of adult patients, with historical controls. Hospitalized patients diagnosed with an ambulatory care sensitive condition will be selected and followed for 1 year after hospital discharge. Data will be collected using validated questionnaires and from patients' medical records. Health care professionals will be evaluated related to their use of education and communication tools and their demographic and psychological profiles. The primary outcome measured will be the patients' 30-day hospital readmission rates. A sample size of 560 patients was calculated to fit a valid logistic model. In addition, qualitative approaches will be used to identify subjective perceptions of providers about the implementation process and of patients about health system use. This research project will gather relevant information about implementation processes for education and communication tools and their impact on human resources training, rates of readmission, and patient-related outcomes.

Quantification of sauter mean diameter in diesel sprays using scattering-absorption extinction measurements

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

Martinez, Gabrielle L; Magnotti, Gina M; Knox, Benjamin W

Quantitative measurements of the primary breakup process in diesel sprays are lacking due to a range of experimental and diagnostic challenges, including: high droplet number density environments, very small characteristic drop size scales (~1-10 μm), and high characteristic velocities in the primary breakup region (~600 m/s). Due to these challenges, existing measurement techniques have failed to resolve a sufficient range of the temporal and spatial scales involved and much remains unknown about the primary atomization process in practical diesel sprays. To gain a better insight into this process, we have developed a joint visible and x-ray extinction measurement technique tomore » quantify axial and radial distributions of the path-integrated Sauter Mean Diameter (SMD) and Liquid Volume Fraction (LVF) for diesel-like sprays. This technique enables measurement of the SMD in regions of moderate droplet number density, enabling construction of the temporal history of drop size development within practical diesel sprays. The experimental campaign was conducted jointly at the Georgia Institute of Technology and Argonne National Laboratory using the Engine Combustion Network “Spray D” injector. X-ray radiography liquid absorption measurements, conducted at the Advanced Photon Source at Argonne, quantify the liquid-fuel mass and volume distribution in the spray. Diffused back-illumination liquid scattering measurements were conducted at Georgia Tech to quantify the optical thickness throughout the spray. By application of Mie-scatter equations, the ratio of the absorption and scattering extinction measurements is demonstrated to yield solutions for the SMD. This work introduces the newly developed scattering-absorption measurement technique and highlights the important considerations that must be taken into account when jointly processing these measurements to extract the SMD. These considerations include co-alignment of measurements taken at different institutions, identification of viable regions where the measurement ratio can be accurately interpreted, and uncertainty analysis in the measurement ratio and resulting SMD. Because the measurement technique provides the spatial history of the SMD development, it is expected to be especially informative to the diesel spray modeling community. Results from this work will aid in understanding the effect of ambient densities and injection pressures on primary breakup and help assess the appropriateness of spray submodels for engine computational fluid dynamics codes.« less

Understanding the work done by NHS commissioning managers: an exploration of the microprocesses underlying day-to-day sensemaking in UK primary care organisations.

PubMed

Checkland, Kath; Harrison, Stephen; Snow, Stephanie; Coleman, Anna; McDermott, Imelda

2013-01-01

The purpose of this paper is to explore the practical daily work undertaken by middle-level managers in Primary Care Trusts (PCTs), focusing upon the micro-processes by which these managers enact sensemaking in their organisations. The research took a case study approach, undertaking detailed case studies in four PCTs in England. Data collection included shadowing managers, meeting observations and interviews. The research elucidated two categories of enactment behaviour exhibited by PCT managers: presence/absence; and the production of artefacts. Being "present" in or "absent" from meetings enacted sensemaking over and above any concrete contribution to the meeting made by the actors involved. This paper explores the factors affecting these processes, and describes the situations in which enactment of sense is most likely to occur. Producing artefacts such as meeting minutes or PowerPoint slides also enacted sense in the study sites in addition to the content of the artefact. The factors affecting this are explored. The study has practical implications for all managers seeking to maximise their influence in their organisations. It also provides specific evidence relevant to managers working in the new Clinical Commissioning Groups currently being formed in England. The study expands the understanding of sensemaking in organisations in two important ways. Firstly, it moves beyond discourse to explore the ways in which behaviours can enact sense. Secondly, it explores the distinction between active and unconscious sensemaking.

Evolution of Primary Fe-Rich Compounds in Secondary Al-Si-Cu Alloys

NASA Astrophysics Data System (ADS)

Fabrizi, Alberto; Capuzzi, Stefano; Timelli, Giulio

Although iron is usually added in die cast Al-Si foundry alloys to prevent die soldering, primary Fe-rich particles are generally considered as "hardspot" inclusions which compromise the mechanical properties of the alloy, namely ductility and toughness. As there is no economical methods to remove the Fe excess in secondary Al-Si alloys at this time, the control of solidification process and chemical composition of the alloy is a common industrial practice to overcome the negative effects connected with the presence of Fe-rich particles. In this work, the size and morphology as well as the nucleation density of primary Fe-rich particles have been studied as function of cooling rate and alloy chemical composition for secondary Al-Si-Cu alloys. The solidification experiments were carried out using differential scanning calorimetry whereas morphology investigations were conducted using optical and scanning electron microscopy. Mcrosegregations and chemical composition of primary Fe-rich particles were examined by energy dispersive spectroscopy.

Asymmetric Distribution of Primary Cilia Allocates Satellite Cells for Self-Renewal.

PubMed

Jaafar Marican, Nur Hayati; Cruz-Migoni, Sara B; Borycki, Anne-Gaëlle

2016-06-14

Regeneration of vertebrate skeletal muscles requires satellite cells, a population of stem cells that are quiescent in normal conditions and divide, differentiate, and self-renew upon activation triggered by exercise, injury, and degenerative diseases. Satellite cell self-renewal is essential for long-term tissue homeostasis, and previous work has identified a number of external cues that control this process. However, little is known of the possible intrinsic control mechanisms of satellite cell self-renewal. Here, we show that quiescent satellite cells harbor a primary cilium, which is rapidly disassembled upon entry into the cell cycle. Contrasting with a commonly accepted belief, cilia reassembly does not occur uniformly in cells exiting the cell cycle. We found that primary cilia reassemble preferentially in cells committed to self-renew, and disruption of cilia reassembly causes a specific deficit in self-renewing satellite cells. These observations indicate that primary cilia provide an intrinsic cue essential for satellite cell self-renewal. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Development of the Champlain primary care cardiovascular disease prevention and management guideline

PubMed Central

Montoya, Lorraine; Liddy, Clare; Hogg, William; Papadakis, Sophia; Dojeiji, Laurie; Russell, Grant; Akbari, Ayub; Pipe, Andrew; Higginson, Lyall

2011-01-01

Abstract Problem addressed A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care. Objective of program As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors. Program description The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services. Conclusion Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care. PMID:21673196

Identification of Causes of the Occupational Stress for Health Providers at Different Levels of Health Care.

PubMed

Trifunovic, Natasa; Jatic, Zaim; Kulenovic, Alma Dzubur

2017-06-01

To identify and compare the stressors in the work environment experienced by employees in primary health care and secondary health care, amongphysiciansand nurses. The survey was conducted to identify types of stressors by assessing health care workers employed in the primary and secondary health care services of the Public Institution, the Health Centre of the Sarajevo Canton, using a questionnaire about stress in the workplace. Among all study participants stressors connected to the organization of work, finance and communication were found to affect their mental health most strongly. The results show a significant difference between primary and secondary health care in experience of stressors related to the organization of work, communication, and stressors related to the emotional and physical risks. Primary health care physicians report a significantly higher experience of stress and impact on mental health compared with other physicians related to emotional difficulties when working in the field of palliative care. Our results also indicate a significant difference between primary and secondary health providers in experiencing stressors related to the organization of work, such as: on-call duty shifts, an inadequate working environment and in the assessment of administrative work overload. The survey identified the most intense stressors for doctors and nurses at primary and secondary levels of health care services. The results of the study indicate that doctors and nurses have a different hierarchy of stressors, as well as subjects at Primary and Secondary Health Care. The results of the study indicate that subjects et Primary Health Care perceive more stressful organizational, emotional and communicational problems.

Production of Titanium Metal by an Electrochemical Molten Salt Process

NASA Astrophysics Data System (ADS)

Fatollahi-Fard, Farzin

Titanium production is a long and complicated process. What we often consider to be the standard method of primary titanium production (the Kroll process), involves many complex steps both before and after to make a useful product from titanium ore. Thus new methods of titanium production, especially electrochemical processes, which can utilize less-processed feedstocks have the potential to be both cheaper and less energy intensive than current titanium production processes. This project is investigating the use of lower-grade titanium ores with the electrochemical MER process for making titanium via a molten salt process. The experimental work carried out has investigated making the MER process feedstock (titanium oxycarbide) with natural titanium ores--such as rutile and ilmenite--and new ways of using the MER electrochemical reactor to "upgrade" titanium ores or the titanium oxycarbide feedstock. It is feasible to use the existing MER electrochemical reactor to both purify the titanium oxycarbide feedstock and produce titanium metal.

Work ability of Chinese migrant workers: the influence of migration characteristics.

PubMed

Han, Lu; Shi, Leiyu; Lu, Liming; Ling, Li

2014-04-13

Migrant workers have become a vital labor supply to China's economy. Their migration process and work conditions may influence their health and work ability. The work ability of migrant workers in China and the influence of the migration process on work ability have not been explored extensively in previous studies. The objective of this study is to evaluate the association of migration characteristics and work-related factors with work ability among migrant workers in the Pearl River Delta. In this cross-sectional survey, the study population consisted of 907 migrant workers from ten factories in the Pearl River Delta who were exposed to organic solvents during work. The primary dependent variable of the study was work ability, measured by the Work Ability Index (WAI). The independent variables were individual characteristics, migration characteristics, and work-related factors. Logistic regression models were used to determine the influence of different factors on work ability and three dimensions of WAI. The result shows that among migration characteristics, social support was significantly associated with all three dimensions of the work ability index. Permanent migration intention and longer length of migration were negatively associated with the mental resource dimension of WAI. WAI was also influenced by individual and work-related factors. The findings of this study suggest that expanding migrants' social networks and social support systems in their work place or living community, (i.e. expanding the functions of labor unions) would be an effective way to improve migrant workers' work ability. Improving of migrant workers' physical and psychosocial related work environments would also increase their work ability.

Educational Reforms and Implications on Teachers' World of Work: Perspectives of Fijian Primary Teachers

ERIC Educational Resources Information Center

Lingam, Govinda; Lingam, Narsamma; Sharma, Lalesh

2017-01-01

This preliminary study reports on educational changes and its impact on primary teachers' world of work in Fiji. Data were gathered from 38 primary teachers, using a questionnaire of Likert scale items and open-ended questions aiming to identify the intensity of the changes that have occurred in their work. The data analysis reveals the…

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings.

PubMed

Anskär, Eva; Lindberg, Malou; Falk, Magnus; Andersson, Agneta

2018-03-07

Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.

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

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.

Cognitive Risk Factors for Specific Learning Disorder: Processing Speed, Temporal Processing, and Working Memory.

PubMed

Moll, Kristina; Göbel, Silke M; Gooch, Debbie; Landerl, Karin; Snowling, Margaret J

2016-01-01

High comorbidity rates between reading disorder (RD) and mathematics disorder (MD) indicate that, although the cognitive core deficits underlying these disorders are distinct, additional domain-general risk factors might be shared between the disorders. Three domain-general cognitive abilities were investigated in children with RD and MD: processing speed, temporal processing, and working memory. Since attention problems frequently co-occur with learning disorders, the study examined whether these three factors, which are known to be associated with attention problems, account for the comorbidity between these disorders. The sample comprised 99 primary school children in four groups: children with RD, children with MD, children with both disorders (RD+MD), and typically developing children (TD controls). Measures of processing speed, temporal processing, and memory were analyzed in a series of ANCOVAs including attention ratings as covariate. All three risk factors were associated with poor attention. After controlling for attention, associations with RD and MD differed: Although deficits in verbal memory were associated with both RD and MD, reduced processing speed was related to RD, but not MD; and the association with RD was restricted to processing speed for familiar nameable symbols. In contrast, impairments in temporal processing and visuospatial memory were associated with MD, but not RD. © Hammill Institute on Disabilities 2014.

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.

The use, publication and future directions of immunocytochemistry in veterinary medicine: a consensus of the Oncology-Pathology Working Group.

PubMed

Priest, H L; Hume, K R; Killick, D; Kozicki, A; Rizzo, V L; Seelig, D; Snyder, L A; Springer, N L; Wright, Z M; Robat, C

2017-09-01

One of the primary objectives of the Oncology Pathology Working Group (OPWG), a joint initiative of the Veterinary Cancer Society and the American College of Veterinary Pathologists, is for oncologists and pathologists to collaboratively generate consensus documents to standardize aspects of and provide guidelines for oncologic pathology. Consensus is established through review of relevant peer-reviewed literature relative to a subgroup's particular focus. In this document, the authors provide descriptions of the literature reviewed, the review process, and a summary of the information gathered on immunocytochemistry. The intent of this publication is to help educate practitioners and pathologists on the process of immunocytochemistry and to provide a guide for the use of this technique in veterinary medicine. This document represents the opinions of the working group and the authors and does not constitute a formal endorsement by the American College of Veterinary Pathologists or the Veterinary Cancer Society. © 2016 John Wiley & Sons Ltd.

Design of the Bottom-up Innovation project--a participatory, primary preventive, organizational level intervention on work-related stress and well-being for workers in Dutch vocational education.

PubMed

Schelvis, Roosmarijn M C; Oude Hengel, Karen M; Wiezer, Noortje M; Blatter, Birgitte M; van Genabeek, Joost A G M; Bohlmeijer, Ernst T; van der Beek, Allard J

2013-08-15

In the educational sector job demands have intensified, while job resources remained the same. A prolonged disbalance between demands and resources contributes to lowered vitality and heightened need for recovery, eventually resulting in burnout, sickness absence and retention problems. Until now stress management interventions in education focused mostly on strengthening the individual capacity to cope with stress, instead of altering the sources of stress at work at the organizational level. These interventions have been only partly effective in influencing burnout and well-being. Therefore, the "Bottom-up Innovation" project tests a two-phased participatory, primary preventive organizational level intervention (i.e. a participatory action approach) that targets and engages all workers in the primary process of schools. It is hypothesized that participating in the project results in increased occupational self-efficacy and organizational efficacy. The central research question: is an organization focused stress management intervention based on participatory action effective in reducing the need for recovery and enhancing vitality in school employees in comparison to business as usual? The study is designed as a controlled trial with mixed methods and three measurement moments: baseline (quantitative measures), six months and 18 months (quantitative and qualitative measures). At first follow-up short term effects of taking part in the needs assessment (phase 1) will be determined. At second follow-up the long term effects of taking part in the needs assessment will be determined as well as the effects of implemented tailored workplace solutions (phase 2). A process evaluation based on quantitative and qualitative data will shed light on whether, how and why the intervention (does not) work(s). "Bottom-up Innovation" is a combined effort of the educational sector, intervention providers and researchers. Results will provide insight into (1) the relation between participating in the intervention and occupational and organizational self-efficacy, (2) how an improved balance between job demands and job resources might affect need for recovery and vitality, in the short and long term, from an organizational perspective, and (3) success and fail factors for implementation of an organizational intervention. Netherlands Trial Register NTR3284.

Factors associated with final year nursing students' desire to work in the primary health care setting: Findings from a national cross-sectional survey.

PubMed

Bloomfield, Jacqueline G; Aggar, Christina; Thomas, Tamsin H T; Gordon, Christopher J

2018-02-01

Registered nurses are under-represented in the primary health care setting both internationally and in Australia, and this shortage is predicted to worsen. To address the increasingly complex healthcare needs of an ageing population, it is vital to develop and sustain a primary health care nursing workforce, yet attracting nurses is challenging. In Australia, registered nurses graduating from university typically commence their careers in hospital-based transition to professional practice programs. Similar programs in primary health care settings may be a valuable strategy for developing the primary health care nursing workforce, yet little is known about nursing students desire to work in this setting, factors that influence this, or their expectations of primary health care-focused transition to professional practice programs. This study sought to identify factors associated with final year nursing students' desire to work in primary health care setting including demographic factors, expectations of future employment conditions, and job content. It also explored expectations of graduate transition programs based in primary health care. A cross-sectional survey design comprising a quantitative online survey. 14 Australian universities from all states/territories, both rural and urban. 530 final-year nursing students. Binary logistic regression identifying factors contributing to desire to work in primary health care. The desire of nursing students to work in primary health care is associated with older age, greater perceived value of employment conditions including flexibility, and less perceived importance of workplace support. Collaborative efforts from primary health care nurses, health professionals, academics and policy makers are needed to attract new graduate nurses to primary health care. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

I.S.Mu.L.T. first-time patellar dislocation guidelines

PubMed Central

Vetrano, Mario; Oliva, Francesco; Bisicchia, Salvatore; Bossa, Michela; De Carli, Angelo; Di Lorenzo, Luigi; Erroi, Davide; Forte, Alfonso; Foti, Calogero; Frizziero, Antonio; Gasparre, Giuseppe; Via, Alessio Giai; Innocenti, Bernardo; Longo, Umile Giuseppe; Mahmoud, Asmaa; Masiero, Stefano; Mazza, Daniele; Natali, Simone; Notarangelo, Christian; Osti, Leonardo; Padulo, Johnny; Pellicciari, Leonardo; Perroni, Fabrizio; Piccirilli, Eleonora; Ramponi, Carlo; Salvatore, Giuseppe; Panni, Alfredo Schiavone; Suarez, Tania; Tarantino, Umberto; Vittadini, Filippo; Vulpiani, Maria Chiara; Ferretti, Andrea; Maffulli, Nicola

2017-01-01

Summary Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to improve the quality of care and rationalize the use of resources. Level of evidence: Ia. PMID:28717605

Understanding Phonological Memory Deficits in Boys with Attention-Deficit/Hyperactivity Disorder (ADHD): Dissociation of Short-Term Storage and Articulatory Rehearsal Processes

ERIC Educational Resources Information Center

Bolden, Jennifer; Rapport, Mark D.; Raiker, Joseph S.; Sarver, Dustin E.; Kofler, Michael J.

2012-01-01

The current study dissociated and examined the two primary components of the phonological working memory subsystem--the short-term store and articulatory rehearsal mechanism--in boys with ADHD (n = 18) relative to typically developing boys (n = 15). Word lists of increasing length (2, 4, and 6 words per trial) were presented to and recalled by…

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

Jonathan Helmus, Scott Collis

The Python-ARM Radar Toolkit (Py-ART) is a collection of radar quality control and retrieval codes which all work on two unifying Python objects: the PyRadar and PyGrid objects. By building ingests to several popular radar formats and then abstracting the interface Py-ART greatly simplifies data processing over several other available utilities. In addition Py-ART makes use of Numpy arrays as its primary storage mechanism enabling use of existing and extensive community software tools.

KENNEDY SPACE CENTER, FLA. - Overhead cables carry the Multi-Purpose Logistics Module Donatello from the payload canister (lower right) to a work stand in the Space Station Processing Facility. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-13

KENNEDY SPACE CENTER, FLA. - Overhead cables carry the Multi-Purpose Logistics Module Donatello from the payload canister (lower right) to a work stand in the Space Station Processing Facility. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - Workers in the Space Station Processing Facility secure the Multi-Purpose Logistics Module Raffaello onto a new work stand. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-10

KENNEDY SPACE CENTER, FLA. - Workers in the Space Station Processing Facility secure the Multi-Purpose Logistics Module Raffaello onto a new work stand. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - Workers on the floor of the Space Station Processing Facility watch as overhead cables carry the Multi-Purpose Logistics Module Donatello to a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-13

KENNEDY SPACE CENTER, FLA. - Workers on the floor of the Space Station Processing Facility watch as overhead cables carry the Multi-Purpose Logistics Module Donatello to a work stand. Previously housed in the Operations and Checkout Building, Donatello was brought into the SSPF for routine testing. This is the first time all three MPLMs (Donatello, Raffaello and Leonardo) are in the SSPF. The MPLMs were built by the Italian Space Agency, to serve as reusable logistics carriers and the primary delivery system to resupply and return station cargo requiring a pressurized environment. The third MPLM, Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

Dynamic Modeling of Process Technologies for Closed-Loop Water Recovery Systems

NASA Technical Reports Server (NTRS)

Allada, Rama Kumar; Lange, Kevin E.; Anderson, Molly S.

2012-01-01

Detailed chemical process simulations are a useful tool in designing and optimizing complex systems and architectures for human life support. Dynamic and steady-state models of these systems help contrast the interactions of various operating parameters and hardware designs, which become extremely useful in trade-study analyses. NASA s Exploration Life Support technology development project recently made use of such models to compliment a series of tests on different waste water distillation systems. This paper presents dynamic simulations of chemical process for primary processor technologies including: the Cascade Distillation System (CDS), the Vapor Compression Distillation (VCD) system, the Wiped-Film Rotating Disk (WFRD), and post-distillation water polishing processes such as the Volatiles Removal Assembly (VRA). These dynamic models were developed using the Aspen Custom Modeler (Registered TradeMark) and Aspen Plus(Registered TradeMark) process simulation tools. The results expand upon previous work for water recovery technology models and emphasize dynamic process modeling and results. The paper discusses system design, modeling details, and model results for each technology and presents some comparisons between the model results and available test data. Following these initial comparisons, some general conclusions and forward work are discussed.

Implementation of GPU accelerated SPECT reconstruction with Monte Carlo-based scatter correction.

PubMed

Bexelius, Tobias; Sohlberg, Antti

2018-06-01

Statistical SPECT reconstruction can be very time-consuming especially when compensations for collimator and detector response, attenuation, and scatter are included in the reconstruction. This work proposes an accelerated SPECT reconstruction algorithm based on graphics processing unit (GPU) processing. Ordered subset expectation maximization (OSEM) algorithm with CT-based attenuation modelling, depth-dependent Gaussian convolution-based collimator-detector response modelling, and Monte Carlo-based scatter compensation was implemented using OpenCL. The OpenCL implementation was compared against the existing multi-threaded OSEM implementation running on a central processing unit (CPU) in terms of scatter-to-primary ratios, standardized uptake values (SUVs), and processing speed using mathematical phantoms and clinical multi-bed bone SPECT/CT studies. The difference in scatter-to-primary ratios, visual appearance, and SUVs between GPU and CPU implementations was minor. On the other hand, at its best, the GPU implementation was noticed to be 24 times faster than the multi-threaded CPU version on a normal 128 × 128 matrix size 3 bed bone SPECT/CT data set when compensations for collimator and detector response, attenuation, and scatter were included. GPU SPECT reconstructions show great promise as an every day clinical reconstruction tool.

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

PubMed

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

2017-08-17

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. 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%). 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. 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. Investigar se características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica estão associadas ao número de internações por condições sensíveis à atenção primária. Neste estudo ecológico, foram analisados dados de municípios brasileiros relativos a características sociodemográficas, de cobertura de programas assistenciais, de estrutura das unidades básicas de saúde e processo de trabalho das equipes de atenção básica. Os dados foram obtidos do primeiro ciclo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica, do Departamento de Informática do Sistema Único de Saúde, do Instituto Brasileiro de Geografia e Estatística e do Programa das Nações Unidas. Estimaram-se as associações por meio de coeficientes de regressão binomial negativa (β) e respectivos intervalos de confiança a 95%, com abordagem hierarquizada em três blocos (alpha = 5%). Na análise ajustada, para o desfecho em 2013, no bloco distal, a cobertura do Programa Bolsa Família (β = -0,001) e de plano privado (β = -0,01) apresentaram associação negativa; e o índice de desenvolvimento humano (β = 1,13), a proporção de pessoa idosa (β = 0,05) e de menor de cinco anos (β = 0,05) e a cobertura da Estratégia de Agentes Comunitários de Saúde (β = 0,002) mostraram associação positiva com internações por condições sensíveis à atenção primária. No bloco intermediário, apresentaram associação negativa o horário mínimo (β = -0,14) e a disponibilidade de vacina (β = -0,16); e associação positiva, a disponibilidade de medicamentos (β = 0,16). No bloco proximal, apenas a variável apoio matricial (β = 0,10) mostrou associação positiva. Na análise ajustada do número de internações por condições sensíveis à atenção primária em 2014, as variáveis apresentaram o mesmo sentido de associação de 2013. Características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica impactam no número de internações por condições sensíveis à atenção primária nos municípios brasileiros.

[Restoration of the idea of contact. Psychopedagogic approach].

PubMed

Richaud, R L

1988-01-01

Our psychopedagogical work with teenagers having serious problems in the school setting led us to set up a clinical approach giving back to thought the ability to link affects and their representations whereas the thought process had seemed exhausted by a never-ending fight to avoid being swallowed up by the primary processes or through representing unbearable phantasms. In our hypothesis, as long as the imaginary can't be represented, it blocks access to any idea of contact. Having contact with works of art, which can serve as models of metamorphosis that has succeeded, seemed, to us, in the concept of a shared dream, as the best way to allows patients to reconnect lost or avoided parts, but from afar. The metaphor takes the place of the nameless crudity and horror of a very real alienating agent.

Functional abdominal pain in childhood: background studies and recent research trends.

PubMed

Levy, Rona L; van Tilburg, Miranda A L

2012-01-01

The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors' research program. Specific areas discussed based on work within the authors' group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research.

Primary mass discrimination of high energy cosmic rays using PNN and k-NN methods

NASA Astrophysics Data System (ADS)

Rastegarzadeh, G.; Nemati, M.

2018-02-01

Probabilistic neural network (PNN) and k-Nearest Neighbors (k-NN) methods are widely used data classification techniques. In this paper, these two methods have been used to classify the Extensive Air Shower (EAS) data sets which were simulated using the CORSIKA code for three primary cosmic rays. The primaries are proton, oxygen and iron nuclei at energies of 100 TeV-10 PeV. This study is performed in the following of the investigations into the primary cosmic ray mass sensitive observables. We propose a new approach for measuring the mass sensitive observables of EAS in order to improve the primary mass separation. In this work, the EAS observables measurement has performed locally instead of total measurements. Also the relationships between the included number of observables in the classification methods and the prediction accuracy have been investigated. We have shown that the local measurements and inclusion of more mass sensitive observables in the classification processes can improve the classifying quality and also we have shown that muons and electrons energy density can be considered as primary mass sensitive observables in primary mass classification. Also it must be noted that this study is performed for Tehran observation level without considering the details of any certain EAS detection array.

Evaluation of a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care: the role of Primary Care Mental Health Specialists.

PubMed

Hamilton-West, Kate; Hotham, Sarah; Yang, Wei; Hedayioglu, Julie; Brigden, Charlotte

2017-07-01

Aim We aimed to evaluate a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care. Patients with stable long-term mental health conditions are often not discharged from secondary mental health services when no longer needed due to insufficient systems and processes to enable safe, effective, recovery-focussed treatment and support. The Primary Care Mental Health Specialist (PCMHS) Service was developed to address this gap; new PCMHS posts were introduced to act as a conduit for patients being discharged from secondary care and a single point of referral back into secondary care, should it be required. The two-year pilot, across six Clinical Commissioning Groups in South East England, began in March 2013. Interviews were conducted with all PCMHS employed in the pilot service (n=13) and a sample of service users (n=12). The views of professionals working alongside the service, including GPs, Psychiatrists and Mental Health Nurses, were captured using a brief online questionnaire (n=50). Time and Activity Recording Sheets were used to capture data required for economic analysis. Findings Our findings indicate that the service is working well from the perspective of patients; staff employed within the service and professionals working alongside the service. Patients described the service as a 'safety net' they could fall back on in case of difficulties, whereas staff used the analogy of a 'bridge' to describe the way the service improved communication and collaboration between the various professionals and organisations involved in the patient's care. Improvements in well-being were seen to result from increased support for those transitioning from secondary to primary care, a more pro-active approach to relapse prevention and increased engagement in daily activities. Each PCMHS covered 36 patients in a one-month period, with a unit cost of £73.01 per patient.

Thermochemical water decomposition. [hydrogen separation for energy applications

NASA Technical Reports Server (NTRS)

Funk, J. E.

1977-01-01

At present, nearly all of the hydrogen consumed in the world is produced by reacting hydrocarbons with water. As the supply of hydrocarbons diminishes, the problem of producing hydrogen from water alone will become increasingly important. Furthermore, producing hydrogen from water is a means of energy conversion by which thermal energy from a primary source, such as solar or nuclear fusion of fission, can be changed into an easily transportable and ecologically acceptable fuel. The attraction of thermochemical processes is that they offer the potential for converting thermal energy to hydrogen more efficiently than by water electrolysis. A thermochemical hydrogen-production process is one which requires only water as material input and mainly thermal energy, or heat, as an energy input. Attention is given to a definition of process thermal efficiency, the thermodynamics of the overall process, the single-stage process, the two-stage process, multistage processes, the work of separation and a process evaluation.

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

[Health situation assessment by primary care workers based on geographic information systems].

PubMed

Ritter, Fernando; Rosa, Roger dos Santos; Flores, Rui

2013-12-01

Primary healthcare has made little use of information systems to assess the population's health situation due to the difficulty in understanding the reports. Generic definitions of actions are common, based on empirical observations. The current study aimed to evaluate whether the introduction of georeferenced indicators can serve to better identify individuals' health situation, which would help planning actions by health teams. Healthcare workers from eight teams answered a questionnaire at three different moments: the first, before reading the information system's reports; the second after reading; and the third after using georeferencing. The results showed a significant difference in the classification of the health situation using georeferencing when compared to the previous moments (p < 0.05). Georeferencing facilitated analysis of the health situation, fostering better monitoring of work processes. Finally, use of the data points to rationalization of actions and possible upgrading of healthcare. The study suggests the use of georeferencing in the work agenda to become an effective tool for orienting actions.

Why wait so long for child care? An analysis of waits, queues and work in a South African urban health centre.

PubMed

Bachmann, M O; Barron, P

1997-01-01

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

Primary care managers' perceptions of their capability in providing care planning to patients with complex needs.

PubMed

Larsson, Lena Gunvor; Bäck-Pettersson, Siv; Kylén, Sven; Marklund, Bertil; Carlström, Eric

2017-01-01

The aim of this study was to investigate primary care managers' perceptions of their capability in providing care planning to patients with complex needs. Care planning is defined as a process where the patient, family and health professionals engage in dialogue about the patient's care needs and plan care interventions together. Semi-structured interviews with 18 primary care managers in western Sweden were conducted using Westrin's theoretical cooperation model. Data were analysed using a qualitative deductive method. Results reveal that the managers' approach to care planning was dominated by non-cooperation and separation. The managers were permeated by uncertainty about the meaning of the task of care planning as such. They did not seem to be familiar with the national legislation stipulating that every healthcare provider must meet patients' need for care interventions and participate in the care planning. To accomplish care planning, the process needs to cross - and overcome - both professional and organisational boundaries. There is also a need for incentives to develop working methods that promote local cooperation in order to facilitate optimal care for patients with complex needs. Copyright © 2016. Published by Elsevier Ireland Ltd.

Analysis of RFI Statistics for Aquarius RFI Detection and Mitigation Improvements

NASA Technical Reports Server (NTRS)

de Matthaeis, Paolo; Soldo, Yan; Le Vine, David M.

2016-01-01

Aquarius is an L-band active/passive sensor designed to globally map sea surface salinity from space. Two instruments, a radar scatterometer and a radiometer, observe the same surface footprint almost simultaneously. The radiometer is the primary instrument for sensing sea surface salinity (SSS), while the scatterometer is included to provide a correction for sea surface roughness, which is a primary source of error in the salinity retrieval. Although the primary objective is the measurement of SSS, the instrument combination operates continuously, acquiring data over land and sea ice as well. An important feature of the data processing includes detection and mitigation of Radio Frequency Interference (RFI) which is done separately for both active and passive instruments. Correcting for RFI is particularly critical over ocean because of the high accuracy required in the brightness temperature measurements for SSS retrieval. It is also necessary for applications of the Aquarius data over land, where man-made interference is widespread, even though less accuracy is required in this case. This paper will provide an overview of the current status of the Aquarius RFI processing and an update on the ongoing work on the improvement of the RFI detection and mitigation performance.

"So, are you back to work yet?" Re-conceptualizing 'work' and 'return to work' in the context of primary bone cancer.

PubMed

Parsons, Janet A; Eakin, Joan M; Bell, Robert S; Franche, Renée-Louise; Davis, Aileen M

2008-12-01

People with primary bone cancer typically are young (usual age-at-onset 16-35 years old) and undergo arduous treatments. The current standard of care (tumour resection and limb reconstruction with or without chemotherapy) results in survival rates in excess of 60%, but also results in significant disability at a time when patients are choosing career paths, establishing their independence and embarking on new roles. To date, the nature of the relationship between experiences of osteosarcoma illness and experiences of vocation has remained unclear. This study sought to examine this relationship using qualitative narrative methodology. In-depth audiotaped interviews were conducted with 14 osteosarcoma survivors (8 men, 6 women) who were being treated at Mount Sinai Hospital, Toronto, Canada. Interview transcripts were analyzed for story typology and thematic content via constant comparison. Respondents reported engaging in three types of 'work': 'illness work', 'identity work' and 'vocational work'. Osteosarcoma illness represented a crisis for respondents, one which necessitated considerable illness work. Illness work was portrayed as all-consuming, whereby respondents were forced to stop vocational work for considerable periods. The illness crisis also precipitated 'identity work'. Respondents recounted a transformative process, of 'becoming other' to whom they had been prior to illness. As a result, respondents told of re-entering the vocational sphere with a different sense of themselves from when they left it. When patients return for surgical follow up, clinicians routinely ask, "So, are you back to work yet?" expecting simple 'yes/no' answers. This study suggests that the answer is instead highly complex, and that patients could be seen as having been 'working' all along. This study offers a re-conceptualization of 'work' and 'return to work' in the context of osteosarcoma, with implications for clinical and return-to-work practices.

The role of prehealth student volunteers at a student-run free clinic in New York, United States.

PubMed

Shabbir, Syed H; Santos, Maria Teresa M

2015-01-01

The medical student-run Einstein Community Health Outreach Clinic provides free healthcare to the uninsured adult population of New York, the United States. During the summer, prehealth student volunteers are recruited to assist with clinic operations. We designed a survey study to identify the baseline characteristics of the volunteers between June and August of 2013 and 2014 in order to evaluate the influence of working in a medical student-run free clinic on their education, impressions, and career goals. A total of 38 volunteers (response rate, 83%) participated in the study. The volunteers were demographically diverse and interested in primary care specialties and community service. After the Einstein Community Health Outreach program, the volunteers showed an improved understanding of the healthcare process and issues relevant to uninsured patients. They also developed favorable attitudes towards primary care medicine and an increased level of interest in pursuing careers in primary care.

Experimental Investigation of A Heat Pipe-Assisted Latent Heat Thermal Energy Storage System

NASA Astrophysics Data System (ADS)

Tiari, Saeed; Mahdavi, Mahboobe; Qiu, Songgang

2016-11-01

In the present work, different operation modes of a latent heat thermal energy storage system assisted by a heat pipe network were studied experimentally. Rubitherm RT55 enclosed by a vertical cylindrical container was used as the Phase Change Material (PCM). The embedded heat pipe network consisting of a primary heat pipe and an array of four secondary heat pipes were employed to transfer heat to the PCM. The primary heat pipe transports heat from the heat source to the heat sink. The secondary heat pipes transfer the extra heat from the heat source to PCM during charging process or retrieve thermal energy from PCM during discharging process. The effects of heat transfer fluid (HTF) flow rate and temperature on the thermal performance of the system were investigated for both charging and discharging processes. It was found that the HTF flow rate has a significant effect on the total charging time of the system. Increasing the HTF flow rate results in a remarkable increase in the system input thermal power. The results also showed that the discharging process is hardly affected by the HTF flow rate but HTF temperature plays an important role in both charging and discharging processes. The authors would like to acknowledge the financial supports by Temple University for the project.

Implementation of the Pan-STARRS Image Processing Pipeline

NASA Astrophysics Data System (ADS)

Fang, Julia; Aspin, C.

2007-12-01

Pan-STARRS, or Panoramic Survey Telescope and Rapid Response System, is a wide-field imaging facility that combines small mirrors with gigapixel cameras. It surveys the entire available sky several times a month, which ultimately requires large amounts of data to be processed and stored right away. Accordingly, the Image Processing Pipeline--the IPP--is a collection of software tools that is responsible for the primary image analysis for Pan-STARRS. It includes data registration, basic image analysis such as obtaining master images and detrending the exposures, mosaic calibration when applicable, and lastly, image sum and difference. In this paper I present my work of the installation of IPP 2.1 and 2.2 on a Linux machine, running the Simtest, which is simulated data to test your installation, and finally applying the IPP to two different sets of UH 2.2m Tek data. This work was conducted by a Research Experience for Undergraduates (REU) position at the University of Hawaii's Institute for Astronomy and funded by the NSF.

Healthcare resources and needs in anticoagulant therapy for patients with nonvalvular atrial fibrillation. SAMOA Study.

PubMed

Barrios, V; Egocheaga-Cabello, M I; Gállego-Culleré, J; Ignacio-García, E; Manzano-Espinosa, L; Martín-Martínez, A; Mateo-Arranz, J; Polo-García, J; Vargas-Ortega, D

2017-05-01

To determine, in the various medical specialties, the healthcare process for anticoagulated patients with nonvalvular atrial fibrillation, to determine the available and necessary resources and to identify potential areas of improvement in the care of these patients. We performed a cross-sectional survey of primary care and specialised physicians involved in the care of anticoagulated patients. The questionnaires referred to the healthcare process, the indication and prescription of anticoagulant therapy and the barriers and deficiencies present for these patients. A total of 893 physicians participated in the study, 437 of whom worked in primary care and 456 of whom were specialists (mostly cardiologists). Forty-two percent of the family doctors indicated that they assessed and prescribed anticoagulant therapy, and 66% performed the regular follow-up of these patients. In both healthcare settings, the physicians noted the lack of standardised protocols. There was also a lack of quality control in the treatment. The role of primary care in managing anticoagulated patients has grown compared with previous reports. The responses of the participating physicians suggest marked gaps in the standardisation of the healthcare process and several areas for improvement in these patients' follow-up. The promotion of training in direct-acting anticoagulant drugs remains pivotal. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Judgements about fellow professionals and the management of patients receiving palliative care in primary care: a qualitative study

PubMed Central

Walshe, Catherine; Todd, Chris; Caress, Ann-Louise; Chew-Graham, Carolyn

2008-01-01

Background Policies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services. Aim To explore the influences on referrals within general and specialist community palliative care services. Design of study Qualitative, multiple-case study. Setting Three primary care trusts in the north-west of England. Method Multiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals. Results Judgements — positive and negative — about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional ‘game playing’ to achieve professionals' desired outcomes. Conclusion Palliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care. PMID:18494176

Primary Schooling and Economic Development: A Review of the Evidence. World Bank Staff Working Paper No. 399.

ERIC Educational Resources Information Center

Colclough, Christopher

By reviewing pertinent studies and data, this paper seeks to define the economic benefits of primary schooling within a worldwide context. The author concludes that investment in primary schooling results in more productivity at work and in the home. The returns from primary schooling in most developing countries are higher than from other forms…

["So I have no way of measuring": a portrait of health education groups in the city of São Paulo, Brazil].

PubMed

Vincha, Kellem Regina Rosendo; Vieira, Viviane Laudelino; Guerra, Lúcia Dias da Silva; Botelho, Fernanda Cangussu; Pava-Cárdenas, Alexandra; Cervato-Mancuso, Ana Maria

2017-09-28

: The study analyzed the social representations of primary health care professionals on evaluative processes of groups that work with food and nutrition, and described the educational strategies used in this care. This was a qualitative study from 2012 to 2014 in the city of São Paulo, Brazil, in which 48 interviews were analyzed. In the analysis of the interviews, for classification of the educational strategies in learning categories and contents, Bogdan & Biklen and Zabala were used, respectively. The evaluative processes used the collective subject discourse technique, based on Jodelet's social representations. Three learning contents were found in the educational strategies and four social representations of the evaluative processes which combined to reveal the presence of a conflict by a practice directed by the work process to quantitative and individual evaluative criteria and a health-promoting practice that used inclusive approaches and participant evaluation. In this practice, the study implicitly identified the presence of autonomy in health. The study revealed the need to acknowledge and systematize group planning as an educational tool that qualifies and empowers comprehensive care.

Work-Related Depression in Primary Care Teams in Brazil.

PubMed

da Silva, Andréa Tenório Correia; Lopes, Claudia de Souza; Susser, Ezra; Menezes, Paulo Rossi

2016-11-01

To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

A novel diamond micro-/nano-machining process for the generation of hierarchical micro-/nano-structures

NASA Astrophysics Data System (ADS)

Zhu, Zhiwei; To, Suet; Ehmann, Kornel F.; Xiao, Gaobo; Zhu, Wule

2016-03-01

A new mechanical micro-/nano-machining process that combines rotary spatial vibrations (RSV) of a diamond tool and the servo motions of the workpiece is proposed and applied for the generation of multi-tier hierarchical micro-/nano-structures. In the proposed micro-/nano-machining system, the servo motion, as the primary cutting motion generated by a slow-tool-servo, is adopted for the fine generation of the primary surfaces with complex shapes. The RSV, as the tertiary cutting operation, is superimposed on the secondary fundamental rotary cutting motion to construct secondary nano-structures on the primary surface. Since the RSV system generally works at much higher frequencies and motion resolution than the primary and secondary motions, it leads to an inherent hierarchical cutting architecture. To investigate the machining performance, complex micro-/nano-structures were generated and explored by both numerical simulations and actual cutting tests. Rotary vibrations of the diamond tool at a constant rotational distance offer an inherent constant cutting velocity, leading to the ability for the generation of homogeneous micro-/nano-structures with fixed amplitudes and frequencies of the vibrations, even over large-scale surfaces. Furthermore, by deliberately combining the non-resonant three-axial vibrations and the servo motion, the generation of a variety of micro-/nano-structures with complex shapes and with flexibly tunable feature sizes can be achieved.

Impact of improved recording of work-relatedness in primary care visits at occupational health services on sickness absences: study protocol for a randomised controlled trial.

PubMed

Atkins, Salla; Ojajärvi, Ulla; Talola, Nina; Viljamaa, Mervi; Nevalainen, Jaakko; Uitti, Jukka

2017-07-26

Employment protects and fosters health. Occupational health services, particularly in Finland, have a central role in protecting employee health and preventing work ability problems. However, primary care within occupational health services is currently underused in informing preventive activities. This study was designed to assess whether the recording of work ability problems and improvement of follow-up of work-related primary care visits can reduce sickness absences and work disability pensions after 1 year. A pragmatic trial will be conducted using patient electronic registers and registers of the central pensions agency in Finland. Twenty-two occupational health centres will be randomised to intervention and control groups. Intervention units will receive training to improve recording of work ability illnesses in the primary care setting and improved follow-up procedures. The intervention impact will be assessed through examining rates of sickness absence across intervention and control clinics as well as before and after the intervention. The trial will develop knowledge of the intervention potential of primary care for preventing work disability pensions and sickness absence. The use of routine patient registers and pensions registers to assess the outcomes of a randomised controlled trial will bring forward trial methodology, particularly when using register-based data. If successful, the intervention will improve the quality of occupational health care primary care and contribute to reducing work disability. ISRCTN Registry reference number ISRCTN45728263 . Registered on 18 April 2016.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.

PubMed

Militello, Laura G; Saleem, Jason J; Borders, Morgan R; Sushereba, Christen E; Haverkamp, Donald; Wolf, Steven P; Doebbeling, Bradley N

2016-03-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise

PubMed Central

Militello, Laura G.; Saleem, Jason J.; Borders, Morgan R.; Sushereba, Christen E.; Haverkamp, Donald; Wolf, Steven P.; Doebbeling, Bradley N.

2016-01-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration’s EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability. PMID:26973441

Assumption-aware tools and agency; an interrogation of the primary artifacts of the program evaluation and design profession in working with complex evaluands and complex contexts.

PubMed

Morrow, Nathan; Nkwake, Apollo M

2016-12-01

Like artisans in a professional guild, we evaluators create tools to suit our ever evolving practice. The tools we use as evaluators are the primary artifacts of our profession, reflect our practice and embody an amalgamation of paradigms and assumptions. With the increasing shifts in evaluation purposes from judging program worth to understanding how programs work, the evaluator's role is changing to that of facilitating stakeholders in a learning process. This involves clarifying purposes and choices, as well as unearthing critical assumptions. In such a role, evaluators become major tool-users and begin to innovate with small refinements or produce completely new tools to fit a specific challenge or context. We interrogate the form and function of 12 tools used by evaluators when working with complex evaluands and complex contexts. The form is described in terms of traditional qualitative techniques and particular characteristics of the elements, use and presentation of each tool. Then the function of each tool is analyzed with respect to articulating assumptions and affecting the agency of evaluators and stakeholders in complex contexts. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2016-12-01

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

Pseudoislets as primary islet replacements for research: report on a symposium at King's College London, London UK.

PubMed

Persaud, Shanta J; Arden, Catherine; Bergsten, Peter; Bone, Adrian J; Brown, James; Dunmore, Simon; Harrison, Moira; Hauge-Evans, Astrid; Kelly, Catriona; King, Aileen; Maffucci, Tania; Marriott, Claire E; McClenaghan, Neville; Morgan, Noel G; Reers, Christina; Russell, Mark A; Turner, Mark D; Willoughby, Emma; Younis, Mustafa Y G; Zhi, Z L; Jones, Peter M

2010-01-01

Laboratory-based research aimed at understanding processes regulating insulin secretion and mechanisms underlying β-cell dysfunction and loss in diabetes often makes use of rodents, as these processes are in many respects similar between rats/mice and humans. Indeed, a rough calculation suggests that islets have been isolated from as many as 150,000 rodents to generate the data contained within papers published in 2009 and the first four months of 2010. Rodent use for islet isolation has been mitigated, to a certain extent, by the availability of a variety of insulin-secreting cell lines that are used by researchers world-wide. However, when maintained as monolayers the cell lines do not replicate the robust, sustained secretory responses of primary islets which limits their usefulness as islet surrogates. On the other hand, there have been several reports that configuration of MIN6 β-cells, derived from a mouse insulinoma, as three-dimensional cell clusters termed ‘pseudoislets’ largely recapitulates the function of primary islet β-cells. The Diabetes Research Group at King’s College London has been using the MIN6 pseudoislet model for over a decade and they hosted a symposium on “Pseudoislets as primary islet replacements for research”, which was funded by the UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), in London on 15th and 16th April 2010. This small, focused meeting was conceived as an opportunity to consolidate information on experiences of working with pseudoislets between different UK labs, and to introduce the theory and practice of pseudoislet culture to laboratories working with islets and/or β-cell lines but who do not currently use pseudoislets. This short review summarizes the background to the development of the cell line-derived pseudoislet model, the key messages arising from the symposium and emerging themes for future pseudoislet research.

A medical home: value and implications of knowledge management.

PubMed

Orzano, A John; McInerney, Claire R; McDaniel, Reuben R; Meese, Abigail; Alajmi, Bibi; Mohr, Stewart M; Tallia, Alfred F

2009-01-01

Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution. We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives. Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants. Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home. Knowledge management differences occur within and between practices and can explain differences in performance. By relying more on social tools rather than costly, high-tech investment, KM leverages primary care's relationship-centered strength, facilitating practice redesign as a medical home.

Expectancies mediate the relationship between perceived injustice and return to work following whiplash injury: A 1-year prospective study.

PubMed

Carriere, J S; Thibault, P; Adams, H; Milioto, M; Ditto, B; Sullivan, M J L

2017-08-01

Emerging evidence suggests that perceived injustice is a risk factor for work disability in individuals with whiplash injury. At present, however, little is known about the processes by which perceived injustice impacts on return to work. The purpose of this study was to examine whether expectancies mediated the relationship between perceived injustice and return to work in patients with whiplash injury. One hundred and fifty-two individuals (81 men, 71 women) with a primary diagnosis of whiplash injury completed self-report measures of pain intensity, perceived injustice and return-to-work expectancies following admission to a rehabilitation programme. Work status was assessed 1 year after discharge. Consistent with previous research, high scores on a measure of perceived injustice were associated with prolonged work disability. Results indicated that high perceptions of injustice were associated with low return-to-work expectancies. Causal mediation analyses revealed that expectancies fully mediated the relationship between perceived injustice and return to work. The findings suggest that intervention techniques designed to target expectancies could improve return-to-work outcomes in patients with whiplash injury. Discussion addresses the processes by which expectancies might impact on return-to-work outcomes and the manner in which negative return-to-work expectancies might be modified through intervention. The study confirms that expectancies are the mechanism through which perceived injustice impacts return to work following whiplash injury. The findings suggest that interventions designed to specifically target return-to-work expectancies might improve rehabilitation outcomes in patients with whiplash injury. © 2017 European Pain Federation - EFIC®.

What do evaluations tell us about implementing new models in rural and remote primary health care? Findings from a narrative analysis of seven service evaluations conducted by an Australian Centre of Research Excellence.

PubMed

Lyle, David; Saurman, Emily; Kirby, Sue; Jones, Debra; Humphreys, John; Wakerman, John

2017-01-01

A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2012 with the goal of providing evidence to inform policy development to increase equity of access to quality health care and the identification of services that should be available to the diverse communities characterising Australia. This article reports on the key findings from seven CRE service evaluations to better understand what made these primary health care (PHC) models work where they worked, and why. We conducted a narrative synthesis of 15 articles reporting on seven CRE service evaluations of different PHC models published between 2012 and 2015. Three different contexts for PHC reform were evaluated: community, regional and clinic based. Themes identified were factors that enabled changes to PHC delivery, processes that supported services to improve access to PHC and requirements for service adaptation to promote sustainability. In both Indigenous and mainstream community settings, the active engagement with local communities, and their participation in, or leadership of, shared decision-making was reported across the three themes. In addition, local governance processes, informed by service activity and impact data, enabled these service changes to be sustained over time. The considerations were different for the outreach, regional and clinic services that relied on internal processes to drive change because they did not require the cooperation of multiple organisations to succeed. The review highlighted that shared decision-making, negotiation and consultation with communities is important and should be used to promote feasible strategies that improve access to community-based PHC services. There is a growing need for service evaluations to report on the feasibility, acceptability and fit of successful service models within context, in addition to reach and effectiveness in order to provide evidence for local dissemination, adaption and implementation strategies.

Membrane-based systems for carbon capture and hydrogen purification

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

Berchtold, Kathryn A

2010-11-24

This presentation describes the activities being conducted at Los Alamos National Laboratory to develop carbon capture technologies for power systems. This work is aimed at continued development and demonstration of a membrane based pre- and post-combustion carbon capture technology and separation schemes. Our primary work entails the development and demonstration of an innovative membrane technology for pre-combustion capture of carbon dioxide that operates over a broad range of conditions relevant to the power industry while meeting the US DOE's Carbon Sequestration Program goals of 90% CO{sub 2} capture at less than a 10% increase in the cost of energy services.more » Separating and capturing carbon dioxide from mixed gas streams is a first and critical step in carbon sequestration. To be technically and economically viable, a successful separation method must be applicable to industrially relevant gas streams at realistic temperatures and pressures as well as be compatible with large gas volumes. Our project team is developing polymer membranes based on polybenzimidazole (PBI) chemistries that can purify hydrogen and capture CO{sub 2} at industrially relevant temperatures. Our primary objectives are to develop and demonstrate polymer-based membrane chemistries, structures, deployment platforms, and sealing technologies that achieve the critical combination of high selectivity, high permeability, chemical stability, and mechanical stability all at elevated temperatures (> 150 C) and packaged in a scalable, economically viable, high area density system amenable to incorporation into an advanced Integrated Gasification Combined-Cycle (IGCC) plant for pre-combustion CO{sub 2} capture. Stability requirements are focused on tolerance to the primary synthesis gas components and impurities at various locations in the IGCC process. Since the process stream compositions and conditions (temperature and pressure) vary throughout the IGCC process, the project is focused on the optimization of a technology that could be positioned upstream or downstream of one or more of the water-gas-shift reactors (WGSRs) or integrated with a WGSR.« less

Economic assessment of single-walled carbon nanotube processes

NASA Astrophysics Data System (ADS)

Isaacs, J. A.; Tanwani, A.; Healy, M. L.; Dahlben, L. J.

2010-02-01

The carbon nanotube market is steadily growing and projected to reach 1.9 billion by 2010. This study examines the economics of manufacturing single-walled carbon nanotubes (SWNT) using process-based cost models developed for arc, CVD, and HiPco processes. Using assumed input parameters, manufacturing costs are calculated for 1 g SWNT for arc, CVD, and HiPco, totaling 1,906, 1,706, and 485, respectively. For each SWNT process, the synthesis and filtration steps showed the highest costs, with direct labor as a primary cost driver. Reductions in production costs are calculated for increased working hours per day and for increased synthesis reaction yield (SRY) in each process. The process-based cost models offer a means for exploring opportunities for cost reductions, and provide a structured system for comparisons among alternative SWNT manufacturing processes. Further, the models can be used to comprehensively evaluate additional scenarios on the economics of environmental, health, and safety best manufacturing practices.

Developing a mental health care plan in a low resource setting: the theory of change approach.

PubMed

Hailemariam, Maji; Fekadu, Abebaw; Selamu, Medhin; Alem, Atalay; Medhin, Girmay; Giorgis, Tedla Wolde; DeSilva, Mary; Breuer, Erica

2015-09-28

Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.

Job stress, coping and health perceptions of Hong Kong primary care nurses.

PubMed

Lee, Joseph K L

2003-04-01

Few empirical studies have investigated job stress, coping and health perceptions of nurses working in primary care settings. One thousand self-report questionnaires, which consisted of the modified Nursing Stress Scale, Coping with Work Stress Checklist and Health Perceptions Questionnaire, were distributed randomly to a group of Hong Kong nurses working in primary care settings, to examine issues related to job stress. Three hundred and sixty-two nurses responded. Findings indicated that nurses in these settings experienced low-to-moderate frequency of stress, adopted direct coping strategies, and perceived themselves as rather healthy. There were also statistically significant links between job stress, coping and perceived health status. The findings of this study suggest that job stress, coping and health perception of nurses working in primary care settings were distinct from their colleagues working in acute care settings.

Improvements in Operational Readiness by Distributing Manufacturing Capability in the Supply Chain through Additive Manufacturing

DTIC Science & Technology

2017-12-01

inefficiencies of a more complex system. Additional time may also be due to the longer distances traveled . The fulfillment time for a requisition to...Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time ...advanced manufacturing methods with additive manufacturing. This work decomposes the additive manufacturing processes into 11 primary functions. The time

Continuous quality improvement at work: the first team--Part II.

PubMed

Bolt, B J; Lehany-Trese, A M; Williams, T P

1995-01-01

This second part of a two-part article follows Cape Canaveral Hospital's first continuous quality improvement team through the processes of goal setting, system analysis, data gathering, and problem resolution in the area of patients' assignment to observation status. The team's primary goal was data-driven improvement. As detailed here, the team's solution to improve the use of observation status is both time-efficient and offers opportunities for financial gain.

Moving toward a United States strategic plan in primary care informatics: a White Paper of the Primary Care Informatics Working Group, American Medical Informatics Association.

PubMed

Little, David R; Zapp, John A; Mullins, Henry C; Zuckerman, Alan E; Teasdale, Sheila; Johnson, Kevin B

2003-01-01

The Primary Care Informatics Working Group (PCIWG) of the American Medical Informatics Association (AMIA) has identified the absence of a national strategy for primary care informatics. Under PCIWG leadership, major national and international societies have come together to create the National Alliance for Primary Care Informatics (NAPCI), to promote a connection between the informatics community and the organisations that support primary care. The PCIWG clinical practice subcommittee has recognised the necessity of a global needs assessment, and proposed work in point-of-care technology, clinical vocabularies, and ambulatory electronic medical record development. Educational needs include a consensus statement on informatics competencies, recommendations for curriculum and teaching methods, and methodologies to evaluate their effectiveness. The research subcommittee seeks to define a primary care informatics research agenda, and to support and disseminate informatics research throughout the primary care community. The AMIA board of directors has enthusiastically endorsed the conceptual basis for this White Paper.

Modelacio de sedimentadors en plantes de tractament d'aigues residuals. Aplicacio al proces de fermentacio - elutracio de fangs primaris

NASA Astrophysics Data System (ADS)

Ribes Bertomeu, Josep

Wastewater treatments require the execution of many conversion processes simultaneously and/or consecutively, making them a tricky object of study. Furthermore, complexity of treatment processes is increasing not only for the more stringent effluent standards required, but also for the new trends towards sustainable development, which in this process are mainly focused on energy saving and nutrient recovery from wastewaters in order to improve their life cycle. For this reason it becomes necessary to use simulation tools which are able to represent all these processes by means of a suitable mathematical model. They can help in determining and predicting the behaviour of the different treatment schemes. These simulators have become essential for the design, control and optimization of wastewater treatment plants (WWTP). Settling processes have a significant role in the accomplishment of effluent standards and the correct operation of the plant. However, many models that are currently employed for WWTP design and simulation do not take into account settling processes or they are handled in a very simple way, by neglecting the biochemical processes that can occur during sedimentation. People of CALAGUA research group have focussed their efforts towards a new philosophy of simulating treatment plants, which is based on the use of a unique model to represent all physical, chemical and biological processes taking place in WWTPs. In this research topic, they have worked on the development of a general quality model that considers biological conversion processes carried out by different microorganism groups, acid base chemical interactions affecting the pH value in the system, and gas-liquid transfer processes. However, a generalized use of such a quality model requires its combination with a flux model, principally for those processes where completely mixture can not be assumed, as for instance, settlers and thickeners in WWTPs. The main objective of this work has been the development and validation of a general settling model that allows simulating the main settling operations taking place in a WWTP, considering both primary and secondary settlers and thickeners. It consists in a one-dimensional model based on the flux theory of Kynch and the double-exponential settling function of Takacs that takes into account flocculation, hindered settling and compression processes. The model has been applied to simulation of settlers and thickeners by means of splitting the system into several horizontal layers, all of them considered as completely mixed reactors which are interconnected by mass flux obtained from the settling model. In order to simulate the conversion processes taking place during sedimentation, the general quality model BNRM1 has been added, and it has been proposed an iterative procedure for solving the equations for each layer in which the settler has been divided. The settling flux model validation, along with the quality model, has been carried out by applying them to a simulation of primary sludge fermentation - elutriation process. This process has been studied on a pilot plant located in the Carraixet WWTP in Alboraia (Valencia). In order to simulate the observed decrease in solids separation efficiency in the studied fermentation - elutriation process, the quality model has been modified with the addition of a new process called "disintegration of complex particulate material". This process influences the settleability of the sludge because it is considered that the disintegrated solids become non-settleable solids. This modification implies the addition of two new kinetic parameters (the specific disintegration velocity for volatile particulate material and the specific disintegration velocity for non volatile particulate material). However, the settling parameter that represents the non-settleable fraction of total suspended solids is eliminated from the model and it has been transformed into an experimental variable which is quite easy to analyze. The result of this modification is a more general model, which is applicable to fermentation - elutriation process working at any operating condition. Finally, the behaviour and capabilities of the developed model have been tested by simulating a complete WWTP on the DESASS simulation software, developed by the research group. This example includes the most important processes that can be used in a WWTP: biological nutrient removal, primary sludge fermentation and sludge digestion. The model allows considering both settling processes and biochemical processes as a whole (denitrification in secondary settlers, primary sludge fermentation and VFA elutriation, phosphorus release in thickeners because of the PAO decay, etc.). The developed model implies an important advance in study of new wastewater treatment processes because it allows dealing with global process optimization problems, by means of full plants simulation. It is very useful for studying the effects of a modification in operation conditions of one element over the operation of the rest of the elements of the WWTP. (Abstract shortened by UMI.).

Self-Reported Work and Family Stress of Female Primary Teachers.

ERIC Educational Resources Information Center

Thomas, Narelle; Clarke, Valerie; Lavery, Judy

2003-01-01

Results of a self-report questionnaire indicated that female primary teachers in Australia report moderate levels of global, work, and family stress. Time and workload pressure was the major work stressor, and responsibility for child rearing the major family stressor. Work stress and home stress both impacted on each other. (EV)

29 CFR 793.13 - Limitation on related and incidental work.

Code of Federal Regulations, 2010 CFR

2010-07-01

... related work which an employee may perform is clearly limited in nature and extent by a number of requirements. One limitation is that the work must be an incident to the employee's primary occupation. The... must constitute his primary job. Another requirement is that the work of the employees must be...

One service, many voices: enhancing consumer participation in a primary health service for multicultural women.

PubMed

Lee, Susan K; Thompson, Sandra C; Amorin-Woods, Deisy

2009-01-01

Consumer participation in primary health care is important in providing quality consumer-focused care, but challenging when working with disadvantaged groups of diverse cultural and linguistic backgrounds. Women's Health Services (WHS) works with women from over 60 different nationalities, including many newly arrived migrants and refugees. New arrivals access a wide range of WHS programmes including medical services, counselling, information, community talks and workshops, referral, and outreach, but few ethnic women attended the alcohol and other drug (AOD) services offered by the organisation. To establish an active consumer reference group to assist understanding and reducing the barriers to AOD services for a heterogeneous disadvantaged group that includes individuals from different cultural, language and educational backgrounds. Leaning heavily on experiences from the mental health field, WHS overcame many practical and philosophical considerations which included: agreeing upon the purpose of the group and how it would operate within the structure of the organisation; the level of English language required by participants for the group to function; issues of resourcing the group; and ensuring an appropriate, workable demographic mix in terms of age, language, and migration experiences. The process and the outcome of establishing a consumer reference group (CRG) in a primary healthcare setting has been valuable for consumers' and health service providers within the organisation.

[Relaunching primary healthcaree].

PubMed

Marcolongo, Adriano; Talarico, Francesco

2014-01-01

The health environment today is characterized by diffuse inequalities, the emergence of chronic diseases, and the introduction of new technologies, all of which, together with other factors are leading to a healthcare system that is becoming increasingly less sustainable from a financial point of view. Primary healthcare, public health and hospitals should work together to define a comprehensive healthcare delivery model characterized by continuity of care, information and management. The proposed model of disease management, in particular of chronic diseases, must reorganize health services around the needs of citizens and the community and involve patients and their families in the disease management process, by promoting self-help groups and patient organizations that cooperate with health services. In order to put this change into effect, evidence-based medicine and evidence-based practice need to be adopted. From an organizational point of view, it will be important to change wage rules, so as to implement a new payment system based upon performance. In this new contest, physicians specialized in hygiene and public health can play an important role that includes leadership, governance and coordination. By integrating the concepts of accountability, community intervention and training, we can acquire the tools to change the current hospital-based system to a new model of primary healthcare that works together with the community to move the focus from healthcare provider to patient.

[Application of spatial working memory task fMRI in evaluation of primary insomnia patient's cognitive dysfunction].

PubMed

Dou, Shewei; Wang, Enfeng; Zhang, Hongju; Tong, Li; Zhang, Xiaoqi; Shi, Dapeng; Cheng, Jingliang; Li, Yongli

2015-06-02

To explore abnormal brain activation of spatial working memory in primary insomnia and its potential neuromechanism. we recruited 30 cases primary insomnia (PI) patients and 30 cases age, gender matched healthy control (HC) subjects from July 2013 to December 2013, the diagnosis of primary insomnia matched the diagnosis criterion of DSM-IV and Classification and diagnostic criteria of mental disorders in China third edition (CCMD-3). All the subjects attended the tests of PSQI, HAMA, HAMD and index of spatial working memory. And then, we collected the data of routine MRI and spatial working memory task fMRI on 3.0 T MRI scanner. After that, we used SPM8 and REST1.8 to analyze the fMRI data, compared difference of PSQI, HAMA, HAMD, index of spatial working memory and brain activation of spatial working memory between PI group and HC group. There were significant difference between PI group and HC group in PSQI, HAMA, HAMD and index of spatial working memory (P < 0.05). In the spatial working memory related activate brain region, compared with HC group, left temporal lobe, occipital lobe and right frontal lobe activation increased and bilateral parahippocampalis, temporal cortex, frontal cortex and superior parietal lobule activation reduced in PI group. Spatial working memory task fMRI revealed the pathological mechanisms of cognitive dysfunction of clinical spatial working memory and emotional disorder in primary insomnia patients.

The aluminum smelting process and innovative alternative technologies.

PubMed

Kvande, Halvor; Drabløs, Per Arne

2014-05-01

The industrial aluminum production process is addressed. The purpose is to give a short but comprehensive description of the electrolysis cell technology, the raw materials used, and the health and safety relevance of the process. This article is based on a study of the extensive chemical and medical literature on primary aluminum production. At present, there are two main technological challenges for the process--to reduce energy consumption and to mitigate greenhouse gas emissions. A future step may be carbon dioxide gas capture and sequestration related to the electric power generation from fossil sources. Workers' health and safety have now become an integrated part of the aluminum business. Work-related injuries and illnesses are preventable, and the ultimate goal to eliminate accidents with lost-time injuries may hopefully be approached in the future.

Process feasibility study in support of silicon material, task 1

NASA Technical Reports Server (NTRS)

Li, K. Y.; Hansen, K. C.; Yaws, C. L.

1979-01-01

Analyses of process system properties were continued for materials involved in the alternate processes under consideration for semiconductor silicon. Primary efforts centered on physical and thermodynamic property data for dichlorosilane. The following property data are reported for dichlorosilane which is involved in processing operations for solar cell grade silicon: critical temperature, critical pressure, critical volume, critical density, acentric factor, vapor pressure, heat of vaporization, gas heat capacity, liquid heat capacity and density. Work was initiated on the assembly of a system to prepare binary gas mixtures of known proportions and to measure the thermal conductivity of these mixtures between 30 and 350 C. The binary gas mixtures include silicon source material such as silanes and halogenated silanes which are used in the production of semiconductor silicon.

All in a Day's Work: Primary Teachers "Performing" and "Caring"

ERIC Educational Resources Information Center

Forrester, Gillian

2005-01-01

This article discusses the current nature of primary teachers' work, which is explored in terms of "performing" and "caring" activities. It considers how the education policies of successive Governments in the UK, particularly for England, have given rise to a "performance culture" in primary schools which emphasises…

The Effect of Noise on the Relationship Between Auditory Working Memory and Comprehension in School-Age Children.

PubMed

Sullivan, Jessica R; Osman, Homira; Schafer, Erin C

2015-06-01

The objectives of the current study were to examine the effect of noise (-5 dB SNR) on auditory comprehension and to examine its relationship with working memory. It was hypothesized that noise has a negative impact on information processing, auditory working memory, and comprehension. Children with normal hearing between the ages of 8 and 10 years were administered working memory and comprehension tasks in quiet and noise. The comprehension measure comprised 5 domains: main idea, details, reasoning, vocabulary, and understanding messages. Performance on auditory working memory and comprehension tasks were significantly poorer in noise than in quiet. The reasoning, details, understanding, and vocabulary subtests were particularly affected in noise (p < .05). The relationship between auditory working memory and comprehension was stronger in noise than in quiet, suggesting an increased contribution of working memory. These data suggest that school-age children's auditory working memory and comprehension are negatively affected by noise. Performance on comprehension tasks in noise is strongly related to demands placed on working memory, supporting the theory that degrading listening conditions draws resources away from the primary task.

Four Mechanistic Models of Peer Influence on Adolescent Cannabis Use.

PubMed

Caouette, Justin D; Feldstein Ewing, Sarah W

2017-06-01

Most adolescents begin exploring cannabis in peer contexts, but the neural mechanisms that underlie peer influence on adolescent cannabis use are still unknown. This theoretical overview elucidates the intersecting roles of neural function and peer factors in cannabis use in adolescents. Novel paradigms using functional magnetic resonance imaging (fMRI) in adolescents have identified distinct neural mechanisms of risk decision-making and incentive processing in peer contexts, centered on reward-motivation and affect regulatory neural networks; these findings inform a theoretical model of peer-driven cannabis use decisions in adolescents. We propose four "mechanistic profiles" of social facilitation of cannabis use in adolescents: (1) peer influence as the primary driver of use; (2) cannabis exploration as the primary driver, which may be enhanced in peer contexts; (3) social anxiety; and (4) negative peer experiences. Identification of "neural targets" involved in motivating cannabis use may inform clinicians about which treatment strategies work best in adolescents with cannabis use problems, and via which social and neurocognitive processes.

A design for an intelligent monitor and controller for space station electrical power using parallel distributed problem solving

NASA Technical Reports Server (NTRS)

Morris, Robert A.

1990-01-01

The emphasis is on defining a set of communicating processes for intelligent spacecraft secondary power distribution and control. The computer hardware and software implementation platform for this work is that of the ADEPTS project at the Johnson Space Center (JSC). The electrical power system design which was used as the basis for this research is that of Space Station Freedom, although the functionality of the processes defined here generalize to any permanent manned space power control application. First, the Space Station Electrical Power Subsystem (EPS) hardware to be monitored is described, followed by a set of scenarios describing typical monitor and control activity. Then, the parallel distributed problem solving approach to knowledge engineering is introduced. There follows a two-step presentation of the intelligent software design for secondary power control. The first step decomposes the problem of monitoring and control into three primary functions. Each of the primary functions is described in detail. Suggestions for refinements and embelishments in design specifications are given.

[Computer usage among primary health care physicians in the Vukovar-Srijem County].

PubMed

Iveković, Hrvoje

2002-01-01

A survey was carried out, aiming at identification of the current usage of computers among primary health care physicians of the Vukovar-Srijem County. The results indicated poor knowledge and practice concerning the computer usage among examinees: 58% of the responders are not aware of the possibilities of computer usage in a GP office and 82% have not had an opportunity to see the software specialised for usage at GP offices. The results obtained from this survey indicate that none of the examinees use computer during daily routine work at the GP office. Only 26% of the examinees have got a computer, and use it at home, mostly for text processing. The Internet is used actively by 8% of examinees. Lack of education and equipment have been identified as main obstacles in the process of introducing computers to GP offices. Positive attitude towards computer usage has been identified, representing an important stimulus towards a more active role of the health centres management in solving this problem.

Large-scale Topographical Screen for Investigation of Physical Neural-Guidance Cues

NASA Astrophysics Data System (ADS)

Li, Wei; Tang, Qing Yuan; Jadhav, Amol D.; Narang, Ankit; Qian, Wei Xian; Shi, Peng; Pang, Stella W.

2015-03-01

A combinatorial approach was used to present primary neurons with a large library of topographical features in the form of micropatterned substrate for high-throughput screening of physical neural-guidance cues that can effectively promote different aspects of neuronal development, including axon and dendritic outgrowth. Notably, the neuronal-guidance capability of specific features was automatically identified using a customized image processing software, thus significantly increasing the screening throughput with minimal subjective bias. Our results indicate that the anisotropic topographies promote axonal and in some cases dendritic extension relative to the isotropic topographies, while dendritic branching showed preference to plain substrates over the microscale features. The results from this work can be readily applied towards engineering novel biomaterials with precise surface topography that can serve as guidance conduits for neuro-regenerative applications. This novel topographical screening strategy combined with the automated processing capability can also be used for high-throughput screening of chemical or genetic regulatory factors in primary neurons.

Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

PubMed

Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

2012-01-01

The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

Design of a liquid membrane target for high repetition rate neutron generation

NASA Astrophysics Data System (ADS)

Poole, Patrick; Andereck, C. David; Storm, Mike; Schumacher, Douglass

2013-10-01

Ultra-bright, pulsed, spatially-small sources of energetic neutrons have applications in radiography and non-destructive remote sensing. Neutrons can be generated by a process wherein ions accelerated from a laser-irradiated primary target subsequently bombard a converter material, causing neutron-producing nuclear reactions, such as 7Li(d,n)8Be. Deuterons from this process are suppressed by contamination that builds up on the rear of the solid primary target. To eliminate this issue we propose a self-replenishing liquid membrane target consisting of heavy water and deuterated surfactant, formed in-vacuum within a moveable wire frame. In addition to removing issues associated with solid target positioning and collateral damage, this apparatus provides flow rate and target thickness control, and allows for the high repetition rates required to generate desired neutron fluxes with a portable laser-based system. The apparatus design will be presented, as well as a novel interferometric method that measures the membrane thickness using tightly-focused light. This work was performed with support from DARPA.

Experimental and Computational Studies of Cortical Neural Network Properties Through Signal Processing

NASA Astrophysics Data System (ADS)

Clawson, Wesley Patrick

Previous studies, both theoretical and experimental, of network level dynamics in the cerebral cortex show evidence for a statistical phenomenon called criticality; a phenomenon originally studied in the context of phase transitions in physical systems and that is associated with favorable information processing in the context of the brain. The focus of this thesis is to expand upon past results with new experimentation and modeling to show a relationship between criticality and the ability to detect and discriminate sensory input. A line of theoretical work predicts maximal sensory discrimination as a functional benefit of criticality, which can then be characterized using mutual information between sensory input, visual stimulus, and neural response,. The primary finding of our experiments in the visual cortex in turtles and neuronal network modeling confirms this theoretical prediction. We show that sensory discrimination is maximized when visual cortex operates near criticality. In addition to presenting this primary finding in detail, this thesis will also address our preliminary results on change-point-detection in experimentally measured cortical dynamics.

Use of Portal Monitors for Detection of Technogenic Radioactive Sources in Scrap Metal

NASA Astrophysics Data System (ADS)

Solovev, D. B.; Merkusheva, A. E.

2017-11-01

The article considers the features of organization of scrap-metal primary radiation control on the specialized enterprises engaging in its deep processing and storage at using by primary technical equipment - radiation portal monitors. The issue of this direction relevance, validity of radiation control implementation with the use of radiation portal monitors, physical and organizational bases of radiation control are considered in detail. The emphasis is put on the considerable increase in the number of technogenic radioactive sources detected in scrap-metal that results in the entering into exploitation of radioactive metallic structures as different building wares. One of reasons of such increase of the number of technogenic radioactive sources getting for processing with scrap-metal is the absence of any recommendations on the radiation portal monitors exploitation. The practical division of the article offers to recommendation on tuning of the modes of work of radiation portal monitors depending on influence the weather factor thus allowing to considerably increase the percent of technogenic radioactive sources detection.

Exploring Situational Awareness in Diagnostic Errors in Primary Care

PubMed Central

Singh, Hardeep; Giardina, Traber Davis; Petersen, Laura A.; Smith, Michael; Wilson, Lindsey; Dismukes, Key; Bhagwath, Gayathri; Thomas, Eric J.

2013-01-01

Objective Diagnostic errors in primary care are harmful but poorly studied. To facilitate understanding of diagnostic errors in real-world primary care settings using electronic health records (EHRs), this study explored the use of the Situational Awareness (SA) framework from aviation human factors research. Methods A mixed-methods study was conducted involving reviews of EHR data followed by semi-structured interviews of selected providers from two institutions in the US. The study population included 380 consecutive patients with colorectal and lung cancers diagnosed between February 2008 and January 2009. Using a pre-tested data collection instrument, trained physicians identified diagnostic errors, defined as lack of timely action on one or more established indications for diagnostic work-up for lung and colorectal cancers. Twenty-six providers involved in cases with and without errors were interviewed. Interviews probed for providers' lack of SA and how this may have influenced the diagnostic process. Results Of 254 cases meeting inclusion criteria, errors were found in 30 (32.6%) of 92 lung cancer cases and 56 (33.5%) of 167 colorectal cancer cases. Analysis of interviews related to error cases revealed evidence of lack of one of four levels of SA applicable to primary care practice: information perception, information comprehension, forecasting future events, and choosing appropriate action based on the first three levels. In cases without error, the application of the SA framework provided insight into processes involved in attention management. Conclusions A framework of SA can help analyze and understand diagnostic errors in primary care settings that use EHRs. PMID:21890757

Role of GIS in social sector planning: can developing countries benefit from the examples of primary health care (PHC) planning in Britain?

PubMed

Ishfaq, Mohammad; Lodhi, Bilal Khan

2012-04-01

Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary health care is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary health care. This paper examines the scope of GIS in social sector planning by concentration on primary health care delivery system in Pakistan. The work is based on example of the UK's decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities' needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for health care, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary health care planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change.

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.

Developing a Decision Support System for Tobacco Use Counseling Using Primary Care Physicians

PubMed Central

Marcy, Theodore W.; Kaplan, Bonnie; Connolly, Scott W.; Michel, George; Shiffman, Richard N.; Flynn, Brian S.

2009-01-01

Background Clinical decision support systems (CDSS) have the potential to improve adherence to guidelines, but only if they are designed to work in the complex environment of ambulatory clinics as otherwise physicians may not use them. Objective To gain input from primary care physicians in designing a CDSS for smoking cessation to ensure that the design is appropriate to a clinical environment before attempts to test this CDSS in a clinical trial. This approach is of general interest to those designing similar systems. Design and Approach We employed an iterative ethnographic process that used multiple evaluation methods to understand physician preferences and workflow integration. Using results from our prior survey of physicians and clinic managers, we developed a prototype CDSS, validated content and design with an expert panel, and then subjected it to usability testing by physicians, followed by iterative design changes based on their feedback. We then performed clinical testing with individual patients, and conducted field tests of the CDSS in two primary care clinics during which four physicians used it for routine patient visits. Results The CDSS prototype was substantially modified through these cycles of usability and clinical testing, including removing a potentially fatal design flaw. During field tests in primary care clinics, physicians incorporated the final CDSS prototype into their workflow, and used it to assist in smoking cessation interventions up to eight times daily. Conclusions A multi-method evaluation process utilizing primary care physicians proved useful for developing a CDSS that was acceptable to physicians and patients, and feasible to use in their clinical environment. PMID:18713526

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.

Stress corrosion crack initiation of alloy 600 in PWR primary water

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

Zhai, Ziqing; Toloczko, Mychailo B.; Olszta, Matthew J.

Stress corrosion crack (SCC) initiation of three mill-annealed (MA) alloy 600 heats in simulated pressurized water reactor primary water has been investigated using constant load tests equipped with in-situ direct current potential drop (DCPD) measurement capabilities. SCC initiation times were greatly reduced by a small amount of cold work. Shallow intergranular (IG) attack and/or cracks were found on most high-energy grain boundaries intersecting the surface with only a small fraction evolving into larger cracks and IGSCC growth. Crack depth profiles were measured and related to DCPD-detected initiation response. Processes controlling the SCC initiation in MA alloy 600 are discussed. INmore » PRESS, CORRECTED PROOF, 05/02/2017 - mfl« less

Detailed requirements document for the Interactive Financial Management System (IFMS), volume 1

NASA Technical Reports Server (NTRS)

Dodson, D. B.

1975-01-01

The detailed requirements for phase 1 (online fund control, subauthorization accounting, and accounts receivable functional capabilities) of the Interactive Financial Management System (IFMS) are described. This includes information on the following: systems requirements, performance requirements, test requirements, and production implementation. Most of the work is centered on systems requirements, and includes discussions on the following processes: resources authority, allotment, primary work authorization, reimbursable order acceptance, purchase request, obligation, cost accrual, cost distribution, disbursement, subauthorization performance, travel, accounts receivable, payroll, property, edit table maintenance, end-of-year, backup input. Other subjects covered include: external systems interfaces, general inquiries, general report requirements, communication requirements, and miscellaneous. Subjects covered under performance requirements include: response time, processing volumes, system reliability, and accuracy. Under test requirements come test data sources, general test approach, and acceptance criteria. Under production implementation come data base establishment, operational stages, and operational requirements.

The Value of Animations in Biology Teaching: A Study of Long-Term Memory Retention

PubMed Central

2007-01-01

Previous work has established that a narrated animation is more effective at communicating a complex biological process (signal transduction) than the equivalent graphic with figure legend. To my knowledge, no study has been done in any subject area on the effectiveness of animations versus graphics in the long-term retention of information, a primary and critical issue in studies of teaching and learning. In this study, involving 393 student responses, three different animations and two graphics—one with and one lacking a legend—were used to determine the long-term retention of information. The results show that students retain more information 21 d after viewing an animation without narration compared with an equivalent graphic whether or not that graphic had a legend. Students' comments provide additional insight into the value of animations in the pedagogical process, and suggestions for future work are proposed. PMID:17785404

The value of animations in biology teaching: a study of long-term memory retention.

PubMed

O'Day, Danton H

2007-01-01

Previous work has established that a narrated animation is more effective at communicating a complex biological process (signal transduction) than the equivalent graphic with figure legend. To my knowledge, no study has been done in any subject area on the effectiveness of animations versus graphics in the long-term retention of information, a primary and critical issue in studies of teaching and learning. In this study, involving 393 student responses, three different animations and two graphics-one with and one lacking a legend-were used to determine the long-term retention of information. The results show that students retain more information 21 d after viewing an animation without narration compared with an equivalent graphic whether or not that graphic had a legend. Students' comments provide additional insight into the value of animations in the pedagogical process, and suggestions for future work are proposed.

Teams and Teamwork During a Cancer Diagnosis: Interdependency Within and Between Teams

PubMed Central

Taplin, Stephen H.; Weaver, Sallie; Chollette, Veronica; Marks, Lawrence B.; Jacobs, Andrew; Schiff, Gordon; Stricker, Carrie T.; Bruinooge, Suanna S.; Salas, Eduardo

2015-01-01

This article discusses the care process among three groups (primary care, radiology, and surgery) aiding a 57-year-old woman during her screening mammography and diagnosis of breast cancer. This is the first in a series of articles exploring principles and topics relevant to teams guiding clinicians involved in cancer care. The challenges demonstrated in this case illustrate how clinicians work within and between groups to deliver this first phase of cancer care. The case helps demonstrate the differences between groups and teams. Focusing on the patient and the overall process of care coordination can help move groups toward becoming teams who deliver better care by identifying and managing goals, roles, and interdependent care tasks. Care providers and researchers can use the case to consider their own work and essential aspects of teamwork needed to improve care, patient outcomes, and the evidence that supports each. PMID:25873059

Estimating the executive demands of a one-back choice reaction time task by means of the selective interference paradigm.

PubMed

Szmalec, Arnaud; Vandierendonck, André

2007-08-01

The present study proposes a new executive task, the one-back choice reaction time (RT) task, and implements the selective interference paradigm to estimate the executive demands of the processing components involved in this task. Based on the similarities between a one-back choice RT task and the n-back updating task, it was hypothesized that one-back delaying of a choice reaction involves executive control. In three experiments, framed within Baddeley's (1986) working-memory model, a one-back choice RT task, a choice RT task, articulatory suppression, and matrix tapping were performed concurrently with primary tasks involving verbal, visuospatial, and executive processing. The results demonstrate that one-back delaying of a choice reaction interferes with tasks requiring executive control, while the potential interference at the level of the verbal or visuospatial working memory slave systems remains minimal.

Secondary ion emission from Ti, V, Cu, Ag and Au surfaces under KeV Cs + irradiation

NASA Astrophysics Data System (ADS)

van der Heide, P. A. W.

2005-02-01

Low energy mono-atomic singly charged secondary ion emissions from Ti, V, Cu, Ag and Au substrates during the initial stages of sputtering with Cs + primary ions have been studied. With the exception of the Ag - secondary ions, all exhibited exponential like correlations with the Cs induced work function changes. This, along with the lack of variations in the valence band structure around the Fermi edge, is consistent with resonance charge transfer to/from states located at the Fermi edge. The insensitivity of Ag - to work function appears to stem from the dominance of a separate ion formation process, namely charge transfer into vacant 4d states in the sputtered population, which themselves appear to be produced through collective oscillations. A similar excitation-mediated process involving different levels also appears to be active in the formation of other negatively charged transition metal ions, albeit to a much lesser degree.

Functional abdominal pain in childhood: Background studies and recent research trends

PubMed Central

Levy, Rona L; van Tilburg, Miranda AL

2012-01-01

The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors’ research program. Specific areas discussed based on work within the authors’ group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research. PMID:23248815

Working memory as separable subsystems: a study with Portuguese primary school children.

PubMed

Campos, Isabel S; Almeida, Leandro S; Ferreira, Aristides I; Martinez, Luis F

2013-01-01

Although much research has been done to study the working memory structure in children in their first school years, the relation of cognitive constructs involved in this process remains uncertain. In particular, it is unclear whether working memory is a domain general construct that coordinates separate codes of verbal and visuospatial storage or whether it is a domain-specific construct with distinct resources of verbal and visuospatial information. This paper investigates the structure of working memory, by using the Working Memory Test Battery for Children (WMTB-C) and by doing confirmatory factor analyses (CFAs) on a sample of Portuguese children (n = 103) between 8 and 9 years of age. The results of the confirmatory factor analyses that provide the best fit of the data correspond to the model that includes Central Executive and Visuospatial Sketchpad in the same factor, co-varying with a Phonological Loop factor. Moreover, the traditional working memory tripartite structure--based on the Baddeley and Hitch Model--revealed good fit to the data.

The Developmental Influence of Primary Memory Capacity on Working Memory and Academic Achievement

PubMed Central

2015-01-01

In this study, we investigate the development of primary memory capacity among children. Children between the ages of 5 and 8 completed 3 novel tasks (split span, interleaved lists, and a modified free-recall task) that measured primary memory by estimating the number of items in the focus of attention that could be spontaneously recalled in serial order. These tasks were calibrated against traditional measures of simple and complex span. Clear age-related changes in these primary memory estimates were observed. There were marked individual differences in primary memory capacity, but each novel measure was predictive of simple span performance. Among older children, each measure shared variance with reading and mathematics performance, whereas for younger children, the interleaved lists task was the strongest single predictor of academic ability. We argue that these novel tasks have considerable potential for the measurement of primary memory capacity and provide new, complementary ways of measuring the transient memory processes that predict academic performance. The interleaved lists task also shared features with interference control tasks, and our findings suggest that young children have a particular difficulty in resisting distraction and that variance in the ability to resist distraction is also shared with measures of educational attainment. PMID:26075630

The developmental influence of primary memory capacity on working memory and academic achievement.

PubMed

Hall, Debbora; Jarrold, Christopher; Towse, John N; Zarandi, Amy L

2015-08-01

In this study, we investigate the development of primary memory capacity among children. Children between the ages of 5 and 8 completed 3 novel tasks (split span, interleaved lists, and a modified free-recall task) that measured primary memory by estimating the number of items in the focus of attention that could be spontaneously recalled in serial order. These tasks were calibrated against traditional measures of simple and complex span. Clear age-related changes in these primary memory estimates were observed. There were marked individual differences in primary memory capacity, but each novel measure was predictive of simple span performance. Among older children, each measure shared variance with reading and mathematics performance, whereas for younger children, the interleaved lists task was the strongest single predictor of academic ability. We argue that these novel tasks have considerable potential for the measurement of primary memory capacity and provide new, complementary ways of measuring the transient memory processes that predict academic performance. The interleaved lists task also shared features with interference control tasks, and our findings suggest that young children have a particular difficulty in resisting distraction and that variance in the ability to resist distraction is also shared with measures of educational attainment. (c) 2015 APA, all rights reserved).

Health technology assessment and primary data collection for reducing uncertainty in decision making.

PubMed

Goeree, Ron; Levin, Les; Chandra, Kiran; Bowen, James M; Blackhouse, Gord; Tarride, Jean-Eric; Burke, Natasha; Bischof, Matthias; Xie, Feng; O'Reilly, Daria

2009-05-01

Health care expenditures continue to escalate, and pressures for increased spending will continue. Health care decision makers from publicly financed systems, private insurance companies, or even from individual health care institutions, will continue to be faced with making difficult purchasing, access, and reimbursement decisions. As a result, decision makers are increasingly turning to evidence-based platforms to help control costs and make the most efficient use of existing resources. Most tools used to assist with evidence-based decision making focus on clinical outcomes. Health technology assessment (HTA) is increasing in popularity because it also considers other factors important for decision making, such as cost, social and ethical values, legal issues, and factors such as the feasibility of implementation. In some jurisdictions, HTAs have also been supplemented with primary data collection to help address uncertainty that may still exist after conducting a traditional HTA. The HTA process adopted in Ontario, Canada, is unique in that assessments are also made to determine what primary data research should be conducted and what should be collected in these studies. In this article, concerns with the traditional HTA process are discussed, followed by a description of the HTA process that has been established in Ontario, with a particular focus on the data collection program followed by the Programs for Assessment of Technology in Health Research Institute. An illustrative example is used to show how the Ontario HTA process works and the role value of information analyses plays in addressing decision uncertainty, determining research feasibility, and determining study data collection needs.

Implementing programs for chronic illness management: the case of hypertension services.

PubMed

Christianson, J B; Pietz, L; Taylor, R; Woolley, A; Knutson, D J

1997-11-01

This article describes the process by which HealthSystem Minnesota (a vertically integrated health care organization), functioning in a competitive managed care environment, has been implementing a hypertension services program. The program involves a team approach to care, with emphasis on patient participation in treatment; decentralized care delivery by nurse coordinators at primary care practice sites; ongoing training and education for patients and providers; and the continuous monitoring and evaluation of patient outcomes and satisfaction. JOB-LEVEL ISSUES: A variety of issues, such as the role and responsibilities of the nurse coordinator, became evident as the program moved towards operational status at four primary care practice sites, which prolonged the implementation period. PROCESS-LEVEL ISSUES: Issues relating to work process changes were more complicated to resolve and required, in some cases, changes in the proposed model. The most significant process-level issues related to educating physicians about the program to secure their participation and support. ORGANIZATION-LEVEL ISSUES: Such issues, which were the most difficult for program implementors to anticipate and resolve, included an organizational culture that emphasized decision making autonomy at primary practice sites. In part, the difficulty encountered in resolving organization-level issues reflected the implementors' lack of awareness of the strength or complexity of the environmental pressures facing the organization, as well as a lack of sensitivity to nuances relating to organizational culture. Two groups of hypertensive patients--at the implementation and comparison sites--will be compared with respect to satisfaction with care, clinical outcomes, and costs. Expansion of the model to patients with other chronic conditions is under consideration.

Influence of income, hours worked, and loan repayment on medical students' decision to pursue a primary care career.

PubMed

Rosenthal, M P; Diamond, J J; Rabinowitz, H K; Bauer, L C; Jones, R L; Kearl, G W; Kelly, R B; Sheets, K J; Jaffe, A; Jonas, A P

To assess the specialty plans of current fourth-year medical students and, for those not choosing primary care specialties, to investigate the potential effect that changes in key economic or lifestyle factors could have in attracting such students to primary care. A survey study was sent to 901 fourth-year medical students in the 1993 graduating classes of six US medical schools. Comparisons were made between students choosing and not choosing primary care specialties. For the non-primary care students, we also evaluated whether alteration of income, hours worked, or loan repayment could attract them to primary care careers. Of the 688 responses (76% response rate), primary care specialties were chosen by 27% of the students and non-primary care specialties by 73%. One quarter (25%) of the non-primary care students indicated they would change to primary care for one of the following factors: income (10%), hours worked (11%), or loan repayment (4%). For students whose debt was $50,000 or greater, the loan repayment option became much more important than for students with lesser debt. In all, a total of 45% (n = 313) of the students indicated either they were planning to enter primary care (n = 188) or they would change to a primary care specialty (n = 125) with appropriate adjustments in income, hours worked, or loan repayment. Significant changes in economic and lifestyle factors could have a direct effect on the ability to attract students to primary care. Including such changes as part of health system reform, especially within the context of a supportive medical school environment, could enable the United States to approach a goal of graduating 50% generalist physicians.

Primary Child Health Care Nurses' assessment of health risks in children of foreign origin and their parents--a theoretical model.

PubMed

Berlin, Anita; Hylander, Ingrid; Törnkvist, Lena

2008-03-01

According to recent studies, intercultural interaction in health care between clients and care-givers seems to be problematic. A recent Swedish study revealed that a majority of Primary Child Health Care Nurses (PCHNurses) experienced difficulties in their interaction with children and parents of foreign origin. As every third child in the Primary Child Heath Care (PCHC) services is of foreign origin it seem to be of utmost importance to examine in depth how these difficulties could be understood and explained. The present study aimed at a theoretical explanation of the core problem concerning PCHNurses' interaction with children and parents of foreign origin, as experienced by the PCHNurses. Fifteen PCHNurses working in the PCHC services were interviewed. Grounded Theory was used as research methodology because focus is on social interactions and the aim is to theoretically explain unarticulated social processes. Anxiety about missing children, exposed to risks of ill-health, due to various conditions in the child's home environment, turned out to be the PCHNurses' main concern. An assessment of health risks was initiated, when PCHNurses thought that psychosocial conditions in the child's environment might cause ill health. Some of the psychosocial conditions were difficult to assess, as they were unfamiliar and not understood by the PCHNurses. In such difficult-to-assess cases, when the PCHNurses considered the possibility of undefined risk to the child's health they held on to the assessment of the cases and worked out strategies to learn and understand more about the child and the child's home environment. A theoretical model grounded in data was created accounting for the variation in the assessment process and the different strategies used. Implications are discussed and recommendations for improvements are given.

Developmental trajectories of children's symbolic numerical magnitude processing skills and associated cognitive competencies.

PubMed

Vanbinst, Kiran; Ceulemans, Eva; Peters, Lien; Ghesquière, Pol; De Smedt, Bert

2018-02-01

Although symbolic numerical magnitude processing skills are key for learning arithmetic, their developmental trajectories remain unknown. Therefore, we delineated during the first 3years of primary education (5-8years of age) groups with distinguishable developmental trajectories of symbolic numerical magnitude processing skills using a model-based clustering approach. Three clusters were identified and were labeled as inaccurate, accurate but slow, and accurate and fast. The clusters did not differ in age, sex, socioeconomic status, or IQ. We also tested whether these clusters differed in domain-specific (nonsymbolic magnitude processing and digit identification) and domain-general (visuospatial short-term memory, verbal working memory, and processing speed) cognitive competencies that might contribute to children's ability to (efficiently) process the numerical meaning of Arabic numerical symbols. We observed minor differences between clusters in these cognitive competencies except for verbal working memory for which no differences were observed. Follow-up analyses further revealed that the above-mentioned cognitive competencies did not merely account for the cluster differences in children's development of symbolic numerical magnitude processing skills, suggesting that other factors account for these individual differences. On the other hand, the three trajectories of symbolic numerical magnitude processing revealed remarkable and stable differences in children's arithmetic fact retrieval, which stresses the importance of symbolic numerical magnitude processing for learning arithmetic. Copyright © 2017 Elsevier Inc. All rights reserved.

Process Analysis of Typhoon Related Ozone Pollution over the Pearl River Delta during the PRIDE-PRD2006

NASA Astrophysics Data System (ADS)

Li, Y.; Wang, X.; Zhang, Y.

2014-12-01

There were two typhoon processes during Campaign PRIDE-PRD2006 in July 2006 and serious ozone pollution episodes occurred before the landing of the typhoons. Chemical transport model CMAQ was employed in this work to simulate the ozone pollution episode related by the typhoon KAEMI. According to the meteorological conditions, the pollution episode could be divided into three phases with the movement of the typhoon, which were (1) far away from the continent; (2) coming close to the continent; (3) before landing. Process analysis was applied to get the contributions of physical and chemical processes for the ozone. It revealed that transport process was dominant during this pollution episode, and the influence of chemical process increased in the second phase. Three typical regions, northern rural area, urban area and Hong Kong area, were selected to study the contribution of each chemical and physical process. In the first phase, the primary process in northern rural area and the urban area was vertical diffusion, accounting for 47% and 46% respectively. In the second phase, the primary process in northern rural area and the urban area was chemical process, accounting for 33% and 31% respectively. In the third phase, the region of high concentration ozone moved southward. For Hong Kong area, the western inflow was prominent as 40%. Sensitivity study showed that urban areas were VOCs-limited regime with decreased ozone concentration when reducing the emission of VOCs. On the contrary, the ozone concentration in downwind rural areas decreased with the reduction of NOx, and the reason may be the decrement of the accumulated precursors.

Workplace reproductive problems.

PubMed

Frazier, L M

2000-12-01

Occupational exposures can harm reproductive processes in men or women. Exposures may affect fertility, pregnancy outcomes or the child's health after delivery. The goal of patient management is to provide counseling at an appropriate level. Over-restricting the patient should be avoided while hazardous exposures should be identified and reduced. The occupational history can be used to estimate the magnitude of each exposure. If the exposure is a known reproductive hazard and the exposure level appears significant, there are several options for making the job safer. Modifications in work practices can be accomplished by advising the patient about changing work practices, writing formal work restrictions and talking with the employer. Temporary job transfers may be available. In some cases, a medical leave is needed. The primary care provider can play a key role in assisting patients to reduce reproductive risks.

Relationship between Quality of Work Life and Work Alienation: Research on Teachers

ERIC Educational Resources Information Center

Çetinkanat, Ayse Canan; Kösterelioglu, Meltem Akin

2016-01-01

The purpose of the study is examined primary school teachers' quality of work life and work alienation perceptions. The sample of the study was composed of teachers (N = 426) employed in Bolu province central and district state primary schools in 2010-2011 academic year. For data collection purposes, "Personal Information Form" was used…

Construing Systems of Management among Primary Headteachers: Moving Forward from Work Activity Studies.

ERIC Educational Resources Information Center

Jones, Norah; Connolly, Michael

2001-01-01

A study used a Personal Construct Theory/Repertory Grid approach to examine the work of 12 Welsh primary headteachers. Analysis of thematic work-activity grids suggests principals have a more coherent view of their work (as centered on children and education) than Henry Mintzberg's observational studies portrayed. (Contains 36 references.) (MLH)

Effectiveness of Student Learning during Experimental Work in Primary School.

PubMed

Logar, Ana; Peklaj, Cirila; Ferk Savec, Vesna

2017-09-01

The aim of the research was to optimize the effectiveness of student learning based on experimental work in chemistry classes in Slovenian primary schools. To obtain evidence about how experimental work is implemented during regular chemistry classes, experimental work was videotaped during 19 units of chemistry lessons at 12 Slovenian primary schools from the pool of randomly selected schools. Altogether 332 eight-grade students were involved in the investigation, with an average age of 14.2 years. Students were videotaped during chemistry lessons, and their worksheets were collected afterward. The 12 chemistry teachers, who conducted lessons in these schools, were interviewed before the lessons; their teaching plans were also collected. The collected data was analyzed using qualitative methods. The results indicate that many teachers in Slovenian primary schools are not fully aware of the potential of experimental work integrated into chemistry lessons for the development of students' experimental competence. Further research of the value of different kinds of training to support teachers for the use of experimental work in chemistry teaching is needed.

Unidirectional signal propagation in primary neurons micropatterned at a single-cell resolution

NASA Astrophysics Data System (ADS)

Yamamoto, H.; Matsumura, R.; Takaoki, H.; Katsurabayashi, S.; Hirano-Iwata, A.; Niwano, M.

2016-07-01

The structure and connectivity of cultured neuronal networks can be controlled by using micropatterned surfaces. Here, we demonstrate that the direction of signal propagation can be precisely controlled at a single-cell resolution by growing primary neurons on micropatterns. To achieve this, we first examined the process by which axons develop and how synapses form in micropatterned primary neurons using immunocytochemistry. By aligning asymmetric micropatterns with a marginal gap, it was possible to pattern primary neurons with a directed polarization axis at the single-cell level. We then examined how synapses develop on micropatterned hippocampal neurons. Three types of micropatterns with different numbers of short paths for dendrite growth were compared. A normal development in synapse density was observed when micropatterns with three or more short paths were used. Finally, we performed double patch clamp recordings on micropatterned neurons to confirm that these synapses are indeed functional, and that the neuronal signal is transmitted unidirectionally in the intended orientation. This work provides a practical guideline for patterning single neurons to design functional neuronal networks in vitro with the direction of signal propagation being controlled.

Development of stitched/RTM composite primary structures

NASA Technical Reports Server (NTRS)

Kullerd, Susan M.; Dow, Marvin B.

1992-01-01

The goal of the NASA Advanced Composites Technology (ACT) Program is to provide the technology required to gain the full benefit of weight savings and performance offered by composite primary structures. Achieving the goal is dependent on developing composite materials and structures which are damage tolerant and economical to manufacture. Researchers at NASA LaRC and Douglas Aircraft Company are investigating stitching reinforcement combined with resin transfer molding (RTM) to create structures meeting the ACT program goals. The Douglas work is being performed under a NASA contract entitled Innovative Composites Aircraft Primary Structures (ICAPS). The research is aimed at materials, processes and structural concepts for application in both transport wings and fuselages. Empirical guidelines are being established for stitching reinforcement in primary structures. New data are presented in this paper for evaluation tests of thick (90-ply) and thin (16-ply) stitched laminates, and from selection tests of RTM composite resins. Tension strength, compression strength and post-impact compression strength data are reported. Elements of a NASA LaRC program to expand the science base for stitched/RTM composites are discussed.

Oral primary care: an analysis of its impact on the incidence and mortality rates of oral cancer.

PubMed

Rocha, Thiago Augusto Hernandes; Thomaz, Erika Bárbara Abreu Fonseca; da Silva, Núbia Cristina; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Barbosa, Allan Claudius Queiroz; Thumé, Elaine; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Vissoci, João Ricardo Nickenig; Staton, Catherine Ann; Facchini, Luiz Augusto

2017-10-30

Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002-2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%). The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (β = 0.59; p = 0.010) and adult smokers (β = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (β = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (β = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (β = -0.01; p < 0.006) and PHC financing (β = -0.52 -9 ; p = 0.014). In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths.

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

Galarraga, Haize; Lados, Diana A.; Dehoff, Ryan R.

Electron Beam Melting (EBM) is a metal powder bed-based Additive Manufacturing (AM) technology that makes possible the fabrication of three dimensional near-net-shaped parts directly from computer models. EBM technology has been in continuously updating, obtaining optimized properties of the processed alloys. Ti-6Al-4V titanium alloy is the most widely used and studied alloy for this technology and is the focus of this work. Several research works have been completed to study the mechanisms of microstructure formation as well as its influence on mechanical properties. However, the relationship is not completely understood, and more systematic research work is necessary in order tomore » attain a better understanding of these features. In this work, samples fabricated at different locations, orientations, and distances from the build platform have been characterized, studying the relationship of these variables with the resulting material intrinsic characteristics and properties (surface topography, microstructure, porosity, micro-hardness and static mechanical properties). This study has revealed that porosity is the main factor controlling mechanical properties relative to the other studied variables. Therefore, in future process developments, decreasing of the porosity should be considered as the primary goal in order to improve mechanical properties.« less

Apollo(R) Thin Film Process Development: Final Technical Report, April 1998 - April 2002

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

Cunningham, D.W.

2002-10-01

BP Solar first started investigative work on CdTe photovoltaics in 1986. The module product name chosen for the CdTe devices is Apollo. The deposition method chosen was electrochemical deposition due to its simplicity and good control of stoichiometric composition. The window layer used is CdS, produced from a chemical-bath deposition. Initial work focused on increasing photovoltaic cell size from a few mm2 to 900 cm2. At BP Solar's Fairfield plant, work is focused on increasing semiconductor deposition to 1 m2. The primary objective of this subcontract is to establish the conditions required for the efficient plating of CdS/CdTe on large-area,more » transparent conducting tin-oxide-coated glass superstrate. The initial phase concentrates on superstrate sizes up to 0.55 m2. Later phases will include work on 0.94 m2 superstrates. The tasks in this subcontract have been split into four main categories: (1) CdS and CdTe film studies; (2) Enhanced laser processing; (3) Outdoor testing program for the Apollo module; and (4) Production waste abatement and closed loop study.« less

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

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.

An Assessment of Nondestructive Evaluation Capability for Complex Additive Manufacturing Aerospace Components

NASA Technical Reports Server (NTRS)

Walker, James; Beshears, Ron; Lambert, Dennis; Tilson, William

2016-01-01

The primary focus of this work is to investigate some of the fundamental relationships between processing, mechanical testing, materials characterization, and NDE for additively manufactured (AM) components using the powder bed fusion direct melt laser sintered process. The goal is to understand the criticality of defects unique to the AM process and then how conventional nondestructive evaluation methods as well as some of the more non-traditional methods such as computed tomography, are effected by the AM material. Specific defects including cracking, porosity and partially/unfused powder will be addressed. Besides line-of-site NDE, as appropriate these inspection capabilities will be put into the context of complex AM geometries where hidden features obscure, or inhibit traditional NDE methods.

Primary and Secondary Labor Markets: Implications for Vocational Rehabilitation.

ERIC Educational Resources Information Center

Hagner, David

2000-01-01

Reviews theoretical and empirical work in labor economics and the sociology of work relating to the segmentation of the labor market into a primary and a secondary sector and examines the implications for vocational rehabilitation. Transition into primary sector employment is explored as an important aspect of career development for individuals…

Relationship between Professional Learning Community, Bureaucratic Structure and Organisational Trust in Primary Education Schools

ERIC Educational Resources Information Center

Kalkan, Fatma

2016-01-01

This research uses relational survey method to determine the relationship between professional learning community, bureaucratic structure and organisational trust according to the perceptions of teachers who work in primary education schools. Data were collected from 805 teachers who work in primary education schools in the districts (Altindag,…

Concept of Supervision and Supervisory Practices at Primary Level in Pakistan

ERIC Educational Resources Information Center

Behlol, Malik Ghulam; Yousuf, Muhammad Imran; Parveen, Qaisara; Kayani, Muhammad Munir

2011-01-01

The study was conducted to find out the practices and problems of supervisors working at primary school level in Pakistan. The teachers, Headmasters, Area Education Officers, District Education Officers, Deputy District Education officers working in primary schools of Rawalpindi District were the population of the study. The questionnaire was…

Health system factors affecting communication with pediatricians: gendered work culture in primary care.

PubMed

Lynch, Sean

2011-01-01

This qualitative study examined the roles that practice setting, education level, and gender may play in social workers' communication satisfaction with pediatricians. Taking an ethnographic approach, the researcher interviewed social workers and pediatricians who worked together to provide mental health services in primary care. The results suggested that gender at the health system level may be an issue and that gendered work culture in primary care was a factor in communication. In particular, reimbursement, an aspect of the gendered work culture, was a substantial communication barrier, and the implications for Medicaid billing are discussed.

Development of data processing interpretation and analysis system for the remote sensing of trace atmospheric gas species

NASA Technical Reports Server (NTRS)

Casas, J. C.; Koziana, J. V.; Saylor, M. S.; Kindle, E. C.

1982-01-01

Problems associated with the development of the measurement of air pollution from satellites (MAPS) experiment program are addressed. The primary thrust of this research was the utilization of the MAPS experiment data in three application areas: low altitude aircraft flights (one to six km); mid altitude aircraft flights (eight to 12 km); and orbiting space platforms. Extensive research work in four major areas of data management was the framework for implementation of the MAPS experiment technique. These areas are: (1) data acquisition; (2) data processing, analysis and interpretation algorithms; (3) data display techniques; and (4) information production.

Modeling coupled nanoparticle aggregation and transport in porous media: A Lagrangian approach

NASA Astrophysics Data System (ADS)

Taghavy, Amir; Pennell, Kurt D.; Abriola, Linda M.

2015-01-01

Changes in nanoparticle size and shape due to particle-particle interactions (i.e., aggregation or agglomeration) may significantly alter particle mobility and retention in porous media. To date, however, few modeling studies have considered the coupling of transport and particle aggregation processes. The majority of particle transport models employ an Eulerian modeling framework and are, consequently, limited in the types of collisions and aggregate sizes that can be considered. In this work, a more general Lagrangian modeling framework is developed and implemented to explore coupled nanoparticle aggregation and transport processes. The model was verified through comparison of model simulations to published results of an experimental and Eulerian modeling study (Raychoudhury et al., 2012) of carboxymethyl cellulose (CMC)-modified nano-sized zero-valent iron particle (nZVI) transport and retention in water-saturated sand columns. A model sensitivity analysis reveals the influence of influent particle concentration (ca. 70 to 700 mg/L), primary particle size (10-100 nm) and pore water velocity (ca. 1-6 m/day) on particle-particle, and, consequently, particle-collector interactions. Model simulations demonstrate that, when environmental conditions promote particle-particle interactions, neglecting aggregation effects can lead to under- or over-estimation of nanoparticle mobility. Results also suggest that the extent to which higher order particle-particle collisions influence aggregation kinetics will increase with the fraction of primary particles. This work demonstrates the potential importance of time-dependent aggregation processes on nanoparticle mobility and provides a numerical model capable of capturing/describing these interactions in water-saturated porous media.

How bone forms in large cancellous defects: critical analysis based on experimental work and literature.

PubMed

Draenert, K; Draenert, M; Erler, M; Draenert, A; Draenert, Y

2011-09-01

The behaviour of physiological biomaterials, β-tricalciumphosphate and hydroxyapatite, is analysed based on current literature and our own experimental work. The properties of graft substitutes based on ceramic materials are clearly defined according to their scientific efficiency. The strength of the materials and their biodegradability are still not fully evaluated. Strength and degradability have a direct proportional relationship and are considered the most efficient way to be adapted by their properties to the needs for the treatment of bone defects. New technologies for the manufacturing process are presented that increase those properties and thus open up new indications and easier application of the ceramic materials. The implantation process as well is carefully validated by animal experiments to avoid failures. Based on the experiments, a completely new approach is defined as to how primary bone formation with osteoconductive ceramics can be achieved. The milestones in that approach comprise a synthetically manufactured replica of the bone marrow spaces as osteoconductive ladder, whereas the bead is defined as bone-forming element. As a result, materials are available with high strength if the ceramic is solid or highly porous and possesses a micro-structure. The injection moulding process allows for the combination of high strength of the material with high porosity. Based on the strong capillary forces, micro-chambered beads fulfil most expectations for primary bone formation in cancellous bone defects, including drug delivery, mechanical strengthening if necessary, and stable implantation in situ by coagulation of the blood and bone marrow suctioned in. Copyright © 2011 Elsevier Ltd. All rights reserved.

Modeling coupled nanoparticle aggregation and transport in porous media: a Lagrangian approach.

PubMed

Taghavy, Amir; Pennell, Kurt D; Abriola, Linda M

2015-01-01

Changes in nanoparticle size and shape due to particle-particle interactions (i.e., aggregation or agglomeration) may significantly alter particle mobility and retention in porous media. To date, however, few modeling studies have considered the coupling of transport and particle aggregation processes. The majority of particle transport models employ an Eulerian modeling framework and are, consequently, limited in the types of collisions and aggregate sizes that can be considered. In this work, a more general Lagrangian modeling framework is developed and implemented to explore coupled nanoparticle aggregation and transport processes. The model was verified through comparison of model simulations to published results of an experimental and Eulerian modeling study (Raychoudhury et al., 2012) of carboxymethyl cellulose (CMC)-modified nano-sized zero-valent iron particle (nZVI) transport and retention in water-saturated sand columns. A model sensitivity analysis reveals the influence of influent particle concentration (ca. 70 to 700 mg/L), primary particle size (10-100 nm) and pore water velocity (ca. 1-6 m/day) on particle-particle, and, consequently, particle-collector interactions. Model simulations demonstrate that, when environmental conditions promote particle-particle interactions, neglecting aggregation effects can lead to under- or over-estimation of nanoparticle mobility. Results also suggest that the extent to which higher order particle-particle collisions influence aggregation kinetics will increase with the fraction of primary particles. This work demonstrates the potential importance of time-dependent aggregation processes on nanoparticle mobility and provides a numerical model capable of capturing/describing these interactions in water-saturated porous media. Copyright © 2014 Elsevier B.V. All rights reserved.

Cognitive components of a mathematical processing network in 9-year-old children.

PubMed

Szűcs, Dénes; Devine, Amy; Soltesz, Fruzsina; Nobes, Alison; Gabriel, Florence

2014-07-01

We determined how various cognitive abilities, including several measures of a proposed domain-specific number sense, relate to mathematical competence in nearly 100 9-year-old children with normal reading skill. Results are consistent with an extended number processing network and suggest that important processing nodes of this network are phonological processing, verbal knowledge, visuo-spatial short-term and working memory, spatial ability and general executive functioning. The model was highly specific to predicting arithmetic performance. There were no strong relations between mathematical achievement and verbal short-term and working memory, sustained attention, response inhibition, finger knowledge and symbolic number comparison performance. Non-verbal intelligence measures were also non-significant predictors when added to our model. Number sense variables were non-significant predictors in the model and they were also non-significant predictors when entered into regression analysis with only a single visuo-spatial WM measure. Number sense variables were predicted by sustained attention. Results support a network theory of mathematical competence in primary school children and falsify the importance of a proposed modular 'number sense'. We suggest an 'executive memory function centric' model of mathematical processing. Mapping a complex processing network requires that studies consider the complex predictor space of mathematics rather than just focusing on a single or a few explanatory factors.

Cognitive components of a mathematical processing network in 9-year-old children

PubMed Central

Szűcs, Dénes; Devine, Amy; Soltesz, Fruzsina; Nobes, Alison; Gabriel, Florence

2014-01-01

We determined how various cognitive abilities, including several measures of a proposed domain-specific number sense, relate to mathematical competence in nearly 100 9-year-old children with normal reading skill. Results are consistent with an extended number processing network and suggest that important processing nodes of this network are phonological processing, verbal knowledge, visuo-spatial short-term and working memory, spatial ability and general executive functioning. The model was highly specific to predicting arithmetic performance. There were no strong relations between mathematical achievement and verbal short-term and working memory, sustained attention, response inhibition, finger knowledge and symbolic number comparison performance. Non-verbal intelligence measures were also non-significant predictors when added to our model. Number sense variables were non-significant predictors in the model and they were also non-significant predictors when entered into regression analysis with only a single visuo-spatial WM measure. Number sense variables were predicted by sustained attention. Results support a network theory of mathematical competence in primary school children and falsify the importance of a proposed modular ‘number sense’. We suggest an ‘executive memory function centric’ model of mathematical processing. Mapping a complex processing network requires that studies consider the complex predictor space of mathematics rather than just focusing on a single or a few explanatory factors. PMID:25089322

Primary Prevention of Sexual Violence in Aotearoa New Zealand.

PubMed

Dickson, Sandra; Willis, Gwenda M

2017-03-01

The extensive and sometimes profoundly damaging effects of sexual violence and large numbers of victims necessitate dedicated attention to primary prevention efforts. Few studies have examined the scope of current prevention activities or their fit with empirical research into effective prevention strategies. The current article presents findings from a survey of primary prevention activities in non-Māori and bicultural communities within Aotearoa New Zealand. Forty-four respondents representing 42 agencies responded to a comprehensive survey that canvased types of sexual violence primary prevention activities undertaken, sexual violence primary prevention programs, and barriers and supports to sexual violence prevention work. Consistent with findings from previous international surveys, the focus of primary prevention work in New Zealand was on sexual violence education and increasing awareness. Findings are discussed in the context of the sexual violence prevention literature and what works in prevention more broadly to help identify promising initiatives as well as gaps in current practices. Recommendations for advancing sexual violence primary prevention research are also provided.

Treatment and recovery.

PubMed

Raia, Susan

2005-01-01

Addiction is a chronic, progressive, fatal disease. It is a primary disease, not caused by any other disease process. It has recognizable symptoms that if left untreated, can lead to premature death, deterioration of physical conditions, social withdrawal and disintegration of all support systems. The family and co-workers are affected as well. There is no cure, but we know that treatment works! Don't stand by while someone you care about needs help. Nurses helping nurses, let's take care of our own.

Tailoring a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) to Tunisia: process and relevant adaptations.

PubMed

Spagnolo, Jessica; Champagne, François; Leduc, Nicole; Melki, Wahid; Guesmi, Imen; Bram, Nesrine; Guisset, Ann-Lise; Piat, Myra; Laporta, Marc; Charfi, Fatma

2018-01-01

In order to make mental health services more accessible, the Tunisian Ministry of Health, in collaboration with the School of Public Health at the University of Montreal, the World Health Organization office in Tunisia and the Montreal World Health Organization-Pan American Health Organization Collaborating Center for Research and Training in Mental Health, implemented a training programme based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) (version 1.0) , developed by the World Health Organization. This article describes the phase prior to the implementation of the training, which was offered to general practitioners working in primary care settings in the Greater Tunis area of Tunisia. The phase prior to implementation consisted of adapting the standard mhGAP-IG (version 1.0) to the local primary healthcare context. This adaptation process, an essential step before piloting the training, involved discussions with stakeholder groups, as well as field observations. Through the adaptation process, we were able to make changes to the standard training format and material. In addition, the process helped uncover systemic barriers to effective mental health care. Targeting these barriers in addition to implementing a training programme may help reduce the mental health treatment gap, and promote implementation that is successful and sustainable.

Cognitive Consilience: Primate Non-Primary Neuroanatomical Circuits Underlying Cognition

PubMed Central

Solari, Soren Van Hout; Stoner, Rich

2011-01-01

Interactions between the cerebral cortex, thalamus, and basal ganglia form the basis of cognitive information processing in the mammalian brain. Understanding the principles of neuroanatomical organization in these structures is critical to understanding the functions they perform and ultimately how the human brain works. We have manually distilled and synthesized hundreds of primate neuroanatomy facts into a single interactive visualization. The resulting picture represents the fundamental neuroanatomical blueprint upon which cognitive functions must be implemented. Within this framework we hypothesize and detail 7 functional circuits corresponding to psychological perspectives on the brain: consolidated long-term declarative memory, short-term declarative memory, working memory/information processing, behavioral memory selection, behavioral memory output, cognitive control, and cortical information flow regulation. Each circuit is described in terms of distinguishable neuronal groups including the cerebral isocortex (9 pyramidal neuronal groups), parahippocampal gyrus and hippocampus, thalamus (4 neuronal groups), basal ganglia (7 neuronal groups), metencephalon, basal forebrain, and other subcortical nuclei. We focus on neuroanatomy related to primate non-primary cortical systems to elucidate the basis underlying the distinct homotypical cognitive architecture. To display the breadth of this review, we introduce a novel method of integrating and presenting data in multiple independent visualizations: an interactive website (http://www.frontiersin.org/files/cognitiveconsilience/index.html) and standalone iPhone and iPad applications. With these tools we present a unique, annotated view of neuroanatomical consilience (integration of knowledge). PMID:22194717

Women's journey to safety - the Transtheoretical model in clinical practice when working with women experiencing Intimate Partner Violence: a scientific review and clinical guidance.

PubMed

Reisenhofer, Sonia; Taft, Angela

2013-12-01

Review the applicability of the Transtheoretical model and provide updated guidance for clinicians working with women experiencing intimate partner violence. Critical review of related primary research conducted from 1990 to March 2013. Women's experiences of creating change within abusive relationships can be located within a stages of change continuum by identifying dominant behavioral clusters. The processes of change and constructs of decisional-balance and turning-points are evident in women's decision-making when they engage in change. Clinicians can use the stages of change to provide a means of assessing women's movement toward their nominated outcomes, and the processes of change, decisional-balance and turning-points, to enhance understanding of, and promote women's movement across stages in their journey to safety. Clinicians should assess women individually for immediate and ongoing safety and well-being, and identify their overarching stage of change. Clinicians can support women in identifying and implementing their personal objectives to enhance self-efficacy and create positive change movement across stages. The three primary objectives identified for clinician support are: 1. Minimizing harm and promoting well-being within an abusive relationship, 2. Achieving safety and well-being within the relationship; halting the abuse, or 3. Achieving safety by ending/leaving intimate relationships. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

KENNEDY SPACE CENTER, FLA. - Workers watch as the Multi-Purpose Logistics Module Raffaello is lowered toward a work stand in the Space Station Processing Facility. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved across the floor to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-10

KENNEDY SPACE CENTER, FLA. - Workers watch as the Multi-Purpose Logistics Module Raffaello is lowered toward a work stand in the Space Station Processing Facility. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved across the floor to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - The Multi-Purpose Logistics Module Raffaello is lifted from its stand in the Space Station Processing Facility to move to another work stand. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It is being moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-10

KENNEDY SPACE CENTER, FLA. - The Multi-Purpose Logistics Module Raffaello is lifted from its stand in the Space Station Processing Facility to move to another work stand. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It is being moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - A worker on the floor watches as the Multi-Purpose Logistics Module Raffaello moves toward another work stand in the Space Station Processing Facility. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved across the floor to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-10

KENNEDY SPACE CENTER, FLA. - A worker on the floor watches as the Multi-Purpose Logistics Module Raffaello moves toward another work stand in the Space Station Processing Facility. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved across the floor to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - An overhead crane is attached to the Multi-Purpose Logistics Module Raffaello in order to move it to another work stand in the Space Station Processing Facility. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It is being moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-10

KENNEDY SPACE CENTER, FLA. - An overhead crane is attached to the Multi-Purpose Logistics Module Raffaello in order to move it to another work stand in the Space Station Processing Facility. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It is being moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

KENNEDY SPACE CENTER, FLA. - Workers in the Space Station Processing Facility prepare to release the overhead crane from the Multi-Purpose Logistics Module Raffaello now secure on a new work stand. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

NASA Image and Video Library

2004-02-10

KENNEDY SPACE CENTER, FLA. - Workers in the Space Station Processing Facility prepare to release the overhead crane from the Multi-Purpose Logistics Module Raffaello now secure on a new work stand. Raffaello is the second MPLM built by the Italian Space Agency, serving as a reusable logistics carrier and primary delivery system to resupply and return station cargo requiring a pressurized environment. It has been moved to allow the third MPLM, Donatello, to be brought in for routine testing. Donatello has been stored in the Operations and Checkout Building. This is the first time all three MPLMs are in the SSPF; the other one is the Leonardo. Raffaello is scheduled to fly on Space Shuttle Atlantis on mission STS-114.

Expectations and perceptions of primary healthcare professionals regarding their own continuous education in Catalonia (Spain): a qualitative study.

PubMed

Mundet-Tuduri, Xavier; Crespo, Ramon; Fernandez-Coll, Ma Luisa; Saumell, Montserrat; Millan-Mata, Flor; Cardona, Àngels; Codern-Bové, Núria

2017-11-15

The planning and execution of continuous education in an organization that provides health services is a complex process. The objectives, learning sequences, and implementation strategies should all be oriented to improving the health of the population. The aim of this study was to analyse the expectations and perceptions of continuous educations by primary healthcare professionals (physicians and nurses) and identify aspects that hinder or encourage the process. A qualitative study with 5 focus groups made up of 25 primary healthcare professionals from the Catalan Health Institute, Barcelona (Catalonia, Spain). The focus groups were audio-recorded and the results transcribed. The analysis involved: a) Reading of the data looking for meanings b) Coding of the data by themes and extracting categories c) Reviewing and refining codes and categories d) Reconstruction of the data providing an explanatory framework for the meanings e) Discussion about the interpretations of the findings and f) Discussed with relevant professionals from PHC (physicians and nurses)"Data regarding thematic content were analyzed with the support of Atlasti 5.1 software. The health needs of the population were often at the core of the learning processes but the participants' views did not always spontaneously refer to improvements in these issues. Common themes that could hinder learning and where identified, including contextual aspects such as work constraints (timetables, places being covered during training) and funding policies. New learning strategies to improve the effectiveness of continuous education were proposed such as the exchange of knowledge, the activation of personal commitment to change, and the improvement of organizational aspects. The primary healthcare professionals in our study viewed continuous education as a professional necessity and would like to translate the knowledge acquired to improving the health of the population. Nevertheless, professional, structural, and organizational issues impede the process.

Prognostic factors for work ability in women with chronic low back pain consulting primary health care: a 2-year prospective longitudinal cohort study.

PubMed

Nordeman, Lena; Gunnarsson, Ronny; Mannerkorpi, Kaisa

2014-05-01

To investigate prognostic factors for future work ability in women with chronic low back pain (CLBP) consulting primary health care. A 2-year prospective longitudinal cohort study of female patients with CLBP within the primary health care was conducted. Patients were assessed at the first assessment and after 2 years. Prognostic factors for work ability (yes/no) were analyzed by multivariate regression. A total of 130 patients were included at first assessment. After 2 years, 123 patients (95%) were followed up. The 6-minute walk test, depression, and earlier work ability predicted work ability at the 2-year follow-up. A nomogram was constructed to assess the probability of future work ability. The 6-minute walk test, work ability, and depression predicted work ability for women with CLBP after 2 years.

A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey

PubMed Central

2011-01-01

Background Many western countries are facing an existing or imminent shortage of primary care physicians especially in rural areas. In Germany, working in rural areas is often thought to be associated with more working hours, a higher number of patients and a lower income than working in urban areas. These perceptions might be key reasons for the shortage. The aim of this analysis was to explore if working time, number of treated patients per week or proportion of privately insured patients vary between rural and urban areas in Germany using two different definitions of rurality within a sample of primary care physicians including general practitioners, general internists and paediatricians. Methods This is a secondary analysis of pre-collected data raised by a questionnaire that was sent to a representative random sample of 1500 primary care physicians chosen by data of the National Association of Statutory Health Insurance Physicians from all federal states in Germany. We employed two different methods of defining rurality; firstly, level of rurality as rated by physicians themselves (urban area, small town, rural area); secondly, rurality defined according to the Organisation for Economic Co-operation and Development. Results This analysis was based upon questionnaire data from 715 physicians. Primary care physicians in single-handed practices in rural areas worked on average four hours more per week than their urban counterparts (p < 0.05). Physicians' gender, the number of patients treated per week and the type of practice (single/group handed) were significantly related to the number of working hours. Neither the proportion of privately insured patients nor the number of patients seen per week differed significantly between rural and urban areas when applying the self-rated classification of rurality. Conclusion Overall this analysis identified few differences between urban and rural primary care physician working conditions. To counter future misdistribution of primary care, students should receive practical experience in rural areas to get more practical knowledge on working conditions. PMID:21988900

Processing and Characterization of PETI Composites Fabricated by High Temperature VARTM

NASA Technical Reports Server (NTRS)

Ghose, Sayata; Cano, Roberto J.; Watson, Kent A.; Britton, Sean M.; Jensen, Brian J.; Connell, John W.; Smith, Joseph G.; Loos, Alfred C.; Heider, Dirk

2011-01-01

The use of composites as primary structures on aerospace vehicles has increased dramatically over the past decade. As these advanced structures increase in size and complexity, their production costs have grown significantly. A major contributor to these manufacturing costs is the requirement of elevated processing pressures, during the thermal cure, to create fully consolidated composites. For certain composite parts, high temperature vacuum assisted resin transfer molding (HT-VARTM) can offer reduced fabrication costs compared to conventional autoclave techniques. The process has been successfully used with phenylethynyl terminated imide (PETI) resins developed by NASA LaRC. In the current study, two PETI resins, LARC(TradeMark) PETI-330 and LARC(TradeMark) PETI-8 have been used to make test specimens using HT-VARTM. Based on previous work at NASA LaRC, larger panels with a quasi-isotropic lay-up were fabricated. The resultant composite specimens exhibited void contents <3% by volume depending on the type of carbon fabric preform used. Mechanical properties of the panels were determined at both room and elevated temperatures. These included open-hole compressive (OHC) and short beam shear (SBS) properties. Limited process modeling efforts were carried out including infusion times, composite panel size limitations and fabric permeability characterization. Work has also been carried out to develop new PETI based resins specifically geared towards HT-VARTM. The results of this work are presented herein.

Practice nursing in Australia: A review of education and career pathways

PubMed Central

Parker, Rhian M; Keleher, Helen M; Francis, Karen; Abdulwadud, Omar

2009-01-01

Background Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia. Methods Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses. Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer. Results Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector. Conclusion There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways. PMID:19473493

Practice nursing in Australia: A review of education and career pathways.

PubMed

Parker, Rhian M; Keleher, Helen M; Francis, Karen; Abdulwadud, Omar

2009-05-27

Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia. Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses.Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer. Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector. There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways.

Relationship Among Signal Fidelity, Hearing Loss, and Working Memory for Digital Noise Suppression.

PubMed

Arehart, Kathryn; Souza, Pamela; Kates, James; Lunner, Thomas; Pedersen, Michael Syskind

2015-01-01

This study considered speech modified by additive babble combined with noise-suppression processing. The purpose was to determine the relative importance of the signal modifications, individual peripheral hearing loss, and individual cognitive capacity on speech intelligibility and speech quality. The participant group consisted of 31 individuals with moderate high-frequency hearing loss ranging in age from 51 to 89 years (mean = 69.6 years). Speech intelligibility and speech quality were measured using low-context sentences presented in babble at several signal-to-noise ratios. Speech stimuli were processed with a binary mask noise-suppression strategy with systematic manipulations of two parameters (error rate and attenuation values). The cumulative effects of signal modification produced by babble and signal processing were quantified using an envelope-distortion metric. Working memory capacity was assessed with a reading span test. Analysis of variance was used to determine the effects of signal processing parameters on perceptual scores. Hierarchical linear modeling was used to determine the role of degree of hearing loss and working memory capacity in individual listener response to the processed noisy speech. The model also considered improvements in envelope fidelity caused by the binary mask and the degradations to envelope caused by error and noise. The participants showed significant benefits in terms of intelligibility scores and quality ratings for noisy speech processed by the ideal binary mask noise-suppression strategy. This benefit was observed across a range of signal-to-noise ratios and persisted when up to a 30% error rate was introduced into the processing. Average intelligibility scores and average quality ratings were well predicted by an objective metric of envelope fidelity. Degree of hearing loss and working memory capacity were significant factors in explaining individual listener's intelligibility scores for binary mask processing applied to speech in babble. Degree of hearing loss and working memory capacity did not predict listeners' quality ratings. The results indicate that envelope fidelity is a primary factor in determining the combined effects of noise and binary mask processing for intelligibility and quality of speech presented in babble noise. Degree of hearing loss and working memory capacity are significant factors in explaining variability in listeners' speech intelligibility scores but not in quality ratings.

Partnership disengagement from primary community care networks (PCCNs): A qualitative study for a national demonstration project

PubMed Central

2010-01-01

Background The Primary Community Care Network (PCCN) Demonstration Project, launched by the Bureau of National Health Insurance (BNHI) in 2003, is still in progress. Partnership structures in PCCNs represent both contractual clinic-to-clinic and clinic-to-hospital member relationships of organizational aspects. The partnership structures are the formal relationships between individuals and the total network. Their organizational design aims to ensure effective communication, coordination, and integration across the total network. Previous studies have focused largely on how contractual integration among the partnerships works and on its effects. Few studies, however, have tried to understand partnership disengagement in PCCNs. This study explores why some partnerships in PCCNs disengage. Methods This study used a qualitative methodology with semi-structured questions for in-depth interviews. The semi-structured questions were pre-designed to explore the factors driving partnership disengagement. Thirty-seven clinic members who had withdrawn from their PCCNs were identified from the 2003-2005 Taiwan Primary Community Care Network Lists. Results Organization/participant factors (extra working time spend and facility competency), network factors (partner collaboration), and community factors (health policy design incompatibility, patient-physician relationship, and effectiveness) are reasons for clinic physicians to withdraw or change their partnerships within the PCCNs. Conclusions To strengthen partnership relationships, several suggestions are made, including to establish clinic and hospital member relationships, and to reduce administrative work. In addition, both educating the public about the concept of family doctors and ensuring well-organized national health policies could help health care providers improve the integration processes. PMID:20359369

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

PubMed

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

2010-02-01

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

Process-orientated psychoanalytic work in initial interviews and the importance of the opening scene.

PubMed

Wegner, Peter

2014-06-01

From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology - a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the 'diagnostic position', the 'therapeutic position', the 'opening scene', the 'countertransference' and the 'analyst's free-floating introspectiveness'. More recent investigations refer to 'process qualities' of the analytic relationship, such as 'synchronization' and 'self-efficacy'. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process-orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession. Copyright © 2014 Institute of Psychoanalysis.

Training tomorrow's clinicians today--managed care essentials: a process for curriculum development.

PubMed

Colenda, C C; Wadland, W; Hayes, O; Anderson, W; Priester, F; Pearson, R; Keefe, C; Fleck, L

2000-05-01

To develop a managed care curriculum for primary care residents. This article outlines a 4-stage curriculum development process focusing on concepts of managed care organization and finance. The stages consist of: (1) identifying the curriculum development work group and framing the scope of the curriculum, (2) identifying stakeholder buy-in and expectations, (3) choosing curricular topics and delivery mechanisms, and (4) outlining the evaluation process. Key elements of building a curriculum development team, content objectives of the curriculum, the rationale for using problem-based learning, and finally, lessons learned from the partnership among the stakeholders are reviewed. The curriculum was delivered to an entering group of postgraduate-year 1 primary care residents. Attitudes among residents toward managed care remained relatively negative and stable over the yearlong curriculum, especially over issues relating to finance, quality of care, control and autonomy of practitioners, time spent with patients, and managed care's impact on the doctor-patient relationship. Residents' baseline knowledge of core concepts about managed care organization and finance improved during the year that the curriculum was delivered. Satisfaction with a problem-based learning approach was high. Problem-based learning, using real-life clinical examples, is a successful approach to resident instruction about managed care.

Are Brief Alcohol Interventions Adequately Embedded in UK Primary Care? A Qualitative Study Utilising Normalisation Process Theory.

PubMed

O'Donnell, Amy; Kaner, Eileen

2017-03-28

Despite substantial evidence for their effectiveness, the adoption of alcohol screening and brief interventions (ASBI) in routine primary care remains inconsistent. Financial incentive schemes were introduced in England between 2008 and 2015 to encourage their delivery. We used Normalisation Process Theory-informed interviews to understand the barriers and facilitators experienced by 14 general practitioners (GPs) as they implemented ASBI during this period. We found multiple factors shaped provision. GPs were broadly cognisant and supportive of preventative alcohol interventions (coherence) but this did not necessarily translate into personal investment in their delivery (cognitive participation). This lack of investment shaped how GPs operationalised such "work" in day-to-day practice (collective action), with ASBI mostly delegated to nurses, and GPs reverting to "business as usual" in their management and treatment of problem drinking (reflexive monitoring). We conclude there has been limited progress towards the goal of an effectively embedded preventative alcohol care pathway in English primary care. Future policy should consider screening strategies that prioritise patients with conditions with a recognised link with excessive alcohol consumption, and which promote more efficient identification of the most problematic drinkers. Improved GP training to build skills and awareness of evidence-based ASBI tools could also help embed best practice over time.

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.

What is found positive in healthcare information and communication technology implementation?-the results of a nationwide survey in Finland.

PubMed

Winblad, Ilkka; Hämäläinen, Päivi; Reponen, Jarmo

2011-03-01

Considerable expectations have been placed on information and communication technology (ICT) in improving the processes and quality of healthcare. Our purpose was to find out which element is found positive in healthcare ICT implementation. An online questionnaire on e-Health implementation submitted to all Finnish public health service providers and a sample from the private sector included an open question about which the electronic working methods, systems, or applications have most positively influenced the fluency or quality of service processes. The electronic health record was mentioned as an item that has positive influence by 52% of the respondents from the hospital districts, 27% of those from the primary healthcare centers, and 38% of those from the private providers. Digital radiology systems (including teleradiology) were mentioned by 52% of the hospital districts and 27% of the primary healthcare centers. The figures for digital laboratory systems (including telelaboratory) were 5% and 11%, respectively. The figures for teleradiology itself were 5% for the hospital districts and 15% for the primary healthcare centers; the figures for telelaboratory systems were 5% and 9%, respectively. The specialized healthcare seem to experience intraorganizational electronic services integrated to the electronic health record, such as digital radiology and laboratory services as exerting a positive influence, whereas the primary healthcare find such influence from different functions such as interorganizational data exchange and telemedicine services. These might indicate where the efforts should be focused when implementing ICT in healthcare.