22 CFR 96.50 - Placement and post-placement monitoring until final adoption in incoming cases.

Code of Federal Regulations, 2011 CFR

2011-04-01

... assumes responsibility for making another placement of the child. (e) The agency or person acts promptly... child's country of origin about any new prospective adoptive parent(s). (1) In all cases where removal... the referral of the child for adoption; (2) Informs the prospective adoptive parent(s) that they will...

22 CFR 96.50 - Placement and post-placement monitoring until final adoption in incoming cases.

Code of Federal Regulations, 2014 CFR

2014-04-01

... assumes responsibility for making another placement of the child. (e) The agency or person acts promptly... child's country of origin about any new prospective adoptive parent(s). (1) In all cases where removal... the referral of the child for adoption; (2) Informs the prospective adoptive parent(s) that they will...

The Early Growth and Development Study: Using the Prospective Adoption Design to Examine Genotype–Environment Interplay

PubMed Central

Leve, Leslie D.; Neiderhiser, Jenae M.; Scaramella, Laura V.; Reiss, David

2009-01-01

The Early Growth and Development Study (EGDS) is a prospective adoption design consisting of 360 linked sets of birth parents, adoptive parents, and adopted children followed from 3 months postpartum through child age 7 years, and an additional 200 linked sets for whom recruitment is underway. The EGDS brings together the study of genotype–environment correlation (rGE) and Genotype x Environment (GxE) interaction to inform intervention development by examining mechanisms whereby family processes mediate or moderate the expression of genetic influences. Participants in the EGDS are recruited through domestic adoption agencies located throughout the United States of America. The assessments occur at 6-month intervals until child age 4-½ years and at ages 6 and 7, when the children are in their 1st and 2nd years of formal schooling (kindergarten and first grade). The data collection includes measures of child characteristics, birth and adoptive parent characteristics, adoptive parenting, prenatal exposure to drugs and maternal stress, birth parent and adopted child salivary cortisol reactivity, and DNA from all participants. The preliminary analyses suggest evidence for GxE interaction beginning in infancy. An intervention perspective on future developments in the field of behavioral genetics is described. PMID:19458782

The Early Growth and Development Study: Using the Prospective Adoption Design to Examine Genotype–Environment Interplay

PubMed Central

Neiderhiser, Jenae M.; Scaramella, Laura V.; Reiss, David

2017-01-01

The Early Growth and Development Study (EGDS) is a prospective adoption design consisting of 360 linked sets of birth parents, adoptive parents, and adopted children followed from 3 months postpartum through child age 7 years and an additional 200 linked sets for whom recruitment is underway. The EGDS brings together the study of genotype–environment correlation and Genotype × Environment (G × E) interaction to inform intervention development by examining mechanisms whereby family processes mediate or moderate the expression of genetic influences. Participants in the EGDS are recruited through domestic adoption agencies located throughout the United States of America. The assessments occur at 6-month intervals until child age 4-½ years and at ages 6 and 7, when the children are in their 1st and 2nd years of formal schooling (kindergarten and first grade). The data collection includes measures of child characteristics, birth and adoptive parent characteristics, adoptive parenting, prenatal exposure to drugs and maternal stress, birth parent and adopted child salivary cortisol reactivity, and DNA from all participants. The preliminary analyses suggest evidence for G×E interaction beginning in infancy. An intervention perspective on future developments in the field of behavioral genetics is described. PMID:20358398

Infant Pathways to Externalizing Behavior: Evidence of Genotype x Environment Interaction

ERIC Educational Resources Information Center

Leve, Leslie D.; Kerr, David C. R.; Shaw, Daniel; Ge, Xiaojia; Neiderhiser, Jenae M.; Scaramella, Laura V.; Reid, John B.; Conger, Rand; Reiss, David

2010-01-01

To further the understanding of the effects of early experiences, 9-month-old infants were observed during a frustration task. The analytical sample was composed of 348 linked triads of participants (adoptive parents, adopted child, and birth parent[s]) from a prospective adoption study. It was hypothesized that genetic risk for externalizing…

Effects of Prenatal and Postnatal Parent Depressive Symptoms on Adopted Child HPA Regulation: Independent and Moderated Influences

ERIC Educational Resources Information Center

Laurent, Heidemarie K.; Leve, Leslie D.; Neiderhiser, Jenae M.; Natsuaki, Misaki N.; Shaw, Daniel S.; Harold, Gordon T.; Reiss, David

2013-01-01

This study used a prospective adoption design to investigate effects of prenatal and postnatal parent depressive symptom exposure on child hypothalamic-pituitary-adrenal (HPA) activity and associated internalizing symptoms. Birth mother prenatal symptoms and adoptive mother/father postnatal (9-month, 27-month) symptoms were assessed with the Beck…

Genetic Liability, Environment, and the Development of Fussiness in Toddlers: The Roles of Maternal Depression and Parental Responsiveness

ERIC Educational Resources Information Center

Natsuaki, Misaki N.; Ge, Xiaojia; Leve, Leslie D.; Neiderhiser, Jenae M.; Shaw, Daniel S.; Conger, Rand D.; Scaramella, Laura V.; Reid, John B.; Reiss, David

2010-01-01

Using a longitudinal, prospective adoption design, the authors of this study examined the effects of the environment (adoptive parents' depressive symptoms and responsiveness) and genetic liability of maternal depression (inferred by birth mothers' major depressive disorder [MDD]) on the development of fussiness in adopted children between 9 and…

Examining Academic Writing Motivation of Prospective Indonesian Language Teachers Using Exploratory Factor Analysis

ERIC Educational Resources Information Center

Surastina; Dedi, Fransisca S. O.

2018-01-01

Motivation determines students' success in academic writing. The current study adopted 28 items of the academic writing motivation questionnaire by Payne (2012) translated into Indonesian language to explore students' motivation in academic writing. This study involved 120 prospective Indonesian language teachers at STKIP PGRI Bandar Lampung that…

Unwed Fathers and Adoption Custody Disputes.

ERIC Educational Resources Information Center

Schwartz, Lita Linzer

1986-01-01

Examines phenomenon of unwed fathers seeking custody of offspring. Cites case studies illustrating varied motives of these fathers not necessarily in the child's best interests. Explores custody disputes with prospective adoptive parents and issues of parental and children's rights in terms of their implications for therapists and attorneys.…

22 CFR 96.14 - Providing adoption services using other providers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (3) A public domestic authority. (c) Pursuant to § 96.44 of subpart F, in the case of accredited...); or (ii) Has prepared or is preparing a background study on a child in a case involving immigration to the United States (incoming case) or a home study on prospective adoptive parent(s) in a case...

Transactional Patterns of Maternal Depressive Symptoms and Mother-Child Mutual Negativity in an Adoption Sample

ERIC Educational Resources Information Center

Roben, Caroline K. P.; Moore, Ginger A.; Cole, Pamela M.; Molenaar, Peter; Leve, Leslie D.; Shaw, Daniel S.; Reiss, David; Neiderhiser, Jenae M.

2015-01-01

Transactional models of analysis can examine both moment-to-moment interactions within a dyad and dyadic patterns of influence across time. This study used data from a prospective adoption study to test a transactional model of parental depressive symptoms and mutual negativity between mother and child over time, utilizing contingency analysis of…

Training opioid addiction treatment providers to adopt contingency management: A prospective pilot trial of a comprehensive implementation science approach.

PubMed

Becker, Sara J; Squires, Daniel D; Strong, David R; Barnett, Nancy P; Monti, Peter M; Petry, Nancy M

2016-01-01

Few prospective studies have evaluated theory-driven approaches to the implementation of evidence-based opioid treatment. This study compared the effectiveness of an implementation model (Science to Service Laboratory; SSL) to training as usual (TAU) in promoting the adoption of contingency management across a multisite opioid addiction treatment program. We also examined whether the SSL affected putative mediators of contingency management adoption (perceived innovation characteristics and organizational readiness to change). Sixty treatment providers (39 SSL, 21 TAU) from 15 geographically diverse satellite clinics (7 SSL, 8 TAU) participated in the 12-month study. Both conditions received didactic contingency management training and those in the predetermined experimental region received 9 months of SSL-enhanced training. Contingency management adoption was monitored biweekly, whereas putative mediators were measured at baseline, 3 months, and 12 months. Relative to providers in the TAU region, treatment providers in the SSL region had comparable likelihood of contingency management adoption in the first 20 weeks of the study, and then significantly higher likelihood of adoption (odds ratios = 2.4-13.5) for the remainder of the study. SSL providers also reported higher levels of one perceived innovation characteristic (Observability) and one aspect of organizational readiness to change (Adequacy of Training Resources), although there was no evidence that the SSL affected these putative mediators over time. Results of this study indicate that a fully powered randomized trial of the SSL is warranted. Considerations for a future evaluation are discussed.

Prospective Elementary Teachers' Aesthetic Experience and Relationships to Mathematics

ERIC Educational Resources Information Center

Chen, Rong-Ji

2017-01-01

Previous research has adopted various approaches to examining teachers' and students' relationships to mathematics. The current study extended this line of research and investigated six prospective elementary school teachers' experiences in mathematics and how they saw themselves as learners of mathematics. One-on-one interviews with the…

Adoption: Overview and Major Recommendations.

ERIC Educational Resources Information Center

Schulman, Irving; Behrman, Richard E.

1993-01-01

Examines a number of facets of adoption in the United States and recommends that the federal government create an adoption data collection system; states implement a uniform adoption law; and the adoption process be more open, both for adoptees and prospective adoptive parents. Also discusses the adoption of children with special needs, and…

Adoption Activities on the Internet: A Call for Regulation

ERIC Educational Resources Information Center

Roby, Jini L.; White, Holly

2010-01-01

There is a growing practice of adoption services on the Internet with varying degrees of regulation, depending on whether it is domestic infant adoption, public foster care adoption, or international adoption. Regulation is particularly lacking in domestic infant adoptions, with Web sites connecting prospective birth and adoptive parents,…

Freshman Year Alcohol and Marijuana Use Prospectively Predict Time to College Graduation and Subsequent Adult Roles and Independence

ERIC Educational Resources Information Center

Wilhite, Emily R.; Ashenhurst, James R.; Marino, Elise N.; Fromme, Kim

2017-01-01

Objective: This study examined how freshman year substance use prospectively predicted time to college graduation, and whether delayed graduation predicted postponed adoption of adult roles and future substance use. Participants: Participants were part of a longitudinal study that began in 2004. The first analyses focused on freshman year (N =…

22 CFR 96.48 - Preparation and training of prospective adoptive parent(s) in incoming cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... particular child. This includes counseling on: (1) The child's history and cultural, racial, religious... share resources to meet the training needs of prospective adoptive parents; (2) Group seminars offered by the agency or person or other agencies or training entities; (3) Individual counseling sessions...

The impact of nutritional status and longitudinal recovery of motor and cognitive milestones in internationally adopted children.

PubMed

Park, Hyun; Bothe, Denise; Holsinger, Eva; Kirchner, H Lester; Olness, Karen; Mandalakas, Anna

2011-01-01

Internationally adopted children often arrive from institutional settings where they have experienced medical, nutritional and psychosocial deprivation. This study uses a validated research assessment tool to prospectively assess the impact of baseline (immediately post adoption) nutritional status on fifty-eight children as measured by weight-for-age, height-for-age, weight-for-height and head circumference-for-age z scores, as a determinant of cognitive (MDI) and psychomotor development (PDI) scores longitudinally. A statistical model was developed to allow for different ages at time of initial assessment as well as variable intervals between follow up visits. The study results show that both acute and chronic measures of malnutrition significantly affect baseline developmental status as well as the rate of improvement in both MDI and PDI scores. This study contributes to the body of literature with its prospective nature, unique statistical model for longitudinal evaluation, and use of a validated assessment tool to assess outcomes.

Training Opioid Addiction Treatment Providers to Adopt Contingency Management: A Prospective Pilot Trial of a Comprehensive Implementation Science Approach

PubMed Central

Becker, Sara J.; Squires, Daniel D.; Strong, David R.; Barnett, Nancy P.; Monti, Peter M.; Petry, Nancy M.

2016-01-01

Background Few prospective studies have evaluated theory-driven approaches to the implementation of evidence-based opioid treatment. This study compared the effectiveness of an implementation model (Science to Service Laboratory; SSL) to training as usual (TAU) in promoting the adoption of contingency management across a multi-site opiate addiction treatment program. We also examined whether the SSL affected putative mediators of contingency management adoption (perceived innovation characteristics and organizational readiness to change). Methods Sixty treatment providers (39 SSL, 21 TAU) from 15 geographically diverse satellite clinics (7 SSL, 8 TAU) participated in the 12-month study. Both conditions received didactic contingency management training and those in the pre-determined experimental region received 9 months of SSL-enhanced training. Contingency management adoption was monitored biweekly, while putative mediators were measured at baseline, 3-, and 12-months. Results Relative to providers in the TAU region, treatment providers in the SSL region had comparable likelihood of contingency management adoption in the first 20 weeks of the study, and then significantly higher likelihood of adoption (odds ratios = 2.4-13.5) for the remainder of the study. SSL providers also reported higher levels of one perceived innovation characteristic (Observability) and one aspect of organizational readiness to change (Adequacy of Training Resources), although there was no evidence that the SSL affected these putative mediators over time. Conclusions Results of this study indicate that a fully powered randomized trial of the SSL is warranted. Considerations for a future evaluation are discussed. PMID:26682582

14 CFR 221.204 - Adoption of provisions of one carrier by another carrier.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Adoption of provisions of one carrier by another carrier. When one carrier adopts the tariffs of another carrier, the effective and prospective fares of the adopted carrier shall be changed to reflect the name of the adopting carrier and the effective date of the adoption. Further, each adopted fare shall bear...

78 FR 21708 - Proposed Collection; Comment Request for Regulation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

... June 10, 2013 to be assured of consideration. ADDRESSES: Direct all written comments to Yvette Lawrence... prospective adoptive parent must file Form W-7A. The regulations assist prospective adoptive parents in... information is reflected in the burden for Form W-7A. The following paragraph applies to all of the...

Birth and adoptive parent antisocial behavior and parenting: A study of evocative gene-environment correlation

PubMed Central

Klahr, Ashlea M.; Burt, S. Alexandra; Leve, Leslie D.; Shaw, Daniel S.; Ganiban, Jody M.; Reiss, David; Neiderhiser, Jenae M.

2017-01-01

Negative parenting is shaped by the genetically-influenced characteristics of children (via evocative rGE) and by parental antisocial behavior, however, it is unclear how these factors jointly impact parenting. The current study examined the effects of birth parent and adoptive parent antisocial behavior on negative parenting. Participants included 546 families within a prospective adoption study. Adoptive parent antisocial behavior emerged as a small but significant predictor of negative parenting at 18 months and of change in parenting from 18 to 27 months. Birth parent antisocial behavior predicted change in adoptive father’s (but not mother’s) parenting over time. These findings highlight the role of parent characteristics and suggest that evocative rGE effects on parenting may be small in magnitude in early childhood. PMID:27716897

Testing the prospective evaluation of a new healthcare system

PubMed Central

Planitz, Birgit; Sanderson, Penelope; Freeman, Clinton; Xiao, Tania; Botea, Adi; Orihuela, Cristina Beltran

2012-01-01

Research into health ICT adoption suggests that the failure to understand the clinical workplace has been a major contributing factor to the failure of many computer-based clinical systems. We suggest that clinicians and administrators need methods for envisioning future use when adopting new ICT. This paper presents and evaluates a six-stage “prospective evaluation” model that clinicians can use when assessing the impact of a new electronic patient information system on a Specialist Outpatients Department (SOPD). The prospective evaluation model encompasses normative, descriptive, formative and projective approaches. We show that this combination helped health informaticians to make reasonably accurate predictions for technology adoption at the SOPD. We suggest some refinements, however, to improve the scope and accuracy of predictions. PMID:23304347

Examining the Influence of Perceived Stress on Developmental Change in Memory and Perceptual Speed for Adopted and Nonadopted Individuals

ERIC Educational Resources Information Center

Ricker, Ashley A.; Corley, Robin; DeFries, John C.; Wadsworth, Sally J.; Reynolds, Chandra A.

2018-01-01

The present study prospectively evaluated cumulative early life perceived stress in relation to differential change in memory and perceptual speed from middle childhood to early adulthood. We aimed to identify periods of cognitive development susceptible to the effects of perceived stress among both adopted and nonadopted individuals. The sample…

Technology Adoption: an Interaction Perspective

NASA Astrophysics Data System (ADS)

Sitorus, Hotna M.; Govindaraju, Rajesri; Wiratmadja, I. I.; Sudirman, Iman

2016-02-01

The success of a new technology depends on how well it is accepted by its intended users. Many technologies face the problem of low adoption rate, despite the benefits. An understanding of what makes people accept or reject a new technology can help speed up the adoption rate. This paper presents a framework for technology adoption based on an interactive perspective, resulting from a literature study on technology adoption. In studying technology adoption, it is necessary to consider the interactions among elements involved in the system, for these interactions may generate new characteristics or new relationships. The interactions among elements in a system adoption have not received sufficient consideration in previous studies of technology adoption. Based on the proposed interaction perspective, technology adoption is elaborated by examining interactions among the individual (i.e. the user or prospective user), the technology, the task and the environment. The framework is formulated by adopting several theories, including Perceived Characteristics of Innovating, Diffusion of Innovation Theory, Technology Acceptance Model, Task-Technology Fit and usability theory. The proposed framework is illustrated in the context of mobile banking adoption. It is aimed to offer a better understanding of determinants of technology adoption in various contexts, including technology in manufacturing systems.

Transactions Between Child Social Wariness and Observed Structured Parenting: Evidence From a Prospective Adoption Study

PubMed Central

Natsuaki, Misaki N.; Leve, Leslie D.; Harold, Gordon T.; Neiderhiser, Jenae M.; Shaw, Daniel S.; Ganiban, Jody; Scaramella, Laura V.; Reiss, David

2013-01-01

This investigation examined the mutual influences between structured parenting and child social wariness during toddlerhood using a longitudinal adoption design. The sample consisted of 361 adoption-linked families, each including an adopted child, adoptive parents, and a birth mother. Heightened social wariness in children at age 18 months predicted reduced levels of observed structured parenting (i.e., less directive parenting with fewer commands and requests) in adoptive mothers at age 27 months. Adoptive fathers’ lower structured parenting at age 18 months predicted subsequent elevation in child social wariness. Birth mothers’ history of fear-related anxiety disorders was not associated with child social wariness. Findings highlight the role of dynamic family transactions in the development of social wariness during toddlerhood. PMID:23448430

Infant pathways to externalizing behavior: evidence of Genotype x Environment interaction.

PubMed

Leve, Leslie D; Kerr, David C R; Shaw, Daniel; Ge, Xiaojia; Neiderhiser, Jenae M; Scaramella, Laura V; Reid, John B; Conger, Rand; Reiss, David

2010-01-01

To further the understanding of the effects of early experiences, 9-month-old infants were observed during a frustration task. The analytical sample was composed of 348 linked triads of participants (adoptive parents, adopted child, and birth parent[s]) from a prospective adoption study. It was hypothesized that genetic risk for externalizing problems and affect dysregulation in the adoptive parents would independently and interactively predict a known precursor to externalizing problems: heightened infant attention to frustrating events. Results supported the moderation hypotheses involving adoptive mother affect dysregulation: Infants at genetic risk showed heightened attention to frustrating events only when the adoptive mother had higher levels of anxious and depressive symptoms. The Genotype x Environment interaction pattern held when substance use during pregnancy was considered.

22 CFR 96.15 - Examples.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the age, sex, and health problems of Child W, Agency X matches Prospective Adoptive Parent(s) Y with.... Identifying a child for adoption and arranging an adoption. Agency X identifies children eligible for adoption... in a Convention country calls Agency X about one of the children. Agency X refers them to an agency...

22 CFR 96.15 - Examples.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the age, sex, and health problems of Child W, Agency X matches Prospective Adoptive Parent(s) Y with.... Identifying a child for adoption and arranging an adoption. Agency X identifies children eligible for adoption... in a Convention country calls Agency X about one of the children. Agency X refers them to an agency...

22 CFR 96.15 - Examples.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the age, sex, and health problems of Child W, Agency X matches Prospective Adoptive Parent(s) Y with.... Identifying a child for adoption and arranging an adoption. Agency X identifies children eligible for adoption... in a Convention country calls Agency X about one of the children. Agency X refers them to an agency...

Predictors of Relationship Dissolution in Lesbian, Gay, and Heterosexual Adoptive Parents

PubMed Central

Goldberg, Abbie E.; Garcia, Randi

2015-01-01

Little work has examined relationship dissolution or divorce in adoptive parents or same-sex parent couples. The current study examined predictors of relationship dissolution across the first 5 years of parenthood among a sample of heterosexual, lesbian, and gay male adoptive couples. Of the 190 couples in the study, 15 (7.9%) dissolved their relationships during the first 5 years of adoptive parenthood. Specifically, 7 of 57 lesbian couples (12.3%), 1 of 49 gay male couples (2.0%), and 7 of 84 heterosexual couples (8.3%) dissolved their unions. Results of our logistic regression analysis revealed that the odds of relationship dissolution were significantly higher for (a) couples who adopted a non-infant (i.e., older) child); (b) participants who reported feeling less prepared for the adoption, three months post-adoptive placement; and (c) couples in which both partners reported very low, or very high, pre-adoption levels of relationship maintenance behaviors. Findings have implications for adoption professionals seeking to support same-sex and heterosexual prospective adopters, as well as societal debates and policy regarding same-sex relationships and parenting. PMID:26053348

Birth and Adoptive Parent Antisocial Behavior and Parenting: A Study of Evocative Gene-Environment Correlation.

PubMed

Klahr, Ashlea M; Burt, S Alexandra; Leve, Leslie D; Shaw, Daniel S; Ganiban, Jody M; Reiss, David; Neiderhiser, Jenae M

2017-03-01

Negative parenting is shaped by the genetically influenced characteristics of children (via evocative rGE) and by parental antisocial behavior; however, it is unclear how these factors jointly impact parenting. This study examined the effects of birth parent and adoptive parent antisocial behavior on negative parenting. Participants included 546 families within a prospective adoption study. Adoptive parent antisocial behavior emerged as a small but significant predictor of negative parenting at 18 months and of change in parenting from 18 to 27 months. Birth parent antisocial behavior predicted change in adoptive father's (but not mother's) parenting over time. These findings highlight the role of parent characteristics and suggest that evocative rGE effects on parenting may be small in magnitude in early childhood. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

The transition into adoptive parenthood: Adoption as a process of continued unsafe uncertainty when family scripts collide.

PubMed

Tasker, Fiona; Wood, Sally

2016-10-01

Our prospective study investigated couples' expectations of adoptive parenthood and explored how these changed with their actual experience of parenthood. Six heterosexual couples were interviewed just before placement began and 6 months after the children had arrived. Interpretative Phenomenological Analysis (IPA) was used to analyse both sets of interview data. Expectations of adoptive parenthood mostly transformed smoothly into adoption experience for couples, but challenges were experienced when family scripts collided and a continued feeling of unsafe uncertainty then prevailed within these newly formed family systems. Family script collision seemed a particular problem for couples adopting sibling pairs. To further professional practice in working with families over the transition to adoptive parenting, we suggest that professionals keep in mind a framework that includes the following: Internal and external world influences on family members, Intergenerational issues, Family scripts and the Structural challenges of adoption (IIFS). © The Author(s) 2016.

Influence of parental depressive symptoms on adopted toddler behaviors: an emerging developmental cascade of genetic and environmental effects.

PubMed

Pemberton, Caroline K; Neiderhiser, Jenae M; Leve, Leslie D; Natsuaki, Misaki N; Shaw, Daniel S; Reiss, David; Ge, Xiaojia

2010-11-01

This study examined the developmental cascade of both genetic and environmental influences on toddlers' behavior problems through the longitudinal and multigenerational assessment of psychosocial risk. We used data from the Early Growth and Development Study, a prospective adoption study, to test the intergenerational transmission of risk through the assessment of adoptive mother, adoptive father, and biological parent depressive symptoms on toddler behavior problems. Given that depression is often chronic, we control for across-time continuity and find that in addition to associations between adoptive mother depressive symptoms and toddler externalizing problems, adoptive father depressive symptoms when the child is 9 months of age were associated with toddler problems and associated with maternal depressive symptoms. Findings also indicated that a genetic effect may indirectly influence toddler problems through prenatal pregnancy risk. These findings help to describe how multiple generations are linked through genetic (biological parent), timing (developmental age of the child), and contextual (marital partner) pathways.

Influence of Parental Depressive Symptoms on Adopted Toddler Behaviors: An Emerging Developmental Cascade of Genetic and Environmental Effects

PubMed Central

Pemberton, Caroline K.; Neiderhiser, Jenae M.; Leve, Leslie D.; Natsuaki, Misaki N.; Shaw, Daniel S.; Reiss, David; Ge, Xiaojia

2011-01-01

This study examined the developmental cascade of both genetic and environmental influences on toddlers’ behavior problems through the longitudinal and multi-generational assessment of psychosocial risk. We used data from the Early Growth and Development Study, a prospective adoption study, to test the intergenerational transmission of risk through the assessment of adoptive mother, adoptive father, and biological parent depressive symptoms on toddler behavior problems. Given that depression is often chronic, we control for across-time continuity and find that in addition to associations between adoptive mother depressive symptoms and toddler externalizing problems, adoptive father depressive symptoms when the child is 9-months of age were associated with toddler problems and associated with maternal depressive symptoms. Findings also indicated that a genetic effect may indirectly influence toddler problems through prenatal pregnancy risk. These findings help to describe how multiple generations are linked through genetic (biological parent), timing (developmental age of the child), and contextual (marital partner) pathways. PMID:20883583

Intercountry Adoption: A Comparison between France and England.

ERIC Educational Resources Information Center

Greenfield, Joanna

1995-01-01

Examined the intercountry adoption experiences of 100 French and 100 English families, comparing policy in each country. Found a lack of effective and sensitive management of the introductory meetings between prospective parents and adoptive children, and of adequate birth records information. (HTH)

Accepting adoption's uncertainty: the limited ethics of pre-adoption genetic testing.

PubMed

Leighton, Kimberly J

2014-06-01

An increasing number of children are adopted in the United States from countries where both medical care and environmental conditions are extremely poor. In response to worries about the accuracy of medical histories, prospective adoptive parents increasingly request genetic testing of children prior to adoption. Though a general consensus on the ethics of pre-adoption genetic testing (PAGT) argues against permitting genetic testing on children available for adoption that is not also permitted for children in general, a view gaining traction argues for expanding the tests permitted. The reasoning behind this view is that the State has a duty to provide a child with parents who are the best "match," and thus all information that advances this end should be obtained. While the matching argument aims to promote the best interests of children, I show how it rests on the claim that what is in the best interests of children available for adoption is for prospective adoptive parents to have their genetic preferences satisfied such that the "genetics" of the children they end up adopting accurately reflects those preferences. Instead of protecting a vulnerable population, I conclude, PAGT contributes to the risks of harm such children face as it encourages people with strong genetic preferences to adopt children whose genetic backgrounds will always be uncertain.

Practice patterns among entrants and incumbents in the home health market after the prospective payment system was implemented.

PubMed

Kim, Hyunjee; Norton, Edward C

2015-03-01

Home health care expenditures were the fastest growing part of Medicare from 2001-2009, despite the implementation of prospective payment. Prior research has shown that home health agencies adopted two specific strategies to take advantage of Medicare policies: provide at least 10 therapy visits to get an enormous marginal payment and recertify patients for additional episodes. We study whether there is heterogeneity in the adoption of those strategic behaviors between home health agency entrants and incumbents and find that entrants were more likely to adopt strategic practice patterns than were incumbents. We also find that for-profit incumbents mimicked one of the practice patterns following entrants in the same market. Our findings suggest that it is important to understand the heterogeneity in providers' behavior and how firms interact with each other in the same market. These findings help explain the rapid rise in expenditures in the home health care market. Copyright © 2015 John Wiley & Sons, Ltd.

Envisaging the Adoption Process to Strengthen Gay- and Lesbian-Headed Families: Recommendations for Adoption Professionals

ERIC Educational Resources Information Center

Matthews, John D.; Cramer, Elizabeth P.

2006-01-01

Although a growing number of child placement agencies are serving lesbians and gay men, a dearth of literature exists for adoption agency policies and practices related to working with this population. This article explores the unique characteristics and strengths of prospective gay and lesbian adoptive parents throughout each of the three phases…

Transactions between child social wariness and observed structured parenting: evidence from a prospective adoption study.

PubMed

Natsuaki, Misaki N; Leve, Leslie D; Harold, Gordon T; Neiderhiser, Jenae M; Shaw, Daniel S; Ganiban, Jody; Scaramella, Laura V; Reiss, David

2013-01-01

This investigation examined the mutual influences between structured parenting and child social wariness during toddlerhood using a longitudinal adoption design. The sample consisted of 361 adoption-linked families, each including an adopted child, adoptive parents, and a birth mother. Heightened social wariness in children at age 18 months predicted reduced levels of observed structured parenting (i.e., less directive parenting with fewer commands and requests) in adoptive mothers at age 27 months. Adoptive fathers' lower structured parenting at age 18 months predicted subsequent elevation in child social wariness. Birth mothers' history of fear-related anxiety disorders was not associated with child social wariness. Findings highlight the role of dynamic family transactions in the development of social wariness during toddlerhood. © 2013 The Authors. Child Development © 2013 Society for Research in Child Development, Inc.

Predictors of relationship dissolution in lesbian, gay, and heterosexual adoptive parents.

PubMed

Goldberg, Abbie E; Garcia, Randi

2015-06-01

Little work has examined relationship dissolution or divorce in adoptive parents or same-sex parent couples. The current study examined predictors of relationship dissolution across the first 5 years of parenthood among a sample of heterosexual, lesbian, and gay male adoptive couples. Of the 190 couples in the study, 15 (7.9%) dissolved their relationships during the first 5 years of adoptive parenthood. Specifically, 7 of 57 lesbian couples (12.3%), 1 of 49 gay male couples (2.0%), and 7 of 84 heterosexual couples (8.3%) dissolved their unions. Results of our logistic regression analysis revealed that the odds of relationship dissolution were significantly higher for (a) couples who adopted a noninfant (i.e., older child); (b) participants who reported feeling less prepared for the adoption, 3 months postadoptive placement; and (c) couples in which both partners reported very low or very high preadoption levels of relationship maintenance behaviors. Findings have implications for adoption professionals seeking to support same-sex and heterosexual prospective adopters, as well as societal debates and policy regarding same-sex relationships and parenting. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Are associations between parental divorce and children's adjustment genetically mediated? An adoption study.

PubMed

O'Connor, T G; Caspi, A; DeFries, J C; Plomin, R

2000-07-01

The hypothesis that the association between parental divorce and children's adjustment is mediated by genetic factors was examined in the Colorado Adoption Project, a prospective longitudinal study of 398 adoptive and biological families. In biological families, children who experienced their parents' separation by the age of 12 years exhibited higher rates of behavioral problems and substance use, and lower levels of achievement and social adjustment, compared with children whose parents' marriages remained intact. Similarly, adopted children who experienced their (adoptive) parents' divorces exhibited elevated levels of behavioral problems and substance use compared with adoptees whose parents did not separate, but there were no differences on achievement and social competence. The findings for psychopathology are consistent with an environmentally mediated explanation for the association between parent divorce and children's adjustment; in contrast, the findings for achievement and social adjustment are consistent with a genetically mediated explanation involving passive genotype-environment correlation.

Adoptive immunotherapy against ovarian cancer.

PubMed

Mittica, Gloria; Capellero, Sonia; Genta, Sofia; Cagnazzo, Celeste; Aglietta, Massimo; Sangiolo, Dario; Valabrega, Giorgio

2016-05-17

The standard front-line therapy for epithelial ovarian cancer (EOC) is combination of debulking surgery and platinum-based chemotherapy. Nevertheless, the majority of patients experience disease recurrence. Although extensive efforts to find new therapeutic options, cancer cells invariably develop drug resistance and disease progression. New therapeutic strategies are needed to improve prognosis of patients with advanced EOC.Recently, several preclinical and clinical studies investigated feasibility and activity of adoptive immunotherapy in EOC. Our aim is to highlight prospective of adoptive immunotherapy in EOC, focusing on HLA-restricted Tumor Infiltrating Lymphocytes (TILs), and MHC-independent immune effectors such as natural killer (NK), and cytokine-induced killer (CIK). Adoptive cell therapy (ACT) has shown activity in several pre-clinical models. Available preclinical and clinical data suggest that adoptive cell therapy may provide the best benefit in settings of low tumor burden, minimal residual disease, or maintenance therapy. Further studies are needed to better define the optimal clinical setting.

Genetic liability, environment, and the development of fussiness in toddlers: the roles of maternal depression and parental responsiveness.

PubMed

Natsuaki, Misaki N; Ge, Xiaojia; Leve, Leslie D; Neiderhiser, Jenae M; Shaw, Daniel S; Conger, Rand D; Scaramella, Laura V; Reid, John B; Reiss, David

2010-09-01

Using a longitudinal, prospective adoption design, the authors of this study examined the effects of the environment (adoptive parents' depressive symptoms and responsiveness) and genetic liability of maternal depression (inferred by birth mothers' major depressive disorder [MDD]) on the development of fussiness in adopted children between 9 and 18 months old. The sample included 281 families linked through adoption, with each family including 4 individuals (i.e., adopted child, birth mother, adoptive father and mother). Results showed that adoptive mothers' depressive symptoms when their child was 9 months old were positively associated with child fussiness at 18 months. A significant interaction between birth mothers' MDD and adoptive mothers' responsiveness indicated that children of birth mothers with MDD showed higher levels of fussiness at 18 months when adoptive mothers had been less responsive to the children at 9 months. However, in the context of high levels of adoptive mothers' responsiveness, children of birth mothers with MDD did not show elevated fussiness at 18 months. Findings are discussed in terms of gene-environment interactions in the intergenerational risk transmission of depression.

22 CFR 96.15 - Examples.

Code of Federal Regulations, 2010 CFR

2010-04-01

... a video of Child Y. The evaluation will be used in a Convention adoption as part of the placement of... the age, sex, and health problems of Child W, Agency X matches Prospective Adoptive Parent(s) Y with...

Adoption of clinical and business trainings by child mental health clinics in New York State.

PubMed

Chor, Ka Ho Brian; Olin, Su-Chin Serene; Weaver, Jamie; Cleek, Andrew F; McKay, Mary M; Hoagwood, Kimberly E; Horwitz, Sarah M

2014-12-01

This study prospectively examined the naturalistic adoption of clinical and business evidence-informed training by all 346 outpatient mental health clinics licensed to treat children, adolescents, and their families in New York State. The study used attendance data (September 2011-August 2013) from the Clinic Technical Assistance Center, a training, consultation, and educational center funded by the state Office of Mental Health, to classify the clinics' adoption of 33 trainings. Adoption behavior was classified by number, type, and intensity of trainings. The clinics were classified into four adopter groups reflecting the highest training intensity in which they participated (low, medium, and high adopters and "super-adopters"). A total of 268 clinics adopted trainings (median=5); business and clinical trainings were about equally accessed (82% versus 78%). Participation was highest for hour-long Webinars (96%) followed by learning collaboratives, which take six to 18 months to complete (34%). Most (73%-94%) adopters of business learning collaboratives and all adopters of clinical learning collaboratives had previously sampled a Webinar, although maintaining participation in learning collaboratives was a challenge. The adopter groups captured meaningful adopter profiles: 41% of clinics were low adopters that selected fewer trainings and participated only in Webinars, and 34% were high or super-adopters that accessed more trainings and participated in at least one learning collaborative. More nuanced definitions of adoption behavior can improve the understanding of clinic adoption of training and hence promote the development of efficient rollout strategies by state systems.

The Relation of Emotional Maltreatment to Early Adolescent Competence: Developmental Processes in a Prospective Study

ERIC Educational Resources Information Center

Shaffer, Anne; Yates, Tuppett M.; Egeland, Byron R.

2009-01-01

Objectives: This investigation examined developmental pathways between childhood emotional maltreatment and adaptational outcomes in early adolescence. This study utilized a developmental psychopathology perspective in adopting a multidimensional approach to the assessment of different forms of emotional maltreatment and later adjustment outcomes.…

Child-evoked maternal negativity from 9 to 27 months: Evidence of gene-environment correlation and its moderation by marital distress.

PubMed

Fearon, R M Pasco; Reiss, David; Leve, Leslie D; Shaw, Daniel S; Scaramella, Laura V; Ganiban, Jody M; Neiderhiser, Jenae M

2015-11-01

Past research has documented pervasive genetic influences on emotional and behavioral disturbance across the life span and on liability to adult psychiatric disorder. Increasingly, interest is turning to mechanisms of gene-environment interplay in attempting to understand the earliest manifestations of genetic risk. We report findings from a prospective adoption study, which aimed to test the role of evocative gene-environment correlation in early development. Included in the study were 561 infants adopted at birth and studied between 9 and 27 months, along with their adoptive parents and birth mothers. Birth mother psychiatric diagnoses and symptoms scales were used as indicators of genetic influence, and multiple self-report measures were used to index adoptive mother parental negativity. We hypothesized that birth mother psychopathology would be associated with greater adoptive parent negativity and that such evocative effects would be amplified under conditions of high adoptive family adversity. The findings suggested that genetic factors associated with birth mother externalizing psychopathology may evoke negative reactions in adoptive mothers in the first year of life, but only when the adoptive family environment is characterized by marital problems. Maternal negativity mediated the effects of genetic risk on child adjustment at 27 months. The results underscore the importance of genetically influenced evocative processes in early development.

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.47 - Preparation of home studies in incoming cases.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Preparation of home studies in incoming cases... Cases) § 96.47 Preparation of home studies in incoming cases. (a) The agency or person ensures that a home study on the prospective adoptive parent(s) (which for purposes of this section includes the...

22 CFR 96.48 - Preparation and training of prospective adoptive parent(s) in incoming cases.

Code of Federal Regulations, 2014 CFR

2014-04-01

... least ten hours (independent of the home study) of preparation and training, as described in paragraphs... cases where training cannot otherwise be provided, an extended home study process, with a system for..., and any other training or counseling needed in light of the child background study or the home study...

22 CFR 96.48 - Preparation and training of prospective adoptive parent(s) in incoming cases.

Code of Federal Regulations, 2012 CFR

2012-04-01

... least ten hours (independent of the home study) of preparation and training, as described in paragraphs... cases where training cannot otherwise be provided, an extended home study process, with a system for..., and any other training or counseling needed in light of the child background study or the home study...

22 CFR 96.48 - Preparation and training of prospective adoptive parent(s) in incoming cases.

Code of Federal Regulations, 2013 CFR

2013-04-01

... least ten hours (independent of the home study) of preparation and training, as described in paragraphs... cases where training cannot otherwise be provided, an extended home study process, with a system for..., and any other training or counseling needed in light of the child background study or the home study...

A global overview of biotech (GM) crops: adoption, impact and future prospects.

PubMed

James, Clive

2010-01-01

In the early 1990s, some were skeptical that genetically modified (GM) crops, now referred to as biotech crops, could deliver improved products and make an impact at the farm level. There was even more skepticism that developing countries would adopt biotech crops. The adoption of and commercialization of biotech crops in 2008 is reviewed. The impact of biotech crops are summarized including their contribution to: global food, feed and fiber security; a safer environment; a more sustainable agriculture; and the alleviation of poverty, and hunger in the developing countries of the world. Future prospects are discussed. Notably, Egypt planted Bt maize for the first time in 2008 thereby becoming the first country in the Arab world to commercialize biotech crops.

Transactional Patterns of Maternal Depressive Symptoms and Mother–Child Mutual Negativity in an Adoption Sample

PubMed Central

Roben, Caroline K. P.; Moore, Ginger A.; Cole, Pamela M.; Molenaar, Peter; Leve, Leslie D.; Shaw, Daniel S.; Reiss, David; Neiderhiser, Jenae M.

2015-01-01

Transactional models of analysis can examine both moment-to-moment interactions within a dyad and dyadic patterns of influence across time. This study used data from a prospective adoption study to test a transactional model of parental depressive symptoms and mutual negativity between mother and child over time, utilizing contingency analysis of second-by-second behavioral data. To consider both genetic and environmental influences on mutual negativity, depressive symptoms were examined in both adoptive and birth mothers. Adoptive mother depressive symptoms at 9 months increased the likelihood that, at 18 months, children reacted negatively to their mothers' negative behavior, which in turn predicted higher levels of adoptive mother depressive symptoms at 27 months, suggesting that over time, mothers' depressive symptoms influence and are influenced by moment-to-moment mutual negativity with their toddlers. Birth mother depressive symptoms moderated the association between mutual negativity at 18 months and adoptive mother depressive symptoms at 27 months, suggesting a child-driven contribution to maternal depressive symptoms that can be measured by a genetic sensitivity. PMID:26170764

The Conceptualization of the Mathematical Modelling Process in Technology-Aided Environment

ERIC Educational Resources Information Center

Hidiroglu, Çaglar Naci; Güzel, Esra Bukova

2017-01-01

The aim of the study is to conceptualize the technology-aided mathematical modelling process in the frame of cognitive modelling perspective. The grounded theory approach was adopted in the study. The research was conducted with seven groups consisting of nineteen prospective mathematics teachers. The data were collected from the video records of…

A Study of Technology Programs: College-Level.

ERIC Educational Resources Information Center

Rochester State Junior Coll., Minn.

Several current technology programs are evaluated and, where appropriate, changes recommended. Jobs at both entry and subsequent promotion levels are described, and manpower needs surveyed. Ordinarily, it is only after discussion with prospective employers (industrial, clinical, medical) that curriculums are adopted and costs estimated for…

22 CFR 96.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... prospective adoptive parent(s), and reporting on such a study; (4) Making non-judicial determinations of the... States Department of State. Central Authority function means any duty required under the Convention to be... the functions vested in the Attorney General by the IAA relating to the INS's responsibilities...

Freshman year alcohol and marijuana use prospectively predict time to college graduation and subsequent adult roles and independence.

PubMed

Wilhite, Emily R; Ashenhurst, James R; Marino, Elise N; Fromme, Kim

2017-01-01

This study examined how freshman year substance use prospectively predicted time to college graduation, and whether delayed graduation predicted postponed adoption of adult roles and future substance use. Participants were part of a longitudinal study that began in 2004. The first analyses focused on freshman year (N = 2,050). The second analyses corresponded to a subset of participants at age 27 (N = 575). Measures included self-reported substance use, adult role adoption, and university reported graduation dates. Results indicated that frequent binge drinking and marijuana use during freshman year predicted delayed college graduation. Those who took longer to graduate were more likely to have lower incomes and were less likely to obtain a graduate degree. Taking 5-6 years to graduate was associated with greater likelihood of alcohol-related problems. Findings support the importance of interventions during freshman year of college to decrease substance use and promote timely graduation.

Post-Adoption Face-to-Face Contact with Birth Parents: Prospective Adopters' Views

ERIC Educational Resources Information Center

Turkington, Selina; Taylor, Brian J.

2009-01-01

The trend in adoption since the 1960s has been away from secrecy and towards greater openness; contact through an intermediary, and direct contact by letter, is now widely accepted. More controversial is the challenge of face-to-face contact with birth parents, and social workers involved in the decision-making process find themselves having to…

[Motivations for a consultation before adoption: A multicenter study].

PubMed

Thieblemont, M; Francois, P; Poirier, V; Bosdure, E; Munck, M-R; Borsa-Dorion, A; Hazart, I; Moukagni-Pelzer, M; Brunel, D; Peyron, F; de Monleon, J-V

2016-01-01

While the number of international adoptions in France is decreasing, adopted children are older and in poorer health than they used to be. This phenomenon has resulted in an increase in the demand for preadoption consultations over the past several years. This study analyses the reasons for these consultations. Prospective multicenter study conducted from 1 January to 31 December 2013. Ten centers contributed to the study, i.e., 196 preadoption consultations. Seeking medical advice was the reason for 88% of the consultations, whether the advice was based on the study of an identified child's medical file (32%) or a country's healthcare characteristics, whether the country was identified (34%) or not (23%). In 6% of cases, the motive for preadoption consultations was social and familial, and in the last 5% it was to obtain general information about adoption and its procedures. In more than 40% of the cases, whether the child or the country identified, Russia is the subject of the consultation because of the complexity of the files and because of the dreaded but rarely mentioned fetal alcohol syndrome. The deterioration of adopted children's health is an additional worry for future adoption applicants. To provide them with the best information possible without making choices for them, specialists should have substantial experience in adoption before going into these preadoption consultations. Copyright © 2015. Published by Elsevier SAS.

Impact of Inuit customary adoption on behavioral problems in school-age Inuit children.

PubMed

Decaluwe, Béatrice; Jacobson, Sandra W; Poirier, Marie-Andrée; Forget-Dubois, Nadine; Jacobson, Joseph L; Muckle, Gina

2015-05-01

A large proportion of Inuit children in Arctic Quebec are adopted in accordance with traditional Inuit customs. In contrast to adoptions in Southern Canada and the United States, the child is adopted at birth and by a close family member; he or she knows who his or her biological parents are, and will typically have contact with them. Studies of other populations have reported an increased incidence of behavior problems in adopted compared with nonadopted children. This study examined the actual extent of the increase in the number of behavior problems seen in Inuit children adopted in accordance with traditional customs. In a prospective longitudinal study conducted in the Canadian Arctic (n = 46 adopted and 231 nonadopted children), prenatal and familial variables were documented at birth and at school age (M = 11.3 years). Behavior problems were assessed on the Teacher Report Form of the Child Behavior Checklist. Adopted children lived in more economically disadvantaged families, but their caregivers were less prone to depression, domestic violence, or alcohol abuse compared with those of the nonadopted children. The adoption status was not related to the teacher's report of attention problems, externalizing or internalizing behaviors, after controlling for confounders. Despite less favorable socioeconomic circumstances, a higher extent of behavioral problems was not seen at school age in Inuit children adopted at birth by a family member. Psychosocial stressors associated with adoption are more likely to be responsible for an association with higher levels of childhood behavior problems rather than adoption per se. (c) 2015 APA, all rights reserved).

The Prospect of Internet of Things and Big Data Analytics in Transportation System

NASA Astrophysics Data System (ADS)

Noori Hussein, Waleed; Kamarudin, L. M.; Hussain, Haider N.; Zakaria, A.; Badlishah Ahmed, R.; Zahri, N. A. H.

2018-05-01

Internet of Things (IoT); the new dawn technology that describes how data, people and interconnected physical objects act based on communicated information, and big data analytics have been adopted by diverse domains for varying purposes. Manufacturing, agriculture, banks, oil and gas, healthcare, retail, hospitality, and food services are few of the sectors that have adopted and massively utilized IoT and big data analytics. The transportation industry is also an early adopter, with significant attendant effects on its processes of tracking shipment, freight monitoring, and transparent warehousing. This is recorded in countries like England, Singapore, Portugal, and Germany, while Malaysia is currently assessing the potentials and researching a purpose-driven adoption and implementation. This paper, based on review of related literature, presents a summary of the inherent prospects in adopting IoT and big data analytics in the Malaysia transportation system. Efficient and safe port environment, predictive maintenance and remote management, boundary-less software platform and connected ecosystem, among others, are the inherent benefits in the IoT and big data analytics for the Malaysia transportation system.

The Association between Parent-Child Conflict and Adolescent Conduct Problems over Time: Results from a Longitudinal Adoption Study

PubMed Central

Klahr, Ashlea M.; McGue, Matt; Iacono, William G.; Burt, S. Alexandra

2010-01-01

A handful of prior adoption studies have confirmed that the cross-sectional relationship between child conduct problems and parent/child conflict is at least partially shared environmental in origin. However, as the direction of causation between parenting and delinquency remains unclear, this relationship could be better explained by the adolescent's propensity to elicit conflictive parenting, a phenomenon referred to as an evocative gene-environment correlation. The current study thus examined the prospective relationship between conduct problems and parent-child conflict in a sample of adoptive families. Participants included 672 adolescents in 405 adoptive families assessed at two time points roughly 4 years apart. Results indicated that parent-child conflict predicts the development of conduct problems, whereas conduct problems do not predict increases in parent-child conflict. Such findings suggest that evocative gene-environment correlations are highly unlikely as an explanation of prior shared environmental effects during adolescence. Moreover, because the adolescents in this study do not share genes with their adoptive parents, the association between conduct problems and parent-child conflict is indicative of shared environmental mediation in particular. Implications of our findings are discussed. PMID:21038930

Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observational study.

PubMed

das Dores Graciano Silva, Maria; Martins, Maria Auxiliadora Parreiras; de Gouvêa Viana, Luciana; Passaglia, Luiz Guilherme; de Menezes, Renata Rezende; de Queiroz Oliveira, João Antonio; da Silva, Jose Luiz Padilha; Ribeiro, Antonio Luiz Pinho

2018-06-06

Adverse drug events (ADEs) can seriously compromise the safety and quality of care provided to hospitalized patients, requiring the adoption of accurate methods to monitor them. We sought to prospectively evaluate the accuracy of the triggers proposed by the Institute for Healthcare Improvement (IHI) for identifying ADEs. A prospective study was conducted in a public university hospital, in 2015, with patients ≥18 years. Triggers proposed by IHI and clinical alterations suspected to be ADEs were searched daily. The number of days in which the patient was hospitalized was considered as unit of measure to evaluate the accuracy of each trigger. Three hundred patients were included in this study. Mean age was 56.3 years (standard deviation (SD) 16.0), and 154 (51.3%) were female. The frequency of patients with ADEs was 24.7% and with at least one trigger was 53.3%. From those patients who had at least one trigger, the most frequent triggers were antiemetics (57.5%) and "abrupt medication stop" (31.8%). Triggers' sensitivity ranged from 0.3 to11.8 % and the positive predictive value ranged from 1.2 to 27.3%. Specificity and negative predictive value were greater than 86%. Most patients identified by the presence of triggers did not have ADEs (64.4%). No triggers were identified in 40 (38.5%) ADEs. IHI Trigger Tool did not show good accuracy in detecting ADEs in this prospective study. The adoption of combined strategies could enhance effectiveness in identifying patient safety flaws. Further discussion might contribute to improve trigger usefulness in clinical practice. This article is protected by copyright. All rights reserved.

Effects of prenatal and postnatal parent depressive symptoms on adopted child HPA regulation: independent and moderated influences.

PubMed

Laurent, Heidemarie K; Leve, Leslie D; Neiderhiser, Jenae M; Natsuaki, Misaki N; Shaw, Daniel S; Harold, Gordon T; Reiss, David

2013-05-01

This study used a prospective adoption design to investigate effects of prenatal and postnatal parent depressive symptom exposure on child hypothalamic-pituitary-adrenal (HPA) activity and associated internalizing symptoms. Birth mother prenatal symptoms and adoptive mother/father postnatal (9-month, 27-month) symptoms were assessed with the Beck Depression Inventory in a sample of 192 families as part of the Early Growth and Development adoption Study. Child morning/evening cortisol levels and child symptoms of internalizing disorders (according to mother/father report on the Child Behavior Checklist) were assessed at 54 months, and birth mother diurnal cortisol was measured at 48 months postnatal. Hierarchical linear modeling was used to test main effects and interactions of parents' symptoms predicting child cortisol, controlling for birth mother cortisol. Prenatal exposure to birth mother symptoms predicted lower child cortisol (main effect), as did postnatal exposure to adoptive parent symptoms (interaction effects). Adoptive mother 9-month symptoms exacerbated cortisol-lowering effects of both concurrent paternal symptoms and later (27-month) maternal symptoms, and the effect of birth mother cortisol. Lower child cortisol, in turn, was associated with higher child internalizing symptoms. Implications are discussed with respect to the intergenerational transmission of depression risk.

Child-evoked maternal negativity from 9 to 27 months: evidence of gene-environment correlation and its moderation by marital distress

PubMed Central

Fearon, R.M. Pasco; Reiss, David; Leve, Leslie D.; Shaw, Daniel S.; Scaramella, Laura V.; Ganiban, Jody M.; Neiderhiser, Jenae M.

2014-01-01

Past research has documented pervasive genetic influences on emotional and behavioral disturbance across the lifespan and on liability to adult psychiatric disorder. Increasingly, interest is turning to mechanisms of gene-environment interplay in attempting to understand the earliest manifestations of genetic risk. We report findings from a prospective adoption study, which aimed to test the role of evocative gene-environment correlation in early development. 561 infants adopted at birth were studied between 9 and 27 months with their adoptive parents and birth mothers. Birth mother psychiatric diagnoses and symptoms scales were used as indicators of genetic influence, and multiple self-report measures were used to index adoptive mother parental negativity. We hypothesized that birth parent psychopathology would be associated with greater adoptive parent negativity, and that such evocative effects would be amplified under conditions of high family adversity. The findings suggested that genetic factors linked to birth mother externalizing psychopathology may evoke negative reactions in adoptive mothers in the first year of life, but primarily when the adoptive family environment was characterized by marital problems. The observed maternal negativity mediated the effects of genetic risk on child adjustment at 27 months. The results underline the importance of genetically-influenced evocative processes in early development. PMID:25216383

Influences of Biological and Adoptive Mothers’ Depression and Antisocial Behavior on Adoptees’ Early Behavior Trajectories

PubMed Central

Kerr, David C. R.; Leve, Leslie D.; Harold, Gordon T.; Natsuaki, Misaki; Neiderhiser, Jenae M.; Shaw, Daniel S.; Reiss, David

2013-01-01

Research clearly demonstrates that parents pass risk for depression and antisocial behavior on to their children. However, most research confounds genetic and environmental mechanisms by studying genetically related individuals. Furthermore, most studies focus on either depression or antisocial behavior in parents or children, despite evidence of co-occurrence and shared etiology, and few consider the early origins of these problems in childhood. We estimated the influence of biological and adoptive mothers’ depression and antisocial behavior on growth in child externalizing and internalizing behaviors across early childhood using data from a prospective adoption study. Participants were 346 matched triads of physically healthy children (196 boys; 150 girls), biological mothers (BM), and adoptive mothers (AM). Latent growth curve models were estimated using AM reports of child internalizing and externalizing behaviors at ages 18, 27, and 54 months. Predictors of intercept (18 months) but not slope were identified. BM lifetime histories of major depressive disorder predicted child externalizing behaviors and BM antisocial behavior predicted child internalizing behavior. AM depressive symptoms and antisocial behavior were associated with both child outcomes. AM paths, but not BM paths were partially replicated using adopted fathers’ reports of child outcomes. BM obstetric complications, prenatal depressive symptoms, and postnatal adoptive family contact with BM did not account for BM paths. This adoption study distinguished risks conferred by biological mothers’ depression and antisocial behavior to children’s behaviors from those associated with adoptive mothers’ related symptoms. Future studies should examine gene-environment interplay to explain the emergence of serious problem trajectories in later childhood. PMID:23408036

Influences of biological and adoptive mothers' depression and antisocial behavior on adoptees' early behavior trajectories.

PubMed

Kerr, David C R; Leve, Leslie D; Harold, Gordon T; Natsuaki, Misaki N; Neiderhiser, Jenae M; Shaw, Daniel S; Reiss, David

2013-07-01

Research clearly demonstrates that parents pass risk for depression and antisocial behavior on to their children. However, most research confounds genetic and environmental mechanisms by studying genetically related individuals. Furthermore, most studies focus on either depression or antisocial behavior in parents or children, despite evidence of co-occurrence and shared etiology, and few consider the early origins of these problems in childhood. We estimated the influence of biological and adoptive mothers' depression and antisocial behavior on growth in child externalizing and internalizing behaviors across early childhood using data from a prospective adoption study. Participants were 346 matched triads of physically healthy children (196 boys; 150 girls), biological mothers (BM), and adoptive mothers (AM). Latent growth curve models were estimated using AM reports of child internalizing and externalizing behaviors at ages 18, 27, and 54 months. Predictors of intercept (18 months) but not slope were identified. BM lifetime histories of major depressive disorder predicted child externalizing behaviors and BM antisocial behavior predicted child internalizing behavior. AM depressive symptoms and antisocial behavior were associated with both child outcomes. AM paths, but not BM paths were partially replicated using adopted fathers' reports of child outcomes. BM obstetric complications, prenatal depressive symptoms, and postnatal adoptive family contact with BM did not account for BM paths. This adoption study distinguished risks conferred by biological mothers' depression and antisocial behavior to children's behaviors from those associated with adoptive mothers' related symptoms. Future studies should examine gene-environment interplay to explain the emergence of serious problem trajectories in later childhood.

Building Families: Diverse Pathways to Parenthood

ERIC Educational Resources Information Center

Rosenblum, Katherine L.; Olshansky, Ellen

2007-01-01

Due to advances in reproductive technology and more progressive adoption laws, prospective parents now have many more choices and opportunities for how they form their families. This article explores the experiences of adoption, gay and lesbian families, and assisted reproductive technology to illustrate the concept that there are many legitimate…

Optimizing diffusion of an online computer tailored lifestyle program: a study protocol.

PubMed

Schneider, Francine; van Osch, Liesbeth A D M; Kremers, Stef P J; Schulz, Daniela N; van Adrichem, Mathieu J G; de Vries, Hein

2011-06-20

Although the Internet is a promising medium to offer lifestyle interventions to large amounts of people at relatively low costs and effort, actual exposure rates of these interventions fail to meet the high expectations. Since public health impact of interventions is determined by intervention efficacy and level of exposure to the intervention, it is imperative to put effort in optimal dissemination. The present project attempts to optimize the dissemination process of a new online computer tailored generic lifestyle program by carefully studying the adoption process and developing a strategy to achieve sustained use of the program. A prospective study will be conducted to yield relevant information concerning the adoption process by studying the level of adoption of the program, determinants involved in adoption and characteristics of adopters and non-adopters as well as satisfied and unsatisfied users. Furthermore, a randomized control trial will be conducted to the test the effectiveness of a proactive strategy using periodic e-mail prompts in optimizing sustained use of the new program. Closely mapping the adoption process will gain insight in characteristics of adopters and non-adopters and satisfied and unsatisfied users. This insight can be used to further optimize the program by making it more suitable for a wider range of users, or to develop adjusted interventions to attract subgroups of users that are not reached or satisfied with the initial intervention. Furthermore, by studying the effect of a proactive strategy using period prompts compared to a reactive strategy to stimulate sustained use of the intervention and, possibly, behaviour change, specific recommendations on the use and the application of prompts in online lifestyle interventions can be developed. Dutch Trial Register NTR1786 and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016).

History, problems, and prospects of Islamic insurance (Takaful) in Bangladesh.

PubMed

Khan, Issa; Rahman, Noor Naemah Binti Abdul; Yusoff, Mohd Yakub Zulkifli Bin Mohd; Nor, Mohd Roslan Bin Mohd

2016-01-01

This study explains the history, current problems, and future possibilities of Islamic insurance (takaful) in Bangladesh. To articulate these issues, the researcher has adopted the qualitative method, and data has been collected through secondary sources i.e. articles, books, and online resources. The study reveals that Islamic insurance in Bangladesh is regulated by the Insurance Act 2010 which is contradictory with Islamic insurance causing numerous problems for Islamic insurance. This study also points out that Islamic insurance is a fast growing industry with huge prospects in Bangladesh. The government should introduce separate regulations for both Islamic and conventional insurance. The research concludes with suggestions for the further development of Islamic insurance in Bangladesh.

Prospects for Integrating Service Learning into Short-Term International Study

ERIC Educational Resources Information Center

Daly, Donna M.; Baker, Suzanne; Williams, Stephen J.

2014-01-01

In an era of significant social, political, and economic globalization, it is crucial for health and human services educators to adopt a more hands on international view vis-à-vis student education. This article presents information that will assist educators in extending domestic service learning concepts and activities into the undergraduate…

Alternative Pathways to Legitimacy: Promotional Practices in the Ontario For-Profit College Sector

ERIC Educational Resources Information Center

Pizarro Milian, Roger; Quirke, Linda

2017-01-01

This study empirically examines how for-profit career colleges in Ontario, Canada market themselves to prospective students. It uses a mixed-methods approach to review the content of 489 online promotional profiles representing 375 unique for-profit colleges. It finds that for-profit colleges adopt several distinct marketing strategies, including…

A Study of Prospective Secondary Mathematics Teachers' Evolving Understanding of Reasoning-and-Proving

ERIC Educational Resources Information Center

Boyle, Justin D.

2012-01-01

Proof is a foundational mathematical activity that has been underrepresented in school mathematics. The recently adopted Common Core State Standards in Mathematics includes eight process standards, several of which promote the inclusion of reasoning and proof across all grades, courses, and students. If students are to reach the expectations…

22 CFR 96.52 - Performance of Convention communication and coordination functions in incoming cases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... prospective adoptive parent(s) and/or the child background study to the authorities that forwarded them. (e... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Performance of Convention communication and... 2000 (IAA) Standards for Convention Accreditation and Approval Standards for Cases in Which A Child Is...

Three Decades of Implementation Research in Higher Education: Limitations and Prospects of Theory Development

ERIC Educational Resources Information Center

Kohoutek, Jan

2013-01-01

The article adopts a comparative approach to review three periods of theory development in research into higher education policy implementation. Given the conceptual affinity between Cerych and Sabatier's 1986 seminal study into higher education policy implementation and public policy implementation theory, the field of public policy is chosen for…

Children adopted from China: a prospective study of their growth and development.

PubMed

Cohen, Nancy J; Lojkasek, Mirek; Zadeh, Zohreh Yaghoub; Pugliese, Mirella; Kiefer, Heidi

2008-04-01

China has become a lead country for international adoption because of the relatively young age of the children and reported positive conditions of the orphanages. This study examined the process and outcome of growth and development of children adopted from China over their first two years with their adoptive families. Seventy infant girls adopted from China at 8 to 21 months of age (Mean age = 13 months) were examined on arrival in Canada and 6, 12, and 24 months later. Comparisons were made with non-adopted Canadian girls of similar age and from a similar family background as adoptive parents on indices of growth and standardized measures of mental, psychomotor, and language development. At arrival, children adopted from China were smaller physically and exhibited developmental delays compared to current peers. Children adopted from China were functioning in the average range on physical and developmental measures within the first 6 months following adoption. However, they were not performing as well as current peers until the end of their second year after adoption. Even then, there was developmental variation in relation to comparison children and continuation of relatively smaller size with respect to height, weight, and head circumference. Physical measurement was related to outcomes at various points on all developmental measures. Deprivation in experience in the first year of life has more long-lasting effects on physical growth than on mental development. The variable most consistently related to development was height-to-age ratio. As a measure of nutritional status, the findings reinforce the critical importance of early nutrition.

Longitudinal Associations Between Marital Instability and Child Sleep Problems across Infancy and Toddlerhood in Adoptive Families

PubMed Central

Mannering, Anne M.; Harold, Gordon T.; Leve, Leslie D.; Shelton, Katherine H.; Shaw, Daniel S.; Conger, Rand D.; Neiderhiser, Jenae M.; Scaramella, Laura V.; Reiss, David

2009-01-01

This study examined the longitudinal association between marital instability and child sleep problems at ages 9 and 18 months in 357 families with a genetically unrelated infant adopted at birth. This design eliminates shared genes as an explanation for similarities between parent and child. Structural equation modeling indicated that T1 marital instability predicted T2 child sleep problems, but T1 child sleep problems did not predict T2 marital instability. This pattern of results was replicated when models were estimated separately for mothers and children and for fathers and children. Thus, even after controlling for stability in sleep problems and marital instability and eliminating shared genetic influences on associations using a longitudinal adoption design, marital instability prospectively predicts early childhood sleep patterns. PMID:21557740

Effects of Prenatal and Postnatal Parent Depressive Symptoms on Adopted Child HPA Regulation: Independent and Moderated Influences

PubMed Central

Laurent, Heidemarie K.; Leve, Leslie D.; Neiderhiser, Jenae M.; Natsuaki, Misaki N.; Shaw, Daniel S.; Harold, Gordon T.; Reiss, David

2013-01-01

This study used a prospective adoption design to investigate effects of prenatal and postnatal parent depressive symptom exposure on child hypothalamic-pituitary-adrenal (HPA) activity and associated internalizing symptoms. Birth mother prenatal symptoms and adoptive mother/father postnatal (9-month, 27-month) symptoms were assessed with the Beck Depression Inventory in a sample of 192 families as part of the Early Growth and Development adoption Study. Child morning/evening cortisol levels and child symptoms of internalizing disorders (according to mother/father report on the Child Behavior Checklist) were assessed at 54 months, and birth mother diurnal cortisol was measured at 48 months postnatal. Hierarchical linear modeling was used to test main effects and interactions of parents’ symptoms predicting child cortisol, controlling for birth mother cortisol. Prenatal exposure to birth mother symptoms predicted lower child cortisol (main effect), as did postnatal exposure to adoptive parent symptoms (interaction effects). Adoptive mother 9-month symptoms exacerbated cortisol-lowering effects of both concurrent paternal symptoms and later (27-month) maternal symptoms, and the effect of birth mother cortisol. Lower child cortisol, in turn, was associated with higher child internalizing symptoms. Implications are discussed with respect to the intergenerational transmission of depression risk. PMID:22686176

Effect of Mobile-Assisted Dialect Awareness Training on the Dialect Attitudes of Prospective English Language Teachers

ERIC Educational Resources Information Center

Bozoglan, Hilal; Gok, Duygu

2017-01-01

The purpose of this study was to investigate the impact of a mobile-assisted dialect awareness programme on the dialect attitudes of pre-service English language teachers in Turkey. The study adopted a pre-test and a post-test design including 58 first-grade pre-service English language teachers in two different classes. The experimental group…

Comparison of Triadic and Provider-Led Intervention Practices in Early Intervention Home Visits

ERIC Educational Resources Information Center

Salisbury, Christine L.; Cushing, Lisa S.

2013-01-01

Despite calls for adoption and use of triadic early intervention practices, remarkably little research has prospectively compared this approach with traditional, provider-led service delivery. The aim of this study was to compare the actions of providers and caregivers within triadic and provider-led interactions with regard to the following: (1)…

State Arts Policy: Trends and Future Prospects

ERIC Educational Resources Information Center

Lowell, Julia F.

2008-01-01

State arts agencies (SAAs)--key players within the U.S. system of public support for the arts--face growing economic, political, and demographic challenges to the roles and missions they adopted when founded in the mid-1960s. This report, the fourth and final in a multiyear study, looks at state arts agencies' efforts to rethink their roles and…

Adoptive parents can be unprepared for the challenges in caring for children with reactive attachment disorder.

PubMed

Smyke, Anna T

2015-04-01

Implications for practice and research: Adoptive parents experience significant challenges in caring for children diagnosed with reactive attachment disorder. Informing prospective adoptive parents about attachment issues and providing concrete assistance to develop healthy attachment relationships may decrease some of the frustration experienced by parents and children affected with the disorder. Future research could address factors contributing to the diagnosis of reactive attachment disorder as well as best practices for ameliorating the disorder.

Longitudinal associations between marital instability and child sleep problems across infancy and toddlerhood in adoptive families.

PubMed

Mannering, Anne M; Harold, Gordon T; Leve, Leslie D; Shelton, Katherine H; Shaw, Daniel S; Conger, Rand D; Neiderhiser, Jenae M; Scaramella, Laura V; Reiss, David

2011-01-01

This study examined the longitudinal association between marital instability and child sleep problems at ages 9 and 18 months in 357 families with a genetically unrelated infant adopted at birth. This design eliminates shared genes as an explanation for similarities between parent and child. Structural equation modeling indicated that T1 marital instability predicted T2 child sleep problems, but T1 child sleep problems did not predict T2 marital instability. This result was replicated when models were estimated separately for mothers and fathers. Thus, even after controlling for stability in sleep problems and marital instability and eliminating shared genetic influences on associations using a longitudinal adoption design, marital instability prospectively predicts early childhood sleep patterns. © 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.

Adoptive cell therapy and modulation of the tumour microenvironment: new insights from ASCO 2016.

PubMed

Khoja, Leila; Gyawali, Bishal

2016-01-01

Immuno-oncology has changed the landscape of cancer treatment in recent years. Immune checkpoint inhibitors (ICI) have shown survival advantage with long term remissions in a variety of cancers. However, there is another approach to harnessing the power of the immune system in combating cancer: the adoptive cell therapy (ACT) strategy. Although ACT is restricted to small specialized centres and has yet to deliver as much success as ICI, some important results were presented at this year's ASCO meeting. Important lessons have been learned from these studies, including the prospects and challenges ahead. In this editorial, we summarize the important studies on ACT presented at the ASCO 2016 meeting and discuss the way forward.

Adoptive cell therapy and modulation of the tumour microenvironment: new insights from ASCO 2016

PubMed Central

Khoja, Leila; Gyawali, Bishal

2016-01-01

Abstract Immuno-oncology has changed the landscape of cancer treatment in recent years. Immune checkpoint inhibitors (ICI) have shown survival advantage with long term remissions in a variety of cancers. However, there is another approach to harnessing the power of the immune system in combating cancer: the adoptive cell therapy (ACT) strategy. Although ACT is restricted to small specialized centres and has yet to deliver as much success as ICI, some important results were presented at this year’s ASCO meeting. Important lessons have been learned from these studies, including the prospects and challenges ahead. In this editorial, we summarize the important studies on ACT presented at the ASCO 2016 meeting and discuss the way forward. PMID:27610200

The Effect of ICT Assisted Project Based Learning Approach on Prospective ICT Integration Skills of Teacher Candidates

ERIC Educational Resources Information Center

Pilten, Pusat; Pilten, Gulhiz; Sahinkaya, Nihan

2017-01-01

The purpose of the present research is studying the effects of information and communication technologies (ICT) assisted project based learning practices on ICT integration skills of pre-service classroom teachers. The research adopted a mixed method. The quantitative dimension of the research was designed with pre-test-post-test control groups.…

The Development of Early Profiles of Temperament: Characterization, Continuity, and Etiology

PubMed Central

Beekman, Charles; Neiderhiser, Jenae M.; Buss, Kristin A.; Loken, Eric; Moore, Ginger A.; Leve, Leslie D.; Ganiban, Jody M.; Shaw, Daniel S.; Reiss, David

2015-01-01

This study used a data-driven, person-centered approach to examine the characterization, continuity, and etiology of child temperament from infancy to toddlerhood. Data from 561 families who participated in an ongoing prospective adoption study, the Early Growth and Development Study, were used to estimate latent profiles of temperament at 9, 18, and 27 months. Results indicated that four profiles of temperament best fit the data at all three points of assessment. The characterization of profiles was stable over time while membership in profiles changed across age. Facets of adoptive parent and birth mother personality were predictive of children’s profile membership at each age, providing preliminary evidence for specific environmental and genetic influences on patterns of temperament development from infancy to toddlerhood. PMID:26332208

Elementary science education: Dilemmas facing preservice teachers

NASA Astrophysics Data System (ADS)

Sullivan, Sherry Elaine

Prospective teachers are involved in a process of induction into a culture of teaching that has rules, or codes of conduct for engaging in teaching practice. This same culture of teaching exists within a larger culture of schooling that also has values and norms for behaviors, that over time have become institutionalized. Teacher educators are faced with the challenging task of preparing preservice teachers to resolve dilemmas that arise from conflicts between the pressure to adopt traditional teaching practices of schooling, or to adopt inquiry-based teaching practices from their university methods classes. One task for researchers in teacher education is to define with greater precision what factors within the culture of schooling hinder or facilitate implementation of inquiry-based methods of science teaching in schools. That task is the focus of this study. A qualitative study was undertaken using a naturalistic research paradigm introduced by Lincoln and Guba in 1985. Participant observation, interviews, discourse analysis of videotapes of lessons from the methods classroom and written artifacts produced by prospective teachers during the semester formed the basis of a grounded theory based on inductive analysis and emergent design. Unstructured interviews were used to negotiate outcomes with participants. Brief case reports of key participants were also written. This study identified three factors that facilitated or hindered the prospective teachers in this research success in implementing inquiry-based science teaching in their field placement classrooms: (a) the culture of teaching/teacher role-socialization, (b) the culture of schooling and its resistance to change, and (c) the culture of teacher education, especially in regards to grades and academic standing. Some recommendations for overcoming these persistent obstacles to best practice in elementary science teaching include: (a) preparing prospective teachers to understand and cope with change processes, (b) to understand the nature of teaching and schooling, and (c) to understand the nature of teacher education itself through explicit discourse about these topics. In addition, development of greater partnerships among university faculty and schools though Partnership School models and other community-building efforts can afford prospective teachers more opportunities to enter the discourse; perhaps even as change agents.

A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion.

PubMed

Maibach, Edward W; Van Duyn, Mary Ann S; Bloodgood, Bonny

2006-07-01

Evidence-based disease prevention practice guidelines can provide a rationale for health programming decisions, which should, in turn, lead to improved public health outcomes. This logic has stimulated the creation of a growing number of evidence-based prevention practice guidelines, including the Guide to Community Preventive Services. Few systematic efforts have been made to document the degree of adoption and implementation of these approaches, although the evidence on translation of research into practice in other health fields indicates that the adoption and implementation rate is low. Drawing on the marketing literature, we suggest three approaches to enhance the adoption and implementation of evidence-based approaches: 1) conducting consumer research with prospective adopters to identify their perspectives on how evidence-based prevention programs can advance their organization's mission, 2) building sustainable distribution channels to promote and deliver evidence-based programs to prospective adopters, and 3) improving access to easily implemented programs that are consistent with evidence-based guidelines. Newly emerging paradigms of prevention research (e.g., RE-AIM) that are more attuned to the needs of the marketplace will likely yield a new generation of evidence-based preventive approaches that can be more effectively disseminated. We suggest that the public health community prioritize the dissemination of evidence-based prevention approaches, because doing so is a potent environmental change strategy for enhancing health.

Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine.

PubMed

Pizones, Javier; Sánchez-Mariscal, Felisa; Zúñiga, Lorenzo; Álvarez, Patricia; Izquierdo, Enrique

2013-04-20

Prospective cohort study. To study magnetic resonance imaging (MRI) accuracy in diagnosing posterior ligamentous complex (PLC) damage, when applying the new dichotomic instability criteria in a prospective cohort of patients with vertebral fracture. Recent studies dispute MRI accuracy to diagnose PLC injuries. They analyze the complex based on 3 categories (intact/indeterminate/rupture), including the indeterminate in the ruptured group (measurement bias) in the accuracy analysis. Moreover, fractures with conservative treatment (selection bias) are not included. Both facts reduce the specificity. A recent study has proposed new criteria where posterior instability is determined with supraspinous ligament (SSL) rupture. Prospective study of patients with acute thoracolumbar fracture, using radiography and MRI (FS-T2-w/short-tau inversion-recovery sequences). 1. The integrity (ruptured/unruptured) of each isolated component of the PLC (facet capsules, interspinous ligament, SSL, and ligamentum flavum) was assessed via MRI and surgical findings. 2. PLC integrity as a whole was assessed, adopting the new dichotomic stability criteria from previous studies. In the MR images, PLC is considered ruptured when the SSL is found discontinued, and intact when not (this excludes the "indeterminate" category). In surgically treated fractures, PLC stability as a whole was assessed dynamically (ruptured/unruptured). In conservative fractures, PLC stability was assessed according to change in vertebral kyphosis measured with the local kyphotic angle at 2-year follow-up (ruptured if difference is > 5°/unruptured if difference is < 5°).3. Comparative analysis among findings provided MRI accuracy in diagnosing PLC damage. Fifty-eight vertebral fractures were studied (38 surgical, 20 conservative), of which 50% were in males; average age, 40.4 years. MRI sensitivity for injury diagnosis of each isolated PLC component varied between 92.3% (interspinous ligament) and 100% (ligamentum flavum). Specificity varied between 52% (facet capsules) and 100% (SSL). PLC integrity sensitivity and specificity as a whole were 91% and 100%, respectively. Adopting the new stability criteria, MRI accuracy in PLC injury diagnosis increases. Specificity is increased (true positives) both in isolated component analysis and PLC as a whole.

How to make the fourth revolution: Human factors in the adoption of electronic instructional aids

NASA Technical Reports Server (NTRS)

Demerath, N. J.; Daniels, L. A.

1973-01-01

The prospects and problems of getting higher education in the United States (high school and above) to more fully utilize electronic technologies are examined. Sociological, psychological, and political factors are analyzed to determine the feasibility of adopting electronic instructional techniques. Differences in organizations, attitudes, and customs of different kinds of students, teachers, administrators, and publics are crucial factors in innovation.

Two is better than one: advances in pathogen-boosted immunotherapy and adoptive T-cell therapy.

PubMed

Xin, Gang; Schauder, David M; Zander, Ryan; Cui, Weiguo

2017-09-01

The recent tremendous successes in clinical trials take cancer immunotherapy into a new era and have attracted major attention from both academia and industry. Among the variety of immunotherapy strategies developed to boost patients' own immune systems to fight against malignant cells, the pathogen-based and adoptive cell transfer therapies have shown the most promise for treating multiple types of cancer. Pathogen-based therapies could either break the immune tolerance to enhance the effectiveness of cancer vaccines or directly infect and kill cancer cells. Adoptive cell transfer can induce a strong durable antitumor response, with recent advances including engineering dual specificity into T cells to recognize multiple antigens and improving the metabolic fitness of transferred cells. In this review, we focus on the recent prospects in these two areas and summarize some ongoing studies that represent potential advancements for anticancer immunotherapy, including testing combinations of these two strategies.

The effects of a parenting prime on sex differences in mate selection criteria.

PubMed

Millar, Murray G; Ostlund, Nelse M

2006-11-01

This study tested an evolutionary hypothesis that the mere prospect of caring for a child will increase sex differences in human mate selection criteria. That is, women would adopt a stronger preference for socially dominant men when parenting had been primed and men would adopt a stronger preference for physically attractive women when parenting had been primed. Male and female university students were randomly assigned to be exposed to a parenting prime or a nonparenting prime. Following the priming procedure, participants rated the romantic appeal of a target person of the opposite sex. Exposure to the parenting prime, the target's social dominance, and the target's physical attractiveness were orthogonally manipulated. As predicted, women adopted a stronger mate preference for social dominance when parenting was at the forefront of the mind. Contrary to predictions, the parenting prime had no effect on men's mate preference for physical attractiveness.

Practical Aspects of Designing and Conducting Validation Studies Involving Multi-study Trials.

PubMed

Coecke, Sandra; Bernasconi, Camilla; Bowe, Gerard; Bostroem, Ann-Charlotte; Burton, Julien; Cole, Thomas; Fortaner, Salvador; Gouliarmou, Varvara; Gray, Andrew; Griesinger, Claudius; Louhimies, Susanna; Gyves, Emilio Mendoza-de; Joossens, Elisabeth; Prinz, Maurits-Jan; Milcamps, Anne; Parissis, Nicholaos; Wilk-Zasadna, Iwona; Barroso, João; Desprez, Bertrand; Langezaal, Ingrid; Liska, Roman; Morath, Siegfried; Reina, Vittorio; Zorzoli, Chiara; Zuang, Valérie

This chapter focuses on practical aspects of conducting prospective in vitro validation studies, and in particular, by laboratories that are members of the European Union Network of Laboratories for the Validation of Alternative Methods (EU-NETVAL) that is coordinated by the EU Reference Laboratory for Alternatives to Animal Testing (EURL ECVAM). Prospective validation studies involving EU-NETVAL, comprising a multi-study trial involving several laboratories or "test facilities", typically consist of two main steps: (1) the design of the validation study by EURL ECVAM and (2) the execution of the multi-study trial by a number of qualified laboratories within EU-NETVAL, coordinated and supported by EURL ECVAM. The approach adopted in the conduct of these validation studies adheres to the principles described in the OECD Guidance Document on the Validation and International Acceptance of new or updated test methods for Hazard Assessment No. 34 (OECD 2005). The context and scope of conducting prospective in vitro validation studies is dealt with in Chap. 4 . Here we focus mainly on the processes followed to carry out a prospective validation of in vitro methods involving different laboratories with the ultimate aim of generating a dataset that can support a decision in relation to the possible development of an international test guideline (e.g. by the OECD) or the establishment of performance standards.

The Development of Early Profiles of Temperament: Characterization, Continuity, and Etiology.

PubMed

Beekman, Charles; Neiderhiser, Jenae M; Buss, Kristin A; Loken, Eric; Moore, Ginger A; Leve, Leslie D; Ganiban, Jody M; Shaw, Daniel S; Reiss, David

2015-01-01

This study used a data-driven, person-centered approach to examine the characterization, continuity, and etiology of child temperament from infancy to toddlerhood. Data from 561 families who participated in an ongoing prospective adoption study, the Early Growth and Development Study, were used to estimate latent profiles of temperament at 9, 18, and 27 months. Results indicated that four profiles of temperament best fit the data at all three points of assessment. The characterization of profiles was stable over time, while membership in profiles changed across age. Facets of adoptive parent and birth mother personality were predictive of children's profile membership at each age, providing preliminary evidence for specific environmental and genetic influences on patterns of temperament development from infancy to toddlerhood. © 2015 The Authors. Child Development © 2015 Society for Research in Child Development, Inc.

Application of electrical geophysics to the release of water resources, case of Ain Leuh (Morocco)

NASA Astrophysics Data System (ADS)

Zitouni, A.; Boukdir, A.; El Fjiji, H.; Baite, W.; Ekouele Mbaki, V. R.; Ben Said, H.; Echakraoui, Z.; Elissami, A.; El Maslouhi, M. R.

2018-05-01

Being seen needs in increasing waters in our contry for fine domestics, manufactures and agricultural, the prospecting of subterranean waters by geologic and hydrogeologic classic method remains inaplicable in the cases of the regions where one does not arrange drillings or polls (soundings) of gratitude (recongnition) in very sufficient (self-important) number. In that case of figure, the method of prospecting geophysics such as the method of nuclear magnetic resonance (NMR) and the method of the geophysics radar are usually used most usually because they showed, worldwide, results very desive in the projects of prospecting and evaluation of the resources in subterranean waters. In the present work, which concerns only the methodology of the electric resistivity, we treat the adopted methodological approach and the study of the case of application in the tray of Ajdir Ain Leuh.

Distant memories: a prospective study of vantage point of trauma memories.

PubMed

Kenny, Lucy M; Bryant, Richard A; Silove, Derrick; Creamer, Mark; O'Donnell, Meaghan; McFarlane, Alexander C

2009-09-01

Adopting an observer perspective to recall trauma memories may function as a form of avoidance that maintains posttraumatic stress disorder (PTSD). We conducted a prospective study to analyze the relationship between memory vantage point and PTSD symptoms. Participants (N= 947) identified the vantage point of their trauma memory and reported PTSD symptoms within 4 weeks of the trauma; 730 participants repeated this process 12 months later. Initially recalling the trauma from an observer vantage point was related to more severe PTSD symptoms at that time and 12 months later. Shifting from a field to an observer perspective a year after trauma was associated with greater PTSD severity at 12 months. These results suggest that remembering trauma from an observer vantage point is related to both immediate and ongoing PTSD symptoms.

[Application of ecosystem service value in land use change research: Bottlenecks and prospects].

PubMed

Zhang, Zhou; Wu, Ci-Fang; Tan, Rong

2013-02-01

In recent years, the application of ecosystem service value in land use change research is a hot topic in many famous international journals. However, policy makers are seldom taking into account the achievements of the related studies in practice. This paper summarized the three main bottlenecks in applying ecosystem service value in land management practices, i. e., the difficulty in measuring the service values, the complexity of driving factors, and the bias of evaluation criteria. Some solutions on the bottlenecks were provided, and the future research directions in China were prospected. It was suggested that in the studies of land use change based on ecosystem service value, it would be more appropriate to adopt comparative analysis method in small scale case studies, especially focusing on the natural ecological resources and the excessive loss of their values.

Disentangling the effects of genetic, prenatal and parenting influences on children's cortisol variability.

PubMed

Marceau, Kristine; Ram, Nilam; Neiderhiser, Jenae M; Laurent, Heidemarie K; Shaw, Daniel S; Fisher, Phil; Natsuaki, Misaki N; Leve, Leslie D

2013-11-01

Developmental plasticity models hypothesize the role of genetic and prenatal environmental influences on the development of the hypothalamic-pituitary-adrenal (HPA) axis and highlight that genes and the prenatal environment may moderate early postnatal environmental influences on HPA functioning. This article examines the interplay of genetic, prenatal and parenting influences across the first 4.5 years of life on a novel index of children's cortisol variability. Repeated measures data were obtained from 134 adoption-linked families, adopted children and both their adoptive parents and birth mothers, who participated in a longitudinal, prospective US domestic adoption study. Genetic and prenatal influences moderated associations between inconsistency in overreactive parenting from child age 9 months to 4.5 years and children's cortisol variability at 4.5 years differently for mothers and fathers. Among children whose birth mothers had high morning cortisol, adoptive fathers' inconsistent overreactive parenting predicted higher cortisol variability, whereas among children with low birth mother morning cortisol adoptive fathers' inconsistent overreactive parenting predicted lower cortisol variability. Among children who experienced high levels of prenatal risk, adoptive mothers' inconsistent overreactive parenting predicted lower cortisol variability and adoptive fathers' inconsistent overreactive parenting predicted higher cortisol variability, whereas among children who experienced low levels of prenatal risk there were no associations between inconsistent overreactive parenting and children's cortisol variability. Findings supported developmental plasticity models and uncovered novel developmental, gene × environment and prenatal × environment influences on children's cortisol functioning.

Media Exposure in Very Young Girls: Prospective and Cross-Sectional Relationships with BMIz, Self-Esteem and Body Size Stereotypes

ERIC Educational Resources Information Center

Rodgers, Rachel F.; Damiano, Stephanie R.; Wertheim, Eleanor H.; Paxton, Susan J.

2017-01-01

Media exposure among young children has been suggested to influence self-concept and the adoption of social stereotypes regarding body weight, as well as being associated with increased weight. The aim of this study was to examine the role of TV/DVD viewing in the development of positive stereotypes toward thinness, self-esteem and body mass index…

Analyzing the performance of PROSPECT model inversion based on different spectral information for leaf biochemical properties retrieval

NASA Astrophysics Data System (ADS)

Sun, Jia; Shi, Shuo; Yang, Jian; Du, Lin; Gong, Wei; Chen, Biwu; Song, Shalei

2018-01-01

Leaf biochemical constituents provide useful information about major ecological processes. As a fast and nondestructive method, remote sensing techniques are critical to reflect leaf biochemistry via models. PROSPECT model has been widely applied in retrieving leaf traits by providing hemispherical reflectance and transmittance. However, the process of measuring both reflectance and transmittance can be time-consuming and laborious. Contrary to use reflectance spectrum alone in PROSPECT model inversion, which has been adopted by many researchers, this study proposes to use transmission spectrum alone, with the increasing availability of the latter through various remote sensing techniques. Then we analyzed the performance of PROSPECT model inversion with (1) only transmission spectrum, (2) only reflectance and (3) both reflectance and transmittance, using synthetic datasets (with varying levels of random noise and systematic noise) and two experimental datasets (LOPEX and ANGERS). The results show that (1) PROSPECT-5 model inversion based solely on transmission spectrum is viable with results generally better than that based solely on reflectance spectrum; (2) leaf dry matter can be better estimated using only transmittance or reflectance than with both reflectance and transmittance spectra.

HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT FOR THE ADOPTION OF INNOVATIVE MEDICAL DEVICES WITHIN FRENCH HOSPITALS: OPPORTUNITIES AND CHALLENGES FOR INDUSTRY.

PubMed

Dutot, Camille; Mercier, Grégoire; Borget, Isabelle; de Sauvebeuf, Côme; Martelli, Nicolas

2017-01-01

Within French university hospitals, some internal committees are in charge of conducting hospital-based health technology assessment (Hb-HTA) to support managerial decisions regarding the adoption of innovations. For manufacturers, hospitals are usually the entry point for new and innovative medical devices, which cannot be accessed without the Hb-HTA committees' approval. Thus, the main objective of this pilot survey was to explore manufacturers' insights into Hb-HTA processes. A two-step pilot survey was conducted in 2014. First, semi-structured phone interviews were carried out to capture manufacturers' feedback on the Hb-HTA procedure. Second, a prospective and iterative questionnaire designed to explore manufacturers' market access strategies was administered. Eight manufacturers from the medical device industry completed the retrospective phone interviews, and five of them participated in the prospective survey. According to the overall feedback, the Hb-HTA process timeline and transparency are major issues, and the expectations of internal committees, especially in terms of clinical evidence, remain difficult to understand. However, despite this and due to the complexity of reimbursement processes at the national level, manufacturers are increasingly considering hospital adoption through Hb-HTA submission as a viable market access and coverage opportunity. Our study reaffirms the primary role of hospitals in the diffusion of innovative medical devices. However, to ensure efficient and broad access to innovation, cooperation between local and national HTA bodies is critical and should be promoted.

Maternal history of adoption or foster care placement in childhood: a risk factor for preterm birth.

PubMed

Bublitz, Margaret H; Rodriguez, Daniel; Polly Gobin, Asi; Waldemore, Marissa; Magee, Susanna; Stroud, Laura R

2014-10-01

The objective of the study was to assess the impact of maternal history of adoption or foster care placement in childhood on the risk for preterm birth (PTB), controlling for other known risk factors for PTB. Participants were 302 pregnant women from a low-income, diverse sample drawn from 2 intensive prospective studies of maternal mood and behavior and fetal and infant development. Gestational age was determined by best obstetric estimate. Maternal history of adoption or foster care placement prior to age 18 years was determined by maternal report. Other maternal characteristics, including maternal medical conditions, psychosocial characteristics, and health behaviors, were measured during the second and third trimesters of pregnancy. The odds of delivering preterm (gestational age <37 weeks) were approximately 4 times greater among women with a history of childhood adoption or foster care placement compared with women who were never placed out of the home during childhood. This association remained significant after adjusting for other known risk factors for PTB including maternal medical conditions, psychosocial characteristics, and negative health behaviors in pregnancy. Findings suggest that a history of adoption/foster care placement is an important risk factor for PTB and may be comparable with other established risk factors for PTB including prior history of PTB, body mass index, African-American race, and advanced maternal age. More studies are needed to understand why women with placement histories may be at increased risk to deliver preterm. Copyright © 2014 Elsevier Inc. All rights reserved.

Combined Influences of Genes, Prenatal Environment, Cortisol, and Parenting on the Development of Children's Internalizing Versus Externalizing Problems.

PubMed

Marceau, Kristine; Laurent, Heidemarie K; Neiderhiser, Jenae M; Reiss, David; Shaw, Daniel S; Natsuaki, Misaki N; Fisher, Philip A; Leve, Leslie D

2015-05-01

Research suggests that genetic, prenatal, endocrine, and parenting influences across development individually contribute to internalizing and externalizing problems in children. The present study tests the combined contributions of genetic risk for psychopathology, prenatal environments (maternal drug use and internalizing symptoms), child cortisol at age 4.5 years, and overreactive parenting influences across childhood on 6-year-old children's internalizing and externalizing problems. We used data from an adoption design that included 361 domestically adopted children and their biological and adopted parents prospectively followed from birth. Only parenting influences contributed (independently) to externalizing problems. However, genetic influences were indirectly associated with internalizing problems (through increased prenatal risk and subsequent morning cortisol), and parenting factors were both directly and indirectly associated with internalizing problems (through morning cortisol). Results suggest that prenatal maternal drug use/symptoms and children's morning cortisol levels are mechanisms of genetic and environmental influences on internalizing problems, but not externalizing problems, in childhood.

Combined influences of genes, prenatal environment, cortisol, and parenting on the development of children’s internalizing vs. externalizing problems

PubMed Central

Marceau, Kristine; Laurent, Heidemarie K.; Neiderhiser, Jenae M.; Reiss, David; Shaw, Daniel S.; Natsuaki, Misaki; Fisher, Philip A.; Leve, Leslie D.

2014-01-01

Research suggests that genetic, prenatal, endocrine, and parenting influences across development individually contribute to internalizing and externalizing problems in children. The present study tests the combined contributions of genetic risk for psychopathology, prenatal environments (maternal drug use and internalizing symptoms), child cortisol at age 4.5 years, and overreactive parenting influences across childhood on 6-year-old children’s internalizing and externalizing problems. We used data from an adoption design that included 361 domestically adopted children and their biological and adopted parents prospectively followed from birth. Only parenting influences contributed (independently) to externalizing problems. However, genetic influences were indirectly associated with internalizing problems (through increased prenatal risk and subsequent morning cortisol), and parenting factors were both directly and indirectly associated with internalizing problems (through morning cortisol). Results suggest that prenatal maternal drug use/symptoms and children’s morning cortisol levels are mechanisms of genetic and environmental influences on internalizing problems, but not externalizing problems, in childhood. PMID:25355319

22 CFR 96.48 - Preparation and training of prospective adoptive parent(s) in incoming cases.

Code of Federal Regulations, 2011 CFR

2011-04-01

... genetic, health, emotional, and developmental risk factors associated with children from the expected..., ethnic, and linguistic background; (2) The known health risks in the specific region or country where the...

76 FR 25787 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

... A. Hospital Inpatient Quality Reporting Program 1. Background a. Overview b. Statutory History and History of Measures Adopted for the Hospital IQR Program c. Maintenance of Technical Specifications for...

Longitudinal Comparison of the Speech and Language Performance of United States-Born and Internationally Adopted Toddlers with Cleft Lip and Palate: A Pilot Study.

PubMed

Scherer, Nancy J; Baker, Shauna; Kaiser, Ann; Frey, Jennifer R

2018-01-01

Objective This study compares the early speech and language development of children with cleft palate with or without cleft lip who were adopted internationally with children born in the United States. Design Prospective longitudinal description of early speech and language development between 18 and 36 months of age. Participants This study compares four children (age range = 19 to 38 months) with cleft palate with or without cleft lip who were adopted internationally with four children (age range = 19 to 38 months) with cleft palate with or without cleft lip who were born in the United States, matched for age, gender, and cleft type across three time points over 10 to 12 months. Main Outcome Measures Children's speech-language skills were analyzed using standardized tests, parent surveys, language samples, and single-word phonological assessments to determine differences between the groups. Results The mean scores for the children in the internationally adopted group were lower than the group born in the United States at all three time points for expressive language and speech sound production measures. Examination of matched pairs demonstrated observable differences for two of the four pairs. No differences were observed in cognitive performance and receptive language measures. Conclusions The results suggest a cumulative effect of later palate repair and/or a variety of health and environmental factors associated with their early circumstances that persist to age 3 years. Early intervention to address the trajectory of speech and language is warranted. Given the findings from this small pilot study, a larger study of the long-term speech and language development of children who are internationally adopted and have cleft palate with or without cleft lip is recommended.

Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University

PubMed Central

He, Zhehao; Zeng, Liping; Zhang, Chong; Wang, Luming; Wang, Zhitian; Rustam, Azmat; Du, Chengli; Lv, Wang

2017-01-01

Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology. PMID:29302429

Cost analysis and facility reimbursement in the long-term health care industry.

PubMed Central

Ullmann, S G

1984-01-01

This article examines costs and develops a system of prospective reimbursement for the industry committed to long-term health care. Together with estimates of average cost functions--for purposes of determining those factors affecting the costs of long-term health care, the author examines in depth the cost effects of patient mix and facility quality. Policy implications are indicated. The article estimates cost savings and predicted improvements in facility performance resulting from adoption of a prospective reimbursement system. PMID:6427138

The Potential and Limitations of Cross-Context Comparative Research on Migration

PubMed Central

Riosmena, Fernando

2017-01-01

This article is an overview of household survey approaches for the comparative study of international migration dynamics. Focusing on differences in the drivers of international mobility at different times and places, I highlight the problems of obtaining data with adequate representation across time periods and geographies, and discuss a broad constellation of prospective and retrospective approaches, paying particular attention to the migration ethnosurvey. I place this methodology within a broader constellation of prospective and retrospective data collection techniques, briefly describing the advantages and disadvantages of each and summarizing the commonalities and differences of ethnosurvey approaches adopted around the world. In particular, I discuss the potential and limitations of cross-context research and suggest post hoc case selection and other adjustments to ameliorate problems. I conclude with ideas about how case and sample selection can help to bolster migration studies in the future. PMID:29093598

Prospective Evaluation of the Energy and CO 2 Emissions Impact of China’s 2010 – 2013 Efficiency Standards for Products

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

Khanna, Nina; Zhou, Nan; Fridley, David

Since China introduced its first mandatory minimum energy performance standards (MEPS) for eight major household products in 1989, its MEPS program has expanded significantly to cover nearly 60 residential, industrial and commercial products. In June of 2012, the pace of standards development for new and revised standards was further accelerated with the launch of the national “100 Energy Efficiency Standards.” Initiatives. An unprecedented 21 MEPS were adopted by China from 2012 to 2013, compared to only 7 MEPS adopted from 2010 to 2011. The Chinese MEPS program now covers 15 products in the residential sector, 15 types of commercial andmore » office equipment, 14 types of industrial equipment and 13 lighting products, making it one of the most comprehensive MEPS program in the world. This study provides an updated prospective evaluation of the potential energy and CO 2 impact of 23 of the 28 MEPS adopted by China from 2010 to 2013. This study updates a previous analysis (Zhou et al. 2011) by quantifying the additional potential energy and CO 2 reductions from the newest standards that have been adopted since 2010. The most recent actual and projected sales, usage, and efficiency data were collected for 14 product categories covered under 23 MEPS adopted between 2010 and 2013. Three scenarios are then used to quantify the energy and CO 2 reduction potential of the one-time implementation of these 23 MEPS, including a baseline counterfactual scenario, the actual MEPS scenario and a best available technologies efficiency scenario. The setting of the baseline efficiency is crucial to determining the savings potential of the new and revised MEPS and international best available technology efficiency levels, as it reflects the market average in the absence of MEPS. For this study, the average baseline is based on either the reported 2010 market-average efficiency if sales-weighted efficiency data is available for new product MEPS and selected products with revised MEPS, or the minimum efficiency requirement of the previous MEPS for products with revised MEPS from 2010 to 2013 that do not have sales-weighted efficiency data. Using sales-weighted efficiency data for the baseline help capture market transformation that has already occurred prior to the implementation of the MEPS, and can better differentiate the savings that are attributable to MEPS. The efficiency levels of best available technologies are taken from recent reviews of international commercially available best available technologies.« less

Birth and adoptive parent anxiety symptoms moderate the link between infant attention control and internalizing problems in toddlerhood.

PubMed

Brooker, Rebecca J; Neiderhiser, Jenae M; Ganiban, Jody M; Leve, Leslie D; Shaw, Daniel S; Reiss, David

2014-05-01

Attention control plays an important role in the development of internalizing symptoms in children. We explored the degree to which infants' genetic and environmentally based risk moderated the link between attention control and internalizing problems during toddlerhood. These associations were examined within a prospective adoption design, enabling the disentanglement of genetic and environmental risk for internalizing problems. Attention control in adopted infants was observed during periods of distress at age 9 months. Birth parents' anxiety symptoms were used as an index of genetic risk, while adoptive parents' anxiety symptoms were used as an index of environmental risk. Adoptive mothers and fathers reported on children's internalizing problems when children were 18 and 27 months old. Greater attention control in infancy appeared to mitigate genetically based risk for internalizing problems during toddlerhood when children were raised by adoptive parents who were low in anxiety. Findings suggest that for genetically susceptible children who are raised in low-risk environments, attention control may provide a protective factor against developing internalizing problems across early life.

Birth and Adoptive Parent Anxiety Symptoms Moderate the Link Between Infant Attention Control and Internalizing Problems in Toddlerhood

PubMed Central

Brooker, Rebecca J.; Neiderhiser, Jenae M.; Ganiban, Jody M.; Leve, Leslie D.; Shaw, Daniel S.; Reiss, David

2013-01-01

Attention control plays an important role in the development of internalizing symptoms in children. We explored the degree to which infants' genetic- and environmentally-based risk moderated the link between attention control and internalizing problems during toddlerhood. These associations were examined within a prospective adoption design, enabling the disentanglement of genetic and environmental risk for internalizing problems. Attention control in adopted infants was observed during periods of distress at age 9 months. Birth parents' anxiety symptoms were used as an index of genetic risk, while adoptive parents' anxiety symptoms were used as an index of environmental risk. Adoptive mothers and fathers reported on children's internalizing problems when children were 18- and 27-months old. Greater attention control in infancy appeared to mitigate genetically-based risk for internalizing problems during toddlerhood when children were raised by adoptive parents who were low in anxiety. Findings suggest that for genetically-susceptible children who are raised in low-risk environments, attention control may provide a protective factor against developing internalizing problems across early life. PMID:24472311

Intergenerational transmission of risk for social inhibition: the interplay between parental responsiveness and genetic influences.

PubMed

Natsuaki, Misaki N; Leve, Leslie D; Neiderhiser, Jenae M; Shaw, Daniel S; Scaramella, Laura V; Ge, Xiaojia; Reiss, David

2013-02-01

To better understand mechanisms underlying the intergenerational transmission of social anxiety, we used a prospective adoption design to examine the roles of genetic influences (inferred from birth mothers' social phobia) and rearing environment (adoptive mothers' and fathers' responsiveness) on the development of socially inhibited, anxious behaviors in children between 18 and 27 months of age. The sample consisted of 275 adoption-linked families, each including an adopted child, adoptive parents, and a birth mother. Results indicated that children whose birth mothers met criteria for the diagnosis of social phobia showed elevated levels of observed behavioral inhibition in a social situation at 27 months of age if their adoptive mothers provided less emotionally and verbally responsive rearing environments at 18 months of age. Conversely, in the context of higher levels of maternal responsiveness, children of birth mothers with a history of social phobia did not show elevated levels of behavioral inhibition. These findings on maternal responsiveness were replicated in a model predicting parent reports of child social anxiety. The findings are discussed in terms of gene-environment interactions in the intergenerational transmission of social anxiety.

Take a Strategic Direction with Debt.

ERIC Educational Resources Information Center

Augustine, John H.

2002-01-01

Offers advice to higher education institutions about financing decisions on their debt portfolios. Addresses developing a debt management framework, factors affecting strategy, interest rate management, establishing a debt management benchmark, and adopting a prospective approach. Sidebars discuss the trade-offs of credit offerings, and…

International adoption: a health and developmental prospective.

PubMed

Mason, Patrick; Narad, Christine

2005-02-01

Adoptions from international countries have become an option for many US families, with over 150,000 children adopted in the past 14 years. Typically, internationally adopted children present with a host of medical and developmental concerns. Issues such as growth stunting, abnormal behaviors, and significant delays in motor, speech, and language development are likely directly related to the prenatal and early postnatal environment experienced prior to adoption. The new family and its health-care team must quickly work to identify and address these issues to aid the child's integration into his or her new family. This article will examine potential issues seen in children who are being adopted, including the impact of early environment on subsequent development. We will summarize early and long-term medical issues and review the extent of developmental delays seen in children adopted internationally. Finally, we will discuss possible mechanisms leading to the observed delays, including the impact of stress on subsequent development. By understanding the extent of expected delays and the mechanisms likely causing the issues, the health-care team will be in a good position to quickly identify and develop intervention protocols that will foster the child's assimilation into his or her new family.

Associations Between Infant Negative Affect and Parent Anxiety Symptoms are Bidirectional: Evidence from Mothers and Fathers

PubMed Central

Brooker, Rebecca J.; Neiderhiser, Jenae M.; Leve, Leslie D.; Shaw, Daniel S.; Scaramella, Laura V.; Reiss, David

2015-01-01

Little is known about child-based effects on parents’ anxiety symptoms early in life despite the possibility that child characteristics may contribute to the quality of the early environment and children’s own long-term risk for psychological disorder. We examined bidirectional effects between parent anxiety symptoms and infant negative affect using a prospective adoption design. Infant negative affect and adoptive parent anxiety symptoms were assessed at child ages 9, 18, and 27 months. Birth parent negative affect was assessed at child age 18 months. More anxiety symptoms in adoptive parents at child age 9 months predicted more negative affect in infants 9 months later. More infant negative affect at child age 9 months predicted more anxiety symptoms in adoptive parents 18 months later. Patterns of results did not differ for adoptive mothers and adoptive fathers. Birth parent negative affect was unrelated to infant or adoptive parent measures. Consistent with expectations, associations between infant negative affect and rearing parents’ anxiety symptoms appear to be bidirectional. In addition to traditional parent-to-child effects, our results suggest that infants’ characteristics may contribute to parent qualities that are known to impact childhood outcomes. PMID:26696939

Dark matter signals from Draco and Willman 1: prospects for MAGIC II and CTA

NASA Astrophysics Data System (ADS)

Bringmann, Torsten; Doro, Michele; Fornasa, Mattia

2009-01-01

The next generation of ground-based Imaging Air Cherenkov Telescopes will play an important role in indirect dark matter searches. In this article, we consider two particularly promising candidate sources for dark matter annihilation signals, the nearby dwarf galaxies Draco and Willman 1, and study the prospects of detecting such a signal for the soon-operating MAGIC II telescope system as well as for the planned installation of CTA, taking special care of describing the experimental features that affect the detectional prospects. For the first time in such studies, we fully take into account the effect of internal bremsstrahlung, which has recently been shown to considerably enhance, in some cases, the gamma-ray flux in the high energies domain where Atmospheric Cherenkov Telescopes operate, thus leading to significantly harder annihilation spectra than traditionally considered. While the detection of the spectral features introduced by internal bremsstrahlung would constitute a smoking gun signature for dark matter annihilation, we find that for most models the overall flux still remains at a level that will be challenging to detect, unless one adopts somewhat favorable descriptions of the smooth dark matter distribution in the dwarfs.

Medicaid prospective payment: Case-mix increase

PubMed Central

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

22 CFR 96.54 - Placement standards in outgoing cases.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., and cultural background. (f) When particular prospective adoptive parent(s) in a Convention country... child's likely feelings of separation, grief, and loss and difficulties in making any cultural, religious, racial, ethnic, or linguistic adjustment. (h) The agency or person takes all appropriate measures...

Serotonin reuptake inhibitors in pregnancy and the risk of major malformations: a systematic review.

PubMed

Bellantuono, Cesario; Migliarese, Giovanni; Gentile, Salvatore

2007-04-01

To review studies conducted to establish the risk of major congenital malformations in women exposed to serotonin reuptake inhibitors (SRIs) during the first trimester of pregnancy. A literature search [corrected] was conducted within PsycINFO [corrected] EMBASE, MEDLINE and Cochrane databases from 1966 to October 2006, to identify studies assessing the risk of major malformations in infants whose mother was taking SRIs (SSRIs and SNRIs) during the first trimester of pregnancy. Fifteen studies were selected for the analysis: seven adopted a prospective cohort design and seven a retrospective design, of these one was a case-control study. The reviewed studies suggest that exposure to fluoxetine, sertraline, citalopram and venlafaxine in early pregnancy is not associated with an increased risk of major congenital malformations. For paroxetine, recent data call for caution in prescribing such a drug in early pregnancy. For the other SRIs, the risk remains substantially undetermined, as data are so far scanty. Given this background, large prospective cohort studies are urgently needed to better assess the risk/benefit ratio of SRIs-treatment during pregnancy. Copyright 2007 John Wiley & Sons, Ltd.

Combinatorial Fgf and Bmp signalling patterns the gastrula ectoderm into prospective neural and epidermal domains

PubMed Central

Kudoh, Tetsuhiro; Concha, Miguel L.; Houart, Corinne; Dawid, Igor B.; Wilson, Stephen W.

2009-01-01

Summary Studies in fish and amphibia have shown that graded Bmp signalling activity regulates dorsal-to-ventral (DV) patterning of the gastrula embryo. In the ectoderm, it is thought that high levels of Bmp activity promote epidermal development ventrally, whereas secreted Bmp antagonists emanating from the organiser induce neural tissue dorsally. However, in zebrafish embryos, the domain of cells destined to contribute to the spinal cord extends all the way to the ventral side of the gastrula, a long way from the organiser. We show that in vegetal (trunk and tail) regions of the zebrafish gastrula, neural specification is initiated at all DV positions of the ectoderm in a manner that is unaffected by levels of Bmp activity and independent of organiser-derived signals. Instead, we find that Fgf activity is required to induce vegetal prospective neural markers and can do so without suppressing Bmp activity. We further show that Bmp signalling does occur within the vegetal prospective neural domain and that Bmp activity promotes the adoption of caudal fate by this tissue. PMID:15262889

Evolving adoptive cellular therapies in urological malignancies.

PubMed

Wong, Yien Ning Sophia; Joshi, Kroopa; Pule, Martin; Peggs, Karl S; Swanton, Charles; Quezada, Sergio A; Linch, Mark

2017-06-01

Immunotherapies have long been used to treat urological cancers but rarely lead to cure. In the past 5 years, success of immune checkpoint inhibition has led to a resurgence of enthusiasm for immunotherapy in the treatment of solid tumours. Increased understanding of tumour immune biology, technological advancements of gene transfer and cell culture, and improved clinical infrastructures for routine delivery of cell products, has made cell-based immunotherapeutics a real prospect for cancer therapy. These scientific and clinical activities, attempting to exploit the innate and adaptive immune systems for therapeutic gain, are well exemplified by the urological malignancies of renal, bladder, prostate, and penile cancer, a group of anatomically localised diseases, each with a distinct biology and different immunotherapeutic challenges. In this Review, we present the results of clinical studies investigating autologous cellular therapies in urological malignancies. Specifically, we discuss the rationale for upcoming studies, and how novel therapies and adoptive cell combinations can be used for personalised cancer therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prospects for adoptive immunotherapy of pancreatic cancer using chimeric antigen receptor-engineered T-cells.

PubMed

Alrifai, Doraid; Sarker, Debashis; Maher, John

2016-01-01

Adoptive immunotherapy using chimeric antigen receptor (CAR) engineered T-cells is emerging as a powerful new approach to cancer immunotherapy. CARs are fusion molecules that couple the antibody-like binding of a native cell surface target to the delivery of a bespoke T-cell activating signal. Recent studies undertaken by several centers have demonstrated highly compelling efficacy in patients with acute and chronic B-cell malignancies. However, comparable therapeutic activity has not been achieved in solid tumors. Modern management of pancreatic ductal adenocarcinoma (PDAC) remains ineffective, reflected in the virtual equivalence of annual incidence and mortality statistics for this tumor type. Increasing evidence indicates that these tumors are recognized by the immune system, but deploy powerful evasion strategies that limit natural immune surveillance and render efforts at immunotherapy challenging. Here, we review preclinical and clinical studies that have been initiated or completed in an effort to develop CAR-based immunotherapy for PDAC. We also consider the hurdles to the effective clinical development of this exciting new therapeutic modality.

The role of hospital payments in the adoption of new medical technologies: an international survey of current practice.

PubMed

Sorenson, Corinna; Drummond, Michael; Torbica, Aleksandra; Callea, Giuditta; Mateus, Ceu

2015-04-01

This study examined the role of prospective payment systems in the adoption of new medical technologies across different countries. A literature review was conducted to provide background for the study and guide development of a survey instrument. The survey was disseminated to hospital payment systems experts in 15 jurisdictions. Fifty-one surveys were disseminated, with 34 returned. The surveys returned covered 14 of the 15 jurisdictions invited to participate. The majority (71%) of countries update the patient classification system and/or payment tariffs on an annual basis to try to account for new technologies. Use of short-term separate or supplementary payments for new technologies occurs in 79% of countries to ensure adequate funding and facilitate adoption. A minority (43%) of countries use evidence of therapeutic benefit and/or costs to determine or update payment tariffs, although it is somewhat more common in establishing short-term payments. The main barrier to using evidence is uncertain or unavailable clinical evidence. Almost three-fourths of respondents believed diagnosis-related group systems incentivize or deter technology adoption, depending on the particular circumstances. Improvements are needed, such as enhanced strategies for evidence generation and linking evidence of value to payments, national and international collaboration and training to improve existing practice, and flexible timelines for short-term payments. Importantly, additional research is needed to understand how different payment policies impact technology uptake as well as quality of care and costs.

Screening and brief intervention for alcohol and other drug use in primary care: associations between organizational climate and practice.

PubMed

Cruvinel, Erica; Richter, Kimber P; Bastos, Ronaldo Rocha; Ronzani, Telmo Mota

2013-02-11

Numerous studies have demonstrated that positive organizational climates contribute to better work performance. Screening and brief intervention (SBI) for alcohol, tobacco, and other drug use has the potential to reach a broad population of hazardous drug users but has not yet been widely adopted in Brazil's health care system. We surveyed 149 primary health care professionals in 30 clinics in Brazil who were trained to conduct SBI among their patients. We prospectively measured how often they delivered SBI to evaluate the association between organizational climate and adoption/performance of SBI. Organizational climate was measured by the 2009 Organizational Climate Scale for Health Organizations, a scale validated in Brazil that assesses leadership, professional development, team spirit, relationship with the community, safety, strategy, and remuneration. Performance of SBI was measured prospectively by weekly assessments during the three months following training. We also assessed self-reported SBI and self-efficacy for performing SBI at three months post-training. We used inferential statistics to depict and test for the significance of associations. Teams with better organizational climates implemented SBI more frequently. Organizational climate factors most closely associated with SBI implementation included professional development and relationship with the community. The dimensions of leadership and remuneration were also significantly associated with SBI. Organizational climate may influence implementation of SBI and ultimately may affect the ability of organizations to identify and address drug use.

Intergenerational Transmission of Risk for Social Inhibition: the Interplay between Parental Responsiveness and Genetic Influences

PubMed Central

Natsuaki, Misaki N.; Leve, Leslie D.; Neiderhiser, Jenae M.; Shaw, Daniel S.; Scaramella, Laura V.; Ge, Xiaojia; Reiss, David

2013-01-01

To better understand mechanisms underlying the intergenerational transmission of social anxiety, we used a prospective adoption design to examine the roles of genetic influences (inferred from birth mothers’ social phobia) and rearing environment (adoptive mothers’ and fathers’ responsiveness) on the development of socially inhibited, anxious behaviors in children between 18 and 27 months of age. The sample consisted of 275 adoption-linked families, each including an adopted child, adoptive parents, and a birth mother. Results indicated that children whose birth mothers met criteria for the diagnosis of social phobia showed elevated levels of observed behavioral inhibition in a social situation at 27 months of age if their adoptive mothers provided less emotionally and verbally responsive rearing environments at 18 months of age. Conversely, in the context of higher levels of maternal responsiveness, children of birth mothers with a history of social phobia did not show elevated levels of behavioral inhibition. These findings on maternal responsiveness were replicated in a model predicting parent reports of child social anxiety. The findings are discussed in terms of genotype × environment interactions in the intergenerational transmission of social anxiety. PMID:23398764

Romanian adoption. The Manitoba experience.

PubMed

Benoit, T C; Jocelyn, L J; Moddemann, D M; Embree, J E

1996-12-01

To study the developmental, behavioral, and medical features in a cohort of Romanian children adopted by Manitoba families. A prospective longitudinal study. The Child Development Clinic, Children's Hospital, Winnipeg, Manitoba, from September 1990 to June 1992. Developmental, behavioral, and medical features were assessed in 22 Romanian children adopted by 18 Manitoba families. Mean (+/- SD) age at adoption was 15.5 +/- 13 months. Mean (+/- SD) age at initial assessment was 19 +/- 12 months and at follow-up, 35 +/- 13 months. Medical complications included 6 children (27%) who were positive for the hepatitis B surface antigen, 5 with intestinal parasites (23%), 1 positive for the human immunodeficiency virus, 1 with rickets (5%), and 1 with monoplegia and cleft palate (5%). Initial growth parameters were less than the fifth percentile for age for head circumference in 10 children (45%), for weight in 8 (36%), and for height in 7 (32%). At follow-up, statistically significant improvement was seen in height and weight. Initial mean (+/- SD) developmental quotients were 82 +/- 20 for gross motor, 83 +/- 23 for fine motor, 83 +/- 19 for cognitive, and 79 +/- 18 for language domains. Follow-up mean developmental quotients improved in all domains (P < .05). Twelve children (55%) displayed abnormal behavior at the initial assessment; behavioral findings persisted in 8 (36%). Initial appropriate activity level and play behavior predicted normal cognitive outcome (P < .05). This longitudinal study of Romanian adoptees delineates improvements in growth and development once the children are placed in a nurturing environment. The persistence of abnormal behavior in some children underscores the importance of further follow-up.

Associations between Health Literacy and Health Behaviors among Urban High School Students

ERIC Educational Resources Information Center

Park, Aesoon; Eckert, Tanya L.; Zaso, Michelle J.; Scott-Sheldon, Lori A. J.; Vanable, Peter A.; Carey, Kate B.; Ewart, Craig K.; Carey, Michael P.

2017-01-01

Background: Health literacy is crucial to develop health-related knowledge, adopt healthy lifestyles, and benefit from health care services. However, research on the association between health literacy and adolescent health outcomes, particularly on their prospective associations, is rare. We assessed health literacy using 3 validated measures,…

The Role of the Principal's Emotional Intelligence in Primary Education Leadership

ERIC Educational Resources Information Center

Brinia, Vasiliki; Zimianiti, Lina; Panagiotopoulos, Konstantinos

2014-01-01

The development of emotional intelligence skills offers sufficient leadership qualities for advancing the organization and for achieving its objectives. In particular, the emotionally intelligent leader--principal is able to inspire and facilitate a self-conscious and organizational culture by adopting the values of understanding, trust, prospect,…

77 FR 27869 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... Considered HAC Candidate: Iatrogenic Pneumothorax With Venous Catheterization 3. Present on Admission (POA.... History of Measures Adopted for the Hospital IQR Program b. Maintenance of Technical Specifications for...-Associated Infection (HAI) Measures (A) Proposed Central Line Associated Blood Stream Infections ((CLABSI...

The Effects of Message Framing on College Students' Career Decision Making

ERIC Educational Resources Information Center

Tansley, Denny P.; Jome, LaRae M.; Haase, Richard F.; Martens, Matthew P.

2007-01-01

Social cognitive career theory posits that verbal persuasion can affect individuals' career self-efficacy, outcome expectations, goals and/or intentions, and behaviors. Prospect theory holds that negatively framed messages can have a powerful effect on people's cognitions related to adopting particular behaviors in situations of uncertainty.…

Psychological Preparation for Peak Performance in Sports Competition

ERIC Educational Resources Information Center

Ohuruogu, Ben; Jonathan, Ugwuanyi I.; Ikechukwu, Ugwu Jude

2016-01-01

This paper attempts to make an overview of various techniques, sport psychologist adopt in psychological preparation of athletes for peak performance. To attain peak performance in sports competitions, coaches and athletes should not base their prospect on physical training on sport skills alone rather should integrate both the mental and physical…

The Computer "Discredit Bureau": An Extension of a Community Information Utility.

ERIC Educational Resources Information Center

Carroll, John M.

The "Discredit" Bureau borrows some of the computerized information-processing techniques adopted by credit-reporting agencies and uses them in the interest of consumers to help them press complaints against suppliers and prospective employers. This is an additional service currently being incorporated into those already afforded by a…

The training intensity distribution among well-trained and elite endurance athletes

PubMed Central

Stöggl, Thomas L.; Sperlich, Billy

2015-01-01

Researchers have retrospectively analyzed the training intensity distribution (TID) of nationally and internationally competitive athletes in different endurance disciplines to determine the optimal volume and intensity for maximal adaptation. The majority of studies present a “pyramidal” TID with a high proportion of high volume, low intensity training (HVLIT). Some world-class athletes appear to adopt a so-called “polarized” TID (i.e., significant % of HVLIT and high-intensity training) during certain phases of the season. However, emerging prospective randomized controlled studies have demonstrated superior responses of variables related to endurance when applying a polarized TID in well-trained and recreational individuals when compared with a TID that emphasizes HVLIT or threshold training. The aims of the present review are to: (1) summarize the main responses of retrospective and prospective studies exploring TID; (2) provide a systematic overview on TIDs during preparation, pre-competition, and competition phases in different endurance disciplines and performance levels; (3) address whether one TID has demonstrated greater efficacy than another; and (4) highlight research gaps in an effort to direct future scientific studies. PMID:26578968

The training intensity distribution among well-trained and elite endurance athletes.

PubMed

Stöggl, Thomas L; Sperlich, Billy

2015-01-01

Researchers have retrospectively analyzed the training intensity distribution (TID) of nationally and internationally competitive athletes in different endurance disciplines to determine the optimal volume and intensity for maximal adaptation. The majority of studies present a "pyramidal" TID with a high proportion of high volume, low intensity training (HVLIT). Some world-class athletes appear to adopt a so-called "polarized" TID (i.e., significant % of HVLIT and high-intensity training) during certain phases of the season. However, emerging prospective randomized controlled studies have demonstrated superior responses of variables related to endurance when applying a polarized TID in well-trained and recreational individuals when compared with a TID that emphasizes HVLIT or threshold training. The aims of the present review are to: (1) summarize the main responses of retrospective and prospective studies exploring TID; (2) provide a systematic overview on TIDs during preparation, pre-competition, and competition phases in different endurance disciplines and performance levels; (3) address whether one TID has demonstrated greater efficacy than another; and (4) highlight research gaps in an effort to direct future scientific studies.

Intelligent postoperative morbidity prediction of heart disease using artificial intelligence techniques.

PubMed

Hsieh, Nan-Chen; Hung, Lun-Ping; Shih, Chun-Che; Keh, Huan-Chao; Chan, Chien-Hui

2012-06-01

Endovascular aneurysm repair (EVAR) is an advanced minimally invasive surgical technology that is helpful for reducing patients' recovery time, postoperative morbidity and mortality. This study proposes an ensemble model to predict postoperative morbidity after EVAR. The ensemble model was developed using a training set of consecutive patients who underwent EVAR between 2000 and 2009. All data required for prediction modeling, including patient demographics, preoperative, co-morbidities, and complication as outcome variables, was collected prospectively and entered into a clinical database. A discretization approach was used to categorize numerical values into informative feature space. Then, the Bayesian network (BN), artificial neural network (ANN), and support vector machine (SVM) were adopted as base models, and stacking combined multiple models. The research outcomes consisted of an ensemble model to predict postoperative morbidity after EVAR, the occurrence of postoperative complications prospectively recorded, and the causal effect knowledge by BNs with Markov blanket concept.

Seed germination test for toxicity evaluation of compost: Its roles, problems and prospects.

PubMed

Luo, Yuan; Liang, Jie; Zeng, Guangming; Chen, Ming; Mo, Dan; Li, Guoxue; Zhang, Difang

2018-01-01

Compost is commonly used for the growth of plants and the remediation of environmental pollution. It is important to evaluate the quality of compost and seed germination test is a powerful tool to examine the toxicity of compost, which is the most important aspect of the quality. Now the test is widely adopted, but the main problem is that the test results vary with different methods and seed species, which limits the development and application of it. The standardization of methods and the modelization of seeds can contribute to solving the problem. Additionally, according to the probabilistic theory of seed germination, the error caused by the analysis and judgment methods of the test results can be reduced. Here, we reviewed the roles, problems and prospects of the seed germination test in the studies of compost. Copyright © 2017 Elsevier Ltd. All rights reserved.

The impact of vegan diet on B-12 status in healthy omnivores: five-year prospective study.

PubMed

Mądry, Edyta; Lisowska, Aleksandra; Grebowiec, Philip; Walkowiak, Jarosław

2012-04-02

There are no long-term prospective studies assessing the impact of the vegan diet on vitamin B-12 (B-12) status. Many vegans take B-12 supplements irregularly or refuse to adopt them at all, considering them to be "unnatural" products. The use of B-12 fortified food may be an alternative. Therefore, we aimed to estimate the long-term effect of a vegan diet on serum B-12 concentrations in healthy omnivore adults, comparing the influence of natural products consumption and B-12 fortified food. A five year prospective study was carried out comprising 20 omnivore healthy adult subjects, who moved to strict vegan diet for 5 years. Ten volunteers followed vegan diet based entirely on natural products, while the remaining ten subjects consumed food fortified in B-12. In all subjects serum vitamin B-12 concentration was determined before and 6, 12, 24 and 60 months after the implementation of the diet. A significant decrease (p < 0.0002) of serum B-12 concentrations in the whole studied group was noted after 60 months of vegan diet. However, observed changes were in fact limited to the subgroup consuming exclusively natural products (p < 0.0001). Transition from omnivore to vegan diet is associated with the risk of vitamin B-12 deficiency. B-12 fortified products might constitute a valuable alternative in vegans refusing to take vitamin supplements.

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2016. Final rule.

PubMed

2015-08-06

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2016 as required by the statute. As required by section 1886(j)(5) of the Act, this rule includes the classification and weighting factors for the IRF PPS's case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2016. This final rule also finalizes policy changes, including the adoption of an IRF-specific market basket that reflects the cost structures of only IRF providers, a 1-year phase-in of the revised wage index changes, a 3-year phase-out of the rural adjustment for certain IRFs, and revisions and updates to the quality reporting program (QRP).

Impact of ambient air pollution on physical activity among adults: a systematic review and meta-analysis.

PubMed

An, Ruopeng; Zhang, Sheng; Ji, Mengmeng; Guan, Chenghua

2018-03-01

This study systematically reviewed literature regarding the impact of ambient air pollution on physical activity among children and adults. Keyword and reference search was conducted in PubMed and Web of Science to systematically identify articles meeting all of the following criteria - study designs: interventions or experiments, retrospective or prospective cohort studies, cross-sectional studies, and case-control studies; subjects: adults; exposures: specific air pollutants and overall air quality; outcomes: physical activity and sedentary behaviour; article types: peer-reviewed publications; and language: articles written in English. Meta-analysis was performed to estimate the pooled effect size of ambient PM 2.5 air pollution on physical inactivity. Seven studies met the inclusion criteria. Among them, six were conducted in the United States, and one was conducted in the United Kingdom. Six adopted a cross-sectional study design, and one used a prospective cohort design. Six had a sample size larger than 10,000. Specific air pollutants assessed included PM 2.5 , PM 10 , O 3 , and NO x , whereas two studies focused on overall air quality. All studies found air pollution level to be negatively associated with physical activity and positively associated with leisure-time physical inactivity. Study participants, and particularly those with respiratory disease, self-reported a reduction in outdoor activities to mitigate the detrimental impact of air pollution. Meta-analysis revealed a one unit (μg/m 3 ) increase in ambient PM 2.5 concentration to be associated with an increase in the odds of physical inactivity by 1.1% (odds ratio = 1.011; 95% confidence interval = 1.001, 1.021; p-value < .001) among US adults. Existing literature in general suggested that air pollution discouraged physical activity. Current literature predominantly adopted a cross-sectional design and focused on the United States. Future studies are warranted to implement a longitudinal study design and evaluate the impact of air pollution on physical activity in heavily polluted developing countries.

Adoption of endovenous laser treatment as the primary treatment modality for varicose veins: the Auckland City Hospital experience.

PubMed

Fernando, Ruchira S W; Muthu, Carl

2014-08-01

To assess the effectiveness of adopting endovenous laser treatment (EVLT) as the primary treatment modality for varicose veins at Auckland City Hospital (Auckland, New Zealand). The outcomes of 354 consecutive EVLT procedures performed between 2007 and 2013 were reviewed. Data was collected from a prospectively maintained procedural database and by retrospective chart review. Of the 319 patients who had an ultrasound, at 1 month post-procedure there was a saphenous vein occlusion rate of 96%. Side effects were minimal with no cases of DVT or skin burns and one case of self-limiting neuralgia. The procedure was well tolerated with a median pain score of 3. Since the adoption of EVLT there has been a large increase in the number of patients treated for varicose veins (28 in 2007 compared to 176 in 2013). EVLT is a safe and effective treatment for varicose veins and its adoption has allowed a large increase in the number of varicose vein patients treated at Auckland City Hospital.

Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.

PubMed

Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas

2014-09-01

To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its enabling factors has the potential to support efforts at implementing national electronic health record implementation endeavors. © The Author(s) 2013.

Factors associated with exercise adherence among older adults. An individual perspective.

PubMed

Rhodes, R E; Martin, A D; Taunton, J E; Rhodes, E C; Donnelly, M; Elliot, J

1999-12-01

This paper reviews the literature concerning factors at the individual level associated with regular exercise among older adults. Twenty-seven cross-sectional and 14 prospective/longitudinal studies met the inclusion criteria of a mean participant age of 65 years or older. The findings are summarised by demographics, exercise experience, exercise knowledge, physiological factors, psychological factors, activity preferences and perceived social influences. In general, education and exercise history correlate positively with regular exercise, while perceived physical frailty and poor health may provide the greatest barrier to exercise adoption and adherence in the elderly. Social-cognitive theories identify several constructs that correlate with the regular exercise behaviour of older adults, such as exercise attitude, perceived behavioural control/self-efficacy, perceived social support and perceived benefits/barriers to continued activity. As well, stage modelling may provide additional information about the readiness for regular exercise behaviour among older adults. However, relatively few studies among older adults exist compared with middle-aged and younger adults. Further, the majority of current research consists of cross-sectional designs or short prospective exercise trials among motivated volunteers that may lack external validity. Future research utilising longitudinal and prospective designs with representative samples of older adults will provide a better understanding of significant causal associations between individual factors and regular exercise behaviour.

A new challenge in clinical research in childhood ALL: the prospective meta-analysis strategy for intergroup collaboration.

PubMed

Valsecchi, M G; Masera, G

1996-12-01

We consider the problems arising in clinical research on childhood acute lymphoblastic leukemia (ALL). Given the therapeutic progress achieved over the last few decades, any improvement in the outcome for the majority of children with ALL is difficult to assess with the usual size trials. Furthermore, the progress in genetics and molecular biology has now led to the identification of subgroups of children, typically with rare characteristics, for whom new treatments still await evaluation. For both these aspects of clinical research, there is an increasing need for international intergroup cooperation. After a discussion on the role of retrospective meta-analysis and randomized controlled trials in ALL research, we suggest that intergroup studies could be made more feasible, but still scientifically rigorous, by adopting a strategy of prospective meta-analysis. This strategy can be described as follows: i) different groups prospectively plan to ask the same randomized question within their protocols which may differ in other aspects, and to pool their data in order to evaluate treatment effect; ii) the management of the study can be de-centralized, by allowing each group to be responsible for conducting its own protocol. We would like to stimulate the debate on the methodological and practical aspects of research perspectives in ALL (and in pediatric oncology).

Optimal global value of information trials: better aligning manufacturer and decision maker interests and enabling feasible risk sharing.

PubMed

Eckermann, Simon; Willan, Andrew R

2013-05-01

Risk sharing arrangements relate to adjusting payments for new health technologies given evidence of their performance over time. Such arrangements rely on prospective information regarding the incremental net benefit of the new technology, and its use in practice. However, once the new technology has been adopted in a particular jurisdiction, randomized clinical trials within that jurisdiction are likely to be infeasible and unethical in the cases where they would be most helpful, i.e. with current evidence of positive while uncertain incremental health and net monetary benefit. Informed patients in these cases would likely be reluctant to participate in a trial, preferring instead to receive the new technology with certainty. Consequently, informing risk sharing arrangements within a jurisdiction is problematic given the infeasibility of collecting prospective trial data. To overcome such problems, we demonstrate that global trials facilitate trialling post adoption, leading to more complete and robust risk sharing arrangements that mitigate the impact of costs of reversal on expected value of information in jurisdictions who adopt while a global trial is undertaken. More generally, optimally designed global trials offer distinct advantages over locally optimal solutions for decision makers and manufacturers alike: avoiding opportunity costs of delay in jurisdictions that adopt; overcoming barriers to evidence collection; and improving levels of expected implementation. Further, the greater strength and translatability of evidence across jurisdictions inherent in optimal global trial design reduces barriers to translation across jurisdictions characteristic of local trials. Consequently, efficiently designed global trials better align the interests of decision makers and manufacturers, increasing the feasibility of risk sharing and the expected strength of evidence over local trials, up until the point that current evidence is globally sufficient.

A seven-year intervention to diffuse economic innovations with safety benefits to Wisconsin dairy farmers.

PubMed

Chapman, L J; Brunette, C M; Taveira, A D

2013-07-01

The purpose of this study was to conduct a targeted information dissemination campaign to persuade agricultural managers to adopt more profitable practices that reduce injury hazards compared to traditional practices. The project disseminated information to northeast Wisconsin dairy managers about three production practices that were more profitable and had safety benefits (barn lights, silage bags, and calf feed mixing sites) using information sources that these managers were known to rely on. The project prospectively evaluated rolling, independent, community-based, probability samples (a different group of operations each year) at baseline and after each of seven intervention years. The project also evaluated comparison samples from either Maryland or New York dairy operations after intervention years two through seven. In baseline versus year seven comparisons, the Wisconsin dairy managers reported getting more information about the three practices. Compared to New York managers, Wisconsin managers reported getting more information after year seven about the three practices. Among Wisconsin managers, intervention year was associated with increased adoption of all three practices. Compared to New York managers, Wisconsin managers were more likely to report adopting two of the three practices after year seven. A targeted campaign that disseminated information to managers through traditional channels was associated with increases in manager reports of getting information about, being aware of and adopting profit-enhancing work practices with safety benefits in a high-hazard industry.

Alternatives to the Present System of School Finance: Their Problems and Prospects

ERIC Educational Resources Information Center

Levin, Betsy

1973-01-01

Examines the recent spate of judicial decisions on school finance requiring that the quality of public education not be a function of a school district's wealth, and explores possible alternative sources of funding such as increasing State sales or income taxes or adopting a statewide property tax. (Author/SF)

Prospective Impact of Responsibility Center Budgeting on Communication and Theatre Programs: View from a State Supported University.

ERIC Educational Resources Information Center

Dick, Robert C.

In response to the nationwide trend toward increased financial pressures and growing demands by state legislatures for accountability, several large universities (including Indiana University) have adopted various forms of "responsibility center budgeting" (RCB), which has fiscal implications for programs in speech communication and…

77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-31

... Electronic Device (CIED) Procedures c. New Candidate HAC Condition: Iatrogenic Pneumothorax With Venous Catheterization 6. RTI Program Evaluation Summary a. RTI Analysis of FY 2011 POA Indicator Reporting Across.... Hospital Inpatient Quality Reporting (IQR) Program 1. Background a. History of Measures Adopted for the...

The Prospects for the Implementation of School-Based Financial Management in Taiwan

ERIC Educational Resources Information Center

Ho, Hsuan-fu

2010-01-01

The current approach to solving educational problems in Taiwan is to adopt policies employed in Western countries. However, given the very different cultural and educational environment of Asia, not all policies effective in Western countries are necessarily applicable to schools in Taiwan. Therefore, an examination of the feasibility and…

Investigating Why Teachers Reported Continued Use and Sharing of an Educational Innovation after the Research Has Ended

ERIC Educational Resources Information Center

Hegedus, Stephen J.; Dalton, Sara; Roschelle, Jeremy; Penuel, William; Dickey-Kurdziolek, Margaret; Tatar, Deborah

2014-01-01

We investigated prospects for reported sustainable adoption and sharing of an educational innovation through survey research including online questionnaires and telephone interviews. This investigation is part of the Scaling-Up SimCalc experimental program, which combines dynamic representational algebra software (SimCalc MathWorlds) with…

Can a barcode scanner for blood collection improve patient identification integrity in the emergency department? A prospective before-and-after study.

PubMed

Spain, David; Crilly, Julia; Pierce, John; Steele, Michael; Scuffham, Paul; Keijzers, Gerben

2015-02-01

To describe the effect of interventions designed to improve patient identification (PI) during pathology collection in the ED. A prospective before-and-after intervention study was conducted between June 2009 and June 2010 in a regional ED in Queensland, Australia. Interventions aimed to improve PI and specimen labelling, and consisted of: (i) education alone; and (ii) education plus an armband scanner that voice-prompted collector behaviour. Main outcomes measured included: frequency of correct key behaviours (KBs) during specimen collection, pathology integrity errors and cost of interventions. Data from 282 ED pathology collections were analysed (before: n = 115, after with education: n = 95, after with education plus armband scanner: n = 72). KBs for PI and labelling improved significantly following education plus armband scanner use. Application of armbands before sample collection increased (36% vs 90%, P < 0.001), as did asking the patient to state their name (25% vs 93%, P < 0.001) and date of birth (22% vs 93%, P < 0.001). These results were similar, albeit less pronounced, when the effect of education only was assessed. No primary patient misidentification was detected in this small study. The annual costs for a hospital to adopt the education programme with and without the armband scanner were $104,045 and $5330 respectively. ED staff had poor behaviours for identifying patients and labelling pathology specimens before intervention. These safety behaviours were considered an assumed skill. Education alone improved critical KBs markedly that was further augmented by the armband scanner. The cost to adopt education alone is relatively low compared to the addition of armband scanner technology. © 2015 The Authors. Emergency Medicine Australasia published by Wiley Publishing Asia Pty Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow-up study in the setting of prospective audits and patient blood management.

PubMed

Madrigal, Emilio; Prajapati, Shyam; Avadhani, Vaidehi; Annen, Kyle; Friedman, Mark T

2017-02-01

A previous study in our hospitals correlated suboptimal documentation and failure to justify transfusions. In light of implemented blood-conservation strategies, including patient blood management (PBM) and prospective audits (PAs), we performed a follow-up study. We reviewed prospectively audited red blood cell (RBC) transfusions received by adult patients from January to July 2014. Survey forms were used to assess the level of documentation and to classify documentation as adequate, intermediate, or inadequate. Transfusions were deemed justified or not by comparisons with hospital transfusion guidelines. We also analyzed the effect of implemented blood-conservation strategies on our hospital transfusion rates and costs from 2009 to 2015. During the study period, there were 259 prospectively audited transfusion events (TEs) (one or more RBC units transfused to a patient), of which we reviewed 94 TEs (36.3%) in 87 patients. TEs with suboptimal (intermediate and inadequate) documentation accounted for 46.8% of the reviewed TEs, of which 81.8% could not be justified compared with 18.0% of nonjustified, adequately documented TEs. The correlation between suboptimal documentation and failure to justify transfusion was significant (p < 0.001). This correlation remained even in a comparison between the site with a PBM program and the sites without such a program. Overall transfusion rates declined after the introduction of PA, although the decline was only statistically significant at the sites with a PBM program. Suboptimal transfusion documentation remains problematic and is highly correlated with nonjustifiable transfusions. Newly adopted approaches to minimize blood transfusions have not improved transfusion documentation and corresponding out-of-guideline transfusions, although overall transfusions have been reduced by PA, particularly in the setting of a PBM program. © 2016 AABB.

Does high sugar consumption exacerbate cardiometabolic risk factors and increase the risk of type 2 diabetes and cardiovascular disease?

PubMed Central

Sonestedt, Emily; Øverby, Nina Cecilie; Laaksonen, David E.; Birgisdottir, Bryndis Eva

2012-01-01

Consumption of sugar has been relatively high in the Nordic countries; the impact of sugar intake on metabolic risk factors and related diseases has been debated. The objectives were to assess the effect of sugar intake (sugar-sweetened beverages, sucrose and fructose) on association with type 2 diabetes, cardiovascular disease and related metabolic risk factors (impaired glucose tolerance, insulin sensitivity, dyslipidemia, blood pressure, uric acid, inflammation markers), and on all-cause mortality, through a systematic review of prospective cohort studies and randomised controlled intervention studies published between January 2000 and search dates. The methods adopted were as follows: the first search was run in PubMed in October 2010. A second search with uric acid as risk marker was run in April 2011. The total search strategy was rerun in April 2011 in SveMed+. An update was run in PubMed in January 2012. Two authors independently selected studies for inclusion from the 2,743 abstracts according to predefined eligibility criteria. The outcome was that out of the 17 studies extracted, 15 were prospective cohort studies and two were randomised controlled crossover trials. All of the studies included only adults. With respect to incident type 2 diabetes (nine studies), four of six prospective cohort studies found a significant positive association for sugar-sweetened beverage intake. In general, larger cohort studies with longer follow-up more often reported positive associations, and BMI seemed to mediate part of the increased risk. For other metabolic or cardiovascular risk factors or outcomes, too few studies have been published to draw conclusions. In conclusion, data from prospective cohort studies published in the years 2000–2011 suggest that sugar-sweetened beverages probably increase the risk of type 2 diabetes. For related metabolic risk factors, cardiovascular disease or all-cause mortality and other types of sugars, too few studies were available to draw conclusions. PMID:22855643

[Simulation of vegetation indices optimizing under retrieval of vegetation biochemical parameters based on PROSPECT + SAIL model].

PubMed

Wu, Ling; Liu, Xiang-Nan; Zhou, Bo-Tian; Liu, Chuan-Hao; Li, Lu-Feng

2012-12-01

This study analyzed the sensitivities of three vegetation biochemical parameters [chlorophyll content (Cab), leaf water content (Cw), and leaf area index (LAI)] to the changes of canopy reflectance, with the effects of each parameter on the wavelength regions of canopy reflectance considered, and selected three vegetation indices as the optimization comparison targets of cost function. Then, the Cab, Cw, and LAI were estimated, based on the particle swarm optimization algorithm and PROSPECT + SAIL model. The results showed that retrieval efficiency with vegetation indices as the optimization comparison targets of cost function was better than that with all spectral reflectance. The correlation coefficients (R2) between the measured and estimated values of Cab, Cw, and LAI were 90.8%, 95.7%, and 99.7%, and the root mean square errors of Cab, Cw, and LAI were 4.73 microg x cm(-2), 0.001 g x cm(-2), and 0.08, respectively. It was suggested that to adopt vegetation indices as the optimization comparison targets of cost function could effectively improve the efficiency and precision of the retrieval of biochemical parameters based on PROSPECT + SAIL model.

Study on fluorouracil-chitosan nanoparticle preparation and its antitumor effect.

PubMed

Chen, Gaimin; Gong, Rudong

2016-05-01

To successfully prepare fluorouracil-chitosan nanoparticles, and further analyze its anti-tumor activity mechanism, this paper makes a comprehensive study of existing preparation prescription and makes a detailed analysis of fluorouracil-chitosan in vitro release and pharmacodynamic behavior of animals. Two-step synthesis method is adopted to prepare 5-FU-CS-mPEG prodrugs, and infrared, (1)H NMR and differential thermal analysis are adopted to analyze characterization synthetic products of prepared drugs. To ensure clinical efficacy of prepared drugs, UV spectrophotometry is adopted for determination of drug loading capacity of prepared drugs, transmission electron microscopy is adopted to observe the appearance, dynamic dialysis method is used to observe in vitro drug release of prepared drugs and fitting of various release models is done. Anti-tumor effect is studied via level of animal pharmacodynamics. After the end of the experiment, tumor inhibition rate, spleen index and thymus index of drugs are calculated. Experimental results show that the prepared drugs are qualified in terms of regular shape, dispersion, drug content, etc. Animal pharmacodynamics experiments have shown that concentration level of drug loading capacity of prepared drugs has a direct impact on anti-tumor rate. The higher the concentration, the higher the anti-tumor rate. Results of pathological tissue sections of mice show that the prepared drugs cause varying degrees of damage to receptor cells, resulting in cell necrosis or apoptosis problem. It can thus be concluded that ion gel method is an effective method to prepare drug-loading nanoparticles, with prepared nanoparticles evenly distributed in regular shape which demonstrate good slow-release characteristics in receptor vitro and vivo. At the same time, after completion of drug preparation, relatively strong anti-tumor activity can be generated for the receptor, so this mode of preparation enjoys broad prospects for development.

Multi-function robots with speech interaction and emotion feedback

NASA Astrophysics Data System (ADS)

Wang, Hongyu; Lou, Guanting; Ma, Mengchao

2018-03-01

Nowadays, the service robots have been applied in many public circumstances; however, most of them still don’t have the function of speech interaction, especially the function of speech-emotion interaction feedback. To make the robot more humanoid, Arduino microcontroller was used in this study for the speech recognition module and servo motor control module to achieve the functions of the robot’s speech interaction and emotion feedback. In addition, W5100 was adopted for network connection to achieve information transmission via Internet, providing broad application prospects for the robot in the area of Internet of Things (IoT).

The Fortune of the Commons: Participatory Evaluation of Small-Scale Fisheries in the Brazilian Amazon

NASA Astrophysics Data System (ADS)

Oviedo, Antonio F. P.; Bursztyn, Marcel

2016-05-01

This paper applies a participatory approach in evaluating small-scale fisheries, focusing on the Arapaima gigas fishery in the Brazilian Amazon. The evaluation uses the social-ecological system (SES) framework, adopted to explain the conditions needed for sustainability and user cooperation in natural resources management, as a more suitable alternative to the `blueprint' or `panaceas' approaches, based only on property rights or governmental intervention. However, managers and users often do not have the necessary information compiled and available for a specific SES while some actions need to be taken immediately. Thus, consensus and negotiation among stakeholders about SES variables may be useful to evaluate system performance and indicate actions to promote sustainability. In the case study, using a consensus-building model, we found that arapaima SES leads to sustainability and is far from being a case of `tragedy of the commons.' More investments in suitable monitoring and enforcement for adaptive management are recommended. Adopting an SES framework based on stakeholders' prospects may be useful until complete interdisciplinary studies become available so as to seek of sustainability in the long term.

Methods and management: NIH administrators, federal oversight, and the Framingham Heart Study.

PubMed

Patel, Sejal S

2012-01-01

This article explores the 1965 controversy over the Framingham Heart Study in the midst of growing oversight into the management of science at the National Institutes of Health (NIH). It describes how, beginning in the early 1960s, federal overseers demanded that NIH administrators adopt particular management styles in administering programs and how these growing pressures led administrators to favor investigative pursuits that allowed for easy prospective accounting of program payoffs, especially those based on experimental methods designed to examine discrete interventions or outcomes of interest. In light of this changing managerial culture within the NIH, the Framingham study and other population laboratories-with their bases in observation and in open-ended study designs-became harder for NIH administrators to justify and defend.

On the Eve of Change: The Making of a Family Leave Policy at the University of Southern California.

ERIC Educational Resources Information Center

Reardon, Kathleen K.

1993-01-01

The University of Southern California's process for revising maternity leave to include fathers and adoptive parents is chronicled, including separate changes in staff and faculty policies. Proposed policies are outlined. Status of the proposed changes during a period of administrative change and future prospects for policy development are…

Prospective English Language Teachers' Experiences in Facebook: Adoption, Use and Educational Use in Turkish Context

ERIC Educational Resources Information Center

Balcikanli, Cem

2015-01-01

There has been an increasing attention given to the role of social networking in educational settings. Teacher education is not an exception to this, for teacher education is approaching social media on two fronts: a) application to enhance learning in the process of teacher preparation or professional development b) applications in classrooms…

How to Make "The Fourth Revolution". Human Factors in the Adoption of Electronic Instructional Aids. Memorandum Number 73/5.

ERIC Educational Resources Information Center

Demerath, Nicholas J.; Daniels, Lois A.

The prospects and problems associated with getting American higher education to utilize more fully electronic technologies are examined. Part I surveys the diversity of higher education and its students and concludes that technological applications will have to be correspondingly varied, despite the tendency to "massification". Part II, consisting…

Structured Parenting of Toddlers at High versus Low Genetic Risk: Two Pathways to Child Problems

ERIC Educational Resources Information Center

Leve, Leslie D.; Harold, Gordon T.; Ge, Xiaojia; Neiderhiser, Jenae M.; Shaw, Daniel; Scaramella, Laura V.; Reiss, David

2009-01-01

Objective: Little is known about how parenting might offset genetic risk to prevent the onset of child problems during toddlerhood. We used a prospective adoption design to separate genetic and environmental influences and test whether associations between structured parenting and toddler behavior problems were conditioned by genetic risk for…

Evaluating Principal-Preparation Programs Based on Placement Rates: Problems and Prospects for Policymakers

ERIC Educational Resources Information Center

Fuller, Edward J.; Hollingworth, Liz

2016-01-01

Recent calls to hold preparation programs accountable for outcomes have led states to develop and adopt preparation program accountability systems. A primary feature of these systems is a focus on outcomes such as placement rates, retention rates, and graduates' effectiveness in improving K-12 student achievement. Yet, little research has examined…

On the Implications of Vygotskian Concepts for Second Language Teaching

ERIC Educational Resources Information Center

Azabdaftari, Behrooz

2013-01-01

This paper represents an attempt to search for the implications of Vygotsky's approach to "the genesis of mind" for second language acquisition (SLA). In so doing, the present author has adopted first a retrospective view--what has already gone in the field of foreign language instruction, and a prospective view--what is contingent on…

Electronic health records: postadoption physician satisfaction and continued use.

PubMed

Wright, Edward; Marvel, Jon

2012-01-01

One goal of public-policy makers in general and health care managers in particular is the adoption and efficient utilization of electronic health record (EHR) systems throughout the health care industry. Consequently, this investigation focused on the effects of known antecedents of technology adoption on physician satisfaction with EHR technology and the continued use of such systems. The American Academy of Family Physicians provided support in the survey of 453 physicians regarding their satisfaction with their EHR use experience. A conceptual model merging technology adoption and computer user satisfaction models was tested using structural equation modeling. Results indicate that effort expectancy (ease of use) has the most substantive effect on physician satisfaction and the continued use of EHR systems. As such, health care managers should be especially sensitive to the user and computer interface of prospective EHR systems to avoid costly and disruptive system selection mistakes.

Is physical activity maintenance from adolescence to young adulthood associated with reduced CVD risk factors, improved mental health and satisfaction with life: the HUNT Study, Norway.

PubMed

Rangul, Vegar; Bauman, Adrian; Holmen, Turid Lingaas; Midthjell, Kristian

2012-12-14

Little is known about the effect maintaining physical activity throughout adolescence has on cardiovascular risk factors and health status in early adulthood. This ten-year prospective longitudinal study investigated whether differences in physical activity patterns from adolescence to young-adulthood showed different associations with subsequent cardio-metabolic risk factors and mental health in young-adulthood. Based on the second and third Norwegian Nord-Trøndelag Health Surveys (HUNT2 and 3), we included 1869 individuals (838 males) participating in Young-HUNT (1995-97), aged 13-19 years and followed-up at HUNT3 (2006-08), aged 23-31. Self-reported physical activity (PA), mental health and perceived health were recorded, along with measurements of body mass index (BMI), waist circumference (WC), total cholesterol (TC), HDL cholesterol, glucose, triglycerides, resting heart rate (HR) and blood pressure. We used separate linear regressions models to investigate associations between physical activity and each CVD risk factor, and logistic regression analysis to examine PA patterns and subsequent mental health. Physically active maintainers were compared to inactive maintainers. Adopters (inactive as adolescents and physically active as young adults) were compared to inactive maintainers and to those who discontinued activity (relapsers). Active maintainers had significantly lower HR, compared to all other PA patterns. Active maintaining men had significantly lower WC than relapsers and inactive maintainers. When adjusted for age and gender, WC, BMI, HR, diastolic blood pressure and HDL-C showed significant differences comparing active maintaining to other PA patterns. Comparing inactive maintainers against adopters, only HR was significantly lower. Male adopters did not differ significantly in CVD risk compared to inactive maintainers and relapsers. Among females adopting was associated with lower HR and TC compared to inactive maintainers. Active maintainers showed better mental health than inactive maintainers. Active maintaining males had an increased likelihood of good mental health compared to adopters. Active maintaining females reported greater satisfaction with life compared to adopters. Those who maintained their physical activity from adolescence to young adulthood demonstrated a significantly lower CVD risk and better mental health, compared to inactive maintainers. Compared to inactivity maintainers and relapsers, adopting physical activity was not significantly associated with lowered CVD risk. Adopting physical activity between adolescence and young adulthood may not necessarily protect against mental distress.

Pharmacogenetics and pharmacogenomics in psoriasis treatment: current challenges and future prospects.

PubMed

Sutherland, Alison; Power, Rebecca J; Rahman, Proton; O'Rielly, Darren D

2016-08-01

Topical, systemic, oral disease modifying, and biologic agents are part of the armamentarium to manage psoriatic disease. The choice of therapy depends upon disease severity, relevant co-morbidities and patient preference. There is great variability in patient response with these agents, and there is still no clear method of selecting the preferred therapeutic agent for efficacy or lack of adverse events. This article will review the pharmacogenetic and pharmacogenomic targets that are currently known with respect to psoriasis vulgaris, and the most frequent co-morbidity of psoriasis, psoriatic arthritis. Presently, no clinically actionable biomarker exists for any therapeutic agent used to treat psoriasis or psoriatic arthritis. The lack of validated outcome measures and conflicting results of open-label studies conducted may be attributed to a multitude of issues that confound discovery. Consequently, studies have been underpowered to identify genes or genetic variants worth translating to clinical practice. In order to achieve a pharmacogenetic/pharmacogenomic signature, improvements in study design of future investigations are required, including carefully designed prospective studies. It is imperative to combine known clinical, serological, and molecular markers with consistent outcomes and an adequate health economic evaluation before they can be adopted widely in clinical practice.

Fluorescence detection, enumeration and characterization of single circulating cells in vivo: technology, applications and future prospects

NASA Astrophysics Data System (ADS)

Hartmann, Carolin; Patil, Roshani; Lin, Charles P.; Niedre, Mark

2018-01-01

There are many diseases and biological processes that involve circulating cells in the bloodstream, such as cancer metastasis, immunology, reproductive medicine, and stem cell therapies. This has driven significant interest in new technologies for the study of circulating cells in small animal research models and clinically. Most currently used methods require drawing and enriching blood samples from the body, but these suffer from a number of limitations. In contrast, ‘in vivo flow cytometry’ (IVFC) refers to set of technologies that allow study of cells directly in the bloodstream of the organism in vivo. In recent years the IVFC field has grown significantly and new techniques have been developed, including fluorescence microscopy, multi-photon, photo-acoustic, and diffuse fluorescence IVFC. In this paper we review recent technical advances in IVFC, with emphasis on instrumentation, contrast mechanisms, and detection sensitivity. We also describe key applications in biomedical research, including cancer research and immunology. Last, we discuss future directions for IVFC, as well as prospects for broader adoption by the biomedical research community and translation to humans clinically.

Fluorescence detection, enumeration and characterization of single circulating cells in vivo: technology, applications and future prospects.

PubMed

Hartmann, Carolin; Patil, Roshani; Lin, Charles P; Niedre, Mark

2017-12-14

There are many diseases and biological processes that involve circulating cells in the bloodstream, such as cancer metastasis, immunology, reproductive medicine, and stem cell therapies. This has driven significant interest in new technologies for the study of circulating cells in small animal research models and clinically. Most currently used methods require drawing and enriching blood samples from the body, but these suffer from a number of limitations. In contrast, 'in vivo flow cytometry' (IVFC) refers to set of technologies that allow study of cells directly in the bloodstream of the organism in vivo. In recent years the IVFC field has grown significantly and new techniques have been developed, including fluorescence microscopy, multi-photon, photo-acoustic, and diffuse fluorescence IVFC. In this paper we review recent technical advances in IVFC, with emphasis on instrumentation, contrast mechanisms, and detection sensitivity. We also describe key applications in biomedical research, including cancer research and immunology. Last, we discuss future directions for IVFC, as well as prospects for broader adoption by the biomedical research community and translation to humans clinically.

Risk of deep venous thrombosis in elective neurosurgical procedures: a prospective, Doppler ultrasound-based study in children 12 years of age or younger.

PubMed

Scherer, Andrea G; White, Ian K; Shaikh, Kashif A; Smith, Jodi L; Ackerman, Laurie L; Fulkerson, Daniel H

2017-07-01

OBJECTIVE The risk of venous thromboembolism (VTE) from deep venous thrombosis (DVT) is significant in neurosurgical patients. VTE is considered a leading cause of preventable hospital deaths and preventing DVT is a closely monitored quality metric, often tied to accreditation, hospital ratings, and reimbursement. Adult protocols include prophylaxis with anticoagulant medications. Children's hospitals may adopt adult protocols, although the incidence of DVT and the risk or efficacy of treatment is not well defined. The incidence of DVT in children is likely less than in adults, although there is very little prospectively collected information. Most consider the risk of DVT to be extremely low in children 12 years of age or younger. However, this consideration is based on tradition and retrospective reviews of trauma databases. In this study, the authors prospectively evaluated pediatric patients undergoing a variety of elective neurosurgical procedures and performed Doppler ultrasound studies before and after surgery. METHODS A total of 100 patients were prospectively enrolled in this study. All of the patients were between the ages of 1 month and 12 years and were undergoing elective neurosurgical procedures. The 91 patients who completed the protocol received a bilateral lower-extremity Doppler ultrasound examination within 48 hours prior to surgery. Patients did not receive either medical or mechanical DVT prophylaxis during or after surgery. The ultrasound examination was repeated within 72 hours after surgery. An independent, board-certified radiologist evaluated all sonograms. We prospectively collected data, including potential risk factors, details of surgery, and details of the clinical course. All patients were followed clinically for at least 1 year. RESULTS There was no clinical or ultrasound evidence of DVT or VTE in any of the 91 patients. There was no clinical evidence of VTE in the 9 patients who did not complete the protocol. CONCLUSIONS In this prospective study, no DVTs were found in 91 patients evaluated by ultrasound and 9 patients followed clinically. While the study is underpowered to give a definitive incidence, the data suggest that the risk of DVT and VTE is very low in children undergoing elective neurosurgical procedures. Prophylactic protocols designed for adults may not apply to pediatric patients. Clinical trial registration no.: NCT02037607 (clinicaltrials.gov).

Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace.

PubMed

Marcus, B H; Emmons, K M; Simkin-Silverman, L R; Linnan, L A; Taylor, E R; Bock, B C; Roberts, M B; Rossi, J S; Abrams, D B

1998-01-01

This study compares the efficacy of a self-help intervention tailored to the individual's stage of motivational readiness for exercise adoption with a standard self-help exercise promotion intervention. Interventions were delivered at baseline and 1 month; assessments were collected at baseline and 3 months. Eleven worksites participating in the Working Healthy Research Trial. Participants (n = 1559) were a subsample of employees at participating worksites, individually randomized to one of two treatment conditions. Printed self-help exercise promotion materials either (1) matched to the individual's stage of motivational readiness for exercise adoption (motivationally tailored), or (2) standard materials (standard). Measures of stage of motivational readiness for exercise and items from the 7-Day Physical Activity Recall. Among intervention completers (n = 903), chi-square analyses showed that, compared to the standard intervention, those receiving the motivationally tailored intervention were significantly more likely to show increases (37% vs. 27%) and less likely to show either no change (52% vs. 58%) or regression (11% vs. 15%) in stage of motivational readiness. Multivariate analyses of variance showed that changes in stage of motivational readiness were significantly associated with changes in self-reported time spent in exercise. This is the first prospective, randomized, controlled trial demonstrating the efficacy of a brief motivationally tailored intervention compared to a standard self-help intervention for exercise adoption. These findings appear to support treatment approaches that tailor interventions to the individual's stage of motivational readiness for exercise adoption.

Children's mental time travel during mind wandering.

PubMed

Ye, Qun; Song, Xiaolan; Zhang, Yi; Wang, Qinqin

2014-01-01

The prospective bias is a salient feature of mind wandering in healthy adults, yet little is known about the temporal focus of children's mind wandering. In the present study, (I) we developed the temporal focus of mind wandering questionnaire for school-age children (TFMWQ-C), a 12-item scale with good test-retest reliability and construct validity. (II) The criterion validity was tested by thought sampling in both choice reaction time task and working memory task. A positive correlation was found between the temporal focus measured by the questionnaire and the one adopted during task-unrelated thoughts (TUTs) by thought sampling probes, especially in the trait level of future-oriented mind wandering. At the same time, children who experienced more TUTs tended to show worse behavioral performance during tasks. (III) The children in both tasks experienced more future-oriented TUTs than past-oriented ones, which was congruent with the results observed in adults; however, in contrast with previous research on adults, the prospective bias was not influenced by task demands. Together these results indicate that the prospective bias of mind wandering has emerged since the school-age (9∼13 years old), and that the relationship between mental time travel (MTT) during mind wandering and the use of cognitive resources differs between children and adults. Our study provides new insights into how this interesting feature of mind wandering may adaptively contribute to the development of children's MTT.

The frequency and severity of capecitabine-induced hypertriglyceridaemia in routine clinical practice: a prospective study

PubMed Central

Michie, C O; Sakala, M; Rivans, I; Strachan, M W J; Clive, S

2010-01-01

Background: Capecitabine is known to rarely cause raised serum triglycerides (TG). In our centre, several patients receiving capecitabine developed raised TG levels corresponding to the ‘very high risk' category for potentially serious acute pancreatitis. Methods: A fasting blood lipid screening protocol was introduced into clinical practice for patients receiving capecitabine. Patients with TGs >5 mmol l−1 were treated and followed up. An 18-month prospective audit was performed to establish the incidence and severity of capecitabine-induced hypertriglyceridaemia (CIHT). Results: A total of 304 patients received capecitabine for colorectal cancer between January 2008 and June 2009. Of these, 212 patients (70%) were screened and 8 (3.7%) developed clinically significant hypertriglyceridaemia requiring lipid-lowering therapy. Two of the eight patients had diabetes and one had pre-existing dyslipidaemia. One suffered cerebral infarction during chemotherapy. There were no cases of acute pancreatitis. Follow-up showed that serum TGs safely and rapidly returned to normal with appropriate treatment without discontinuation of capecitabine. Conclusions: This is the first prospective study evaluating CIHT. These results suggest that it should be classed as a ‘common' undesired effect of capecitabine. Despite this, the incidence does not justify routine screening in all patients. Targeted screening in those with diabetes or pre-existing hyperlipidaemia is recommended, together with adoption of a clear management policy. PMID:20664584

Identifying new patient prospects: efficacy of usage segmentation. For some health care services, usage-based segmentation schemes can be wasteful and ineffective.

PubMed

Sarel, D; Marmorstein, H

1996-01-01

Even though there is intuitive appeal in identifying the user profile for a given service and then targeting similar nonusers, this approach can be very misleading when marketing health care services with low market penetration. If usage segmentation is employed without checking other indicators of latent demand and perceived barriers to use, significant misallocation of marketing resources is likely to occur. Confidentiality and embarrassment can be significant barriers to use by segments that are excellent patient prospects. In this study of mental and behavioral care, females and non-whites were found to be more concerned with confidentiality than were members of the user group. Lack of awareness can be a much bigger impediment to adoption than negative attitudes. Health care marketers need to design communications that not only increase awareness and familiarity for services with low market penetration, but also address other issues of concern to highly receptive segments.

Infant emotional distress, maternal restriction at a home meal, and child BMI gain through age 6years in the Colorado Adoption Project.

PubMed

Hittner, James B; Johnson, Cassandra; Tripicchio, Gina; Faith, Myles S

2016-04-01

Infant temperament and parental feeding practices may be risk factors for childhood obesity, however most studies have relied upon parent-report assessments. We tested whether infant emotional distress and maternal restrictive feeding at 12-months of age, assessed observationally at a home feeding interaction, predicted child BMI through age 6years. We conducted a prospective observational study of 86 children (34 girls and 52 boys, from 55 adoptive and 31 non-adoptive families) enrolled in the Colorado Adoption Project. Mother-infant feeding interactions were video-recorded during a home snack or meal at year 1, and child anthropometrics (length or height, and weight) were assessed at years 1 through 6. The main outcome measures were child weight-for-length at year 1 and body mass index (BMI: kg/m(2)) at years 2-6. Results of generalized linear models indicated that greater infant emotional distress at 12-months predicted greater increases in child weight status through age 6years, B=0.62 and odds ratio (OR)=1.87. In separate analyses, restrictive feeding interacted with child sex in predicting weight status trajectories (p=.012). Male infants whose mothers displayed any compared to no restriction at year 1 showed a downward BMI trajectory from 2 to 6years; for female infants, exposure to any compared to no restriction prompts predicted increasing BMI from 4 to 6years. In sum, early obesity prevention strategies should pay greater attention to infant temperament, especially distress and negative affect, and how parents respond to such cues. Additionally, 'responsive feeding' strategies that provide an alternative to restriction warrant greater research during infancy. Copyright © 2016. Published by Elsevier Ltd.

Development of Selective Lamellar Keratoplasty within an Asian Corneal Transplant Program: The Singapore Corneal Transplant Study (An American Ophthalmological Society Thesis)

PubMed Central

Tan, Donald; Ang, Marcus; Arundhati, Anshu; Khor, Wei-Boon

2015-01-01

Purpose: To evaluate outcomes of anterior lamellar keratoplasty (ALK) and endothelial keratoplasty (EK) within the Singapore Corneal Transplant Study (SCTS), with the hypothesis that both ALK and EK are able to provide equivalent or improved clinical outcomes, compared to penetrating keratoplasty (PK), and to determine changing trends globally with other international databases. Methods: Clinical data on all transplants performed was derived from our SCTS database, a prospective national keratoplasty registry, and clinical outcomes (graft survival, endothelial cell loss, complications, visual acuity) were compared between PK, ALK, and EK. Global trends on indications and forms of keratoplasty performed in 2011/2012 were obtained from national keratoplasty or eye banking registries, corneal/ophthalmological societies, national eye banks, and national ophthalmic institutions. Results: Global rates of EK surgery vary widely, from 52% (Sweden) to 0% (South Africa), with higher adoption by industrialized countries. ALK adoption rates similarly vary from 28.7% (China) to 1.0% (Philippines). SCTS data show high adoption rates in Singapore: EK 44% and ALK 28%. Our surgical modifications to big-bubble deep anterior lamellar keratoplasty (DALK) surgery resulted in visual outcomes matching PK, and a low conversion to PK of 2.1%, whereas our evolving approaches to donor insertion in Descemet’s stripping automated endothelial keratoplasty (DSAEK) show significant reduction in 1-year postoperative endothelial cell loss rates from 60% (folding), to 22% to 30% (Sheets Glide), to 15% (EndoGlide inserter). Conclusion: Improvements in various forms of ALK and EK surgery can lead to better visual outcomes, longer graft survival, and reduced complications, as compared to PK. Global trends suggest adoption of these procedures at different rates. PMID:26755854

[Developmental trajectories of anxiety disorder symptoms in adolescents: a five-year prospective community study].

PubMed

Hale, W W; Klimstra, T A; Wijsbroek, S A M; Raaijmakers, Q A W; Muris, P; van Hoof, A; Meeus, W H J

2009-01-01

The relatively recent adoption of modern statistical analysis methods, such as latent growth modelling (lgm), makes it possible to study differences in the individual trajectories of development over time. To examine prospectively the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents (N = 1,318) from the general population over a period of five years. The adolescents were divided into two cohorts: early adolescents (average age 12 at the first measurement) and middle adolescents (average age 16 at the first measurement). Age and gender differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of lgm. results Over the course of five years there was a slight decrease in panic disorder, school anxiety and separation anxiety disorder symptoms for all adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase in generalised anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys. The use of individual trajectory-based analyses, enabled us to study advance our understanding of age and gender differences in the development of adolescent anxiety symptoms.

Implications of prospective payment under DRGs for hospital marketing.

PubMed

Folland, S; Ziegenfuss, J T; Chao, P

1988-12-01

The authors analyze the hospital marketing implications of Medicare's prospective payment system under DRGs. They take an appropriately broad view of marketing and consider related impacts on culture, structure, and management, in addition to the traditional marketing mix. The article serves to present in one place the ideas and discussions on the subject from a wide and disparate literature. The aim throughout is to identify those marketing responses warranting recommendation. The recommendations are assembled in a concluding section. Though many of the ideas are not new, they have yet to be widely adopted by hospitals. Hence they represent untapped marketing opportunities attributable to the advent of the DRG system. The authors conclude with suggestions for future research.

75 FR 49233 - Amendments to Form ADV

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

...The Securities and Exchange Commission is adopting amendments to Part 2 of Form ADV, and related rules under the Investment Advisers Act, to require investment advisers registered with us to provide new and prospective clients with a brochure and brochure supplements written in plain English. These amendments are designed to provide new and prospective advisory clients with clearly written, meaningful, current disclosure of the business practices, conflicts of interest and background of the investment adviser and its advisory personnel. Advisers must file their brochures with us electronically and we will make them available to the public through our Web site. The Commission also is withdrawing the Advisers Act rule requiring advisers to disclose certain disciplinary and financial information.

Genetic and Environmental Influences on Parent-Child Conflict and Child Depression Through Late Adolescence.

PubMed

Samek, Diana R; Wilson, Sylia; McGue, Matt; Iacono, William G

2016-04-04

Few studies have investigated potential gender differences in the genetic and environmental influences on the prospective associations between parent-child conflict and later depression, a notable gap given substantial gender differences in rates of depression and suggestive evidence of differences in the etiology of depression among females and males. To fill this gap, we evaluated whether the prospective relationship between parent-child conflict and major depressive disorder symptoms varied as a function of parent-child gender composition. A combined twin and adoption sample was used (53% female; 85% European ancestry), containing 1,627 adolescent sibling pairs (789 monozygotic twin pairs, 594 dizygotic/full-biological pairs, 244 genetically unrelated pairs) with assessments at two time points in adolescence (approximate ages 15 and 18). Prospective associations between parent-child conflict and subsequent adolescent depression were explained predominately through common genetic influences for mother-daughter and mother-son pairs but less so for father-daughter and father-son pairs. Results support the notion that processes of gene-environment correlation involved in the prospective associations between parent-child conflict, and later adolescent depression appear to be less relevant to father-child relationships in comparison to mother-child relationships. Notably, results did not show that parent-child conflict was more relevant to the etiology of major depressive disorder (MDD) for girls than boys; gender differences in depression do not appear to be due to differences in the associations between parent-child conflict and child depression.

Genetic and Environmental Influences on Parent-Child Conflict and Child Depression Through Late Adolescence

PubMed Central

Samek, Diana R.; Wilson, Sylia; McGue, Matt; Iacono, William G.

2016-01-01

Objective Few studies have investigated potential gender differences in the genetic and environmental influences on the prospective associations between parent-child conflict and later depression, a notable gap given substantial gender differences in rates of depression and suggestive evidence of differences in the etiology of depression among females and males. To fill this gap, we evaluated whether the prospective relationship between parent-child conflict and major depressive disorder (MDD) symptoms varied as a function of parent-child gender composition. Method A combined twin and adoption sample was used (53% female; 85% European ancestry), containing 1,627 adolescent sibling pairs (789 monozygotic twin pairs, 594 dizygotic/full-biological pairs, 244 genetically unrelated pairs) with assessments at two time points in adolescence (ages ~15 to ~18). Results Prospective associations between parent-child conflict and subsequent adolescent depression were explained predominately through common genetic influences for mother-daughter and mother-son pairs, but less so for father-daughter and father-son pairs. Conclusion Processes of gene-environment correlation involved in the prospective associations between parent-child conflict and later adolescent depression appear to be less relevant to father-child relationships in comparison to mother-child relationships. Notably, results did not show parent-child conflict was more relevant to the etiology of MDD for girls than boys; gender differences in depression do not appear to be due to differences in the associations between parent-child conflict and child depression. PMID:27043719

Do case-mix adjusted nursing home reimbursements actually reflect costs? Minnesota's experience.

PubMed

Nyman, J A; Connor, R A

1994-07-01

Some states have adopted Medicaid reimbursement systems that pay nursing homes according to patient type. These case-mix adjusted reimbursements are intended in part to eliminate the incentive in prospective systems to exclude less profitable patients. This study estimates the marginal costs of different patient types under Minnesota's case-mix system and compares them to their corresponding reimbursements. We find that estimated costs do not match reimbursement rates, again making some patient types less profitable than others. Further, in confirmation of our estimates, we find that the percentage change in patient days between 1986 and 1990 is explained by our profitability estimates.

Martial arts and psychological health.

PubMed

Fuller, J R

1988-12-01

The misleading public image of the martial arts masks a rich though esoteric psychological legacy containing informative parallels for contemporary psychotherapeutic concepts and practices. To date, empirical research on the martial arts has lacked sophistication in the questions it has posed and in the methodology adopted to answer them. Whilst not entirely consistent, findings from studies of martial artists' personalities, outlooks and behaviour have generally indicated positive psychological effects of training. Clinical and psychotherapeutic applications are at an exploratory stage but appear promising. As an exemplar the psychological facets of the art of Aikido are discussed, and prospective uses of martial arts principles as systemic or adjunctive therapies are considered.

Methods and Management: NIH Administrators, Federal Oversight, and the Framingham Heart Study

PubMed Central

Patel, Sejal S.

2012-01-01

Summary This article explores the 1965 controversy over the Framingham Heart Study in the midst of growing oversight into the management of science at the National Institutes of Health (NIH). It describes how, beginning in the early 1960s, federal overseers demanded that NIH administrators adopt particular management styles in administering programs and how these growing pressures led administrators to favor investigative pursuits that allowed for easy prospective accounting of program payoffs, especially those based on experimental methods designed to examine discrete interventions or outcomes of interest. In light of this changing managerial culture within the NIH, the Framingham study and other population laboratories—with their bases in observation and in open-ended study designs—became harder for NIH administrators to justify and defend. PMID:22643985

The development and status of Bt rice in China.

PubMed

Li, Yunhe; Hallerman, Eric M; Liu, Qingsong; Wu, Kongming; Peng, Yufa

2016-03-01

Multiple lines of transgenic rice expressing insecticidal genes from the bacterium Bacillus thuringiensis (Bt) have been developed in China, posing the prospect of increases in production with decreased application of pesticides. We explore the issues facing adoption of Bt rice for commercial production in China. A body of safety assessment work on Bt rice has shown that Bt rice poses a negligible risk to the environment and that Bt rice products are as safe as non-Bt control rice products as food. China has a relatively well-developed regulatory system for risk assessment and management of genetically modified (GM) plants; however, decision-making regarding approval of commercial production has become politicized, and two Bt rice lines that otherwise were ready have not been allowed to enter the Chinese agricultural system. We predict that Chinese farmers would value the prospect of increased yield with decreased use of pesticide and would readily adopt production of Bt rice. That Bt rice lines may not be commercialized in the near future we attribute to social pressures, largely due to the low level of understanding and acceptance of GM crops by Chinese consumers. Hence, enhancing communication of GM crop science-related issues to the public is an important, unmet need. While the dynamics of each issue are particular to China, they typify those in many countries where adoption of GM crops has been not been rapid; hence, the assessment of these dynamics might inform resolution of these issues in other countries. © 2015 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.

The Feasibility of Using Computer and Internet in Teaching Family Education for the 8th Grade Class

ERIC Educational Resources Information Center

Alluhaydan, Nuwayyir Saleh F.

2016-01-01

This paper is just a sample template for the prospective authors of IISTE. Over the decades, the concepts of holons and holonic systems have been adopted in many research fields, but they are scarcely attempted on labour planning. A literature gap exists, thus motivating the author to come up with a holonic model that uses exponential smoothing to…

Remigration and social change--prospects for the migrant worker sending countries of the Middle East.

PubMed

Stauth, G

1987-01-01

The author examines sociocultural aspects of the remigration of workers in the Middle East. He "suggests that migrants adopt, collectively, new cultural attitudes which they will attempt to maintain after getting re-settled back home." Consideration is given to consumerism and the religious beliefs of the repatriated workers. Special emphasis is given to return migration to Egypt and Pakistan. excerpt

The Evidence Value Matrix for Diagnostic Imaging.

PubMed

Seidel, David; Frank, Richard A; Schmidt, Sebastian

2016-10-01

Evidence and value are independent factors that together affect the adoption of diagnostic imaging. For example, noncoverage decisions by reimbursement authorities can be justified by a lack of evidence and/or value. To create transparency and a common understanding among various stakeholders, we have proposed a two-dimensional matrix that allows classification of imaging devices into three distinct categories based on the available evidence and value: "question marks" (low value demonstrated in studies of any evidence level), "candidates" (high value demonstrated in retrospective case-control studies and smaller case series), and "stars" (high value demonstrated in large prospective cohort studies or, preferably, randomized controlled trials). We use several examples to illustrate the application of our matrix. A major benefit of the matrix includes the development of specific strategies for evidence and value generation. High-evidence/low-value studies are expensive and unlikely to convince decision makers, given the uncertainty of the impact on patient management and outcomes. Developing question marks into candidates first and then into stars will often be quicker and less expensive ("success sequence"). Only this more sophisticated and objective approach can justify the additional funding necessary to generate the evidence base to inform reimbursement by payers and adoption by providers. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Exploring the interaction of patient activation and message design variables: message frame and presentation mode influence on the walking behavior of patients with type 2 diabetes.

PubMed

Ledford, Christy J W

2012-10-01

Examining interpersonal (physician-patient) communication strategies for promoting walking exercise to patients with type 2 diabetes assigned to primary care clinics, the study evaluated two message design variables--frame and presentation mode--as influencers of communication and adoption success. The single-site, four-week, prospective intervention study followed a 2×3 factorial, non-equivalent comparison group quasi-experimental design. Results showed frame was significantly related to steps walked; however, when including patient activation as an interaction, frame was non-significant. The model including patient activation interactions, however, detected significant mode effects on behavior. Results provide evidence that statistics are most effectively used with activated patients.

Is physical activity maintenance from adolescence to young adulthood associated with reduced CVD risk factors, improved mental health and satisfaction with life: the HUNT Study, Norway

PubMed Central

2012-01-01

Background Little is known about the effect maintaining physical activity throughout adolescence has on cardiovascular risk factors and health status in early adulthood. This ten-year prospective longitudinal study investigated whether differences in physical activity patterns from adolescence to young-adulthood showed different associations with subsequent cardio-metabolic risk factors and mental health in young-adulthood. Methods Based on the second and third Norwegian Nord-Trøndelag Health Surveys (HUNT2 and 3), we included 1869 individuals (838 males) participating in Young-HUNT (1995–97), aged 13–19 years and followed-up at HUNT3 (2006–08), aged 23–31. Self-reported physical activity (PA), mental health and perceived health were recorded, along with measurements of body mass index (BMI), waist circumference (WC), total cholesterol (TC), HDL cholesterol, glucose, triglycerides, resting heart rate (HR) and blood pressure. We used separate linear regressions models to investigate associations between physical activity and each CVD risk factor, and logistic regression analysis to examine PA patterns and subsequent mental health. Physically active maintainers were compared to inactive maintainers. Adopters (inactive as adolescents and physically active as young adults) were compared to inactive maintainers and to those who discontinued activity (relapsers). Results Active maintainers had significantly lower HR, compared to all other PA patterns. Active maintaining men had significantly lower WC than relapsers and inactive maintainers. When adjusted for age and gender, WC, BMI, HR, diastolic blood pressure and HDL-C showed significant differences comparing active maintaining to other PA patterns. Comparing inactive maintainers against adopters, only HR was significantly lower. Male adopters did not differ significantly in CVD risk compared to inactive maintainers and relapsers. Among females adopting was associated with lower HR and TC compared to inactive maintainers. Active maintainers showed better mental health than inactive maintainers. Active maintaining males had an increased likelihood of good mental health compared to adopters. Active maintaining females reported greater satisfaction with life compared to adopters. Conclusions Those who maintained their physical activity from adolescence to young adulthood demonstrated a significantly lower CVD risk and better mental health, compared to inactive maintainers. Compared to inactivity maintainers and relapsers, adopting physical activity was not significantly associated with lowered CVD risk. Adopting physical activity between adolescence and young adulthood may not necessarily protect against mental distress. PMID:23241306

Anticipated affective consequences of physical activity adoption and maintenance.

PubMed

Dunton, Genevieve Fridlund; Vaughan, Elaine

2008-11-01

The expected emotional consequences of future actions are thought to play an important role in health behavior change. This research examined whether anticipated affective consequences of success and failure vary across stages of physical activity change and differentially predict physical activity adoption as compared to maintenance. Using a prospective design over a 3-month period, a community sample of 329 healthy, middle-aged adults were assessed at 2 time points. Anticipated positive and negative emotions, stage of behavior change (precontemplation [PC], contemplation [C], preparation [P], action [A], maintenance [M]), and level of physical activity. At baseline, anticipated positive emotions were greater in C versus PC, whereas anticipated negative emotions were greater in M versus A and in M versus P. Higher anticipated positive but not negative emotions predicted physical activity adoption and maintenance after 3 months. Although the expected affective consequences of future success and failure differentiated among individuals in the early and later stages of physical activity change, respectively; only the anticipated affective consequences of success predicted future behavior.

Implications of climate change predictions for UK cropping and prospects for possible mitigation: a review of challenges and potential responses.

PubMed

Rial-Lovera, Karen; Davies, W Paul; Cannon, Nicola D

2017-01-01

The UK, like the rest of the world, is confronting the impacts of climate change. Further changes are expected and they will have a profound effect on agriculture. Future crop production will take place against increasing CO 2 levels and temperatures, decreasing water availability, and increasing frequency of extreme weather events. This review contributes to research on agricultural practices for climate change, but with a more regional perspective. The present study explores climate change impacts on UK agriculture, particularly food crop production, and how to mitigate and build resilience to climate change by adopting and/or changing soil management practices, including fertilisation and tillage systems, new crop adoption and variety choice. Some mitigation can be adopted in the shorter term, such as changes in crop type and reduction in fertiliser use, but in other cases the options will need greater investment and longer adaptation period. This is the case for new crop variety development and deployment, and possible changes to soil cultivations. Uncertainty of future weather conditions, particularly extreme weather, also affect decision-making for adoption of practices by farmers to ensure more stable and sustainable production. Even when there is real potential for climate change mitigation, it can sometimes be more difficult to accomplish with certainty on-farm. Better future climate projections and long-term investments will be required to create more resilient agricultural systems in the UK in the face of climate change challenges. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women.

PubMed

Moraloglu, Ozlem; Kansu-Celik, Hatice; Tasci, Yasemin; Karakaya, Burcu Kısa; Yilmaz, Yasar; Cakir, Ebru; Yakut, Halil Ibrahim

2017-01-01

To assess the effects on neonatal and maternal outcomes of different pushing positions during the second stage of labor in nulliparous women. This prospective study included 102 healthy, pregnant, nulliparous women who were randomly allocated to either of two positions: a squatting using bars (n = 51), or a supine position modified to 45 degree of semi-fowler (n = 51) during the second stage of labor. Duration of the second stage of labor, maternal pain, postpartum blood loss, abnormal fetal heart rate patterns that required intervention, and newborn outcomes were compared between the two groups. The trial showed that women who adopted the squatting position using bars experienced a significant reduction in the duration of the second stage of labor; they were less likely to be induced, and their Visual Analog Scale score was lower than those who were allocated the supine position modified to 45 degree of semi-fowler during second stage of labor (p < 0.05). There were no significant differences with regard to postpartum blood loss, neonatal birth weight, Apgar score at one and five minutes, or admission to the Neonatal Intensive Care Unit. In healthy nulliparous women, adopting a squatting position using bars was associated with a shorter second stage of labor, lower Visual Analog Scale score, more satisfaction, and a reduction in oxytocin requirements compared with adopting the supine position. For Turkish women, the squatting position is easy to adopt as it is more appropriate in terms of Turkish social habits and traditions.

Children’s mental time travel during mind wandering

PubMed Central

Ye, Qun; Song, Xiaolan; Zhang, Yi; Wang, Qinqin

2014-01-01

The prospective bias is a salient feature of mind wandering in healthy adults, yet little is known about the temporal focus of children’s mind wandering. In the present study, (I) we developed the temporal focus of mind wandering questionnaire for school-age children (TFMWQ-C), a 12-item scale with good test–retest reliability and construct validity. (II) The criterion validity was tested by thought sampling in both choice reaction time task and working memory task. A positive correlation was found between the temporal focus measured by the questionnaire and the one adopted during task-unrelated thoughts (TUTs) by thought sampling probes, especially in the trait level of future-oriented mind wandering. At the same time, children who experienced more TUTs tended to show worse behavioral performance during tasks. (III) The children in both tasks experienced more future-oriented TUTs than past-oriented ones, which was congruent with the results observed in adults; however, in contrast with previous research on adults, the prospective bias was not influenced by task demands. Together these results indicate that the prospective bias of mind wandering has emerged since the school-age (9∼13 years old), and that the relationship between mental time travel (MTT) during mind wandering and the use of cognitive resources differs between children and adults. Our study provides new insights into how this interesting feature of mind wandering may adaptively contribute to the development of children’s MTT. PMID:25191301

What will the crowd fund? Preferences of prospective donors for drug development fundraising campaigns.

PubMed

Dragojlovic, Nick; Lynd, Larry D

2016-12-01

Biomedical researchers are increasingly turning to project-based online fundraising (i.e., crowdfunding) as a complementary source of research funding. To help inform the fundraising strategies adopted by researchers who take this approach, we conducted an online survey of prospective donors in North America. Respondents indicated not only an overwhelming preference for donating to projects conducted by nonprofit research organizations, but also an openness to donating to companies that have a 'for-benefit' corporate structure. They also showed a strong preference for projects that have alternate sources of funding, that have the potential to yield a curative therapy, and that focus on common and pediatric diseases. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fluorescence detection, enumeration and characterization of single circulating cells in vivo: technology, applications and future prospects.

PubMed

Hartmann, Carolin; Patil, Roshani; Lin, Charles P; Niedre, Mark J

2017-11-08

There are many diseases and biological processes that involve circulating cells in the bloodstream, such as cancer metastasis, immune reaction/inflammation, reproductive medicine, and stem cell therapies. This has driven significant interest in new technologies for the study of circulating cells in small animal research models and clinically. Most currently used methods require drawing and enriching blood samples from the body, but these suffer from a number of limitations. In contrast, "in vivo flow cytometry" (IVFC) refers to set of technologies that allow study of cells directly in the bloodstream of the organism in vivo. In recent years the IVFC field has grown significantly and new techniques have been developed, including fluorescence microscopy, multi-photon, photo-acoustic, and diffuse fluorescence IVFC. In this paper we review recent technical advances in IVFC, with emphasis on instrumentation, contrast mechanisms, and detection sensitivity. We also describe key applications in biomedical research, including cancer research and immunology. Last, we discuss future directions for IVFC, as well as prospects for broader adoption by the biomedical research community and translation to humans clinically. © 2017 Institute of Physics and Engineering in Medicine.

Endovascular treatment of chronic cerebro spinal venous insufficiency in patients with multiple sclerosis modifies circulating markers of endothelial dysfunction and coagulation activation: a prospective study.

PubMed

Napolitano, Mariasanta; Bruno, Aldo; Mastrangelo, Diego; De Vizia, Marcella; Bernardo, Benedetto; Rosa, Buonagura; De Lucia, Domenico

2014-10-01

We performed a monocentric observational prospective study to evaluate coagulation activation and endothelial dysfunction parameters in patients with multiple sclerosis undergoing endovascular treatment for cerebro-spinal-venous insufficiency. Between February 2011 and July 2012, 144 endovascular procedures in 110 patients with multiple sclerosis and chronical cerebro-spinal venous insufficiency were performed and they were prospectively analyzed. Each patient was included in the study according to previously published criteria, assessed by the investigators before enrollment. Endothelial dysfunction and coagulation activation parameters were determined before the procedure and during follow-up at 1, 3, 6, 9, 12, 15 and 18 months after treatment, respectively. After the endovascular procedure, patients were treated with standard therapies, with the addition of mesoglycan. Fifty-five percent of patients experienced a favorable outcome of multiple sclerosis within 1 month after treatment, 25% regressed in the following 3 months, 24.9% did not experience any benefit. In only 0.1% patients, acute recurrence was observed and it was treated with high-dose immunosuppressive therapy. No major complications were observed. Coagulation activation and endothelial dysfunction parameters were shown to be reduced at 1 month and stable up to 12-month follow-up, and they were furthermore associated with a good clinical outcome. Endovascular procedures performed by a qualified staff are well tolerated; they can be associated with other currently adopted treatments. Correlations between inflammation, coagulation activation and neurodegenerative disorders are here supported by the observed variations in plasma levels of markers of coagulation activation and endothelial dysfunction.

Nutritional Counseling Promotes Changes in the Dietary Habits of Overweight and Obese Adolescents with Polycystic Ovary Syndrome.

PubMed

Carolo, Adriana Lúcia; Mendes, Maria Célia; Rosa E Silva, Ana Carolina Japur de Sá; Vieira, Carolina Sales; Silva de Sá, Marcos Felipe; Ferriani, Rui Alberto; Reis, Rosana Maria Dos

2017-12-01

Objective  To evaluate the effects of nutritional counseling on the dietary habits and anthropometric parameters of overweight and obese adolescents with polycystic ovary syndrome (PCOS). Methods  This was a prospective, longitudinal and auto-controlled study. Thirty adolescents aged 13-19 years-old, diagnosed with PCOS received nutritional counseling and were followed-up for 6 months. After the follow-up period, the results were evaluated through body weight, body mass index (BMI) and waist circumference (WC). Results  Sixty-percent of the adolescents adhered to the nutritional counseling and, of these, 50% lost weight. Adolescents who lost weight changed their dietary habits by adopting hypocaloric diets and eating more meals per day, as per nutritional counseling. The waist circumference (WC) decreased significantly, although the body weight decreased non-significantly after adoption of a hypocaloric diet. Conclusion  Although there was no significant weight loss, there was a considerable reduction in the WC associated with hypocaloric diets and with eating a greater number of meals per day. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

Gender relations, demographic change and the prospects for sustainable development in Africa.

PubMed

Ahonsi, B A

1995-01-01

The author explores the interrelationships between gender relations, demographic change, and Africa's prospects for sustainable development in the larger context of the ecological, economic, and sociopolitical forces which shape living conditions in the region. To make the analysis manageable, the author adopts the concept of sustainable development as the organizing and selecting principle in the exploration of issues central to the development of his argument. Rapid and uneven population growth is just one of many factors implicated in Africa's econo-environmental crisis. However, its strong synergism with gender relations and the limited scope for overcoming the externally derived problems suggests that a transition to lower fertility and higher women's status may be Africa's most realistic road to sustainable development. Discussion is presented under the following headings: concept of sustainable development as an analytical framework, salient aspects of Africa's demography, environmental degradation in Africa, economic stagnation and decline, gender considerations common to the key aspects of Africa's development crisis, and movement toward an enhanced prospect for sustainable development in Africa.

Prediction of Incident Hypertension Within the Next Year: Prospective Study Using Statewide Electronic Health Records and Machine Learning

PubMed Central

Zhang, Yan; Wang, Oliver; Jin, Bo; Xia, Minjie; Liu, Modi; Zhou, Xin; Wu, Qian; Guo, Yanting; Zhu, Chunqing; Li, Yu-Ming; Culver, Devore S; Alfreds, Shaun T; Stearns, Frank; Sylvester, Karl G; Widen, Eric

2018-01-01

Background As a high-prevalence health condition, hypertension is clinically costly, difficult to manage, and often leads to severe and life-threatening diseases such as cardiovascular disease (CVD) and stroke. Objective The aim of this study was to develop and validate prospectively a risk prediction model of incident essential hypertension within the following year. Methods Data from individual patient electronic health records (EHRs) were extracted from the Maine Health Information Exchange network. Retrospective (N=823,627, calendar year 2013) and prospective (N=680,810, calendar year 2014) cohorts were formed. A machine learning algorithm, XGBoost, was adopted in the process of feature selection and model building. It generated an ensemble of classification trees and assigned a final predictive risk score to each individual. Results The 1-year incident hypertension risk model attained areas under the curve (AUCs) of 0.917 and 0.870 in the retrospective and prospective cohorts, respectively. Risk scores were calculated and stratified into five risk categories, with 4526 out of 381,544 patients (1.19%) in the lowest risk category (score 0-0.05) and 21,050 out of 41,329 patients (50.93%) in the highest risk category (score 0.4-1) receiving a diagnosis of incident hypertension in the following 1 year. Type 2 diabetes, lipid disorders, CVDs, mental illness, clinical utilization indicators, and socioeconomic determinants were recognized as driving or associated features of incident essential hypertension. The very high risk population mainly comprised elderly (age>50 years) individuals with multiple chronic conditions, especially those receiving medications for mental disorders. Disparities were also found in social determinants, including some community-level factors associated with higher risk and others that were protective against hypertension. Conclusions With statewide EHR datasets, our study prospectively validated an accurate 1-year risk prediction model for incident essential hypertension. Our real-time predictive analytic model has been deployed in the state of Maine, providing implications in interventions for hypertension and related diseases and hopefully enhancing hypertension care. PMID:29382633

Safety, tolerability and effectiveness of an ergonomic intervention with chiropractic care for knowledge workers with upper-extremity musculoskeletal disorders: a prospective case series.

PubMed

Sherrod, Chuck; Johnson, Dale; Chester, Bruce

2014-01-01

One hundred and sixty million office workers (knowledge workers) in the U.S. and 2/3 of the developed countries use computers on a daily basis. Investigate the effectiveness of ergonomic and diversified chiropractic care for the reduction of pain, discomfort and impaired productivity in knowledge workers presenting with neck and upper extremity musculoskeletal complaints. A one-year prospective case series (n=5 applying ergonomic job task analyses and ongoing surveillance at baseline, 8 weeks, 16 weeks and one-year for musculoskeletal discomfort (CMDQ and VAS, quality of life (Rand SF-36, productivity and forward head posture (FHP). CMDQ and VAS scores decreased by 45% (neck) and 80% (upper extremities); productivity increased from 65% to 100%; physical functioning, role physical and role emotional improved for 4 of 5 subjects; body pain and general health improved for 3 of 5. Average FHP changed from 1-inch (baseline) to 1/4-inch (16-weeks) to 1/2-inch (one year). Effectiveness of this intervention for the reduction of risks depended upon the subject's adoption of safe workstyle behaviors and postures. A transtheoretical model (TTM) for behavior change is discussed as a possible methodology to enhance the adoption of safer work habits.

Introduction of Infant Flow nasal continuous airway pressure as the standard of practice in Poland: the initial 2-year experience.

PubMed

Swietliński, Janusz; Bober, Klaudiusz; Gajewska, Elzbieta; Helwich, Ewa; Lauterbach, Ryszard; Manowska, Małgorzata; Maruszewski, Bohdan; Szczapa, Jerzy; Hubicki, Lech

2007-03-01

The aim of this prospective study was to evaluate whether a change in the standard of newborn care for respiratory insufficiency by widely introducing more aggressive use of nasal continuous airway pressure (nCPAP) and including Infant Flow technology would result in satisfactory outcomes. Prospectively defined analysis. Fifty-seven secondary and tertiary care neonatal centers in Poland. Patients were 1,299 newborns. None. We carried out a prospectively defined analysis of 1,299 newborns included in the program between August 1, 2003, and April 30, 2005. The inclusion criterion was the occurrence of symptoms of respiratory failure irrespective of its etiology. Respiratory support was provided with the use of the Infant Flow Advance Driver. The analysis was made on data from prospectively designed questionnaires completed following each infant's treatment. Infants were placed into categories based on clinical indication for use. The primary end point was avoiding tracheal intubation. A high rate of acceptance of the new practice was observed across the substantial demographic and clinical diversity of newborns. Tracheal intubation was avoided in 78% of infants treated electively with nCPAP. Of those being weaned from mechanical ventilation, 61.2% were successfully weaned. Related complications were low (1.4% pneumothorax, 12% nasal injuries). The new method of nCPAP with Infant Flow was adopted as standard practice in Poland. We monitored its safety and effectiveness over a 2-yr period and found it to be safe and effective as implemented. Additional research is still needed to determine the optimum patient population, strategy for use, and devices.

An office or a bedroom? Challenges for family-centered care in the pediatric intensive care unit.

PubMed

Macdonald, Mary Ellen; Liben, Stephen; Carnevale, Franco A; Cohen, S Robin

2012-09-01

Although the modern pediatric intensive care unit (PICU) has followed general pediatrics and adopted the family-centered care model, little is known about how families prospectively experience PICU care. The authors' goal was to better understand the experiences of families whose child was hospitalized in a PICU. They conducted a 12-month prospective ethnographic study in a PICU in a tertiary care hospital in a large North American urban center. Data were obtained via participant-observation and formal and informal interviews with 18 families and staff key informants. Findings revealed a disconnect between the espoused model of family-centered care and quotidian professional practices. This divergence emerged in the authors' analysis as a heuristic that contrasts a professional "office" to a sick child's "bedroom." PICU practices and protocols transformed the child into a patient and parents into visitors; issues such as noise, visitation, turf, and privacy could favor staff comfort and convenience over that of the child and family. The authors' discussion highlights suggestions to overcome this divergence in order to truly make the PICU family centered.

Alcohol consumption and risk of type 2 diabetes mellitus in Japanese: a systematic review.

PubMed

Seike, Nobuko; Noda, Mitsuhiko; Kadowaki, Takashi

2008-01-01

To evaluate the association between alcohol consumption and the risk for type 2 diabetes (DM) in Japanese. We searched the MEDLINE data base with the key words 'alcohol intake' (or 'alcohol consumption') and 'Japanese' cross-linked with 'diabetes mellitus' (or 'impaired glucose tolerance'). The reports we sought were restricted to prospective cohort studies, randomized controlled trials, meta-analyses and systematic reviews. Computerized and hand searches were conducted in June 2007. Seven prospective cohort studies were adopted. We previously reported that in lean Japanese men (BMI < or =22.0 kg/m2), moderate to heavy alcohol intake is a risk factor for diabetes. One study found heavy alcohol intake to be associated with an increased risk in low-BMI men while moderate alcohol intake was associated with a reduced risk in higher-BMI men. Another study suggested daily alcohol consumption to be a risk factor in low-BMI participants, while being protective in middle-BMI participants. Yet another study demonstrated a U-shaped association between alcohol consumption and the risk of diabetes in men. Three other studies, which did not divide the subjects in terms of BMI values, indicated alcohol intake to be an increased risk for diabetes, two being in men and one being in women, respectively. For a large number of Japanese men who have relatively low BMI, alcohol intake is an established risk factor for diabetes.

Motivation, study habits, and expectations of medical students in Singapore.

PubMed

Amin, Zubair; Tani, Massimiliano; Eng, Khoo Hoon; Samarasekara, Dujeepa D; Huak, Chan Yiong

2009-12-01

To determine the motivation and incentives in education, learning experience and teaching techniques, and expectations about future careers among medical students from a multi-ethnic Asian country. Pre-validated questionnaire-based survey with stratified random sampling among medical students. The questionnaire combined qualitative responses with semi-quantitative measures of available alternatives. The response rate was 83.1%. The most important factor for pursuing university study was 'prospect of finding an interesting challenging job' (rank 1-75%). Family made a significant contribution in decision making. Given the chance, a majority (67.2%) of respondents would prefer to study overseas. The main deterring factors were cost (67.7%), distance from home (28%), and local opportunity for post-graduation (23.4%). Despite their inclination of study overseas, the majority (73.9%) of the respondents indicated they were either very satisfied or satisfied with their current choice of university study. Only 20% of students were comfortable in asking questions in classroom as asking questions was deemed 'too risky' and 'unnecessary to get better grades'. Students adopted strategies related to assessment and competition to monitor their study. Senior students reported university education as less relevant to their future careers as compared to junior students (p = 0.002). Students' learning behaviour is determined by complex factors such as educational incentives, learning support, assessment and competition. Among several external factors, family, job prospects and expectations about the future play a critical role in education.

Can mobile technology improve response times of junior doctors to urgent out-of-hours calls? A prospective observational study.

PubMed

Herrod, P J J; Barclay, C; Blakey, J D

2014-04-01

The Hospital at Night system has been widely adopted to manage Out-of-Hours workload. However, it has the potential to introduce delays and corruption of information. The introduction of newer technologies to replace landlines, pagers and paper may ameliorate these issues. To establish if the introduction of a Hospital at Night system supported by a wireless taskflow system affected the escalation of high Early Warning Scores (EWSs) to medical attention, and the time taken to medical review. Prospective 'pre and post' observational study in a teaching hospital in the UK. Review of observation charts and medical records, and data extraction from the electronic taskflow system. The implementation of a technology-supported Hospital at Night system was associated with a significant decrease in time to documentation of initial review in those who were reviewed. However, there was no change in the proportion of those with a high EWS that were reviewed, and throughout the study a majority of patients with high EWSs were not reviewed in accordance with guidelines. Introduction of a Hospital at Night system supported by mobile technology appeared to improve the transfer of information, but did not affect the nursing decision whether to escalate abnormal findings.

Coping with Racial Discrimination: The Role of Substance Use

PubMed Central

Gerrard, Meg; Stock, Michelle L.; Roberts, Megan E.; Gibbons, Frederick X.; O’Hara, Ross E.; Weng, Chih-Yuan; Wills, Thomas A.

2014-01-01

Three studies tested the hypothesis that the relation between perceived racial discrimination and substance use reported in previous research is moderated by use of substances as a coping mechanism. Studies 1 and 2 were experimental studies of African American adolescents’ and young adults’ reactions to a discrimination experience. Results revealed that those who endorsed substance use-as-coping reported more willingness to use substances after experiencing discrimination. Study 3 was a prospective study of the relation between perceived discrimination and substance use over an 8-year period in African American adolescents. Results demonstrated that discrimination is associated with increases in substance use, but only among adolescents who endorse substance use-as-coping. Together, these three studies provide evidence that experiencing discrimination has both short- and long-term detrimental effects on African Americans’ substance use, but significantly more so for those who adopt a pattern of using substances as a coping mechanism. PMID:22545585

Prospects for the use of animal cell cultures in screening of pharmaceutical substances

NASA Astrophysics Data System (ADS)

Kolesnikova, S. G.; Moiseeva, I. Y.

2017-01-01

Currently, there is a tendency to reduce the use of animals in conducting safety tests of chemical substances. Therefore, in vitro methods are a good alternative or adjunct to in vivo safety tests. This is especially important at the stage of pre-clinical drug trial. In 2004, the international standard for the principles of good laboratory practice (GLP) [1] was adopted which regulates chemicals trials in cell cultures. However, in Russia, until recently, this issue has been neglected. Research works have been scarce. In 2013, the standard for GLP principles and compliance monitoring was adopted in Russia [2]. The feasibility of using animal cell cultures as drug testing system has been proved by the experimental base and is now being introduced into practice [3].

Electroencephalography for children with autistic spectrum disorder: a sedation protocol.

PubMed

Keidan, Ilan; Ben-Menachem, Erez; Tzadok, Michal; Ben-Zeev, Bruria; Berkenstadt, Haim

2015-02-01

To report the effectiveness and efficiency of a predetermined sedation protocol for providing sedation for electroencephalograph (EEG) studies in children with autism. Sleep EEG has been advocated for the majority of children with autism spectrum disorder. In most cases, sedation is required to allow adequate studies. Most sedation drugs have negative effects on the EEG pattern. The sedation protocol we adopted included chloral hydrate, dexmedetomidine, and ketamine and was evaluated prospectively for 2 years. One hundred and eighty-three children with autistic spectrum disorder were sedated with the described drug protocol that was efficient, provided adequate EEG readings, and was not associated with serious adverse events. Our protocol kept costs to a minimum but provided appropriate escalation in care when required. © 2014 John Wiley & Sons Ltd.

Impacts of Model Building Energy Codes

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

Athalye, Rahul A.; Sivaraman, Deepak; Elliott, Douglas B.

The U.S. Department of Energy (DOE) Building Energy Codes Program (BECP) periodically evaluates national and state-level impacts associated with energy codes in residential and commercial buildings. Pacific Northwest National Laboratory (PNNL), funded by DOE, conducted an assessment of the prospective impacts of national model building energy codes from 2010 through 2040. A previous PNNL study evaluated the impact of the Building Energy Codes Program; this study looked more broadly at overall code impacts. This report describes the methodology used for the assessment and presents the impacts in terms of energy savings, consumer cost savings, and reduced CO 2 emissions atmore » the state level and at aggregated levels. This analysis does not represent all potential savings from energy codes in the U.S. because it excludes several states which have codes which are fundamentally different from the national model energy codes or which do not have state-wide codes. Energy codes follow a three-phase cycle that starts with the development of a new model code, proceeds with the adoption of the new code by states and local jurisdictions, and finishes when buildings comply with the code. The development of new model code editions creates the potential for increased energy savings. After a new model code is adopted, potential savings are realized in the field when new buildings (or additions and alterations) are constructed to comply with the new code. Delayed adoption of a model code and incomplete compliance with the code’s requirements erode potential savings. The contributions of all three phases are crucial to the overall impact of codes, and are considered in this assessment.« less

Clinical impact of negative-pressure wound therapy: a 1,126-patient observational prospective study.

PubMed

Téot, Luc; Guillot-Masanovic, Margot; Miquel, Pierre; Truchetet, François; Meaume, Sylvie; Dompmartin, Anne; Charles Kerihuel, Jean; Trial, Chloé; Faure, Christine

2014-01-01

Negative-pressure wound therapy (NPWT) was developed in the early 1990s and reported in 1997 by Argenta and Morykwas. Ignored at first, this technique progressively came to be considered as an outstanding advancement in reconstructive surgery. Several randomized controlled studies produced evidence for the effect of NPWT on promotion of granulation tissue formation and prevention of tissue damage and amputation. However, no important longitudinal study has yet produced clinical and economic data on the consequences of integrating NPWT into practice in multiple institutions. This prospective, comparative longitudinal study of NPWT as a clinical-practice innovation was conducted in 1,126 patients between March 2006 and June 2009 in 30 university and nonuniversity public and private hospitals in France. NPWT was proposed in a nonrandomized fashion for various clinical indications, and the patients were divided into two groups, one using NPWT, the second using standard care. Efficacy criteria were spontaneous closure, closure after surgical coverage using skin grafts or flaps, or achievement of 40% wound area regression. The results, observed in a pragmatic but not randomized study, are suggestive of a favorable impact of NPWT in multiple clinical situations. The significance of differences between surgical patients who underwent NPWT and those who did not was unclear, as NPWT had already been adopted by most of the surgical wards. © 2014 by the Wound Healing Society.

Augmenting the impact of technology adoption with financial incentive to improve radiology report signature times.

PubMed

Andriole, Katherine P; Prevedello, Luciano M; Dufault, Allen; Pezeshk, Parham; Bransfield, Robert; Hanson, Richard; Doubilet, Peter M; Seltzer, Steven E; Khorasani, Ramin

2010-03-01

Radiology report signature time (ST) can be a substantial component of total report turnaround time. Poor turnaround time resulting from lengthy ST can adversely affect patient care. The combination of technology adoption with financial incentive was evaluated to determine if ST improvement can be augmented and sustained. This prospective study was performed at a 751-bed, urban, tertiary care adult teaching hospital. Test-site imaging volume approximated 48,000 examinations per month. The radiology department has 100 trainees and 124 attending radiologists serving multiple institutions. Over a study period of 4 years and 4 months, three interventions focused on radiologist signature performance were implemented: 1) a notification paging application that alerted radiologists when reports were ready for signature, 2) a picture archiving and communications systems (PACS)-integrated speech recognition report generation system, and 3) a departmental financial incentive to reward radiologists semiannually for ST performance. Signature time was compared before and after the interventions. Wilcoxon and linear regression statistical analyses were used to assess the significance of trends. Technology adoption (paging plus speech recognition) reduced median ST from >5 to <1 hour (P < .001) and 80th-percentile ST from >24 to 15 to 18 hours (P < .001). Subsequent addition of a financial incentive further improved 80th-percentile ST to 4 to 8 hours (P < .001). The gains in median and 80th-percentile ST were sustained over the final 31 months of the study period. Technology interventions coupled with financial incentive can result in synergistic and sustainable improvement in radiologist report-signing behavior. The addition of a financial incentive leads to better performance than that achievable through technology alone.

Lower limb dynamics vary in shod runners who acutely transition to barefoot running.

PubMed

Hashish, Rami; Samarawickrame, Sachithra D; Powers, Christopher M; Salem, George J

2016-01-25

Relative to traditional shod rear-foot strike (RFS) running, habituated barefoot running is associated with a forefoot-strike (FFS) and lower loading rates. Accordingly, barefoot running has been purported to reduce lower-extremity injury risk. Investigations, however, indicate that novice barefoot runners may not innately adopt a FFS. Therefore, the purpose of this study was to examine lower-extremity dynamics of habitually shod runners who acutely transition to barefoot running. 22 recreational RFS runners were included in this investigation. This laboratory controlled study consisted of two visits one-week apart, examining habitually shod, then novice barefoot running. Foot-strike patterns and loading rates were determined using motion analysis and force plates, and joint energy absorption was calculated using inverse dynamics. Of the 22 runners, 8 maintained a RFS, 9 adopted a MFS, and 5 adopted a FFS during novice barefoot running. All runners demonstrated a reduction in knee energy absorption when running barefoot; MFS and FFS runners also demonstrated a significant increase in ankle energy absorption. Runners who maintained a RFS presented with loading rates significantly higher than traditional shoe running, whereas FFS runners demonstrated a significant reduction in loading rate. Mid-foot strikers did not demonstrate a significant change in loading rate. These results indicate that habitually shod RFS runners demonstrate a variety of foot-strike and lower-extremity dynamic responses during the acute transition to barefoot running. Accordingly, explicit instruction regarding foot-strike patterns may be necessary if transitioning to barefoot. Long-term prospective studies are required in order to determine the influence of FFS barefoot running on injury rates. Copyright © 2015 Elsevier Ltd. All rights reserved.

Etiology of child mortality in Goroka, Papua New Guinea: a prospective two-year study.

PubMed Central

Duke, Trevor; Michael, Audrey; Mgone, Joyce; Frank, Dale; Wal, Tilda; Sehuko, Rebecca

2002-01-01

OBJECTIVE: To collect accurate data on disease- and microbial-specific causes and avoidable factors in child deaths in a developing country. METHODS: A systematic prospective audit of deaths of children seen at Goroka Hospital in the highlands of Papua New Guinea was carried out. Over a 24-month period, we studied 353 consecutive deaths of children: 126 neonates, 186 children aged 1-59 months, and 41 children aged 5-12 years. FINDINGS: The most frequent age-specific clinical diagnoses were as follows: for neonates--very low birth weight, septicaemia, birth asphyxia and congenital syphilis; for children aged 1-59 months--pneumonia, septicaemia, marasmus and meningitis; and for children aged 5-12 years--malignancies and septicaemia. At least one microbial cause of death was identified for 179 (50.7%) children and two or more were identified for 37 (10.5%). Nine microbial pathogens accounted for 41% of all childhood deaths and 76% of all deaths that had any infective component. Potentially avoidable factors were identified for 177 (50%) of deaths. The most frequently occurring factors were as follows: no antenatal care in high-risk pregnancies (8.8% of all deaths), very delayed presentation (7.9%), vaccine-preventable diseases (7.9%), informal adoption or child abandonment leading to severe malnutrition (5.7%), and lack of screening for maternal syphilis (5.4%). Sepsis due to enteric Gram-negative bacilli occurred in 87 (24.6%). The strongest associations with death from Gram- negative sepsis were adoption/abandonment leading to severe malnutrition, village births, and prolonged hospital stay. CONCLUSIONS: Reductions in child mortality will depend on addressing the commonest causes of death, which include disease states, microbial pathogens, adverse social circumstances and health service failures. Systematic mortality audits in selected regions where child mortality is high may be useful for setting priorities, estimating the potential benefit of specific and non-specific interventions, and providing continuous feedback on the quality of care provided and the outcome of health reforms. PMID:11884969

Structured parenting of toddlers at high versus low genetic risk: two pathways to child problems.

PubMed

Leve, Leslie D; Harold, Gordon T; Ge, Xiaojia; Neiderhiser, Jenae M; Shaw, Daniel; Scaramella, Laura V; Reiss, David

2009-11-01

Little is known about how parenting might offset genetic risk to prevent the onset of child problems during toddlerhood. We used a prospective adoption design to separate genetic and environmental influences and test whether associations between structured parenting and toddler behavior problems were conditioned by genetic risk for psychopathology. The sample included 290 linked sets of adoptive families and birth mothers and 95 linked birth fathers. Genetic risk was assessed via birth mother and birth father psychopathology (anxiety, depression, antisociality, and drug use). Structured parenting was assessed via microsocial coding of adoptive mothers' behavior during a cleanup task. Toddler behavior problems were assessed with the Child Behavior Checklist. Controlling for temperamental risk at 9 months, there was an interaction between birth mother psychopathology and adoptive mothers' parenting on toddler behavior problems at 18 months. The interaction indicated two pathways to child problems: structured parenting was beneficial for toddlers at high genetic risk but was related to behavior problems for toddlers at low genetic risk. This crossover interaction pattern was replicated with birth father psychopathology as the index of genetic risk. The effects of structured parenting on toddler behavior problems varied as a function of genetic risk. Children at genetic risk might benefit from parenting interventions during toddlerhood that enhance structured parenting.

Early pushing urge in labour and midwifery practice: a prospective observational study at an Italian maternity hospital.

PubMed

Borrelli, Sara E; Locatelli, Anna; Nespoli, Antonella

2013-08-01

to investigate the early pushing urge (EPU) incidence in one maternity unit and explore how it is managed by midwives. The relation to some obstetric outcomes was also observed but not analysed in depth. prospective observational study. Italian maternity hospital. 60 women (44 nullips and 16 multips) experiencing EPU during labour. the total EPU incidence percentage was 7.6%. The single midwives' incidences range had a very wide margin, noting an inverse proportion between the number of diagnoses of EPU and midwife's waiting time between urge to push and vaginal examination. Two care policies were adopted in relation to the phenomenon: the stop pushing technique (n=52/60) and the 'let the woman do what she feels' technique (n=8/60). In case of stop pushing techniques, midwives proposed several combined techniques (change of maternal position, blowing breath, vocalisation, use of the bath). The EPU diagnosis at less than 8cm of cervical dilatation was associated with more medical interventions. Maternal and neonatal outcomes were within the range of normal physiology. An association between the dilatation at EPU diagnosis and obstetric outcomes was observed, in particular the modality of childbirth and perineal outcomes. this paper contributes new knowledge to the body of literature around the EPU phenomenon during labour and midwifery practices adopted in response to it. Overall, it could be argued that EPU is a physiologic variation in labour if maternal and fetal conditions are good. Midwives might suggest techniques to woman to help her to stay with the pain, such as change of position, blowing breath, vocalisation and use of the bath. However, the impact of policies, guidelines and culture on midwifery practices of the specific setting are a limitation of the study because it is not representative of other similar maternity units. Thus, a larger scale work should be considered, including different units and settings. The optimal response to the phenomenon should be studied, considering EPU at different dilatation ranges. Future investigations could also focus on qualitative analysis of women and midwives' personal experience in relation to the phenomenon. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Effects of Bar-coding Technology on Medication Errors: A Systematic Literature Review.

PubMed

Hutton, Kevin; Ding, Qian; Wellman, Gregory

2017-02-24

The bar-coding technology adoptions have risen drastically in U.S. health systems in the past decade. However, few studies have addressed the impact of bar-coding technology with strong prospective methodologies and the research, which has been conducted from both in-pharmacy and bedside implementations. This systematic literature review is to examine the effectiveness of bar-coding technology on preventing medication errors and what types of medication errors may be prevented in the hospital setting. A systematic search of databases was performed from 1998 to December 2016. Studies measuring the effect of bar-coding technology on medication errors were included in a full-text review. Studies with the outcomes other than medication errors such as efficiency or workarounds were excluded. The outcomes were measured and findings were summarized for each retained study. A total of 2603 articles were initially identified and 10 studies, which used prospective before-and-after study design, were fully reviewed in this article. Of the 10 included studies, 9 took place in the United States, whereas the remaining was conducted in the United Kingdom. One research article focused on bar-coding implementation in a pharmacy setting, whereas the other 9 focused on bar coding within patient care areas. All 10 studies showed overall positive effects associated with bar-coding implementation. The results of this review show that bar-coding technology may reduce medication errors in hospital settings, particularly on preventing targeted wrong dose, wrong drug, wrong patient, unauthorized drug, and wrong route errors.

Pelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review.

PubMed

Murray, Louise Janet; Lilley, John; Hawkins, Maria A; Henry, Ann M; Dickinson, Peter; Sebag-Montefiore, David

2017-11-01

To perform a systematic review regarding the use of stereotactic ablative radiotherapy (SABR) for the re-irradiation of recurrent malignant disease within the pelvis, to guide the clinical implementation of this technique. A systematic search strategy was adopted using the MEDLINE, EMBASE and Cochrane Library databases. 195 articles were identified, of which 17 were appropriate for inclusion. Studies were small and data largely retrospective. In total, 205 patients are reported to have received pelvic SABR re-irradiation. Dose and fractionation schedules and re-irradiated volumes are highly variable. Little information is provided regarding organ at risk constraints adopted in the re-irradiation setting. Treatment appears well-tolerated overall, with nine grade 3 and six grade 4 toxicities amongst thirteen re-irradiated patients. Local control at one year ranged from 51% to 100%. Symptomatic improvements were also noted. For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

US hospital payment adjustments for innovative technology lag behind those in Germany, France, and Japan.

PubMed

Hernandez, John; Machacz, Susanne F; Robinson, James C

2015-02-01

Medicare pioneered add-on payments to facilitate the adoption of innovative technologies under its hospital prospective payment system. US policy makers are now experimenting with broader value-based payment initiatives, but these have not been adjusted for innovation. This article examines the structure, processes, and experience with Medicare's hospital new technology add-on payment program since its inception in 2001 and compares it with analogous payment systems in Germany, France, and Japan. Between 2001 and 2015 CMS approved nineteen of fifty-three applications for the new technology add-on payment program. We found that the program resulted in $201.7 million in Medicare payments in fiscal years 2002-13-less than half the level anticipated by Congress and only 34 percent of the amount projected by CMS. The US program approved considerably fewer innovative technologies, compared to analogous technology payment mechanisms in Germany, France and Japan. We conclude that it is important to adjust payments for new medical innovations within prospective and value-based payment systems explicitly as well as implicitly. The most straightforward method to use in adjusting value-based payments is for the insurer to retrospectively adjust spending targets to account for the cost of new technologies. If CMS made such retrospective adjustments, it would not financially penalize hospitals for adopting beneficial innovations. Project HOPE—The People-to-People Health Foundation, Inc.

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.

PubMed

2017-08-03

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

In Search of a Pony: Sources, Methods, Outcomes, and Motivated Reasoning.

PubMed

Stone, Marc B

2018-05-01

It is highly desirable to be able to evaluate the effect of policy interventions. Such evaluations should have expected outcomes based upon sound theory and be carefully planned, objectively evaluated and prospectively executed. In many cases, however, assessments originate with investigators' poorly substantiated beliefs about the effects of a policy. Instead of designing studies that test falsifiable hypotheses, these investigators adopt methods and data sources that serve as little more than descriptions of these beliefs in the guise of analysis. Interrupted time series analysis is one of the most popular forms of analysis used to present these beliefs. It is intuitively appealing but, in most cases, it is based upon false analogies, fallacious assumptions and analytical errors.

[Prospective economic evaluation of image-guided radiation therapy for prostate cancer in the framework of the national programme for innovative and costly therapies assessment].

PubMed

Pommier, P; Morelle, M; Perrier, L; de Crevoisier, R; Laplanche, A; Dudouet, P; Mahé, M-A; Chauvet, B; Nguyen, T-D; Créhange, G; Zawadi, A; Chapet, O; Latorzeff, I; Bossi, A; Beckendorf, V; Touboul, E; Muracciole, X; Bachaud, J-M; Supiot, S; Lagrange, J-L

2012-09-01

The main objective of the economical study was to prospectively and randomly assess the additional costs of daily versus weekly patient positioning quality control in image-guided radiotherapy (IGRT), taking into account the modalities of the 3D-imaging: tomography (CBCT) or gold seeds implants. A secondary objective was to prospectively assess the additional costs of 3D versus 2D imaging with portal imaging for patient positioning controls. Economics data are issued from a multicenter randomized medico-economics trial comparing the two frequencies of patient positioning control during prostate IGRT. A prospective cohort with patient positioning control with PI (control group) was constituted for the cost comparison between 3D (IGRT) versus 2D imaging. The economical evaluation was focused to the radiotherapy direct costs, adopting the hospital's point of view and using a microcosting method applied to the parameters that may lead to cost differences between evaluated strategies. The economical analysis included a total of 241 patients enrolled between 2007 and 2011 in seven centres, 183 in the randomized study (128 with CBCT and 55 with fiducial markers) and 58 in the control group. Compared to weekly controls, the average additional cost per patient of daily controls was €847 (CBCT) and €179 (markers). Compared to PI, the average additional cost per patient was €1392 (CBCT) and €997 (fiducial markers) for daily controls; €545 (CBCT) and €818 (markers) in case of weekly controls. A daily frequency for image control in IGRT and 3D images patient positioning control (IGRT) for prostate cancer lead to significant additional cost compared to weekly control and 2D imaging (PI). Long-term clinical assessment will permit to assess the medico-economical ratio of these innovative radiotherapy modalities. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004

PubMed Central

Dermout, Sylvia; van de Wiel, Harry; Heintz, Peter; Jansen, Kees; Ankum, Willem

2010-01-01

BACKGROUND Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997 and 2004. METHODS A prospective study was conducted of all intended parents, and surrogate mothers and their partners (if present), in which medical, psychological and legal aspects of patient selection were assessed by questionnaires and interviews developed for this study. RESULTS More than 500 couples enquired about surrogacy by telephone or e-mail. More than 200 couples applied for surrogacy in the Centre, of which, after extensive screening, 35 couples actually entered the IVF programme and 24 completed the treatment, resulting in 16 children being born to 13 women. Recommendations for non-commercial surrogacy are given, including abandoning the 1-year waiting period before adoption, currently dictated by law, avoiding a period of unnecessary psychological distress. CONCLUSIONS Our study has shown that non-commercial IVF surrogacy is feasible, with good results in terms of pregnancy outcome and psychological outcome for all parents, and with no legal problems relating to the adoption procedures arising. The extensive screening of medical, psychological and legal aspects was a key element in helping to ensure the safety and success of the procedure. PMID:19945960

The IGNITE (investigation to guide new insight into translational effectiveness) trial: Protocol for a translational study of an evidenced-based wellness program in fire departments

PubMed Central

2010-01-01

Background Worksites are important locations for interventions to promote health. However, occupational programs with documented efficacy often are not used, and those being implemented have not been studied. The research in this report was funded through the American Reinvestment and Recovery Act Challenge Topic 'Pathways for Translational Research,' to define and prioritize determinants that enable and hinder translation of evidenced-based health interventions in well-defined settings. Methods The IGNITE (investigation to guide new insights for translational effectiveness) trial is a prospective cohort study of a worksite wellness and injury reduction program from adoption to final outcomes among 12 fire departments. It will employ a mixed methods strategy to define a translational model. We will assess decision to adopt, installation, use, and outcomes (reach, individual outcomes, and economic effects) using onsite measurements, surveys, focus groups, and key informant interviews. Quantitative data will be used to define the model and conduct mediation analysis of each translational phase. Qualitative data will expand on, challenge, and confirm survey findings and allow a more thorough understanding and convergent validity by overcoming biases in qualitative and quantitative methods used alone. Discussion Findings will inform worksite wellness in fire departments. The resultant prioritized influences and model of effective translation can be validated and manipulated in these and other settings to more efficiently move science to service. PMID:20932290

Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004.

PubMed

Dermout, Sylvia; van de Wiel, Harry; Heintz, Peter; Jansen, Kees; Ankum, Willem

2010-02-01

Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997 and 2004. A prospective study was conducted of all intended parents, and surrogate mothers and their partners (if present), in which medical, psychological and legal aspects of patient selection were assessed by questionnaires and interviews developed for this study. More than 500 couples enquired about surrogacy by telephone or e-mail. More than 200 couples applied for surrogacy in the Centre, of which, after extensive screening, 35 couples actually entered the IVF programme and 24 completed the treatment, resulting in 16 children being born to 13 women. Recommendations for non-commercial surrogacy are given, including abandoning the 1-year waiting period before adoption, currently dictated by law, avoiding a period of unnecessary psychological distress. Our study has shown that non-commercial IVF surrogacy is feasible, with good results in terms of pregnancy outcome and psychological outcome for all parents, and with no legal problems relating to the adoption procedures arising. The extensive screening of medical, psychological and legal aspects was a key element in helping to ensure the safety and success of the procedure.

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2014. Final rule.

PubMed

2013-08-06

This final rule updates the payment rates used under the prospective payment system for skilled nursing facilities (SNFs) for fiscal year (FY) 2014. In addition, it revises and rebases the SNF market basket, revises and updates the labor related share, and makes certain technical and conforming revisions in the regulations text. This final rule also includes a policy for reporting the SNF market basket forecast error in certain limited circumstances and adds a new item to the Minimum Data Set (MDS), Version 3.0 for reporting the number of distinct therapy days. Finally, this final rule adopts a change to the diagnosis code used to determine which residents will receive the AIDS add-on payment, effective for services provided on or after the October 1, 2014 implementation date for conversion to ICD-10-CM.

Implications of global budget payment system on nursing home costs.

PubMed

Di Giorgio, Laura; Filippini, Massimo; Masiero, Giuliano

2014-04-01

Pressure on health care systems due to the increasing expenditures of the elderly population is pushing policy makers to adopt new regulation and payment schemes for nursing home services. We consider the behavior of nonprofit nursing homes under different payment schemes and empirically investigate the implications of prospective payments on nursing home costs under tightly regulated quality aspects. To evaluate the impact of the policy change introduced in 2006 in Southern Switzerland - from retrospective to prospective payment - we use a panel of 41 homes observed over a 10-years period (2001-2010). We employ a fixed effects model with a time trend that is allowed to change after the policy reform. There is evidence that the new payment system slightly reduces costs without impacting quality. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PANDAS: A systematic review of treatment options.

PubMed

Farhood, Zachary; Ong, Adrian A; Discolo, Christopher M

2016-10-01

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is a rare but important condition for pediatric otolaryngologists to recognize. Several treatment options exist including tonsillectomy, antibiotic treatment/prophylaxis, intravenous immunoglobulin (IVIG), and psychiatric medications/therapy. A systematic review of the PubMed, EMBASE, and Scopus databases was performed searching for articles that focused exclusively on the aforementioned treatment modalities in the PANDAS population. Review articles, single patient case reports, and studies examining the natural history or diagnostic strategies were excluded. Five articles regarding tonsillectomy treatments with level of evidence (LOE) 4 were found but no clear benefit could be determined. Three articles were selected involving the use of antibiotic therapy. One prospective study and one double-blind randomized control trial (DB RCT) supported the use of antibiotics but a separate DB RCT showed no benefit. Two selected articles described the use of IVIG: one unblinded RCT and one retrospective study. One prospective study on cognitive-behavioral therapy (CBT) showed benefit in PANDAS. There is a paucity of high-level studies regarding this rare disorder and no hard treatment recommendations can be made. Tonsillectomy should only be performed in those who are surgical candidates based on current published guidelines. Antibiotics are an option but provide uncertain benefit. CBT remains a low-risk option. Studies support the use of IVIG, however more investigation is needed prior to widespread adoption of this treatment given its potential risks. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

High Impact = High Statistical Standards? Not Necessarily So

PubMed Central

Tressoldi, Patrizio E.; Giofré, David; Sella, Francesco; Cumming, Geoff

2013-01-01

What are the statistical practices of articles published in journals with a high impact factor? Are there differences compared with articles published in journals with a somewhat lower impact factor that have adopted editorial policies to reduce the impact of limitations of Null Hypothesis Significance Testing? To investigate these questions, the current study analyzed all articles related to psychological, neuropsychological and medical issues, published in 2011 in four journals with high impact factors: Science, Nature, The New England Journal of Medicine and The Lancet, and three journals with relatively lower impact factors: Neuropsychology, Journal of Experimental Psychology-Applied and the American Journal of Public Health. Results show that Null Hypothesis Significance Testing without any use of confidence intervals, effect size, prospective power and model estimation, is the prevalent statistical practice used in articles published in Nature, 89%, followed by articles published in Science, 42%. By contrast, in all other journals, both with high and lower impact factors, most articles report confidence intervals and/or effect size measures. We interpreted these differences as consequences of the editorial policies adopted by the journal editors, which are probably the most effective means to improve the statistical practices in journals with high or low impact factors. PMID:23418533

High impact  =  high statistical standards? Not necessarily so.

PubMed

Tressoldi, Patrizio E; Giofré, David; Sella, Francesco; Cumming, Geoff

2013-01-01

What are the statistical practices of articles published in journals with a high impact factor? Are there differences compared with articles published in journals with a somewhat lower impact factor that have adopted editorial policies to reduce the impact of limitations of Null Hypothesis Significance Testing? To investigate these questions, the current study analyzed all articles related to psychological, neuropsychological and medical issues, published in 2011 in four journals with high impact factors: Science, Nature, The New England Journal of Medicine and The Lancet, and three journals with relatively lower impact factors: Neuropsychology, Journal of Experimental Psychology-Applied and the American Journal of Public Health. Results show that Null Hypothesis Significance Testing without any use of confidence intervals, effect size, prospective power and model estimation, is the prevalent statistical practice used in articles published in Nature, 89%, followed by articles published in Science, 42%. By contrast, in all other journals, both with high and lower impact factors, most articles report confidence intervals and/or effect size measures. We interpreted these differences as consequences of the editorial policies adopted by the journal editors, which are probably the most effective means to improve the statistical practices in journals with high or low impact factors.

Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association.

PubMed

Insel, Richard A; Dunne, Jessica L; Atkinson, Mark A; Chiang, Jane L; Dabelea, Dana; Gottlieb, Peter A; Greenbaum, Carla J; Herold, Kevan C; Krischer, Jeffrey P; Lernmark, Åke; Ratner, Robert E; Rewers, Marian J; Schatz, Desmond A; Skyler, Jay S; Sosenko, Jay M; Ziegler, Anette-G

2015-10-01

Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of β-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of β-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classification provides a standardized taxonomy for type 1 diabetes and will aid the development of therapies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benefit/risk ratio that will impact regulatory approval, reimbursement, and adoption of interventions in the early stages of type 1 diabetes to prevent symptomatic disease. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Wave equation datuming applied to marine OBS data and to land high resolution seismic profiling

NASA Astrophysics Data System (ADS)

Barison, Erika; Brancatelli, Giuseppe; Nicolich, Rinaldo; Accaino, Flavio; Giustiniani, Michela; Tinivella, Umberta

2011-03-01

One key step in seismic data processing flows is the computation of static corrections, which relocate shots and receivers at the same datum plane and remove near surface weathering effects. We applied a standard static correction and a wave equation datuming and compared the obtained results in two case studies: 1) a sparse ocean bottom seismometers dataset for deep crustal prospecting; 2) a high resolution land reflection dataset for hydrogeological investigation. In both cases, a detailed velocity field, obtained by tomographic inversion of the first breaks, was adopted to relocate shots and receivers to the datum plane. The results emphasize the importance of wave equation datuming to properly handle complex near surface conditions. In the first dataset, the deployed ocean bottom seismometers were relocated to the sea level (shot positions) and a standard processing sequence was subsequently applied to the output. In the second dataset, the application of wave equation datuming allowed us to remove the coherent noise, such as ground roll, and to improve the image quality with respect to the application of static correction. The comparison of the two approaches evidences that the main reflecting markers are better resolved when the wave equation datuming procedure is adopted.

Cerium Binding Activity of Pectins Isolated from the Seagrasses Zostera marina and Phyllospadix iwatensis

PubMed Central

Khotimchenko, Yuri; Khozhaenko, Elena; Kovalev, Valeri; Khotimchenko, Maxim

2012-01-01

Cerium binding activity of three different water soluble pectin compounds of different origin was studied in a batch sorption system. The Langmuir, Freundlich and BET sorption models were adopted to describe the binding reactions between metal ions and pectin molecules. The Langmuir model provided the best fit. Within the pH range from 4.0 to 6.0, the largest amount of the cerium ions was bound by pectin isolated from the seagrass Phylospadix iwatensis in comparison to pectin extracted from the seagrass Zostera marina and pectin obtained from citrus peel (commercial grade). The Langmuir constants were also highest for the pectin samples isolated from the seagrass P. iwatensis. The results obtained from this study suggest that pectin is a prospective source for the development of radioisotope-removing pharmaceuticals. PMID:22690146

Prospective motion correction using inductively coupled wireless RF coils.

PubMed

Ooi, Melvyn B; Aksoy, Murat; Maclaren, Julian; Watkins, Ronald D; Bammer, Roland

2013-09-01

A novel prospective motion correction technique for brain MRI is presented that uses miniature wireless radio-frequency coils, or "wireless markers," for position tracking. Each marker is free of traditional cable connections to the scanner. Instead, its signal is wirelessly linked to the MR receiver via inductive coupling with the head coil. Real-time tracking of rigid head motion is performed using a pair of glasses integrated with three wireless markers. A tracking pulse-sequence, combined with knowledge of the markers' unique geometrical arrangement, is used to measure their positions. Tracking data from the glasses is then used to prospectively update the orientation and position of the image-volume so that it follows the motion of the head. Wireless-marker position measurements were comparable to measurements using traditional wired radio-frequency tracking coils, with the standard deviation of the difference < 0.01 mm over the range of positions measured inside the head coil. Wireless-marker safety was verified with B1 maps and temperature measurements. Prospective motion correction was demonstrated in a 2D spin-echo scan while the subject performed a series of deliberate head rotations. Prospective motion correction using wireless markers enables high quality images to be acquired even during bulk motions. Wireless markers are small, avoid radio-frequency safety risks from electrical cables, are not hampered by mechanical connections to the scanner, and require minimal setup times. These advantages may help to facilitate adoption in the clinic. Copyright © 2013 Wiley Periodicals, Inc.

Prospective Motion Correction using Inductively-Coupled Wireless RF Coils

PubMed Central

Ooi, Melvyn B.; Aksoy, Murat; Maclaren, Julian; Watkins, Ronald D.; Bammer, Roland

2013-01-01

Purpose A novel prospective motion correction technique for brain MRI is presented that uses miniature wireless radio-frequency (RF) coils, or “wireless markers”, for position tracking. Methods Each marker is free of traditional cable connections to the scanner. Instead, its signal is wirelessly linked to the MR receiver via inductive coupling with the head coil. Real-time tracking of rigid head motion is performed using a pair of glasses integrated with three wireless markers. A tracking pulse-sequence, combined with knowledge of the markers’ unique geometrical arrangement, is used to measure their positions. Tracking data from the glasses is then used to prospectively update the orientation and position of the image-volume so that it follows the motion of the head. Results Wireless-marker position measurements were comparable to measurements using traditional wired RF tracking coils, with the standard deviation of the difference < 0.01 mm over the range of positions measured inside the head coil. RF safety was verified with B1 maps and temperature measurements. Prospective motion correction was demonstrated in a 2D spin-echo scan while the subject performed a series of deliberate head rotations. Conclusion Prospective motion correction using wireless markers enables high quality images to be acquired even during bulk motions. Wireless markers are small, avoid RF safety risks from electrical cables, are not hampered by mechanical connections to the scanner, and require minimal setup times. These advantages may help to facilitate adoption in the clinic. PMID:23813444

Motivations and Perceptions of Early Adopters of Personalized Genomics: Perspectives from Research Participants

PubMed Central

Gollust, S.E.; Gordon, E.S.; Zayac, C.; Griffin, G.; Christman, M.F.; Pyeritz, R.E.; Wawak, L.; Bernhardt, B.A.

2011-01-01

Background/Aims: To predict the potential public health impact of personal genomics, empirical research on public perceptions of these services is needed. In this study, ‘early adopters’ of personal genomics were surveyed to assess their motivations, perceptions and intentions. Methods: Participants were recruited from everyone who registered to attend an enrollment event for the Coriell Personalized Medicine Collaborative, a United States-based (Camden, N.J.) research study of the utility of personalized medicine, between March 31, 2009 and April 1, 2010 (n = 369). Participants completed an Internet-based survey about their motivations, awareness of personalized medicine, perceptions of study risks and benefits, and intentions to share results with health care providers. Results: Respondents were motivated to participate for their own curiosity and to find out their disease risk to improve their health. Fewer than 10% expressed deterministic perspectives about genetic risk, but 32% had misperceptions about the research study or personal genomic testing. Most respondents perceived the study to have health-related benefits. Nearly all (92%) intended to share their results with physicians, primarily to request specific medical recommendations. Conclusion: Early adopters of personal genomics are prospectively enthusiastic about using genomic profiling information to improve their health, in close consultation with their physicians. This suggests that early users (i.e. through direct-to-consumer companies or research) may follow up with the health care system. Further research should address whether intentions to seek care match actual behaviors. PMID:21654153

Application of the statistical process control method for prospective patient safety monitoring during the learning phase: robotic kidney transplantation with regional hypothermia (IDEAL phase 2a-b).

PubMed

Sood, Akshay; Ghani, Khurshid R; Ahlawat, Rajesh; Modi, Pranjal; Abaza, Ronney; Jeong, Wooju; Sammon, Jesse D; Diaz, Mireya; Kher, Vijay; Menon, Mani; Bhandari, Mahendra

2014-08-01

Traditional evaluation of the learning curve (LC) of an operation has been retrospective. Furthermore, LC analysis does not permit patient safety monitoring. To prospectively monitor patient safety during the learning phase of robotic kidney transplantation (RKT) and determine when it could be considered learned using the techniques of statistical process control (SPC). From January through May 2013, 41 patients with end-stage renal disease underwent RKT with regional hypothermia at one of two tertiary referral centers adopting RKT. Transplant recipients were classified into three groups based on the robotic training and kidney transplant experience of the surgeons: group 1, robot trained with limited kidney transplant experience (n=7); group 2, robot trained and kidney transplant experienced (n=20); and group 3, kidney transplant experienced with limited robot training (n=14). We employed prospective monitoring using SPC techniques, including cumulative summation (CUSUM) and Shewhart control charts, to perform LC analysis and patient safety monitoring, respectively. Outcomes assessed included post-transplant graft function and measures of surgical process (anastomotic and ischemic times). CUSUM and Shewhart control charts are time trend analytic techniques that allow comparative assessment of outcomes following a new intervention (RKT) relative to those achieved with established techniques (open kidney transplant; target value) in a prospective fashion. CUSUM analysis revealed an initial learning phase for group 3, whereas groups 1 and 2 had no to minimal learning time. The learning phase for group 3 varied depending on the parameter assessed. Shewhart control charts demonstrated no compromise in functional outcomes for groups 1 and 2. Graft function was compromised in one patient in group 3 (p<0.05) secondary to reasons unrelated to RKT. In multivariable analysis, robot training was significantly associated with improved task-completion times (p<0.01). Graft function was not adversely affected by either the lack of robotic training (p=0.22) or kidney transplant experience (p=0.72). The LC and patient safety of a new surgical technique can be assessed prospectively using CUSUM and Shewhart control chart analytic techniques. These methods allow determination of the duration of mentorship and identification of adverse events in a timely manner. A new operation can be considered learned when outcomes achieved with the new intervention are at par with outcomes following established techniques. Statistical process control techniques allowed for robust, objective, and prospective monitoring of robotic kidney transplantation and can similarly be applied to other new interventions during the introduction and adoption phase. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Peripheral inflammatory markers in amnestic mild cognitive impairment.

PubMed

Karim, Salman; Hopkins, Steve; Purandare, Nitin; Crowther, Jackie; Morris, Julie; Tyrrell, Pippa; Burns, Alistair

2014-03-01

To prospectively monitor plasma inflammatory marker concentrations in peripheral blood, over 12 months, in subjects with amnestic mild cognitive impairment (MCI), and to determine the relationship between peripheral inflammatory markers and cognitive decline. Seventy patients with amnestic MCI were recruited from two sites providing specialist memory assessment services in Manchester. The baseline assessment included physical examination, neuro-psychological testing and venous blood samples for C-reactive protein (CRP) and interleukin 6 (IL-6) concentrations. Sixty two participants were followed up after 12 months and the assessments were repeated. Data analysis revealed a significant rise in CRP, but not IL-6 concentrations over 12 months, which was not confounded by demographic variables. The neuro-psychological test scores had no association with CRP or IL-6 concentrations at baseline or 12 months follow-up. This study adopted the unique approach of prospectively investigating peripheral inflammatory markers in a cohort with amnestic MCI. A significant rise in CRP concentrations over 12 months, but lack of significant association with cognition, provide no evidence for a relationship between systemic inflammation and cognitive decline in amnestic MCI. © 2013 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15-year experience.

PubMed

Salem, Riad; Gabr, Ahmed; Riaz, Ahsun; Mora, Ronald; Ali, Rehan; Abecassis, Michael; Hickey, Ryan; Kulik, Laura; Ganger, Daniel; Flamm, Steven; Atassi, Rohi; Atassi, Bassel; Sato, Kent; Benson, Al B; Mulcahy, Mary F; Abouchaleh, Nadine; Asadi, Ali Al; Desai, Kush; Thornburg, Bartley; Vouche, Michael; Habib, Ali; Caicedo, Juan; Miller, Frank H; Yaghmai, Vahid; Kallini, Joseph R; Mouli, Samdeep; Lewandowski, Robert J

2017-12-01

Yttrium-90 transarterial radioembolization (TARE) is a locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1,000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline. OS outcomes were reported using censoring and intention-to-treat methodologies. All treatments were outpatient, with a median one treatment per patient. Five hundred six (51%) were CP A, 450 (45%) CP B, and 44 (4%) CP C. Two hundred sixty-three (26%) patients were BCLC A, 152 (15%) B, 541 (54%) C, and 44 (4%) D. Three hundred sixty-eight (37%) were UNOS T1/T2, 169 (17%) T3, 147 (15%) T4a, 223 (22%) T4b, and 93 (9%) N/M. In CP A patients, censored OS for BCLC A was 47.3 (confidence interval [CI], 39.5-80.3) months, BCLC B 25.0 (CI, 17.3-30.5) months, and BCLC C 15.0 (CI, 13.8-17.7) months. In CP B patients, censored OS for BCLC A was 27 (CI, 21-30.2) months, BCLC B 15.0 (CI, 12.3-19.0) months, and BCLC C 8.0 (CI, 6.8-9.5) months. Forty-nine (5%) and 110 (11%) patients developed grade 3/4 albumin and bilirubin toxicities, respectively. Based on our experience with 1,000 patients over 15 years, we have made a decision to adopt TARE as the first-line transarterial LRT for patients with HCC. Our decision was informed by prospective data and incrementally reported demonstrating outcomes stratified by BCLC, applied as either neoadjuvant or definitive treatment. (Hepatology 2017). © 2017 by the American Association for the Study of Liver Diseases.

Explaining resource consumption among non-normal neonates

PubMed Central

Schwartz, Rachel M.; Michelman, Thomas; Pezzullo, John; Phibbs, Ciaran S.

1991-01-01

The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use. PMID:10122360

Engineered T cells for cancer treatment

PubMed Central

Anurathapan, Usanarat; Leen, Ann M.; Brenner, Malcolm K.; Vera, Juan F.

2014-01-01

Adoptively transferred T cells have the capacity to traffic to distant tumor sites, infiltrate even fibrotic tissue and kill antigen-expressing tumor cells. A variety of groups have investigated different genetic engineering strategies designed to enhance tumor specificity, increase T cell potency, improve proliferation, persistence, or migratory capacity, and increase safety. In this review we focus on recent developments in the T cell engineering arena, discuss the application of these engineered cell products clinically, and outline future prospects for this therapeutic modality. PMID:24239105

Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: prospective cohort study.

PubMed

Li, Yanping; Ley, Sylvia H; Tobias, Deirdre K; Chiuve, Stephanie E; VanderWeele, Tyler J; Rich-Edwards, Janet W; Curhan, Gary C; Willett, Walter C; Manson, JoAnn E; Hu, Frank B; Qi, Lu

2015-07-21

To prospectively assess the joint association of birth weight and established lifestyle risk factors in adulthood with incident type 2 diabetes and to quantitatively decompose the attributing effects to birth weight only, to adulthood lifestyle only, and to their interaction. Prospective cohort study. Health Professionals Follow-up Study (1986-2010), Nurses' Health Study (1980-2010), and Nurses' Health Study II (1991-2011). 149,794 men and women without diabetes, cardiovascular disease, or cancer at baseline. Incident cases of type 2 diabetes, identified through self report and validated by a supplementary questionnaire. Unhealthy lifestyle was defined on the basis of body mass index, smoking, physical activity, alcohol consumption, and the alternate healthy eating index. During 20-30 years of follow-up, 11,709 new cases of type 2 diabetes were documented. The multivariate adjusted relative risk of type 2 diabetes was 1.45 (95% confidence interval 1.32 to 1.59) per kg lower birth weight and 2.10 (1.71 to 2.58) per unhealthy lifestyle factor. The relative risk of type 2 diabetes associated with a combination of per kg lower birth weight and per unhealthy lifestyle factor was 2.86 (2.26 to 3.63), which was more than the addition of the risk associated with each individual factor, indicating a significant interaction on an additive scale (P for interaction < 0.001). The attributable proportions of joint effect were 22% (95% confidence interval 18.3% to 26.4%) to lower birth weight alone, 59% (57.1% to 61.5%) to unhealthy lifestyle alone, and 18% (13.9% to 21.3%) to their interaction. Most cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle, but simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases. © Li et al 2015.

Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: prospective cohort study

PubMed Central

Ley, Sylvia H; Tobias, Deirdre K; Chiuve, Stephanie E; VanderWeele, Tyler J; Rich-Edwards, Janet W; Curhan, Gary C; Willett, Walter C; Manson, JoAnn E; Hu, Frank B

2015-01-01

Objectives To prospectively assess the joint association of birth weight and established lifestyle risk factors in adulthood with incident type 2 diabetes and to quantitatively decompose the attributing effects to birth weight only, to adulthood lifestyle only, and to their interaction. Design Prospective cohort study. Setting Health Professionals Follow-up Study (1986-2010), Nurses’ Health Study (1980-2010), and Nurses’ Health Study II (1991-2011). Participants 149 794 men and women without diabetes, cardiovascular disease, or cancer at baseline. Main outcome measure Incident cases of type 2 diabetes, identified through self report and validated by a supplementary questionnaire. Unhealthy lifestyle was defined on the basis of body mass index, smoking, physical activity, alcohol consumption, and the alternate healthy eating index. Results During 20-30 years of follow-up, 11 709 new cases of type 2 diabetes were documented. The multivariate adjusted relative risk of type 2 diabetes was 1.45 (95% confidence interval 1.32 to 1.59) per kg lower birth weight and 2.10 (1.71 to 2.58) per unhealthy lifestyle factor. The relative risk of type 2 diabetes associated with a combination of per kg lower birth weight and per unhealthy lifestyle factor was 2.86 (2.26 to 3.63), which was more than the addition of the risk associated with each individual factor, indicating a significant interaction on an additive scale (P for interaction<0.001). The attributable proportions of joint effect were 22% (95% confidence interval 18.3% to 26.4%) to lower birth weight alone, 59% (57.1% to 61.5%) to unhealthy lifestyle alone, and 18% (13.9% to 21.3%) to their interaction. Conclusion Most cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle, but simultaneous improvement of both prenatal and postnatal factors could further prevent additional cases. PMID:26199273

Is Payment a Benefit?

PubMed Central

Wertheimer, Alan

2011-01-01

What I call “the standard view” claims that IRBs should not regard financial payment as a benefit to subjects for the purpose of risk/benefit assessment. Although the standard view is universally accepted, there is little defense of that view in the canonical documents of research ethics or the scholarly literature. This article claims that insofar as IRBs should be concerned with the interests and autonomy of research subjects, they should reject the standard view and adopt “the incorporation view.” The incorporation view is more consistent with the underlying soft-paternalist justification for risk-benefit assessment and demonstrates respect for the autonomy of prospective subjects. Adoption of the standard view precludes protocols that advance the interests of subjects, investigators, and society. After considering several objections to the argument, I consider several arguments for the standard view that do not appeal to the interests and autonomy of research subjects. PMID:21726261

Recent advances in T-cell immunotherapy for haematological malignancies.

PubMed

Rouce, Rayne H; Sharma, Sandhya; Huynh, Mai; Heslop, Helen E

2017-03-01

In vitro discoveries have paved the way for bench-to-bedside translation in adoptive T cell immunotherapy, resulting in remarkable clinical responses in a variety of haematological malignancies. Adoptively transferred T cells genetically modified to express CD19 CARs have shown great promise, although many unanswered questions regarding how to optimize T-cell therapies for both safety and efficacy remain. Similarly, T cells that recognize viral or tumour antigens though their native receptors have produced encouraging clinical responses. Honing manufacturing processes will increase the availability of T-cell products, while combining T-cell therapies has the ability to increase complete response rates. Lastly, innovative mechanisms to control these therapies may improve safety profiles while genome editing offers the prospect of modulating T-cell function. This review will focus on recent advances in T-cell immunotherapy, highlighting both clinical and pre-clinical advances, as well as exploring what the future holds. © 2016 John Wiley & Sons Ltd.

Adoptive T-cell therapy for cancer: The era of engineered T cells.

PubMed

Bonini, Chiara; Mondino, Anna

2015-09-01

Tumors originate from a number of genetic events that deregulate homeostatic mechanisms controlling normal cell behavior. The immune system, devoted to patrol the organism against pathogenic events, can identify transformed cells, and in several cases cause their elimination. It is however clear that several mechanisms encompassing both central and peripheral tolerance limit antitumor immunity, often resulting into progressive diseases. Adoptive T-cell therapy with either allogeneic or autologous T cells can transfer therapeutic immunity. To date, genetic engineering of T cells appears to be a powerful tool for shaping tumor immunity. In this review, we discuss the most recent achievements in the areas of suicide gene therapy, and TCR-modified T cells and chimeric antigen receptor gene-modified T cells. We provide an overview of current strategies aimed at improving the safety and efficacy of these approaches, with an outlook on prospective developments. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Cancer treatment by photodynamic therapy combined with NK-cell-line-based adoptive immunotherapy

NASA Astrophysics Data System (ADS)

Korbelik, Mladen; Sun, Jinghai

1998-05-01

Treatment of solid cancers by photodynamic therapy (PDT) triggers a strong acute inflammatory reaction localized to the illuminated malignant tissue. This event is regulated by a massive release of various potent mediators which have a profound effect not only on local host cell populations, but also attract different types of immune cells to the treated tumor. Phagocytosis of PDT-damaged cancerous cells by antigen presenting cells, such as activated tumor associated macrophages, enables the recognition of even poorly immunogenic tumors by specific immune effector cells and the generation of immune memory populations. Because of its inflammatory/immune character, PDT is exceptionally responsive to adjuvant treatments with various types of immunotherapy. Combining PDT with immuneactivators, such as cytokines or other specific or non-specific immune agents, rendered marked improvements in tumor cures with various cancer models. Another clinically attractive strategy is adoptive immunotherapy, and the prospects of its use in conjunction with PDT are outlined.

Coping with racial discrimination: the role of substance use.

PubMed

Gerrard, Meg; Stock, Michelle L; Roberts, Megan E; Gibbons, Frederick X; O'Hara, Ross E; Weng, Chih-Yuan; Wills, Thomas A

2012-09-01

Three studies tested the hypothesis that the relation between perceived racial discrimination and substance use reported in previous research is moderated by use of substances as a coping mechanism. Studies 1 and 2 were experimental studies of African American adolescents' and young adults' reactions to a discrimination experience. Results revealed that those who endorsed substance use-as-coping reported more willingness to use substances after experiencing discrimination. Study 3 was a prospective study of the relation between perceived discrimination and substance use over an 8-year period in African American adolescents. Results demonstrated that discrimination is associated with increases in substance use, but only among adolescents who endorse substance use-as-coping. Together, these three studies provide evidence that experiencing discrimination has both short- and long-term detrimental effects on African Americans' substance use, but significantly more so for those who adopt a pattern of using substances as a coping mechanism. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Quit and Smoking Reduction Rates in Vape Shop Consumers: A Prospective 12-Month Survey

PubMed Central

Polosa, Riccardo; Caponnetto, Pasquale; Cibella, Fabio; Le-Houezec, Jacques

2015-01-01

Aims: Here, we present results from a prospective pilot study that was aimed at surveying changes in daily cigarette consumption in smokers making their first purchase at vape shops. Modifications in products purchase were also noted. Design: Participants were instructed how to charge, fill, activate and use their e-cigarettes (e-cigs). Participants were encouraged to use these products in the anticipation of reducing the number of cig/day smoked. Settings: Staff from LIAF contacted 10 vape shops in the province of the city of Catania (Italy) that acted as sponsors to the 2013 No Tobacco Day. Participants: 71 adult smokers (≥18 years old) making their first purchase at local participating vape shops were asked by professional retail staff to complete a form. Measurements: Their cigarette consumption was followed-up prospectively at 6 and 12 months. Details of products purchase (i.e., e-cigs hardware, e-liquid nicotine strengths and flavours) were also noted. Findings: Retention rate was elevated, with 69% of participants attending their final follow-up visit. At 12 month, 40.8% subjects could be classified as quitters, 25.4% as reducers and 33.8% as failures. Switching from standard refillables (initial choice) to more advanced devices (MODs) was observed in this study (from 8.5% at baseline to 18.4% at 12 month) as well as a trend in decreasing the e-liquid nicotine strength, with more participants adopting low nicotine strength (from 49.3% at baseline to 57.1% at 12 month). Conclusions: We have found that smokers purchasing e-cigarettes from vape shops with professional advice and support can achieve high success rates. PMID:25811767

Vedolizumab Effectiveness and Safety Over the First Year of Use in an IBD Clinical Practice.

PubMed

Vivio, Emily E; Kanuri, Navya; Gilbertsen, Joanna J; Monroe, Kelly; Dey, Neelendu; Chen, Chien-Huan; Gutierrez, Alexandra M; Ciorba, Matthew A

2016-04-01

Vedolizumab inhibits leucocyte vascular adhesion and migration into the gastrointestinal tract through α4β7 integrin blockade. This agent became available in mid-2014 for the treatment of moderate to severe Crohn's disease (CD) and UC (UC). The aim of this study was to assess the patterns of use, effectiveness and safety of vedolizumab in an inflammatory bowel disease (IBD) clinical practice. Patients beginning vedolizumab were enrolled with informed consent. A prospective cohort was followed with laboratory, disease activity and quality-of-life assessments made during infusion visits up to week 14. Duration of vedolizumab use, mucosal healing and safety were analysed retrospectively for all patients not captured in the prospective component of this study. One hundred and two patients started vedolizumab, with 51 patients (30 CD, 21 UC) followed prospectively. The CD patients exhibited a significant decrease in Crohn's Disease Activity Index (p = 0.04) and Harvey-Bradshaw index (p < 0.01) by week 14. The UC patients demonstrated improved partial Mayo scores at weeks 6 (p < 0.01) and 14 (p < 0.001). Ninety percent of all CD and UC patients remained on vedolizumab up to week 14. IBD-related quality of life was improved by week 6 in CD and UC cohorts (p = 0.02 and p < 0.01 respectively). Colectomy for lack of response and systemic histoplamosis were notable reasons for early discontinuation of vedolizumab, which was otherwise well tolerated. Vedolizumab was efficacious and a high percentage of patients continued this therapy beyond induction dosing. Observed safety signals may be attributed to the refractory IBD disease state of this early-adopting clinical cohort. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Vedolizumab Effectiveness and Safety Over the First Year of Use in an IBD Clinical Practice

PubMed Central

Vivio, Emily E.; Kanuri, Navya; Gilbertsen, Joanna J.; Monroe, Kelly; Dey, Neelendu; Chen, Chien-Huan; Gutierrez, Alexandra M.

2016-01-01

Background and aims: Vedolizumab inhibits leucocyte vascular adhesion and migration into the gastrointestinal tract through α4β7 integrin blockade. This agent became available in mid-2014 for the treatment of moderate to severe Crohn’s disease (CD) and UC (UC). The aim of this study was to assess the patterns of use, effectiveness and safety of vedolizumab in an inflammatory bowel disease (IBD) clinical practice. Methods: Patients beginning vedolizumab were enrolled with informed consent. A prospective cohort was followed with laboratory, disease activity and quality-of-life assessments made during infusion visits up to week 14. Duration of vedolizumab use, mucosal healing and safety were analysed retrospectively for all patients not captured in the prospective component of this study. Results: One hundred and two patients started vedolizumab, with 51 patients (30 CD, 21 UC) followed prospectively. The CD patients exhibited a significant decrease in Crohn’s Disease Activity Index (p = 0.04) and Harvey–Bradshaw index (p < 0.01) by week 14. The UC patients demonstrated improved partial Mayo scores at weeks 6 (p < 0.01) and 14 (p < 0.001). Ninety percent of all CD and UC patients remained on vedolizumab up to week 14. IBD-related quality of life was improved by week 6 in CD and UC cohorts (p = 0.02 and p < 0.01 respectively). Colectomy for lack of response and systemic histoplamosis were notable reasons for early discontinuation of vedolizumab, which was otherwise well tolerated. Conclusions: Vedolizumab was efficacious and a high percentage of patients continued this therapy beyond induction dosing. Observed safety signals may be attributed to the refractory IBD disease state of this early-adopting clinical cohort. PMID:26681763

Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop.

PubMed

Smith, Grace L; Ganz, Patricia A; Bekelman, Justin E; Chmura, Steven J; Dignam, James J; Efstathiou, Jason A; Jagsi, Reshma; Johnstone, Peter A; Steinberg, Michael L; Williams, Stephen B; Yu, James B; Zietman, Anthony L; Weichselbaum, Ralph R; Tina Shih, Ya-Chen

2017-03-01

Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology. The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders. Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided. Discussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Teaching science as argument: Prospective elementary teachers' knowledge

NASA Astrophysics Data System (ADS)

Barreto-Espino, Reizelie

For the past two decades there has been increasing emphasis on argumentation in school science. In 2007, the National Research Council published a synthesis report that emphasizes the centrality of constructing, evaluating, and using scientific explanations. Participating in argumentation is seen as fundamental to children's science learning experiences. These new expectations increase challenges for elementary teachers since their understanding of and experiences with science are overwhelmingly inconsistent with teaching science as argument. These challenges are further amplified when dealing with prospective elementary teachers. The current study was guided by the following research questions: (1) What are the ways in which preservice elementary teachers appropriate components of "teaching science as argument" during their student teaching experience? (2) To what extent do components from prospective elementary teachers' reflections influence planning for science teaching? (3) What elements from the context influence preservice elementary teachers' attention to teaching science as argument? This study followed a multi-participant case study approach and analyses were informed by grounded theory. Three participants were selected from a larger cohort of prospective elementary teachers enrolled in an innovative Elementary Professional Development School (PDS) partnership at a large Northeast University. Cross-case analysis allowed for the development of five key assertions: (1) The presence of opportunities for interacting with phenomena and collecting first hand data helped participants increase their emphasis on evidence-based explanations. (2) Participants viewed science talks as an essential mechanism for engaging students in the construction of evidence-based explanations and as being fundamental to meaning-making. (3) Participants demonstrated attention to scientific subject matter during instruction rather than merely focusing on activities and/or inquiry processes. (4) Scaffolded protocols positively influenced participants' attention to having students construct evidence-based explanations during science planning and teaching. (5) Teachers' beliefs about children's science capabilities influence their attention to and adoption of practices associated with teaching science as argument. Findings are discussed in terms of their implications for teacher education, such as the use of coherent conceptual frameworks to guide coursework and field experiences and the development of video-based cases that represent "images of the possible" associated with challenging reform-oriented teaching practices.

The MURDOCK Study: a long-term initiative for disease reclassification through advanced biomarker discovery and integration with electronic health records

PubMed Central

Tenenbaum, Jessica D; Christian, Victoria; Cornish, Melissa A; Dolor, Rowena J; Dunham, Ashley A; Ginsburg, Geoffrey S; Kraus, Virginia B; McHutchison, John G; Nahm, Meredith L; Newby, L Kristin; Svetkey, Laura P; Udayakumar, Krishna; Califf, Robert M

2012-01-01

Background Facing critically low return per dollar invested on clinical research and clinical care, the American biomedical enterprise is in need of a significant transformation. A confluence of high-throughput “omic” technologies and increasing adoption of the electronic health record has fueled excitement for a new paradigm for biomedical research and practice. The ability to simultaneously measure thousands of molecular variables and assess their relationships with clinical data collected during the course of care could enable reclassification of disease not only by gross phenotypic observation but according to underlying molecular mechanism and influence of social determinants.In turn, this reclassification could enable development of targeted therapeutic interventions as well as disease prevention strategies at the individual and population levels. Methods/Design The MURDOCK Study consists of distinct project “horizons” or stages. Horizon 1 entailed the generation and analysis of molecular data for existing large,clinically well-annotated cohorts in four disease areas. Horizon 1.5 involves creating and maintaining a 50,000-person,community volunteer registry for biomarker signature validation and prospective studies, including integration of environmental and social data. Horizon 2 leverages and prospectively recruits Horizon 1.5 volunteers, and extends the study to additional disease areas of interest. Horizon 3 will expand the study through regional, national,and international partnerships. Discussion The MURDOCK Study embodies a new model of team science investigation and represents a significant resource for translational research. The study team invites inquiries to form new collaborations to exploit the rich resources provided by these biospecimens and associated study data. PMID:22937207

Algae Biofuel in the Nigerian Energy Context

NASA Astrophysics Data System (ADS)

Elegbede, Isa; Guerrero, Cinthya

2016-05-01

The issue of energy consumption is one of the issues that have significantly become recognized as an important topic of global discourse. Fossil fuels production reportedly experiencing a gradual depletion in the oil-producing nations of the world. Most studies have relatively focused on biofuel development and adoption, however, the awareness of a prospect in the commercial cultivation of algae having potential to create economic boost in Nigeria, inspired this research. This study aims at exploring the potential of the commercialization of a different but commonly found organism, algae, in Nigeria. Here, parameters such as; water quality, light, carbon, average temperature required for the growth of algae, and additional beneficial nutrients found in algae were analysed. A comparative cum qualitative review of analysis was used as the study made use of empirical findings on the work as well as the author's deductions. The research explored the cultivation of algae with the two major seasonal differences (i.e. rainy and dry) in Nigeria as a backdrop. The results indicated that there was no significant difference in the contribution of algae and other sources of biofuels as a necessity for bioenergy in Nigeria. However, for an effective sustainability of this prospect, adequate measures need to be put in place in form of funding, provision of an economically-enabling environment for the cultivation process as well as proper healthcare service in the face of possible health hazard from technological processes. Further studies can seek to expand on the potential of cultivating algae in the Harmattan season.

Fabrication of flexible piezoelectric PZT/fabric composite.

PubMed

Chen, Caifeng; Hong, Daiwei; Wang, Andong; Ni, Chaoying

2013-01-01

Flexible piezoelectric PZT/fabric composite material is pliable and tough in nature which is in a lack of traditional PZT patches. It has great application prospect in improving the sensitivity of sensor/actuator made by piezoelectric materials especially when they are used for curved surfaces or complicated conditions. In this paper, glass fiber cloth was adopted as carrier to grow PZT piezoelectric crystal particles by hydrothermal method, and the optimum conditions were studied. The results showed that the soft glass fiber cloth was an ideal kind of carrier. A large number of cubic-shaped PZT nanocrystallines grew firmly in the carrier with a dense and uniform distribution. The best hydrothermal condition was found to be pH 13, reaction time 24 h, and reaction temperature 200°C.

Fabrication of Flexible Piezoelectric PZT/Fabric Composite

PubMed Central

Chen, Caifeng; Hong, Daiwei; Wang, Andong; Ni, Chaoying

2013-01-01

Flexible piezoelectric PZT/fabric composite material is pliable and tough in nature which is in a lack of traditional PZT patches. It has great application prospect in improving the sensitivity of sensor/actuator made by piezoelectric materials especially when they are used for curved surfaces or complicated conditions. In this paper, glass fiber cloth was adopted as carrier to grow PZT piezoelectric crystal particles by hydrothermal method, and the optimum conditions were studied. The results showed that the soft glass fiber cloth was an ideal kind of carrier. A large number of cubic-shaped PZT nanocrystallines grew firmly in the carrier with a dense and uniform distribution. The best hydrothermal condition was found to be pH 13, reaction time 24 h, and reaction temperature 200°C. PMID:24348194

Metastatic Lung Lesions as a Preferred Resection Site for Immunotherapy With Tumor Infiltrating Lymphocytes.

PubMed

Ben-Avi, Ronny; Itzhaki, Orit; Simansky, David; Zippel, Dov; Markel, Gal; Ben Nun, Alon; Schachter, Jacob; Besser, Michal J

2016-06-01

Adoptive cell therapy with tumor infiltrating lymphocytes (TIL) yields 50% response rates in metastatic melanoma and shows promising clinical results in other solid tumors. Autologous TIL cultures are isolated from resected tumor tissue, expanded ex vivo to large numbers and reinfused to the preconditioned patient. In this prospective study, we validate the origin of the tumor biopsy and its effect on T-cell function and clinical response. One hundred forty-four patients underwent surgery and 79 patients were treated with TIL adoptive cell therapy. Cultures from lung tissue were compared with other origins. The success rate of establishing TIL culture from lung tissue was significantly higher compared with nonlung tissue (94% vs. 72%, respectively, P≤0.003). Lung-derived TIL cultures gave rise to higher cell numbers (P≤0.011) and exhibited increased in vitro antitumor reactivity. The average fold expansion for lung-derived TIL during a rapid expansion procedure was 1349±557 compared with 1061±473 for nonlung TIL (P≤0.038). Patients treated with TIL cultures of lung origin (compared with nonlung) had prolonged median overall survival (29 vs. 9.5 mo; P≤0.065). Given the remarkable advancement in minimally invasive thoracic surgery and the results of this study, we suggest efforts should be taken to resect lung metastasis rather than other sites to generate TIL cultures for clinical use.

Responses of Aquatic Saproxylic Macroinvertebrates to Reduced-Impact Logging in Central Amazonia.

PubMed

Roque, F O; Escarpinati, S C; Valente-Neto, F; Hamada, N

2015-08-01

Reduced-impact logging (RIL) is an alternative land use because it reduces damage to forest cover in comparison with clear-cut practices. However, management practices adopted in RIL can affect wood availability and, consequently, fauna associated with dead wood during part of their life cycle (saproxylic). In this study, we evaluated whether aquatic saproxylic macroinvertebrates are affected by reduced-impact logging in Central Amazonia. We selected six streams in areas under reduced-impacted logging and six in primary forest areas and collected submerged woody debris. We did not find any differences in water pH, conductivity, and wood availability between reduced-impacted forest and primary forest streams. We found 248 saproxylic aquatic macroinvertebrates belonging to 37 taxa. We found five wood specialist (Dryops, Lutrochus, Stenochironomus, Oukuriella, and Endotribelos) and 32 generalists, totalling 98 and 150 individuals, respectively. In general, our results show that reduced-impact logging does not affect richness, abundance, and composition of saproxylic macroinvertebrates. The main explanation for this pattern is that management practices do not change important macroinvertebrate niche dimensions, including wood availability and the water's chemical and physical variables. Thus, controlled logging, such as applied in the area of the Central Amazonian streams studied, opens a new prospect for insect conservation and commercial exploitation of wood, which is not possible when clear-cut practices are adopted.

The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S.

PubMed

Titler, Marita G; Conlon, Paul; Reynolds, Margaret A; Ripley, Robert; Tsodikov, Alex; Wilson, Deleise S; Montie, Mary

2016-08-01

Falls are a major public health problem internationally. Many hospitals have implemented fall risk assessment tools, but few have implemented interventions to mitigate patient-specific fall risks. Little research has been done to examine the effect of implementing evidence-based fall prevention interventions to mitigate patient-specific fall risk factors in hospitalized adults. To evaluate the impact of implementing, in 3 U.S. hospitals, evidence-based fall prevention interventions targeted to patient-specific fall risk factors (Targeted Risk Factor Fall Prevention Bundle). Fall rates, fall injury rates, types of fall injuries and adoption of the Targeted Risk Factor Fall Prevention Bundle were compared prior to and following implementation. A prospective pre-post implementation cohort design. Thirteen adult medical-surgical units from three community hospitals in the Midwest region of the U.S. Nurses who were employed at least 20hours/week, provided direct patient care, and licensed as an RN (n=157 pre; 140 post); and medical records of patients 21years of age or older, who received care on the study unit for more than 24hours during the designated data collection period (n=390 pre and post). A multi-faceted Translating Research Into Practice Intervention was used to implement the Targeted Risk Factor Fall Prevention Bundle composed of evidence-based fall prevention interventions designed to mitigate patient-specific fall risks. Dependent variables (fall rates, fall injury rates, fall injury type, use of Targeted Risk Factor Fall Prevention Bundle) were collected at baseline, and following completion of the 15month implementation phase. Nurse questionnaires included the Stage of Adoption Scale, and the Use of Research Findings in Practice Scale to measure adoption of evidence-based fall prevention practices. A Medical Record Abstract Form was used to abstract data about use of targeted risk-specific fall prevention interventions. Number of falls, and number and types of fall injuries were collected for each study unit for 3months pre- and post-implementation. Data were analyzed using multivariate analysis. Fall rates declined 22% (p=0.09). Types of fall injuries changed from major and moderate to minor injuries. Fall injury rates did not decline. Use of fall prevention interventions improved significantly (p<0.001) for mobility, toileting, cognition, and risk reduction for injury, but did not change for those targeting medications. Using the Translating Research Into Practice intervention promoted use of many evidence-based fall prevention interventions to mitigate patient-specific fall risk factors in hospitalized adults. Copyright © 2015. Published by Elsevier Inc.

Findings From a Prospective Randomized Controlled Trial of an Individualized Music Listening Program for Persons With Dementia.

PubMed

Kwak, Jung; Anderson, Keith; O'Connell Valuch, Katharine

2018-06-01

Music & Memory (M&M) is a passive music intervention that uses personalized music playlists delivered on digital music players. This program has been increasingly adopted in nursing homes across the United States to facilitate communication, engagement, and socialization among persons with dementia (PWDs); however, few studies have evaluated the program's effect on PWDs' outcomes. In the present study, a randomized controlled crossover design was used to examine the impact of the M&M program on 59 PWDs in 10 nursing homes over a 14-week period. Residents' evaluated outcomes included agitation, behavioral symptoms, and use of psychotropic medications. Although trends supported the positive effects of M&M, no statistically significant differences were found in any of the outcomes measured over time. Methodological limitations withstanding, these findings call into question the effectiveness of the M&M program and the ability of facility staff to implement this intervention with fidelity.

Recovering from conflict in romantic relationships: a developmental perspective.

PubMed

Salvatore, Jessica E; Kuo, Sally I-Chun; Steele, Ryan D; Simpson, Jeffry A; Collins, W Andrew

2011-03-01

This study adopted a developmental perspective on recovery from conflict in romantic relationships. Participants were 73 young adults (target participants), studied since birth, and their romantic partners. A novel observational coding scheme was used to evaluate each participant's degree of conflict recovery, operationalized as the extent to which the participant disengaged from conflict during a 4-min "cool-down" task immediately following a 10-min conflict discussion. Conflict recovery was systematically associated with developmental and dyadic processes. Targets who were rated as securely attached more times in infancy recovered from conflict better, as did their romantic partners. Concurrently, having a romantic partner who displayed better recovery predicted more positive relationship emotions and greater relationship satisfaction. Prospectively, target participants' early attachment security and their partners' degree of conflict recovery interacted to predict relationship stability 2 years later, such that having a partner who recovered from conflict better buffered targets with insecure histories.

Barriers to the universal adoption of bilateral internal mammary artery grafting.

PubMed

Umakanthan, Jeremiah; Jeyakumar, Panch; Umakanthan, Branavan; Jeyakumar, Nikeshan; Senthilkumar, Nadarajah; Saraswathy, Mathioli R; Umakanthan, Padminidevi; Umakanthan, Janani; Sial, Tamoor; Abrina, Sofia; Buendia, Frances M; Pan, Irene; Kamath, Ramadas K; Pathmarajah, Canagaratnam; Sivalingam, Kanagaratnam; Nathan, Shan A; Sunder, Shun K; Mahendra, Tom; Umakanthan, Ramanan

2015-04-01

The left internal mammary artery (LIMA) graft is considered the "gold standard" of coronary artery bypass grafting (CABG). This conduit provides increased survival, symptomatic relief, increased freedom from myocardial infarction, and increased freedom from re-intervention when compared to saphenous venous grafting. It has a remarkable long term patency rate with clinical and angiographic outcomes that are unmatched by other conduits. Given the fact that patients often require more than one graft during a coronary revascularization procedure, the prospect of bilateral internal mammary artery (BIMA) grafting has been very appealing to some surgeons. BIMA grafting has been extensively studied via multiple retrospective and prospective cohort studies and findings have indicated that BIMA grafting can have an increased survival benefit when compared to LIMA grafting alone. As a result, this technique has accrued increasing popularity over the course of the last decade. Yet, questions still remain on whether BIMA grafting is the optimal treatment modality for patients in terms of long-term prognosis. There is limited data at the present time from randomized controlled trials and only 4-12% of CABGs performed today utilize BIMA grafting. Concerns regarding perioperative complications, which patient subsets are at higher risks for complications from the technique, and the technical challenges involved in utilizing and teaching the technique have limited its widespread use. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Exclusion of androgen insensitivity syndrome in girls with inguinal hernias: current surgical practice.

PubMed

Burge, D M; Sugarman, I S

2002-12-01

To review the current approach of paediatric surgeons to the exclusion of androgen insensitivity syndrome (CAIS) in girls with inguinal hernias (IH), a questionnaire was sent to all specialist paediatric surgeons in the United Kingdom and Ireland asking if they exclude CAIS, how they exclude it, and what they say to parents preoperatively. In all, 32 surgeons responded (29%); 41% made no attempt to exclude CAIS because they thought the incidence was too low to justify exclusion; 19(59%) excluded CAIS at the time of surgery by assessment of the internal genitalia. Only 1 performed karyotyping primarily, and then only for bilateral IH. Although most would proceed to karyotyping if the primary assessment suggested CAIS, some would not. Of those who exclude CAIS, only 1 mentions CAIS preoperatively, 6 others mention gonadal inspection, and 12/19 (63%) make no comment. Thirty-one surgeons agreed to take part in a prospective study to define the incidence of CAIS in girls with IH. It is concluded that surgeons who exclude CAIS in girls with IH adopt different assessment methods, some of which may be unreliable. However, many do not attempt to exclude CAIS, believing the incidence to be too low. As the health and medicolegal consequences of failing to exclude CAIS may be considerable, surgeons should consider changing their practice. A prospective study should be undertaken to determine the incidence of CAIS in girls with IH.

Early childhood social disadvantage is associated with poor health behaviours in adulthood

PubMed Central

Non, Amy L.; Román, Jorge Carlos; Gross, Christopher L.; Gilman, Stephen E.; Loucks, Eric B.; Buka, Stephen L.; Kubzansky, Laura D.

2016-01-01

Background Individual health behaviours are considered important risk factors for cardiometabolic diseases. These behaviours may be socially patterned by early exposure to social disadvantage, but few studies have prospectively tested this hypothesis empirically. Aim We investigated whether childhood social disadvantage was associated with likelihood of engaging in less healthy behaviours 40 years later. Subjects and Methods Prospective data were analysed from the New England Family Study, a 2005–2007 adult follow-up of a cohort initiated in 1959–1966 (n=565). Childhood social environment (birth-age 7) was assessed using a cumulative index of socioeconomic and family stability factors. Logistic regression models evaluated associations between social disadvantage and each health-related behaviour and obesity in adulthood. Results Relative to low disadvantage, higher disadvantage was associated with 3.6-fold greater odds of smoking (95% CI: 1.9, 7.0), 4.8-fold greater odds (in women only) of excess alcohol consumption (95% CI: 1.6, 14.2), and 2.7-fold greater odds of obesity (95% CI: 1.3, 5.5), but was not associated with unhealthy diet or physical inactivity. Conclusion These findings suggest childhood social disadvantage may contribute to adult cardiometabolic disease by predisposing children to adopt certain unhealthy behaviours. If replicated, such findings may support intervention strategies that target social environmental factors and behavioural pathways that are established early in life. PMID:26727037

Predictors and outcomes of superior mesenteric artery syndrome in patients with constipation: a prospective, nested case-control study.

PubMed

Xu, Lin; Yu, Wen-Kui; Lin, Zhi-Liang; Jiang, Jun; Feng, Xiao-Bo; Li, Ning

2014-10-01

Superior mesenteric artery (SMA) syndrome may occur in patients with constipation, whereas the association between these two distinct diseases has not been confirmed yet. We investigated the incidence, risk factors and treatment strategy associated with SMA syndrome in constipated patients. We conducted a prospective nested case-control study from a 9-year hospitalization cohort (n=973). Cases were matched to controls 1:4 on factors of age and gender. Cases developed SMA syndrome in long term follow-up (n=26) and controls did not (n=104). Independent risk factors were identified by using univariate analysis and conditional logistic regression analysis. Enteral nutritional support was applied in all cases and its curative effect was evaluated by retrospective analysis. The incidence of SMA syndrome was 2.67%. The risk factors under scrutiny were body mass index (BMI)≤18 (odds ratio (OR) 2.89, 95% CI 1.14 to 9.31) and abnormal colon transit time (OR 3.57, 95% CI 1.36 to 9.35). Twenty-two patients recovered after treatment of nutritional support, and the success rate of conservative treatment was 84.6%. BMI≤18 and prolonged colon transit time both were risk factors associated with SMA syndrome in constipated patients. Enteral nutritional support should be adopted as the first-line treatment for this condition.

The effect of St John’s wort extracts on CYP3A: a systematic review of prospective clinical trials

PubMed Central

Whitten, D L; Myers, S P; Hawrelak, J A; Wohlmuth, H

2006-01-01

Aim The aim of this systematic review was to assess the quality and outcomes of clinical trials investigating the effect of St John’s wort extracts on the metabolism of drugs by CYP3A. Methods Prospective clinical trials assessing the effect of St John’s wort (SJW) extracts on metabolism by CYP3A were identified through computer-based searches (from their inception to May 2005) of Medline, Cinahl, PsycINFO, AMED, Current Contents and Embase, hand-searches of bibliographies of relevant papers and consultation with manufacturers and researchers in the field. Two reviewers selected trials for inclusion, independently extracted data and recorded details on study design. Results Thirty-one studies met the eligibility criteria. More than two-thirds of the studies employed a before-and-after design, less than one-third of the studies used a crossover design, and only three studies were double-blind and placebo controlled. In 12 studies the SJW extract had been assayed, and 14 studies stated the specific SJW extract used. Results from 26 studies, including all of the 19 studies that used high-dose hyperforin extracts (>10 mg day−1), had outcomes consistent with CYP3A induction. The three studies using low-dose hyperforin extracts (<4 mg day−1) demonstrated no significant effect on CYP3A. Conclusion There is reasonable evidence to suggest that high-dose hyperforin SJW extracts induce CYP3A. More studies are required to determine whether decreased CYP3A induction occurs after low-dose hyperforin extracts. Future studies should adopt study designs with a control phase or control group, identify the specific SJW extract employed and provide quantitative analyses of key constituents. PMID:17010103

The future of simulation technologies for complex cardiovascular procedures.

PubMed

Cates, Christopher U; Gallagher, Anthony G

2012-09-01

Changing work practices and the evolution of more complex interventions in cardiovascular medicine are forcing a paradigm shift in the way doctors are trained. Implantable cardioverter defibrillator (ICD), transcatheter aortic valve implantation (TAVI), carotid artery stenting (CAS), and acute stroke intervention procedures are forcing these changes at a faster pace than in other disciplines. As a consequence, cardiovascular medicine has had to develop a sophisticated understanding of precisely what is meant by 'training' and 'skill'. An evolving conclusion is that procedure training on a virtual reality (VR) simulator presents a viable current solution. These simulations should characterize the important performance characteristics of procedural skill that have metrics derived and defined from, and then benchmarked to experienced operators (i.e. level of proficiency). Simulation training is optimal with metric-based feedback, particularly formative trainee error assessments, proximate to their performance. In prospective, randomized studies, learners who trained to a benchmarked proficiency level on the simulator performed significantly better than learners who were traditionally trained. In addition, cardiovascular medicine now has available the most sophisticated virtual reality simulators in medicine and these have been used for the roll-out of interventions such as CAS in the USA and globally with cardiovascular society and industry partnered training programmes. The Food and Drug Administration has advocated the use of VR simulation as part of the approval of new devices and the American Board of Internal Medicine has adopted simulation as part of its maintenance of certification. Simulation is rapidly becoming a mainstay of cardiovascular education, training, certification, and the safe adoption of new technology. If cardiovascular medicine is to continue to lead in the adoption and integration of simulation, then, it must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and then resolve to commit resources so as to continue to lead this revolution in physician training.

Therapeutic Management of Feline Chronic Gingivostomatitis: A Systematic Review of the Literature

PubMed Central

Winer, Jenna N.; Arzi, Boaz; Verstraete, Frank J. M.

2016-01-01

Feline chronic gingivostomatitis (FCGS) is a disease characterized by protracted and potentially debilitating oral inflammation in cats, the etiology of which is currently unknown. The purpose of this review is to apply an evidence-based medicine approach to systematically review and critically evaluate the scientific literature reporting the outcome of medical and surgical management of FCGS. Those articles meeting inclusion criteria were reviewed and assigned an “Experimental Design Grade” (EDG) and an “Evidence Grade” (EG) in order to score relative strength of study design and produced data. Studies were evaluated and compared, especially highlighting the treatments, the outcomes, and the therapeutic success rates. This review found a lack of consistency between articles’ data, rendering direct comparison of results unreliable. The field of FCGS research, and ultimately patient care, would benefit from standardizing studies by adopting use of a consistent semi-quantitative scoring system and extending follow-up duration. Future researchers should commit to large prospective studies that compare existing treatments and demonstrate the promise of new treatments. PMID:27486584

Bridging the gap: a review of dose investigations in paediatric investigation plans

PubMed Central

Hampson, Lisa V; Herold, Ralf; Posch, Martin; Saperia, Julia; Whitehead, Anne

2014-01-01

Aims In the EU, development of new medicines for children should follow a prospectively agreed paediatric investigation plan (PIP). Finding the right dose for children is crucial but challenging due to the variability of pharmacokinetics across age groups and the limited sample sizes available. We examined strategies adopted in PIPs to support paediatric dosing recommendations to identify common assumptions underlying dose investigations and the attempts planned to verify them in children. Methods We extracted data from 73 PIP opinions recently adopted by the Paediatric Committee of the European Medicines Agency. These opinions represented 79 medicinal development programmes and comprised a total of 97 dose investigation studies. We identified the design of these dose investigation studies, recorded the analyses planned and determined the criteria used to define target doses. Results Most dose investigation studies are clinical trials (83 of 97) that evaluate a single dosing rule. Sample sizes used to investigate dose are highly variable across programmes, with smaller numbers used in younger children (< 2 years). Many studies (40 of 97) do not pre-specify a target dose criterion. Of those that do, most (33 of 57 studies) guide decisions using pharmacokinetic data alone. Conclusions Common assumptions underlying dose investigation strategies include dose proportionality and similar exposure−response relationships in adults and children. Few development programmes pre-specify steps to verify assumptions in children. There is scope for the use of Bayesian methods as a framework for synthesizing existing information to quantify prior uncertainty about assumptions. This process can inform the design of optimal drug development strategies. PMID:24720849

Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments

PubMed Central

2011-01-01

Background Injuries represent a significant and growing public health concern in China. This Review was conducted to document the characteristics of injured patients presenting to the emergency department of Chinese hospitals and to assess of the nature of information collected and reported in published surveillance studies. Methods A systematic search of MEDLINE and China Academic Journals supplemented with a hand search of journals was performed. Studies published in the period 1997 to 2007 were included and research published in Chinese was the focus. Search terms included emergency, injury, medical care. Results Of the 268 studies identified, 13 were injury surveillance studies set in the emergency department. Nine were collaborative studies of which eight were prospective studies. Of the five single centre studies only one was of a prospective design. Transport, falls and industrial injuries were common mechanisms of injury. Study strengths were large patient sample sizes and for the collaborative studies a large number of participating hospitals. There was however limited use of internationally recognised injury classification and severity coding indices. Conclusion Despite the limited number of studies identified, the scope of each highlights the willingness and the capacity to conduct surveillance studies in the emergency department. This Review highlights the need for the adoption of standardized injury coding indices in the collection and reporting of patient health data. While high level injury surveillance systems focus on population-based priority setting, this Review demonstrates the need to establish an internationally comparable trauma registry that would permit monitoring of the trauma system and would by extension facilitate the optimal care of the injured patient through the development of informed quality assurance programs and the implementation of evidence-based health policy. PMID:22029774

Prospects for chimeric antigen receptor (CAR) γδ T cells: A potential game changer for adoptive T cell cancer immunotherapy.

PubMed

Mirzaei, Hamid Reza; Mirzaei, Hamed; Lee, Sang Yun; Hadjati, Jamshid; Till, Brian G

2016-10-01

Excitement is growing for therapies that harness the power of patients' immune systems to combat their diseases. One approach to immunotherapy involves engineering patients' own T cells to express a chimeric antigen receptor (CAR) to treat advanced cancers, particularly those refractory to conventional therapeutic agents. Although these engineered immune cells have made remarkable strides in the treatment of patients with certain hematologic malignancies, success with solid tumors has been limited, probably due to immunosuppressive mechanisms in the tumor niche. In nearly all studies to date, T cells bearing αβ receptors have been used to generate CAR T cells. In this review, we highlight biological characteristics of γδ T cells that are distinct from those of αβ T cells, including homing to epithelial and mucosal tissues and unique functions such as direct antigen recognition, lack of alloreactivity, and ability to present antigens. We offer our perspective that these features make γδ T cells promising for use in cellular therapy against several types of solid tumors, including melanoma and gastrointestinal cancers. Engineered γδ T cells should be considered as a new platform for adoptive T cell cancer therapy for mucosal tumors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Assessment of Clinical Effect of Perioperative Comprehensive Nursing Intervention Pattern in 23G Minimally Invasive Vitreous Surgery.

PubMed

Shen, Jie; Li, Su-Yan; Wang, Jian-Yu; Chen, Jing; Wang, Wen

2016-01-01

We observed the clinical effects of comprehensive nursing intervention pattern in 23G minimally invasive vitreous surgery according to the comprehensive nursing intervention table developed by our hospital, which would supply a basis for its clinical application. In this prospective study, we followed 120 patients undergoing 23G minimally invasive vitreous surgery from Xuzhou First People's Hospital from February 2013 to February 2015 and divided them into control and observation groups by a random number table (60 patients in each group). A regular nursing pattern was adopted for the control group, and a comprehensive nursing intervention pattern was adopted for the observation group. After that, a comparative analysis was made to identify the differences between the clinical effects of the two groups. Scores of cognition ratio, patient compliance and comfort level of patients in the observation group were higher than those of the control group were, and there was significant difference between the groups (P< 0.05). Complication incidence of the observation group is significantly lower than that of the control group (P<0.05). The comprehensive nursing intervention pattern developed by our hospital can improve clinical effects notably, which is of application value .We recommend it to be applied in eye diseases.

Azobenzene-functionalized carbon nanotubes as high-energy density solar thermal fuels.

PubMed

Kolpak, Alexie M; Grossman, Jeffrey C

2011-08-10

Solar thermal fuels, which reversibly store solar energy in molecular bonds, are a tantalizing prospect for clean, renewable, and transportable energy conversion/storage. However, large-scale adoption requires enhanced energy storage capacity and thermal stability. Here we present a novel solar thermal fuel, composed of azobenzene-functionalized carbon nanotubes, with the volumetric energy density of Li-ion batteries. Our work also demonstrates that the inclusion of nanoscale templates is an effective strategy for design of highly cyclable, thermally stable, and energy-dense solar thermal fuels.

Immunotherapy for Ovarian Cancer: What's Next?

PubMed Central

Kandalaft, Lana E.; Powell, Daniel J.; Singh, Nathan; Coukos, George

2011-01-01

In the past decade, we have witnessed important gains in the treatment of ovarian cancer; however, additional advances are required to reduce mortality. With compelling evidence that ovarian cancers are immunogenic tumors, immunotherapy should be further pursued and optimized. The dramatic advances in laboratory and clinical procedures in cellular immunotherapy, along with the development of powerful immunomodulatory antibodies, create new opportunities in ovarian cancer therapeutics. Herein, we review current progress and future prospects in vaccine and adoptive T-cell therapy development as well as immunomodulatory therapy tools available for immediate clinical testing. PMID:21079136

Opening the black box: a study of the process of NICE guidelines implementation.

PubMed

Spyridonidis, Dimitrios; Calnan, Michael

2011-10-01

This study informs 'evidence-based' implementation by using an innovative methodology to provide further understanding of the implementation process in the English NHS using two distinctly different NICE clinical guidelines as exemplars. The implementation process was tracked retrospectively and prospectively using a comparative case-study and longitudinal design. 74 unstructured interviews were carried out with 48 key informants (managers and clinicians) between 2007 and 2009. This study has shown that the NICE guidelines implementation process has both planned and emergent components, which was well illustrated by the use of the prospective longitudinal design in this study. The implementation process might be characterised as strategic and planned to begin with but became uncontrolled and subject to negotiation as it moved from the planning phase to adoption in everyday practice. The variations in the implementation process could be best accounted for in terms of differences in the structure and nature of the local organisational context. The latter pointed to the importance of managers as well as clinicians in decision-making about implementation. While national priorities determine the context for implementation the shape of the process is influenced by the interactions between doctors and managers, which influence the way they respond to external policy initiatives such as NICE guidelines. NICE and other national health policy-makers need to recognise that the introduction of planned change 'initiatives' in clinical practice are subject to social and political influences at the micro level as well as the macro level. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Prospective Memory Deficits in Ecstasy Users: Effects of Longer Ongoing Task Delay Interval

PubMed Central

WEINBORN, MICHAEL; WOODS, STEVEN PAUL; NULSEN, CLAIRE; PARK, KATHERINE

2011-01-01

Ecstasy use has been associated with neurotoxicity and neurocognitive impairment in a variety of domains, including prospective memory (ProM), which involves the delayed execution of a previously encoded intention in response to a specific cue. The present study adopted the multiprocess theory of ProM to evaluate the hypothesis that ecstasy users would evidence differentially impaired ProM on longer versus shorter ongoing task delays. Ecstasy (n = 31) users, high-risk alcohol users (n = 21) and healthy nonusers (n = 31) completed the short (2-min) and long (15-min) delay ProM scales of the Memory for Intentions Screening Test. Results showed a significant group by ProM delay interaction, such that ecstasy users performed comparably to the comparison groups on short-delay trials, but were impaired on long-delay ProM, particularly for time-based cues. Among the ecstasy users, long-delay ProM was positively associated with risky decision-making, but not with retrospective memory or other aspects of executive functions. These findings suggest that ecstasy users may be particularly susceptible to deficits in strategic target monitoring and maintenance of cue-intention pairings over longer ProM delays. Findings are discussed in the context of their potential everyday functioning (e.g., academic, vocational) and treatment implications for ecstasy users. PMID:22047194

A learning setup for a post-coma adolescent with profound multiple disabilities involving small forehead movements and new microswitch technology.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Didden, Robert; Oliva, Doretta; Calzolari, Cinzia; Montironi, Gianluigi

2007-09-01

A learning setup was arranged for an adolescent with profound multiple disabilities and a diagnosis of vegetative state. Signs of learning by the adolescent would underline an improvement in his immediate situation with potential implications for his general prospect, and could help revise his diagnosis. The response adopted in the learning setup was forehead skin movement. The microswitch technology used for detecting such a response consisted of (a) an optic sensor (i.e., barcode reader), (b) a small tag with horizontal bars attached to the participant's forehead, and (c) an electronic control system that activated stimuli in relation to the participant's forehead responses. The study followed an ABABACAB sequence, in which A represented baseline periods, B intervention periods with stimuli contingent on the response, and C a control condition with stimuli presented non-contingently. Data showed that the level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase, indicating clear signs of learning. Intervention strategies based on a learning format and suitable technology might be useful to improve the situation and prospect of persons with profound multiple disabilities and a diagnosis of vegetative state.

Reducing patients' falls rate in an Academic Medical Center (AMC) using Six Sigma "DMAIC" approach.

PubMed

Kuwaiti, Ahmed Al; Subbarayalu, Arun Vijay

2017-05-08

Purpose The purpose of this paper is to evaluate the impact of adopting the Six Sigma define, measure, analyze, improve and control (DMAIC) approach in reducing patients fall rate in an Academic Medical Center, Saudi Arabia. Design/methodology/approach A prospective study design was adopted and this study was conducted at King Fahd Hospital of the University (KFHU) during the year 2014. Based on the historical data of the patients' falls reported at KFHU during the year 2013, the goal was fixed to reduce the falls rate from 7.18 to<3 (over 60 percent reduction) by the end of December 2014. This study was conducted through the five phases of "DMAIC" approach using various quality tools. Three time periods were identified, namely, pre-intervention phase; intervention phase; and post-intervention phase. Appropriate strategies were identified through the process of brainstorming and were implemented to study the potential causes leading to the occurrence of falls. Findings The pre-intervention falls rate was reported as 6.57 whereas the post-intervention falls rate was measured as 1.91 (demonstrating a 70.93 percent reduction) after the implementation of improvement strategies. The adherence rate toward the practice of carrying falls risk assessment and hourly rounding was observed to be high where 88 percent of nurses are regularly practicing it. A control plan was also executed to sustain the improvements obtained. Originality/value The Six Sigma "DMAIC" approach improves the processes related to the prevention of falls. A greater reduction in patients falls rate (over 70 percent) was observed after the implementation of the improvement strategy.

Health impact of sport and exercise in emerging adult men: a prospective study.

PubMed

Henchoz, Yves; Baggio, Stéphanie; N'Goran, Alexandra A; Studer, Joseph; Deline, Stéphane; Mohler-Kuo, Meichun; Daeppen, Jean-Bernard; Gmel, Gerhard

2014-10-01

Health benefits of sport and exercise are well documented in children, adolescents and adults, but little is known about emerging adulthood-a period of life characterized by significant demographic and developmental changes. The present study aimed to assess the health impact of changes in sport and exercise levels during that specific period of life. The analysis used baseline and 15-month follow-up data (N = 4,846) from the cohort study on substance use risk factors. Associations between baseline exercise levels or changes in exercise levels and health indicators (i.e., health-related quality of life, depression, body mass index, alcohol dependence, nicotine dependence and cannabis use disorder) were measured using chi-squared tests and ANOVA. Direction of effects was tested using cross-lagged analysis. At baseline, all health indicator scores were observed to be better for regular exercisers than for other exercise levels. At follow-up, participants who had maintained regular exercise over time had better scores than those who had remained irregular exercisers or had discontinued, but their scores for health-related quality of life and depression were close to those of participants who had adopted regular exercise after the baseline questionnaire. Cross-lagged analysis indicated that regular exercise at baseline was a significant predictor of health-related quality of life and substance use dependence at follow-up, but was itself predicted only by health-related quality of life. From a health promotion perspective, this study emphasizes how important it is for emerging adult men to maintain, or adopt, regular sport and exercise.

The asthma mobile health study, smartphone data collected using ResearchKit.

PubMed

Chan, Yu-Feng Yvonne; Bot, Brian M; Zweig, Micol; Tignor, Nicole; Ma, Weiping; Suver, Christine; Cedeno, Rafhael; Scott, Erick R; Gregory Hershman, Steven; Schadt, Eric E; Wang, Pei

2018-05-22

Widespread adoption of smart mobile platforms coupled with a growing ecosystem of sensors including passive location tracking and the ability to leverage external data sources create an opportunity to generate an unprecedented depth of data on individuals. Mobile health technologies could be utilized for chronic disease management as well as research to advance our understanding of common diseases, such as asthma. We conducted a prospective observational asthma study to assess the feasibility of this type of approach, clinical characteristics of cohorts recruited via a mobile platform, the validity of data collected, user retention patterns, and user data sharing preferences. We describe data and descriptive statistics from the Asthma Mobile Health Study, whereby participants engaged with an iPhone application built using Apple's ResearchKit framework. Data from 6346 U.S. participants, who agreed to share their data broadly, have been made available for further research. These resources have the potential to enable the research community to work collaboratively towards improving our understanding of asthma as well as mobile health research best practices.

Biofuels Potential for Transportation Fuels in Vietnam: A Status Quo and SWOT Analysis

NASA Astrophysics Data System (ADS)

Trinh, Tu Anh; Phuong Linh Le, Thi

2018-04-01

Petroleum consumption for road transportation is well-known as the largest source of CO2 emissions. Worldwide, biofuel is becoming more attractive as substitute for crude oil owing to the increasing demand for environmentally friendly energy and its contribution towards petro dependency reduction and climate change mitigation. This paper reviews the facts and prospects of biofuel production in Vietnam. A SWOT model is adopted to study the strengths, weaknesses, opportunities and threats of biofuels production. The conclusion is drawn that with advantages of weather conditions, soil conditions, the availability of biomass and commitment from government, the country has potential to develop biobuels for domestic consumption. However, threats to production are posed by social acceptance, land use, and technology. Thus, biofuels production still need more supports from government through robust policies, regulations, and institutional framework.

Role of chronic exercise on pelvic floor support and function

PubMed Central

Shaw, Janet M.; Nygaard, Ingrid E.

2017-01-01

Purpose of review To summarize recent literature about the potential role of chronic exercise on pelvic floor support and function. Recent findings Stress urinary incontinence is common during physical activity. Scant evidence suggests a dose-response association between higher volumes of exercise and urinary incontinence. Athletes do not appear to have greater pelvic floor muscle strength or worse pelvic floor support compared to non-athletes. Pelvic floor muscle electromyographic activity increases substantially as running speeds increase. Summary Based on the current literature, no strong conclusions can be drawn about whether chronic exercise exerts a positive or negative influence on pelvic floor support and function. Adopting longitudinal research methodology that prospectively monitors exercise exposure and subsequent changes in pelvic floor support and function would help to reduce selection bias associated with cross sectional studies on groups of athletes. PMID:28212118

SWOT analysis of the renewable energy sources in Romania - case study: solar energy

NASA Astrophysics Data System (ADS)

Lupu, A. G.; Dumencu, A.; Atanasiu, M. V.; Panaite, C. E.; Dumitrașcu, Gh; Popescu, A.

2016-08-01

The evolution of energy sector worldwide triggered intense preoccupation on both finding alternative renewable energy sources and environmental issues. Romania is considered to have technological potential and geographical location suitable to renewable energy usage for electricity generation. But this high potential is not fully exploited in the context of policies and regulations adopted globally, and more specific, European Union (EU) environmental and energy strategies and legislation related to renewable energy sources. This SWOT analysis of solar energy source presents the state of the art, potential and future prospects for development of renewable energy in Romania. The analysis concluded that the development of solar energy sector in Romania depends largely on: viability of legislative framework on renewable energy sources, increased subsidies for solar R&D, simplified methodology of green certificates, and educating the public, investors, developers and decision-makers.

Influences of Risk History and Adoption Preparation on Post-Adoption Services Use in U.S. Adoptions

ERIC Educational Resources Information Center

Wind, Leslie H.; Brooks, Devon; Barth, Richard P.

2007-01-01

In spite of the need for pre- and post-adoption support, studies indicate low levels of services utilization among adoptive families, particularly those involving children with special needs. This study examines the relationship between utilization of adoptions services and adoptive child and family characteristics, pre-adoptive risk history, and…

New entrants' practice patterns in Medicare home health care after the prospective payment system revision in 2008.

PubMed

Kim, Hyunjee; Jung, Jeah Kyoungrae

2015-09-01

Medicare home health care spending increased under the prospective payment system (PPS) that was introduced specifically to control the rising spending. To explain this unexpected spending rise, we focused on new home health agencies that entered the market under the PPS. The high profit margins under the PPS attracted many new agencies to the market partially due to home health care's unique feature of low entry costs. We examined whether new entrants were more likely to adopt the practice patterns leading to higher profit margins than incumbent agencies that had been operating in the market before the PPS. Using 2008 to 2010 Medicare Home Health Claims and Provider of Services File, we estimated regressions of agencies' practice patterns controlling for agency and patient characteristics. We found that new entrants were more likely than incumbents to adopt practice patterns leading to high profit margins. They were more likely to target the 14th and 20th therapy visit where marginal revenue is relatively greater than that of other number of visits. Under the payment system that compensates extra therapy visits but not for other types of visits, entrants were also more likely to provide therapy visits, but less likely to provide medical social service visits. Given the high entry rates of agencies under the PPS, distinct practice patterns among entrants explain the drastic home health spending increase under the PPS. Heterogeneity in agencies' practice patterns also suggests an opportunity to improve efficiency in the Medicare home health care market. Copyright © 2015 Elsevier Inc. All rights reserved.

The Bedside Index for Severity in Acute Pancreatitis: a systematic review of prospective studies to determine predictive performance

PubMed Central

Chandra, Subhash; Murali, Arvind; Bansal, Reena; Agarwal, Dipti; Holm, Adrian

2017-01-01

ABSTRACT Background: predicting the development of severe disease has remained a major challenge in management of acute pancreatitis. The Bedside Index for Severity in Acute Pancreatitis (BISAP) is easy to calculate from the data available in the first 24 hours. Here, we performed a systematic review to determine the prognostic accuracy of the BISAP for severe acute pancreatitis (SAP). Methods: major databases of biomedical publications were searched during the first week of October 2015. Two independent reviewers searched records in two phases. Studies that reported prognostic accuracy of the BISAP for SAP from prospective cohorts were included. The pooled area under the receiver operating curve (AUC) was calculated. Results: Twelve studies were included for data-synthesis and methodology quality assessment was performed for 10. All the studies had enrolled consecutive patients, had a broad spectrum of the disease severity, reported explicit interpretation of the predictor, outcome of interest was well defined and had adequate follow-up. Blinded outcome assessment was reported in only one study. The pooled AUC was 0.85 (95% CI 0.80–0.90). There was significant heterogeneity, I 2 86.6%. Studies using revised Atlanta classification in defining SAP had a pooled AUC of 0.92 (95% CI, 0.90–0.95), but heterogeneity persisted, I 2 67%. Subgroup analysis based on rate of SAP (>20% vs <20%) did not eliminate the heterogeneity. Conclusion: the BISAP has very good predictive performance for SAP across different patient population and etiologies. Studies to evaluate the impact of incorporating the BISAP into clinical practice to improve outcome in acute pancreatitis are needed before adoption could be advocated with confidence. PMID:29046745

Human resource information systems in health care: a systematic evidence review

PubMed Central

Tursunbayeva, Aizhan; Bunduchi, Raluca; Franco, Massimo

2017-01-01

Objective: This systematic review aimed to: (1) determine the prevalence and scope of existing research on human resource information systems (HRIS) in health organizations; (2) analyze, classify, and synthesize evidence on the processes and impacts of HRIS development, implementation, and adoption; and (3) generate recommendations for HRIS research, practice, and policy, with reference to the needs of different stakeholders. Methods: A structured search strategy was used to interrogate 10 electronic databases indexing research from the health, social, management, technology, and interdisciplinary sciences, alongside gray literature sources and reference lists of qualifying studies. There were no restrictions on language or publication year. Two reviewers screened publications, extracted data, and coded findings according to the innovation stages covered in the studies. The Critical Appraisal Skills Program checklist was adopted to assess study quality. The process of study selection was charted using a Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) diagram. Results: Of the 6824 publications identified by the search strategy, 68, covering 42 studies, were included for final analysis. Research on HRIS in health was interdisciplinary, often atheoretical, conducted primarily in the hospital sector of high-income economies, and largely focused uncritically on use and realized benefits. Discussion and Conclusions: While studies of HRIS in health exist, the overall lack of evaluative research raises unanswered questions about their capacity to improve quality and efficiency and enable learning health systems, as well as how sociotechnical complexity influences implementation and effectiveness. We offer this analysis to decision makers and managers considering or currently implementing an HRIS, and make recommendations for further research. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42015023581. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015023581#.VYu1BPlVjDU. PMID:27707821

Human resource information systems in health care: a systematic evidence review.

PubMed

Tursunbayeva, Aizhan; Bunduchi, Raluca; Franco, Massimo; Pagliari, Claudia

2017-05-01

This systematic review aimed to: (1) determine the prevalence and scope of existing research on human resource information systems (HRIS) in health organizations; (2) analyze, classify, and synthesize evidence on the processes and impacts of HRIS development, implementation, and adoption; and (3) generate recommendations for HRIS research, practice, and policy, with reference to the needs of different stakeholders. A structured search strategy was used to interrogate 10 electronic databases indexing research from the health, social, management, technology, and interdisciplinary sciences, alongside gray literature sources and reference lists of qualifying studies. There were no restrictions on language or publication year. Two reviewers screened publications, extracted data, and coded findings according to the innovation stages covered in the studies. The Critical Appraisal Skills Program checklist was adopted to assess study quality. The process of study selection was charted using a Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) diagram. Of the 6824 publications identified by the search strategy, 68, covering 42 studies, were included for final analysis. Research on HRIS in health was interdisciplinary, often atheoretical, conducted primarily in the hospital sector of high-income economies, and largely focused uncritically on use and realized benefits. While studies of HRIS in health exist, the overall lack of evaluative research raises unanswered questions about their capacity to improve quality and efficiency and enable learning health systems, as well as how sociotechnical complexity influences implementation and effectiveness. We offer this analysis to decision makers and managers considering or currently implementing an HRIS, and make recommendations for further research. International Prospective Register of Systematic Reviews (PROSPERO): CRD42015023581. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015023581#.VYu1BPlVjDU . © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Ethical Design of Intelligent Assistive Technologies for Dementia: A Descriptive Review.

PubMed

Ienca, Marcello; Wangmo, Tenzin; Jotterand, Fabrice; Kressig, Reto W; Elger, Bernice

2017-09-22

The use of Intelligent Assistive Technology (IAT) in dementia care opens the prospects of reducing the global burden of dementia and enabling novel opportunities to improve the lives of dementia patients. However, with current adoption rates being reportedly low, the potential of IATs might remain under-expressed as long as the reasons for suboptimal adoption remain unaddressed. Among these, ethical and social considerations are critical. This article reviews the spectrum of IATs for dementia and investigates the prevalence of ethical considerations in the design of current IATs. Our screening shows that a significant portion of current IATs is designed in the absence of explicit ethical considerations. These results suggest that the lack of ethical consideration might be a codeterminant of current structural limitations in the translation of IATs from designing labs to bedside. Based on these data, we call for a coordinated effort to proactively incorporate ethical considerations early in the design and development of new products.

Rapid targeted mutational analysis of human tumours: a clinical platform to guide personalized cancer medicine

PubMed Central

Dias-Santagata, Dora; Akhavanfard, Sara; David, Serena S; Vernovsky, Kathy; Kuhlmann, Georgiana; Boisvert, Susan L; Stubbs, Hannah; McDermott, Ultan; Settleman, Jeffrey; Kwak, Eunice L; Clark, Jeffrey W; Isakoff, Steven J; Sequist, Lecia V; Engelman, Jeffrey A; Lynch, Thomas J; Haber, Daniel A; Louis, David N; Ellisen, Leif W; Borger, Darrell R; Iafrate, A John

2010-01-01

Targeted cancer therapy requires the rapid and accurate identification of genetic abnormalities predictive of therapeutic response. We sought to develop a high-throughput genotyping platform that would allow prospective patient selection to the best available therapies, and that could readily and inexpensively be adopted by most clinical laboratories. We developed a highly sensitive multiplexed clinical assay that performs very well with nucleic acid derived from formalin fixation and paraffin embedding (FFPE) tissue, and tests for 120 previously described mutations in 13 cancer genes. Genetic profiling of 250 primary tumours was consistent with the documented oncogene mutational spectrum and identified rare events in some cancer types. The assay is currently being used for clinical testing of tumour samples and contributing to cancer patient management. This work therefore establishes a platform for real-time targeted genotyping that can be widely adopted. We expect that efforts like this one will play an increasingly important role in cancer management. PMID:20432502

Investigating local policy drivers for alcohol harm prevention: a comparative case study of two local authorities in England.

PubMed

Mooney, John D; Holmes, John; Gavens, Lucy; de Vocht, Frank; Hickman, Matt; Lock, Karen; Brennan, Alan

2017-10-18

The considerable challenges associated with implementing national level alcohol policies have encouraged a renewed focus on the prospects for local-level policies in the UK and elsewhere. We adopted a case study approach to identify the major characteristics and drivers of differences in the patterns of local alcohol policies and services in two contrasting local authority (LA) areas in England. Data were collected via thirteen semi-structured interviews with key informants (including public health, licensing and trading standards) and documentary analysis, including harm reduction strategies and statements of licensing policy. A two-stage thematic analysis was used to categorize all relevant statements into seven over-arching themes, by which document sources were then also analysed. Three of the seven over-arching themes (drink environment, treatment services and barriers and facilitators), provided for the most explanatory detail informing the contrasting policy responses of the two LAs: LA1 pursued a risk-informed strategy via a specialist police team working proactively with problem premises and screening systematically to identify riskier drinking. LA2 adopted a more upstream regulatory approach around restrictions on availability with less emphasis on co-ordinated screening and treatment measures. New powers over alcohol policy for LAs in England can produce markedly different policies for reducing alcohol-related harm. These difference are rooted in economic, opportunistic, organisational and personnel factors particular to the LAs themselves and may lead to closely tailored solutions in some policy areas and poorer co-ordination and attention in others.

Adoptive cell transfer using autologous tumor infiltrating lymphocytes in gynecologic malignancies.

PubMed

Mayor, Paul; Starbuck, Kristen; Zsiros, Emese

2018-05-23

During the last decade, the field of cancer immunotherapy has been entirely transformed by the development of new and more effective treatment modalities with impressive response rates and the prospect of long survival. One of the major breakthroughs is adoptive cell transfer (ACT) based on autologous T cells derived from tumor-infiltrating lymphocytes (TILs). TIL-based ACT is a highly personalized cancer treatment. T cells are harvested from autologous fresh tumor tissues, and after ex vivo activation and extensive expansion, are reinfused to patients. TIL-based therapies have only been offered in small phase I/II studies in a few centers given the highly specialized care required, the complexity of TIL production and the very intensive nature of the three-step treatment protocol. The treatment includes high-dose lymphodepleting chemotherapy, the infusion of the expanded and activated T cells and interleukin-2 (IL-2) injections to increase survival of the T cells. Despite the limited data on ACT, the small published studies consistently confirm an impressive clinical response rate of up to 50% in metastatic melanoma patients, including a significant proportion of patients with durable complete response. These remarkable results justify the need for larger clinical trials in other solid tumors, including gynecologic malignancies. In this review we provide an overview of the current clinical results, future applications of TIL-based ACT in gynecologic malignancies, and on risks and challenges associated with modern T cell therapy. Copyright © 2018. Published by Elsevier Inc.

Quality Issues Identified During the Evaluation of Biosimilars by the European Medicines Agency's Committee for Medicinal Products for Human Use.

PubMed

Cilia, Mark; Ruiz, Sol; Richardson, Peter; Salmonson, Tomas; Serracino-Inglott, Anthony; Wirth, Francesca; Borg, John Joseph

2018-02-01

The aim of this study was to identify trends in deficiencies raised during the EU evaluation of the quality part of dossiers for marketing authorisation applications of biosimilar medicinal products. All adopted day 120 list of questions on the quality module of 22 marketing authorisation applications for biosimilars submitted to the European Medicines Agency and concluded by the end of October 2015 was analysed. Frequencies of common deficiencies identified were calculated and summarised descriptions included. Frequencies and trends on quality deficiencies were recorded and presented for 22 biosimilar applications. Thirty-two 'major objections' for 9 products were identified from 14 marketing authorisation applications with 15 raised for drug substance and 17 for drug product. In addition, 547 'other concerns' for drug substance and 495 for drug product were also adopted. The frequencies and trends of the identified deficiencies together with their impact were discussed from a regulatory perspective and how these impact key manufacturing processes and key materials used in the production of biosimilars. This study provides an insight to the regulatory challenges prospective companies need to consider when developing biosimilars; it also helps elucidate common pitfalls in the development and production of biosimilars and in the submission of dossiers for their marketing authorisations. The results are expected to be of interest to pharmaceutical companies but also to regulators to obtain consistent information on medicinal products based on transparent rules safeguarding the necessary pharmaceutical quality of medicinal products.

Adopting Ultrasound Guidance for Prone Percutaneous Nephrolithotomy: Evaluating the Learning Curve for the Experienced Surgeon

PubMed Central

Usawachintachit, Manint; Masic, Selma; Allen, Isabel E.; Li, Jianxing

2016-01-01

Abstract Objectives: To define the learning curve associated with adopting ultrasound guidance for prone percutaneous nephrolithotomy (PCNL) for the experienced surgeon. Methods: A prospective cohort study of consecutive patients undergoing PCNL with ultrasound guidance for renal tract access and dilation was performed. Clinical data reviewed included success in gaining renal access with ultrasound guidance, total fluoroscopic screening time, and radiation exposure dose. PCNL cases performed with fluoroscopic guidance matched for stone size served as control cases. Results: One hundred consecutive ultrasound-guided procedures performed by a single experienced endourologist were divided into five experience groups. Significant improvement in renal access success rate with ultrasound was seen after 20 cases (p < 0.05). Total fluoroscopic screening time, radiation exposure dose, and operative time were also statistically significantly improved over the study period. When compared with fluoroscopy-guided PCNL, significant decreases in total fluoroscopic screening time (33.4 ± 35.3 seconds vs 157.5 ± 84.9 seconds, p < 0.05) and radiation exposure (7.0 ± 8.7 mGy vs 47.8 ± 45.9 mGy, p < 0.05) were seen. No differences in complication rates were found. Conclusions: Ultrasound-guided renal access for PCNL can be performed effectively after 20 cases. Transition to the use of ultrasound will quickly reduce radiation exposure for patients and intraoperative personnel. PMID:27150671

A Prospective Hospital-based Surveillance to Estimate Rotavirus Disease Burden in Bhutanese Children under 5 Years of Age.

PubMed

Wangchuk, Sonam; Dorji, Tshering; Tsheten; Tshering, Karchung; Zangmo, Sangay; Pem Tshering, Kunzang; Dorji, Tandin; Nishizono, Akira; Ahmed, Kamruddin

2015-03-01

As part of efforts to develop an informed policy for rotavirus vaccination, this prospective study was conducted to estimate the burden of rotavirus diarrhea among children less than 5 years old attended to the Department of Pediatrics, Jigme Dorji Wangchuk National Referral Hospital (JDWNRH), Thimphu, Bhutan. The duration of the study was three years, extending from February 2010 through December 2012. We estimated the frequency of hospitalization in the pediatric ward and dehydration treatment unit (DTU) for diarrhea and the number of events attributable to rotavirus infection among children under 5 years of age. During the study period, a total of 284 children (1 in 45) were hospitalized in the pediatric ward, and 2,220 (1 in 6) in the DTU with diarrhea among children residing in the Thimphu district. Group A rotavirus was detected in 32.5% and 18.8% of the stool samples from children hospitalized in the pediatric ward, respectively. Overall, 22.3% of the stool samples were rotavirus-positive, and the majority (90.8%) of them was detected in children under 2 years of age. From this study, we estimated that the annual incidence of hospitalization in the pediatric ward and DTU due to rotavirus diarrhea was 2.4/1000 (95% CI 1.7-3.4) and 10.8/1000 (95% CI 9.1-12.7) children, respectively. This study revealed that rotavirus is a major cause of diarrhea in Bhutanese children in Thimphu district and since no study has been performed previously, represents an important finding for policy discussions regarding the adoption of a rotavirus vaccine in Bhutan.

Prospective study on the reciprocal relationship between intimate partner violence and depression among women in Korea.

PubMed

Kim, Jinseok; Lee, Joohee

2013-12-01

This study aimed to examine the bi-directional relationship between intimate partner violence (IPV) and depression using prospective data. Data from the Korean Welfare Panel Study (KOWEPS) were used to test whether IPV was associated with an increased overall level of depression and with the rate of change over time in depressive symptoms and whether this model of change in depressive symptoms was associated with subsequent incidences of IPV. This study utilized data from 3153 married women who participated in the KOWEPS from 2006 through 2009. The KOWEPS is a panel study of a nationally representative sample of Korean households. The women's responses to multiple questions adopted from the Conflict Tactics Scale (CTS) were used to create a dichotomous IPV variable at Wave1 and Wave4. The CESD-11 was used to measure the women's level of depression. We utilized a latent growth model (LGM) of depression using IPV at Wave1 as a predictor and IPV at Wave4 as an outcome predicted by the model parameters of the LGM of depression. We found that after controlling for the effects of age, education, social support and income, IPV at Wave1 was positively associated with overall depression levels and negatively associated with the growth rate of depression. Further, IPV at Wave4 was associated with the intercept and the slope of the depression LGM and with IPV at Wave1. The overall model fit the data well. This study indicated that experiencing IPV influences a woman's level of depression in terms of its overall level and rate of change, which, in turn, influences the victim's likelihood of experiencing subsequent IPV. Copyright © 2013 Elsevier Ltd. All rights reserved.

Central venous access by trainees: a systematic review and meta-analysis of the use of simulation to improve success rate on patients.

PubMed

Madenci, Arin L; Solis, Carolina V; de Moya, Marc A

2014-02-01

Simulation training for invasive procedures may improve patient safety by enabling efficient training. This study is a meta-analysis with rigorous inclusion and exclusion criteria designed to assess the real patient procedural success of simulation training for central venous access. Published randomized controlled trials and prospective 2-group cohort studies that used simulation for the training of procedures involving central venous access were identified. The quality of each study was assessed. The primary outcome was the proportion of trainees who demonstrated the ability to successfully complete the procedure. Secondary outcomes included the mean number of attempts to procedural success and periprocedural adverse events. Proportions were compared between groups using risk ratios (RRs), whereas continuous variables were compared using weighted mean differences. Random-effects analysis was used to determine pooled effect sizes. We identified 550 studies, of which 5 (3 randomized controlled trials, 2 prospective 2-group cohort studies) studies of central venous catheter (CVC) insertion were included in the meta-analysis, composed of 407 medical trainees. The simulation group had a significantly larger proportion of trainees who successfully placed CVCs (RR, 1.09; 95% confidence interval [CI], 1.03-1.16, P<0.01). In addition, the simulation group had significantly fewer mean attempts to CVC insertion (weighted mean difference, -1.42; 95% CI, -2.34 to -0.49, P<0.01). There was no significant difference in the rate of adverse events between the groups (RR, 0.50; 95% CI, 0.19-1.29; P=0.15). Training programs should consider adopting simulation training for CVC insertion to improve the real patient procedural success of trainees.

Medicare Postacute Care Payment Reforms Have Potential to Improve Efficiency, but May Need Changes to Cut Costs

PubMed Central

Grabowski, David C.; Huckfeldt, Peter J.; Sood, Neeraj; Escarce, José J; Newhouse, Joseph P.

2012-01-01

The Affordable Care Act mandates changes in payment policies for Medicare postacute care services intended to contain spending in the long run and help ensure the program’s financial sustainability. In addition to reducing annual payment increases to providers under the existing prospective payment systems, the act calls for demonstration projects of bundled payment, accountable care organizations, and other strategies to promote care coordination and reduce spending. Experience with the adoption of Medicare prospective payment systems in postacute care settings approximately a decade ago suggests that current reforms could, but need not necessarily, produce such undesirable effects as decreased access for less profitable patients, poorer patient outcomes, and only short-lived curbs on spending. Policy makers will need to be vigilant in monitoring the impact of the Affordable Care Act reforms and be prepared to amend policies as necessary to ensure that the reforms exert persistent controls on spending without compromising the delivery of patient-appropriate postacute services. PMID:22949442

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2015. Final rule.

PubMed

2014-08-05

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. In addition, it adopts the most recent Office of Management and Budget (OMB) statistical area delineations to identify a facility's urban or rural status for the purpose of determining which set of rate tables will apply to the facility, and to determine the SNF PPS wage index including a 1-year transition with a blended wage index for all providers for FY 2015. This final rule also contains a revision to policies related to the Change of Therapy (COT) Other Medicare Required Assessment (OMRA). This final rule includes a discussion of a provision related to the Affordable Care Act involving Civil Money Penalties. Finally, this final rule discusses the SNF therapy payment research currently underway within CMS, observed trends related to therapy utilization among SNF providers, and the agency's commitment to accelerating health information exchange in SNFs.

Prospective political analysis for policy design: enhancing the political viability of single-payer health reform in Vermont.

PubMed

Blanchet, Nathan J; Fox, Ashley M

2013-06-01

In 2011 the state of Vermont adopted legislation that aims to create the nation's first state-level single-payer health care system, a system that would go well beyond national reform efforts. To conduct a prospective, institutional stakeholder analysis to guide development of a politically viable, universal health care reform proposal, as commissioned by Vermont's legislature in July 2010. A total of 64 semi-structured stakeholder interviews with nearly 120 individuals, representing 60 different groups/institutions, were conducted between July and December 2010. Interviews probed stakeholders regarding five major design components: financing options, decoupling insurance from employment, organization/governance, comprehensiveness of benefits, and payment reform. There was a range of opposition and support across stakeholder groups and components, and more remarkably a diversity of views within groups often believed to be unwavering supporters or detractors of comprehensive health reform. Given the balance of conflicting views, relative power, and acceptable trade-offs, the research team proposed a single-payer health care system financed through payroll taxes, decoupled from employment, with a generous benefit package, governed by a public-private intermediary. Prospective political analysis can assist in choosing among a range of technically sound policy options to create a more politically viable health reform package. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Comparative Analysis Study of Open Source GIS in Malaysia

NASA Astrophysics Data System (ADS)

Rasid, Muhammad Zamir Abdul; Kamis, Naddia; Khuizham Abd Halim, Mohd

2014-06-01

Open source origin might appear like a major prospective change which is qualified to deliver in various industries and also competing means in developing countries. The leading purpose of this research study is to basically discover the degree of adopting Open Source Software (OSS) that is connected with Geographic Information System (GIS) application within Malaysia. It was derived based on inadequate awareness with regards to the origin ideas or even on account of techie deficiencies in the open origin instruments. This particular research has been carried out based on two significant stages; the first stage involved a survey questionnaire: to evaluate the awareness and acceptance level based on the comparison feedback regarding OSS and commercial GIS. This particular survey was conducted among three groups of candidates: government servant, university students and lecturers, as well as individual. The approaches of measuring awareness in this research were based on a comprehending signal plus a notion signal for each survey questions. These kinds of signs had been designed throughout the analysis in order to supply a measurable and also a descriptive signal to produce the final result. The second stage involved an interview session with a major organization that carries out available origin internet GIS; the Federal Department of Town and Country Planning Peninsular Malaysia (JPBD). The impact of this preliminary study was to understand the particular viewpoint of different groups of people on the available origin, and also their insufficient awareness with regards to origin ideas as well as likelihood may be significant root of adopting level connected with available origin options.

Predictors of physical activity change among adults using observational designs.

PubMed

Rhodes, Ryan E; Quinlan, Alison

2015-03-01

Regular physical activity (PA) is foundational to human health, yet most people are inactive. A sound understanding of the determinants of PA may be instructive for building interventions and/or identifying critical target groups to promote PA. Most research on PA correlates has been biased by cross-sectional or passive prospective designs that fail to examine within-person analysis of PA change. The purpose of this review was to collect and appraise the available literature on the predictors of PA change conceived broadly in terms of increases/decreases from baseline assessment as well as specifically in terms of adoption and maintenance. Eligible studies were from English, peer-reviewed published articles that examined predictors of natural change of PA over 3 months + using observational (non-experimental) data in adult samples. Searches were performed from June 2012 to January 2014 in eight databases. Sixty-seven independent data-sets, from 12 countries, primarily of medium quality/risk of bias, were identified with 26 correlates spanning demographic, behavioral, intra-individual, inter-individual, and environmental categories. Only intention and the onset of motherhood could reliably predict overall PA change. Among datasets configured to predict PA adoption, affective judgments and behavioral processes of change were the only reliable predictors, although both only have a small number of available studies. There were no reliable predictors of maintenance when compared to PA relapse. The results underscore the importance of individual-level motivation and behavioral regulation in PA change, but also denote critical social variables. These findings, however, are constrained by PA measurement bias and limited studies that employed time-varying covariation between predictor variables and PA.

Thyroid surgery at a volunteer program in Sub-Saharan Africa.

PubMed

Pereira Pérez, Fernando; Calvo Espino, Pablo; Sánchez Arteaga, Alejandro; Muñoz Rodriguez, Joaquín Manuel; Nges, Lionel W; Kemmoe, Mireille; Vidal Fernández, Mercedes; Blázquez, Francisco Javier; Vives Espejo-Saavedra, Teresa; Picón Maroñas, Marina; Varela de Ugarte, Andrés

2016-01-01

The aim of this study is to demonstrate our experience at a volunteer surgical program in Cameroon, which is of special interest given to the inability to adopt international treatment guidelines for thyroid surgery in areas of limited resources due to the lack of preoperative testing and to the difficulty to obtain sustitutive hormonal treatment. This is a prospective observational study that includes 16 cases of thyroid surgery in Dschang (Cameroon) during June 2015. The patients were previously selected by a local medical team. All patients were black, 15 women and one man, with a mean age of 41 years. The surgical technique used for the removal of unilateral disease was hemithyroidectomy with isthmectomy and bilateral subtotal thyroidectomy for bilateral disease. Five subtotal thyroidectomies, 9hemithyroidectomies and 2isthmectomies were performed. Prethyroid muscles were divided only in one case. We visualized 86% of the parathyroid glands and 84% of the recurrent laryngeal nerves. The main complications observed were one symptomatic cervical haematoma that required reoperation and 2surgical wound infections. There were no clinical episodes of hypocalemia or recurrent nerve lesion. The mean length of stay was 2.3 days. At follow-up, all bilateral thyroidectomies developed high TSH levels. Thyroid surgery is safe in developing countries adopting protocols and techniques we use in our environment (avoiding total thyroidectomy). Bilateral thyroidectomies should not be performed unless functional studies are available in the follow-up and a thyroid hormone supplement stock guaranteed whenever necessary. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Comparison of healthy lifestyle behaviors among individuals with and without cardiovascular diseases from urban and rural areas in China: A cross-sectional study.

PubMed

Wang, Chuangshi; Li, Wei; Yin, Lu; Bo, Jian; Peng, Yaguang; Wang, Yang

2017-01-01

The study aimed to explore the gap of prevalence of healthy lifestyle behaviors including smoking cessation, quitting drinking, physical activity and healthy eating between Chinese adults with and without cardiovascular diseases (CVDs). This study is a cross-sectional component of Prospective Urban Rural Epidemiology (PURE)-China study, which recruited ~46,000 participants from 70 rural and 45 urban communities between 2005 and 2009. Participants were divided into disease (with CVDs) and control (without any diseases) groups. The adjusted rates were estimated for different strata by the generalized, linear mixed-effects model, including community as a random effect with additional adjustment for age, sex, education and income. Among 40,490 participants, <10% had all four healthy lifestyle behaviors (disease group versus control group: urban areas: 7.8% versus 8.1%; rural areas: 3.4% versus 3.2%). The rates of smoking cessation and quitting drinking were significantly higher in disease group for both urban and rural residents (P<0.001). In urban areas, higher rates were observed in all other three healthy lifestyle behaviors except physical activity in low-income regions (P<0.05). Similarly, the higher trends were observed for stopping smoking and drinking while opposite trends for healthy eating among rural residents from low-income regions (P<0.05). Our study showed that the prevalence of adopting all four behaviors was low among Chinese adults. Individuals with CVDs were more likely to follow healthy lifestyle behaviors, but it still indicated a large gap between the actual and ideal adoption of healthy lifestyle behaviors, which called for the promotion of population-wide strategies to modify lifestyle behaviors in addition to individual health-care intervention strategies.

Comparison of healthy lifestyle behaviors among individuals with and without cardiovascular diseases from urban and rural areas in China: A cross-sectional study

PubMed Central

Wang, Chuangshi; Yin, Lu; Bo, Jian; Peng, Yaguang; Wang, Yang

2017-01-01

Introduction The study aimed to explore the gap of prevalence of healthy lifestyle behaviors including smoking cessation, quitting drinking, physical activity and healthy eating between Chinese adults with and without cardiovascular diseases (CVDs). Methods This study is a cross-sectional component of Prospective Urban Rural Epidemiology (PURE)-China study, which recruited ~46,000 participants from 70 rural and 45 urban communities between 2005 and 2009. Participants were divided into disease (with CVDs) and control (without any diseases) groups. The adjusted rates were estimated for different strata by the generalized, linear mixed-effects model, including community as a random effect with additional adjustment for age, sex, education and income. Results Among 40,490 participants, <10% had all four healthy lifestyle behaviors (disease group versus control group: urban areas: 7.8% versus 8.1%; rural areas: 3.4% versus 3.2%). The rates of smoking cessation and quitting drinking were significantly higher in disease group for both urban and rural residents (P<0.001). In urban areas, higher rates were observed in all other three healthy lifestyle behaviors except physical activity in low-income regions (P<0.05). Similarly, the higher trends were observed for stopping smoking and drinking while opposite trends for healthy eating among rural residents from low-income regions (P<0.05). Conclusions Our study showed that the prevalence of adopting all four behaviors was low among Chinese adults. Individuals with CVDs were more likely to follow healthy lifestyle behaviors, but it still indicated a large gap between the actual and ideal adoption of healthy lifestyle behaviors, which called for the promotion of population-wide strategies to modify lifestyle behaviors in addition to individual health-care intervention strategies. PMID:28771516

Bridging the gap: a review of dose investigations in paediatric investigation plans.

PubMed

Hampson, Lisa V; Herold, Ralf; Posch, Martin; Saperia, Julia; Whitehead, Anne

2014-10-01

In the EU, development of new medicines for children should follow a prospectively agreed paediatric investigation plan (PIP). Finding the right dose for children is crucial but challenging due to the variability of pharmacokinetics across age groups and the limited sample sizes available. We examined strategies adopted in PIPs to support paediatric dosing recommendations to identify common assumptions underlying dose investigations and the attempts planned to verify them in children. We extracted data from 73 PIP opinions recently adopted by the Paediatric Committee of the European Medicines Agency. These opinions represented 79 medicinal development programmes and comprised a total of 97 dose investigation studies. We identified the design of these dose investigation studies, recorded the analyses planned and determined the criteria used to define target doses. Most dose investigation studies are clinical trials (83 of 97) that evaluate a single dosing rule. Sample sizes used to investigate dose are highly variable across programmes, with smaller numbers used in younger children (< 2 years). Many studies (40 of 97) do not pre-specify a target dose criterion. Of those that do, most (33 of 57 studies) guide decisions using pharmacokinetic data alone. Common assumptions underlying dose investigation strategies include dose proportionality and similar exposure-response relationships in adults and children. Few development programmes pre-specify steps to verify assumptions in children. There is scope for the use of Bayesian methods as a framework for synthesizing existing information to quantify prior uncertainty about assumptions. This process can inform the design of optimal drug development strategies. © 2014 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of The British Pharmacological Society.

"Apping Up": Prospects for Information Technology Innovation in Return to Work Communication.

PubMed

Singh, Ripdaman; O'Hagan, Fergal

2018-03-21

Purpose During return to work (RTW), communication between health care providers and employers largely takes place through standardize paper-based forms. Information technology (IT) platforms may provide advantages in enabling information exchange and decision-making through sharing of guidelines and resources. We investigated stakeholder perspectives on the prospect of IT use for RTW communication in Ontario, Canada. Methods Consistent with the exploratory nature of the questions, qualitative methods were used. Primary data were interviews with health care providers (HCPs), employers, and workers with experience in RTW. The first portion of initial interviews elicited general perspectives and experiences related to RTW communication. Participants were then exposed to a prototype IT communication platform and elicited their feedback. Follow-up interviews with HCP's and EMP's were used to allow further reflection and clarification of data. We used progressive, thematic coding to analyze data. Results 12 HCPs, 7 employers, and 5 workers participated in the study. Five inter-related themes were obtained. Participants expressed no absolute objection to the use of IT for RTW communication but varying degrees of support. Participants revealed how media change depended on a prospective IT innovation's perceived usefulness, fit with current practices, capacity to gain buy-in from other stakeholders, and ability to demonstrate positive performance in actual practice. Conclusions Findings suggest that a transition to an IT-mediated tool for RTW communication is supported in principle; however, major caveats exist in relation to perceived value and fit with stakeholder practice. System support and stakeholder cooperation are likely necessary to adopt the change, yet IT-mediated communication has yet to demonstrate value. To avoid circularity, proof of principal needs to be established through an implementation trial of such technology.

A cluster-randomized effectiveness trial of a physician-pharmacist collaborative model to improve blood pressure control.

PubMed

Carter, Barry L; Clarke, William; Ardery, Gail; Weber, Cynthia A; James, Paul A; Vander Weg, Mark; Chrischilles, Elizabeth A; Vaughn, Thomas; Egan, Brent M

2010-07-01

Numerous studies have demonstrated the value of team-based care to improve blood pressure (BP) control, but there is limited information on whether these models would be adopted in diverse populations. The purpose of this study was to evaluate whether a collaborative model between physicians and pharmacists can improve BP control in multiple primary care medical offices with diverse geographic and patient characteristics and whether long-term BP control can be sustained. This study is a randomized prospective trial in 27 primary care offices first stratified by the percentage of underrepresented minorities and the level of clinical pharmacy services within the office. Each office is then randomized to either a 9- or 24-month intervention or a control group. Patients will be enrolled in this study until 2012. The results of this study should provide information on whether this model can be implemented in large numbers of diverse offices, if it is effective in diverse populations, and whether BP control can be sustained long term. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00935077.

Predicting Ly-alpha intensities in coronal streamers

NASA Technical Reports Server (NTRS)

Noci, Giancarlo; Poletto, Giannina; Suess, Steven T.; Wang, A.-H.; Wu, S. T.

1992-01-01

SOHO (Solar and Heliospheric Observatory) UVCS (Ultraviolet Coronagraph Spectrometer) will make long term observations of coronal streamers in UV lines, providing a new tool for the analysis of structures which have been known for decades but are still far from being adequately described. Work to evaluate the Lyman alpha brightness of coronal streamers is reported, adopting the streamer models obtained, via a time dependent numerical relaxation technique. This will yield understanding on the role of geometric versus physical factors in determining the streamer lyman alpha intensity and provide guidelines for UVCS observational operations. Future prospects along this line of research are summarized.

Group purchasing--an international future? Health Industry Group Purchasing Association Expo Conference, October 9-11, 1996, Orlando, Florida, USA.

PubMed

Pickering, E

1997-01-01

As Providers and suppliers in the U.S. health care market place have adopted a mindset more attuned to today's economic realities, they've made cost cutting a top priority-and to help them achieve that, they have turned to GPOs and the prospects they offer for control of supply costs through bulk buying. Will the purchasing world cross international boundaries and get even smaller? What benefits can be expected from group purchasing organisations developing an international network? Can the International Hospital Federation play a role?

Accounting and reimbursement schemes for inpatient care in France.

PubMed

Bellanger, Martine M; Tardif, Laurent

2006-08-01

The new French case-mix system of hospital payment was adopted in 2004 for public hospitals and in March 2005 for private-for-profit hospitals. Implementing this reform requires a period of transition but the challenges ahead can already be predicted. Prices will have to change before this mode of reimbursement can have any real impact. This requires producing more detailed hospital cost data and using fine measuring tools such as the cost accounting method developed for use in this context. This article describes and analyses the main tools and methods selected to implement the new French prospective payment system.

The role of siblings in adoption outcomes and experiences from adolescence to emerging adulthood.

PubMed

Farr, Rachel H; Flood, Margaux E; Grotevant, Harold D

2016-04-01

In many families, siblings play important roles in shaping each other's outcomes and experiences across development. In adoptive families, siblings may affect adoptees' feelings about adoption and birth family contact. Among "target adoptees" (i.e., 1 participating adopted individual within adoptive families) with siblings who may have also been adopted or the biological children of the adoptive parents, we examined how adoption experiences and individual adjustment from adolescence into emerging adulthood were associated with sibling relationship dynamics. We present 3 studies using longitudinal, mixed method data within the same overarching sample of adoptive families. Study 1 was a follow-up to Berge et al.'s (2006) study of adolescent adoptees and their adopted siblings with birth family contact; we found evidence of changes in the status of contact collectively experienced by 26 adopted sibling pairs when target adoptees were emerging adults. In Study 2, we found that target adoptees (n = 91) with siblings (adopted or not) who were more involved with target adoptees' birth family contact demonstrated more favorable behavioral outcomes than target adoptees who had uninvolved siblings. Finally in Study 3, for target adoptees with siblings who were also adopted (n = 51), results showed that target adoptees felt more positively about their own adoption when siblings expressed similar positive feelings about individual adoption experiences. Implications of our findings are discussed in terms of the enduring contributions of sibling relationships from childhood into adulthood and the unique ways in which adoptive siblings are important in shaping one another's experiences of adoption. (c) 2016 APA, all rights reserved).

The Role of Siblings in Adoption Outcomes and Experiences from Adolescence to Emerging Adulthood

PubMed Central

Farr, Rachel H.; Flood, Margaux E.; Grotevant, Harold D.

2015-01-01

In many families, siblings play important roles in shaping each other’s outcomes and experiences across development. In adoptive families, siblings may affect adoptees’ feelings about adoption and birth family contact. Among “target adoptees” (i.e., one participating adopted individual within adoptive families) with siblings who may have also been adopted or the biological children of the adoptive parents, we examined how adoption experiences and individual adjustment from adolescence into emerging adulthood were associated with sibling relationship dynamics. We present three studies using longitudinal, mixed method data within the same overarching sample of adoptive families. Study 1 was a follow-up to Berge et al.’s (2006) study of adolescent adoptees and their adopted siblings with birth family contact; we found evidence of changes in the status of contact collectively experienced by 26 adopted sibling pairs when target adoptees were emerging adults. In Study 2, we found that target adoptees (n = 91) with siblings (adopted or not) who were more involved with target adoptees’ birth family contact demonstrated more favorable behavioral outcomes than target adoptees who had uninvolved siblings. Finally in Study 3, for target adoptees with siblings who were also adopted (n = 51), results showed that target adoptees felt more positively about their own adoption when siblings expressed similar positive feelings about individual adoption experiences. Implications of our findings are discussed in terms of the enduring contributions of sibling relationships from childhood into adulthood, and the unique ways in which adoptive siblings are important in shaping one another’s experiences of adoption. PMID:26651349

Prospective phase II study evaluating the efficacy of swallow ability screening tests and pneumonia prevention using a team approach for elderly patients with gastric cancer.

PubMed

Miki, Yuichiro; Makuuchi, Rie; Honda, Shinsaku; Tokunaga, Masanori; Tanizawa, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Yurikusa, Takashi; Tanuma, Akira; Terashima, Masanori

2018-03-01

Aging partly impairs swallowing function, which is considered a risk factor for postoperative pneumonia (PP). We evaluated the efficacy of a new team-based strategy to reduce the incidence of PP in elderly patients with gastric cancer. This single-center, prospective phase II study included elderly patients (≥75 years old) with gastric cancer undergoing gastric surgery. The primary endpoint was the incidence of Clavien-Dindo grade II or higher PP. Patients were initially screened using three swallowing function screening tests: a symptom questionnaire, the modified water swallow test (MSWT), and the repetitive saliva swallowing test (RSST). All patients were provided standard preoperative oral checks and care and simple neck muscle training. For patients who screened positive, a videofluorographic swallowing study was performed; if an abnormality was found, the patient was given intensive swallowing rehabilitation both pre- and postoperatively. Of 86 eligible patients enrolled, PP developed in 3 (3.5%). The 60% confidence interval of 1.8-6.3% had an upper limit below the prespecified threshold of 7.8%. Positive screening results were found for 19 patients (22.1%) on the symptom questionnaire, 3 (3.5%) on the MSWT, and 1 (1.2%) on the RSST. PP was not observed in any patients who screened positive. In conclusion, although the screening tests we adopted here were not sufficient to identify patients at high risk of aspiration pneumonia, perioperative interventions using a team approach might be effective in reducing the incidence of PP in elderly patients with gastric cancer.

A Big Five Personality Typology in Adolescents with Congenital Heart Disease: Prospective Associations with Psychosocial Functioning and Perceived Health.

PubMed

Rassart, Jessica; Luyckx, Koen; Goossens, Eva; Oris, Leen; Apers, Silke; Moons, Philip

2016-06-01

This study aimed (1) to identify different personality types in adolescents with congenital heart disease (CHD), and (2) to relate these personality types to psychosocial functioning and several domains of perceived health, both concurrently and prospectively. Hence, this study aimed to expand previous research by adopting a person-centered approach to personality through focusing on personality types rather than singular traits. Adolescents with CHD were selected from the database of pediatric and congenital cardiology of the University Hospitals Leuven. A total of 366 adolescents (15-20 years old) with CHD participated at time 1. These adolescents completed questionnaires on the Big Five personality traits, depressive symptoms, loneliness, and generic and disease-specific domains of health. Nine months later, 313 patients again completed questionnaires. Cluster analysis at time 1 revealed three personality types: resilients (37 %), undercontrollers (34 %), and overcontrollers (29 %), closely resembling typologies obtained in previous community samples. Resilients, under-, and overcontrollers did not differ in terms of disease complexity, but differed on depressive symptoms, loneliness, and generic and disease-specific domains of perceived health at both time-points. Overall, resilients showed the most favorable outcomes and overcontrollers the poorest, with undercontrollers scoring in-between. Personality assessment can help clinicians in identifying adolescents at risk for physical and psychosocial difficulties later in time. In this study, both over- and undercontrollers were identified as high-risk groups. Our findings show that both personality traits and types should be taken into account to obtain a detailed view on the associations between personality and health.

Joseph Constantine Carpue and the Bicentennial of the Birth of Modern Plastic Surgery.

PubMed

Freshwater, M Felix

2015-08-01

September 2014 marked the bicentennial of the birth of modern plastic surgery. It was then that Carpue began a prospective observational study of nasal reconstruction that culminated in his 1816 monograph, which caused an explosion of interest in reconstructive surgery throughout Europe. In conducting his study, Carpue demonstrated ethical standards and the power of planning a procedure. His methods to document his results accurately would remain unsurpassed until photography was adopted at the end of the 19th century. Carpue took an apocryphal story of surgery performed in India more than twenty years earlier and transformed it into the beginning of modern plastic surgery. He succeeded in a number of unrecognized tasks that are themselves landmarks not only in plastic surgical history, but surgical history: devising the first prospective observational study, using exclusion criteria, maintaining appropriate patient confidentiality, setting a standard for preoperative disclosure and ethical approval over a century before these measures were codified, having independent documentation of his preoperative and postoperative findings, devising a method to objectively monitor and document the forehead flap, and describing the potential value of tissue expansion. He shared his experience by publishing his results and by lecturing in Europe. His contemporaries recognized him for his contributions and he was honored by election to the Royal Society. Carpue launched the modern era of plastic surgery in an ethical, logical, and objective manner. While plastic surgery has changed in the last two centuries, the principles that Carpue followed remain valid. © 2015 The American Society for Aesthetic Plastic Surgery, Inc.

Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery

PubMed Central

Cascella, Marco; Fusco, Roberta; Caliendo, Domenico; Granata, Vincenza; Carbone, Domenico; Muzio, Maria Rosaria; Laurelli, Giuseppe; Greggi, Stefano; Falcone, Francesca; Forte, Cira Antonietta; Cuomo, Arturo

2017-01-01

Background Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep. Methods Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3). Results Six patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients. Conclusions Anesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient. PMID:29108303

Anesthetic dreaming, anesthesia awareness and patient satisfaction after deep sedation with propofol target controlled infusion: A prospective cohort study of patients undergoing day case breast surgery.

PubMed

Cascella, Marco; Fusco, Roberta; Caliendo, Domenico; Granata, Vincenza; Carbone, Domenico; Muzio, Maria Rosaria; Laurelli, Giuseppe; Greggi, Stefano; Falcone, Francesca; Forte, Cira Antonietta; Cuomo, Arturo

2017-10-03

Anesthetic dreaming and anesthesia awareness are well distinct phenomena. Although the incidence of intraoperative awareness is more common among patients who reported a dream after surgery, the exact correlation between the two phenomena remains an unsolved rebus. The main purpose of this study was to investigate anesthetic dreaming, anesthesia awareness and psychological consequences eventually occurred under deep sedation. Intraoperative dreaming experiences were correlated with dream features in natural sleep. Fifty-one patients, undergoing surgical excision of fibroadenomas under a Bispectral index-guided deep sedation anesthesia with propofol target controlled infusion, were enrolled into this prospective study. Psychological assessment was performed through the State Trait Anxiety Inventory. A questionnaire was adopted to register dreaming and anesthesia awareness. Data were collected after emergence (t0), 24 hours (t1), 1 month (t2), 6 months (t3). Six patients (12%) reported anesthetic dreaming at t0 confirming the response at each subsequent evaluation. One patient (2%) confirmed dreaming during anesthesia in all, but denied it at t0. There was a high correlation between the intraoperative dream contents and the features of dreams in natural sleep. No cases of anesthesia awareness were detected. A similar level of satisfaction was observed in dreaming and no-dreaming patients. Anesthetic dreaming does not seem to influence satisfaction of patients undergoing deep sedation with propofol target controlled infusion. A psychological assessment would seem to improve the evaluation of possible psychological consequences in dreamer patient.

Determinants of Health Behaviors After Gestational Diabetes Mellitus: A Prospective Cohort Study in Geneva.

PubMed

Kaiser, Barbara; Jeannot, Emilien; Razurel, Chantal

2016-09-01

Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. The objective of this study was to specify the determinants of postpartum physical activity and dietary habits after a pregnancy complicated by GDM in a population of Swiss women. This information will be used to improve health promotion and diabetes prevention interventions for women with a history of GDM. A prospective cohort study of 173 pregnant women with a diagnosis of GDM was carried out. Quantitative data were collected at the end of pregnancy (T1) and at 6 months postpartum (T3). Bivariate and multivariate logistic regression analysis was conducted to assess associations between the level of healthy lifestyle at 6 months postpartum, clinical and sociodemographic characteristics, motivation to adopt a healthy lifestyle after birth at the end of pregnancy, and postulated psychosocial correlates of health behaviors. Multivariate regression analysis showed that only 2 variables were determinants in a low adherence to healthy lifestyle in the postpartum period after GDM: a lower level of social support (odds ratio [OR], 1.5; P < .001) and more perceived barriers to a healthy lifestyle (OR, 1.2; P = .002). This study shows that, for women who had GDM, the problem of low adherence to a healthy lifestyle to prevent the onset of type 2 diabetes may be secondary to the lack of resources available for the promotion and development of healthy eating habits and regular physical activity. The findings of this study suggest that some women with a history of GDM do not have the means and resources in the postpartum period to apply the advice given during antenatal monitoring. © 2016 by the American College of Nurse-Midwives.

A prospective study from south India to compare the severity of malaria caused by Plasmodium vivax, P. falciparum and dual infection.

PubMed

Mitra, Shubhanker; Abhilash, Kpp; Arora, Shalabh; Miraclin, Angel

2015-12-01

Traditionally, Plasmodium falciparum has been attributed to cause severe malaria, whereas P. vivax is considered to cause "benign" tertian malaria. Recently, there has been an increasing body of evidence challenging this conviction. However, the spectrum and degree of severity of the disease caused by P. vivax, as per World Health Organization (2012) remains unclear. Thus, in this prospective study, we aimed at comparing the severity of malaria caused by P. vivax, P. falciparum and dual infection. Adult patients presenting to Christian Medical College, Vellore from October 2012 to September 2013 with microscopically confirmed malaria were included in the study. Their clinical and laboratory parameters were recorded and analyzed. Paired t-test and chi-square with 95% CI and post-hoc analyses using the Scheffι post-hoc criterion were used to assess the statistical significance at the level of α <0.05. In total, 131 cases of malaria were identified during the study period, comprising 83 cases of P. vivax, 35 cases of P. falciparum and 13 cases of mixed vivax and falciparum infections. The spectrum and degree of hematological, hepatic, renal, metabolic, central nervous system complications of vivax malaria was not different from that of falciparum group. Thrombocytopenia and hyperbilirubinemia were the most common laboratory abnormalities identified in all the groups. This cross-sectional comparative study clearly demonstrates that clinical features, complications and case-fatality rates in vivax malaria can be as severe as in falciparum malaria. Hence, vivax malaria could not be considered benign; and appropriate preventive strategies along with antimalarial therapies should be adopted for control and elimination of this disease.

Understanding the Links Between Self-Report Emotional Intelligence and Suicide Risk: Does Psychological Distress Mediate This Relationship Across Time and Samples?

PubMed Central

Mérida-López, Sergio; Extremera, Natalio; Rey, Lourdes

2018-01-01

Objective: In the last decades, increasing attention has been paid to examining psychological resources that might contribute to our understanding of suicide risk. Although Emotional Intelligence (EI) is one dimension that has been linked with decreased suicidal ideation and behaviors, we detected several gaps in the literature in this area regarding the research designs and samples involved. In this research, we aimed to test a mediator model considering self-report EI, psychological distress and suicide risk across samples adopting both cross-sectional and prospective designs in two independent studies. Method: In Study 1, our purpose was to examine the potential role of psychological distress as a mediator in the relationship between self-report EI and suicide risk in a community sample comprised of 438 adults (270 women; mean age: 33.21 years). In Study 2, we sought to examine the proposed mediator model considering a 2-month prospective design in a sample of college students (n = 330 in T1; n = 311 in T2; 264 women; mean age: 22.22 years). Results: In Study 1, we found that psychological distress partially mediated the effect of self-report EI on suicide risk. More interestingly, findings from Study 2 showed that psychological distress fully mediated the relationship between self-report EI and suicide risk at Time 2. Conclusion: These results point out the role of psychological distress as a mediator in the association between self-report EI and suicide risk. These findings suggest an underlying process by which self-report EI may act as a protective factor against suicidal ideation and behaviors. In line with the limitations of our work, plausible avenues for future research and interventions are discussed. PMID:29867607

Leveraging the trusted clinician: documenting disease management program enrollment.

PubMed

Frazee, Sharon Glave; Kirkpatrick, Patricia; Fabius, Raymond; Chimera, Joseph

2007-02-01

The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard TDM with a worksite-based primary care and pharmacy delivery protocol led by trusted clinicians. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols, and compares them on contact and enrollment efficiency. The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by trusted clinicians with traditional TDM increases contact and enrollment rates, resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment in disease management programming.

Psychosocial problems in families of children with cancer.

PubMed

Rajajee, Sarala; Ezhilarasi, S; Indumathi, D

2007-09-01

The aim of this study is to assess the effect of diagnosis of cancer on the parents, to study the coping response adopted by the child and the family and to evolve counseling strategies. Prospective questionnaire based. Thirty-four parents of children suffering from cancer were included, of which 15 belonged to joint families and 19 to nuclear families. The family support played an important role in giving emotional sustenance, besides shared care of the child, the sibling and the household. Emotional and psychological impact was maximum on the mothers. Siblings of the cancer child were also affected both by way of behaviour problems and school performance. Behaviour problems in the cancer child included temper tantrums, as also verbal and physical abuse of mothers. Group therapy was useful for sharing emotional trauma and exchanging day to day problems of childcare. Positive outlook helped in better care of the cancer child. The family structure was the foundation for emotional and psychological security. Psychological support by professional tumour support group would enhance this.

Ease of adoption of clinical natural language processing software: An evaluation of five systems.

PubMed

Zheng, Kai; Vydiswaran, V G Vinod; Liu, Yang; Wang, Yue; Stubbs, Amber; Uzuner, Özlem; Gururaj, Anupama E; Bayer, Samuel; Aberdeen, John; Rumshisky, Anna; Pakhomov, Serguei; Liu, Hongfang; Xu, Hua

2015-12-01

In recognition of potential barriers that may inhibit the widespread adoption of biomedical software, the 2014 i2b2 Challenge introduced a special track, Track 3 - Software Usability Assessment, in order to develop a better understanding of the adoption issues that might be associated with the state-of-the-art clinical NLP systems. This paper reports the ease of adoption assessment methods we developed for this track, and the results of evaluating five clinical NLP system submissions. A team of human evaluators performed a series of scripted adoptability test tasks with each of the participating systems. The evaluation team consisted of four "expert evaluators" with training in computer science, and eight "end user evaluators" with mixed backgrounds in medicine, nursing, pharmacy, and health informatics. We assessed how easy it is to adopt the submitted systems along the following three dimensions: communication effectiveness (i.e., how effective a system is in communicating its designed objectives to intended audience), effort required to install, and effort required to use. We used a formal software usability testing tool, TURF, to record the evaluators' interactions with the systems and 'think-aloud' data revealing their thought processes when installing and using the systems and when resolving unexpected issues. Overall, the ease of adoption ratings that the five systems received are unsatisfactory. Installation of some of the systems proved to be rather difficult, and some systems failed to adequately communicate their designed objectives to intended adopters. Further, the average ratings provided by the end user evaluators on ease of use and ease of interpreting output are -0.35 and -0.53, respectively, indicating that this group of users generally deemed the systems extremely difficult to work with. While the ratings provided by the expert evaluators are higher, 0.6 and 0.45, respectively, these ratings are still low indicating that they also experienced considerable struggles. The results of the Track 3 evaluation show that the adoptability of the five participating clinical NLP systems has a great margin for improvement. Remedy strategies suggested by the evaluators included (1) more detailed and operation system specific use instructions; (2) provision of more pertinent onscreen feedback for easier diagnosis of problems; (3) including screen walk-throughs in use instructions so users know what to expect and what might have gone wrong; (4) avoiding jargon and acronyms in materials intended for end users; and (5) packaging prerequisites required within software distributions so that prospective adopters of the software do not have to obtain each of the third-party components on their own. Copyright © 2015 Elsevier Inc. All rights reserved.

Performance Characterization of Dye-Sensitized Photovoltaics under Indoor Lighting.

PubMed

Chen, Chia-Yuan; Jian, Zih-Hong; Huang, Shih-Han; Lee, Kun-Mu; Kao, Ming-Hsuan; Shen, Chang-Hong; Shieh, Jia-Min; Wang, Chin-Li; Chang, Chiung-Wen; Lin, Bo-Zhi; Lin, Ching-Yao; Chang, Ting-Kuang; Chi, Yun; Chi, Cheng-Yu; Wang, Wei-Ting; Tai, Yian; Lu, Ming-De; Tung, Yung-Liang; Chou, Po-Ting; Wu, Wen-Ti; Chow, Tahsin J; Chen, Peter; Luo, Xiang-Hao; Lee, Yuh-Lang; Wu, Chih-Chung; Chen, Chih-Ming; Yeh, Chen-Yu; Fan, Miao-Syuan; Peng, Jia-De; Ho, Kuo-Chuan; Liu, Yu-Nan; Lee, Hsiao-Yi; Chen, Chien-Yu; Lin, Hao-Wu; Yen, Chia-Te; Huang, Yu-Ching; Tsao, Cheng-Si; Ting, Yu-Chien; Wei, Tzu-Chien; Wu, Chun-Guey

2017-04-20

Indoor utilization of emerging photovoltaics is promising; however, efficiency characterization under room lighting is challenging. We report the first round-robin interlaboratory study of performance measurement for dye-sensitized photovoltaics (cells and mini-modules) and one silicon solar cell under a fluorescent dim light. Among 15 research groups, the relative deviation in power conversion efficiency (PCE) of the samples reaches an unprecedented 152%. On the basis of the comprehensive results, the gap between photometry and radiometry measurements and the response of devices to the dim illumination are identified as critical obstacles to the correct PCE. Therefore, we use an illuminometer as a prime standard with a spectroradiometer to quantify the intensity of indoor lighting and adopt the reverse-biased current-voltage (I-V) characteristics as an indicator to qualify the I-V sampling time for dye-sensitized photovoltaics. The recommendations can brighten the prospects of emerging photovoltaics for indoor applications.

Environmental impact assessment: Retrospect and prospect

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

Jay, Stephen; Jones, Carys; Slinn, Paul

2007-05-15

The widespread experience of environmental impact assessment (EIA) as an anticipatory environmental management tool has generated a considerable debate over the extent to which it is achieving its purposes. This has been measured in terms of EIA 'effectiveness', especially as discussion has moved away from issues of procedural implementation, to the more substantive goals of EIA and its place within broader decision-making contexts. Empirical studies have revealed the relatively weak degree of influence on planning decisions that is being exerted by EIA, which is increasingly being attributed to its rationalist beginnings. This article seeks to direct this debate towards themore » founding political purposes of EIA which, it is argued, provide a neglected, yet strong, basis for EIA reform. A number of illustrative suggestions are made as a result of this redirection, to enable EIA to adopt a more determinative role in decision making and to contribute to more sustainable patterns of development planning.« less

Nitric Oxide Donor-Based Cancer Therapy: Advances and Prospects.

PubMed

Huang, Zhangjian; Fu, Junjie; Zhang, Yihua

2017-09-28

The increasing understanding of the role of nitric oxide (NO) in cancer biology has generated significant progress in the use of NO donor-based therapy to fight cancer. These advances strongly suggest the potential adoption of NO donor-based therapy in clinical practice, and this has been supported by several clinical studies in the past decade. In this review, we first highlight several types of important NO donors, including recently developed NO donors bearing a dinitroazetidine skeleton, represented by RRx-001, with potential utility in cancer therapy. Special emphasis is then given to the combination of NO donor(s) with other therapies to achieve synergy and to the hybridization of NO donor(s) with an anticancer drug/agent/fragment to enhance the activity or specificity or to reduce toxicity. In addition, we briefly describe inducible NO synthase gene therapy and nanotechnology, which have recently entered the field of NO donor therapy.

Childhood intussusception: A prospective study of management trend in a developing country.

PubMed

Ogundoyin, Olakayode Olaolu; Olulana, Dare Isaac; Lawal, Taiwo Akeem

2015-01-01

The management of intussusception has evolved universally from the use of hydrostatic reduction through operative reduction to the use of pneumatic reduction for the acute and uncomplicated cases and surgical reduction for the complicated cases. However, the process of evolution has been very slow in the developing countries, especially sub-Saharan Africa, due to lack of requisite facilities and expertise to manage these patients nonoperatively. This study examined the trends in the management of childhood intussusception in a developing country, compared operative and nonoperative modalities of treatment, and assessed the impact of delayed presentation on the outcome of management. This was a prospective study of the management of children with intussusception at the University College Hospital, Ibadan, Nigeria. Fifty-five consecutive cases of intussusception that presented to the Children Emergency Unit of the University College Hospital between January 2005 and December 2011 were prospectively studied. Details of sex, age of the patients, clinical presentation, duration of symptoms, mode of treatment, and incidence of recurrence were recorded and analyzed. The median age was 7 months. Moreover, the duration of symptoms varied from 1 to 21 days with a mean of 4 days. Twenty-two patients (40%) had attempted hydrostatic reduction; this was successful in 14 patients (63.6%), whereas 8 patients (36.4%) had failed reduction. In all, 41 patients (74.6%) had operative management of intussusceptions; primary operative intervention was carried out in 33 patients (60%) and secondary surgical management in 8 patients (14.5%) with failed hydrostatic reduction. At surgery, manual reduction of intussusception was carried out on 17 patients (30.9%) and resection of devitalized bowel with end to end anastomosis was carried out on the remaining 24 patients (43.6%). The incidence of surgical intervention for intussusception was 74.6%, mortality was 3.6%, and recurrence rate was 3.6%. Nonoperative management of intussusception should be adopted in carefully selected cases of intussusception in this subregion as it will help to reduce the financial burden on the parents while surgical management should be reserved for the complicated cases.

A Longitudinal Study of Family Structure and Size and Adoption Outcomes.

ERIC Educational Resources Information Center

Barth, Richard P.; Brooks, Devon

1997-01-01

This follow-up study of international and domestic adoptions, involving participants first studied in 1981, investigated the role of family size and structure, particularly the presence of both biological and adopted children in a family, on adoption outcomes. Data suggested that families who adopt children and have birth children may have less…

[Acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages:a clinical randomized controlled trial].

PubMed

Wang, Zhanyou; Zhou, Xuelong; Xie, Lishuang; Liang, Dongyue; Wang, Ying; Zhang, Hong-An; Zheng, Jinghong

2016-10-12

To compare the efficacy difference between acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages. The randomized controlled prospective study method was adopted. Sixty cases of avascular necrosis of femoral head at Ficat-ArletⅠto Ⅱ stages were randomized into an acupotomy group (32 cases) and an acupuncture group (28 cases) by the third part. In the acupotomy group, the acupotomy was adopted for the loose solution at the treatment sites of hip joint, once every two weeks, totally for 3 times. In the acupuncture group, ashi points around the hip joint were selected and stimulated with warm acupuncture therapy, once every day, for 6 weeks. Harris hip score was observed before and after treatment. The efficacy was evaluated in the two groups. Harris hip score was improved significantly after treatment in the two groups (both P <0.05). The result in acupotomy group was better than that in the acupuncture group ( P <0.05). The effective rate was 90.6% (29/32) in the acupotomy group, better than 75.0% (21/28) in the acupuncture group after treatment ( P <0.05). Harris hip score and the effective rate in the acupotomy group are better than those in the treatment with routine acupuncture for avascular necrosis of femoral head at the early and middle stages.

Model for end-stage liver disease-based allocation system for liver transplantation in Argentina: does it work outside the United States?

PubMed

McCormack, L; Gadano, A; Lendoire, J; Imventarza, O; Andriani, O; Gil, O; Toselli, L; Bisigniano, L; de Santibañes, E

2010-09-01

In July 2005, Argentina was the first country after the United States to adopt the MELD system. The purpose of the present study was to analyse the impact of this new system on the adult liver waiting list (WL). Between 2005 and 2009, 1773 adult patients were listed for liver transplantation: 150 emergencies and 1623 electives. Elective patients were categorized using the MELD system. A prospective database was used to analyse mortality and probability to be transplanted (PTBT) on the WL. The waiting time increased inversely with the MELD score and PTBT positively correlated with MELD score. With scores >/= 18 the PTBT remained over 50%. However, the largest MELD subgroup with <10 points (n = 433) had the lower PTBT (3%). In contrast, patients with T(2) hepatocellular carcinoma benefited excessively with the highest PTBT (84.2%) and the lowest mortality rate (5.4%). The WL mortality increased after MELD adoption (10% vs. 14.8% vs. P < 0.01). Patients with <10 MELD points had >fourfold probability of dying on the WL than PTBT (14.3% vs. 3%; P < 0.0001). After MELD implementation, WL mortality increased and most patients who died had a low MELD score. A comprehensive revision of the MELD system must be performed to include cultural and socio-economical variables that could affect each country individually.

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

Yahalom, Joachim, E-mail: yahalomj@mskcc.org; Illidge, Tim; Specht, Lena

Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT inmore » the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT.« less

Teaching oral hygiene to children with autism.

PubMed

Pilebro, C; Bäckman, B

2005-01-01

The need for improved oral hygiene routines in individuals with disabilities has been documented in many reports. The aim of this study was to evaluate whether visual pedagogy is a suitable way to teach children with autism how to brush their teeth. The investigation took the form of a prospective study including clinical examinations and structured interviews. Based on visual pedagogy, a series of pictures were produced that showed a structured method and technique of tooth brushing. The pictures were placed in the bathroom or wherever tooth brushing was performed. Fourteen children with autism aged between 5 and 13 years (mean age = 9.3 years), and their parents participated. Before the study, all parents found it difficult/very difficult to maintain good oral hygiene in their child. All children had visible plaque on their maxillary incisors and canines. After 12 months, the amount of visible plaque was reduced. After 18 months, most parents found maintaining good oral hygiene easier than before the study. All but one child/parent adopted the programme. Visual pedagogy is a useful tool in helping people with autism to improve their oral hygiene.

Trunk kinematics and low back pain during pruning among vineyard workers—A field study at the Chateau Larose-Trintaudon

PubMed Central

Balaguier, Romain; Madeleine, Pascal; Rose-Dulcina, Kévin; Vuillerme, Nicolas

2017-01-01

The prevalence of low back disorders is dramatically high in viticulture. Field measurements that objectively quantify work exposure can provide information on the relationship between the adopted trunk postures and low back pain. The purposes of the present study were three-fold (1) to carry out a kinematics analysis of vineyard-workers’ pruning activity by extracting the duration of bending and rotation of the trunk, (2) to question separately the relationship between the duration of forward bending or trunk rotation with low back pain intensity and pressure pain sensitivity and (3) to question the relationship between the combined duration of forward bending and trunk rotation on low back pain intensity and pressure pain sensitivity. Fifteen vineyard-workers were asked to perform pruning activity for 12 minutes with a wireless triaxial accelerometer placed on their trunk. Kinematic analysis of the trunk showed that vineyard-workers spent more than 50% of the time with the trunk flexed greater than 30° and more than 20% with the trunk rotated greater than 10°. These results show that pruning activity lead to the adoption of forward bended and rotated trunk postures that could significantly increase the risk of work related musculoskeletal disorders in the low back. However, this result was mitigated by the observation of an absence of significant association between the duration of forward bending and trunk rotation with low back pain intensity or pressure pain sensitivity. Even if prospective field measurements and studies assessing the effects of low back pain confounders are needed, this field study provides new genuine information on trunk kinematics during pruning activity. PMID:28384277

Healthy Behaviour Change and Cardiovascular Outcomes in Newly Diagnosed Type 2 Diabetes Patients - ADDITION-Cambridge Cohort Study

PubMed Central

Long, Gráinne H; Cooper, Andrew J M; Wareham, Nicholas J; Griffin, Simon J; Simmons, Rebecca K

2014-01-01

OBJECTIVE To examine whether improvements in health behaviours are associated with reduced risk of cardiovascular disease (CVD) in individuals with newly-diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS Population-based prospective cohort study of 867 newly diagnosed diabetes patients aged between 40 and 69 years from the treatment phase of the ADDITION-Cambridge study. As the results for all analyses were similar by trial arm, data were pooled and results presented for the whole cohort. Participants were identified via population-based stepwise screening between 2002 and 2006 and underwent assessment of physical activity (EPAQ questionnaire), diet (plasma vitamin C and self-report), and alcohol consumption (self-report) at baseline and one year. A composite primary CVD outcome was examined, comprised of cardiovascular mortality, non-fatal myocardial infarction, nonfatal stroke and revascularisation. RESULTS After a mean (SD) follow-up of 5.1 (1.1) years, 6% of the cohort experienced a CVD event (12.2/1000-person years; 95% CI 9.3 to 15.9). CVD risk was inversely related to the number of positive health behaviours changed in the year following diabetes diagnosis. The relative risk (95% CI) for primary CVD event in individuals who did not change any health behavior compared to those who adopted three/four healthy behaviors was 4.17 (1.02 to 17.09), adjusting for age, sex, study group, social class occupation and prescription of cardio-protective medication (ptrend = 0.005). CONCLUSIONS Cardiovascular disease risk was inversely associated with the number of healthy behaviour changes adopted in the year following diagnosis of diabetes. Interventions that promote early achievement of these goals in newly diagnosed patients could help reduce the burden of diabetes-related morbidity and mortality. PMID:24658389

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Patterns and Predictors of Adoption Openness and Contact: 14 Years Postadoption

ERIC Educational Resources Information Center

Crea, Thomas M.; Barth, Richard P.

2009-01-01

Increased attention is being paid to open adoption arrangements between birth parents and adopted children and families. This study examines openness and contact among 469 adoptions at 14 years postadoption from the fourth wave of the California Long-Range Adoption Study (CLAS) and 378 adoptions matched across all waves. The proportion of families…

Post-Adoption Contact, Adoption Communicative Openness, and Satisfaction with Contact as Predictors of Externalizing Behavior in Adolescence and Emerging Adulthood

ERIC Educational Resources Information Center

Grotevant, Harold D.; Rueter, Martha; Von Korff, Lynn; Gonzalez, Christopher

2011-01-01

Background: This study examined the relation between three variables related to adoptive family relationships (post-adoption contact between adoptive and birth family members, adoption communicative openness, and satisfaction with contact) and adoptee externalizing behavior in adolescence and emerging adulthood. Method: The study included 190…

Prediction in Child Development: A Longitudinal Study of Adoptive and Nonadoptive Families. The Delaware Family Study.

ERIC Educational Resources Information Center

Hoopes, Janet L.

A longitudinal study was conducted to determine factors predicting successful adoptions before placement and to identify differences and similarities between adoptive and biological families. Data collected on both adopted children and on their adoptive families before placement was related to data collected on the same children and families 6…

Framing the inborn aging process and longevity science.

PubMed

Farrelly, Colin

2010-06-01

The medical sciences are currently dominated by the "disease-model" approach to health extension, an approach that prioritizes the study of pathological mechanisms with the goal of discovering treatment modalities for specific diseases. This approach has marginalized research on the aging process itself, research that could lead to an intervention that retards aging, thus conferring health dividends that would far exceed what could be expected by eliminating any specific disease of aging. This paper offers a diagnosis of how this sub-optimal approach to health extension arose and some general prescriptions concerning how progress could be made in terms of adopting a more rational approach to health extension. Drawing on empirical findings from psychology and economics, "prospect theory" is applied to the challenges of "framing" the inborn aging process given the cognitive capacities of real (rather than rational) decision-makers under conditions of risk and uncertainty. Prospect theory reveals that preferences are in fact dependent on whether particular outcomes of a choice are regarded as "a loss" or "a gain", relative to a reference point (or "aspiration level for survival"). And this has significant consequences for the way biogerontologists ought to characterise the central aspirations of the field (i.e. to prevent disease versus extend lifespan). Furthermore, it reveals the importance of shifting the existing reference point of the medical sciences to one that is shaped by the findings of evolutionary biology and biodemography.

A behavioural and neural evaluation of prospective decision-making under risk

PubMed Central

Symmonds, Mkael; Bossaerts, Peter; Dolan, Raymond J.

2010-01-01

Making the best choice when faced with a chain of decisions requires a person to judge both anticipated outcomes and future actions. Although economic decision-making models account for both risk and reward in single choice contexts there is a dearth of similar knowledge about sequential choice. Classical utility-based models assume that decision-makers select and follow an optimal pre-determined strategy, irrespective of the particular order in which options are presented. An alternative model involves continuously re-evaluating decision utilities, without prescribing a specific future set of choices. Here, using behavioral and functional magnetic resonance imaging (fMRI) data, we studied human subjects in a sequential choice task and use these data to compare alternative decision models of valuation and strategy selection. We provide evidence that subjects adopt a model of re-evaluating decision utilities, where available strategies are continuously updated and combined in assessing action values. We validate this model by using simultaneously-acquired fMRI data to show that sequential choice evokes a pattern of neural response consistent with a tracking of anticipated distribution of future reward, as expected in such a model. Thus, brain activity evoked at each decision point reflects the expected mean, variance and skewness of possible payoffs, consistent with the idea that sequential choice evokes a prospective evaluation of both available strategies and possible outcomes. PMID:20980595

Use of the Ion PGM and the GeneReader NGS Systems in Daily Routine Practice for Advanced Lung Adenocarcinoma Patients: A Practical Point of View Reporting a Comparative Study and Assessment of 90 Patients.

PubMed

Heeke, Simon; Hofman, Véronique; Long-Mira, Elodie; Lespinet, Virginie; Lalvée, Salomé; Bordone, Olivier; Ribeyre, Camille; Tanga, Virginie; Benzaquen, Jonathan; Leroy, Sylvie; Cohen, Charlotte; Mouroux, Jérôme; Marquette, Charles Hugo; Ilié, Marius; Hofman, Paul

2018-03-21

Background : With the integration of various targeted therapies into the clinical management of patients with advanced lung adenocarcinoma, next-generation sequencing (NGS) has become the technology of choice and has led to an increase in simultaneously interrogated genes. However, the broader adoption of NGS for routine clinical practice is still hampered by sophisticated workflows, complex bioinformatics analysis and medical interpretation. Therefore, the performance of the novel QIAGEN GeneReader NGS system was compared to an in-house ISO-15189 certified Ion PGM NGS platform. Methods : Clinical samples from 90 patients (60 Retrospectively and 30 Prospectively) with lung adenocarcinoma were sequenced with both systems. Mutations were analyzed and EGFR , KRAS , BRAF , NRAS , ALK , PIK3CA and ERBB2 genes were compared and sampling time and suitability for clinical testing were assessed. Results : Both sequencing systems showed perfect concordance for the overlapping genes. Correlation of allele frequency was r ² = 0.93 for the retrospective patients and r ² = 0.81 for the prospective patients. Hands-on time and total run time were shorter using the PGM system, while the GeneReader platform provided good traceability and up-to-date interpretation of the results. Conclusion : We demonstrated the suitability of the GeneReader NGS system in routine practice in a clinical pathology laboratory setting.

A behavioral and neural evaluation of prospective decision-making under risk.

PubMed

Symmonds, Mkael; Bossaerts, Peter; Dolan, Raymond J

2010-10-27

Making the best choice when faced with a chain of decisions requires a person to judge both anticipated outcomes and future actions. Although economic decision-making models account for both risk and reward in single-choice contexts, there is a dearth of similar knowledge about sequential choice. Classical utility-based models assume that decision-makers select and follow an optimal predetermined strategy, regardless of the particular order in which options are presented. An alternative model involves continuously reevaluating decision utilities, without prescribing a specific future set of choices. Here, using behavioral and functional magnetic resonance imaging (fMRI) data, we studied human subjects in a sequential choice task and use these data to compare alternative decision models of valuation and strategy selection. We provide evidence that subjects adopt a model of reevaluating decision utilities, in which available strategies are continuously updated and combined in assessing action values. We validate this model by using simultaneously acquired fMRI data to show that sequential choice evokes a pattern of neural response consistent with a tracking of anticipated distribution of future reward, as expected in such a model. Thus, brain activity evoked at each decision point reflects the expected mean, variance, and skewness of possible payoffs, consistent with the idea that sequential choice evokes a prospective evaluation of both available strategies and possible outcomes.

Observing relationships in Finnish adoptive families: Oulu Family Rating Scale.

PubMed

Tienari, Pekka; Wynne, Lyman C; Sorri, Anneli; Lahti, Ilpo; Moring, Juha; Nieminen, Pentti; Joukamaa, Matti; Naarala, Mikko; Seitamaa, Markku; Wahlberg, Karl-Erik; Miettunen, Jouko

2005-01-01

Adoption studies were intended to separate genetic from environmental "causal" factors. In earlier adoption studies, psychiatric diagnostic labels for the adoptive parents were used as a proxy for the multiple dimensions of the family rearing environment. In the Finnish Adoption Study, research design provided the opportunity to study directly the adoptive family rearing environment. For this purpose 33 sub-scales were selected creating what we call Oulu Family Rating Scale (OPAS, Oulun PerheArviointiSkaala). In this paper, the manual for scoring of these sub-scales is presented.

Challenges and strategies for cohort retention and data collection in an indigenous population: Australian Aboriginal Birth Cohort.

PubMed

Lawrance, Megan; Sayers, Susan M; Singh, Gurmeet R

2014-02-26

Longitudinal prospective birth cohort studies are pivotal to identifying fundamental causes and determinants of disease and health over the life course. There is limited information about the challenges, retention, and collection strategies in the study of Indigenous populations. The aim is to describe the follow-up rates of an Australian Aboriginal Birth Cohort study and how they were achieved. Participants were 686 babies enrolled between January 1987 and March 1990, born to a mother recorded in the Delivery Suite Register of the Royal Darwin Hospital (RDH) as a self-identified Aboriginal. The majority of the participants (70%) resided in Northern Territory within rural, remote and very remote Aboriginal communities that maintain traditional connections to their land and culture. The Aboriginal communities are within a sparsely populated (0.2 people/ km2) area of approximately 900,000 km² (347 sq miles), with poor communication and transport infrastructures. Follow-ups collecting biomedical and lifestyle data directly from participants in over 40 locations were conducted at 11.4 years (Wave-2) and 18.2 years (Wave-3), with Wave-4 follow-up currently underway. Follow-ups at 11 and 18 years of age successfully examined 86% and 72% of living participants respectively. Strategies addressing logistic, cultural and ethical challenges are documented. Satisfactory follow-up rates of a prospective longitudinal Indigenous birth cohort with traditional characteristics are possible while maintaining scientific rigor in a challenging setting. Approaches included flexibility, respect, and transparent communication along with the adoption of culturally sensitive behaviours. This work should inform and assist researchers undertaking or planning similar studies in Indigenous and developing populations.

Use of nesiritide before and after publications suggesting drug-related risks in patients with acute decompensated heart failure.

PubMed

Hauptman, Paul J; Schnitzler, Mark A; Swindle, Jason; Burroughs, Thomas E

2006-10-18

The rate of adoption of new therapies for cardiovascular diseases following the publication of favorable clinical trial results has been studied; however, less is known about the rates of de-adoption of a drug when negative studies are published. To evaluate the use of nesiritide before and after March and April 2005 publications in 2 high-impact journals that suggested an increased risk of renal failure and mortality with intravenous nesiritide for acute decompensated heart failure. Analysis of a large prospective hospital database, developed for quality and utilization benchmarking, of 491 acute care US hospitals at which 385,627 inpatient admissions occurred with a primary International Classification of Diseases, Ninth Revision (ICD-9) code for heart failure between January and August 2001 (prior to nesiritide release) and January 2004 to December 2005 (before and after publication periods). In addition, any patient admitted who received nesiritide in the absence of a primary or secondary heart failure code was evaluated for potential off-label use of the drug. Use of nesiritide and other intravenous vasoactive therapy among patients admitted with heart failure. Nesiritide use decreased from a peak of 16.6% (2351 of 14,167 admissions) in March 2005 to 5.6% (611 of 10,822 admissions) in December 2005 (P<.001). Among those patients treated with nesiritide, the mean duration of treatment changed minimally, from 2.3 to 2.1 days. Although the use of inotropes also decreased during the period under study, the changes were more modest; furthermore, of those patients who were prescribed intravenous vasoactive therapy, a higher percentage were prescribed inotropes after publication (3272 [21.5%] of 15 193 patients from January-April 2005 vs 5750 [29.6%] of 19 445 patients from May-December 2005, P<.001). The use of nesiritide, in the absence of an ICD-9 heart failure code, was small. Rapid de-adoption of nesiritide occurred following 2 publications suggesting risk with the drug. Further analyses are required to evaluate the consequences of these changes on patient outcomes and to anticipate how publications of adverse findings can influence practice.

Evaluation of earthquake potential in China

NASA Astrophysics Data System (ADS)

Rong, Yufang

I present three earthquake potential estimates for magnitude 5.4 and larger earthquakes for China. The potential is expressed as the rate density (that is, the probability per unit area, magnitude and time). The three methods employ smoothed seismicity-, geologic slip rate-, and geodetic strain rate data. I test all three estimates, and another published estimate, against earthquake data. I constructed a special earthquake catalog which combines previous catalogs covering different times. I estimated moment magnitudes for some events using regression relationships that are derived in this study. I used the special catalog to construct the smoothed seismicity model and to test all models retrospectively. In all the models, I adopted a kind of Gutenberg-Richter magnitude distribution with modifications at higher magnitude. The assumed magnitude distribution depends on three parameters: a multiplicative " a-value," the slope or "b-value," and a "corner magnitude" marking a rapid decrease of earthquake rate with magnitude. I assumed the "b-value" to be constant for the whole study area and estimated the other parameters from regional or local geophysical data. The smoothed seismicity method assumes that the rate density is proportional to the magnitude of past earthquakes and declines as a negative power of the epicentral distance out to a few hundred kilometers. I derived the upper magnitude limit from the special catalog, and estimated local "a-values" from smoothed seismicity. I have begun a "prospective" test, and earthquakes since the beginning of 2000 are quite compatible with the model. For the geologic estimations, I adopted the seismic source zones that are used in the published Global Seismic Hazard Assessment Project (GSHAP) model. The zones are divided according to geological, geodetic and seismicity data. Corner magnitudes are estimated from fault length, while fault slip rates and an assumed locking depth determine earthquake rates. The geological model fits the earthquake data better than the GSHAP model. By smoothing geodetic strain rate, another potential model was constructed and tested. I derived the upper magnitude limit from the Special catalog, and assume local "a-values" proportional to geodetic strain rates. "Prospective" tests show that the geodetic strain rate model is quite compatible with earthquakes. By assuming the smoothed seismicity model as a null hypothesis, I tested every other model against it. Test results indicate that the smoothed seismicity model performs best.

8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Convention adoption home study requirements... IMMIGRANT PETITIONS Intercountry Adoption of a Convention Adoptee § 204.311 Convention adoption home study requirements. (a) Purpose. For immigration purposes, a home study is a process for screening and preparing an...

8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Convention adoption home study requirements... IMMIGRANT PETITIONS Intercountry Adoption of a Convention Adoptee § 204.311 Convention adoption home study requirements. (a) Purpose. For immigration purposes, a home study is a process for screening and preparing an...

8 CFR 204.311 - Convention adoption home study requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Convention adoption home study requirements... IMMIGRANT PETITIONS Intercountry Adoption of a Convention Adoptee § 204.311 Convention adoption home study requirements. (a) Purpose. For immigration purposes, a home study is a process for screening and preparing an...

Determinants of Cat Choice and Outcomes for Adult Cats and Kittens Adopted from an Australian Animal Shelter

PubMed Central

Zito, Sarah; Paterson, Mandy; Vankan, Dianne; Morton, John; Bennett, Pauleen; Phillips, Clive

2015-01-01

Simple Summary Commonly, more adult cats than kittens are euthanized in animal shelters. We surveyed 382 cat adopters to assess adoption outcomes and potential determinants of adopters’ choice of cat age group and price. Most adopters had benevolent motivations for adopting from the shelter and had put considerable thought into the adoption and responsible ownership requirements. However, adult cat adopters were more likely to have been influenced by price than kitten adopters. Adoption outcomes were generally positive in all age and adoption price groups. This study provides evidence to inform the design of strategies to encourage adult cat adoptions. Abstract The percentage of adult cats euthanized in animal shelters is greater than that of kittens because adult cats are less likely to be adopted. This study aimed to provide evidence to inform the design of strategies to encourage adult cat adoptions. One such strategy is to discount adoption prices, but there are concerns that this may result in poor adoption outcomes. We surveyed 382 cat adopters at the time of adoption, to assess potential determinants of adopters’ cat age group choice (adult or kitten) and, for adult cat adopters, the price they are willing to pay. The same respondents were surveyed again 6–12 months after the adoption to compare outcomes between cat age groups and between adult cats in two price categories. Most adopters had benevolent motivations for adopting from the shelter and had put considerable thought into the adoption and requirements for responsible ownership. However, adult cat adopters were more likely to have been influenced by price than kitten adopters. Adoption outcomes were generally positive for both adult cats and kittens and for adult cats adopted at low prices. The latter finding alleviates concerns about the outcomes of “low-cost” adoptions in populations, such as the study population, and lends support for the use of “low-cost” adoptions as an option for attempting to increase adoption rates. In addition, the results provide information that can be used to inform future campaigns aimed at increasing the number of adult cat adoptions, particularly in devising marketing strategies for adult cats. PMID:26479236

International adoption of children with birth defects: current knowledge and areas for further research.

PubMed

Cochran, Meagan E; Nelson, Katherine R; Robin, Nathaniel H

2014-12-01

To summarize the existing literature on the international adoption of children with birth defects and identify areas for further research. International adoption brings thousands of children to the United States each year, and children with birth defects are overrepresented in this population. Studies have demonstrated disparities in the health of children adopted from different countries as well as the complexity of medical care needed after adoption. Although the health of children involved in international adoption has been well studied, there is a lack of information about the experiences of the adoptive parents of children with birth defects. We discuss a pilot study conducted on adoptive parents of children with a specific birth defect, orofacial clefting, and discuss areas for future research.

Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals

PubMed Central

Cornford, Tony; Barber, Nicholas; Avery, Anthony; Takian, Amirhossein; Lichtner, Valentina; Petrakaki, Dimitra; Crowe, Sarah; Marsden, Kate; Robertson, Ann; Morrison, Zoe; Klecun, Ela; Prescott, Robin; Quinn, Casey; Jani, Yogini; Ficociello, Maryam; Voutsina, Katerina; Paton, James; Fernando, Bernard; Jacklin, Ann; Cresswell, Kathrin

2011-01-01

Objectives To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England. Design Theoretically informed, longitudinal qualitative evaluation based on case studies. Setting 12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years. Data sources Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. Results Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS providers. There was early evidence that deploying systems resulted in important learning within and between organisations and the development of relevant competencies within NHS hospitals. Conclusions Implementation of the NHS Care Records Service in “early adopter” sites proved time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients. Although our results might not be directly transferable to later adopting sites because the functionalities we evaluated were new and untried in the English context, they shed light on the processes involved in implementing major new systems. The move to increased local decision making that we advocated based on our interim analysis has been pursued and welcomed by the NHS, but it is important that policymakers do not lose sight of the overall goal of an integrated interoperable solution. PMID:22006942

Processes linked to contact changes in adoptive kinship networks.

PubMed

Dunbar, Nora; van Dulmen, Manfred H M; Ayers-Lopez, Susan; Berge, Jerica M; Christian, Cinda; Gossman, Ginger; Henney, M Susan M; Mendenhall, Tai J; Grotevant, Harold D; McRoy, Ruth G

2006-12-01

The purpose of this study was to reveal underlying processes in adoptive kinship networks that experienced increases or decreases in levels of openness during the child's adolescent years. Intensive case study analyses were conducted for 8 adoptive kinship networks (each including an adoptive mother, adoptive father, adopted adolescent, and birth mother), half of whom had experienced an increase in openness from indirect (mediated) to direct (fully disclosed) contact and half of whom had ceased indirect contact between Waves 1 and 2 of a longitudinal study. Adoptive mothers tended to be more involved in contact with the birth mother than were adoptive fathers or adopted adolescents. Members of adoptive kinship networks in which a decrease in level of contact took place had incongruent perspectives about who initiated the stop in contact and why the stop took place. Birth mothers were less satisfied with their degree of contact than were adoptive parents. Adults' satisfaction with contact was related to feelings of control over type and amount of interactions and permeability of family boundaries. In all adoptive kinship networks, responsibility for contact had shifted toward the adopted adolescent regardless of whether the adolescent was aware of this change in responsibility.

Implementation of a volunteer university student research assistant program in an emergency department: the nuts and bolts for success.

PubMed

Steadman, Patrick E; Crudden, Johanna; Boutis, Kathy

2015-09-01

Prospective research studies often advance clinical practice in the emergency department (ED), but they can be costly and difficult to perform. In this report, we describe the implementation of a volunteer university student research assistant program that provides students exposure to medicine and clinical research while simultaneously increasing the capacity of an ED's research program. This type of program provides 15 hours per day of research assistant coverage for patient screening and enrolment for minimal risk research studies, and screening for higher risk studies. The latter is true without the added burden or costs of co-administering university course credit or pay for service, which are common features of most of these types of programs currently in operation. We have shown that our volunteer-based program is effective for an ED's research success as well as for its student participants. For other EDs interested in adopting similar programs, we provide the details on how to get such a program started and highlight the structure and non-monetary incentives that facilitate a program's ongoing success.

Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

PubMed

Goh, Brian K P; Low, Tze-Yi; Lee, Ser-Yee; Chan, Chung-Yip; Chung, Alexander Y F; Ooi, London L P J

2018-05-24

Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS. This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon. The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions. Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy. © 2018 Royal Australasian College of Surgeons.

A Study of Self-Esteem in Adopted Non-adopted Adolescents.

ERIC Educational Resources Information Center

Steward, Robbie J.; Lynn, Betty Jane

This study tested the hypothesis that adopted adolescents have lower self-esteem than do non-adopted adolescents. Male and female students (N=159) between the ages of 18 and 22 were conveniently sampled from college undergraduate populations. Forty-four of the participants reported adoptive status. Each participant completed the Coopersmith…

Taking stock of agroforestry adoption studies

Treesearch

Subhrendu K. Pattanayak; D. Evan Mercer; Erin Sills; Jui-Chen Yang

2003-01-01

In light of the large number of empirical studies of agroforestry adoption published during the last decade, we believe it is time to take stock and identify general determinants of agroforestry adoption. In reviewing 120 articles on adoption of agricultural and forestry technology by small holders, we find five categories of factors that explain technology adoption...

Domestic Transracial Adoption: In the Words of African American Adoptees

ERIC Educational Resources Information Center

Smith, Ellen M.

2013-01-01

Domestic transracial adoption has sparked more controversy than any other type of adoption. For the purposes of this study domestic transracial adoption is defined as European American parents adopting African American children. Many of the studies completed are contradictory and fail to control for variables that affect the outcome such as age of…

Lesbian, Gay, and Heterosexual Couples in Open Adoption Arrangements: A Qualitative Study

ERIC Educational Resources Information Center

Goldberg, Abbie E.; Kinkler, Lori A.; Richardson, Hannah B.; Downing, Jordan B.

2011-01-01

Little research has attended to the role of gender and sexual orientation in shaping open adoption dynamics. This qualitative, longitudinal study of 45 adoptive couples (15 lesbian, 15 gay, and 15 heterosexual couples) examined adopters' motivations for open adoption, changes in attitudes about openness, and early relationship dynamics. Key…

Adopted children's emotion regulation: The role of parental attitudes and communication about adoption.

PubMed

Soares, Joana; Barbosa-Ducharne, Maria; Palacios, Jesús; Pacheco, Ana

2017-02-01

Acknowledgement/rejection of adoption related differences and communication about adoption are two of the most important features of  adoptive family dynamics. The present study focuses on the role played by these two variables on the adoptees’ emotion regulation. The adoptive parents of 70 school-aged children participated in the study. Data showed that participant parents perceived their adopted children’s emotion regulation as adequate. In relation to family dynamics, acknowledgment of the adoption specificities significantly predicted the emotional lability/negativity of the adoptees, simultaneously mediated by the emotional quality of and the parental satisfaction with the communication about adoption. Furthermore, there was an indirect effect of early adversity on the adopted child’s emotional lability. These findings provide new insight into adopted children’s emotional development, highlighting the importance of the family environment and pre-adoption experiences.

a Study of Risk Preferences and Perceptions of Weather Variability of Smallholder Subsistence Farmers in Malawi

NASA Astrophysics Data System (ADS)

Yoon, S.; Michelson, H. C.

2013-12-01

In 2011, the global population reached seven billion people. According to Foley et al. (2011) nearly one billion still suffer from chronic hunger. World population is expected to increase by another 9-11 billion by 2050. As demand for food grows, the world food system faces three primary challenges: to ensure that the current population of seven billion is adequately fed, to double food production to meet future population growth, and to achieve both in an environmentally sustainable way. As pressures on the global food system grow, sub-Saharan presents a special set of opportunities and challenges. In parts of sub-Saharan Africa, smallholder adoption of productivity-increasing agricultural technologies has proved a pervasive challenge and staple grain yields in the region lag significantly behind the rest of the world. National policies and internationally-funded initiatives such as the Alliance for a Green Revolution in Africa (AGRA) have proposed to close the agricultural yield gap through promotion of small farmer adoption of technologies that increase production efficiency, such as improved seeds, fertilizer and irrigation. However, research has found that even when these productivity-enhancing technologies are provided at subsidized costs, many projects report take-up rates well below 100%. In order to understand why farmers are not making investments to improve staple crop yields, it is critical to investigate the nature of the problem of the low take-up rate. Possible hypotheses include: credit constraints, opportunity costs, and farmer risk and/or time preferences that lead them to delay investment. Our project in Mwandama, Malawi uses techniques from prospect theory and expected utility theory to provide insight into farmer decision-making around technology adoption. We build on past research conducted in Ethiopia, India and Uganda, which has found that poor farmers systematically underweight the likelihood of good outcomes. We use a new methodology called parametric Dynamic Experiments for Estimating Preferences developed at Columbia University to measure three prospect theory parameters using an adaptive survey tool installed on a tablet PC. Our work is the first to use an adaptive survey tool to measure risk preferences and to combine these measures with both panel data on agricultural investments and beliefs about climate change using scenarios. Despite the need for better understanding of how farmer preferences over time and risk might influence technology adoption and production decisions made by farmers in sub-Saharan Africa, there is a critical gap in research about this topic. Whether and how vulnerability to climate change has entered the mind frame of farmers is explored with a scenario setup, in which farmers are asked to provide advice to a hypothetical farmer facing low yields due to a prolonged drought. Farmer responses to the scenarios give us information about both the channel through which farmers receive information about agriculture and adaptation and primary factors mentioned to be important agricultural strategies in the face of increasingly unpredictable weather patterns. This research offers insights to understand decision-making process of smallholder farmers, who face adverse effects of weather variability and the present problem of low soil fertility.

Functional Performances on Admission Predict In-Hospital Falls, Injurious Falls, and Fractures in Older Patients: A Prospective Study.

PubMed

Hars, Mélany; Audet, Marie-Claude; Herrmann, François; De Chassey, Jean; Rizzoli, René; Reny, Jean-Luc; Gold, Gabriel; Ferrari, Serge; Trombetti, Andrea

2018-05-01

Falls are common among older inpatients and remain a great challenge for hospitals. Despite the relevance of physical impairments to falls, the prognostic value of performance-based functional measures for in-hospital falls and injurious falls remains unknown. This study aimed to determine the predictive ability and accuracy of various functional tests administered at or close to admission in a geriatric hospital to identify in-hospital fallers and injurious fallers. In this prospective study, conducted in a geriatric hospital in Geneva, Switzerland, 807 inpatients (mean age 85.0 years) were subjected to a battery of functional tests administered by physiotherapists within 3 days (interquartile range 1 to 6) of admission, including Short Physical Performance Battery (SPPB), simplified Tinetti, and Timed Up and Go tests. Patients were prospectively followed up for falls and injurious falls until discharge using mandatory standardized incident report forms and electronic patients' records. During a median length of hospital stay of 23 days (interquartile range 14 to 36), 329 falls occurred in 189 (23.4%) patients, including 161 injurious falls of which 24 were serious. In-hospital fallers displayed significantly poorer functional performances at admission on all tests compared with non-fallers (p < 0.001 for all). In multivariate analysis controlling for age, sex, previous falls, and fall as cause of admission, poorer functional performances on all functional tests predicted in-hospital falls and injurious falls (p < 0.001 for all). The SPPB only significantly predicted serious injurious falls (adjusted odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.60-0.96) and fractures (adjusted OR = 0.76; 95% CI 0.59-0.98). In conclusion, poor functional performances, as assessed by SPPB, are independent predictors of in-hospital falls, injurious falls, and fractures in patients admitted to a geriatric hospital. These findings should help to design preventive strategies for in-hospital falls and support the adoption of objective performance-based functional measures into routine hospital practice. © 2018 American Society for Bone and Mineral Research. © 2018 American Society for Bone and Mineral Research.

Individual and Combined Effects of Dietary Factors on Risk of Incident Hypertension: Prospective Analysis From the NutriNet-Santé Cohort.

PubMed

Lelong, Helene; Blacher, Jacques; Baudry, Julia; Adriouch, Solia; Galan, Pilar; Fezeu, Leopold; Hercberg, Serge; Kesse-Guyot, Emmanuelle

2017-10-01

Dietary intake is pointed as one of the major determinants in hypertension development. Data in the area are mostly obtained from cross-sectional studies. We aimed to investigate the prospective association between (1) individual nutritional factors and (2) adherence to the Dietary Approach to Stop Hypertension and the risk of incident hypertension in a large cohort study. We prospectively examined the incidence of hypertension among 80 426 French adults participating in the NutriNet-Santé cohort study. Self-reported sociodemographic, lifestyle health questionnaires and dietary consumption assessed by three 24-hour records were completed at baseline and yearly thereafter. Associations between quartiles (Q) of nutrients and food groups and adherence to Dietary Approach to Stop Hypertension diet and hypertension risk were assessed by multivariable Cox proportional hazards models. During a mean follow-up of 3.4±2.1 years, 2413 cases of incident hypertension were documented. Dietary intakes of sodium (Q4 versus Q1): hazard ratio (HR)=1.17 (95% confidence interval [CI], 1.02-1.35), potassium: HR=0.82 (95% CI, 0.72-0.94), animal protein: HR=1.26 (95% CI, 1.11-1.43), vegetable protein: HR=0.85 (95% CI, 0.75-0.95), fiber: HR =0.81 (95% CI, 0.71-0.93), magnesium: HR=0.77 (95% CI, 0.67-0.89), fruit and vegetables: HR=0.85 (95% CI, 0.74-0.97), whole grain: HR=0.84(95% CI, 0.76-0.93), nuts: HR=0.72 (95% CI, 0.63-0.83), and red and processed meat: HR=1.25 (95% CI, 1.11-0.42) were associated with risk of hypertension. Besides, adherence to the Dietary Approach to Stop Hypertension was strongly inversely associated with incident hypertension: (Q4 versus Q1) HR=0.66 (95% CI, 0.58-0.75). Our results confirmed the association of several nutritional factors intake and incident hypertension and highlighted that adopting a global healthy diet could strongly contribute to the prevention of hypertension. © 2017 American Heart Association, Inc.

The problem-solving approach in the teaching of number theory

NASA Astrophysics Data System (ADS)

Toh, Pee Choon; Hoong Leong, Yew; Toh, Tin Lam; Dindyal, Jaguthsing; Quek, Khiok Seng; Guan Tay, Eng; Him Ho, Foo

2014-02-01

Mathematical problem solving is the mainstay of the mathematics curriculum for Singapore schools. In the preparation of prospective mathematics teachers, the authors, who are mathematics teacher educators, deem it important that pre-service mathematics teachers experience non-routine problem solving and acquire an attitude that predisposes them to adopt a Pólya-style approach in learning mathematics. The Practical Worksheet is an instructional scaffold we adopted to help our pre-service mathematics teachers develop problem-solving dispositions alongside the learning of the subject matter. The Worksheet was initially used in a design experiment aimed at teaching problem solving in a secondary school. In this paper, we describe an application and adaptation of the MProSE (Mathematical Problem Solving for Everyone) design experiment to a university level number theory course for pre-service mathematics teachers. The goal of the enterprise was to help the pre-service mathematics teachers develop problem-solving dispositions alongside the learning of the subject matter. Our analysis of the pre-service mathematics teachers' work shows that the MProSE design holds promise for mathematics courses at the tertiary level.

Effectiveness of modified seminars as a teaching-learning method in pharmacology

PubMed Central

Palappallil, Dhanya Sasidharan; Sushama, Jitha; Ramnath, Sai Nathan

2016-01-01

Context: Student-led seminars (SLS) are adopted as a teaching-learning (T-L) method in pharmacology. Previous studies assessing the feedback on T-L methods in pharmacology points out that the traditional seminars consistently received poor feedbacks as they were not favorite among the students. Aims: This study aimed to obtain feedback on traditional SLS, introduce modified SLS and compare the modified seminars with the traditional ones. Settings and Design: This was a prospective interventional study done for 2 months in medical undergraduates of fifth semester attending Pharmacology seminars at a Government Medical College in South India. Subjects and Methods: Structured questionnaire was used to elicit feedback from participants. The responses were coded on 5-point Likert scale. Modifications in seminar sessions such as role plays, quiz, tests, group discussion, and patient-oriented problem-solving exercises were introduced along with SLS. Statistical Analysis Used: The data were analyzed using SPSS version 16. The descriptive data were expressed using frequencies and percentages. Wilcoxon signed rank test, and Friedman tests were used to compare traditional with modified seminars. Results: The participants identified interaction as the most important component of a seminar. Majority opined that the teacher should summarize at the end of SLS. Student feedback shows that modified seminars created more interest, enthusiasm, and inspiration to learn the topic when compared to traditional SLS. They also increased peer coordination and group dynamics. Students opined that communication skills and teacher-student interactions were not improved with modified seminars. Conclusions: Interventions in the form of modified SLS may be adopted to break the monotony of traditional seminars through active participation, peer interaction, and teamwork. PMID:27563587

Design of special purpose database for credit cooperation bank business processing network system

NASA Astrophysics Data System (ADS)

Yu, Yongling; Zong, Sisheng; Shi, Jinfa

2011-12-01

With the popularization of e-finance in the city, the construction of e-finance is transfering to the vast rural market, and quickly to develop in depth. Developing the business processing network system suitable for the rural credit cooperative Banks can make business processing conveniently, and have a good application prospect. In this paper, We analyse the necessity of adopting special purpose distributed database in Credit Cooperation Band System, give corresponding distributed database system structure , design the specical purpose database and interface technology . The application in Tongbai Rural Credit Cooperatives has shown that system has better performance and higher efficiency.

Quality assurance and stability reference (QUASAR) monitoring concept for calibration/validation

NASA Astrophysics Data System (ADS)

Teillet, Philippe M.; Horler, D. N.; O'Neill, Norman T.

1997-12-01

The paper introduces the concept that calibration/validation (cal/val) can play an essential role in bringing remote sensing to mainstream consumers in an information-based society, provided that cal/val is an integral part of a quality-assurance strategy. A market model for remote sensing is introduced and used to demonstrate that quality assurance is the key to bridging the gap between early adopters of technology and mainstream markets. The paper goes on to propose the semi-continuous monitoring of quality assurance and stability reference (QUASAR) sites as an important first step towards a cal/val infrastructure beneficial to mainstream users. Prospective QUASAR test sites are described.

Bioprocessing Data for the Production of Marine Enzymes

PubMed Central

Sarkar, Sreyashi; Pramanik, Arnab; Mitra, Anindita; Mukherjee, Joydeep

2010-01-01

This review is a synopsis of different bioprocess engineering approaches adopted for the production of marine enzymes. Three major modes of operation: batch, fed-batch and continuous have been used for production of enzymes (such as protease, chitinase, agarase, peroxidase) mainly from marine bacteria and fungi on a laboratory bioreactor and pilot plant scales. Submerged, immobilized and solid-state processes in batch mode were widely employed. The fed-batch process was also applied in several bioprocesses. Continuous processes with suspended cells as well as with immobilized cells have been used. Investigations in shake flasks were conducted with the prospect of large-scale processing in reactors. PMID:20479981

Chimeric antigen receptor for adoptive immunotherapy of cancer: latest research and future prospects.

PubMed

Shi, Huan; Sun, Meili; Liu, Lin; Wang, Zhehai

2014-09-21

Chimeric antigen receptors (CARs) are recombinant receptors that combine the specificity of an antigen-specific antibody with the T-cell's activating functions. Initial clinical trials of genetically engineered CAR T cells have significantly raised the profile of T cell therapy, and great efforts have been made to improve this approach. In this review, we provide a structural overview of the development of CAR technology and highlight areas that require further refinement. We also discuss critical issues related to CAR therapy, including the optimization of CAR T cells, the route of administration, CAR toxicity and the blocking of inhibitory molecules.

Design of multi-language trading system of ethnic characteristic agricultural products based on android

NASA Astrophysics Data System (ADS)

Huanqin, Wu; Yasheng, Jin; Yugang, Dai

2017-06-01

Under the current situation where Internet technology develops rapidly, mobile E-commerce technology has brought great convenience to our life. Now, the graphical user interface (GUI) of most E-commerce platforms only supports Chinese. Thus, the development of Android client of E-commerce that supports ethnic languages owns a great prospect. The principle that combines front end design and database technology is adopted in this paper to construct the Android client system of E-commerce platforms that supports ethnic languages, which realizes the displaying, browsing, querying, searching, trading and other functions of ethnic characteristic agricultural products on android platforms.

Why farmers adopt best management practice in the United States: A meta-analysis of the adoption literature

USGS Publications Warehouse

Baumgart-Getz, Adam; Stalker Prokopy, Linda; Floress, Kristin

2012-01-01

This meta-analysis of both published and unpublished studies assesses factors believed to influence adoption of agricultural Best Management Practices in the United States. Using an established statistical technique to summarize the adoption literature in the United States, we identified the following variables as having the largest impact on adoption: access to and quality of information, financial capacity, and being connected to agency or local networks of farmers or watershed groups. This study shows that various approaches to data collection affect the results and comparability of adoption studies. In particular, environmental awareness and farmer attitudes have been inconsistently used and measured across the literature. This meta-analysis concludes with suggestions regarding the future direction of adoption studies, along with guidelines for how data should be presented to enhance the adoption of conservation practices and guide research.

Korean Adoptee Identity: Adoptive and Ethnic Identity Profiles of Adopted Korean Americans

ERIC Educational Resources Information Center

Beaupre, Adam J.; Reichwald, Reed; Zhou, Xiang; Raleigh, Elizabeth; Lee, Richard M.

2015-01-01

Adopted Korean adolescents face the task of grappling with their identity as Koreans and coming to terms with their adoptive status. In order to explore these dual identities, the authors conducted a person-centered study of the identity profiles of 189 adopted Korean American adolescents. Using cluster analytic procedures, the study examined…

Developing and validating a model to predict the success of an IHCS implementation: the Readiness for Implementation Model.

PubMed

Wen, Kuang-Yi; Gustafson, David H; Hawkins, Robert P; Brennan, Patricia F; Dinauer, Susan; Johnson, Pauley R; Siegler, Tracy

2010-01-01

To develop and validate the Readiness for Implementation Model (RIM). This model predicts a healthcare organization's potential for success in implementing an interactive health communication system (IHCS). The model consists of seven weighted factors, with each factor containing five to seven elements. Two decision-analytic approaches, self-explicated and conjoint analysis, were used to measure the weights of the RIM with a sample of 410 experts. The RIM model with weights was then validated in a prospective study of 25 IHCS implementation cases. Orthogonal main effects design was used to develop 700 conjoint-analysis profiles, which varied on seven factors. Each of the 410 experts rated the importance and desirability of the factors and their levels, as well as a set of 10 different profiles. For the prospective 25-case validation, three time-repeated measures of the RIM scores were collected for comparison with the implementation outcomes. Two of the seven factors, 'organizational motivation' and 'meeting user needs,' were found to be most important in predicting implementation readiness. No statistically significant difference was found in the predictive validity of the two approaches (self-explicated and conjoint analysis). The RIM was a better predictor for the 1-year implementation outcome than the half-year outcome. The expert sample, the order of the survey tasks, the additive model, and basing the RIM cut-off score on experience are possible limitations of the study. The RIM needs to be empirically evaluated in institutions adopting IHCS and sustaining the system in the long term.

Surgical approach to TIR3 cytology class A prospective evaluation.

PubMed

D'Alessandro, Nicola; Fasano, Giovanni Michele; Gilio, Francesco; Iside, Giovanni; Izzo, Maria Lucia; Loffredo, Andrea; Pinto, Margherita; Tramontano, Salvatore; Tramutola, Giuseppe; Citro, Giuseppe

2014-01-01

Fine-needle aspiration (FNA) has proven to be a safe and reliable method of investigation of thyroid lesions. Referencing to European classification, the associated risk of malignancy for TIR3, category reserved for aspirates that contain architectural and/or nuclear atypia, is variable in such studies. Aims of study were evaluating safety of surgical approach, assessing perioperative parameters surgically related, and estimating neoplastic rate for TIR3 group. A prospective evaluation of all TIR3 submitted to thyroidectomy was conducted by assessing histopatohologic results between January 2005 and December 2012, considering two categories, positive (neoplastic) and negative (not neoplastic) group. Intraoperative and complication rate was analyzed on TIR3 population. A total of 1514 total thyroidectomy was performed from 2005 to 2012: a total of 148 cases was considered on TIR3 group. Positive cases amounted to 64 (43.2%), 29 of which were carcinoma (19.6% of total population) and 35 of which were adenoma, while negative cases amounted to 84 (56.8%). Sensitivity and specificity of TIR3 as neoplastic screening was 43.2% and 82.1%. A total of 32 linfectomies was performed (21.6% of group). Positive group presented a significant lower mean age than negative group (42.1 vs 56.2 years) TIR3 group represents a various category, with probably different malignancy risk. Our results and neoplasms rate confirmed that surgical option should be gold standard, in order to define atypical pattern and reduce delayed diagnoses. Choice of a second FNA or a imaging monitoring should be adopted for specific condition. Fine-needle aspiration, Thyroidectomy, TIR3, Thyroid cancer.

Internationally adopted children from non-European countries: general development during the first two years in the adoptive family.

PubMed

Dalen, Monica; Theie, Steinar

2012-01-01

Internationally adopted children are often delayed in their development and demonstrate more behaviour problems than nonadopted children due to adverse preadoption circumstances. This is especially true for children adopted from Eastern European countries. Few studies have focused on children adopted from non-European countries. This paper presents results from an ongoing longitudinal study of 119 internationally adopted children from non-European countries during their first two years in Norway. Several scales measuring different aspects of the children's development are included in the study: communication and gross motor development, temperamental characteristics, and behaviour problems. The results show that internationally adopted children are delayed in their general development when they first arrive in their adoptive families. After two years the children have made significant progress in development. However, they still lag behind in communication and motor skills compared to non-adopted children. The temperamental characteristics seem very stable from time of adoption until two years after adoption. The children demonstrate a low frequency of behaviour problems. However, the behaviour problems have changed during the two years. At time of adoption they show more nonphysically challenging behaviour while after two years their physically challenging behaviour has increased.

Single-use instruments, cutting blocks, and trials increase efficiency in the operating room during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases.

PubMed

Mont, Michael A; McElroy, Mark J; Johnson, Aaron J; Pivec, Robert

2013-08-01

The purpose of this prospective controlled trial was to determine if efficiency increases could be achieved in non-navigated and navigated total knee arthroplasties by replacing traditional saws, cutting blocks, and trials with specialized saws and single-use cutting blocks and trials. Various timing metrics during total knee arthroplasty, including operating room preparation times and specific intra-operative times, were measured in 400 procedures performed by eight different surgeons at 6 institutions. Efficiency increases were the result of statistically significant reductions in combined instrument setup and cleanup times as well as in adjusted surgical episode times in navigated total knee arthroplasties. Single-use instruments show promising benefits, but adequate patient follow-up is needed to confirm safety and efficacy before they can be widely adopted. Nevertheless, the authors believe that the use of single-use instruments, cutting guides, and trial implants for total knee arthroplasty will play an increasing role in improving operating room efficiency. Copyright © 2013 Elsevier Inc. All rights reserved.

Uterus transplantation: current progress and future prospects

PubMed Central

Johannesson, Liza; Järvholm, Stina

2016-01-01

Even if reproductive medicine has been remarkably successful during the past few decades, with the introduction of in vitro fertilization in the late 1970s and intracytoplasmic sperm injection in the early 1990s, it has been repeatedly mocked by infertility due to an absolute uterine factor. No treatment has been available for the women suffering from an absent or dysfunctional uterus, in terms of carrying a pregnancy. Approximately one in 500 women suffer from absolute uterine infertility, and the option so far to become a mother has been to either adopt or utilize gestational surrogacy. As of today, a total of eleven cases of human uterus transplantations have been reported worldwide, conducted in three different countries. The results of these initial experimental cases far exceed what might be expected of a novel surgical method. Many more uterus transplantations are to be expected in the near future, as other research teams’ preparations are being ready to be put into clinical practice. In this review, we summarize the current worldwide experience of uterus transplantation as a treatment of absolute uterine factor infertility and the future prospects of human uterus transplantation. PMID:26917976

Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection. Final Rule.

PubMed

2015-08-04

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF Value-Based Purchasing (VBP) Program, and includes a discussion of SNF VBP Program policies we are considering for future rulemaking to promote higher quality and more efficient health care for Medicare beneficiaries. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also amends the requirements that a long-term care (LTC) facility must meet to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program, by establishing requirements that implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.

Insoluble drug delivery strategies: review of recent advances and business prospects

PubMed Central

Kalepu, Sandeep; Nekkanti, Vijaykumar

2015-01-01

The emerging trends in the combinatorial chemistry and drug design have led to the development of drug candidates with greater lipophilicity, high molecular weight and poor water solubility. Majority of the failures in new drug development have been attributed to poor water solubility of the drug. Issues associated with poor solubility can lead to low bioavailability resulting in suboptimal drug delivery. About 40% of drugs with market approval and nearly 90% of molecules in the discovery pipeline are poorly water-soluble. With the advent of various insoluble drug delivery technologies, the challenge to formulate poorly water soluble drugs could be achieved. Numerous drugs associated with poor solubility and low bioavailabilities have been formulated into successful drug products. Several marketed drugs were reformulated to improve efficacy, safety and patient compliance. In order to gain marketing exclusivity and patent protection for such products, revitalization of poorly soluble drugs using insoluble drug delivery technologies have been successfully adopted by many pharmaceutical companies. This review covers the recent advances in the field of insoluble drug delivery and business prospects. PMID:26579474

Prenatal Testing for Adult-Onset Conditions: the Position of the National Society of Genetic Counselors.

PubMed

Hercher, Laura; Uhlmann, Wendy R; Hoffman, Erin P; Gustafson, Shanna; Chen, Kelly M

2016-12-01

Advances in genetic testing and the availability of such testing in pregnancy allows prospective parents to test their future child for adult-onset conditions. This ability raises several complex ethical issues. Prospective parents have reproductive rights to obtain information about their fetus. This information may or may not alter pregnancy management. These rights can be in conflict with the rights of the future individual, who will be denied the right to elect or decline testing. This paper highlights the complexity of these issues, details discussions that went into the National Society of Genetic Counselors (NSGC) Public Policy Task Force's development of the Prenatal testing for Adult-Onset Conditions position statement adopted in November 2014, and cites relevant literature on this topic through December 2015. Issues addressed include parental rights and autonomy, rights of the future child, the right not to know, possible adverse effects on childhood and the need for genetic counseling. This paper will serve as a reference to genetic counselors and healthcare professionals when faced with this situation in clinical practice.

Money, kisses, and electric shocks: on the affective psychology of risk.

PubMed

Rottenstreich, Y; Hsee, C K

2001-05-01

Prospect theory's S-shaped weighting function is often said to reflect the psychophysics of chance. We propose an affective rather than psychophysical deconstruction of the weighting function resting on two assumptions. First, preferences depend on the affective reactions associated with potential outcomes of a risky choice. Second, even with monetary values controlled, some outcomes are relatively affect-rich and others relatively affect-poor. Although the psychophysical and affective approaches are complementary, the affective approach has one novel implication: Weighting functions will be more S-shaped for lotteries involving affect-rich than affect-poor outcomes. That is, people will be more sensitive to departures from impossibility and certainty but less sensitive to intermediate probability variations for affect-rich outcomes. We corroborated this prediction by observing probability-outcome interactions: An affect-poor prize was preferred over an affect-rich prize under certainty, but the direction of preference reversed under low probability. We suggest that the assumption of probability-outcome independence, adopted by both expected-utility and prospect theory, may hold across outcomes of different monetary values, but not different affective values.

A Non-Modeling Exploration of Residential Solar Photovoltaic (PV) Adoption and Non-Adoption

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

Moezzi, Mithra; Ingle, Aaron; Lutzenhiser, Loren

Although U.S. deployment of residential rooftop solar photovoltaic (PV) systems has accelerated in recent years, PV is still installed on less than 1 percent of single-family homes. Most research on household PV adoption focuses on scaling initial markets and modeling predicted growth rather than considering more broadly why adoption occurs. Among the studies that have investigated the characteristics of PV adoption, most collected data from adopters, sometimes with additional non-adopter data, and rarely from people who considered but did not adopt PV. Yet the vast majority of Americans are non-adopters, and they are a diverse group - understanding their waysmore » of evaluating PV adoption is important. Similarly, PV is a unique consumer product, which makes it difficult to apply findings from studies of other technologies to PV. In addition, little research addresses the experience of households after they install PV. This report helps fill some of these gaps in the existing literature. The results inform a more detailed understanding of residential PV adoption, while helping ensure that adoption is sufficiently beneficial to adopters and even non-adopters.« less

Improvement of nutritional support strategies after surgery for benign liver tumor through nutritional risk screening: a prospective, randomized, controlled, single-blind clinical study.

PubMed

Lu, Xin; Li, Ying; Yang, Huayu; Sang, Xinting; Zhao, Haitao; Xu, Haifeng; Du, Shunda; Xu, Yiyao; Chi, Tianyi; Zhong, Shouxian; Yu, Kang; Mao, Yilei

2013-02-01

The rising of individualized therapy requires nutritional risk screening has become a major topic for each particular disease, yet most of the screenings were for malignancies, less for benign diseases. There is no report on the screening of patients with benign liver tumors postoperatively. We aim to evaluate the nutritional support strategies post operation for benign liver tumors through nutritional risk screening. In this prospective, randomized, controlled study, 95 patients who underwent hepatectomy for benign tumors were divided into two groups. Fifty patients in the control group were given routine permissive underfeeding nutritional supply (75 kJ/kg/d), and 45 patients in the experimental group were given lower energy (42 kJ/kg/d) in accordance of their surgical trauma. Routine blood tests, liver/kidney function were monitored before surgery and at the day 1, 3, 5, 9 after surgery, patients were observed for the time of flatus, complications, length of hospitalization (LOH), nutrition-related costs, and other clinical parameters. This completed study is registered with Clinicaltrials.gov, number NCT01292330. The nutrition-related expenses (494.0±181.0 vs. 1,514.4±348.4 RMB, P<0.05) and the total hospital costs (18,495.2±4735.0 vs. 21,432.7±8,291.2 RMB, P<0.05) for patients in the experimental group were significantly lower than those in the control group. Meanwhile, the lowered energy supply after the surgeries did not have adverse effects on clinical parameters, complications, and LOH. Patient with benign liver tumors can adopt an even lower postoperative nutritional supply that close to that for mild non-surgical conditions, and lower than the postoperative permissive underfeeding standard.

Outcomes and satisfaction of two optional cadaveric dissection courses: A 3-year prospective study.

PubMed

Pais, Diogo; Casal, Diogo; Mascarenhas-Lemos, Luís; Barata, Pedro; Moxham, Bernard J; Goyri-O'Neill, João

2017-03-01

Teaching time dedicated to anatomy education has been reduced at many medical schools around the world, including Nova Medical School in Lisbon, Portugal. In order to minimize the effects of this reduction, the authors introduced two optional, semester-long cadaveric dissection courses for the first two years of the medical school curriculum. These courses were named Regional Anatomy I (RAI) and Regional Anatomy II (RAII). In RAI, students focus on dissecting the thorax, abdomen, pelvis, and perineum. In RAII, the focus shifts to the head, neck, back, and upper and lower limbs. This study prospectively analyzes students' academic achievement and perceptions within the context of these two, newly-introduced, cadaveric dissection courses. Students' satisfaction was assessed anonymously through a questionnaire that included items regarding students' perception of the usefulness of the courses for undergraduate teaching, as well as with regards to future professional activity. For each of the three academic years studied, the final score (1 to 20) in General Anatomy (GA), RAI, and RAII was on average 14.26 ± 1.89; 16.94 ± 1.02; 17.49 ± 1.01, respectively. The mean results were lower in GA than RAI or RAII (P < 0.001). Furthermore, students who undertook these courses ranked them highly with regards to consolidating their knowledge of anatomy, preparing for other undergraduate courses, and training for future clinical practice. These survey data, combined with data on participating students' academic achievement, lend strong support to the adoption of similar courses as complementary and compulsory disciplines in a modern medical curriculum. Anat Sci Educ 10: 127-136. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

Screening for retinopathy of prematurity in China: a neonatal units-based prospective study.

PubMed

Xu, Yu; Zhou, Xiaohong; Zhang, Qi; Ji, Xunda; Zhang, Qin; Zhu, Jianxing; Chen, Chao; Zhao, Peiquan

2013-12-19

To analyze the incidence and severity of retinopathy of prematurity (ROP) in China, and to explore the workload implications of applying different criteria. A prospective, neonatal units-based study undertaken in two tertiary level hospitals in Shanghai, China, from January 1, 2010 to December 31, 2012. All infants with birth weight (BW) of 2000 g or less and/or gestational age (GA) of 34 weeks or less were screened for ROP. Retinopathy of prematurity was classified using the international classification, and was treated in accordance with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. A total of 2825 (93.7%) of 3014 eligible infants were screened, and ROP was diagnosed in 503 infants (17.8%). One hundred ninety-one infants (6.8%) had type 1 or worse ROP and were treated with laser or vitrectomy. The mean GA of ROP patients was 29.9 ± 2.1 weeks and their mean BW was 1425 ± 266 g. Infants who needed treatment for ROP had a mean GA of 29.3 ± 2.1 weeks and mean BW of 1331 ± 330 g. Among these treated infants, 18 infants (9.4%) exceeded the United Kingdom's (UK) screening criteria, and 28 (14.7%) exceeded the criteria used in the United States (US). If narrower criteria, as in GA less than or equal to 33 weeks and/or BW less than or equal to 1750 g were adopted, almost 16.9% fewer infants would not have been examined, with no infant missing treatment. Larger, older infants are at risk in China and screening criteria used in the US and UK may not be suitable for China. Further population-based studies are recommended to determine the necessity of modifying the current ROP screening protocol.

Serum neuron-specific enolase levels from the same patients differ between laboratories: assessment of a prospective post-cardiac arrest cohort.

PubMed

Mlynash, Michael; Buckwalter, Marion S; Okada, Ami; Caulfield, Anna Finley; Venkatasubramanian, Chitra; Eyngorn, Irina; Verbeek, Marcel M; Wijman, Christine A C

2013-10-01

In comatose post-cardiac arrest patients, a serum neuron-specific enolase (NSE) level of >33 μg/L within 72 h was identified as a reliable marker for poor outcome in a large Dutch study (PROPAC), and this level was subsequently adopted in an American Academy of Neurology practice parameter. Later studies reported that NSE >33 μg/L is not a reliable predictor of poor prognosis. To test whether different clinical laboratories contribute to this variability, we compared NSE levels from the laboratory used in the PROPAC study (DLM-Nijmegen) with those of our hospital's laboratory (ARUP) using paired blood samples. We prospectively enrolled cardiac arrest patients who remained comatose after resuscitation. During the first 3 days, paired blood samples for serum NSE were drawn at a median of 10 min apart. After standard preparation for each lab, one sample was sent to ARUP laboratories and the other to DLM-Nijmegen. Fifty-four paired serum samples from 33 patients were included. Although the serum NSE measurements correlated well between laboratories (R = 0.91), the results from ARUP were approximately 30% lower than those from DLM-Nijmegen. Therapeutic hypothermia did not affect this relationship. Two patients had favorable outcomes after hypothermia despite NSE levels measured by DLM-Nijmegen as >33 μg/L. Absolute serum NSE levels of comatose cardiac arrest patients differ between laboratories. Any specific absolute cut-off levels proposed to prognosticate poor outcome should not be used without detailed data on how neurologic outcomes correspond to a particular laboratory's method, and even then only in conjunction with other prognostic variables.

Individualizing Risk of Multidrug-Resistant Pathogens in Community-Onset Pneumonia

PubMed Central

Falcone, Marco; Russo, Alessandro; Giannella, Maddalena; Cangemi, Roberto; Scarpellini, Maria Gabriella; Bertazzoni, Giuliano; Alarcón, José Martínez; Taliani, Gloria; Palange, Paolo; Farcomeni, Alessio; Vestri, Annarita; Bouza, Emilio; Violi, Francesco; Venditti, Mario

2015-01-01

Introduction The diffusion of multidrug-resistant (MDR) bacteria has created the need to identify risk factors for acquiring resistant pathogens in patients living in the community. Objective To analyze clinical features of patients with community-onset pneumonia due to MDR pathogens, to evaluate performance of existing scoring tools and to develop a bedside risk score for an early identification of these patients in the Emergency Department. Patients and Methods This was an open, observational, prospective study of consecutive patients with pneumonia, coming from the community, from January 2011 to January 2013. The new score was validated on an external cohort of 929 patients with pneumonia admitted in internal medicine departments participating at a multicenter prospective study in Spain. Results A total of 900 patients were included in the study. The final logistic regression model consisted of four variables: 1) one risk factor for HCAP, 2) bilateral pulmonary infiltration, 3) the presence of pleural effusion, and 4) the severity of respiratory impairment calculated by use of PaO2/FiO2 ratio. A new risk score, the ARUC score, was developed; compared to Aliberti, Shorr, and Shindo scores, this point score system has a good discrimination performance (AUC 0.76, 95% CI 0.71-0.82) and calibration (Hosmer-Lemeshow, χ2 = 7.64; p = 0.469). The new score outperformed HCAP definition in predicting etiology due to MDR organism. The performance of this bedside score was confirmed in the validation cohort (AUC 0.68, 95% CI 0.60-0.77). Conclusion Physicians working in ED should adopt simple risk scores, like ARUC score, to select the most appropriate antibiotic regimens. This individualized approach may help clinicians to identify those patients who need an empirical broad-spectrum antibiotic therapy. PMID:25860142

The Effects of Stress on Physical Activity and Exercise

PubMed Central

Stults-Kolehmainen, Matthew A.; Sinha, Rajita

2013-01-01

Background Psychological stress and physical activity (PA) are believed to be reciprocally related; however, most research examining the relationship between these constructs is devoted to the study of exercise and/or PA as an instrument to mitigate distress. Objective The aim of this paper was to review the literature investigating the influence of stress on indicators of PA and exercise. Methods A systematic search of Web of Science, Pub-Med, and SPORTDiscus was employed to find all relevant studies focusing on human participants. Search terms included “stress”, “exercise”, and “physical activity”. A rating scale (0–9) modified for this study was utilized to assess the quality of all studies with multiple time points. Results The literature search found 168 studies that examined the influence of stress on PA. Studies varied widely in their theoretical orientation and included perceived stress, distress, life events, job strain, role strain, and work–family conflict but not lifetime cumulative adversity. To more clearly address the question, prospective studies (n = 55) were considered for further review, the majority of which indicated that psychological stress predicts less PA (behavioral inhibition) and/or exercise or more sedentary behavior (76.4 %). Both objective (i.e., life events) and subjective (i.e., distress) measures of stress related to reduced PA. Prospective studies investigating the effects of objective markers of stress nearly all agreed (six of seven studies) that stress has a negative effect on PA. This was true for research examining (a) PA at periods of objectively varying levels of stress (i.e., final examinations vs. a control time point) and (b) chronically stressed populations (e.g., caregivers, parents of children with a cancer diagnosis) that were less likely to be active than controls over time. Studies examining older adults (>50 years), cohorts with both men and women, and larger sample sizes (n > 100) were more likely to show an inverse association. 85.7 % of higher-quality prospective research (≥7 on a 9-point scale) showed the same trend. Interestingly, some prospective studies (18.2 %) report evidence that PA was positively impacted by stress (behavioral activation). This should not be surprising as some individuals utilize exercise to cope with stress. Several other factors may moderate stress and PA relationships, such as stages of change for exercise. Habitually active individuals exercise more in the face of stress, and those in beginning stages exercise less. Consequently, stress may have a differential impact on exercise adoption, maintenance, and relapse. Preliminary evidence suggests that combining stress management programming with exercise interventions may allay stress-related reductions in PA, though rigorous testing of these techniques has yet to be produced. Conclusions Overall, the majority of the literature finds that the experience of stress impairs efforts to be physically active. Future work should center on the development of a theory explaining the mechanisms underlying the multifarious influences of stress on PA behaviors. PMID:24030837

The effects of stress on physical activity and exercise.

PubMed

Stults-Kolehmainen, Matthew A; Sinha, Rajita

2014-01-01

Psychological stress and physical activity (PA) are believed to be reciprocally related; however, most research examining the relationship between these constructs is devoted to the study of exercise and/or PA as an instrument to mitigate distress. The aim of this paper was to review the literature investigating the influence of stress on indicators of PA and exercise. A systematic search of Web of Science, PubMed, and SPORTDiscus was employed to find all relevant studies focusing on human participants. Search terms included "stress", "exercise", and "physical activity". A rating scale (0-9) modified for this study was utilized to assess the quality of all studies with multiple time points. The literature search found 168 studies that examined the influence of stress on PA. Studies varied widely in their theoretical orientation and included perceived stress, distress, life events, job strain, role strain, and work-family conflict but not lifetime cumulative adversity. To more clearly address the question, prospective studies (n = 55) were considered for further review, the majority of which indicated that psychological stress predicts less PA (behavioral inhibition) and/or exercise or more sedentary behavior (76.4 %). Both objective (i.e., life events) and subjective (i.e., distress) measures of stress related to reduced PA. Prospective studies investigating the effects of objective markers of stress nearly all agreed (six of seven studies) that stress has a negative effect on PA. This was true for research examining (a) PA at periods of objectively varying levels of stress (i.e., final examinations vs. a control time point) and (b) chronically stressed populations (e.g., caregivers, parents of children with a cancer diagnosis) that were less likely to be active than controls over time. Studies examining older adults (>50 years), cohorts with both men and women, and larger sample sizes (n > 100) were more likely to show an inverse association. 85.7 % of higher-quality prospective research (≥ 7 on a 9-point scale) showed the same trend. Interestingly, some prospective studies (18.2 %) report evidence that PA was positively impacted by stress (behavioral activation). This should not be surprising as some individuals utilize exercise to cope with stress. Several other factors may moderate stress and PA relationships, such as stages of change for exercise. Habitually active individuals exercise more in the face of stress, and those in beginning stages exercise less. Consequently, stress may have a differential impact on exercise adoption, maintenance, and relapse. Preliminary evidence suggests that combining stress management programming with exercise interventions may allay stress-related reductions in PA, though rigorous testing of these techniques has yet to be produced. Overall, the majority of the literature finds that the experience of stress impairs efforts to be physically active. Future work should center on the development of a theory explaining the mechanisms underlying the multifarious influences of stress on PA behaviors.

High School Sports Involvement Diminishes the Association Between Childhood Conduct Disorder and Adult Antisocial Behavior

PubMed Central

Samek, Diana R.; Elkins, Irene J.; Keyes, Margaret A.; Iacono, William G.; McGue, Matt

2015-01-01

Purpose Life course–persistent antisocial behavior manifests as a display of aggressive and antisocial behavior beginning in childhood (conduct disorder [CD]) and lasting through adulthood (adult antisocial personality disorder). This study aimed to build on prior research by evaluating whether involvement in high school sports helped attenuate the association between CD and subsequent adult antisocial behavior (AAB). Methods A prospective sample of 967 male and female adolescents (56% adopted) was used. Structured interviews were used to assess CD (symptoms before the age of 15 years), involvement in sports during high school, and past-year adult antisocial personality disorder symptoms in young adulthood (M age = 22.4 years). Results As expected, the association between CD and AAB was significantly less for those involved in sports (β = .28; p < .001) compared with those not involved in sports (β = .49; p < .001), χ2(1) = 4.13; p = .04. This difference remained after including known covariates of antisocial behavior in the model (age, gender, adoption status), and results were consistent across males and females. Involvement in other extracurricular activities (e.g., student government, plays, clubs) did not significantly moderate the relationship between CD and AAB. Conclusions Although selection effects were evident (those with more CD symptoms were less likely to be involved in sports), findings nevertheless suggest high school sports involvement may be a notable factor related to disrupting persistent antisocial behavior beginning in childhood and adolescence and lasting through young adulthood. Implications are discussed. PMID:25937472

Challenging the wisdom of puncture at the calyceal fornix in percutaneous nephrolithotripsy: feasibility and safety study with 137 patients operated via a non-calyceal percutaneous track.

PubMed

Kyriazis, Iason; Kallidonis, Panagiotis; Vasilas, Marinos; Panagopoulos, Vasilios; Kamal, Wissam; Liatsikos, Evangelos

2017-05-01

To present our experience with a central, non-calyceal puncture protocol for percutaneous nephrolithotripsy (PCNL) in an attempt to challenge the opinion of worldwide adopted calyceal puncture as the less traumatic site of percutaneous entrance into the collecting system. During 2012, a total of 137 consecutive, unselected patients were subjected to PCNL in our department. Non-calyceal punctures were performed to all cases and followed by subsequent track dilations up to 30 Fr. Perioperative and postoperative data were prospectively collected and analyzed. Mean operative time (from skin puncture to nephrostomy tube placement) was 48 min. Patients with single, multiple and staghorn stones had primary stone-free rates of 89.2, 80.4 and 66.7 % after PCNL, respectively. The overall complication rate was 10.2 %, while bleeding complications were minimal. Only 4 patients (2.9 %) required blood transfusion. Five patients (3.6 %) had Clavien Grade IIIa complications requiring an intervention for their management and none Grade IV or V. Despite the absence of evidence that non-calyceal percutaneous tracts could be a risk factor for complications, the concept of calyceal puncture has been worldwide adopted by PCNL surgeons as the sole safe percutaneous entrance into the collective system. Based on our experience, other pathways than the worldwide recognized rule, calyceal puncture, are possible and probably not as dangerous as has been previously stated.

Gaps and gains from engaging districts stakeholders for community-based health professions education in Uganda: a qualitative study.

PubMed

Okello, Elialilia S; Nankumbi, Joyce; Ruzaaza, Gad Ndaruhutse; Bakengesa, Evelyn; Gumikiriza, Joy; Arubaku, Wilfred; Acio, Christine; Samantha, Mary; Matte, Michael

2015-12-01

Community-based education research and service (COBERS) is a brand of community-based education that has been adopted by the Medical Education and Service for All Ugandans consortium. The COBERS programme is aimed at equipping students in health professional education with the knowledge, attitudes and skills required to provide appropriate health care services. For sustainability purposes, the health professional training institutions have made efforts to involve various stakeholders in the implementation of the programme. However, the actual engagement process and outcome of such efforts have not been documented. This paper documents gaps and gains made in engaging district stakeholders for community-based education. Key informant interviews, focus group discussions and document review were used to collect data. Atlas.ti, computer software for qualitative data was used to aid analysis. The analysis revealed that the adopted engagement model has registered some gains including increased awareness among district leaders about potential opportunities offered by COBERS such as boosting of human resources at health facilities, opportunities for professional development for health care workers at health facilities, and establishment of linkages between prospective employees and employers. However, the engagement model left some gaps in terms of knowledge, awareness and ownership of the programme among some sections of stakeholders. The apparent information gap about the programme among district stakeholders, especially the political leadership, may hinder concerted partnership. The findings highlight the need for health professional education institutions to broaden the scope of actively engaged stakeholders with the district level.

Open Adoption: Adoptive Parents' Reactions Two Decades Later

ERIC Educational Resources Information Center

Siegel, Deborah H.

2013-01-01

Unlike in the past, most adoption agencies today offer birth parents and adoptive parents the opportunity to share identifying information and have contact with each other. To understand the impacts of different open adoption arrangements, a qualitative descriptive study using a snowball sample of 44 adoptive parents throughout New England began…

Openness in Adoption: Exploring Family Connections.

ERIC Educational Resources Information Center

Grotevant, Harold D.; McRoy, Ruth G.

Noting social and demographic changes provoking a trend toward openness in adoption practice, this book presents the findings from a nationwide study examining the impact of variations in openness in adoption on participants in the adoptive kinship network: adopted children, adoptive parents, and the children's birth parents. The first chapter of…

Importance of triggers and veto-barriers for the implementation of sanitation in informal peri-urban settlements – The case of Cochabamba, Bolivia

PubMed Central

Rauch, Sebastien; Cossio, Claudia; Landaeta, Graciela; McConville, Jennifer

2018-01-01

An estimated 2.4 billion people lack access to improved sanitation which has devastating consequences for human health and the environment. Understanding what constitute sanitation demand is crucial for accelerating the spread of improved sanitation. This study aims to understand the adoption mechanisms for improved sanitation. An informal peri-urban settlement in Cochabamba, Bolivia was selected as a case study to understand adoption patterns. Various qualitative methods of data collection and analysis were employed. The findings showed that pour-flush toilets was the only preferred sanitation alternative at the study site. An adoption framework for waterborne toilets was developed based on diffusion of innovation theory. Factors that influence adoption were identified. Some functioned as triggers and initiated adoption, whereas some factors blocked adoption and constituted veto-barriers. Most factors were connected to the individual household situation and its members, but neighborhood development also affected pour-flush adoption. Based on adoption time the residents were divided into the following adoption groups: first adopters, early majority, late majority, laggards and non-adopters. Each adoption group followed its own adoption route with specific characteristics and respective triggers or veto-barriers. We argue that the strong demand for waterborne toilets in peri-urban areas need to be recognized and the developed framework could be used for customizing sanitation improvement programs for certain target groups. PMID:29617459

Importance of triggers and veto-barriers for the implementation of sanitation in informal peri-urban settlements - The case of Cochabamba, Bolivia.

PubMed

Helgegren, Ida; Rauch, Sebastien; Cossio, Claudia; Landaeta, Graciela; McConville, Jennifer

2018-01-01

An estimated 2.4 billion people lack access to improved sanitation which has devastating consequences for human health and the environment. Understanding what constitute sanitation demand is crucial for accelerating the spread of improved sanitation. This study aims to understand the adoption mechanisms for improved sanitation. An informal peri-urban settlement in Cochabamba, Bolivia was selected as a case study to understand adoption patterns. Various qualitative methods of data collection and analysis were employed. The findings showed that pour-flush toilets was the only preferred sanitation alternative at the study site. An adoption framework for waterborne toilets was developed based on diffusion of innovation theory. Factors that influence adoption were identified. Some functioned as triggers and initiated adoption, whereas some factors blocked adoption and constituted veto-barriers. Most factors were connected to the individual household situation and its members, but neighborhood development also affected pour-flush adoption. Based on adoption time the residents were divided into the following adoption groups: first adopters, early majority, late majority, laggards and non-adopters. Each adoption group followed its own adoption route with specific characteristics and respective triggers or veto-barriers. We argue that the strong demand for waterborne toilets in peri-urban areas need to be recognized and the developed framework could be used for customizing sanitation improvement programs for certain target groups.

Determinants of Cat Choice and Outcomes for Adult Cats and Kittens Adopted from an Australian Animal Shelter.

PubMed

Zito, Sarah; Paterson, Mandy; Vankan, Dianne; Morton, John; Bennett, Pauleen; Phillips, Clive

2015-04-29

The percentage of adult cats euthanized in animal shelters is greater than that of kittens because adult cats are less likely to be adopted. This study aimed to provide evidence to inform the design of strategies to encourage adult cat adoptions. One such strategy is to discount adoption prices, but there are concerns that this may result in poor adoption outcomes. We surveyed 382 cat adopters at the time of adoption, to assess potential determinants of adopters' cat age group choice (adult or kitten) and, for adult cat adopters, the price they are willing to pay. The same respondents were surveyed again 6-12 months after the adoption to compare outcomes between cat age groups and between adult cats in two price categories. Most adopters had benevolent motivations for adopting from the shelter and had put considerable thought into the adoption and requirements for responsible ownership. However, adult cat adopters were more likely to have been influenced by price than kitten adopters. Adoption outcomes were generally positive for both adult cats and kittens and for adult cats adopted at low prices. The latter finding alleviates concerns about the outcomes of "low-cost" adoptions in populations, such as the study population, and lends support for the use of "low-cost" adoptions as an option for attempting to increase adoption rates. In addition, the results provide information that can be used to inform future campaigns aimed at increasing the number of adult cat adoptions, particularly in devising marketing strategies for adult cats.

[Adoptive parents' satisfaction with the adoption experience and with its impact on family life].

PubMed

Sánchez-Sandoval, Yolanda

2011-11-01

In this study, we discuss the relevance of adoptive families' satisfaction in the assessment of adoption processes. The effects of adoption on a sample group of 272 adoptive families are analyzed. Most families show high levels of satisfaction as to: their decision to adopt, the features of their adopted children and how adoption has affected them as individuals and as a family. Statistical analyses show that these families can have different satisfaction levels depending on certain features of the adoptees, of the adoptive families or of their educational style. Life satisfaction of the adoptees is also related to how their adoptive parents evaluate the adoption.

Factors affecting the initiation of breastfeeding: implications for breastfeeding promotion.

PubMed

Earle, Sarah

2002-09-01

Breastfeeding rates in the United Kingdom (UK) are one of the lowest in the developed world and certainly the lowest in Europe. There have been numerous studies of breastfeeding in the UK, most of which have adopted a quantitative approach, and they have largely focused on obstetric or socio-demographic factors in the decision to breastfeed. Whilst these studies have an important role to play, this paper draws on a study that adopts a qualitative methodology to explore women's personal experiences and perceptions of breastfeeding. A qualitative study of 19 primagravidae was undertaken and completed in 1998. Participants were recruited to the study via 12 antenatal clinics in the West Midlands, England, UK. Their ages ranged from 16 to 30 years and the majority described themselves as 'white'. The majority of participants were in paid employment in a variety of occupations. The study was prospective in design. Participants were interviewed three times either during pregnancy or after childbirth: the first stage was between 6 and 14 weeks of pregnancy; the second stage was between 34 and 39 weeks; and the third stage was between 6 and 14 weeks after childbirth. The data indicate that there are several factors affecting breastfeeding initiation. First, infant feeding decisions seem to be made prior to, or irrespective of, contact with health professionals. Secondly, the data suggest that health promotion campaigns in the UK have been influential in their ability to educate women about the benefits of breastfeeding. However, this did not dissuade participants from formula feeding once their decision was made. The desire for paternal involvement also seemed to be another influential factor; fathers were either seen as able to alleviate the daily grind of early motherhood, or there was a desire for 'shared parenting'. Finally, some of the formula feeding women expressed a strong desire to re-establish their identities as separate individuals and as 'non-mothers'.

Midmarket Solar Policies in the United States: A Guide for Midsized Solar Customers

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

Tian, Tian; Liu, Chang; O'Shaughnessy, Eric

The midscale market for solar photovoltaics (PV) has not experienced the same high growth rate as residential- or utility-scale market segments in the past five years when solar PV deployment increased rapidly. Midscale solar can be defined as behind-the-meter solar PV between 50 kilowatts and 2 megawatts adopted by multi-housing residential, commercial, industrial, non-profit, and other entities. A number of challenges face the midscale segment, including difficulties in contracting, mismatch between tenant lease and PV financing terms, high transaction costs relative to project sizes, and inefficiencies in matching prospective projects with capital. The changing policy landscape across U.S. states providesmore » both opportunities and challenges to midmarket solar. Some states, such as California, are expanding system capacity limits for policies such as net metering, thus enabling a wider range of customers to benefit from excess generation. A number of states and utilities are making changes to rate design to introduce new or higher user fees for solar customers or reduced tariffs for net metering, which decrease the value of solar generation. An understanding of these policies relative to project feasibility and economics is important for prospective customers to make informed decisions to adopt solar PV. This guide complements existing solar policy resources to help potential customers navigate through the policy landscape in order to make informed decisions for their solar investment. The first part of this guide introduces the key solar policies necessary for policy-based decision-making, which involves using knowledge of a solar policy to improve project economics and efficiency. Policies that could result in policy-based decisions include interconnection standards, net metering, user fees, incentives, and third-party ownership policies. The goal of this section is to equip prospective customers and project developers with the tools necessary to understand and use solar policies in a dynamic policy environment. The second part of this guide provides a complete, state-by-state inventory of midmarket solar policies for potential customers and developers to use as reference when making policy-based decisions. Although solar policies are dynamic, the profiles provide a framework for assessing policies to build the parameters that could be used to determine feasibility and structure of a solar PV system for midmarket customers and developers.« less

Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?

PubMed

Leathers, Sonya J; Spielfogel, Jill E; Gleeson, James P; Rolock, Nancy

2012-05-01

Adoption is particularly important for foster children with special mental health needs who are unable to return home, as adoption increases parental support often critically needed by youth with mental health issues. Unfortunately, significant behavior problems frequently inhibit foster parents from adopting, and little is known about factors that predict adoption when a child has behavior problems. Previous research suggests that foster parent behavioral training could potentially increase rates of successful adoptions for pre-school-aged foster children with behavior problems (Fisher, Kim, & Pears, 2009), but this has not been previously tested in older samples. In older children, effective treatment of behavior problems might also increase adoption by reducing the interference of behavior problems and strengthening the child's foster home integration. This pilot study focused on this question by testing associations between behavior problems, foster home integration, an evidence-based foster parent intervention, and adoption likelihood. This study used an intent-to-treat design to compare foster home integration and adoption likelihood for 31 foster children with histories of abuse and neglect whose foster parents received a foster behavioral parenting intervention (see Chamberlain, 2003) or usual services. Random effect regression analyses were used to estimate outcomes across four time points. As expected, externalizing behavior problems had a negative effect on both integration and adoption, and foster home integration had an independent positive effect on adoption. Internalizing behavior problems (e.g., depression/anxiety) were not related to adoption or integration. However, the intervention did not have a direct effect on either foster home integration or adoption despite its positive effect on behavior problems. Results from this preliminary study provide further evidence of the negative effect of externalizing behavior problems on adoption. Its findings also suggest that foster home integration is an important dimension of foster home adaptation that appears particularly relevant to chances for adoption. While behavior problems appear to weaken foster home integration, integration is also an independent predictor of adoption likelihood. If these results are replicated in a larger study, consideration of foster home integration in case planning and future intervention studies focused on increasing permanency could potentially improve outcomes for foster children with behavior problems.

Implementing the ABCDE Bundle into Everyday Care: Opportunities, Challenges and Lessons Learned for Implementing the ICU Pain, Agitation and Delirium (PAD) Guidelines

PubMed Central

Balas, Michele C.; Burke, William J.; Gannon, David; Cohen, Marlene Z.; Colburn, Lois; Bevil, Catherine; Franz, Doug; Olsen, Keith M.; Ely, E. Wesley; Vasilevskis, Eduard E.

2014-01-01

Objective The Awakening and Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle is an evidence-based, interprofessional, multicomponent strategy for minimizing sedative exposure, reducing duration of mechanical ventilation and managing intensive care unit (ICU) acquired delirium and weakness. The purpose of this study was to identify facilitators and barriers to ABCDE bundle adoption and to evaluate the extent to which bundle implementation was effective, sustainable, and conducive to dissemination. Design Prospective, before-after, mixed-methods study. Setting Five adult ICUs, 1 step-down unit, and a special care unit located in a 624 bed, academic medical center Subjects Interprofessional ICU team members at participating institution. Interventions and Measurements In collaboration with the participating institution, we developed, implemented, and refined an ABCDE bundle policy. Over the course of an 18 month period, all ICU team members were offered the opportunity to participate in numerous, multimodal educational efforts. Three focus group sessions, 3 online surveys, and 1 educational evaluation were administered in an attempt to identify facilitators and barriers to bundle adoption. Main Results Factors believed to facilitate bundle implementation included: 1) the performance of daily, interdisciplinary, rounds, 2) engagement of key implementation leaders, 3) sustained and diverse educational efforts, and 4) the bundle's quality and strength. Barriers identified included: 1) intervention related issues (e.g. timing of trials, fear of adverse events), 2) communication and care coordination challenges, 3) knowledge deficits, 4) workload concerns, and 5) documentation burden. Despite these challenges, participants believed implementation ultimately benefited patients, improved interdisciplinary communication, and empowered nurses and other ICU team members. Conclusions In this study of the implementation of the ABCDE bundle in a tertiary care setting, clear factors were identified that both advanced and impeded adoption of this complex intervention that requires interprofessional education, coordination, and cooperation. Focusing on these factors preemptively should enable a more effective and lasting implementation of the bundle and better care for critically ill patients. Lessons learned from this study will also help healthcare providers optimize implementation of the recent ICU Pain, Agitation and Delirium (PAD) Guidelines, which has many similarities but also some important differences as compared to the ABCDE bundle PMID:23989089

Stalling HIV through social marketing: prospects in Pakistan.

PubMed

Husain, Sara; Shaikh, Babar T

2005-07-01

Over the last two decades HIV/AIDS has evolved from a series of interesting case-reports to a growing epidemic that threatens the entire world. It is feared to cause devastation among large pockets of populations and may roll back more than thirty years of public health achievements. This killer disease has been more amenable to behavioral change than by provision of curative services and attempts are being made to educate the public about this threat. Various techniques of promotion have been tried through out the world including television dramas/soaps, mass media and school curricula. Social marketing is an evolving strategy used to influence human behavior and choices. By using the principles of marketing and promoting behavior as a product, social marketers attempt to understand the dynamics of human behaviour and devise messages and products to change, modify, accept or reject unsafe behaviors or practices. Thus, social marketers provide an effective force to combat the spread of HIV and may serve to be invaluable allies in health promotion efforts. In a complex and diversified cultural milieu of Pakistan, social marketing can have a significant impact on health determinants and the conditions that will facilitate the adoption of health-oriented behaviors and practices. This paper gives an account of the elements needed for the success of a health promotion strategy adopted in a developing country and makes a case for social marketing to be adopted as the lead strategy for stalling HIV/AIDS in Pakistan.

A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

PubMed Central

Slater, Helen; Davies, Stephanie Joy; Parsons, Richard; Quintner, John Louis; Schug, Stephan Alexander

2012-01-01

Background Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). Methods To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1 =  nil and 5 =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). Results Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  = −5.6±8.2, p<0.0001; 95% confidence interval: −7.6 to −3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention. Conclusion An interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice. PMID:22662264

Tuberculin skin testing and T-SPOT.TB in internationally adopted children.

PubMed

Spicer, Kevin B; Turner, Joanne; Wang, Shu-Hua; Koranyi, Katalin; Powell, Dwight A

2015-06-01

Diagnosis of latent tuberculosis infection is a problem in children because of lack of a diagnostic standard and potential impact of previous Bacille Calmette-Guérin vaccination and exposure to environmental mycobacteria. Effectiveness and usefulness of interferon-gamma release assays in infants and younger children have yet to be clearly demonstrated. Prospective cohort study including 109 children (4 months to 16 years) seen in an international adoption clinic at Nationwide Children's Hospital, Columbus, OH. Children were adopted from 14 countries, mostly (72.5%) from China, Russia and Ethiopia. Correspondence between tuberculin skin test (TST) and the T-SPOT.TB assay was evaluated. Factors associated with positive results on the TST and T-SPOT.TB were determined, and the impact of age on test performance was specifically addressed. TST was positive in 23.4% (25 of 107). T-SPOT.TB was positive in 4.6% (5 of 109). Overall agreement between TST and T-SPOT.TB was 71%, with prevalence-adjusted, bias-adjusted Kappa of 0.68. History of Mycobacterium tuberculosis exposure was associated with positive results on TST (odds ratio: 25.4, 95% confidence interval: 4.8-261.6, exact logistic regression) and T-SPOT.TB (odds ratio: 78.9, 95% confidence interval: 9.7-∞). All 5 children with positive T-SPOT.TB had TST induration ≥15 mm. No patient less than 1 year of age (n = 17) had positive TST or T-SPOT.TB. Positive TST was not associated with Bacille Calmette-Guérin vaccination or scar. TST was positive in a significant percentage of international adoptees. T-SPOT.TB was rarely positive and discordant results reflected negative T-SPOT.TB with positive TST. In this population latent tuberculosis infection may be over-estimated by TST. Regardless, in our context at the time of the study, treatment decisions were based upon TST results, not results of the T-SPOT.TB assay. Age was consistently associated with findings on TST and T-SPOT.TB with no positive result on either test for any child <1 year of age.

A policy-into-practice intervention to increase the uptake of evidence-based management of low back pain in primary care: a prospective cohort study.

PubMed

Slater, Helen; Davies, Stephanie Joy; Parsons, Richard; Quintner, John Louis; Schug, Stephan Alexander

2012-01-01

Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1  =  nil and 5  =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  =  -5.6±8.2, p<0.0001; 95% confidence interval: -7.6 to -3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention. An interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice.

How To Adopt Internationally: A Guide for Agency-Directed and Independent Adoptions. 2000-2002 Edition.

ERIC Educational Resources Information Center

Nelson-Erichsen, Jean; Erichsen, Heino R.

Many potential adoptive parents seeking international adoption find the process to be extremely complex. This guide details the international adoption process, including organizing a home study and fulfilling state requirements as well as selecting a country from which to adopt, working through emigration and immigration agencies, and traveling…

Adoption Practice in Canada: Emerging Trends and Challenges.

ERIC Educational Resources Information Center

Sobol, Michael P.; Daly, Kerry

1995-01-01

Reports the results of the National Adoption Study of Canada (NAS), which is based on demographic adoption statistics and a survey of adoption agencies and practitioners. The NAS found that between 1981 and 1990 the number of adoptions decreased by 47% and that private adoptions are accounting for an ever-increasing proportion of infant…

Assessing the performance of the Oxford Nanopore Technologies MinION

PubMed Central

Laver, T.; Harrison, J.; O’Neill, P.A.; Moore, K.; Farbos, A.; Paszkiewicz, K.; Studholme, D.J.

2015-01-01

The Oxford Nanopore Technologies (ONT) MinION is a new sequencing technology that potentially offers read lengths of tens of kilobases (kb) limited only by the length of DNA molecules presented to it. The device has a low capital cost, is by far the most portable DNA sequencer available, and can produce data in real-time. It has numerous prospective applications including improving genome sequence assemblies and resolution of repeat-rich regions. Before such a technology is widely adopted, it is important to assess its performance and limitations in respect of throughput and accuracy. In this study we assessed the performance of the MinION by re-sequencing three bacterial genomes, with very different nucleotide compositions ranging from 28.6% to 70.7%; the high G + C strain was underrepresented in the sequencing reads. We estimate the error rate of the MinION (after base calling) to be 38.2%. Mean and median read lengths were 2 kb and 1 kb respectively, while the longest single read was 98 kb. The whole length of a 5 kb rRNA operon was covered by a single read. As the first nanopore-based single molecule sequencer available to researchers, the MinION is an exciting prospect; however, the current error rate limits its ability to compete with existing sequencing technologies, though we do show that MinION sequence reads can enhance contiguity of de novo assembly when used in conjunction with Illumina MiSeq data. PMID:26753127

Evaluating community health centers’ adoption of a new global capitation payment (eCHANGE) study protocol

PubMed Central

Angier, H; O’Malley, JP; Marino, M; McConnell, KJ; Cottrell, E; Jacob, RL; Likumahuwa-Ackman, S; Heintzman, J; Huguet, N; Bailey, SR; DeVoe, JE

2017-01-01

Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon’s Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment. We will implement a difference-in-difference analytic approach to evaluate pre-post APM changes between intervention and control groups, including: 1) clinic-level outcomes, 2) patient-level clinical outcomes, and 3) patient-level econometric outcomes. Findings from the project will be of national significance, as there is a need for evidence regarding how novel payment methods might enhance PCMH capabilities and support their capacity to produce better quality and outcomes. If this capitated payment method is proven effective, study findings will inform dissemination of similar APMs nationwide. PMID:27836506

Mechanism by which BMI influences leisure-time physical activity behavior.

PubMed

Godin, Gaston; Bélanger-Gravel, Ariane; Nolin, Bertrand

2008-06-01

The objective of this prospective study was to clarify the mechanism by which BMI influences leisure-time physical activity. This was achieved in accordance with the assumptions underlying the Theory of Planned Behavior (TPB), considered as one of the most useful theories to predict behavior adoption. At baseline, a sample of 1,530 respondents completed a short questionnaire to measure intention and perceived behavioral control (PBC), the two proximal determinants of behavior of TPB. Past behavior, sociodemographic variables, and weight and height were also assessed. The dependent variable, leisure-time physical activity was assessed 3 months later. Hierarchical multiple regression analyses revealed that BMI is a direct predictor of future leisure-time physical activity, not mediated by the variables of TPB. Additional hierarchical analyses indicated that BMI was not a moderator of the intention-behavior and PBC-behavior relationships. The results of this study suggest that high BMI is a significant negative determinant of leisure-time physical activity. This observation reinforces the importance of preventing weight gain as a health promotion strategy for avoiding a sedentary lifestyle.

Links between livestock production, the environment and sustainable development.

PubMed

Pradbre, J-P

2014-12-01

This study examines the prospects for strong growth in the supply and demand for animal products worldwide, especially in developing countries, where 80% of the world's population lives. Based on scientific publications, statistics and field observations, it reviews greenhouse gas emission levels from livestock, the ability of ruminant livestock systems to sequester carbon and the capacity of the livestock industry to meet the challenge of sustainable development and to share its benefits while minimising impacts to climate change. Special attention is paid to the situation of the 800 million livestock farmers in the world living at the extreme end of poverty. The study underlines the importance of improving livestock productivity and the interdependence of the economic, environmental and social components of sustainable development. It highlights how, in the least developed countries and most lower-middle-income countries, the pressure exerted by animal diseases hampers efforts to improve livestock productivity. Poor livestock farmers have not sufficiently benefited from development policies and need support to adopt technological advances to meet the challenges of sustainable development and poverty reduction.

Evaluating community health centers' adoption of a new global capitation payment (eCHANGE) study protocol.

PubMed

Angier, H; O'Malley, J P; Marino, M; McConnell, K J; Cottrell, E; Jacob, R L; Likumahuwa-Ackman, S; Heintzman, J; Huguet, N; Bailey, S R; DeVoe, J E

2017-01-01

Primary care patient-centered medical homes (PCMHs) are an effective healthcare delivery model. Evidence regarding the most effective payment models for increased coordination efforts is sparse. This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The APM is a primary care payment reform intervention that changed Oregon's Medicaid payment for several CHCs from fee-for-service reimbursement to a per-member-per-month capitated payment. We will implement a difference-in-difference analytic approach to evaluate pre-post APM changes between intervention and control groups, including: 1) clinic-level outcomes, 2) patient-level clinical outcomes, and 3) patient-level econometric outcomes. Findings from the project will be of national significance, as there is a need for evidence regarding how novel payment methods might enhance PCMH capabilities and support their capacity to produce better quality and outcomes. If this capitated payment method is proven effective, study findings will inform dissemination of similar APMs nationwide. Copyright © 2016 Elsevier Inc. All rights reserved.

Microprocessor-controlled hemodynamics: a step towards improved efficiency and safety.

PubMed

Keogh, B E; Jacobs, J; Royston, D; Taylor, K M

1989-02-01

Manual titration of sodium nitroprusside (SNP) is widely used for treatment of hypertension following cardiac surgery. This study compared conventional manual control with control by a research prototype of an automatic infusion module based on a proportional plus integral plus derivative (PID) negative feedback loop. Two groups of coronary artery bypass patients requiring SNP for postoperative hypertension were studied prospectively. In the first group, hypertension was controlled by manual adjustment of the SNP infusion rate, and in the second, the infusion rate was controlled automatically. The actual and desired mean arterial pressures (MAP) over consecutive ten-second epochs were recorded during the period of infusion. The MAP was maintained within 10% of the desired MAP 45.8% of the time in the manual group, compared with 90.0% in the automatic group, and the mean percent error in the automatic group was significantly less than in the manual group (P less than 0.01). It is concluded that adoption of such systems will result in improved patient safety and may facilitate more effective distribution of nursing staff within intensive care units.

Asthma and allergic rhinitis in adoptees and their adoptive parents.

PubMed

Smith, J M; Cadoret, R J; Burns, T L; Troughton, E P

1998-08-01

Since the highest risk for the development of atopic disease is in early life, environmental risk factors need to be separated from the genetic component in this high risk period. Adoptees removed at birth and placed in adoptive families present a way to separate environmental and genetic factors at this early susceptible age. An opportunity for a pilot study of asthma and allergic rhinitis in adoptive families was presented when a psychiatrist (RC) was planning a behavioral study of young adult adoptees and their adoptive parents. A detailed questionnaire about allergic rhinitis and asthma was added after the psychiatrists' interview. Placement was not influenced by a history of allergy in adoptive or natural parents. The adoptee and at least one adoptive parent completed questionnaires in 367 families. The adoptees had been removed at birth and placed in the adoptive family within 3 months (83% within 1 month). Compared with adoptive families without asthma or allergic rhinitis, an adoptive mother with asthma or rhinitis, when the adoptive father was not affected, increased the risk for asthma in the adoptee (OR = 3.2, P < .0005). Asthma in the adoptive mother alone (OR = 3.2, P < .005) and allergic rhinitis alone (OR = 3.4, P < .005) increased the risk for asthma in the adoptee. Adoptive father asthma or allergic rhinitis showed a trend toward increased asthma in the adoptee (OR = 1.9, P < .1). This should be considered a pilot or feasibility study since subjects could not be examined or tested. Finding a risk for atopic respiratory disease or asthma associated with adoption by parents with asthma or allergic rhinitis suggests that further well planned adoptee studies should be made.

[The outcomes of Adoption in the Case of the "British Chinese Adoption Study"].

PubMed

Rushton, Alan

2015-01-01

Practitioners can over-estimate the incidence of problems in adopted children and adults because they do not see those who make good psychological and social adjustments. Research into adoption outcomes can be hard to interpret without information about differing pre-adoption histories. Examples are given of research into three types of adoption: domestic infant adoption, adoptions from public care of maltreated children and international adoption of ex-orphanage children. Although negative outcomes are indisputably evident for some, recovery from adversity is more common than many would predict. It is important to recognize that subsequent nurturing in consistent and stimulating environments can build a platform for effective adaptations to challenges in the future. However, a proper understanding of the consequences of adoption has been limited by the fact that follow-up studies have rarely extended beyond adolescence and early adulthood. The British Chinese Adoption Study is a 50 year follow-up of orphanage girls internationally adopted into the United Kingdom, and is given as an example of good outcomes despite early years of adversity. Scores on mental health assessments were equivalent to the non-adopted, age-matched comparison group of UK women. Most of the women were rated as "good functioning" and educational achievements were many times higher than the comparison women. Life-long adverse effects are not inevitable following early adversity. Improved circumstances can promote recovery and good adult adjustment. Practice and research implications are discussed.

Germline BRCA mutation evaluation in a prospective triple-negative breast cancer registry: implications for hereditary breast and/or ovarian cancer syndrome testing

PubMed Central

Klemp, Jennifer R.; Kimler, Bruce F.; Mahnken, Jonathan D.; Geier, Larry J.; Khan, Qamar J.; Elia, Manana; Connor, Carol S.; McGinness, Marilee K.; Mammen, Joshua M. W.; Wagner, Jamie L.; Ward, Claire; Ranallo, Lori; Knight, Catherine J.; Stecklein, Shane R.; Jensen, Roy A.; Fabian, Carol J.; Godwin, Andrew K.

2014-01-01

NCCN guidelines recommend genetic testing for all triple-negative breast cancer (TNBC) patients aged ≤60 years. However, due to the lack of prospective information in unselected patients, these guidelines are not uniformly adopted by clinicians and insurance carriers. The aim of this study was to determine the prevalence of BRCA mutations and evaluate the utility of NCCN guidelines in unselected TNBC population. Stage I–IV TNBC patients were enrolled on a prospective registry at academic and community practices. All patients underwent BRCA1/2 testing. Significant family history (SFH) was defined >1 relative with breast cancer at age ≤50 or ≥1 relative with ovarian cancer. Mutation prevalence in the entire cohort and subgroups was calculated. 207 TNBC patients were enrolled between 2011 and 2013. Racial/ethnic distribution: Caucasian (80 %), African–American (14 %), Ashkenazi (1 %). Deleterious BRCA1/2 mutations were identified in 15.4 % (32/207) of patients (BRCA1:11.1 %, BRCA2:4.3 %). SFH reported by 36 % of patients. Mutation prevalence in patients with and without SFH was 31.6 and 6.1 %, respectively. When assessed by age at TNBC diagnosis, the mutation prevalences were 27.6 % (≤50 years), 11.4 % (51–60 years), and 4.9 % (≥61 years). Using SFH or age ≤50 as criteria, 25 and 34 % of mutations, respectively, were missed. Mutation prevalence in patients meeting NCCN guidelines was 18.3 % (32/175) and 0 % (0/32) in patients who did not meet guidelines (p = .0059). In this unselected academic and community population with negligible Ashkenazi representation, we observed an overall BRCA mutation prevalence rate of 15.4 %. BRCA testing based on NCCN guidelines identified all carriers supporting its routine application in clinical practice for TNBC. PMID:24807107

Facilitators & Barriers to the Adoption of Ergonomic Solutions in Construction

PubMed Central

Dale, Ann Marie; Jaegers, Lisa; Welch, Laura; Barnidge, Ellen; Weaver, Nancy; Evanoff, Bradley A.

2017-01-01

Background Rates of musculoskeletal disorders in construction remain high. Few studies have described barriers and facilitators to the use of available ergonomic solutions. This paper describes these barriers and facilitators and their relationship to the level of adoption. Methods Three analysts rated 16 proposed ergonomic solutions from a participatory ergonomics study and assessed the level of adoption, six adoption characteristics, and identified the category of adoption from a theoretical model. Results Twelve solutions were always or intermittently used and were rated positively for characteristics of relative advantage, compatibility with existing work processes, and trialability. Locus of control (worker vs. contractor) was not related to adoption. Simple solutions faced fewer barriers to adoption than those rated as complex. Conclusions Specific adoption characteristics can help predict the use of new ergonomic solutions in construction. Adoption of complex solutions must involve multiple stakeholders, more time, and shifts in culture or work systems. PMID:28195660

Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2015.

PubMed

2014-08-06

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2015 as required by the statute. This final rule finalizes a policy to collect data on the amount and mode (that is, Individual, Concurrent, Group, and Co-Treatment) of therapy provided in the IRF setting according to therapy discipline, revises the list of diagnosis and impairment group codes that presumptively meet the "60 percent rule'' compliance criteria, provides a way for IRFs to indicate on the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) form whether the prior treatment and severity requirements have been met for arthritis cases to presumptively meet the "60 percent rule'' compliance criteria, and revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP). This rule also delays the effective date for the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that were finalized in FY 2014 IRF PPS final rule and adopts the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that are finalized in this rule. This final rule also addresses the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for the IRF prospective payment system (PPS), which will be effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions.

Concerted action of neuroepithelial basal shrinkage and active epithelial migration ensures efficient optic cup morphogenesis

PubMed Central

Sidhaye, Jaydeep; Norden, Caren

2017-01-01

Organ formation is a multi-scale event that involves changes at the intracellular, cellular and tissue level. Organogenesis often starts with the formation of characteristically shaped organ precursors. However, the cellular mechanisms driving organ precursor formation are often not clear. Here, using zebrafish, we investigate the epithelial rearrangements responsible for the development of the hemispherical retinal neuroepithelium (RNE), a part of the optic cup. We show that in addition to basal shrinkage of RNE cells, active migration of connected epithelial cells into the RNE is a crucial player in its formation. This cellular movement is driven by progressive cell-matrix contacts and actively translocates prospective RNE cells to their correct location before they adopt neuroepithelial fate. Failure of this migration during neuroepithelium formation leads to ectopic determination of RNE cells and consequently impairs optic cup formation. Overall, this study illustrates how spatiotemporal coordination between morphogenic movements and fate determination critically influences organogenesis. DOI: http://dx.doi.org/10.7554/eLife.22689.001 PMID:28372636

Initial Experience and Usage Patterns With the Owlet Smart Sock Monitor in 47,495 Newborns.

PubMed

Dangerfield, Michelle I; Ward, Kenneth; Davidson, Luke; Adamian, Milena

2017-01-01

We report the largest experience, to our knowledge, of home cardiorespiratory monitoring in 47,495 newborns using the novel Owlet Smart Sock (OSS) technology (October 2015 to May 2017). On average, 47,495 newborns were monitored for 6 months, 4.5 d/wk, 9.9 h/d. Continuous readings of oxygen saturation and heart rate were obtained from 39,626 full-term newborns. OSS users were likely first-time parents in their 30s with at least a college degree; 37% had a healthcare professional in the family; and 28% were at or below median income level per the US Census Bureau. "Peace of mind" was the reason to own an OSS in 75%, and 82% of parents followed Safe Sleep Guidelines. A total of 94% of parents reported a better quality of sleep. The fast and continuous pace of device adoption and reported experience suggest excellent parental acceptance of the OSS. Prospective studies are warranted to further evaluate its applications in the high-risk newborn population.

Research on distributed optical fiber sensing data processing method based on LabVIEW

NASA Astrophysics Data System (ADS)

Li, Zhonghu; Yang, Meifang; Wang, Luling; Wang, Jinming; Yan, Junhong; Zuo, Jing

2018-01-01

The pipeline leak detection and leak location problem have gotten extensive attention in the industry. In this paper, the distributed optical fiber sensing system is designed based on the heat supply pipeline. The data processing method of distributed optical fiber sensing based on LabVIEW is studied emphatically. The hardware system includes laser, sensing optical fiber, wavelength division multiplexer, photoelectric detector, data acquisition card and computer etc. The software system is developed using LabVIEW. The software system adopts wavelet denoising method to deal with the temperature information, which improved the SNR. By extracting the characteristic value of the fiber temperature information, the system can realize the functions of temperature measurement, leak location and measurement signal storage and inquiry etc. Compared with traditional negative pressure wave method or acoustic signal method, the distributed optical fiber temperature measuring system can measure several temperatures in one measurement and locate the leak point accurately. It has a broad application prospect.

Comparative analysis between academic and patent publications based on Fenton Technologies among China, Brazil, and the rest of the world.

PubMed

de Luna, Airton José; Santos, Douglas Alves

2017-03-01

Worldwide, year by year, Fenton's Technologies have been highlighted in both academic and patent scopes, in part due to their proven efficiency as environment-friendly technologies destined to the abatement of organic pollutants, and also by their growing interest to produce industrial applications. Thus, aiming to understand the effective dynamic between two worlds, academy vs patents, the present study performs a comparative analysis about publications on Fenton-based Technologies (FbT). Therefore, in this work, technological foresight techniques were adopted focusing on patent and non-patent databases, employing for this, the Web of Science (WoS) database as a prospecting tool. The main results for the last decade point out to a strong increment of the Fenton's Technologies, as much in R&D as in patent applications in the world. Chinese Universities and firms command the scenario. There is an expressive gap between the academic and patent issues.

Genetic engineering with T cell receptors.

PubMed

Zhang, Ling; Morgan, Richard A

2012-06-01

In the past two decades, human gene transfer research has been translated from a laboratory technology to clinical evaluation. The success of adoptive transfer of tumor-reactive lymphocytes to treat the patients with metastatic melanoma has led to new strategies to redirect normal T cells to recognize tumor antigens by genetic engineering with tumor antigen-specific T cell receptor (TCR) genes. This new strategy can generate large numbers of defined antigen-specific cells for therapeutic application. Much progress has been made to TCR gene transfer systems by optimizing gene expression and gene transfer protocols. Vector and protein modifications have enabled excellent expression of introduced TCR chains in human lymphocytes with reduced mis-pairing between the introduced and endogenous TCR chains. Initial clinical studies have demonstrated that TCR gene-engineered T cells could mediate tumor regression in vivo. In this review, we discuss the progress and prospects of TCR gene-engineered T cells as a therapeutic strategy for treating patients with melanoma and other cancers. Published by Elsevier B.V.

Experimental adoption of RCM in EDF substations

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

Heroin, G.; Aupied, J.; Sanchis, G.

1996-08-01

EDF, after testing Reliability Centered Maintenance (RCM) on systems used in nuclear power plants, has now successfully extended RCM to all of its nuclear power plants. In the light of this experience, EDF has committed itself to a pilot study on a line bay of a 400 kV substation in 1992. The RCM method as applied benefited from EDF`s policy of maintenance, introduced five years ago on all substations, which has enhanced prospects of reliability. The original feature in the selection of maintenance tasks was that it brought into play two criteria for failure assessment - frequency and seriousness -more » and two criteria for maintenance task selection - efficiency and facility. The final outcome of RCM as applied to substation maintenance is to categorize maintenance tasks into: (1) essential maintenance tasks, (2) optional tasks, depending on the type and location of the substation, as well as on factors relating to local management of maintenance policy, and (3) unnecessary tasks.« less

Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling.

PubMed

Van Houdenhoven, Mark; van Oostrum, Jeroen M; Hans, Erwin W; Wullink, Gerhard; Kazemier, Geert

2007-09-01

An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques. We applied advanced mathematical algorithms in combination with scenarios that model relaxation of various organizational barriers using prospectively collected data. The setting is the main inpatient OR department of a university hospital, which sets its surgical case schedules 2 wk in advance using a block planning method. The main outcome measures are the number of freed OR blocks and OR utilization. Lowering organizational barriers and applying mathematical algorithms can yield a 4.5% point increase in OR utilization (95% confidence interval 4.0%-5.0%). This is obtained by reducing the total required OR time. Efficient OR departments can further improve their efficiency. The paper shows that a radical cultural change that comprises the use of mathematical algorithms and lowering organizational barriers improves OR utilization.

Automated technology to speed recognition of signs of illness in older adults.

PubMed

Rantz, Marilyn J; Skubic, Marjorie; Koopman, Richelle J; Alexander, Gregory L; Phillips, Lorraine; Musterman, Katy; Back, Jessica; Aud, Myra A; Galambos, Colleen; Guevara, Rainer Dane; Miller, Steven J

2012-04-01

Our team has developed a technological innovation that detects changes in health status that indicate impending acute illness or exacerbation of chronic illness before usual assessment methods or self-reports of illness. We successfully used this information in a 1-year prospective study to alert health care providers so they could readily assess the situation and initiate early treatment to improve functional independence. Intervention participants showed significant improvements (as compared with the control group) for the Short Physical Performance Battery gait speed score at Quarter 3 (p = 0.03), hand grip-left at Quarter 2 (p = 0.02), hand grip-right at Quarter 4 (p = 0.05), and the GAITRite functional ambulation profile score at Quarter 2 (p = 0.05). Technological methods such as these could be widely adopted in older adult housing, long-term care settings, and in private homes where older adults wish to remain independent for as long as possible. Copyright 2012, SLACK Incorporated.

Relations Between Autonomous Motivation and Leisure-Time Physical Activity Participation: The Mediating Role of Self-Regulation Techniques.

PubMed

Nurmi, Johanna; Hagger, Martin S; Haukkala, Ari; Araújo-Soares, Vera; Hankonen, Nelli

2016-04-01

This study tested the predictive validity of a multitheory process model in which the effect of autonomous motivation from self-determination theory on physical activity participation is mediated by the adoption of self-regulatory techniques based on control theory. Finnish adolescents (N = 411, aged 17-19) completed a prospective survey including validated measures of the predictors and physical activity, at baseline and after one month (N = 177). A subsample used an accelerometer to objectively measure physical activity and further validate the physical activity self-report assessment tool (n = 44). Autonomous motivation statistically significantly predicted action planning, coping planning, and self-monitoring. Coping planning and self-monitoring mediated the effect of autonomous motivation on physical activity, although self-monitoring was the most prominent. Controlled motivation had no effect on self-regulation techniques or physical activity. Developing interventions that support autonomous motivation for physical activity may foster increased engagement in self-regulation techniques and positively affect physical activity behavior.

A model for the adoption of ICT by health workers in Africa.

PubMed

Jimoh, Lanrewaju; Pate, Muhammad A; Lin, Li; Schulman, Kevin A

2012-11-01

To investigate the potential of information and communication technology (ICT) adoption among maternal and child health workers in rural Nigeria. A prospective, quantitative survey design was used to collect data from quasi-randomly selected clusters of 25 rural health facilities in 5 of the 36 states in Nigeria over a 2-month period from June to July 2010. A total of 200 maternal and child health workers were included in the survey, and the data were analyzed using a modified theory of acceptance model (TAM). There was no significant difference between ICT knowledge and attitude scores across states. There were significant differences in perceived ease of use (P<.001) and perceived usefulness scores (P=.001) across states. Midwives reported higher scores on all the constructs but a lower score on endemic barriers (which is a more positive outcome). However, the differences were only statistically significant for perceived usefulness (P=.05) and endemic barriers (P<.001). Regression analysis revealed that there was no interaction between worker group and age. Older workers were likely to have lower scores on knowledge and attitude but higher scores on perceived ease of use and perceived usefulness. Lastly, we found that worker preference for ICT application in health varied across worker groups and conflicted with government/employer priorities. Although the objective of this study was exploratory, the results provide insight into the intricacies involved in the deployment of ICT in low-resource settings. Use of an expanded TAM should be considered as a mandatory part of any pre-implementation study of ICT among health workers in sub-Saharan Africa. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Randomized Selection Design Trial Evaluating CD8+-Enriched Versus Unselected Tumor-Infiltrating Lymphocytes for Adoptive Cell Therapy for Patients With Melanoma

PubMed Central

Dudley, Mark E.; Gross, Colin A.; Somerville, Robert P.T.; Hong, Young; Schaub, Nicholas P.; Rosati, Shannon F.; White, Donald E.; Nathan, Debbie; Restifo, Nicholas P.; Steinberg, Seth M.; Wunderlich, John R.; Kammula, Udai S.; Sherry, Richard M.; Yang, James C.; Phan, Giao Q.; Hughes, Marybeth S.; Laurencot, Carolyn M.; Rosenberg, Steven A.

2013-01-01

Purpose Adoptive cell therapy (ACT) with autologous tumor-infiltrating lymphocytes (TILs) and high-dose interleukin-2 (IL-2) administered to lymphodepleted patients with melanoma can cause durable tumor regressions. The optimal TIL product for ACT is unknown. Patients and Methods Patients with metastatic melanoma were prospectively assigned to receive unselected young TILs versus CD8+-enriched TILs. All patients received lymphodepleting chemotherapy and high-dose IL-2 therapy and were assessed for response, toxicity, survival, and immunologic end points. Results Thirty-four patients received unselected young TILs with a median of 8.0% CD4+ lymphocytes, and 35 patients received CD8+-enriched TILs with a median of 0.3% CD4+ lymphocytes. One month after TIL infusion, patients who received CD8+-enriched TILs had significantly fewer CD4+ peripheral blood lymphocytes (P = .01). Twelve patients responded to therapy with unselected young TILs (according to Response Evaluation Criteria in Solid Tumors [RECIST]), and seven patients responded to CD8+-enriched TILs (35% v 20%; not significant). Retrospective studies showed a significant association between response to treatment and interferon gamma secretion by the infused TILs in response to autologous tumor (P = .04), and in the subgroup of patients who received TILs from subcutaneous tumors, eight of 15 patients receiving unselected young TILs responded but none of eight patients receiving CD8+-enriched TILs responded. Conclusion A randomized selection design trial was feasible for improving individualized TIL therapy. Since the evidence indicates that CD8+-enriched TILs are not more potent therapeutically and they are more laborious to prepare, future studies should focus on unselected young TILs. PMID:23650429

Response to booster doses of hepatitis B vaccine among young adults who had received neonatal vaccination.

PubMed

Chan, Paul K S; Ngai, Karry L K; Lao, Terence T; Wong, Martin C S; Cheung, Theresa; Yeung, Apple C M; Chan, Martin C W; Luk, Scotty W C

2014-01-01

Newborns who have received hepatitis B immunization in 1980s are now young adults joining healthcare disciplines. The need for booster, pre- and post-booster checks becomes a practical question. The aim of this study is to refine the HBV vaccination policy for newly admitted students in the future. A prospective study on medical and nursing school entrants to evaluate hepatitis B serostatus and the response to booster doses among young adults. Among 212 students, 17-23-year-old, born after adoption of neonatal immunization, 2 (0.9%) were HBsAg positive, 40 (18.9%) were anti-HBs positive. At 1 month after a single-dose booster for anti-HBs-negative students, 14.5% had anti-HBs <10 mIU/mL, 29.0% and 56.5% were 10-100 and >100 mIU/mL, respectively. The anti-HBs levels were significantly higher for females than males (mean [SD]: 431 [418] vs. 246 [339] mIU/mL, P = 0.047). At 2-4 month after the third booster dose, 97.1% had anti-HBs >100 mIU/mL and 2.9% had 10-100 mIU/mL. Pre-booster check is still worthwhile to identify carriers among newly recruited healthcare workers born after adoption of neonatal immunization. A 3-dose booster, rather than a single dose, is required for the majority to achieve an anti-HBs level >100 mIU/mL, as memory immunity has declined in a substantial proportion of individuals. Cost-effectiveness of post-booster check for anti-HBs is low and should be further evaluated based on contextual specific utilization of results.

Good Practices for Real-World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making.

PubMed

Berger, Marc L; Sox, Harold; Willke, Richard J; Brixner, Diana L; Eichler, Hans-Georg; Goettsch, Wim; Madigan, David; Makady, Amr; Schneeweiss, Sebastian; Tarricone, Rosanna; Wang, Shirley V; Watkins, John; Mullins, C Daniel

2017-09-01

Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders. Copyright © 2017. Published by Elsevier Inc.

Depression in adoptive parents: a model of understanding through grounded theory.

PubMed

Foli, Karen J

2010-04-01

A limited number of studies have explored parental depression in the postadoption time periods and these studies frequently lack a social context of the adoptive parent experience. The objective of this study is to form a midrange theoretical interpretation of parental postadoption depression as shared by adoptive parents and experts through a grounded theory approach. Semistructured interviews of adoptive parents, who acknowledge being depressed after the child is placed in the home, and adoption experts are audiotaped, transcribed, and coded to reveal themes. In total, 30 interviews are conducted. Researchers are also participant-observers during an adoptive parent support group meeting. Data reveal recurrent themes in relation to postadoption depression. These themes take into account the various contexts of adoption (international and domestic, public and private, etc.). Parents express unfulfilled and unrealistic expectations in the domains of self, child, family or friends, and society or others. A theoretical model is presented to facilitate the understanding of depression reported by adoptive parents.

The experience of adoptive parents in adoption reunion relationships: a qualitative study.

PubMed

Petta, Gabrielle A; Steed, Lyndall G

2005-04-01

The issues experienced by adoptive parents when faced with an adult child's searching or reunion relationship with his or her birth family, how adoptive parents place themselves within this process, and the factors that influence their experience at this time were explored in a qualitative study of 21 adoptive parents. Themes derived from semistructured interviews are discussed, and implications for clinical practice and future research are suggested. Copyright (c) 2005 APA, all rights reserved.

A comparison of the results of prospective and retrospective cohort studies in the field of digestive surgery.

PubMed

Ukai, Tomohiko; Shikata, Satoru; Nakayama, Takeo; Takemura, Yousuke C

2017-07-01

We compared the results of prospective and retrospective cohort studies in the field of digestive surgery to clarify whether the results of prospective cohort studies were more similar to those of randomized controlled trials (RCTs). We conducted a secondary analysis of the results to compare the results of RCTs with those of cohort studies in meta-analyses of 18 digestive surgical topics. The data from the prospective and retrospective cohort studies were combined. The summary estimates of each design were compared with those of RCTs. We used the Z score to investigate discrepancies. Twenty-nine outcomes of 11 topics were investigated in 289 cohort studies (prospective, n = 69; retrospective, n = 220). These were compared with the outcomes of 123 RCTs. In comparison to retrospective studies, the summary estimates of the prospective cohort studies were more similar to those of the RCTs [19/29 (prospective) vs. 10/29 (retrospective), P = 0.035). Five of the 29 outcomes of prospective studies and 6 of 29 outcomes of retrospective studies (P = 0.99) showed significant discrepancies in comparison to RCTs. In the digestive surgical field, the results of prospective cohort studies tended to be more similar to those of RCTs than retrospective studies; however, there were no significant discrepancies between the two types of cohort study.

Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?

PubMed Central

Leathers, Sonya J.; Spielfogel, Jill E.; Gleeson, James P.; Rolock, Nancy

2015-01-01

Objectives Adoption is particularly important for foster children with special mental health needs who are unable to return home, as adoption increases parental support often critically needed by youth with mental health issues. Unfortunately, significant behavior problems frequently inhibit foster parents from adopting, and little is known about factors that predict adoption when a child has behavior problems. Previous research suggests that foster parent behavioral training could potentially increase rates of successful adoptions for pre-school-aged foster children with behavior problems (Fisher, Kim, & Pears, 2009), but this has not been previously tested in older samples. In older children, effective treatment of behavior problems might also increase adoption by reducing the interference of behavior problems and strengthening the child’s foster home integration. This pilot study focused on this question by testing associations between behavior problems, foster home integration, an evidence-based foster parent intervention, and adoption likelihood. Methods This study used an intent-to-treat design to compare foster home integration and adoption likelihood for 31 foster children with histories of abuse and neglect whose foster parents received a foster behavioral parenting intervention (see Chamberlain, 2003) or usual services. Random effect regression analyses were used to estimate outcomes across four time points. Results As expected, externalizing behavior problems had a negative effect on both integration and adoption, and foster home integration had an independent positive effect on adoption. Internalizing behavior problems (e.g., depression/anxiety) were not related to adoption or integration. However, the intervention did not have a direct effect on either foster home integration or adoption despite its positive effect on behavior problems. Conclusions Results from this preliminary study provide further evidence of the negative effect of externalizing behavior problems on adoption. Its findings also suggest that foster home integration is an important dimension of foster home adaptation that appears particularly relevant to chances for adoption. While behavior problems appear to weaken foster home integration, integration is also an independent predictor of adoption likelihood. If these results are replicated in a larger study, consideration of foster home integration in case planning and future intervention studies focused on increasing permanency could potentially improve outcomes for foster children with behavior problems. PMID:26617425

Open adoption of infants: adoptive parents' feelings seven years later.

PubMed

Siegel, Deborah H

2003-07-01

Adoptions today increasingly include contact between adoptive and birth families. What do these "open adoptions" look like? How do the participants feel about them? This article, based on part of a longitudinal study that first examined adoptive parents' perceptions of their infants' open adoptions seven years ago, explores the parents' reactions now that their children are school age. This qualitative descriptive research revealed changes in the openness in the adoptions over time and identified four dimensions along which open adoptions vary. Findings showed parents' enthusiasm for the openness in their adoptions, regardless of the type and extent of openness. Implications for social work practice, education, and policy are explored.

Why Did You Choose This Pet?: Adopters and Pet Selection Preferences in Five Animal Shelters in the United States

PubMed Central

Weiss, Emily; Miller, Katherine; Mohan-Gibbons, Heather; Vela, Carla

2012-01-01

Simple Summary This study examined reasons why adopters chose their pet in an animal shelter, what behaviors were first exhibited by the pet to the adopter, what information was important during their selection process, and the relative importance of seeing the animals’ behavior in various contexts. Abstract Responses from an adopter survey (n = 1,491) determined reasons for pet selection, type of information received by the adopter, and the context in which the animal’s behavior was observed. Appearance of the animal, social behavior with adopter, and personality were the top reasons for adoption across species and age groups. Most adopters stated that information about the animal from a staff member or volunteer was more important than information on cage cards, and health and behavior information was particularly important. Adopters found greater importance in interacting with the animal rather than viewing it in its kennel. The results of this study can be used by shelters to create better adoption matches, prioritize shelter resources and staff training, and potentially increase adoptions. Additionally, some simple training techniques are suggested to facilitate adopter-friendly behaviors from sheltered dogs and cats. PMID:26486914

The Nature of E-Learning Adoption by Stakeholders of a University in Africa

ERIC Educational Resources Information Center

Ansong, Eric; Boateng, Richard; Boateng, Sheena L.; Anderson, Augustus B.

2017-01-01

Studies looking at the nature of technology adoption from a multi-dimensional perspective have remained below expectation especially in African countries. This study, therefore, sought to explore the nature of e-learning adoption in the University of Ghana using a multi-stakeholder approach. A quantitative survey approach was adopted for this…

A Descriptive Study of the Intent of State Level Textbook Adoption.

ERIC Educational Resources Information Center

Tulley, Michael A.

In an effort to better understand the intents of those policies that prescribe state-level textbook adoption, a study collected and analyzed data from (1) the textbook adoption statutes of each of the 22 "state adoption" states, (2) documents and policy manuals produced by the state departments of education of each of these 22 states,…

Does adopting a prenatal substance use protocol reduce racial disparities in CPS reporting related to maternal drug use? A California case study.

PubMed

Roberts, S C M; Zahnd, E; Sufrin, C; Armstrong, M A

2015-02-01

This study examined whether adopting a standardized prenatal substance use protocol (protocol) in a hospital labor and delivery unit reduced racial disparities in reporting to child protective services (CPS) related to maternal drug use during pregnancy. This study used an interrupted time series design with a non-equivalent control. One hospital adopted a protocol and another hospital group serving a similar geographic population did not change protocols. Data on CPS reporting disparities from these hospitals over 3.5 years were analyzed using segmented regression. In the hospital that adopted the protocol, almost five times more black than white newborns were reported during the study period. Adopting the protocol was not associated with reduced disparities. Adopting a protocol cannot be assumed to reduce CPS reporting disparities. Efforts to encourage hospitals to adopt protocols as a strategy to reduce disparities may be misguided. Other strategies to reduce disparities are needed.

Budget impact of rare diseases: proposal for a theoretical framework based on evidence from Bulgaria.

PubMed

Iskrov, G; Jessop, E; Miteva-Katrandzhieva, T; Stefanov, R

2015-05-01

This study aimed to estimate the impact of rare disease (RD) drugs on Bulgaria's National Health Insurance Fund's (NHIF) total drug budget for 2011-2014. While standard budget impact analysis is usually used in a prospective way, assessing the impact of new health technologies on the health system's sustainability, we adopted a retrospective approach instead. Budget impact was quantified from a NHIF perspective. Descriptive statistics was used to analyse cost details, while dynamics was studied, using chain-linked growth rates (every period preceding the accounting period serves as a base). NHIF costs for RD therapies were expected to increase up to 74.5 million BGN in 2014 (7.8% of NHIF's total pharmaceutical expenditure). Greatest increase in cost per patient and number of patients treated was observed in conditions, for which there were newly approved for funding therapies. While simple cost drivers are well known - number of patients treated and mean cost per patient - in real-world settings these two factors are likely to depend on the availability and accessibility of effective innovative therapies. As RD were historically underdiagnosed, undertreated and underfunded in Bulgaria, improved access to RD drugs will inevitably lead to increasing budget burden for payers. Based on the evidence from this study, we propose a theoretical framework of a budget impact study for RD. First, a retrospective analysis could provide essential health policy insights in terms of impact on accessibility and population health, which are significant benchmarks in shaping funding decisions in healthcare. We suggest an interaction between the classical prospective BIA with the retrospective analysis in order to optimise health policy decision-making. Second, we recommend budget impact studies to focus on RD rather than orphan drugs (OD). In policy context, RD are the public health priority. OD are just one of the tools to address the complex issues of RD. Moreover, OD is a dynamic characteristic and compromises the consistency and comparability of the calculated budget indicators.

Sexually transmitted disease syndromic case management through public sector facilities: development and assessment study in Punjab Pakistan.

PubMed

Khan, Muhammad Amir; Javed, Wajiha; Ahmed, Maqsood; Walley, John; Munir, Muhammad Arif

2014-01-01

Sexually transmitted infections (STIs) are a priority health problem. We proposed a prospective study in two districts of Punjab, using an intervention package, which included guidelines and protocols on syndrome-based management of STIs, adapted in light of technical guidelines from the National AIDS Control Program and the World Health Organization. The aim of this study was to assess the operational effectiveness of STI case management guidelines and to assess factors that determine the adherence to guidelines for management of STIs at public health facilities in Pakistan. A prospective study lasting 18 months (January 2008 to June 2009), which reviewed early implementation experiences of updated case management guidelines for delivery of syndrome-based STI/reproductive tract infection care, through public-sector health care facilities. The project was implemented in two districts of Punjab, Sargodha and Jhang. A Cox regression model with stratification was done. The prevalence of STI was 26 per 100,000 patients. In women, the reported symptoms were 80% vaginal discharge and 12% abdominal pain. Forty-four percent of men had a genital ulcer and 29% of men had genital discharge. Age of participants ranged from 13 to 60 years. The study comprised 28.6% men and 71.4% women. The majority of the population attending these clinics was from rural areas (70%). The variables independently associated with adherence to guidelines were availability of male paramedic, age of patient, and type of diagnosis made. There was an important interaction (effect modification) present between the area of health facility and patient sex. Screening, diagnosis, and treatment costs for many STIs are expensive and thus an easier, low-cost, syndrome-based public health strategy is the adoption of the proposed STI syndrome case management guidelines. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

A QUESTIONNAIRE TO ASSESS THE RELEVANCE AND CREDIBILITY OF OBSERVATIONAL STUDIES TO INFORM HEALTH CARE DECISION MAKING: AN ISPOR-AMCP-NPC GOOD PRACTICE TASK FORCE REPORT

PubMed Central

Berger, Marc L; Martin, Bradley C; Husereau, Don; Worley, Karen; Allen, Dan; Yang, Winnie; Mullins, C. Daniel; Kahler, Kristijan; Quon, Nicole C.; Devine, Scott; Graham, John; Cannon, Eric; Crown, William

2014-01-01

Evidence-based healthcare decisions are best informed by comparisons of all relevant interventions used to treat conditions in specific patient populations. Observational studies are being performed to help fill evidence gaps. However, widespread adoption of evidence from observational studies has been limited due to a variety of factors, including the lack of consensus regarding accepted principles for their evaluation and interpretation. Two Task Forces were formed to develop questionnaires to assist decision makers in evaluating observational studies, with one Task Force addressing retrospective research and the other prospective research. The intent was to promote a structured approach to reduce the potential for subjective interpretation of evidence and drive consistency in decision-making. Separately developed questionnaires were combined into a single questionnaire consisting of 33 items. These were divided into two domains: relevance and credibility. Relevance addresses the extent to which findings, if accurate, apply to the setting of interest to the decision maker. Credibility addresses the extent to which the study findings accurately answer the study question. The questionnaire provides a guide for assessing the degree of confidence that should be placed from observational studies and promotes awareness of the subtleties involved in evaluating those. PMID:24636373

The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention.

PubMed

McKay, Virginia R; Margaret Dolcini, M; Hoffer, Lee D

2017-12-01

Evidence-based intervention (EBI) de-adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de-adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010-2014), but then de-adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi-structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues' implementation framework, we developed a narrative of RESPECT implementation, delivery, and de-adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de-adoption had wide-reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de-adoption as a phase of the implementation cycle. Furthermore, EBI de-adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.

Predicting re-involvement for children adopted out of a public child welfare system.

PubMed

Orsi, Rebecca

2015-01-01

Some of the approximately 400,000 children currently placed out-of-home in a public child welfare system will not reunify with their family of origin. They may instead be adopted into a new family. Adoption placements can be characterized by poor adjustment for children; some such placements even result in disruption or dissolution. We conducted a stratified Cox regression of 4,016 children from the Colorado public child welfare system. All of the children had a finalized adoption during the years 2002 through 2006. The two outcomes analyzed were new child protection and youth-in-conflict referrals and assessments for these previously adopted children. New child welfare referrals and assessments may be early indicators of poor adjustment for adopted children within the adoptive family. Study results indicate that older children and Hispanic children had higher rates of referral and assessment. Children with a pre-adoption history including longer time out-of-home or a larger number of out-of-home placements also experienced higher referral and assessment rates. Additional factors which predicted subsequent system re-involvement included presence of paid adoption assistance, adoption by a non-relative foster parent and younger adoptive parent age. Several study results were moderated by the presence or absence of an ethnic match between the child and the adoptive parents. We provide an overview of the statistical model used for analysis and we discuss implications of the study results for child welfare practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Adoption Research: Trends, Topics, Outcomes

ERIC Educational Resources Information Center

Palacios, Jesus; Brodzinsky, David

2010-01-01

The current article provides a review of adoption research since its inception as a field of study. Three historical trends in adoption research are identified: the first focusing on risk in adoption and identifying adoptee-nonadoptee differences in adjustment; the second examining the capacity of adopted children to recover from early adversity;…

Open Adoption of Infants: Adoptive Parents' Perceptions of Advantages and Disadvantages.

ERIC Educational Resources Information Center

Siegel, Deborah H.

1993-01-01

Conducted qualitative study of adoptive parents' (n=21 couples) reactions to recent open adoptions of their infants. Findings indicated overwhelmingly positive feelings about open adoption. Respondents often noted that issue of openness was eclipsed by other concerns: coping with infertility, finding a baby, dealing with personnel, and dealing…

Is Early Experience Destiny? Review of Research on Long-Term Outcomes following International Adoption with Special Reference to the British Chinese Adoption Study.

PubMed

Grant, Margaret; Rushton, Alan; Simmonds, John

2016-01-01

The pathway from adverse early experience to adulthood for internationally adopted children is complex in identifying key influences, impacts, and outcomes. This review arose from the authors' involvement in the British Chinese Adoption Study, a recent outcomes study that explored the links between early orphanage care, adoptive experiences, and midadulthood. It differs from previous reviews in focusing on a greater length of time since adoption. Both quantitative and qualitative studies were included to allow for examination of a fuller range of adult-related outcomes rather than mental health scores alone. The sampling, methods, and results of reviewed articles are summarised and a critical commentary is provided. Despite methodological differences and identified strengths and weaknesses, conclusions are drawn on the basis of the evidence available. Special attention is paid to the interpretation of negative outcomes. Findings identify areas that should be explored further in order to gain a fuller understanding of midlife outcomes of people who experienced a poor start in life followed by international adoption. Such studies help in refining lifespan developmental theories.

PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management: The PREVENT multi-center study.

PubMed

Maltais, Simon; Kilic, Ahmet; Nathan, Sriram; Keebler, Mary; Emani, Sitaramesh; Ransom, John; Katz, Jason N; Sheridan, Brett; Brieke, Andreas; Egnaczyk, Gregory; Entwistle, John W; Adamson, Robert; Stulak, John; Uriel, Nir; O'Connell, John B; Farrar, David J; Sundareswaran, Kartik S; Gregoric, Igor

2017-01-01

Recommended structured clinical practices including implant technique, anti-coagulation strategy, and pump speed management (PREVENT [PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management] recommendations) were developed to address risk of early (<3 months) pump thrombosis (PT) risk with HeartMate II (HMII; St. Jude Medical, Inc. [Thoratec Corporation], Pleasanton, CA). We prospectively assessed the HMII PT rate in the current era when participating centers adhered to the PREVENT recommendations. PREVENT was a prospective, multi-center, single-arm, non-randomized study of 300 patients implanted with HMII at 24 participating sites. Confirmed PT (any suspected PT confirmed visually and/or adjudicated by an independent assessor) was evaluated at 3 months (primary end-point) and at 6 months after implantation. The population included 83% men (age 57 years ± 13), 78% destination therapy, and 83% Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1-3. Primary end-point analysis showed a confirmed PT of 2.9% at 3 months and 4.8% at 6 months. Adherence to key recommendations included 78% to surgical recommendations, 95% to heparin bridging, and 79% to pump speeds ≥9,000 RPMs (92% >8,600 RPMs). Full adherence to implant techniques, heparin bridging, and pump speeds ≥9,000 RPMs resulted in a significantly lower risk of PT (1.9% vs 8.9%; p < 0.01) and lower composite risk of suspected thrombosis, hemolysis, and ischemic stroke (5.7% vs 17.7%; p < 0.01) at 6 months. Adoption of all components of a structured surgical implant technique and clinical management strategy (PREVENT recommendations) is associated with low rates of confirmed PT. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Perivascular Stem Cells: A Prospectively Purified Mesenchymal Stem Cell Population for Bone Tissue Engineering

PubMed Central

James, Aaron W.; Zara, Janette N.; Zhang, Xinli; Askarinam, Asal; Goyal, Raghav; Chiang, Michael; Yuan, Wei; Chang, Le; Corselli, Mirko; Shen, Jia; Pang, Shen; Stoker, David; Wu, Ben

2012-01-01

Adipose tissue is an ideal source of mesenchymal stem cells for bone tissue engineering: it is largely dispensable and readily accessible with minimal morbidity. However, the stromal vascular fraction (SVF) of adipose tissue is a heterogeneous cell population, which leads to unreliable bone formation. In the present study, we prospectively purified human perivascular stem cells (PSCs) from adipose tissue and compared their bone-forming capacity with that of traditionally derived SVF. PSCs are a population (sorted by fluorescence-activated cell sorting) of pericytes (CD146+CD34−CD45−) and adventitial cells (CD146−CD34+CD45−), each of which we have previously reported to have properties of mesenchymal stem cells. Here, we found that PSCs underwent osteogenic differentiation in vitro and formed bone after intramuscular implantation without the need for predifferentiation. We next sought to optimize PSCs for in vivo bone formation, adopting a demineralized bone matrix for osteoinduction and tricalcium phosphate particle formulation for protein release. Patient-matched, purified PSCs formed significantly more bone in comparison with traditionally derived SVF by all parameters. Recombinant bone morphogenetic protein 2 increased in vivo bone formation but with a massive adipogenic response. In contrast, recombinant Nel-like molecule 1 (NELL-1; a novel osteoinductive growth factor) selectively enhanced bone formation. These studies suggest that adipose-derived human PSCs are a new cell source for future efforts in skeletal regenerative medicine. Moreover, PSCs are a stem cell-based therapeutic that is readily approvable by the U.S. Food and Drug Administration, with potentially increased safety, purity, identity, potency, and efficacy. Finally, NELL-1 is a candidate growth factor able to induce human PSC osteogenesis. PMID:23197855

Effect of cardiac rehabilitation referral strategies on utilization rates: a prospective, controlled study.

PubMed

Grace, Sherry L; Russell, Kelly L; Reid, Robert D; Oh, Paul; Anand, Sonia; Rush, James; Williamson, Karen; Gupta, Milan; Alter, David A; Stewart, Donna E

2011-02-14

Although cardiac rehabilitation (CR) has been shown to reduce mortality and is a recommended component in clinical practice guidelines, CR referral and utilization rates remain low. Referral strategies have been implemented to increase CR use but have yet to be compared concurrently. To determine the optimal strategy to maximize CR referral, enrollment, and participation, we evaluated 3 referral strategies compared with usual care: "automatic" only via discharge order or electronic record, health care provider liaison only, or a combined approach. In this prospective controlled study, 2635 inpatients with coronary artery disease from 11 Ontario, Canada, hospitals using 1 of the 4 referral strategies completed a sociodemographic survey, and clinical data were extracted from medical charts. One year later, 1809 participants completed a mailed survey that assessed CR utilization. Referral strategies were compared using generalized estimating equations to control for effect of hospital. Adjusted analyses revealed referral strategy was significantly related to CR referral and enrollment (P<.001). Combined automatic and liaison referral resulted in the greatest CR use (odds ratio [OR], 8.41; 85.8% referral, 73.5% enrollment), followed by automatic only (OR, 3.27; 70.2% referral, 60.0% enrollment), and liaison only (OR, 3.35; 59.0% referral, 50.6% enrollment), compared with usual referral (32.2% referral, 29.0% enrollment). The degree of CR participation did not differ by referral strategy among referred participants (mean [SD] percentage of classes attended, 82.87% [27.20%]; P=.88). Automatic referral combined with a patient discussion can achieve among the highest rates of CR referral reported. Wider adoption of such strategies could ensure that 45% more patients being treated for cardiac disease would have access to and realize the benefits of CR. ©2011 American Medical Association. All rights reserved.

Computational tools for Breakthrough Propulsion Physics: State of the art and future prospects

NASA Astrophysics Data System (ADS)

Maccone, Claudio

2000-01-01

To address problems in Breakthrough Propulsion Physics (BPP) one needs sheer computing capabilities. This is because General Relativity and Quantum Field Theory are so mathematically sophisticated that the amount of analytical calculations is prohibitive and one can hardly do all of them by hand. In this paper we make a comparative review of the main tensor calculus capabilities of the three most advanced and commercially available ``symbolic manipulator'' codes: Macsyma, Maple V and Mathematica. We also point out that currently one faces such a variety of different conventions in tensor calculus that it is difficult or impossible to compare results obtained by different scholars in General Relativity and Quantum Field Theory. Mathematical physicists, experimental physicists and engineers have each their own way of customizing tensors, especially by using the different metric signatures, different metric determinant signs, different definitions of the basic Riemann and Ricci tensors, and by adopting different systems of physical units. This chaos greatly hampers progress toward the chief NASA BPP goal: the design of the NASA Warp Drive. It is thus concluded that NASA should put order by establishing international standards in symbolic tensor calculus and enforcing anyone working in BPP to adopt these NASA BPP Standards. .

Some enuretic derivatives in an adult analysis.

PubMed

Browne, N D

1986-01-01

The paper traces the effects of early overstimulation--leading as it does to precocious erotization and rage. Together, these combine in a manic defence by denying deadness in inner psychic reality. The rage being such as the ego cannot cope with, reappears in the recurrent fugitive dream. The paper shows how the patient is most threatened in his dreams where he repeatedly protects himself from death by castration; where death means death of inner psychic reality. In life his rage is never overt but is principally mocking, putting the other in the open while he remains protected from risks. In the same way just as the patient is most threatened in sleep, so he is likewise threatened by the change of mind at the prospect of sexual arousal. The adoption of a fetish affords protection, as it serves to negate total psychic inner deadness. The fetish itself is a sort of screen against loss and grief where these affects have been previously sexualized. Likewise the earlier adoption of the phobia of spilling liquids brought the enuretic event under ego-control by making the risks more conscious and therefore more available to act as a screen against loss and grief.

Advances in the Treatment of Metastatic Melanoma: Adoptive T Cell Therapy

PubMed Central

Bernatchez, Chantale; Radvanyi, Laszlo G.; Hwu, Patrick

2012-01-01

Metastatic melanoma is notoriously resistant to chemotherapy and radiotherapy regimens. The prospect for newly diagnosed metastatic melanoma patients is grim with a median survival of less than a year. Currently, the only therapies resulting in long term disease free intervals, high dose Interleukin-2 (IL-2) and more recently anti-CTLA-41, work through activation of the immune system. However, with both therapies the response rate is low. Advances in our knowledge of how the immune system interacts with cancer have led to a number of strategies to manipulate anti-tumor immune responses through immunotherapy. This review will focus on one avenue of immunotherapy using the transfer of T cells referred to as “Adoptive Cell Therapy” (ACT), which involves the ex vivo expansion of autologous tumor-specific T cells to large numbers that are ultimately transferred back to the patient to boost anti-tumor immunity. This approach has been shown to be effective in the treatment of virally induced cancers, as well as metastatic melanoma. Recent successes with ACT hold promise and further emphasize the tremendous potential benefit of harnessing the immune system in the fight against cancer. PMID:22484193

In emergency departments, radiologists' access to EHRs may influence interpretations and medical management.

PubMed

Franczak, Michael J; Klein, Madeline; Raslau, Flavius; Bergholte, Jo; Mark, Leighton P; Ulmer, John L

2014-05-01

The adoption of electronic health records (EHRs) that meet federal meaningful-use standards is a major US national policy priority. Policy makers recognize the potential of electronic communication in delivering high-quality health care, particularly in an environment of expanding remote access to medical care and the ever-increasing need to transmit health care records across institutions. To demonstrate this principle, we sought to estimate the significance of EHR access in emergent neuroradiologic interpretations. Three neuroradiologists conducted a prospective expert-rater analysis of 2,000 consecutive head computed tomography (CT) exams ordered by emergency department (ED) physicians. For each head CT exam, the neuroradiologists compared medical information generated by ED physicians to information generated by the interpreting radiologists who had access to additional EHR-derived patient data. In 6.1 percent of the head CT exams, the neuroradiologists reached consensus--meaning two out of three agreed--that the additional clinical data derived from the EHR was "very likely" to influence radiological interpretations and that the lack of that data would have adversely affected medical management in those patients. Health care providers must recognize the value of implementing EHRs and foster their widespread adoption.

From sword to chrysanthemum: Japan's culture of anti-miltarism

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

Berger, T.U.

The end of the Cold War and the phenomenal increase in Japan's economic and technological power put Japan today in the position to become, if it chooses, a military as well as economic superpower. The diminution of the Soviet threat and the increasing US preoccupation with domestic problems give Japan a latitude for independent action it has not had since the end of World War II. At the same time the US-Japanese security alliance, which has enabled Japan to adopt a minimalist approach to defense and national security, is being weakened by ideologically charged trade and other economic frictions andmore » a growing American perception of Japan as a threat to its interests. Moreover, in the long run Japan faces the prospect of having to deal with other rising regional powers, most notably the People's Republic of China. This changing international security environment thus raises question whether Japan, having become an economic rival of the United States, may not in the future become a military competitor as well; whether, after having adopted a pacifist stance for half a century, Japan may choose to unsheathe its sword once again.« less

How Self-Objectification Impacts Physical Activity Among Adolescent Girls in Costa Rica.

PubMed

Monge-Rojas, Rafael; Fuster-Baraona, Tamara; Garita-Arce, Carlos; Sánchez-López, Marta; Colon-Ramos, Uriyoán; Smith-Castro, Vanessa

2017-02-01

In Latin America, more than 80% of adolescent girls are physically inactive. Inactivity may be reinforced by female stereotypes and objectification in the Latin American sociocultural context. We examined the influence of objectification on the adoption of an active lifestyle among 192 adolescents (14 and 17 years old) from urban and rural areas in Costa Rica. Analyses of 48 focus-groups sessions were grounded in Objectification Theory. Vigorous exercises were gender-typed as masculine while girls had to maintain an aesthetic appearance at all times. Adolescents described how girls were anxious around the prospect of being shamed and sexually objectified during exercises. This contributed to a decrease in girls' desire to engage in physical activities. Among males, there is also a budding tolerance of female participation in vigorous sports, as long as girls maintained a feminine stereotype outside their participation. Self-objectification influenced Costa Rican adolescent girls' decisions to participate in physical activities. Interventions may include: procuring safe environments for physical activity where girls are protected from fear of ridicule and objectification; sensitizing boys about girl objectification and fostering the adoption of a modern positive masculine and female identities to encourage girls' participation in sports.

Selective effects of acute alcohol intake on the prospective and retrospective components of a prospective-memory task with emotional targets.

PubMed

Walter, Nora T; Bayen, Ute J

2016-01-01

Prospective memory involves remembering to do something in the future and has a prospective component (remembering that something must be done) and a retrospective component (remembering what must be done and when it must be done). Initial studies reported an impairment in prospective-memory performance due to acute alcohol consumption. Retrospective-memory studies demonstrated that alcohol effects vary depending on the emotionality of the information that needs to be learned. The aim of the present study was to investigate possible differential effects of a mild acute alcohol dose (0.4 g/kg) on the prospective and retrospective components of prospective memory depending on cue valence. Seventy-five participants were allocated to an alcohol or placebo group and performed a prospective-memory task in which prospective-memory cue valence was manipulated (negative, neutral, positive). The multinomial model of event-based prospective memory (Smith and Bayen 2004) was used to measure alcohol and valence effects on the two prospective-memory components separately. Overall, no main effect of alcohol or valence on prospective-memory performance occurred. However, model-based analyses demonstrated a significantly higher retrospective component for positive compared with negative cues in the placebo group. In the alcohol group, the prospective component was weaker for negative than for neutral cues and the retrospective component was stronger for positive than for neutral cues. Group comparisons showed that the alcohol group had a significantly lower prospective component for negative cues and a lower retrospective component for neutral cues. This is the first study to demonstrate selective alcohol effects on prospective-memory components depending on prospective-memory cue valence.

Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence

PubMed Central

Pace, Cecilia S.; Di Folco, Simona; Guerriero, Viviana; Santona, Alessandra; Terrone, Grazia

2015-01-01

Introduction: Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Method: Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4–9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers’ state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents’ verbal intelligence was controlled for. Results: Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers’ AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure–insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents’ verbal intelligence made a significant contribution to this prediction. Discussion: Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment representations of their late-adopted adolescent children. PMID:26441801

Adoptive parenting and attachment: association of the internal working models between adoptive mothers and their late-adopted children during adolescence.

PubMed

Pace, Cecilia S; Di Folco, Simona; Guerriero, Viviana; Santona, Alessandra; Terrone, Grazia

2015-01-01

Recent literature has shown that the good outcome of adoption would mostly depend on the quality of adoptive parenting, which is strongly associated with the security of parental internal working models (IWMs) of attachment. Specifically, attachment states-of-mind of adoptive mothers classified as free and autonomous and without lack of resolution of loss or trauma could represent a good protective factor for adopted children, previously maltreated and neglected. While most research on adoptive families focused on pre-school and school-aged children, the aim of this study was to assess the concordance of IWMs of attachment in adoptive dyads during adolescence. Our pilot-study involved 76 participants: 30 adoptive mothers (mean age = 51.5 ± 4.3), and their 46 late-adopted adolescents (mean age = 13.9 ± 1.6), who were all aged 4-9 years old at time of adoption (mean age = 6.3 ± 1.5). Attachment representations of adopted adolescents were assessed by the Friend and Family Interview (FFI), while adoptive mothers' state-of-mind with respect to attachment was classified by the Adult Attachment Interview (AAI). Adolescents' verbal intelligence was controlled for. Late-adopted adolescents were classified as follows: 67% secure, 26% dismissing, and 7% preoccupied in the FFI, while their adoptive mothers' AAI classifications were 70% free-autonomous, 7% dismissing, and 23% unresolved. We found a significant concordance of 70% (32 dyads) between the secure-insecure FFI and AAI classifications. Specifically adoptive mothers with high coherence of transcript and low unresolved loss tend to have late-adopted children with high secure attachment, even if the adolescents' verbal intelligence made a significant contribution to this prediction. Our results provides an empirical contribution to the literature concerning the concordance of attachment in adoptive dyads, highlighting the beneficial impact of highly coherent states-of-mind of adoptive mothers on the attachment representations of their late-adopted adolescent children.

Lyme disease: why the controversy?

PubMed

Beaman, M H

2016-12-01

Some Australians have become convinced of the existence of locally acquired Lyme disease (LD). The history of LD, since its recognition in the early 1970s, is reviewed as a model for investigative approaches to unknown syndromes. Australian Management Guidelines for LD include the requirement for diagnostic testing by National Association of Testing Authorities-accredited laboratories using Therapeutic Goods Administration-licensed tests, which result in the efficient diagnosis of LD in overseas travellers. Despite this, patients who have not left Australia pay many thousands of dollars for non-specialist consultations and testing at overseas laboratories. Unproven long-term therapy with multiple antibiotics has resulted in serious complications, including allergies, line sepsis, pancreatitis and pseudomembranous colitis. Studies have shown that LD vectors are not found in Australia, and Lyme Borrelia has not been found in Australian vectors, animals or patients with autochthonous illnesses. I propose that (i) A non-controversial name for the chronic syndrome should be adopted, 'Australian Multisystem Disorder'. (ii) Research funding should enable the development of a consensus case definition and studies of the epidemiology of this syndrome with laboratory investigations to identify an aetiology and surrogate markers of disease. Prospective, randomised treatment studies could then be undertaken using ethical protocols. © 2016 Royal Australasian College of Physicians.

Online Sellers’ Website Quality Influencing Online Buyers’ Purchase Intention

NASA Astrophysics Data System (ADS)

Shea Lee, Tan; Ariff, Mohd Shoki Md; Zakuan, Norhayati; Sulaiman, Zuraidah; Zameri Mat Saman, Muhamad

2016-05-01

The increase adoption of Internet among young users in Malaysia provides high prospect for online seller. Young users aged between 18 and 25 years old are important to online sellers because they are actively involved in online purchasing and this group of online buyers is expected to dominate future online market. Therefore, examining online sellers’ website quality and online buyers’ purchase intention is crucial. Based on the Theory of planned behavior (TPB), a conceptual model of online sellers’ website quality and purchase intention of online buyers was developed. E-tailQ instrument was adapted in this study which composed of website design, reliability/fulfillment, security, privacy & trust, and customer service. Using online questionnaire and convenience sampling procedure, primary data were obtained from 240 online buyers aged between 18 to 25 years old. It was discovered that website design, website reliability/fulfillment, website security, privacy & trust, and website customer service positively and significantly influence intention of online buyers to continuously purchase via online channels. This study concludes that online sellers’ website quality is important in predicting online buyers’ purchase intention. Recommendation and implication of this study were discussed focusing on how online sellers should improve their website quality to stay competitive in online business.

Gay and Lesbian Adoptive Families: An Exploratory Study of Family Functioning, Adoptive Child's Behavior, and Familial Support Networks

ERIC Educational Resources Information Center

Erich, Stephen; Leung, Patrick; Kindle, Peter; Carter, Sharon

2005-01-01

Traditional legal and social forces have hindered the adoption of children by gay and lesbian individuals and couples. Using a convenience sample drawn from gay and lesbian support groups and Internet sites, this exploratory study examines adoptive families with gay and lesbian parents in terms of family functioning capabilities, child's behavior,…

Using the RE-AIM framework to evaluate a community-based summer camp for children with obesity: a prospective feasibility study.

PubMed

Burke, Shauna M; Shapiro, Sheree; Petrella, Robert J; Irwin, Jennifer D; Jackman, Michelle; Pearson, Erin S; Prapavessis, Harry; Shoemaker, Joel Kevin

2015-01-01

Increasing rates of childhood overweight and obesity highlight a need for the evaluation of lifestyle interventions. The purpose of the study was to determine the Reach, Effectiveness, Adoption, Implementation and Maintenance of a novel family-focused program targeting children with obesity (i.e., the Children's Health and Activity Modification Program [C.H.A.M.P.]) using the RE-AIM framework, an evaluation tool for community-based health interventions. A single-centre, single cohort interventional feasibility study was conducted over the course of two years. Children with obesity and their families completed a 4-week group-based lifestyle intervention in Year 1 (n = 15; M age = 10.6; 53% female) and/or Year 2 (n = 25; M age = 10.6; 56% female). Outcome variables were measured pre- and post-intervention, as well as 6- and 12-months following completion of the formal program. Overall, C.H.A.M.P. had high reach in terms of participant representativeness. In addition, participation in the program was associated with significantly improved standardized body mass index (BMI-z), body fat percentage, lean mass percentage, and child- and parent-proxy reported quality of life (QOL; effectiveness/individual maintenance). Furthermore, a number of community partnerships were built, strengthened, and maintained prior to, during, and following implementation of the two-year program (adoption/setting maintenance, respectively). Finally, the intervention was delivered as intended as evidenced by high adherence to the schedule, attendance rates, and cost effectiveness (implementation). Based on RE-AIM metrics, C.H.A.M.P. appears to be a promising childhood obesity program. The findings reported will inform researchers and practitioners on how to design and implement future community-based programs addressing pediatric obesity. ISRCTN Registry, Study ID ISRCTN13143236. Registered 27 March 2015.

Mother-Daughter Agreement on Adolescent Adopted Chinese Girls' Academic Performance and Internalizing Symptoms

ERIC Educational Resources Information Center

Tan, Tony Xing; Marn, Travis

2014-01-01

This study reported mother-daughter agreement on adolescent adopted Chinese girls' adjustment. Data on the girls' academic performance and internalizing syndromes were collected from the adopted Chinese girls and their adoptive mothers separately. The adoptive mothers also provided data on mother-daughter relationship quality. There were 219 girls…

Attitudes and Actions That Adoptive Parents Perceive as Helpful in the Process of Raising Their Internationally Adopted Adolescent

ERIC Educational Resources Information Center

Kuzmina, Marina V.

2017-01-01

This phenomenological dissertation study explored the lived experiences of adoptive parents in the process of raising their internationally adopted adolescents. The researcher interviewed 9 participants. Criteria for selection of the research sample included having personal experience with parenting one or more international adolescents adopted at…

Understanding Adoptive Families: An Integrative Review of Empirical Research and Future Directions for Counseling Psychology

ERIC Educational Resources Information Center

O'Brien, Karen M.; Zamostny, Kathy P.

2003-01-01

Contrary to societal stereotypes about adoption, this integrative review of published empirical research on adoptive families noted several positive and few negative out-comes with regard to satisfaction with the adoption, familial functioning, and parent-child communication. The critical analysis of 38 studies on adoptive families revealed a…

Implications of Transnational Adoption Status for Adult Korean Adoptees

ERIC Educational Resources Information Center

Langrehr, Kimberly J.; Yoon, Eunju; Hacker, Jason; Caudill, Kathy

2015-01-01

This study used a consensual qualitative research method to explore the implications of transnational adoption in the lives of 12 adult Korean adoptees. From the analysis, 6 domains emerged: (a) adoption history and preadoptive memories, (b) meaning of adoption, (c) adoptive family dynamics, (d) racism, (e) identity formation, and (f) counseling…

Beyond preadoptive risk: The impact of adoptive family environment on adopted youth's psychosocial adjustment.

PubMed

Ji, Juye; Brooks, Devon; Barth, Richard P; Kim, Hansung

2010-07-01

Adopted children often are exposed to preadoptive stressors--such as prenatal substance exposure, child maltreatment, and out-of-home placements--that increase their risks for psychosocial maladjustment. Psychosocial adjustment of adopted children emerges as the product of pre- and postadoptive factors. This study builds on previous research, which fails to simultaneously assess the influences of pre- and postadoptive factors, by examining the impact of adoptive family sense of coherence on adoptee's psychosocial adjustment beyond the effects of preadoptive risks. Using a sample of adoptive families (n = 385) taking part in the California Long Range Adoption Study, structural equation modeling analyses were performed. Results indicate a significant impact of family sense of coherence on adoptees' psychosocial adjustment and a considerably less significant role of preadoptive risks. The findings suggest the importance of assessing adoptive family's ability to respond to stress and of helping families to build and maintain their capacity to cope with stress despite the sometimes fractious pressures of adoption.