Influence of memory theme and posttraumatic stress disorder on memory specificity in British and Iranian trauma survivors.

PubMed

Jobson, Laura; Cheraghi, Sepideh

2016-09-01

This study investigated the influence of culture, memory theme and posttraumatic stress disorder (PTSD) on autobiographical memory specificity in Iranian and British trauma survivors. Participants completed the Autobiographical Memory Test and PTSD Diagnostic Scale. The results indicated that the British group provided significantly more personal-themed memories than the Iranian group, while the Iranian group provided significantly more social-themed memories than the British group. The British group also provided a significantly greater proportion of specific personal-themed and social-themed memories than the Iranian group. Overall, in both cultural groups memory specificity was found to be significantly correlated with PTSD symptoms. These findings provide further evidence that regardless of memory theme, specificity of autobiographical memories function to differentiate the self from others and reaffirm the independent self. They also further highlight that pan-culturally an overgeneral retrieval style may be employed by those with PTSD symptoms.

Views on dignity in providing health care for older people.

PubMed

Calnan, Michael; Woolhead, Gillian; Dieppe, Paul; Tadd, Win

The aim of this study was to explore the salience and meaning of dignity and dignified care for care providers and the implications for the proviosion of care. The project forms part of an international study being undertaken in different European countries comparing health and social care workers' views on dignity. Focus groups were chosen as the primary method of data collection. Twelve focus groups were carried out involving a total of 52 participants representing a range of occupational groups. All participants stated that dignity and respect were important for people of all age groups. The evidence that emerged from these focus groups showed that, in spite of the appropriate intentions of providers, older people were not consistently provided with dignified care. In order to ensure dignity in providing care for older people, tasks need to be organised around older people's needs and time frames. Without such changes there is a danger that 'institutional ageism' will persist in the health service.

Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.

PubMed

Allen, Kelli D; Oddone, Eugene Z; Coffman, Cynthia J; Jeffreys, Amy S; Bosworth, Hayden B; Chatterjee, Ranee; McDuffie, Jennifer; Strauss, Jennifer L; Yancy, William S; Datta, Santanu K; Corsino, Leonor; Dolor, Rowena J

2017-03-21

A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). 10 Duke University Health System community-based primary care clinics. 537 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. The study involved 1 health care network. Data on provider referrals were not collected. Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Facebook Discussion Groups Provide a Robust Worldwide Platform for Free Pathology Education.

PubMed

Gonzalez, Raul S; Amer, Sadiq M; Yahia, Nejib Ben; Costa, Felipe D'Almeida; Noatay, Manu; Qiao, Jian-Hua; Rosado, Flavia G; Rosen, Yale; Sedassari, Bruno Tavares; Yantiss, Rhonda K; Gardner, Jerad M

2017-05-01

- Facebook (Menlo Park, California) is one of many online sites that provide potential educational tools for pathologists. We have each founded Facebook groups dedicated to anatomic pathology, in which members can share cases, ask questions, and contribute to discussions. - To report our experiences in founding and maintaining these Facebook groups and to characterize the contributed content. - We circulated a survey among the group founders, then compiled and analyzed the responses. - The groups varied in membership and in the quality of member contribution. Most posts were of pathology cases, although other topics (such as research articles) were also shared. All groups remained active and received posts from users all over the world, although all groups had many noncontributing members and received unwanted messages (which were screened and removed). Most founders were glad they had founded the groups because they provided an opportunity to both teach and learn. - Each analyzed Facebook group had a different character, and some downsides exist, but the groups all provided a no-cost way for pathologists and others across the world to interact online with many colleagues.

The Magic of Balanced Groups: Educational Applications of Magic Squares

ERIC Educational Resources Information Center

Bosse, Michael J.; Nandakumar, N. R.; Ore, Melanie L.

2007-01-01

This paper provides students with many interesting observations regarding the nature of magic squares, magic rectangles, and quasi-magic squares and provides tools for teachers to group students into ability-balanced cooperative learning groups.

Medical care of hepatitis B among Asian American populations: perspectives from three provider groups.

PubMed

Hwang, Jessica P; Roundtree, Aimee K; Engebretson, Joan C; Suarez-Almazor, Maria E

2010-03-01

Physicians can play a significant role in helping to decrease the hepatitis B virus (HBV) burden among Asian Americans. Few studies have described knowledge and practice patterns in the medical community among different provider types regarding HBV and liver cancer. Our study explores the HBV beliefs, attitudes and practice patterns of medical providers serving Asian American communities. We conducted three focus groups with primary care providers, liver specialists, and other providers predominantly serving Asian American community. We asked about practices and barriers to appropriate medical care and outreach. We moderated three focus groups with 23 participants, 18 of whom completed and returned demographic surveys. Twelve were of Asian ethnicity and 13 spoke English as a second language. Only eight screened at least half of their patients, most (72%) using the hepatitis B surface antigen test. We used grounded theory methods to analyze focus group transcripts. Participants frequently discussed cultural and financial barriers to hepatitis care. They admitted reluctance to screen for HBV because patients might be unwilling or unable to afford treatment. Cultural differences were discussed most by primary care providers; best methods of outreach were discussed most by liver specialists; and alternative medicine was discussed most by acupuncturists and other providers. More resources are needed to lower financial barriers complicating HBV care and encourage providing guideline-recommended screenings. Other providers can help promote HBV screening and increase community and cultural awareness.

Customer assessment of long-term care pharmacy provider services.

PubMed

Clark, Thomas R

2008-09-01

Assess performance of long-term care pharmacy providers on key services offered to nursing facilities. Cross-sectional; nursing facility team. Random phone survey of nursing facility team members. 485 nursing facility team members (practicing in nursing facilities, interacting with > or = 1 consultant pharmacist); 46 members excluded, unable to identify facility's pharmacy provider. Directors of nursing, medical directors, and administrators were asked to rate long-term care pharmacy provider performance of eight commonly offered pharmacy services. All groups evaluated pharmacy provider performance of these services using a five-point scale. Results are broken down by employer type. Average rating for eight pharmacy services was 3.64. Top two services: "Labeling medications accurately" ranked in top 1-2 services for all groups (combined rating of 3.97) and "Provides medication administration system" ranked in top 1-3 services for all groups (combined rating of 3.95). One service, "Provides educational inservices," ranked lowest for all groups (combined rating of 3.54). In general, when looking at the eight services in combination for all providers, all services were ranked between Good and Very Good (average score of 3.64). Therefore, while the pharmacy provider is performing above average for these services, there is room for improvement in all of these services. These results can be used as a benchmark. Detailed data results and sample surveys are available online at www.ascp.com/supplements. These surveys can be used by the pharmacy provider to solicit assessments from their own facilities on these services.

Motivational Interviewing and Dietary Counseling for Obesity in Primary Care: An RCT

PubMed Central

McMaster, Fiona; Bocian, Alison; Harris, Donna; Zhou, Yan; Snetselaar, Linda; Schwartz, Robert; Myers, Esther; Gotlieb, Jaquelin; Foster, Jan; Hollinger, Donna; Smith, Karen; Woolford, Susan; Mueller, Dru; Wasserman, Richard C.

2015-01-01

BACKGROUND AND OBJECTIVE: Few studies have tested the impact of motivational interviewing (MI) delivered by primary care providers on pediatric obesity. This study tested the efficacy of MI delivered by providers and registered dietitians (RDs) to parents of overweight children aged 2 through 8. METHODS: Forty-two practices from the Pediatric Research in Office Settings Network of the American Academy of Pediatrics were randomly assigned to 1 of 3 groups. Group 1 (usual care) measured BMI percentile at baseline and 1- and 2-year follow-up. Group 2 (provider only) delivered 4 MI counseling sessions to parents of the index child over 2 years. Group 3 (provider + RD) delivered 4 provider MI sessions plus 6 MI sessions from a RD. The primary outcome was child BMI percentile at 2-year follow up. RESULTS: At 2-year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for groups 1, 2, and 3, respectively. The group 3 mean was significantly (P = .02) lower than group 1. Mean changes from baseline in BMI percentile were 1.8, 3.8, and 4.9 across groups 1, 2, and 3. CONCLUSIONS: MI delivered by providers and RDs (group 3) resulted in statistically significant reductions in BMI percentile. Research is needed to determine the clinical significance and persistence of the BMI effects observed. How the intervention can be brought to scale (in particular, how to train physicians to use MI effectively and how best to train RDs and integrate them into primary care settings) also merits future research. PMID:25825539

Health outcomes can be improved by implementing an occupational physiotherapy provider programme.

PubMed

Pizzari, Tania; Davidson, Megan

2013-03-01

To evaluate the return to work and health outcomes of a physiotherapy network provider programme. A prospective case-control study was conducted with 21 clients of network occupational physiotherapy (OP) providers and 21 matched clients of non-network providers. Health outcomes and return to work were recorded 3 and 6 months following the commencement of physiotherapy. Health outcomes included the Short Form (SF)-12, return to usual activities and the global perceived effect of treatment. Within-group changes and between-group differences were analysed. Within-group changes showed the OP group improved significantly in physical functioning (p = 0.006), and the control group deteriorated in mental health status (p = 0.016) as measured by the SF-12. Mean change over time between groups from the 3-month to 6-month follow-ups showed a significant difference favouring the OP group for return to usual activities (p = 0.027) and the physical component of the SF-12 (p = 0.009). All job-attached participants returned to work following their accident, so there was no difference between the groups. The OP clients demonstrated a greater change in physical functioning health outcomes over time. This study provides preliminary support for the implementation of the OP scheme. Copyright © 2012 John Wiley & Sons, Ltd.

Diabetes self-management among Arab Americans: patient and provider perspectives.

PubMed

Fritz, Heather; DiZazzo-Miller, Rosanne; Bertran, Elizabeth A; Pociask, Fredrick D; Tarakji, Sandra; Arnetz, Judith; Lysack, Catherine L; Jaber, Linda A

2016-08-31

Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers. Qualitative content analysis was used to analyze five focus groups-two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients. Four distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships. Findings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

Highly porous and mechanically strong ceramic oxide aerogels

NASA Technical Reports Server (NTRS)

Johnston, James C. (Inventor); Leventis, Nicholas (Inventor); Ilhan, Ulvi F. (Inventor); Meador, Mary Ann B. (Inventor); Fabrizio, Eve F. (Inventor)

2012-01-01

Structurally stable and mechanically strong ceramic oxide aerogels are provided. The aerogels are cross-linked via organic polymer chains that are attached to and extend from surface-bound functional groups provided or present over the internal surfaces of a mesoporous ceramic oxide particle network via appropriate chemical reactions. The functional groups can be hydroxyl groups, which are native to ceramic oxides, or they can be non-hydroxyl functional groups that can be decorated over the internal surfaces of the ceramic oxide network. Methods of preparing such mechanically strong ceramic oxide aerogels also are provided.

Highly porous and mechanically strong ceramic oxide aerogels

NASA Technical Reports Server (NTRS)

Fabrizio, Eve F. (Inventor); Leventis, Nicholas (Inventor); Ilhan, Ulvi F. (Inventor); Meador, Mary Ann B. (Inventor); Johnston, James C. (Inventor)

2010-01-01

Structurally stable and mechanically strong ceramic oxide aerogels are provided. The aerogels are cross-linked via organic polymer chains that are attached to and extend from surface-bound functional groups provided or present over the internal surfaces of a mesoporous ceramic oxide particle network via appropriate chemical reactions. The functional groups can be hydroxyl groups, which are native to ceramic oxides, or they can be non-hydroxyl functional groups that can be decorated over the internal surfaces of the ceramic oxide network. Methods of preparing such mechanically strong ceramic oxide aerogels also are provided.

The challenge of vaccinating adults: attitudes and beliefs of the Canadian public and healthcare providers.

PubMed

MacDougall, D M; Halperin, B A; MacKinnon-Cameron, D; Li, Li; McNeil, S A; Langley, J M; Halperin, S A

2015-09-29

Vaccine coverage for recommended vaccines is low among adults. The objective of this study was to assess the knowledge, attitudes, beliefs and behaviours of adults and healthcare providers related to four vaccine-preventable diseases and vaccines (diphtheria-tetanus-pertussis, zoster, pneumococcus and influenza). We undertook a survey and focus groups of Canadian adults and healthcare providers (doctors, nurses, pharmacists). A total of 4023 adults completed the survey and 62 participated in the focus groups; 1167 providers completed the survey and 45 participated in the focus groups. Only 46.3% of adults thought they were up-to-date on their vaccines; 30% did not know. In contrast, 75.6% of providers reported being up-to-date. Only 57.5% of adults thought it was important to receive all recommended vaccines (compared to 87.1-91.5% of providers). Positive attitudes towards vaccines paralleled concern about the burden of illness and confidence in the vaccines, with providers being more aware of disease burden and confident in vaccine effectiveness than the public. Between 55.0% and 59.7% of adults reported willingness to be vaccinated if recommended by their healthcare provider. However, such recommendations were variable; while 77.4% of the public reported being offered and 52.8% reported being recommended the influenza vaccine by their provider, only 10.8% were offered and 5.6% recommended pertussis vaccine. Barriers and facilitators to improved vaccine coverage in adults, such as trust-mistrust of health authorities, pharmaceutical companies and national recommendations, autonomy versus the public good and logistical issues (such as insufficient time and lack of vaccination status tracking), were identified by both the public and providers. Despite guidelines for adult vaccination, there are substantial gaps in knowledge and attitudes and beliefs among both the public and healthcare providers that lead to low vaccine coverage. A systematic approach that involves education, elimination of barriers and establishing and improving infrastructure for adult immunisation is required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Breaking the silence. Battered women's perspectives on medical care.

PubMed

Rodriguez, M A; Quiroga, S S; Bauer, H M

1996-03-01

To determine the barriers to identification and management of domestic violence from the battered women's perspective. Qualitative research methods using semistructured focus groups. Urban and suburban community-based organizations serving women and their families in the San Francisco Bay (Calif) area. Fifty-one women with histories of domestic violence comprised eight focus groups divided as follows: two groups of Latino (n=14), two groups of white (n=14), Asian (n=14), and two groups of African-American (n=9) women. Participants from all ethnic groups identified major factors that affect identification and management of battered women in the health care setting. Factors that interfere with patient disclosure included threats of violence from the partner, embarrassment, adherence to gender roles, concerns about police involvement and lack of trust in the health care provider. One factor that predisposed a woman to seek help from providers was a need for the providers to exhibit compassion, awareness, and respect for the patient's need to make the final decisions about her situation. Most participants said that providers should take the initiative to ask directly about domestic violence, establish a supportive patient-provider relationship, and refer battered women to available community resources. The major institutional barriers to using the health care system included the high cost of medical care and long waiting periods. Many battered women experience social, institutional, and provider barriers to obtaining help from the health care system for problems related to domestic violence. Providers as well as institutions can overcome these barriers through an understanding of the social context of domestic violence and the victim's needs. Identification may be improved through a trusting patient-provider relationship and by direct questioning about domestic violence.

Group visits for chronic illness management: implementation challenges and recommendations.

PubMed

Jones, Katherine R; Kaewluang, Napatsawan; Lekhak, Nirmala

2014-01-01

The group visit approach to improve chronic illness self-management appears promising in terms of selected outcomes, but little information is available about best ways to organize and implement group visits. This literature review of 84 articles identified group visit implementation challenges, including lack of a group visit billing code, inadequate administrative support and resources, difficult participant recruitment and retention, and logistical issues such as space and scheduling. Recommendations for future implementation initiatives were also abstracted from the literature. Patients and providers can benefit from well-planned and well-conducted group visits. These benefits include greater patient and provider satisfaction, reduced overall utilization, improved clinical outcomes, and greater provider efficiency and productivity.

The effect of test kit provision, and individual and family education on the uptake rates of fecal occult blood test in an Asian population: a randomized controlled trial.

PubMed

Ha, Tam Cam; Yong, Sook Kwin; Yeoh, Kheng-Wei; Kamberakis, Kay; Yeo, Richard Ming Chert; Koh, Gerald Choon-Huat

2014-11-01

The purpose of the study was to investigate whether fecal occult blood test (FOBT) home-delivery and individual education or combined with family education increases FOBT uptake rates in Singapore. This is a randomized controlled intervention study of Singaporean residents aged 50 years and above, conducted in May 2012 till May 2013. Eligible individuals in randomly selected households were screened, and one member was randomly selected and allocated to one of the four arms: Group A (individual and family education, FOBT kits provided), Group B (individual education only, FOBT kits provided), Group C (no education, FOBT kits provided) and Group D (no education or FOBT kits provided). Overall response rate was 74.7 %. The FOBT return rates for groups A, B, C and D were 24.5 % [CI 16.2-34.4 %], 25.3 % [CI 16.4-36.0 %], 10.7 % [CI 4.7-19.9 %] and 2.2 % [CI 0.3-7.7 %], respectively. Respondents who were provided education and home-delivered FOBT kits were 15 times more likely to return FOBT kits [Group A: OR 15.0 (3.4-66.2); Group B: OR 15.5 (3.5-68.8)] and those provided with home-delivered FOBT without education were five times more likely to return FOBT kits [Group C: OR 5.8 (1.2-28.3)] than those without education and FOBT kits (Group D). There was no significant difference in return of FOBT kits whether education was provided to subject with or without a family member. Home delivery of FOBT kits increased FOBT return rates and individual education combined with home-delivered FOBT increased FOBT return rates even further. However, additional combination with family education did not increase FOBT rates further.

Impact of Blood Pressure Dysregulation on Health-Related Quality of Life in Persons With Spinal Cord Injury: Development of a Conceptual Model

PubMed Central

Carlozzi, Noelle E.; Fyffe, Denise; Morin, Kel G.; Byrne, Rachel; Tulsky, David S.; Victorson, David; Lai, Jin-Shei; Wecht, Jill M.

2015-01-01

Objectives To identify medically relevant aspects of blood pressure dysregulation (BPD) related to quality of life in individuals with spinal cord injury (SCI), and to propose an integrated conceptual framework based on input from both individuals with SCI and their clinical providers. This framework will serve as a guide for the development of a patient-reported outcome (PRO) measure specifically related to BPD. Design Three focus groups with individuals with SCI and 3 groups with SCI providers were analyzed using grounded-theory based qualitative analysis to ascertain how blood pressure impacts health-related quality of life (HRQOL) in individuals with SCI. Setting Focus groups were conducted at 2 Veterans Affairs medical centers and a research center. Participants Individuals with SCI (n=27) in 3 focus groups and clinical providers (n=25) in 3 focus groups. Interventions Not applicable. Main Outcome Measures Not applicable. Results Qualitative analysis indicated that all focus groups spent the highest percentage of time discussing symptoms of BPD (39%), followed by precipitators/causes of BPD (16%), preventative actions (15%), corrective actions (12%), and the impact that BPD has on social or emotional functioning (8%). While patient/consumer focus groups and provider focus groups raised similar issues, providers spent more time discussing precipitators/causes of BPD and preventative actions (38%) than patient/consumer groups (24%). Conclusions These results suggest that BPD uniquely and adversely impacts HRQOL in persons with SCI. While both individuals with SCI and their providers highlighted the relevant symptoms of BPD, the SCI providers offered additional detailed information regarding the precipitators/causes and what can be done to prevent/treat BPD. Further, the results suggest that persons with SCI are aware of how BPD impacts their HRQOL and are able to distinguish between subtle signs and symptoms. These findings exemplify the need for a validated and sensitive clinical measurement tool that can assess the extent to which BPD impacts HRQOL in patients with SCI. PMID:23499779

75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...

Real-time video communication improves provider performance in a simulated neonatal resuscitation.

PubMed

Fang, Jennifer L; Carey, William A; Lang, Tara R; Lohse, Christine M; Colby, Christopher E

2014-11-01

To determine if a real-time audiovisual link with a neonatologist, termed video-assisted resuscitation or VAR, improves provider performance during a simulated neonatal resuscitation scenario. Using high-fidelity simulation, 46 study participants were presented with a neonatal resuscitation scenario. The control group performed independently, while the intervention group utilized VAR. Time to effective ventilation was compared using Wilcoxon rank sum tests. Providers' use of the corrective steps for ineffective ventilation per the NRP algorithm was compared using Cochran-Armitage trend tests. The time needed to establish effective ventilation was significantly reduced in the intervention group when compared to the control group (mean time 2 min 42 s versus 4 min 11 s, p<0.001). In the setting of ineffective ventilation, only 35% of control subjects used three or more of the first five corrective steps and none of them used all five steps. Providers in the control group most frequently neglected to open the mouth and increase positive pressure. In contrast, all of those in the intervention group used all of the first five corrective steps, p<0.001. All participants in the control group decided to intubate the infant to establish effective ventilation, compared to none in the intervention group, p<0.001. Using VAR during a simulated neonatal resuscitation scenario significantly reduces the time to establish effective ventilation and improves provider adherence to NRP guidelines. This technology may be a means for regional centers to support local providers during a neonatal emergency to improve patient safety and improve neonatal outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Microcredit, family planning programs, and contraceptive behavior: evidence from a field experiment in Ethiopia.

PubMed

Desai, Jaikishan; Tarozzi, Alessandro

2011-05-01

The impact of community-based family planning programs and access to credit on contraceptive use, fertility, and family size preferences has not been established conclusively in the literature. We provide additional evidence on the possible effect of such programs by describing the results of a randomized field experiment whose main purpose was to increase the use of contraceptive methods in rural areas of Ethiopia. In the experiment, administrative areas were randomly allocated to one of three intervention groups or to a fourth control group. In the first intervention group, both credit and family planning services were provided and the credit officers also provided information on family planning. Only credit or family planning services, but not both, were provided in the other two intervention groups, while areas in the control group received neither type of service. Using pre- and post-intervention surveys, we find that neither type of program, combined or in isolation, led to an increase in contraceptive use that is significantly greater than that observed in the control group. We conjecture that the lack of impact has much to do with the mismatch between women's preferred contraceptive method (injectibles) and the contraceptives provided by community-based agents (pills and condoms).

Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers

PubMed Central

Samuel, Susan M.; Flynn, Rachel; Zappitelli, Michael; Dart, Allison; Parekh, Rulan; Pinsk, Maury; Mammen, Cherry; Wade, Andrew; Scott, Shannon D.

2017-01-01

Background: Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. Methods: Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. Results: Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. Interpretation: Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. PMID:28592406

Effectiveness of the Lunch is in the Bag program on communication between the parent, child and child-care provider around fruits, vegetables and whole grain foods: a group-randomized controlled trial

PubMed Central

Rashid, Tasnuva; Ranjit, Nalini; Byrd-Williams, Courtney; Chuang, Ru-Jye; Roberts-Gray, Cindy; Briley, Margaret; Sweitzer, Sara; Hoelscher, Deanna M.

2015-01-01

Objective To evaluate the effectiveness of the parent- and early care education (ECE) center-based Lunch is in the Bag program on communication between parent, child, and their ECE center providers around fruits, vegetables and whole grain foods (FVWG). Method A total of n=30 ECE center; 577 parent-child dyads participated in this group-randomized controlled trial conducted from 2011–2013 in Texas (n=15 ECE center, 327 dyads intervention group; n=15 ECE center, 250 dyads comparison group). Parent-child and parent-ECE center provider communication was measured using a parent-reported survey administered at baseline and end of the five-week intervention period. Multilevel linear regression analysis was used to compare the pre-to-post intervention changes in the parent-child and parent-ECE center provider communication scales. Significance was set at p<0.05. Results At baseline, parent-child and parent-ECE center provider communication scores were low. There was a significant increase post-intervention in the parent-ECE center provider communication around vegetables (Adjusted β = 0.78, 95%CI: 0.13, 1.43, p=0.002), and around fruit (Adjusted β = 0.62, 95%CI: 0.04, 0.20, p=0.04) among the parents in the intervention group as compared to those in the comparison group. There were no significant intervention effects on parent-child communication. Conclusion Lunch is in the Bag had significant positive effects on improving communication between the parents and ECE center providers around FVWG. PMID:26190371

Effect of patient selection method on provider group performance estimates.

PubMed

Thorpe, Carolyn T; Flood, Grace E; Kraft, Sally A; Everett, Christine M; Smith, Maureen A

2011-08-01

Performance measurement at the provider group level is increasingly advocated, but different methods for selecting patients when calculating provider group performance have received little evaluation. We compared 2 currently used methods according to characteristics of the patients selected and impact on performance estimates. We analyzed Medicare claims data for fee-for-service beneficiaries with diabetes ever seen at an academic multispeciality physician group in 2003 to 2004. We examined sample size, sociodemographics, clinical characteristics, and receipt of recommended diabetes monitoring in 2004 for the groups of patients selected using 2 methods implemented in large-scale performance initiatives: the Plurality Provider Algorithm and the Diabetes Care Home method. We examined differences among discordantly assigned patients to determine evidence for differential selection regarding these measures. Fewer patients were selected under the Diabetes Care Home method (n=3558) than the Plurality Provider Algorithm (n=4859). Compared with the Plurality Provider Algorithm, the Diabetes Care Home method preferentially selected patients who were female, not entitled because of disability, older, more likely to have hypertension, and less likely to have kidney disease and peripheral vascular disease, and had lower levels of predicted utilization. Diabetes performance was higher under Diabetes Care Home method, with 67% versus 58% receiving >1 A1c tests, 70% versus 65% receiving ≥1 low-density lipoprotein (LDL) test, and 38% versus 37% receiving an eye examination. The method used to select patients when calculating provider group performance may affect patient case mix and estimated performance levels, and warrants careful consideration when comparing performance estimates.

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers.

PubMed

Kominiarek, Michelle A; Gay, Franklin; Peacock, Nadine

2015-08-01

To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥ 30 kg/m(2) and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Women frequently stated a GWG goal >20 lbs. Women described a body image not in line with clinical recommendations ("200 pounds is not that big."). They avoided the term "obese". They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of "exercise" varied. Family members could help, but generational differences posed challenges. Most had to "encourage myself" and "do this for me and the baby". Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

Lead and uranium group abundances in cosmic rays

NASA Technical Reports Server (NTRS)

Yadav, J. S.; Perelygin, V. P.

1985-01-01

The importance of Lead and Uranium group abundances in cosmic rays is discussed in understanding their evolution and propagation. The electronic detectors can provide good charge resolution but poor data statistics. The plastic detectors can provide somewhat better statistics but charge resolution deteriorates. The extraterrestrial crystals can provide good statistics but with poor charge resolution. Recent studies of extraterrestrial crystals regarding their calibration to accelerated uranium ion beam and track etch kinetics are discussed. It is hoped that a charge resolution of two charge units can be achieved provided an additional parameter is taken into account. The prospects to study abundances of Lead group, Uranium group and superheavy element in extraterrestrial crystals are discussed, and usefulness of these studies in the light of studies with electronic and plastic detectors is assessed.

Periodic nanostructures from self assembled wedge-type block-copolymers

DOEpatents

Xia, Yan; Sveinbjornsson, Benjamin R.; Grubbs, Robert H.; Weitekamp, Raymond; Miyake, Garret M.; Piunova, Victoria; Daeffler, Christopher Scot

2015-06-02

The invention provides a class of wedge-type block copolymers having a plurality of chemically different blocks, at least a portion of which incorporates a wedge group-containing block providing useful properties. For example, use of one or more wedge group-containing blocks in some block copolymers of the invention significantly inhibits chain entanglement and, thus, the present block copolymers materials provide a class of polymer materials capable of efficient molecular self-assembly to generate a range of structures, such as periodic nanostructures and microstructures. Materials of the present invention include copolymers having one or more wedge group-containing blocks, and optionally for some applications copolymers also incorporating one or more polymer side group-containing blocks. The present invention also provides useful methods of making and using wedge-type block copolymers.

Improving youth question-asking and provider education during pediatric asthma visits.

PubMed

Sleath, Betsy; Carpenter, Delesha M; Davis, Scott A; Watson, Claire Hayes; Lee, Charles; Loughlin, Ceila E; Garcia, Nacire; Reuland, Daniel S; Tudor, Gail

2018-06-01

We conducted a pragmatic randomized controlled trial to test the effectiveness of an asthma question prompt list with video intervention to increase youth question-asking and provider education during visits. English or Spanish-speaking youth ages 11-17 with persistent asthma and their parents were enrolled from four rural and suburban pediatric clinics. Youth were randomized to the intervention or usual care groups. Intervention group adolescents watched the video on an iPad and then completed an asthma question prompt list before their visits. Generalized estimating equations were used to analyze the data. Forty providers and 359 patients participated. Intervention group youth were significantly more likely to ask one or more questions about medications, triggers, and environmental control than usual care youth. Providers were significantly more likely to educate intervention group youth about rescue medications, triggers, and environmental control. Intervention group caregivers were not significantly more likely to ask questions. The intervention increased youth question-asking and provider education about medications, triggers, and environmental control. The intervention did not impact caregiver question-asking. Providers/practices should consider having youth complete question prompt lists and watch the video with their parents before visits to increase youth question-asking during visits. Copyright © 2018 Elsevier B.V. All rights reserved.

Provider Opinions Regarding the Development of a Stigma-Reduction Intervention Tailored for Providers.

PubMed

Mittal, Dinesh; Corrigan, Patrick; Drummond, Karen L; Porchia, Sylvia; Sullivan, Greer

2016-10-01

Interventions involving contact with a person who has recovered from mental illness are most effective at reducing stigma. This study sought input from health care providers to inform the design of a contact intervention intended to reduce provider stigma toward persons with serious mental illness. Using a purposive sampling strategy, data were collected from providers at five Veterans Affairs hospitals in the southeastern United States. Seven focus groups were conducted, and 83 health care providers participated. A semistructured interview guide was used to elicit providers' opinions about the target group of a contact intervention for providers, what providers would consider a credible contact, the preferred format for delivery, the usefulness of potentially tailoring the intervention to a specific facility, and how to measure change in clinical behaviors. Focus group data were analyzed using rapid data analysis techniques. Participants uniformly recommended a broad target audience for the stigma-reduction intervention, including all primary care and specialist providers. They suggested that the person providing the "lived experience" for the contact intervention should be either a health care provider or a patient with serious mental illness. Face-to-face presentation was favored, but video presentation was considered more feasible. Participants stated that information about local disparities in care rendered to patients with or without mental illness would convince providers of how stigma may be a contributing factor to these disparities. Multiple training opportunities were favored, while mandatory training was disliked. Standard stigma-reduction interventions with subgroups of the general public (e.g., providers) may need to be modified for optimum subgroup effectiveness. © 2015 Society for Public Health Education.

The Role of Healthcare Providers and Caregivers in Educating Older Adults about Foodborne Illness Prevention

ERIC Educational Resources Information Center

Wohlgenant, Kelly C.; Cates, Sheryl C.; Godwin, Sandria L.; Speller-Henderson, Leslie

2012-01-01

Adults aged 60 or older are more likely than younger adults to experience severe complications or even death as a result of foodborne infections. This study investigated which specific groups of healthcare providers or other caregivers are most receptive to providing food safety information to older adults. Telephone-based focus groups were…

Methods and compositions for diagnosing and preventing a group B streptococcal infection

DOEpatents

Brady, Linda Jeannine [Gainesville, FL; Seifert, Kyle N [Harrisonburg, VA; Adderson, Elisabeth E [Memphis, TN; Bohnsack, John F [Salt Lake City, UT

2009-09-15

The present invention provides a group B streptococcal (GBS) surface antigen, designated epsilon antigen, that is co-expressed with the delta antigen on a subset of serotype III GBS. Epsilon is expressed on more pathogenic Restriction Digest Pattern (RDP) III-3 GBS, but not on RDP types 1, 2, or 4. Accordingly, the present invention provides compositions and methods for detecting a group B streptococcus serotype III, RDP III-3 strain. Vaccines and methods of identifying agents which inhibit adhesion of a group B streptococcal cell to a host cell are also provided.

Improving the United States airline industry's capacity to provide safe and dignified services to travelers with disabilities: focus group findings.

PubMed

McCarthy, Michael J

2011-01-01

As a component of a training development project for intercity air travel providers, we investigated the capacity of the airline industry to meet the needs of travelers with disabilities by exploring: (1) the level of sensitivity among personnel to travelers' needs, (2) training currently provided, (3) areas in which additional training might be beneficial, and (4) organisational/systems-level commitment to dignified assistance to all travelers. Forty-four airline/vendor employees participated in nine focus groups in four US cities. Groups were audio recorded and transcribed. A grounded-theory approach was used to develop a coding system which was then applied to transcripts to identify themes. Factors influencing capacity grouped broadly into four areas: characteristics of the job/system, characteristics of current training, characteristics of providers themselves, and characteristics of travelers. At an interpersonal level, providers were empathetic and desired to provide dignified services. They lacked training and adequate equipment in some cases, however, and organisational commitment varied between companies. Traveler characteristics were also shown to impact service delivery. Results are promising but additional regulatory and organisational policies are needed to ensure quality services. Providers and consumers of intercity air travel services may benefit from the findings and recommendations of this study.

The effect of providing nutritional information about fast-food restaurant menus on parents' meal choices for their children.

PubMed

Ahn, Jae-Young; Park, Hae-Ryun; Lee, Kiwon; Kwon, Sooyoun; Kim, Soyeong; Yang, Jihye; Song, Kyung-Hee; Lee, Youngmi

2015-12-01

To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants.

Empowering Adolescent Survivors of Sexual Abuse: Application of a Solution-Focused Ericksonian Counseling Group

ERIC Educational Resources Information Center

Kress, Victoria E.; Hoffman, Rachel M.

2008-01-01

This article describes a solution-focused and Ericksonian group counseling model that can be used with adolescent girls who have been sexually abused. An overview of the components of this approach is provided. A postintervention focus group provided additional results and ideas for the future development of the group counseling model.

Diversity in Collaborative Research Communities: A Multicultural, Multidisciplinary Thesis Writing Group in Public Health

ERIC Educational Resources Information Center

Guerin, Cally; Xafis, Vicki; Doda, Diana V.; Gillam, Marianne H.; Larg, Allison J.; Luckner, Helene; Jahan, Nasreen; Widayati, Aris; Xu, Chuangzhou

2013-01-01

Writing groups for doctoral students are generally agreed to provide valuable learning spaces for Ph.D. candidates. Here an academic developer and the eight members of a writing group formed in a Discipline of Public Health provide an account of their experiences of collaborating in a multicultural, multidisciplinary thesis writing group. We…

Benefit incidence analysis of healthcare in Bangladesh - equity matters for universal health coverage.

PubMed

Khan, Jahangir A M; Ahmed, Sayem; MacLennan, Mary; Sarker, Abdur Razzaque; Sultana, Marufa; Rahman, Hafizur

2017-04-01

Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country. This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh. The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by 'self-reported illness and symptoms') across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used. An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t -value = 9.50). Healthcare benefits from private providers (CI = 0.237, t -value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t -value = 2.98) and NGO (CI = 0.095, t -value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits. Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A focus group study to understand biases and confounders in a cluster randomized controlled trial on low back pain in primary care in Norway.

PubMed

Werner, Erik L; Løchting, Ida; Storheim, Kjersti; Grotle, Margreth

2018-05-22

Cluster randomized controlled trials are often used in research in primary care but creates challenges regarding biases and confounders. We recently presented a study on low back pain from primary care in Norway with equal effects in the intervention and the control group. In order to understand the specific mechanisms that may produce biases in a cluster randomized trial we conducted a focus group study among the participating health care providers. The aim of this study was to understand how the participating providers themselves influenced on the study and thereby possibly on the results of the cluster randomized controlled trial. The providers were invited to share their experiences from their participation in the COPE study, from recruitment of patients to accomplishment of either the intervention or control consultations. Six clinicians from the intervention group and four from the control group took part in the focus group interviews. The group discussions focused on feasibility of the study in primary care and particularly on identifying potential biases and confounders in the study. The audio-recorded interviews were transcribed verbatim and analyzed according to a systematic text condensation. The themes for the analysis emerged from the group discussions. A personal interest for back pain, logistic factors at the clinics and an assessment of the patients' capacity to accomplish the study prior to their recruitment was reported. The providers were allowed to provide additional therapy to the intervention and it turned out that some of these could be regarded as opposed to the messages of the intervention. The providers seemed to select different items from the educational package according to personal beliefs and their perception of the patients' acceptance. The study disclosed several potential biases to the COPE study which may have impacted on the study results. Awareness of these is highly important when planning and conducting a cluster randomized controlled trial. Procedures in the recruitment of both providers and patients seem to be key factors and the providers should be aware of their role in a scientific study in order to standardize the provision of the intervention.

Psychodrama: A Creative Approach for Addressing Parallel Process in Group Supervision

ERIC Educational Resources Information Center

Hinkle, Michelle Gimenez

2008-01-01

This article provides a model for using psychodrama to address issues of parallel process during group supervision. Information on how to utilize the specific concepts and techniques of psychodrama in relation to group supervision is discussed. A case vignette of the model is provided.

Short-term effects of using verbal instructions and demonstration at the beginning of learning a complex skill in figure skating.

PubMed

Haguenauer, Marianne; Fargier, Patrick; Legreneur, Pierre; Dufour, Anne-Béatrice; Cogerino, Geneviève; Begon, Mickaël; Monteil, Karine M

2005-02-01

This study examined whether providing verbal instructions plus demonstration and task repetition facilitates the early acquisition of a sport skill for which learners had a prior knowledge of the individual motor components. After one demonstration of the task by an expert, 18 novice skaters practiced a figure skating jump during a 15-min. period. Subjects were randomly assigned to one of 3 groups: a group provided with a verbal instruction that specified the subgoals of the task (Subgoals group), a group provided with a verbal instruction that used a metaphor (Metaphoric group), and a group not receiving any specific instruction during training (Control group). Subjects were filmed prior to and immediately following the practice session. Analysis indicated that the modifications of performance were related to the demonstration and the subsequent task repetitions only. Providing additional verbal instructions generated no effect. Therefore, guiding the learner toward a solution to the task problem by means of verbal instruction seems to be ineffective if done too early in the course of learning.

Social support, organizational characteristics, psychological well-being, and group appraisal in three self-help group populations.

PubMed

Maton, K I

1988-02-01

This study examined the relationship of three social support and three organizational variables to two well-being and two group appraisal variables among 144 members of Compassionate Friends, Multiple Sclerosis, and Overeaters Anonymous self-help groups. An anonymous questionnaire was the major research instrument. Receiving social support was not significantly related to depression or anxiety but was positively related to perceived group benefits and group satisfaction. Providing social support and friendship were each positively related to one well-being and one group appraisal variable. Bidirectional supporters (i.e., individuals high on both receiving and providing support) reported more favorable well-being and group appraisal than Receivers, Providers, and Low Supporters. At the group level of analysis (n = 15 groups), groups with higher levels of role differentiation, greater order and organization, and in which leaders were perceived as more capable contained members who reported more positive well-being and group appraisal. The implications for future research and professional consultation to self-help groups are discussed.

SBML Level 3 package: Groups, Version 1 Release 1

PubMed Central

Hucka, Michael; Smith, Lucian P.

2017-01-01

Summary Biological models often contain components that have relationships with each other, or that modelers want to treat as belonging to groups with common characteristics or shared metadata. The SBML Level 3 Version 1 Core specification does not provide an explicit mechanism for expressing such relationships, but it does provide a mechanism for SBML packages to extend the Core specification and add additional syntactical constructs. The SBML Groups package for SBML Level 3 adds the necessary features to SBML to allow grouping of model components to be expressed. Such groups do not affect the mathematical interpretation of a model, but they do provide a way to add information that can be useful for modelers and software tools. The SBML Groups package enables a modeler to include definitions of groups and nested groups, each of which may be annotated to convey why that group was created, and what it represents. PMID:28187406

Economic models for prevention: making a system work for patients

PubMed Central

2015-01-01

The purpose of this article is to describe alternative means of providing patient centered, preventive based, services using an alternative non-profit, economic model. Hard to reach, vulnerable groups, including children, adults and elders, often have difficulties accessing traditional dental services for a number of reasons, including economic barriers. By partnering with community organizations that serve these groups, collaborative services and new opportunities for access are provided. The concept of a dental home is well accepted as a means of providing care, and, for these groups, provision of such services within community settings provides a sustainable means of delivery. Dental homes provided through community partnerships can deliver evidence based dental care, focused on a preventive model to achieve and maintain oral health. By using a non-profit model, the entire dental team is provided with incentives to deliver measurable quality improvements in care, rather than a more traditional focus on volume of activity alone. Examples are provided that demonstrate how integrated oral health services can deliver improved health outcomes with the potential to reduce total costs while improving quality. PMID:26391814

Effects of librarian-provided services in healthcare settings: a systematic review.

PubMed

Perrier, Laure; Farrell, Ann; Ayala, A Patricia; Lightfoot, David; Kenny, Tim; Aaronson, Ellen; Allee, Nancy; Brigham, Tara; Connor, Elizabeth; Constantinescu, Teodora; Muellenbach, Joanne; Epstein, Helen-Ann Brown; Weiss, Ardis

2014-01-01

To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Pharmacist-provided diabetes management and education via a telemonitoring program.

PubMed

Shane-McWhorter, Laura; McAdam-Marx, Carrie; Lenert, Leslie; Petersen, Marta; Woolsey, Sarah; Coursey, Jeffrey M; Whittaker, Thomas C; Hyer, Christian; LaMarche, Deb; Carroll, Patricia; Chuy, Libbey

2015-01-01

To assess clinical outcomes (glycosylated hemoglobin [A1C], blood pressure, and lipids) and other measurements (disease state knowledge, adherence, and self-efficacy) associated with the use of approved telemonitoring devices to expand and improve chronic disease management of patients with diabetes, with or without hypertension. Four community health centers (CHCs) in Utah. Federally qualified safety net clinics that provide medical care to underserved patients. Pharmacist-led diabetes management using telemonitoring was compared with a group of patients receiving usual care (without telemonitoring). Daily blood glucose (BG) and blood pressure (BP) values were reviewed and the pharmacist provided phone follow-up to assess and manage out-of-range BG and BP values. Changes in A1C, BP, and low-density lipoprotein (LDL) at approximately 6 months were compared between the telemonitoring group and the usual care group. Patient activation, diabetes/hypertension knowledge, and medication adherence were measured in the telemonitoring group. Of 150 patients, 75 received pharmacist-provided diabetes management and education via telemonitoring, and 75 received usual medical care. Change in A1C was significantly greater in the telemonitoring group compared with the usual care group (2.07% decrease vs. 0.66% decrease; P <0.001). Although BP and LDL levels also declined, differences between the two groups were not statistically significant. Patient activation measure, diabetes/hypertension knowledge, and medication adherence with antihypertensives (but not diabetes medications) improved in the telemonitoring group. Pharmacist-provided diabetes management via telemonitoring resulted in a significant improvement in A1C in federally qualified CHCs in Utah compared with usual medical care. Telemonitoring may be considered a model for providing clinical pharmacy services to patients with diabetes.

Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

PubMed

Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

2016-01-01

We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria.

Insects and their life cycle: Steps to take to assess threats

Treesearch

Alicia M. Bray; Jason B. Oliver

2013-01-01

This paper provides a brief overview of the importance of wood-boring insects to the forest nursery industry. Descriptions of the major insect groups are provided with special attention to the life stages that are most problematic within each group. Steps are provided to guide individuals to mitigate potential threats if a new insect is detected causing damage to trees...

49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

Code of Federal Regulations, 2012 CFR

2012-10-01

... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee the...

49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

Code of Federal Regulations, 2014 CFR

2014-10-01

... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee the...

49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

Code of Federal Regulations, 2011 CFR

2011-10-01

... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee the...

49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

Code of Federal Regulations, 2013 CFR

2013-10-01

... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee the...

49 CFR 39.37 - May PVOs require a passenger with a disability to provide advance notice in order to obtain...

Code of Federal Regulations, 2010 CFR

2010-10-01

... provide advance notice in order to obtain particular auxiliary aids and services or to arrange group... aids and services or to arrange group travel? (a) Except as provided in this section, as a PVO you must... particular auxiliary aids and services, you may request reasonable advance notice to guarantee the...

Functions of an Adult Sickle Cell Group: Education, Task Orientation, and Support.

ERIC Educational Resources Information Center

Butler, Dennis J.; Beltran, Lou R.

1993-01-01

Reports on development of adult sickle cell support group and provides description of psychosocial factors most prevalent in patients' lives (anxiety about death, disruption of social support network, disability, dependence on pain medication, conflicts with health care providers). Notes that support group enhanced participants' knowledge about…

Medical Oversight, Educational Core Content, and Proposed Scopes of Practice of Wilderness EMS Providers: A Joint Project Developed by Wilderness EMS Educators, Medical Directors, and Regulators Using a Delphi Approach.

PubMed

Millin, Michael G; Johnson, David E; Schimelpfenig, Tod; Conover, Keith; Sholl, Matthew; Busko, Jonnathan; Alter, Rachael; Smith, Will; Symonds, Jennifer; Taillac, Peter; Hawkins, Seth C

2017-01-01

A disparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content. This core content is a foundation for wilderness EMS provider scopes of practice and builds on both the National EMS Education Standards and the National EMS Scope of Practice Model. These experts also identified the conditions when oversight is needed for wilderness EMS providers. By consensus, this group of experts identified the educational core content for four unique levels of wilderness EMS providers: Wilderness Emergency Medical Responder (WEMR), Wilderness Emergency Medical Technician (WEMT), Wilderness Advanced Emergency Medical Technician (WAEMT), and Wilderness Paramedic (WParamedic). These levels include specialized skills and techniques pertinent to the operational environment. The skills and techniques increase in complexity with more advanced certification levels, and address the unique circumstances of providing care to patients in the wilderness environment. Furthermore, this group identified that providers having a defined duty to act should be functioning with medical oversight. This group of experts defined the educational core content supporting the specific scopes of practice that each certification level of wilderness EMS provider should have when providing patient care in the wilderness setting. Wilderness EMS providers are, indeed, providing health care and should thus function within defined scopes of practice and with physician medical director oversight.

Mobile phone-based clinical guidance for rural health providers in India.

PubMed

Gautham, Meenakshi; Iyengar, M Sriram; Johnson, Craig W

2015-12-01

There are few tried and tested mobile technology applications to enhance and standardize the quality of health care by frontline rural health providers in low-resource settings. We developed a media-rich, mobile phone-based clinical guidance system for management of fevers, diarrhoeas and respiratory problems by rural health providers. Using a randomized control design, we field tested this application with 16 rural health providers and 128 patients at two rural/tribal sites in Tamil Nadu, Southern India. Protocol compliance for both groups, phone usability, acceptability and patient feedback for the experimental group were evaluated. Linear mixed-model analyses showed statistically significant improvements in protocol compliance in the experimental group. Usability and acceptability among patients and rural health providers were very high. Our results indicate that mobile phone-based, media-rich procedural guidance applications have significant potential for achieving consistently standardized quality of care by diverse frontline rural health providers, with patient acceptance. © The Author(s) 2014.

Effectiveness of the Lunch is in the Bag program on communication between the parent, child and child-care provider around fruits, vegetables and whole grain foods: A group-randomized controlled trial.

PubMed

Sharma, Shreela V; Rashid, Tasnuva; Ranjit, Nalini; Byrd-Williams, Courtney; Chuang, Ru-Jye; Roberts-Gray, Cynthia; Briley, Margaret; Sweitzer, Sara; Hoelscher, Deanna M

2015-12-01

To evaluate the effectiveness of the parent- and early care education (ECE) center-based Lunch is in the Bag program on communication between parent, child, and their ECE center providers around fruits, vegetables and whole grain foods (FVWG). A total of n=30 ECE center; 577 parent-child dyads participated in this group-randomized controlled trial conducted from 2011 to 2013 in Texas (n=15 ECE center, 327 dyads intervention group; n=15 ECE center, 250 dyads comparison group). Parent-child and parent-ECE center provider communication was measured using a parent-reported survey administered at baseline and end of the five-week intervention period. Multilevel linear regression analysis was used to compare the pre-to-post intervention changes in the parent-child and parent-ECE center provider communication scales. Significance was set at p<0.05. At baseline, parent-child and parent-ECE center provider communication scores were low. There was a significant increase post-intervention in the parent-ECE center provider communication around vegetables (Adjusted β=0.78, 95%CI: 0.13, 1.43, p=0.002), and around fruit (Adjusted β=0.62, 95%CI: 0.04, 0.20, p=0.04) among the parents in the intervention group as compared to those in the comparison group. There were no significant intervention effects on parent-child communication. Lunch is in the Bag had significant positive effects on improving communication between the parents and ECE center providers around FVWG. Copyright © 2015 Elsevier Inc. All rights reserved.

Focus Group Guide

DTIC Science & Technology

2017-07-01

o Open-ended and exploratory questions. o Provide all an opportunity to participate. o Do not allow the group to get out of control . Manage...website under Assessment to Solutions at www.deomi.org. Focus Group Guide DEFENSE EQUAL OPPORTUNITY MANAGEMENT...www.deomi.org, provides a variety of tools and information to support conducting a focus group and the climate assessment process. Cover The cover

Medicaid and the politics of groups: recipients, providers, and policy making.

PubMed

Kronebusch, K

1997-06-01

There is a substantial heterogeneity of interests within the Medicaid program. Its major beneficiary groups include the elderly, people with disabilities, children in low-income families, and adults receiving Aid to Families with Dependent Children. Providers who deliver medical services to these recipients represent another set of potential claimants. These groups are likely to be treated differently by the politics that affect the design and management of the Medicaid program. The Medicaid recipient groups vary in several important dimensions: First, the groups differ politically, a dimension that includes their political participation, their relationships to parties and electoral coalitions, the images they present to other political actors, and the legacy of public policies that affect them. Second, the groups have different medical and social needs. Third, the groups differ with respect to economic constraints, including the political economy of labor markets and of government spending programs, and they have differing relationships to the various types of medical providers. The medical providers are themselves political actors with a variety of characteristics that create political advantages relative to recipients, although there is also diversity among providers. The politics of the Medicaid program involves more than simply technical decisions about eligibility, coverage of medical services, reimbursement, and the implementation of managed care initiatives. Instead the differences between the program's multiple claimants are an important element of current Medicaid politics and the likely path of future reforms.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

PubMed

Bazant, Eva; Sarkar, Supriya; Banda, Joseph; Kanjipite, Webby; Reinhardt, Stephanie; Shasulwe, Hildah; Mulilo, Joyce Monica Chongo; Kim, Young Mi

2014-12-20

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

Feedback to semi-professional counselors in treating child aggression.

PubMed

Shechtman, Zipora; Tutian, Rony

2017-05-01

To investigate the impact of outcome feedback provided to semi-professional counselors of children and adolescents at risk for aggressive behavior, following group treatment. Participants included 230 aggressive children and adolescents and 64 educators in a quasi-experimental design of 3 conditions: experimental group with feedback, experimental group without feedback, and control group (no treatment). The current study employed a feedback system based on self-report aggression scores measured after each session, provided to teachers, including an alert system and weekly follow-up group support. Outcomes were more favorable for the treatment children than the control group, but feedback had no impact on the results. Outcome feedback provided to group therapists does not have an effect on children and adolescents' reduction of aggression. Further research is needed to identify possible reasons for failure to show feedback effect.

[Problems in Providing Care to Young Workers with Mental Health Disturbance - A Survey Using of the Cases of Workers Who Had Taken Sick Leave Due to Mental Health Disturbance].

PubMed

Ikegami, Kazunori; Eguchi, Masafumi; Osaki, Yohei; Nakao, Tomo; Nakamoto, Kengo; Hiro, Hisanori

2016-06-01

In this study we discuss the measures of providing care to young workers with mental health disturbance by analyzing the cases of workers who had taken sick leave due to mental health disturbance. We analyzed 36 cases, collected from 11 occupational physicians, of workers who had taken sick leave due to mental health disturbance, and discuss measures for providing care to such young workers. We organized and classified data containing the details of the care provided to the workers and analyzed the main aspects and problems in providing it. We compared two age groups of workers: a below age 30 group, and an age 30 and above group. We observed that occupational nurses were more frequently the primary persons who dealt with workplace consultations in the below age 30 group (before sick leave: 38.9%; during sick leave: 38.9%) compared to the age 30 and above group (before sick leave: 16.7%, during sick leave: 11.1%). Most of the case providers expressed the opinion that a support system is necessary to help the workers return to work and it is an important factor in providing care to workers who have taken sick leave due to mental health disturbance. Coordination with the families of the workers was also important in the below age 30 group. It might be difficult to assign young workers to suitable workplaces or duties because of their inadequate job skills, lack of sufficient experience, and influence of personal factors on mental health. Our results suggest that it is important to provide appropriate care for young workers with mental health disturbance, such as support by occupational nurses, and to strengthen the collaboration between their families and the workplace staff.

Reactions to intragroup deviance: does disidentification have a role?

PubMed

Cameira, Miguel; Ribeiro, Tiago Azevedo

2014-01-01

In this study, we address previous evidence about the interchangeable use of derogation and disidentification in protecting the self from intragroup deviance. We argue that when the in-group stands for a valued social identity, members may disidentify from the group, but only if the immediate context provides no opportunity to derogate. In the present experiments (n = 80 and n = 79), we provided or did not provide participants with the opportunity to recommend a punishment for an in-group or an out-group deviant. We also measured in-group identification before and after exposure to deviant behavior and after judgment. The results show that participants first disidentified from the in-group but, when presented with an opportunity to judge the deviant, also derogated. Importantly, participants who could judge the deviant also recovered their initial in-group identification level. Participants' reactions to the out-group deviant suggest they used an intergroup rather than intragroup strategy.

The effect of providing nutritional information about fast-food restaurant menus on parents' meal choices for their children

PubMed Central

Ahn, Jae-Young; Park, Hae-Ryun; Lee, Kiwon; Kwon, Sooyoun; Kim, Soyeong; Yang, Jihye; Song, Kyung-Hee

2015-01-01

BACKGROUND/OBJECTIVES To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. SUBJECTS/METHODS An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. RESULTS The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). CONCLUSIONS The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants. PMID:26634057

A Randomized Controlled Trial of the Effectiveness of Traditional and Mobile Public Health Communications With Health Care Providers.

PubMed

Baseman, Janet; Revere, Debra; Painter, Ian; Oberle, Mark; Duchin, Jeffrey; Thiede, Hanne; Nett, Randall; MacEachern, Dorothy; Stergachis, Andy

2016-02-01

Health care providers play an essential role in public health emergency preparedness and response. We conducted a 4-year randomized controlled trial to systematically compare the effectiveness of traditional and mobile communication strategies for sending time-sensitive public health messages to providers. Subjects (N=848) included providers who might be leveraged to assist with emergency preparedness and response activities, such as physicians, pharmacists, nurse practitioners, physician's assistants, and veterinarians. Providers were randomly assigned to a group that received time-sensitive quarterly messages via e-mail, fax, or cell phone text messaging (SMS) or to a no-message control group. Follow-up phone interviews elicited information about message receipt, topic recall, and perceived credibility and trustworthiness of message and source. Our main outcome measures were awareness and recall of message content, which was compared across delivery methods. Per-protocol analysis revealed that e-mail messages were recalled at a higher rate than were messaged delivered by fax or SMS, whereas the as-treated analysis found that e-mail and fax groups had similar recall rates and both had higher recall rates than the SMS group. This is the first study to systematically evaluate the relative effectiveness of public health message delivery systems. Our findings provide guidance to improve public health agency communications with providers before, during, and after a public health emergency.

75 FR 41787 - Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive Services... Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage offered in...

Small-Group Instruction: Theory and Practice.

ERIC Educational Resources Information Center

Olmstead, Joseph A.

The volume is an analysis of the state of the art of small-group methods of instruction. It describes some of the more commonly used small-group techniques and the rationale behind them, and provides an analysis of their potential use for various types and conditions of instructional environments. Explicit guidelines are provided to assist…

A Randomized Trial of Contingency Management Delivered in the Context of Group Counseling

ERIC Educational Resources Information Center

Petry, Nancy M.; Weinstock, Jeremiah; Alessi, Sheila M.

2011-01-01

Objective: Contingency management (CM) is efficacious in reducing drug use. Typically, reinforcers are provided on an individual basis to patients for submitting drug-negative samples. However, most treatment is provided in a group context, and poor attendance is a substantial concern. This study evaluated whether adding CM to group-based…

78 FR 17023 - Certain Outbound Property Transfers by Domestic Corporations; Certain Stock Distributions by...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-19

... five or fewer (but at least one) domestic corporations (each a control group member, and together the control group) and basis adjustments and other conditions as provided in regulations are satisfied. The... provided, at the election of the U.S. transferor and members of the control group (elective exception...

Mathematically Gifted in the Heterogeneously Grouped Mathematics Classroom: What Is a Teacher to Do?

ERIC Educational Resources Information Center

Reed, Catherine Finlayson

2004-01-01

Differentiation provides one method by which teachers can provide appropriate challenges at appropriate levels for all learners in a heterogeneously grouped mathematics classroom, where the range of abilities and interests can be wide. This article considers a heterogeneously grouped high school geometry class where differentiation is practiced.…

Health care access and quality for persons with disability: Patient and provider recommendations.

PubMed

McClintock, Heather F; Kurichi, Jibby E; Barg, Frances K; Krueger, Alice; Colletti, Patrice M; Wearing, Krizia A; Bogner, Hillary R

2018-07-01

Significant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD. We sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community. In all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life ® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology. Themes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform. Both PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement. Copyright © 2018 Elsevier Inc. All rights reserved.

A psychotherapeutic approach to task-oriented groups of severely ill patients.

PubMed Central

Wilson, W. H.; Diamond, R. J.; Factor, R. M.

1985-01-01

This paper presents a conceptual approach for leading various types of groups of chronically mentally ill patients. Although these groups may have a concrete, task-oriented purpose, with skillful leadership they also function as psychotherapy groups. The developmental deficits in ego functions, object relations, and social skills that severely impair such groups can be compensated by non-interpretative actions of the therapists. The group leader must actively work to provide for the structure, stability, and safety of the group when group members are unable to provide these for themselves. PMID:4049917

Implementation of online suicide-specific training for VA providers.

PubMed

Marshall, Elizabeth; York, Janet; Magruder, Kathryn; Yeager, Derik; Knapp, Rebecca; De Santis, Mark L; Burriss, Louisa; Mauldin, Mary; Sulkowski, Stan; Pope, Charlene; Jobes, David A

2014-10-01

Due to the gap in suicide-specific intervention training for mental health students and professionals, e-learning is one solution to improving provider skills in the Veterans Affairs (VA) health system. This study focused on the development and evaluation of an equivalent e-learning alternative to the Collaborative Assessment and Management of Suicidality (CAMS) in-person training approach at a Veteran Health Affairs medical center. The study used a multicenter, randomized, cluster, and three group design. the development of e-CAMS was an iterative process and included pilot testing. Eligible and consenting mental health providers, who completed a CAMS pre-survey, were randomized. Provider satisfaction was assessed using the standard VA evaluation of training consisting of 20 items. Two post training focus groups, divided by learning conditions, were conducted to assess practice adoption using a protocol focused on experiences with training and delivery of CAMS. A total of 215 providers in five sites were randomized to three conditions: 69 to e-learning, 70 to in-person, 76 to the control. The providers were primarily female, Caucasian, midlife providers. Based on frequency scores of satisfaction items, both learning groups rated the trainings positively. In focus groups representing divided by learning conditions, participants described positive reactions to CAMS training and similar individual and institutional barriers to full implementation of CAMS. This is the first evaluation study of a suicide-specific e-learning training within the VA. The e-CAMS appears equivalent to the in-person CAMS in terms of provider satisfaction with training and practice adoption, consistent with other comparisons of training deliveries across specialty areas. Additional evaluation of provider confidence and adoption and patient outcomes is in progress. The e-CAMS has the potential to provide ongoing training for VA and military mental health providers and serve as a tutorial for psychiatrists in preparation for specialty boards.

Impact of Psychological Screening on Routine Outpatient Care of Hematopoietic Cell Transplantation Survivors

PubMed Central

Hoodin, Flora; Zhao, Lili; Carey, Jillian; Levine, John E.; Kitko, Carrie

2017-01-01

Hematopoietic cell transplantation (HCT) recipients are at high risk for psychological distress with reported prevalence rates as high as 40%. Although published guidelines advocate periodic routine screening, it is unclear how screening affects management of psychological symptoms at routine post-HCT outpatient clinic visits. We hypothesized that providers will be more likely to act on patients’ psychological symptoms if a screening survey is completed and reviewed prior to a clinic visit. We used a brief, diagnostically focused Patient Health Questionnaire (PHQ), to assess for depressive disorders, anxiety, substance abuse, and problems in occupational or interpersonal functioning (functional disruption). Adult HCT survivors were randomized to complete the PHQ prior to meeting with their medical provider (n = 50; experimental group) or afterwards (n = 51; control group). Providers used the experimental group PHQ results at their discretion during the visits. Both providers and patients rated their satisfaction with management of psychological concerns after the visit. The prevalence of clinically significant depression (21%), anxiety (14%), or suicidal ideation (8%) did not differ between the two groups. Patients in the experimental group were significantly more likely to have discussion of psychological symptoms than the control group (68% versus 49%, P = 0.05). Medical providers were significantly more satisfied with the management of psychological issues for the experimental group (P < 0.001). Patients with depression or anxiety were significantly more likely to prefer the PHQ be used at future visits (P = 0.02 and P = 0.001 respectively). These findings suggest an informative yet brief self-report psychological screen can be easily integrated into routine care of HCT survivors, stimulates discussion of psychological symptoms, and improves provider satisfaction with psychological symptom management. Future research will evaluate whether serial prospective administration improves patient outcomes. PMID:23892043

20 CFR 632.253 - Special operating provisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

...: vocational exposure, counseling, testing, resume preparation, job interview preparation, providing labor... apprenticeship programs, and similar activities. It may be provided on a group or individual basis. In providing...

Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy.

PubMed

Teoh, Deanna; Isaksson Vogel, Rachel; Hultman, Gretchen; Monu, Minnu; Downs, Levi; Geller, Melissa A; Le, Chap; Melton-Meaux, Genevieve; Kulasingam, Shalini

2017-03-01

To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups. A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ and Wilcoxon rank-sum tests. A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1-54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7-43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1-31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group. For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries

PubMed Central

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk. PMID:23780467

42 CFR 421.404 - Assignment of providers and suppliers to MACs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... section— Chain provider means a group of two or more providers under common ownership or control. Common..., prosthetics, orthotics, and supplies (DMEPOS) means the types of services specified in § 421.210(b). Eligible....202 of this chapter. Qualified chain provider means a chain provider comprised of— (1) 10 or more...

42 CFR 421.404 - Assignment of providers and suppliers to MACs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... section— Chain provider means a group of two or more providers under common ownership or control. Common..., prosthetics, orthotics, and supplies (DMEPOS) means the types of services specified in § 421.210(b). Eligible....202 of this chapter. Qualified chain provider means a chain provider comprised of— (1) 10 or more...

42 CFR 421.404 - Assignment of providers and suppliers to MACs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... section— Chain provider means a group of two or more providers under common ownership or control. Common..., prosthetics, orthotics, and supplies (DMEPOS) means the types of services specified in § 421.210(b). Eligible....202 of this chapter. Qualified chain provider means a chain provider comprised of— (1) 10 or more...

42 CFR 421.404 - Assignment of providers and suppliers to MACs.

Code of Federal Regulations, 2010 CFR

2010-10-01

...— Chain provider means a group of two or more providers under common ownership or control. Common control..., prosthetics, orthotics, and supplies (DMEPOS) means the types of services specified in § 421.210(b). Eligible....202 of this chapter. Qualified chain provider means a chain provider comprised of— (1) 10 or more...

42 CFR 421.404 - Assignment of providers and suppliers to MACs.

Code of Federal Regulations, 2011 CFR

2011-10-01

...— Chain provider means a group of two or more providers under common ownership or control. Common control..., prosthetics, orthotics, and supplies (DMEPOS) means the types of services specified in § 421.210(b). Eligible....202 of this chapter. Qualified chain provider means a chain provider comprised of— (1) 10 or more...

Providing Social Support for Underrepresented Racial and Ethnic Minority PhD Students in the Biomedical Sciences: A Career Coaching Model

PubMed Central

Williams, Simon N.; Thakore, Bhoomi K.; McGee, Richard

2017-01-01

Improvement in the proportion of underrepresented racial and ethnic minorities (URMs) in academic positions has been unsatisfactory. Although this is a complex problem, one key issue is that graduate students often rely on research mentors for career-related support, the effectiveness of which can be variable. We present results from a novel academic career “coaching” intervention, one aim of which was to provide supplementary social support for PhD students, particularly those from underrepresented backgrounds. Coaching was delivered both within small groups and on an individual basis, with a diverse group of coaches and students coming from many universities. Coaches were provided with additional diversity training. Ninety-six semistructured interviews with 33 URM students over 3 years were analyzed using a qualitative framework approach. For most of the URM PhD students, coaching provided social support in the form of emotional, informational, and appraisal support. Coaching groups provided a noncompetitive environment and “community of support” within which students were able to learn from one another’s experiences and discuss negative and stressful experiences related to their graduate school, lab, or career plans. This coached peer group model is capable of providing the social support that many URM students do not find at their home universities. PMID:29196425

Control of complex physically simulated robot groups

NASA Astrophysics Data System (ADS)

Brogan, David C.

2001-10-01

Actuated systems such as robots take many forms and sizes but each requires solving the difficult task of utilizing available control inputs to accomplish desired system performance. Coordinated groups of robots provide the opportunity to accomplish more complex tasks, to adapt to changing environmental conditions, and to survive individual failures. Similarly, groups of simulated robots, represented as graphical characters, can test the design of experimental scenarios and provide autonomous interactive counterparts for video games. The complexity of writing control algorithms for these groups currently hinders their use. A combination of biologically inspired heuristics, search strategies, and optimization techniques serve to reduce the complexity of controlling these real and simulated characters and to provide computationally feasible solutions.

Reasons for discharges against medical advice: a qualitative study

PubMed Central

Onukwugha, Eberechukwu; Saunders, Elijah; Mullins, C. Daniel; Pradel, Françoise G.; Zuckerman, Marni; Weir, Matthew R.

2013-01-01

Background There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multi-category provider focus group interviews (FGIs). Methods Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical center along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group, and one nurse/social worker group were held. Focus group interviews were transcribed and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions. Results Eighteen patients, 5 physicians, 6 nurses and 4 social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker group FGIs of reasons why patients leave against medical advice: 1) drug addiction, 2) pain management, 3) external obligations, 4) wait time, 5) doctor’s bedside manner, 6) teaching hospital setting, and 7) communication. Solutions to tackle DAMA identified by participants revolve mainly around enhanced communication and provider education. Conclusions In a large, academic medical center we find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication. PMID:20538627

Input Providing vs. Output-Prompting Negotiation Strategies in Learning Grammar among Young EFL Learners

ERIC Educational Resources Information Center

Mousavi, Khorshid; Alavinia, Parviz; Gholami, Javad

2018-01-01

The present study investigated the comparison between short and long-term effectiveness of input-providing and output-prompting negotiation strategies on mastering the target structures. To this end, the participants were divided into three groups, namely two experimental groups who had a special kind of treatment, and one control group without…

75 FR 27141 - Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-13

... Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age 26 Under... Information and Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage...

77 FR 31786 - Regulations Revising Rules Regarding Agency for a Consolidated Group

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

...). The proposed regulations provide guidance concerning the identity and authority of the agent for the...) of the designation of the agent for the group so that IRS records will reflect the identity of the...) Identity of the agent for the group--(1) In general. Except as otherwise provided in this section, the...

An Approach to Supervision for Doctoral and Entry-Level Group Counseling Students

ERIC Educational Resources Information Center

Walsh, Robyn; Bambacus, Elizabeth; Gibson, Donna

2017-01-01

The purpose of this article is to provide a supervision approach to experiential groups that replaces professors with doctoral students in the chain of supervision, enlists a faculty member to provide supervision of supervision to the doctoral students, and translates supervision theory to meet the unique needs of group counseling supervision.…

A proposed group management scheme for XTP multicast

NASA Technical Reports Server (NTRS)

Dempsey, Bert J.; Weaver, Alfred C.

1990-01-01

The purpose of a group management scheme is to enable its associated transfer layer protocol to be responsive to user determined reliability requirements for multicasting. Group management (GM) must assist the client process in coordinating multicast group membership, allow the user to express the subset of the multicast group that a particular multicast distribution must reach in order to be successful (reliable), and provide the transfer layer protocol with the group membership information necessary to guarantee delivery to this subset. GM provides services and mechanisms that respond to the need of the client process or process level management protocols to coordinate, modify, and determine attributes of the multicast group, especially membership. XTP GM provides a link between process groups and their multicast groups by maintaining a group membership database that identifies members in a name space understood by the underlying transfer layer protocol. Other attributes of the multicast group useful to both the client process and the data transfer protocol may be stored in the database. Examples include the relative dispersion, most recent update, and default delivery parameters of a group.

Health provider responsiveness to social accountability initiatives in low- and middle-income countries: a realist review.

PubMed

Lodenstein, Elsbet; Dieleman, Marjolein; Gerretsen, Barend; Broerse, Jacqueline E W

2017-02-01

Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful searches for cases were combined with a systematic search in four databases. To be included in the review, the initiatives needed to describe at least one outcome at the level of frontline service provision. Some 37 social accountability initiatives in 15 countries met these criteria. Using a realist approach, retroductive analysis and triangulation of methods and sources were performed to construct Context-Mechanism-Outcome configurations that explain potential pathways to provider responsiveness. The findings suggest that health provider receptivity to citizens' demands for better health care is mediated by health providers' perceptions of the legitimacy of citizen groups and by the extent to which citizen groups provide personal and professional support to health providers. Some citizen groups activated political or formal bureaucratic accountability channels but the effect on provider responsiveness of such strategies was more mixed. Favourable contexts for health provider responsiveness comprise socio-political contexts in which providers self-identify as activists, health system contexts in which health providers depend on citizens' expertise and capacities, and health system contexts where providers have the self-perceived ability to change the system in which they operate. Rather than providing recipes for successful social accountability initiatives, the synthesis proposes a programme theory that can support reflections on the theories of change underpinning social accountability initiatives and interventions to improve the quality of primary health care in different settings. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Self-reflection, gender and science achievement

NASA Astrophysics Data System (ADS)

Shoop, Kathleen A.

Drawing on socio-cognitive learning theory, this study compared achievement scores of 134 male and female high school biology students randomly assigned to groups which either used self-reflection, used self-reflection and received feedback, or did not self-reflect. Following a pretest, the teacher provided self-reflection strategy instruction to students in the two intervention groups and then subsequently provided in-class self-reflection time for these groups. The posttest concluded the unit; the retention measure was five weeks later. A quasi-experimental 3 x 3 x 2 (time x intervention x gender) factorial repeated-measures control group design was used for this study; a repeated measures ANOVA and several one-way ANOVA's were used to answer the research questions. Results from the repeated-measures ANOVA revealed significant results for Time and Time x Intervention, with the reflection group demonstrating significantly lower gains from pretest to posttest than the other two groups. The ANOVA examining differences between those who reflected and those who reflected and received feedback provided significant results with similar results for the difference between the control group and the reflection group. For teachers and students this study provides several areas of practical significance. Primarily, teachers may find lower student achievement if students regularly self-reflect but do not receive feedback for their reflection.

Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management.

PubMed

Turner, Kea; Samuel, Cleo A; Donovan, Heidi As; Beckjord, Ellen; Cardy, Alexandra; Dew, Mary Amanda; van Londen, G J

2017-04-01

Providers' communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care. We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street's (2007) Framework for Patient-Centered Communication in Cancer Care. The findings of this study suggest providers' communication behaviors including managing survivors' uncertainty, responding to survivors' emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers' discipline. There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers' roles in symptom assessment, and determine best practices for AET symptom communication.

77 FR 55482 - Public Workshop on Marine Technology and Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-10

... provide a unique opportunity for classification societies, industry groups, standards development... email at [email protected] . You may also contact Lieutenant Commander Ken Hettler, Office of Design and... provides a unique opportunity for classification societies, industry groups, standards development...

Distributing Expertise: A Dutch Experiment in Public Interest Science.

ERIC Educational Resources Information Center

Nelkin, Dorothy; Rip, Arie

1979-01-01

In order to provide public access to scientific expertise, the Dutch have instituted a science shops program. Science advisory groups, located at five universities, promote socially relevant research in the universities and provide technical information to client groups. (BB)

The role of the trauma nurse leader in a pediatric trauma center.

PubMed

Wurster, Lee Ann; Coffey, Carla; Haley, Kathy; Covert, Julia

2009-01-01

The trauma nurse leader role was developed by a group of trauma surgeons, hospital administrators, and emergency department and trauma leaders at Nationwide Children's Hospital who recognized the need for the development of a core group of nurses who provided expert trauma care. The intent was to provide an experienced group of nurses who could identify and resolve issues in the trauma room. Through increased education, exposure, mentoring, and professional development, the trauma nurse leader role has become an essential part of the specialized pediatric trauma care provided at Nationwide Children's Hospital.

Thermally stable surfactants and compositions and methods of use thereof

DOEpatents

Chaiko, David J [Woodridge, IL

2008-09-02

There are provided novel thermally stable surfactants for use with fillers in the preparation of polymer composites and nanocomposites. Typically, surfactants of the invention are urethanes, ureas or esters of thiocarbamic acid having a hydrocarbyl group of from 10 to 50 carbons and optionally including an ionizable or charged group (e.g., carboxyl group or quaternary amine). Thus, there are provided surfactants having Formula I: ##STR00001## wherein the variables are as defined herein. Further provided are methods of making thermally stable surfactants and compositions, including composites and nanocomposites, using fillers coated with the surfactants.

Using and joining a franchised private sector provider network in Myanmar.

PubMed

O'Connell, Kathryn; Hom, Mo; Aung, Tin; Theuss, Marc; Huntington, Dale

2011-01-01

Quality is central to understanding provider motivations to join and remain within a social franchising network. Quality also appears as a key issue from the client's perspective, and may influence why a client chooses to use a franchised provider over another type of provider. The dynamic relationships between providers of social franchising clinics and clients who use these services have not been thoroughly investigated in the context of Myanmar, which has an established social franchising network. This study examines client motivations to use a Sun Quality Health network provider and provider motivations to join and remain in the Sun Quality Health network. Taken together, these two aims provide an opportunity to explore the symbiotic relationship between client satisfaction and provider incentives to increase the utilization of reproductive health care services. Results from a series of focus group discussions with clients of reproductive health services and franchised providers shows that women chose health services provided by franchised private sector general practitioners because of its perceived higher quality, associated with the availability of effective, affordable, drugs. A key finding of the study is associated with providers. Provider focus group discussions indicate that a principle determinate for joining and remaining in the Sun Quality Health Network was serving the poor.

Using and Joining a Franchised Private Sector Provider Network in Myanmar

PubMed Central

O'Connell, Kathryn; Hom, Mo; Aung, Tin; Theuss, Marc; Huntington, Dale

2011-01-01

Background Quality is central to understanding provider motivations to join and remain within a social franchising network. Quality also appears as a key issue from the client's perspective, and may influence why a client chooses to use a franchised provider over another type of provider. The dynamic relationships between providers of social franchising clinics and clients who use these services have not been thoroughly investigated in the context of Myanmar, which has an established social franchising network. This study examines client motivations to use a Sun Quality Health network provider and provider motivations to join and remain in the Sun Quality Health network. Taken together, these two aims provide an opportunity to explore the symbiotic relationship between client satisfaction and provider incentives to increase the utilization of reproductive health care services. Methods and Findings Results from a series of focus group discussions with clients of reproductive health services and franchised providers shows that women chose health services provided by franchised private sector general practitioners because of its perceived higher quality, associated with the availability of effective, affordable, drugs. A key finding of the study is associated with providers. Provider focus group discussions indicate that a principle determinate for joining and remaining in the Sun Quality Health Network was serving the poor. PMID:22180781

Professional service use for a serious personal problem: Comparing older African Americans, Black Caribbeans, and non-Hispanic Whites using the National Survey of American Life

PubMed Central

Woodward, Amanda Toler; Chatters, Linda M.; Taylor, Harry Owen; Taylor, Robert Joseph

2014-01-01

Objectives Examines combinations of professionals visited for a serious personal problem. Methods The sample includes those aged 55 and older (n=862) from the National Survey of American Life (NSAL). Latent class analysis was used to identify groups of respondents based on types of professionals visited. Multinomial logistic regression was used to identify factors associated with group membership. Results Classes included health provider plus clergy, physician plus mental health provider, and limited provider use. Whites were more likely than African Americans to fall into the health provider plus clergy and physician plus mental health provider classes. Those with physical and emotional problems were more likely to be in the health provider plus clergy and physician plus mental health provider classes, respectively. Discussion Most respondents were in the limited provider use class suggesting that for many of problems, minimal professional help is utilized. Physicians and clergy were important across all three classes. PMID:25552527

Antidiabetic Effect of Morinda citrifolia (Noni) Fermented by Cheonggukjang in KK-Ay Diabetic Mice

PubMed Central

Lee, So-Young; Park, So-Lim; Hwang, Jin-Taek; Yi, Sung-Hun; Nam, Young-Do; Lim, Seong-Il

2012-01-01

Antidiabetic effects of Morinda citrifolia (aka Noni) fermented by Cheonggukjang (fast-fermented soybean paste) were evaluated using a T2DM (type 2 diabetes mellitus) murine model. Six-week-old KK-Ay/TaJcl mice were randomly divided into four groups: (1) the diabetic control (DC) group, provided with a normal mouse diet; (2) the positive control (PC) group, provided with a functional health food diet; (3) the M. citrifolia (MC) group, provided with an MC-based diet; (4) the fermented M. citrifolia (FMC) group, provided with an FMC-based diet. Over a testing period of 90 days, food and water intake decreased significantly in the FMC and PC groups compared with the DC group. Blood glucose levels in the FMC group were 211.60–252.20 mg/dL after 90 days, while those in the control group were over 400 mg/dL after 20 days. In addition, FMC supplementation reduced glycosylated hemoglobin (HbA1c) levels, enhanced insulin sensitivity, and significantly decreased serum triglycerides and low-density lipoprotein (LDL) cholesterol. Furthermore, a fermented M. citrifolia 70% ethanolic extract (FMCE) activated peroxisome proliferator-activated receptor-(PPAR-) γ and stimulated glucose uptake via stimulation of AMP-activated protein kinase (AMPK) in cultured C2C12 cells. These results suggest that FMC can be employed as a functional health food for T2DM management. PMID:22969823

Increased Procurement of Thoracic Donor Organs After Thyroid Hormone Therapy.

PubMed

Novitzky, Dimitri; Mi, Zhibao; Collins, Joseph F; Cooper, David K C

2015-01-01

Hormonal therapy to the brain-dead organ donor can include thyroid hormone (triiodothyronine [T3] or levothyroxine [T4]), antidiuretic hormone, corticosteroids, or insulin. There has been a controversy on whether thyroid hormone enables more organs to be procured. Data on 63,593 donors of hearts and lungs (2000-2009) were retrospectively reviewed. Documentation on T3/T4 was available in all donors (study 1), and in 40,124 details of all 4 hormones were recorded (study 2). In this cohort, group A (23,022) received T3/T4 and group B (17,102) no T3/T4. Univariate analyses and multiple regressions were performed. Posttransplant graft and recipient survival at 1 and 12 months were compared. In study 1, 30,962 donors received T3/T4, with 36.59% providing a heart and 20.05% providing 1 or both lungs. Of the 32,631 donors who did not receive T3/T4, only 29.62% provided a heart and 14.61% provided lungs, an increase of 6.97% hearts and 5.44% lungs from T3/T4-treated donors (both P < 0.0001). In study 2, 34.99% of group A provided a heart and 20.99% provided lungs. In group B only 25.76% provided a heart and 15.09% provided lungs, an increase of 9.23% (hearts) and 5.90% (lungs), respectively, in group A (both P < 0.0001). The results of multiple regression analyses indicated a beneficial effect of T3/T4 on heart (P < 0.0001) and lung (P < 0.0001) procurement independent of other factors. T3/T4 therapy to the donor was associated with either improved posttransplant graft and recipient survival or no difference in survival. T3/T4 therapy results in more transplantable hearts and lungs, with no detriment to posttransplant graft or recipient survival. Copyright © 2015 Elsevier Inc. All rights reserved.

Framework for Flexible Security in Group Communications

NASA Technical Reports Server (NTRS)

McDaniel, Patrick; Prakash, Atul

2006-01-01

The Antigone software system defines a framework for the flexible definition and implementation of security policies in group communication systems. Antigone does not dictate the available security policies, but provides high-level mechanisms for implementing them. A central element of the Antigone architecture is a suite of such mechanisms comprising micro-protocols that provide the basic services needed by secure groups.

Group Work with Adolescents: Principles and Practice. Second Edition. Social Work Practice with Children and Families

ERIC Educational Resources Information Center

Malekoff, Andrew

2006-01-01

This popular text provides essential knowledge and skills for conducting creative, strengths-based group work with adolescents. A rich introduction to the field, enlivened by numerous illustrations from actual sessions, the book provides principles and guidelines for practice in a wide range of settings. The book covers all phases of group work,…

42 CFR 422.205 - Provider antidiscrimination rules.

Code of Federal Regulations, 2014 CFR

2014-10-01

... designed to maintain quality and control costs consistent with its responsibilities. [65 FR 40324, June 29... certification. If an MA organization declines to include a given provider or group of providers in its network...

42 CFR 422.205 - Provider antidiscrimination rules.

Code of Federal Regulations, 2012 CFR

2012-10-01

... designed to maintain quality and control costs consistent with its responsibilities. [65 FR 40324, June 29... certification. If an MA organization declines to include a given provider or group of providers in its network...

Chimpanzees do not take advantage of very low cost opportunities to deliver food to unrelated group members.

PubMed

Vonk, Jennifer; Brosnan, Sarah F; Silk, Joan B; Henrich, Joseph; Richardson, Amanda S; Lambeth, Susan P; Schapiro, Steven J; Povinelli, Daniel J

2008-05-01

We conducted experiments on two populations of chimpanzees, Pan troglodytes , to determine whether they would take advantage of opportunities to provide food rewards to familiar group members at little cost to themselves. In both of the experiments described here, chimpanzees were able to deliver identical rewards to themselves and to other members of their social groups. We compared the chimpanzees' behaviour when they were paired with another chimpanzee and when they were alone. If chimpanzees are motivated to provide benefits to others, they are expected to consistently deliver rewards to others and to distinguish between the partner-present and partner-absent conditions. Results from both experiments indicate that our subjects were largely indifferent to the benefits they could provide to others. They were less likely to provide rewards to potential recipients as the experiment progressed, and all but one of the 18 subjects were as likely to deliver rewards to an empty enclosure as to an enclosure housing another chimpanzee. These results, in conjunction with similar results obtained in previous experiments, suggest that chimpanzees are not motivated by prosocial sentiments to provide food rewards to other group members.

Chimpanzees do not take advantage of very low cost opportunities to deliver food to unrelated group members

PubMed Central

VONK, JENNIFER; BROSNAN, SARAH F.; SILK, JOAN B.; HENRICH, JOSEPH; RICHARDSON, AMANDA S.; LAMBETH, SUSAN P.; SCHAPIRO, STEVEN J.; POVINELLI, DANIEL J.

2015-01-01

We conducted experiments on two populations of chimpanzees, Pan troglodytes, to determine whether they would take advantage of opportunities to provide food rewards to familiar group members at little cost to themselves. In both of the experiments described here, chimpanzees were able to deliver identical rewards to themselves and to other members of their social groups. We compared the chimpanzees’ behaviour when they were paired with another chimpanzee and when they were alone. If chimpanzees are motivated to provide benefits to others, they are expected to consistently deliver rewards to others and to distinguish between the partner-present and partner-absent conditions. Results from both experiments indicate that our subjects were largely indifferent to the benefits they could provide to others. They were less likely to provide rewards to potential recipients as the experiment progressed, and all but one of the 18 subjects were as likely to deliver rewards to an empty enclosure as to an enclosure housing another chimpanzee. These results, in conjunction with similar results obtained in previous experiments, suggest that chimpanzees are not motivated by prosocial sentiments to provide food rewards to other group members. PMID:27011388

Price transparency for MRIs increased use of less costly providers and triggered provider competition.

PubMed

Wu, Sze-jung; Sylwestrzak, Gosia; Shah, Christiane; DeVries, Andrea

2014-08-01

To encourage patients to select high-value providers, an insurer-initiated price transparency program that focused on elective advanced imaging procedures was implemented. Patients having at least one outpatient magnetic resonance imaging (MRI) scan in 2010 or 2012 were divided according to their membership in commercial health plans participating in the program (the intervention group) or in nonparticipating commercial health plans (the reference group) in similar US geographic regions. Patients in the intervention group were informed of price differences among available MRI facilities and given the option of selecting different providers. For those patients, the program resulted in a $220 cost reduction (18.7 percent) per test and a decrease in use of hospital-based facilities from 53 percent in 2010 to 45 percent in 2012. Price variation between hospital and nonhospital facilities for the intervention group was reduced by 30 percent after implementation. Nonparticipating members residing in intervention areas also observed price reductions, which indicates increased price competition among providers. The program significantly reduced imaging costs. This suggests that patients select lower-price facilities when informed about available alternatives. Project HOPE—The People-to-People Health Foundation, Inc.

Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage.

PubMed

Bradley, Cathy J; Neumark, David

2017-08-01

In a randomized controlled trial, we studied low-income adults newly covered by a primary care program to determine whether a cash incentive could encourage them to make an initial visit to a primary care provider. Subjects were randomly assigned to one of four groups: three groups whose members received $10 to complete a baseline survey during an interview and who were randomized to incentives of $50, $25, or $0 to visit their assigned primary care provider within six months after enrolling in the study; and a nonincentivized control group not contacted by the research team. Subjects in the $50 and $25 incentive groups were more likely to see a primary care provider (77 percent and 74 percent, respectively), compared to subjects in the $0 incentive group (68 percent). The effects of the intervention were about twice as large when we compared the proportions of subjects in the $50 and $25 incentive groups who visited their providers and the proportion in the nonincentivized group (61 percent). Cash incentive programs may steer newly covered low-income patients toward primary care, which could result in improved health outcomes and lower costs. Project HOPE—The People-to-People Health Foundation, Inc.

The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.

PubMed

Fenwick, Jennifer; Sidebotham, Mary; Gamble, Jenny; Creedy, Debra K

2018-02-01

Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work p<.001; CBI Client p<.001) and Anxiety (p=.007) and Depression (p=.004) sub-scales. Midwives providing continuity reported significantly higher scores on the PEMs Autonomy/Empowerment subscale (p<.001) and the Skills and Resources subscale (p=.002). There was no difference between the groups in terms of satisfaction with time off and work-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Improving performance of Zambia Defence Force antiretroviral therapy providers: evaluation of a standards-based approach

PubMed Central

Kim, Young Mi; Banda, Joseph; Kanjipite, Webby; Sarkar, Supriya; Bazant, Eva; Hiner, Cyndi; Tholandi, Maya; Reinhardt, Stephanie; Njobvu, Panganani Dalisani; Kols, Adrienne; Benavides, Bruno

2013-01-01

ABSTRACT Background: The Zambia Defence Force (ZDF) has applied the Standards-Based Management and Recognition (SBM-R®) approach, which uses detailed performance standards, at some health facilities to improve HIV-related services offered to military personnel and surrounding civilian communities. This study examines the effectiveness of the SBM-R approach in improving facility readiness and provider performance at ZDF facilities. Methods: We collected data on facility readiness and provider performance before and after the 2010–2012 intervention at 4 intervention sites selected for their relatively poor performance and 4 comparison sites. Assessors observed whether each facility met 16 readiness standards and whether providers met 9 performance standards during consultations with 354 returning antiretroviral therapy (ART) clients. We then calculated the percentages of criteria achieved for each readiness and performance standard and conducted bivariate and multivariate analyses of provider performance data. Results: Facilities' ART readiness scores exceeded 80% before the intervention at both intervention and comparison sites. At endline, scores improved on 4 facility readiness standards in the intervention group but on only 1 standard in the comparison group. Multivariate analysis found that the overall provider performance score increased significantly in the intervention group (from 58% to 84%; P<.01) but not in the comparison group (from 62% to 70%). The before-and-after improvement in scores was significantly greater among intervention sites than among comparison sites for 2 standards—initial assessment of the client's condition and nutrition counseling. Conclusion: The standards-based approach, which involved intensive and mutually reinforcing intervention activities, showed modest improvements in some aspects of providers' performance during ART consultations. Further research is needed to determine whether improvements in provider performance affect client outcomes such as adherence to ART. PMID:25276534

ASHE Directory of Funded Research Opportunities for Pre-Post-Doctoral Students of Higher Education.

ERIC Educational Resources Information Center

Carter, Glenda, Comp.

Information about 18 organizations that provide funding for individual, group, or organizational research efforts is presented. The organizations include foundations, corporations, and government and nonprofit agencies. Descriptions are provided for 13 organizations that provide educational grants and 5 organizations that provide miscellaneous…

76 FR 72931 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-28

... Systems (CAHPS) Clinician and Group Survey Comparative Database.'' In accordance with the Paperwork... Providers and Systems (CAHPS) Clinician and Group Survey Comparative Database The Agency for Healthcare..., and provided critical data illuminating key aspects of survey design and administration. In July 2007...

45 CFR 1307.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... progress of the children it serves that have been combined to provide summary information about groups of... other groups of children such as dual language learners, or to provide summary information by specific... children's status and progress across domains of language and literacy development, cognition and general...

45 CFR 1307.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... progress of the children it serves that have been combined to provide summary information about groups of... other groups of children such as dual language learners, or to provide summary information by specific... children's status and progress across domains of language and literacy development, cognition and general...

45 CFR 1307.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... progress of the children it serves that have been combined to provide summary information about groups of... other groups of children such as dual language learners, or to provide summary information by specific... children's status and progress across domains of language and literacy development, cognition and general...

EFOMP project on the role of biomedical physics in the education of healthcare professionals

NASA Astrophysics Data System (ADS)

Caruana, Carmel J.; Wasilewska-Radwanska, M.; Aurengo, A.; Dendy, P. P.; Karenauskaite, V.; Malisan, M. R.; Meijer, J. H.; Mornstein, V.; Rokita, E.; Vano, E.; Wucherer, M.

2009-01-01

The policy statements describing the role of the medical physicist (and engineer) published by organizations representing medical physics (and engineering) in Europe include the responsibility of providing a contribution to the education of healthcare professionals (physicians and paramedical professions). As a consequence, medical physicists and engineers provide educational services in most Faculties of Medicine / Health Science in Europe. In 2005, the EFOMP council took the decision to set up a Special Interest Group to develop the role of the medical physics educator in such faculties and to work with other healthcare professional groups to produce updated European curricula for them. The effort of the group would provide a base for the progress of the role, its relevance to contemporary healthcare professional education and provide input for future EFOMP policy documents regarding this important aspect of the role of the medical physicist. The present communication will present the group, summarise its latest research and indicate future research directions.

Professional online community membership and participation among healthcare providers: An extension to nurse practitioners and physician assistants.

PubMed

Betts, Kevin R; O'Donoghue, Amie C; Aikin, Kathryn J; Kelly, Bridget J; Boudewyns, Vanessa

2016-12-01

Professional online communities allow healthcare providers to exchange ideas with their colleagues about best practices for patient care. Research on this topic has focused almost exclusively on primary care physicians and specialists, to the exclusion of advanced practice providers such as nurse practitioners and physician assistants. We expand this literature by examining membership and participation on these websites among each of these provider groups. Participants (N = 2008; approximately 500 per provider group) responded to an Internet-based survey in which they were asked if they use professional online communities to dialogue with colleagues and if so, what their motivation is for doing so. Nearly half of the participants in our sample reported utilizing professional online communities. Select differences were observed between provider groups, but overall, similar patterns emerged in their membership and participation on these websites. Nurse practitioners and physician assistants utilize professional online communities in similar proportion to primary care physicians and specialists. Providers should be cognizant of the impact this use may have for both themselves and their patients. Researchers are urged to take into account the various professional roles within the healthcare community while developing research on this topic. ©2016 American Association of Nurse Practitioners.

A case study of healthcare providers' goals during interprofessional rounds.

PubMed

Prystajecky, Michael; Lee, Tiffany; Abonyi, Sylvia; Perry, Robert; Ward, Heather

2017-07-01

Daily interprofessional rounds enhance collaboration among healthcare providers and improve hospital performance measures. However, it is unclear how healthcare providers' goals influence the processes and outcomes of interprofessional rounds. The purpose of this case study was to explore the goals of healthcare providers attending interprofessional rounds in an internal medicine ward. The second purpose was to explore the challenges encountered by healthcare providers while pursuing these goals. Three focus groups were held with healthcare providers of diverse professional backgrounds. Focus group field notes and transcripts were analysed using thematic analysis. The data indicated that there was no consensus among healthcare providers regarding the goals of interprofessional rounds. Discharge planning and patient care delivery were perceived as competing priorities during rounds, which limited the participation of healthcare providers. Nevertheless, study participants identified goals of rounds that were relevant to most care providers: developing shared perspectives of patients through direct communication, promoting collaborative decision making, coordinating care, and strengthening interprofessional relationships. Challenges in achieving the goals of interprofessional rounds included inconsistent attendance, exchange of irrelevant information, variable participation by healthcare providers, and inconsistent leadership. The findings of this study underscore the importance of shared goals in the context of interprofessional rounding.

Assessing health plan ownership.

PubMed

Eyestone, Katherine M; Moore, Keith D; Coddington, Dean C

2014-01-01

In the emerging healthcare environment, providers will require many capabilities of traditional health plans simply to remain viable. Providers that are contemplating entering the health plan business should consider the likely strategic, structural, and cultural effects of such a strategy on their organizations. Providers that own health plans will need to determine how they will differentiate themselves in the markets to foster patient loyalty and which insurance lines of business they will pursue (e.g., individual, small group, large group, or other).

A randomized intervention study of sun protection promotion in well-child care.

PubMed

Crane, Lori A; Deas, Ann; Mokrohisky, Stefan T; Ehrsam, Gretchen; Jones, Richard H; Dellavalle, Robert; Byers, Tim E; Morelli, Joseph

2006-03-01

This study evaluated the behavioral impact of a skin cancer prevention program in which health care providers delivered advice and materials to parents of infants over a 3-year period from 1998 to 2001. Fourteen offices of a large managed care organization in Colorado were randomly assigned to the intervention or control groups. 728 infants and their parents were recruited within 6 months of birth. At intervention offices, health care providers attended orientation sessions, prompts for delivering sun protection advice were placed in medical records, and parents received sun protection packets at each well-child visit between 2 and 36 months of age. Based on provider self-report and exit interviews of parents, providers in the intervention group delivered approximately twice as much sun protection advice as providers in the control group. Annual telephone interviews of parents indicated small but statistically significant differences in parent sun protection practices favoring the intervention. Skin exams revealed no significant differences in tanning, freckling, or number of nevi. Behavioral differences between groups appeared to grow over the 3 years of follow-up. This intervention strategy was successful in increasing the delivery of sun protection advice by health care providers and resulted in changes in parents' behaviors. While the behavioral effect was probably not strong enough to reduce risk for skin cancer, the effect may increase as children age and have more opportunities for overexposure to the sun.

Reasons for discharges against medical advice: a qualitative study.

PubMed

Onukwugha, Eberechukwu; Saunders, Elijah; Mullins, C Daniel; Pradel, Françoise G; Zuckerman, Marni; Weir, Matthew R

2010-10-01

There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multicategory provider focus-group interviews (FGIs). Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical centre along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group and one nurse/social worker group were held. Focus-group interviews were transcribed, and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions. Eighteen patients, five physicians, six nurses and four social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker FGIs of reasons why patients leave against medical advice: (1) drug addiction, (2) pain management, (3) external obligations, (4) wait time, (5) doctor's bedside manner, (6) teaching hospital setting and (7) communication. Solutions to tackle DAMA identified by participants revolved mainly around enhanced communication and provider education. In a large, academic medical centre, the authors find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication.

The space shuttle payload planning working groups: Executive summaries

NASA Technical Reports Server (NTRS)

1973-01-01

The findings of a space shuttle payload planning group session are presented. The purpose of the workshop is: (1) to provide guidance for the design and development of the space shuttle and the spacelab and (2) to plan a space science and applications program for the 1980 time period. Individual groups were organized to cover the various space sciences, applications, technologies, and life sciences. Summaries of the reports submitted by the working groups are provided.

A smartphone application to educate undergraduate nursing students about providing care for infant airway obstruction.

PubMed

Kim, Shin-Jeong; Shin, Hyewon; Lee, Jungeun; Kang, SoRa; Bartlett, Robin

2017-01-01

This study had two aims: (a) to develop a smartphone-based application and (b) to evaluate the effectiveness of the application by measuring nursing students' knowledge, skills, and confidence in simulated performance when providing that care. We conducted a randomized trial using a pre- and post-test design at a university in Korea. Seventy-three junior nursing students participated. A smartphone-based app using a video was developed for the experimental group and one time lecture-based education was designed for the control group. We provided the app and information about its use to the experimental group, and we encouraged its use. We provided classroom instruction to the control group. Then, learning outcomes were evaluated. The smartphone-based education group showed significantly higher scores on skills (t=4.774, p<0.001) and confidence in performance (t=2.888, p=0.005) than the control group. The scores on knowledge (t=0.886, p=0.379) and satisfaction with the learning method (t=0.168, p=0.867) for the experimental group were higher than for the control group, but the differences were not statistically significant. This study suggests that smartphone-based education may be an effective method to use in nursing education related to teaching infant airway obstruction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Men Who Are Abusive to Their Female Intimate Partners: Incorporating Family of Origin Work into Group Treatment

ERIC Educational Resources Information Center

Musick-Neily, Erin Francess; McBride, Dawn Lorraine

2012-01-01

This paper examines and provides a rationale for incorporating past victimization into group treatment for men who have been abusive to their female intimate partners. It begins with providing a general overview of the issue of family violence in Canada and in the U.S including statistics and an overview of group treatment effectiveness overall.…

More than the Sum of the Parts: Using Small Group Learning in Adult Basic and Literacy Education. A 353 Special Demonstration Project.

ERIC Educational Resources Information Center

Imel, Susan; And Others

This guide provides practical information that teachers and administrators can use to initiate the small group learning approach in adult basic and literacy education (ABLE). A locator index directs readers to specific topics. Chapter 1 describes small group learning, provides a rationale, and points out advantages and disadvantages for learners,…

A Snapshot of the Calculus Classroom

ERIC Educational Resources Information Center

Weathers, Tony D.; Latterell, Carmen M.

2003-01-01

Essentially a focus group to discuss textbook related issues, a meeting of calculus instructors from a wide variety of environments was convened and sponsored by McGraw Hill to provide feedback on the current state of the calculus classroom. This paper provides a description of the group's discussions.

Carbon-based composite electrocatalysts for low temperature fuel cells

DOEpatents

Popov, Branko N [Columbia, SC; Lee, Jog-Won [Columbia, SC; Subramanian, Nalini P [Kennesaw, GA; Kumaraguru, Swaminatha P [Honeoye Falls, NY; Colon-Mercado, Hector R [Columbia, SC; Nallathambi, Vijayadurga [T-Nagar, IN; Li, Xuguang [Columbia, SC; Wu, Gang [West Columbia, SC

2009-12-08

A process for synthesis of a catalyst is provided. The process includes providing a carbon precursor material, oxidizing the carbon precursor material whereby an oxygen functional group is introduced into the carbon precursor material, and adding a nitrogen functional group into the oxidized carbon precursor material.

Impact of psychological screening on routine outpatient care of hematopoietic cell transplantation survivors.

PubMed

Hoodin, Flora; Zhao, Lili; Carey, Jillian; Levine, John E; Kitko, Carrie

2013-10-01

Hematopoietic cell transplantation recipients are at high risk for psychological distress, with reported prevalence rates as high as 40%. Although published guidelines advocate periodic routine screening, it is unclear how screening affects management of psychological symptoms at routine post-HCT outpatient clinic visits. We hypothesized that providers will be more likely to act on patients' psychological symptoms if a screening survey is completed and reviewed before a clinic visit. We used a brief, diagnostically focused Patient Health Questionnaire (PHQ), to assess for depressive disorders, anxiety, substance abuse, and problems in occupational or interpersonal functioning (functional disruption). Adult HCT survivors were randomized to complete the PHQ before meeting with their medical provider (n = 50; experimental group) or afterwards (n = 51; control group). Providers used the experimental group PHQ results at their discretion during the visits. Both providers and patients rated their satisfaction with management of psychological concerns after the visit. The prevalence of clinically significant depression (21%), anxiety (14%), or suicidal ideation (8%) did not differ between the 2 groups. Patients in the experimental group were significantly more likely to have discussion of psychological symptoms than the control group (68% versus 49%, P = .05). Medical providers were significantly more satisfied with the management of psychological issues for the experimental group (P < .001). Patients with depression or anxiety were significantly more likely to prefer the PHQ be used at future visits (P = .02 and P = .001, respectively). These findings suggest an informative yet brief self-report psychological screen can be easily integrated into routine care of hematopoietic cell transplantation survivors, stimulates discussion of psychological symptoms, and improves provider satisfaction with psychological symptom management. Future research will evaluate whether serial prospective administration improves patient outcomes. Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Team Clinic: An Innovative Group Care Model for Youth with Type 1 Diabetes-Engaging Patients and Meeting Educational Needs.

PubMed

Berget, Cari; Lindwall, Jennifer; Shea, Jacqueline J; Klingensmith, Georgeanna J; Anderson, Barbara J; Cain, Cindy; Raymond, Jennifer K

2017-06-01

The purpose of this pilot was to implement an innovative group care model, "Team Clinic", for adolescents with type 1 diabetes and assess patient and provider perspectives. Ninety-one intervention patients and 87 controls were enrolled. Ninety-six percent of intervention adolescents endorsed increased support and perceived connecting with peers as important. The medical providers and staff also provided positive feedback stating Team Clinic allowed more creativity in education and higher quality of care. Team Clinic may be a promising model to engage adolescents and incorporate education and support into clinic visits in a format valued by patients and providers.

Drum-Assisted Recovery Therapy for Native Americans (DARTNA): results from a pretest and focus groups.

PubMed

Dickerson, Daniel L; Venner, Kamilla L; Duran, Bonnie; Annon, Jeffrey J; Hale, Benjamin; Funmaker, George

2014-01-01

Drum-Assisted Recovery Therapy for Native Americans (DARTNA) is a substance abuse treatment intervention for American Indians/Alaska Natives (AI/ANs). This article provides results from 1) an initial pretest of DARTNA provided to 10 AI/AN patients with histories of substance use disorders, and 2) three subsequent focus groups conducted among AI/AN DARTNA pretest participants, substance abuse treatment providers, and the DARTNA Community Advisory Board. These research activities were conducted to finalize the DARTNA treatment manual; participants also provided helpful feedback which will assist toward this goal. Results suggest that DARTNA may be beneficial for AI/ANs with substance use problems.

Beyond literacy and numeracy in patient provider communication: Focus groups suggest roles for empowerment, provider attitude and language

PubMed Central

Brugge, Doug; Edgar, Timothy; George, Kelly; Heung, Janette; Laws, M Barton

2009-01-01

Background Although the number of people living in the United States with limited English proficiency (LEP) is substantial, the impact of language on patients' experience of provider-patient communication has been little explored. Methods We conducted a series of 12 exploratory focus groups in English, Spanish and Cantonese to elicit discussion about patient-provider communication, particularly with respect to the concerns of the health literacy framework, i.e. ability to accurately understand, interpret and apply information given by providers. Within each language, 2 groups had high education and 2 had low education participants to partially account for literacy levels, which cannot be assessed consistently across three languages. Eighty-five (85) adults enrolled in the focus groups. The resulting video tapes were transcribed, translated and analyzed via content analysis. Results We identified 5 themes: 1) language discordant communication; 2) language concordant communication; 3) empowerment; 4) providers' attitudes; 5) issues with the health care system. Despite efforts by facilitators to elicit responses related to cognitive understanding, issues of interpersonal process were more salient, and respondents did not readily separate issues of accurate understanding from their overall narratives of experience with health care and illness. Thematic codes often appeared to be associated with education level, language and/or culture. Conclusion Our most salient finding was that for most of our participants there was no clear demarcation between literacy and numeracy, language interpretation, health communication, interpersonal relations with their provider and the rest of their experience with the health care system. PMID:19772555

Behavior of stabled horses provided continuous or intermittent access to drinking water.

PubMed

McDonnell, S M; Freeman, D A; Cymbaluk, N F; Schott, H C; Hinchcliff, K; Kyle, B

1999-11-01

To compare quantitative measures and clinical assessments of behavior as an indication of psychologic well-being of stabled horses provided drinking water continuously or via 1 of 3 intermittent delivery systems. 22 Quarter Horse (QH) or QH-crossbred mares and 17 Belgian or Belgian-crossbred mares (study 1) and 24 QH or QH-crossbred mares and 18 Belgian or Belgian-crossbred mares (study 2). Stabled horses were provided water continuously or via 1 of 3 intermittent water delivery systems in 2 study periods during a 2-year period. Continuous 24-hour videotaped samples were used to compare quantitative measures and clinical assessments of behavior among groups provided water by the various water delivery systems. All horses had clinically normal behavior. Significant differences in well being were not detected among groups provided water by the various delivery systems. Various continuous and intermittent water delivery systems can provide adequately for the psychologic well-being of stabled horses.

The new World Organisation for Animal Health standards on avian influenza and international trade.

PubMed

Thiermann, Alex B

2007-03-01

In 2002, the World Organisation for Animal Health began a review of the chapter on avian influenza by convening a group of experts to revise the most recent scientific literature. The group drafted the initial text that would provide the necessary recommendations on avian influenza control and prevention measures. The main objectives of this draft were to provide clear notification criteria, as well as commodity-specific, risk-based mitigating measures, that would provide safety when trading and encourage transparent reporting.

77 FR 5021 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-01

...) Clinician and Group Survey Comparative Database.'' In accordance with the Paperwork Reduction Act, 44 U.S.C... Providers and Systems (CAHPS) Clinician and Group Survey Comparative Database The Agency for Healthcare..., and provided critical data illuminating key aspects of survey design and administration. In July 2007...

Bilingual Vocational Education. Project Abstracts 1987-1988.

ERIC Educational Resources Information Center

Office of Vocational and Adult Education (ED), Washington, DC.

Abstracts are provided for 16 bilingual vocational education projects offered in 1987-88. Each abstract provides information on: grantee; state; project title; project director, address, and telephone number; project officer and U.S. Department of Education address; language group(s) served; occupational skills area(s); length of training cycle…

42 CFR 436.301 - General rules.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICAL ASSISTANCE PROGRAMS ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS Optional Coverage of... provide Medicaid to any or all of the following groups of individuals: (i) Individuals under age 21 (§ 436...) Disabled (§ 436.322). (3) If the agency provides Medicaid to any individual in a group specified in...

The public's opinions of physicians: do perceived choice and exercised choice matter?

PubMed

Tai-Seale, Ming; Pescosolido, Bernice

2003-09-01

To assess whether the public's opinions of physicians are affected by one's perceived ability to choose providers and by past experience with switching providers or health plans. Cross-sectional survey of the American general public in 1998. Multivariate quantitative analyses of opinions according to respondents' perceived ability to choose providers, history of exercising choice of providers or plans, and health status. Exploratory factor analyses resulted in 4 scales of opinions: trusting personal physician, positive opinions of physicians as a group, negative opinions of physicians as a group, and concerns about the influence of managed care on personal physicians' practice patterns. Although 75% (879/1172) of the sample perceived that they could use any physician they wanted, only 20% had ever switched health providers or plans owing to dissatisfaction. Perceived lack of choice is associated with lower levels of trust in personal physicians and with higher levels of concern about the influence of managed care on personal physicians. Individuals who have not switched in the past are more positive about physicians as a group and are less concerned about the influence of managed care. Health status affected opinions significantly. Educational attainment is negatively associated with opinions. The public's opinions of physicians are significantly associated with one's perceived ability to choose any provider, past experience with switching health providers or plans, health status, and education. Ensuring consumer choice of providers and targeting those who have switched in the past and the sick could potentially improve the public's opinions. Meaningful provider quality information is necessary to ensure choices that can enhance consumer welfare.

Biosimilars: Opportunities to Promote Optimization Through Payer and Provider Collaboration.

PubMed

Manolis, Chronis H; Rajasenan, Kiran; Harwin, William; McClelland, Scott; Lopes, Maria; Farnum, Carolyn

2016-09-01

A panel was convened that consisted of 1 medical director, 2 pharmacy directors, and 2 oncologists, who represented the University of Pittsburgh Medical Center Health Plan, an integrated delivery network, and Florida Blue, a progressive regional health plan. This panel met in order to share ideas, discuss challenges, and develop practical solutions to promote optimal utilization in order to encourage collaboration between payers and providers to help ensure the success of biosimilar entrants into the marketplace. Live meetings were conducted in Orlando, Florida, and Pittsburgh, Pennsylvania, and were followed by virtual meetings to solidify ideas and concepts for this supplement. It is important for biosimilar manufacturers to identify potential payer, provider, and patient obstacles in order to develop strategic and tactical plans to preemptively address these potential obstacles. Gathering payer and provider insights will shed light on various issues such as access and reimbursement. Biosimilar manufacturers must be proactive in the education of payers, providers, and patients to ensure access to biosimilars. A strong factor emphasized among this group was that the assumption surrounding biosimilar development and use is the potential for health care cost savings. According to the panel, payers and providers must carefully consider economic implications and potential cost-effectiveness in order to increase the acceptance or understanding of biosimilars in clinical practice. The group identified 3 major challenges surrounding biosimilar adoption: (1) provider confidence in biosimilar education and clinical value, (2) provider confidence in reimbursement for new biosimilars, and (3) creating shared payer and provider cost-savings. After identification of the 3 challenges, the group posed potential solutions to help with biosimilar adoption.

Environments predicting intermittent shortening access reduce operant performance but not home cage binge size in rats

PubMed Central

Wojnicki, F.H.E.; Babbs, R.K.; Corwin, R.L.W

2013-01-01

When non-food-deprived rats are given brief access to vegetable shortening (a semi-solid fat used in baked products) on an intermittent basis (Monday, Wednesday, Friday), they consume significantly more and emit more operant responses for shortening than a separate group of rats given brief access to shortening every day. Since both groups are traditionally housed in the same room, it is possible that the environmental cues associated with placing shortening in the cages (e.g., investigator in room, cages opening and closing, etc.) provide predictable cues to the daily group, but unpredictable cues to the intermittent group. The present study examined the effects of providing predictable environmental cues to an isolated intermittent group in order to examine the independent contributions of intermittency and predictability on intake and operant performance. Two groups of rats were housed in the same room, with one group provided 30-min intermittent (INT) access and the second group provided 30-min daily access (D) to shortening. A third group (ISO) of rats was housed in a room by themselves in which all environmental cues associated with intermittent shortening availability were highly predictable. After five weeks of home cage shortening access, all rats were then exposed to several different operant schedules of reinforcement. The INT and ISO groups consumed significantly more shortening in the home cage than the D group. In contrast, the INT group earned significantly more reinforcers than both the ISO and D groups under all but one of the reinforcement schedules, while ISO and D did not differ. These data indicate that intermittent access will generate binge-type eating in the home cage independent of cue predictability. However, predictable cues in the home cage reduce operant responding independent of intermittent access. PMID:23535243

Comparing the effects of single shot sciatic nerve block versus posterior capsule local anesthetic infiltration on analgesia and functional outcome after total knee arthroplasty: a prospective, randomized, double-blinded, controlled trial.

PubMed

Safa, Ben; Gollish, Jeffrey; Haslam, Lynn; McCartney, Colin J L

2014-06-01

Peripheral nerve blocks appear to provide effective analgesia for patients undergoing total knee arthroplasty. Although the literature supports the use of femoral nerve block, addition of sciatic nerve block is controversial. In this study we investigated the value of sciatic nerve block and an alternative technique of posterior capsule local anesthetic infiltration analgesia. 100 patients were prospectively randomized into three groups. Group 1: sciatic nerve block; Group 2: posterior local anesthetic infiltration; Group 3: control. All patients received a femoral nerve block and spinal anesthesia. There were no differences in pain scores between groups. Sciatic nerve block provided a brief clinically insignificant opioid sparing effect. We conclude that sciatic nerve block and posterior local anesthetic infiltration do not provide significant analgesic benefits. Copyright © 2014 Elsevier Inc. All rights reserved.

Diazo Groups Endure Metabolism and Enable Chemoselectivity in Cellulo

PubMed Central

2015-01-01

We introduce a stabilized diazo group as a reporter for chemical biology. ManDiaz, which is a diazo derivative of N-acetylmannosamine, is found to endure cellular metabolism and label the surface of a mammalian cell. There its diazo group can undergo a 1,3-dipolar cycloaddition with a strained alkyne, providing a signal comparable to that from the azido congener, ManNAz. The chemoselectivity of diazo and alkynyl groups enables dual labeling of cells that is not possible with azido and alkynyl groups. Thus, the diazo group, which is approximately half the size of an azido group, provides unique opportunities for orthogonal labeling of cellular components. PMID:25658416

Diazo groups endure metabolism and enable chemoselectivity in cellulo.

PubMed

Andersen, Kristen A; Aronoff, Matthew R; McGrath, Nicholas A; Raines, Ronald T

2015-02-25

We introduce a stabilized diazo group as a reporter for chemical biology. ManDiaz, which is a diazo derivative of N-acetylmannosamine, is found to endure cellular metabolism and label the surface of a mammalian cell. There its diazo group can undergo a 1,3-dipolar cycloaddition with a strained alkyne, providing a signal comparable to that from the azido congener, ManNAz. The chemoselectivity of diazo and alkynyl groups enables dual labeling of cells that is not possible with azido and alkynyl groups. Thus, the diazo group, which is approximately half the size of an azido group, provides unique opportunities for orthogonal labeling of cellular components.

Sunspot Positions and Areas from Observations by Galileo Galilei

NASA Astrophysics Data System (ADS)

Vokhmyanin, M. V.; Zolotova, N. V.

2018-02-01

Sunspot records in the seventeenth century provide important information on the solar activity before the Maunder minimum, yielding reliable sunspot indices and the solar butterfly diagram. Galilei's letters to Cardinal Francesco Barberini and Marcus Welser contain daily solar observations on 3 - 11 May, 2 June - 8 July, and 19 - 21 August 1612. These historical archives do not provide the time of observation, which results in uncertainty in the sunspot coordinates. To obtain them, we present a method that minimizes the discrepancy between the sunspot latitudes. We provide areas and heliographic coordinates of 82 sunspot groups. In contrast to Sheiner's butterfly diagram, we found only one sunspot group near the Equator. This provides a higher reliability of Galilei's drawings. Large sunspot groups are found to emerge at the same longitude in the northern hemisphere from 3 May to 21 August, which indicates an active longitude.

Research, Development and Demonstration (RD&D) Needs for Light Water Reactor (LWR) Technologies A Report to the Reactor Technology Subcommittee of the Nuclear Energy Advisory Committee (NEAC) Office of Nuclear Energy U.S. Department of Energy

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

McCarthy, Kathryn A.; Adams, Bradley J.

The LWR RD&D Working Group developed a detailed list of RD&D suggestions and recommendations, which are provided in Appendix D. The Working Group then undertook a systematic ranking process, described in Appendix E. The results of the ranking process are not meant to be a strict set of priorities, but rather should provide insight into how the items generally ranked within the Working Group. Future discussions and investigation into these items could provide information that would support a change in these priorities or in their emphasis. The results of this prioritization are provided below. Note that in general, many RD&Dmore » ideas are applicable to both new Advanced Light Water Reactor (ALWR) plants and currently operating plants.« less

Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting.

PubMed

Haga, Susanne B; LaPointe, Nancy M Allen; Cho, Alex; Reed, Shelby D; Mills, Rachel; Moaddeb, Jivan; Ginsburg, Geoffrey S

2014-09-01

To describe the rationale and design of a pilot program to implement and evaluate pharmacogenetic (PGx) testing in a primary care setting. Several factors have impeded the uptake of PGx testing, including lack of provider knowledge and challenges with operationalizing PGx testing in a clinical practice setting. We plan to compare two strategies for the implementation of PGx testing: a pharmacist-initiated testing arm compared with a physician-initiated PGx testing arm. Providers in both groups will be required to attend an introduction to PGx seminar. Anticipated results: We anticipate that providers in the pharmacist-initiated group will be more likely to order PGx testing than providers in the physician-initiated group. Overall, we aim to generate data that will inform an effective delivery model for PGx testing and to facilitate a seamless integration of PGx testing in primary care practices.

Benefit of social media on patient engagement and satisfaction: Results of a 9-month, qualitative pilot study using Facebook.

PubMed

Dhar, Vikrom K; Kim, Young; Graff, Justin T; Jung, Andrew D; Garrett, Jennifer; Dick, Lauren E; Harris, Jenifer; Shah, Shimul A

2018-03-01

Despite the potential benefits of social media, health care providers are often hesitant to engage patients through these sites. Our aim was to explore how implementation of social media may affect patient engagement and satisfaction. In September 2016 a Facebook support group was created for liver transplant patients to use as a virtual community forum. Data including user demographics and group activity were reviewed. A survey was conducted evaluating users' perceptions regarding participation in the group. Over 9 months, 350 unique users (50% liver transplant patients, 36% caregivers/friends, 14% health care providers) contributed 339 posts, 2,338 comments, and 6,274 reactions to the group; 98% of posts were reacted to or commented on by other group members. Patients were the most active users compared with health care providers and caregivers. A total of 95% of survey respondents reported that joining the group had a positive impact on their care; and 97% reported that their main motivation for joining was to provide or receive support from other patients. This pilot study indicates that the integration of social media into clinical practice can empower surgeons to synthesize effectively a patient support community that augments patient engagement and satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

Stigmatizing attitudes and beliefs about bulimia nervosa: gender, age, education and income variability in a community sample.

PubMed

McLean, Siân A; Paxton, Susan J; Massey, Robin; Hay, Phillipa J; Mond, Jonathan M; Rodgers, Bryan

2014-05-01

Stigmatizing attitudes towards eating disorders negatively impacts treatment seeking. To determine the effect of interventions to reduce stigma, a measure of stigma that is simple to implement is required. This study aimed to develop a measure of stigmatizing attitudes and beliefs towards bulimia nervosa (SAB-BN) and evaluate the distribution of beliefs across gender, age, education, and income groups. Participants were 1828 community adults (890 men; 938 women) aged 18-65 sampled from the Australian Electoral Roll responded to a mailed questionnaire. Participants provided demographic information and completed the SAB-BN questionnaire. Five components of stigmatizing attitudes and beliefs were identified; advantages of BN, minimization/low seriousness, unreliability, social distance, and personal responsibility. Stigma was low except on social distance and personal responsibility sub-scales, which indicated negative attitudes toward people with bulimia. Men compared with women and lower compared with higher education and income groups held significantly higher stigmatizing attitudes and beliefs. There were few differences between age groups in stigma. Differences between demographic groups provides evidence for known-groups validity. The SAB-BN questionnaire provides a potentially useful tool for evaluating stigma in relation to BN. Results provide insight into components of stigma and the demographic groups to whom interventions should be targeted. Copyright © 2013 Wiley Periodicals, Inc.

Health Care Transition Preparation and Experiences in a U.S. National Sample of Young Adults With Type 1 Diabetes.

PubMed

Garvey, Katharine C; Foster, Nicole C; Agarwal, Shivani; DiMeglio, Linda A; Anderson, Barbara J; Corathers, Sarah D; Desimone, Marisa E; Libman, Ingrid M; Lyons, Sarah K; Peters, Anne L; Raymond, Jennifer K; Laffel, Lori M

2017-03-01

Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. We developed a survey to evaluate transition experiences in two groups of young adults with type 1 diabetes, before (PEDS) and after (ADULT) transition to adult care. We fielded an electronic survey to young adults (18 to <30 years) at 60 T1D Exchange Clinic Registry centers. Surveys were completed by 602 young adults, 303 in the PEDS group (60% female, age 20 ± 2 years) and 299 in the ADULT group (62% female, age 24 ± 3 years). In the PEDS group, mean anticipated transition age was 22 ± 2 years; 64% remained in pediatric care because of emotional attachment to the provider. The ADULT group transitioned at age 19 ± 2 years, mainly after pediatric provider recommendation. More than 80% of respondents reported receiving counseling on type 1 diabetes self-management and screening tests from pediatric providers, but less than half (43% PEDS and 33% ADULT) reported discussing reproductive health. In the PEDS group, half had discussed transfer with pediatric providers. Of the ADULT participants, 63% received an adult provider referral, and 66% felt mostly/completely prepared to transition. ADULT participants with fewer pretransition pediatric visits or who felt unprepared for transition had increased odds of gaps >6 months between pediatric and adult care. Receipt of transition preparation counseling was not associated with self-reported hemoglobin A 1c <7.0% in either group. These results support the need for intensive efforts to integrate transition preparation counseling and care coordination into pediatric type 1 diabetes care. © 2017 by the American Diabetes Association.

Market competition and price of disease management programmes: an observational study.

PubMed

van Dijk, Christel E; Venema, Bob; de Jong, Judith D; de Bakker, Dinny H

2014-10-30

Managed competition was introduced into the health care system in several countries including the Netherlands, although effects of competition of both providers and health insurers on the price of health care are inconclusive. We investigated the association between competition of both providers (care groups) and health insurers and the price of disease management programmes (DMPs). Data from 76 DMP contractual agreements for type II diabetes mellitus in 2008, 2009 and 2010 were used to analyse the association between market competition and the price of DMPs. Market competition was calculated per municipal health services region (GGD). Insurer market competition was measured by the Herfindahl-Hirschman Index (HHI), care group competition by the number of care groups and the care group market share of GPs. The effect of competition was cross-sectionally studied with linear regression analyses. Insurer market concentration (HHI) and care group market share were not associated with the price of DMPs. The number of care groups in a GGD region was associated with a lower price (-€4.68; 95% CI: -8.36 - -1.00). The mean difference in the price of DMPs between health insurers was €58. The price of DMPs seems to be more dependent on the particular health insurer than on market conditions. For competition among health insurers and provider groups to develop, preconditions such as selective contracting and option for patient to change provider should be in place.

Computer tablet distraction reduces pain and anxiety in pediatric burn patients undergoing hydrotherapy: A randomized trial.

PubMed

Burns-Nader, Sherwood; Joe, Lindsay; Pinion, Kelly

2017-09-01

Distraction is often used in conjunction with analgesics to minimize pain in pediatric burn patients during treatment procedures. Computer tablets provide many options for distraction items in one tool and are often used during medical procedures. Few studies have examined the effectiveness of tablet distraction in improving the care of pediatric burn patients. This study examines the effectiveness of tablet distraction provided by a child life specialist to minimize pain and anxiety in pediatric burn patients undergoing hydrotherapy. Thirty pediatric patients (4-12) undergoing hydrotherapy for the treatment of burns participated in this randomized clinical trial. The tablet distraction group received tablet distraction provided by a child life specialist while those in the control group received standard care. Pain was assessed through self-reports and observation reports. Anxiety was assessed through behavioral observations. Length of procedure was also recorded. Nurses reported significantly less pain for the tablet distraction group compared to the control group. There was no significant difference between groups on self-reported pain. The tablet distraction group displayed significantly less anxiety during the procedure compared to the control group. Also, the tablet distraction group returned to baseline after the procedure while those in the control group displayed higher anxiety post-procedure. There was no difference in the length of the procedure between groups. These findings suggest tablet distraction provided by a child life specialist may be an effective method for improving pain and anxiety in children undergoing hydrotherapy treatment for burns. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Decreasing Distortion Energies without Strain: Diazo-Selective 1,3-Dipolar Cycloadditions.

PubMed

Gold, Brian; Aronoff, Matthew R; Raines, Ronald T

2016-07-15

The diazo group has attributes that complement those of the azido group for applications in chemical biology. Here, we use computational analyses to provide insights into the chemoselectivity of the diazo group in 1,3-dipolar cycloadditions. Dipole distortion energies are responsible for ∼80% of the overall energetic barrier for these reactions. Here, we show that diazo compounds, unlike azides, provide an opportunity to decrease that barrier substantially without introducing strain into the dipolarophile. The ensuing rate enhancement is due to the greater nucleophilic character of a diazo group compared to that of an azido group, which can accommodate decreased distortion energies without predistortion. The tuning of distortion energies with substituents in a diazo compound or dipolarophile can enhance reactivity and selectivity in a predictable manner. Notably, these advantages of diazo groups are amplified in water. Our findings provide a theoretical framework that can guide the design and application of both diazo compounds and azides in "orthogonal" contexts, especially for biological investigations.

Multiple comparison analysis testing in ANOVA.

PubMed

McHugh, Mary L

2011-01-01

The Analysis of Variance (ANOVA) test has long been an important tool for researchers conducting studies on multiple experimental groups and one or more control groups. However, ANOVA cannot provide detailed information on differences among the various study groups, or on complex combinations of study groups. To fully understand group differences in an ANOVA, researchers must conduct tests of the differences between particular pairs of experimental and control groups. Tests conducted on subsets of data tested previously in another analysis are called post hoc tests. A class of post hoc tests that provide this type of detailed information for ANOVA results are called "multiple comparison analysis" tests. The most commonly used multiple comparison analysis statistics include the following tests: Tukey, Newman-Keuls, Scheffee, Bonferroni and Dunnett. These statistical tools each have specific uses, advantages and disadvantages. Some are best used for testing theory while others are useful in generating new theory. Selection of the appropriate post hoc test will provide researchers with the most detailed information while limiting Type 1 errors due to alpha inflation.

Innovation in survivor care: group visits.

PubMed

Trotter, Kathryn; Frazier, Alana; Hendricks, Colleen K; Scarsella, Heidi

2011-04-01

The Centering Cancer Survivorship (CCS) follow-up care program is an innovation in healthcare delivery that meets the needs of cancer survivors and cancer centers. Piloted in a breast cancer clinic, the program provides an avenue for provision of psychological support and health-promotion activities, as well as surveillance for recurrence or late effects. The program empowers each survivor by enlisting her to produce a written breast cancer survivorship care plan for personal use and to share with her primary care provider. Concurrently, this innovation should enhance the viability of the primary cancer center by freeing appointment slots for oncologists who provide expensive therapies to newly diagnosed patients. The CCS program's central feature is the implementation of a multidisciplinary clinic designated specifically for breast cancer survivors in which follow-up care is provided through a group visit medical model. This model of care provides opportunities for health assessment, patient empowerment, and patient education within a framework of social support from peers with similar issues. The group visit model may be well suited to addressing the unique chronic healthcare needs of breast cancer survivors. Further evaluation is needed to verify cost-benefit analysis.

Ion binding compounds, radionuclide complexes, methods of making radionuclide complexes, methods of extracting radionuclides, and methods of delivering radionuclides to target locations

DOEpatents

Chen, Xiaoyuan; Wai, Chien M.; Fisher, Darrell R.

2000-01-01

The invention pertains to compounds for binding lanthanide ions and actinide ions. The invention further pertains to compounds for binding radionuclides, and to methods of making radionuclide complexes. Also, the invention pertains to methods of extracting radionuclides. Additionally, the invention pertains to methods of delivering radionuclides to target locations. In one aspect, the invention includes a compound comprising: a) a calix[n]arene group, wherein n is an integer greater than 3, the calix[n]arene group comprising an upper rim and a lower rim; b) at least one ionizable group attached to the lower rim; and c) an ion selected from the group consisting of lanthanide and actinide elements bound to the ionizable group. In another aspect, the invention includes a method of extracting a radionuclide, comprising: a) providing a sample comprising a radionuclide; b) providing a calix[n]arene compound in contact with the sample, wherein n is an integer greater than 3; and c) extracting radionuclide from the sample into the calix[n]arene compound. In yet another aspect, the invention includes a method of delivering a radionuclide to a target location, comprising: a) providing a calix[n]arene compound, wherein n is an integer greater than 3, the calix[n]arene compound comprising at least one ionizable group; b) providing a radionuclide bound to the calix[n]arene compound; and c) providing an antibody attached to the calix[n]arene compound, the antibody being specific for a material found at the target location.

Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi

PubMed Central

Baig, Lubna; Tanzil, Sana; Shaikh, Shiraz; Hashmi, Ibrahim; Khan, Muhammad Arslan; Polkowski, Maciej

2018-01-01

Background & Objective: Considering high burden of violence against healthcare workers in Pakistan APPNA Institute of Public Health developed a training to prevent reactive violence among healthcare providers. The purpose of this training was to equip healthcare providers with skills essential to control aggressive behaviors and prevent verbal and non-verbal violence in workplace settings. This study assesses the effectiveness of training in prevention, de-escalation and management of violence in healthcare settings. Methods: A quasi-experimental study was conducted in October, 2016 using mixed method concurrent embedded design. The study assessed effectiveness of de-escalation trainings among health care providers working in emergency and gynecology and obstetrics departments of two teaching hospitals in Karachi. Quantitative assessment was done through structured interviews and qualitative through Focus Group Discussions. Healthcare providers` confidence in coping with patient aggression was also measured using a standard validated tool”. Results: The overall self-perceived mean score of Confidence in Coping with Patient Aggression Instrument “(CCPAI)” scale was significantly higher in intervention group (Mean= 27.49, SD=3.53) as compared to control group (Mean= 23.92, SD=4.52) (p<0.001). No statistically significant difference was observed between intervention and control groups with regard to frequency of violence faced by HCPs post training and major perpetrators of violence.. Conclusion: De-escalation of violence training was effective in improving confidence of healthcare providers in coping with patient aggression. PMID:29805396

Comparative techniques of medial rectus muscle retraction for endoscopic exposure of the medial intraconal space.

PubMed

Lin, Giant C; Freitag, Suzanne K; Kocharyan, Armine; Yoon, Michael K; Lefebvre, Daniel R; Bleier, Benjamin S

2016-05-01

The medial rectus muscle (MRM) is the medial boundary to the intraconal space of the orbit, and retraction of the MRM is oftentimes necessary for endoscopic removal of intraconal tumors, e.g., orbital hemangioma. We evaluated each of the reported methods of MRM retraction for endoscopic orbital surgery and quantified the degree of intraconal exposure conferred by each method. Eight orbits from four cadaver heads were dissected. In each orbit, medial orbital decompression was performed and the MRM was retracted by using four previously described techniques: (1) external MRM retraction at the globe insertion point by using vessel loop (external group), (2) transseptal MRM retraction by using vessel loop (transseptal group), (3) transchoanal retraction of the MRM by using vessel loop (choanal group), and (4) transseptal four-handed technique by using double ball retraction by a second surgeon (transseptal double ball group). The length, height, and area of exposure of the medial intraconal space were quantified and compared. The average ± standard deviation (SD) anterior-posterior exposures for the external group, transseptal group, and transseptal double ball group were 17.51 ± 3.39 mm, 16.59 ± 4.16 mm, and 18.0 ± 15.25 mm, respectively. The choanal group provided significantly less exposure (12.39 ± 3.44 mm, p = 0.049) than the other groups. The average ± SD vertical exposures for the transseptal group, choanal group, and transseptal double ball group were 12.53 ± 4.38 mm, 13.05 ± 5.86 mm, and 13.57 ± 3.74 mm, respectively. The external group provided significantly less exposure (4.51 ± 1.56 mm, p = 0.0072) than the other groups. The transseptal and transseptal double ball groups provided the greatest total access by surface area (58.88 ± 26.96 mm(2) and 62.94 ± 34.74 mm(2), respectively) compared with the external and choanal groups (34.82 ± 23.37 mm(2) and 43.10 ± 23.68 mm(2), respectively). Although the transseptal trajectory of MRM retraction was optimal, the difference in total area of exposure between the static vessel loop retraction and the dynamic, four-handed technique with double ball instrument retraction was not significant. Of note, the exposure provided by the choanal technique required the surgeon to work both above and below the muscle. Retraction of the MRM toward the choanae provided the least length of exposure, and external retraction exposed the least height and total area. Transseptal MRM retraction was most favorable and provided the largest endoscopic corridor to the medial intraconal space. A four-handed approach for endoscopic intraconal surgery of the orbit may offer advantages in dynamic adjustments in retraction.

Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.

PubMed

Tannenbaum, David; Doctor, Jason N; Persell, Stephen D; Friedberg, Mark W; Meeker, Daniella; Friesema, Elisha M; Goldstein, Noah J; Linder, Jeffrey A; Fox, Craig R

2015-03-01

Healthcare professionals are rapidly adopting electronic health records (EHRs). Within EHRs, seemingly innocuous menu design configurations can influence provider decisions for better or worse. The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. We surveyed 166 primary care providers in a research network of practices in the greater Chicago area, of whom 84 responded (51% response rate). Respondents and non-respondents were similar on all observable dimensions except that respondents were more likely to work in an academic setting. The questionnaire consisted of seven clinical vignettes. Each vignette described typical signs and symptoms for acute respiratory infections, and providers chose treatments from a menu of options. For each vignette, providers were randomly assigned to one of two menu partitions. For antibiotic-inappropriate vignettes, the treatment menu either listed over-the-counter (OTC) medications individually while grouping prescriptions together, or displayed the reverse partition. For antibiotic-appropriate vignettes, the treatment menu either listed narrow-spectrum antibiotics individually while grouping broad-spectrum antibiotics, or displayed the reverse partition. The main outcome was provider treatment choice. For antibiotic-inappropriate vignettes, we categorized responses as prescription drugs or OTC-only options. For antibiotic-appropriate vignettes, we categorized responses as broad- or narrow-spectrum antibiotics. Across vignettes, there was an 11.5 percentage point reduction in choosing aggressive treatment options (e.g., broad-spectrum antibiotics) when aggressive options were grouped compared to when those same options were listed individually (95% CI: 2.9 to 20.1%; p = .008). Provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise. The careful crafting of EHR order sets can serve as an important opportunity to improve patient care without constraining physicians' ability to prescribe what they believe is best for their patients.

Charming Users into Scripting CIAO with Python

NASA Astrophysics Data System (ADS)

Burke, D. J.

2011-07-01

The Science Data Systems group of the Chandra X-ray Center provides a number of scripts and Python modules that extend the capabilities of CIAO. Experience in converting the existing scripts—written in a variety of languages such as bash, csh/tcsh, Perl and S-Lang—to Python, and conversations with users, led to the development of the ciao_contrib.runtool module. This allows users to easily run CIAO tools from Python scripts, and utilizes the metadata provided by the parameter-file system to create an API that provides the flexibility and safety guarantees of the command-line. The module is provided to the user community and is being used within our group to create new scripts.

Comparison of Adherence to Chlamydia Screening Guidelines Among Title X Providers and Non-Title X Providers in the California Family Planning, Access, Care, and Treatment Program

PubMed Central

Thiel de Bocanegra, Heike; Hulett, Denis; Park, Hye-Youn; Darney, Philip

2012-01-01

Abstract Background Annual chlamydia screening is recommended for adolescent and young adult females and targeted screening is recommended for women ≥26 years based on risk. Although screening levels have increased over time, adherence to these guidelines varies, with high levels of adherence among Title X family planning providers. However, previous studies of provider variation in screening rates have not adjusted for differences in clinic and client population characteristics. Methods Administrative claims from the California Family Planning, Access, Care, and Treatment (Family PACT) program were used to (1) examine clinic and client sociodemographic characteristics by provider group—Title X-funded public sector, non-Title X public sector, and private sector providers, and (2) estimate age-specific screening and differences in rates by provider group during 2009. Results Among 833 providers, Title X providers were more likely than non-Title X public sector providers and private sector providers to serve a higher client volume, a higher proportion of clients aged ≤25 years, and a higher proportion of African American clients. Non-Title X public providers were more likely to be located in rural areas, compared with Title X grantees and private sector providers. Title X providers had the largest absolute difference in screening rates for young females vs. older females (10.9%). Unadjusted screening rates for young clients were lower among non-Title X public sector providers (54%) compared with private sector and Title X providers (64% each). After controlling for provider group, urban location, client volume, and percent African American, private sector providers had higher screening rates than Title X and non-Title X public providers. Conclusions Screening rates for females were higher among private providers compared with Title X and non-Title X public providers. However, only Title X providers were more likely to adhere to screening guidelines through high screening rates for young females and low screening rates for older females. PMID:22694761

The Content and Interactivity of Health Support Group Websites

ERIC Educational Resources Information Center

Harrison, Sandra; Barlow, Julie; Williams, Gareth

2007-01-01

Objective: To assess the online contents and interactivity provided by health support group (HSG) websites representing a range of chronic diseases. Design: Survey of 80 HSG websites. Method: A checklist of website content was developed rating the level of information and advice, interactivity and online support provided by each HSG website. Each…

76 FR 7836 - PJM Power Providers Group v. PJM Interconnection, L.L.C.; Notice of Complaint

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-11

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL11-20-000] PJM Power..., pursuant to section 206 of the Federal Power Act, and Rule 206 of the Federal Energy Regulatory Commission's (Commission) Rules of Practice and Procedure, 18 CFR 385.206, PJM Power Providers Group...

42 CFR 425.504 - Incorporating reporting requirements related to the Physician Quality Reporting System.

Code of Federal Regulations, 2012 CFR

2012-10-01

... under their ACO participant TIN as a group practice under the Physician Quality Reporting System Group... participant TIN, on behalf of its ACO supplier/provider participants who are eligible professionals, will... Physician Fee Schedule for that TIN. (4) ACO participant TINs and individual ACO providers/suppliers who are...

42 CFR 425.504 - Incorporating reporting requirements related to the Physician Quality Reporting System.

Code of Federal Regulations, 2013 CFR

2013-10-01

... under their ACO participant TIN as a group practice under the Physician Quality Reporting System Group... participant TIN, on behalf of its ACO supplier/provider participants who are eligible professionals, will... Physician Fee Schedule for that TIN. (4) ACO participant TINs and individual ACO providers/suppliers who are...

Multi-Disciplinary Peer-Mark Moderation of Group Work

ERIC Educational Resources Information Center

Willmot, Peter; Pond, Keith

2012-01-01

Self and peer assessment offers benefits for enhancing student learning. Peer moderation provides a convenient solution for awarding individual marks in group assignments. This paper provides a significant review of peer-mark moderation, and describes an award winning, web-based tool that was developed in the UK and is now spreading across the…

38 CFR 63.15 - Duties of, and standards applicable to, non-VA community-based providers.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Adequate meals must be provided in a setting that encourages social interaction; nutritious snacks between... group therapy, social skills training, self-help group meetings or peer counseling. (2) Professional... environment that promotes a lifestyle free of substance abuse. (2) The environment must be conducive to social...

38 CFR 63.15 - Duties of, and standards applicable to, non-VA community-based providers.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Adequate meals must be provided in a setting that encourages social interaction; nutritious snacks between... group therapy, social skills training, self-help group meetings or peer counseling. (2) Professional... environment that promotes a lifestyle free of substance abuse. (2) The environment must be conducive to social...

38 CFR 63.15 - Duties of, and standards applicable to, non-VA community-based providers.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Adequate meals must be provided in a setting that encourages social interaction; nutritious snacks between... group therapy, social skills training, self-help group meetings or peer counseling. (2) Professional... environment that promotes a lifestyle free of substance abuse. (2) The environment must be conducive to social...

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

Escher's Tessellations in Understanding Group Theory

ERIC Educational Resources Information Center

Konyalioglu, Serpil

2009-01-01

In this study, it is explained how to use Escher's tessellations in teaching group concept which is one of the most abstract concepts in mathematics. MC Escher's monohedral tessellations provide detailed study in an undergraduate course in abstract algebra. This study attempts to provide useful visual references for the students on learning some…

Improving Vocabulary and Pre-Literacy Skills of At-Risk Preschoolers through Teacher Professional Development

ERIC Educational Resources Information Center

Wasik, Barbara A.; Hindman, Annemarie H.

2011-01-01

In a randomized control study, Head Start teachers were assigned to either an intervention group that received intensive, ongoing professional development (PD) or to a comparison group that received the "business as usual" PD provided by Head Start. The PD intervention provided teachers with conceptual knowledge and instructional…

Defense.gov - Special Report: Haiti Earthquake Relief

Science.gov Websites

. Top Stories Medical Group Provides Assistance MANDRIN, Haiti, July 14, 2010 - Airmen with the 56th Medical Group provided optometry, dental and general services at the New Horizons medical site. Story assigned to Joint Task Force New Horizons have made major progress on their engineering and medical

Comparative satisfaction of receiving medical abortion service from nurses and auxiliary nurse-midwives or doctors in Nepal: results of a randomized trial.

PubMed

Tamang, Anand; Shah, Iqbal H; Shrestha, Pragya; Warriner, I K; Wang, Duolao; Thapa, Kusum; My Huong, N T; Meirik, Olav

2017-12-16

Early first-trimester medical abortion (MA) service (≤ 63 days) has been provided by doctors and nurses under doctors' supervision since 2009 in Nepal. This paper assesses whether MA services provided by specifically trained and certified nurses and auxiliary nurse-midwives independently from doctors' supervision, is considered as satisfactory by women as those provided by doctors. The data come from a multi-center, randomized, controlled equivalence trial conducted between April 2009 and March 2010 in five district hospitals in Nepal. Women seeking MA were randomly assigned to doctors or nurses and auxiliary nurse-midwives(ANMs).Eligible women were administered 200 mg mifepristone orally followed by 800 μg misoprostol vaginally two days later by their assigned providers and followed up 10-14 days later. At the follow-up visit women's reported satisfaction with MA service they received was measured. Of 1295 women screened for eligibility, 535 were randomly assigned to a doctor and 542 to a nurse or ANM. Nineteen women were lost-to-follow up in the former group and 27 were lost-to-follow up or did not complete the acceptability interview in the latter group. This study is, therefore, based on516womenin the doctor's group and 515 women in the nurse or ANM group. All women in the nurse or ANM group reported being satisfied or highly satisfied by MA compared to 99% in the doctor's group. Satisfaction was similar regardless of the type of provider; 38% among nurse or ANM and 35% among the doctor group were "highly satisfied", and 62% and 64%, respectively, were "satisfied". Women's experiences such as 'less than expected amount or duration of bleeding following MA', 'shorter than expected duration of the abortion process', and 'able to manage symptoms', were found to be associated with women's higher satisfaction with MA. Counseling and information on the method, potential complications of MA and post-abortion contraception was nearly universal. No statistically significant differences were found in the level of satisfaction by age, parity, marital status, education or occupation of women. Women's satisfaction with MA service provided by trained nurses or auxiliary nurse-midwives was similar to that provided by doctors. The findings, therefore, provide support for extending safe and accessible medical abortion services by government-trained nurses and auxiliary nurse midwives to women seeking early first trimester pregnancy termination. The trial was retrospectively registered with ClinicalTrials.gov (identifier: NCT01186302 ). Registered August 20, 2010.

An Analysis of the Effects of Communication Skills Training Provided to the Mothers of Six-Year-Old Children on the Social Skills of Children

ERIC Educational Resources Information Center

Erbay, Filiz; Arslan, Emel; Cagdas, Aysel

2011-01-01

This study aims to analyze the effects of communication skills training program provided to the mothers on the social skills of their children. The study uses pre- and post- tests control group design. Experiment and control groups consisted of a total of 30 six-year-old children who were enrolled in nursery school. Experiment group consisted of…

How to buy and sell a group practice.

PubMed

Groth, C D

1988-01-01

This article reviews the world of mergers, acquisitions and divestitures, providing guidelines for the group practice administrator who is in the position of considering a merger or sale. The importance of strategic planning is discussed, and a set of working tools for buying and selling a medical practice is provided, along with suggestions for ways for groups to compete with industrial health/clinic programs in the area of long-term growth/acquisition programs.

Cultural perceptions and clinical experiences of nursing students in Eastern Turkey.

PubMed

Karatay, G; Bowers, B; Karadağ, E B; Demir, M C

2016-12-01

This study explored Turkish nursing students' perceptions of providing care to patients culturally different from themselves. Increasing migration will increase the need for nurses to provide care across cultural groups. Twenty one students in the second year of a 4-year nursing programme participated in 3 focus groups. Data were analysed using directed content analysis. Research questions were based on Campinha-Bacote's model. Three themes were identified: perceived cultural barriers, perceived cultural facilitators and identifying culturally sensitive actions. Generally, students were able to define culture but were unable to say how culture would affect nursing practice. Students were unprepared to practice in a multicultural setting. Cultural awareness is insufficient for determining how to respond to cultural differences. The study is limited by its restriction to a single school of nursing and a single curriculum. The multiple, ongoing political, religious and ethnic conflicts will require nurses to provide care to patients from other cultural groups, in some instances to people identified as adversaries to the group the nurse may represent. Understanding cultural differences is insufficient to do this effectively. Learning culturally competent care requires opportunities to provide, be guided through and reflect on care to individuals from different cultural groups. Standards for culturally competent care should be adopted by all care delivery settings. Public and organizational policies openly declaring healthcare settings as cultural safe zones, and explicit organizational commitment to culturally safe care, would set clear expectations for providers and help ensure a positive patient experience. © 2016 International Council of Nurses.

Increasing children's physical activity levels during recess periods in elementary schools: the effects of providing game equipment.

PubMed

Verstraete, Stefanie J M; Cardon, Greet M; De Clercq, Dirk L R; De Bourdeaudhuij, Ilse M M

2006-08-01

During recess, children can be active on a daily basis, making it an important school environmental factor for the promotion of health-related physical activity. The aim of the present study was to investigate the effects of providing game equipment on children's physical activity levels during morning recess and lunch break in elementary schools. Seven elementary schools were randomly assigned to the intervention group (four schools), including 122 children (75 boys, 47 girls, mean age: 10.8 +/- 0.6 years), and to the control group (three schools), including 113 children (46 boys, 67 girls, mean age: 10.9 +/- 0.7 years). Children's activity levels were measured before and three months after providing game equipment, using MTI accelerometers. During lunch break, children's moderate and vigorous physical activity significantly increased in the intervention group (moderate: from 38 to 50%, vigorous: from 10 to 11%), while it decreased in the control group (moderate: from 44 to 39%, vigorous: from 11 to 5%). At morning recess, providing game equipment was effective in increasing children's moderate physical activity (from 41 to 45%), while it decreased in the control group (from 41 to 34%). Providing game equipment during recess periods was found to be effective in increasing children's physical activity levels. This finding suggests that promoting physical activity through game equipment provision during recess periods can contribute to reach the daily activity levels recommended for good health.

Factors Affecting Adherence to Osteoporosis Medications: A Focus Group Approach Examining Viewpoints of Patients and Providers

PubMed Central

Iversen, Maura D; Vora, Ruchita R; Servi, Amber; Solomon, Daniel H

2011-01-01

This is a qualitative study using a focus group approach, conducted to determine factors influencing adherence to osteoporosis medications among older adults. Thirty-two patients aged 65 to 85 years from the greater Boston area who were prescribed an osteoporosis medication, 11 general medicine physicians and 1 nurse practitioner were recruited from Boston based hospitals affiliated with a large healthcare system. Focus groups consisting of 6 to 8 subjects including males and females were held separately for providers and patients and conducted until thematic saturation was reached. Responses were obtained from patients and providers during the focus group interviews conducted by a trained focus group moderator. All interviews were audio taped and transcribed by a medical transcriptionist. According to patients, factors affecting adherence to osteoporosis drugs included lack of knowledge about osteoporosis, dissatisfaction with their doctor visits, side effects, and difficulty or failure to remember instructions for taking medications. Physicians reported lack of patient knowledge, structural barriers, medication side effects, and the inability to track patients’ adherence to their medications as barriers to adherence. This study identifies the extent of and reasons for non-adherence as perceived by patients and providers, and provides insights into strategies to modify treatment plans to address non-adherence. The results from this study were used to develop a RCT to conduct and evaluate patient and physician targeted interventions to improve adherence to osteoporosis medications and to examine cost effectiveness of alternative strategies. PMID:21937896

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2011 CFR

2011-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2012 CFR

2012-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2010 CFR

2010-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2014 CFR

2014-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2013 CFR

2013-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

A qualitative study of patient and provider perspectives on using web-based pain coping skills training to treat persistent cancer pain.

PubMed

Rini, Christine; Vu, Maihan B; Lerner, Hannah; Bloom, Catherine; Carda-Auten, Jessica; Wood, William A; Basch, Ethan M; Voorhees, Peter M; Reeder-Hayes, Katherine E; Keefe, Francis J

2018-04-01

Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care. Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data. Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care. Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.

Do two current canine parvovirus type 2 and 2b vaccines provide protection against the new type 2c variant?

PubMed

Larson, Laurie J; Schultz, R D

2008-01-01

Three groups (n=9 or 10) of 12-week-old canine parvovirus type 2 (CPV-2) antibody-negative puppies were vaccinated: one group with a product containing modified-live CPV-2b (Galaxy DA2PPv; Schering-Plough Animal Health), one group with a product containing modified-live CPV-2 (Continuum DAP, Intervet), and one group (controls) with sterile saline. All puppies receiving CPV-2 and CPV-2b vaccines developed antibody as determined by the hemagglutination inhibition assay. All groups of puppies were challenged with a combination of virulent CPV-2b and CPV-2c 5 weeks after vaccination. All puppies in the CPV-2 and CPV-2b vaccinated groups were protected from disease, whereas all control group puppies developed disease and 50% died or were euthanized. This study demonstrated that the CPV-2 and CPV-2b vaccine components of the Continuum DAP and Galaxy DA2PPv products, respectively, provided protection against the CPV-2b virus and also provided complete protection against the new CPV-2c variant.

Use of technology with health care providers: perspectives from urban youth.

PubMed

Lindstrom Johnson, Sarah; Tandon, S Darius; Trent, Maria; Jones, Vanya; Cheng, Tina L

2012-06-01

To evaluate urban youths' use of and access to technology and solicit their opinions about using technology with healthcare providers. Urban youth (aged 14-24 years) were invited to participate in focus groups in which a trained focus group facilitator used a survey and a structured guide to elicit responses regarding the foregoing objective. All sessions were audiotaped and transcribed. Emergent themes were determined with the assistance of Atlas TI. Survey data were analyzed in SPSS (SPSS Inc, Chicago, Illinois). Eight focus groups including 82 primarily low-income urban African-American adolescents and young adults (mean age, 18.5 years) were completed. The participants reported fairly high access to and use of technology. However, they expressed some concerns regarding the use of technology with healthcare providers. Many worried about the confidentiality of conversations conducted using technology. Face-to-face meetings with a healthcare provider were preferred by most participants, who felt that the information provided would be better tailored to their individual needs and more credible. Although urban youth were high users of technology, they expressed reservations about using technology with health care providers. When developing new technology communication and information dissemination strategies, it is critical to understand and address these concerns while involving young people in the research and development process. Copyright © 2012 Mosby, Inc. All rights reserved.

Patient-provider communication and low-income adults: age, race, literacy, and optimism predict communication satisfaction.

PubMed

Jensen, Jakob D; King, Andy J; Guntzviller, Lisa M; Davis, LaShara A

2010-04-01

To assess whether literacy, numeracy, and optimism are related to low-income adults' satisfaction with their healthcare provider's communication skills. Low-income adults (N=131) were recruited from seven counties in Indiana through University extension programs. To achieve research triangulation, participants were surveyed and interviewed about their communication satisfaction with health providers. Survey data revealed that four variables significantly predicted satisfaction: age, race, literacy, and optimism. Low-income adults in the current study were more critical of their healthcare provider's communication skills if they were younger, White, functionally literate, and pessimistic. Follow-up interviews confirmed this pattern and suggested it was a byproduct of patient activism. In low-income populations, communication satisfaction may be lower for groups that are traditionally active in doctor-patient interactions (e.g., younger patients, patients with higher literacy skills). Healthcare providers should be aware that older, non-White, optimistic, and literacy deficient patients report greater communication satisfaction than their younger, White, pessimistic, and functionally literate peers. Both groups may be coping with their situation, the former by withdrawing and the latter by actively pushing for a higher standard of care. Healthcare providers should continue to seek out ways to facilitate dialogue with these underserved groups. 2009 Elsevier Ireland Ltd. All rights reserved.

Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?

PubMed

McCalmont, Jean C; Jones, Kim D; Bennett, Robert M; Friend, Ronald

(1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations. A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training. The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9). Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.

Disaster response team FAST skills training with a portable ultrasound simulator compared to traditional training: pilot study.

PubMed

Paddock, Michael T; Bailitz, John; Horowitz, Russ; Khishfe, Basem; Cosby, Karen; Sergel, Michelle J

2015-03-01

Pre-hospital focused assessment with sonography in trauma (FAST) has been effectively used to improve patient care in multiple mass casualty events throughout the world. Although requisite FAST knowledge may now be learned remotely by disaster response team members, traditional live instructor and model hands-on FAST skills training remains logistically challenging. The objective of this pilot study was to compare the effectiveness of a novel portable ultrasound (US) simulator with traditional FAST skills training for a deployed mixed provider disaster response team. We randomized participants into one of three training groups stratified by provider role: Group A. Traditional Skills Training, Group B. US Simulator Skills Training, and Group C. Traditional Skills Training Plus US Simulator Skills Training. After skills training, we measured participants' FAST image acquisition and interpretation skills using a standardized direct observation tool (SDOT) with healthy models and review of FAST patient images. Pre- and post-course US and FAST knowledge were also assessed using a previously validated multiple-choice evaluation. We used the ANOVA procedure to determine the statistical significance of differences between the means of each group's skills scores. Paired sample t-tests were used to determine the statistical significance of pre- and post-course mean knowledge scores within groups. We enrolled 36 participants, 12 randomized to each training group. Randomization resulted in similar distribution of participants between training groups with respect to provider role, age, sex, and prior US training. For the FAST SDOT image acquisition and interpretation mean skills scores, there was no statistically significant difference between training groups. For US and FAST mean knowledge scores, there was a statistically significant improvement between pre- and post-course scores within each group, but again there was not a statistically significant difference between training groups. This pilot study of a deployed mixed-provider disaster response team suggests that a novel portable US simulator may provide equivalent skills training in comparison to traditional live instructor and model training. Further studies with a larger sample size and other measures of short- and long-term clinical performance are warranted.

A Summary of Taxonomies of Digital System Failure Modes Provided by the DigRel Task Group

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

Chu T. L.; Yue M.; Postma, W.

2012-06-25

Recently, the CSNI directed WGRisk to set up a task group called DIGREL to initiate a new task on developing a taxonomy of failure modes of digital components for the purposes of PSA. It is an important step towards standardized digital I&C reliability assessment techniques for PSA. The objective of this paper is to provide a comparison of the failure mode taxonomies provided by the participants. The failure modes are classified in terms of their levels of detail. Software and hardware failure modes are discussed separately.

Methods for immobilizing nucleic acids on a gel substrate

DOEpatents

Mirzabekov, Andrei Darievich; Proudnikov, Dimitri Y.; Timofeev, Edward N.; Kochetkova, Svetlana V.; Florentiev, Vladimir L.; Shick, Valentine V.

1999-01-01

A method for labeling oligonucleotide molecules, and for immobilizing oligonucleotide and DNA molecules is provided comprising modifying the molecules to create a chemically active group, and contacting activated fluorescent dyes to the region. A method for preparing an immobilization substrate is also provided comprising modifying a gel to contain desired functional groups which covalently interact with certain moieties of the oligonucleotide molecules. A method for immobilizing biomolecules and other molecules within a gel by copolymerization of allyl-substituted oligonucleotides, DNA and proteins with acrylamide is also provided.

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).

PubMed

Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

2014-07-08

To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Impact of a "No Mobile Device" Policy on Developmental Surveillance in a Pediatric Clinic.

PubMed

Regan, Paul A; Fogel, Benjamin S; Hicks, Steven D

2018-04-01

Children commonly use mobile devices at pediatric office visits. This practice may affect patient-provider interaction and undermine accuracy of developmental surveillance. A randomized, provider-blinded, controlled trial examined whether a policy prohibiting mobile device use in a pediatric clinic improved accuracy of pediatricians' developmental surveillance. Children, aged 18 to 36 months, were randomized to device-prohibited (intervention; n = 58) or device-allowed (control; n = 54) groups. After a 30-minute well-visit, development was evaluated as "normal," "borderline," or "delayed" in 5 categories using the Ages and Stages Questionnaire (ASQ-3). ASQ-3 results were compared with providers' clinical assessment in each category. Provider-ASQ discrepancies were more common for intervention participants ( P = .025). Providers "missed" more ASQ-3 "delayed" scores ( P = .005) in the intervention group, particularly in the fine motor domain ( P = .018). Prohibiting mobile device use at well-visits did not improve accuracy of providers' developmental surveillance. Mobile devices may entertain children at well-visits, allowing opportunities for parent-provider discussion, or observation of fine motor skills.

The anti-human trafficking collaboration model and serving victims: Providers' perspectives on the impact and experience.

PubMed

Kim, Hea-Won; Park, Taekyung; Quiring, Stephanie; Barrett, Diana

2018-01-01

A coalition model is often used to serve victims of human trafficking but little is known about whether the model is adequately meeting the needs of the victims. The purpose of this study was to examine anti-human trafficking collaboration model in terms of its impact and the collaborative experience, including challenges and lessons learned from the service providers' perspective. Mixed methods study was conducted to evaluate the impact of a citywide anti-trafficking coalition model from the providers' perspectives. Web-based survey was administered with service providers (n = 32) and focus groups were conducted with Core Group members (n = 10). Providers reported the coalition model has made important impacts in the community by increasing coordination among the key agencies, law enforcement, and service providers and improving quality of service provision. Providers identified the improved and expanded partnerships among coalition members as the key contributing factor to the success of the coalition model. Several key strategies were suggested to improve the coalition model: improved referral tracking, key partner and protocol development, and information sharing.

Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials.

PubMed

Barnato, Amber E; Moore, Robert; Moore, Charity G; Kohatsu, Neal D; Sudore, Rebecca L

2017-07-01

Medicaid populations have low rates of advance care planning (ACP). Potential policy interventions include financial incentives. To test the effectiveness of patient plus provider financial incentive compared with provider financial incentive alone for increasing ACP discussions among Medicaid patients. Between April 2014 and July 2015, we conducted two sequential assessor-blinded pragmatic randomized trials in a health plan that pays primary care providers (PCPs) $100 to discuss ACP: 1) a parallel cluster trial (provider-delivered patient incentive) and 2) an individual-level trial (mail-delivered patient incentive). Control and intervention arms included encouragement to complete ACP, instructions for using an online ACP tool, and (in the intervention arm) $50 for completing the online ACP tool and a small probability of $1000 (i.e., lottery) for discussing ACP with their PCP. The primary outcome was provider-reported ACP discussion within three months. In the provider-delivered patient incentive study, 38 PCPs were randomized to the intervention (n = 18) or control (n = 20) and given 10 patient packets each to distribute. Using an intention-to-treat analysis, there were 27 of 180 ACP discussions (15%) in the intervention group and 5 of 200 (2.5%) in the control group (P = .0391). In the mail-delivered patient incentive study, there were 5 of 187 ACP discussions (2.7%) in the intervention group and 5 of 189 (2.6%) in the control group (P = .99). ACP rates were low despite an existing provider financial incentive. Adding a provider-delivered patient financial incentive, but not a mail-delivered patient incentive, modestly increased ACP discussions. PCP encouragement combined with a patient incentive may be more powerful than either encouragement or incentive alone. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The relationship between primary healthcare providers and their external supervisors in Rwanda.

PubMed

Schriver, Michael; Cubaka, Vincent K; Nyirazinyoye, Laetitia; Itangishaka, Sylvere; Kallestrup, Per

2017-11-01

External supervision of Rwandan primary healthcare facilities unfolds as an interaction between supervisors and healthcare providers. Their relationship has not been thoroughly studied in Rwanda, and rarely in Africa. To explore perceived characteristics and effects of the relationship between providers in public primary healthcare facilities and their external supervisors in Rwanda. We conducted three focus group discussions with primary healthcare providers (n = 16), three with external supervisors (n = 15) and one mixed (n = 5). Focus groups were facilitated under low-moderator involvement. Findings were extracted thematically and discussed with participating and non-participating providers and supervisors. While external supervision is intended as a source of motivation and professional development in addition to its managerial purpose, it appeared linked to excessive evaluation anxiety among Rwandan primary healthcare providers. Supervisors related this mainly to inescapable evaluations within performance-based financing, whereas providers additionally related it to communication problems. External supervision appeared driven by systematic performance evaluations, which may prompt a strongly asymmetric supervisory power relation and challenge intentions to explore providers' experienced work problems. There is a risk that this may harm provider motivation, calling for careful attention to factors that influence the supervisory relationship. It is a dilemma that providers most in need of supervision to improve performance may be most unlikely to benefit from it. This study reveals a need for provider-oriented supportive supervision including constructive attention on providers who have performance difficulties, effective relationship building and communication, objective and diligent evaluation and two-way feedback channels.

Provider perceptions of reproductive health service quality in jordanian public community health centers.

PubMed

Al-Qutob, Raeda; Nasir, Laeth S

2008-05-01

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

Correlates of HPV vaccine initiation and provider recommendation among male adolescents, 2014 NIS-Teen.

PubMed

Landis, Kathryn; Bednarczyk, Robert A; Gaydos, Laura M

2018-05-08

Vaccination is a safe and effective way to prevent Human Papillomavirus (HPV) infection and related cancers; however, HPV vaccine uptake remains low in the US. After the 2011 Advisory Committee on Immunization Practices (ACIP) recommendation for routine HPV vaccination of adolescent males, several studies have examined predictors for initiating the vaccine series in this population of interest, particularly with regard to provider recommendations. This study examined racial and ethnic differences for HPV vaccine initiation and provider recommendation in male adolescents. Based on prior HPV vaccine uptake estimates and healthcare utilization data, we hypothesized that minority adolescents would be more likely to initiate HPV vaccines, but less likely to receive a provider recommendation compared to white counterparts. We analyzed the 2014 National Immunization Survey-Teen (NIS-Teen), which included 10,753 male adolescents with provider-verified vaccination data in 50 US states, using multivariate logistic regression models to evaluate racial/ethnic differences in HPV vaccine initiation and provider recommendation. The odds of HPV vaccine initiation were 76 percent higher for Hispanic adolescents and 43 percent higher for non-Hispanic Other or Multiple race adolescents compared to white adolescents. Approximately half of parents reported receiving a provider recommendation for vaccination, with no significant difference in the odds of receiving a provider recommendation across racial/ethnic groups. Despite similar frequency of recommendations across racial and ethnic groups, male adolescents who are racial/ethnic minorities are more likely to initiate vaccination. Future research should focus on developing tailored interventions to increase HPV vaccine receipt among males of all racial/ethnic groups. Copyright © 2018 Elsevier Ltd. All rights reserved.

Training South African Mental Health Care Providers to Talk About Sex in the Era of AIDS

PubMed Central

Collins, Pamela Y.; Mestry, Kezziah; Wainberg, Milton L.; Nzama, Thobile; Lindegger, Graham

2009-01-01

Objective Mental health care providers in South Africa often lack the skills to conduct effective prevention activities in psychiatric settings. This article describes the development and evaluation of an HIV education program for mental health care providers at three psychiatric institutions in South Africa. Methods The research team worked with a core group of 16 mental health care providers to assess HIV training needs and to develop a training intervention focused on identified issues. The training intervention was administered to three groups (42 total) during three 1.5-day workshops. Providers completed pre- and postintervention assessments that measured knowledge and attitudes about HIV and AIDS. Results Data analysis revealed a significant increase in reported levels of comfort with HIV care (d=.54), perceived knowledge of HIV (d=1.17), and factual knowledge (d=.74). Conclusions This contextually relevant HIV education curriculum changed providers’ attitudes and knowledge, demonstrated the feasibility of administering the training program, and provided a foundation for further prevention activities. PMID:17085615

A Multimodal Mindfulness Training to Address Mental Health Symptoms in Providers Who Care for and Interact With Children in Relation to End-of-Life Care.

PubMed

O'Mahony, Sean; Gerhart, James; Abrams, Ira; Greene, Michelle; McFadden, Rory; Tamizuddin, Sara; Levy, Mitchell M

2017-11-01

Medical providers may face unique emotional challenges when confronted with the suffering of chronically ill, dying, and bereaved children. This study assessed the preliminary outcomes of participation in a group-based multimodal mindfulness training pilot designed to reduce symptoms of burnout and mental health symptoms in providers who interact with children in the context of end-of-life care. A total of 13 medical providers who care for children facing life-threatening illness or bereaved children participated in a 9-session multimodal mindfulness session. Mental health symptoms and burnout were assessed prior to the program, at the program midpoint, and at the conclusion of the program. Participation in the pilot was associated with significant reductions in depressive and posttraumatic stress disorder (PTSD) symptoms among providers ( P < .05). Mindfulness-based programs may help providers recognize and address symptoms of depression and PTSD. Additional research is needed to enhance access and uptake of programming among larger groups of participants.

Do group-specific equations provide the best estimates of stature?

PubMed

Albanese, John; Osley, Stephanie E; Tuck, Andrew

2016-04-01

An estimate of stature can be used by a forensic anthropologist with the preliminary identification of an unknown individual when human skeletal remains are recovered. Fordisc is a computer application that can be used to estimate stature; like many other methods it requires the user to assign an unknown individual to a specific group defined by sex, race/ancestry, and century of birth before an equation is applied. The assumption is that a group-specific equation controls for group differences and should provide the best results most often. In this paper we assess the utility and benefits of using group-specific equations to estimate stature using Fordisc. Using the maximum length of the humerus and the maximum length of the femur from individuals with documented stature, we address the question: Do sex-, race/ancestry- and century-specific stature equations provide the best results when estimating stature? The data for our sample of 19th Century White males (n=28) were entered into Fordisc and stature was estimated using 22 different equation options for a total of 616 trials: 19th and 20th Century Black males, 19th and 20th Century Black females, 19th and 20th Century White females, 19th and 20th Century White males, 19th and 20th Century any, and 20th Century Hispanic males. The equations were assessed for utility in any one case (how many times the estimated range bracketed the documented stature) and in aggregate using 1-way ANOVA and other approaches. This group-specific equation that should have provided the best results was outperformed by several other equations for both the femur and humerus. These results suggest that group-specific equations do not provide better results for estimating stature while at the same time are more difficult to apply because an unknown must be allocated to a given group before stature can be estimated. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Participant Roles in Bullying: How Can Peer Bystanders Be Utilized in Interventions?

ERIC Educational Resources Information Center

Salmivalli, Christina

2014-01-01

This article provides a view of school bullying as a group phenomenon and practical implications stemming from this approach. The motivation for bullying perpetration often relates to one's social standing in the group. Peer bystanders are typically present when bullying takes place, often providing the perpetrators with social rewards. The…

Emotional Literacy Support Assistants' Views on Supervision Provided by Educational Psychologists: What EPs Can Learn from Group Supervision

ERIC Educational Resources Information Center

Osborne, Cara; Burton, Sheila

2014-01-01

The Educational Psychology Service in this study has responsibility for providing group supervision to Emotional Literacy Support Assistants (ELSAs) working in schools. To date, little research has examined this type of inter-professional supervision arrangement. The current study used a questionnaire to examine ELSAs' views on the supervision…

A New Group-Formation Method for Student Projects

ERIC Educational Resources Information Center

Borges, Jose; Dias, Teresa Galvao; Cunha, Joao Falcao E.

2009-01-01

In BSc/MSc engineering programmes at Faculty of Engineering of the University of Porto (FEUP), the need to provide students with teamwork experiences close to a real world environment was identified as an important issue. A new group-formation method that aims to provide an enriching teamwork experience is proposed. Students are asked to answer a…

Marketing medical services to an aging America.

PubMed

Mast, L J

1993-01-01

Consumers over age 50 currently comprise 40 percent of consumer demand. Medical services provided in the group practice setting must be structured to accommodate the unique needs of their increasing number of elderly patients According to this professional paper, the development of a marketing plan will provide a strategy that will keep the medical group competitive among older consumers.

49 CFR 214.353 - Training and qualification of roadway workers who provide on-track safety for roadway work groups.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RAILROAD WORKPLACE SAFETY Roadway Worker Protection § 214.353 Training and qualification of roadway workers... workers who provide for the on-track safety of groups of roadway workers through establishment of working...) All the on-track safety training and qualification required of the roadway workers to be supervised...

75 FR 2856 - Atlantic Highly Migratory Species; Advisory Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-19

... of a group from which individuals will be selected to review and/or provide the data and analyses and... section. The SEDAR Pool will be a group from which individuals will be selected to review and/ or provide..., each of the 18 constituent states, both the U.S. Virgin Islands and Puerto Rico, and each of the...

The Scripps Research Institute (La Jolla, CA)

DOEpatents

Schultz, Peter G.; Wang, Lei

2010-01-05

The invention provides proteins attached to solid supports, and methods of preparing such solid support-bound proteins are provided. The proteins are attached to solid supports by means of an unnatural amino acid incorporated into the protein, which unnatural amino acid includes a reactive group that can react with a second reactive group that is attached to a solid support.

Transition, Retraining, and Change for Entry. Final Report from July 1, 1983 - August 31, 1984.

ERIC Educational Resources Information Center

VanderLugt, Marilyn J.

Goals of the "Transition, Retraining, and Change for Entry" project were to provide counseling and/or group support for single heads of households or persons entering nontraditional employment and to provide placement services for the target group. A third goal was to disseminate information about the value of and opportunities in…

The Campbell Collaboration Crime and Justice Group: Early Development and Progress

ERIC Educational Resources Information Center

Petrosino, Anthony; Farrington, David P.; Sherman, Lawrence W.

2003-01-01

The Campbell Collaboration Crime and Justice Group was inaugurated in 2000 to prepare, update, and disseminate systematic reviews on what works to reduce crime or improve justice. After providing a brief description of a systematic review and the origins of the Campbell Collaboration, this paper provides an overview of the first 36 months of the…

Tongue Measures in Individuals with Normal and Impaired Swallowing

ERIC Educational Resources Information Center

Stierwalt, Julie A. G.; Youmans, Scott R.

2007-01-01

Purpose: This investigation sought to add to the extant literature on measures of normal tongue function, to provide information on measures of tongue function in a group of individuals with oral phase dysphagia, and to provide a comparison of these 2 groups matched for age and gender. Method: The Iowa Oral Performance Instrument was utilized to…

From Credit to Collective Action: The Role of Microfinance in Promoting Women's Social Capital and Normative Influence

ERIC Educational Resources Information Center

Sanyal, Paromita

2009-01-01

Can economic ties positively influence social relations and actions? If so, how does this influence operate? Microfinance programs, which provide credit through a group-based lending strategy, provide the ideal setting for exploring these questions. This article examines whether structuring socially isolated women into peer-groups for an…

12 CFR 571.27 - Renewal of opt-out.

Code of Federal Regulations, 2010 CFR

2010-01-01

... period. Each opt-out renewal must be effective for a period of at least five years as provided in § 571... (ii) As part of a joint renewal notice from two or more members of an affiliated group of companies... provided by multiple companies with the ABC name or multiple companies in the ABC group or family of...

Teaching Large Groups the Tennis Serve: Optimizing Practice Opportunities and Providing Individual Feedback

ERIC Educational Resources Information Center

Hume, Donald

2018-01-01

This article describes a progressive methodology for teaching the tennis serve to large groups with a focus on optimizing practice opportunities and providing individual feedback to players. Specifically, it delineates teaching the serve to 24 players on two courts. The methodology can be adapted for more players and/or more courts as appropriate,…

Focus Group Evaluation of Customized Family Health History Education Materials in a North Carolina Community

ERIC Educational Resources Information Center

Powell, Karen; Edelson, Vaughn; O'Leary, James; Christianson, Carol; Henrich, Vincent

2011-01-01

The "Does It Run In The Family?" booklets provide educational materials about family health history (FHH) and basic genetics to readers of all levels and are customizable for local communities. Purpose: The booklets were customized and provided to focus groups to evaluate their usefulness in conveying health information at a low reading…

76 FR 45248 - PJM Interconnection, L.L.C., PJM Power Providers Group v. PJM Interconnection, L.L.C...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

...-002; Docket No. EL11-20-001] PJM Interconnection, L.L.C., PJM Power Providers Group v. PJM Interconnection, L.L.C.; Supplemental Notice of Staff Technical Conference On June 13, 2011, the Commission issued... Resources Services, Inc., Maryland Public Service Commission, Monitoring Analytics, L.L.C., National Rural...

The Development and Application of Distance Learning Courses on the Internet.

ERIC Educational Resources Information Center

Fuks, Hugo; Gerosa, Marco Aurelio; Lucena, Carlos Jose Pereira de

2002-01-01

Presents the methodology, results, and difficulties encountered in the development and delivery of a course through the Internet at a university in Rio de Janeiro. Provides a model for group work, including group discussions; and shows how a Web-based environment can be used to provide support and to facilitate cooperative learning. (Author/LRW)

Teaching clinical interviewing skills using role-playing: conveying empathy to performing a suicide assessment: a primer for individual role-playing and scripted group role-playing.

PubMed

Shea, Shawn Christopher; Barney, Christine

2015-03-01

This article provides a useful introduction to the art of role-playing in both the individual format and the group format using scripted group role-playing (SGRP). Role-playing can provide powerful learning opportunities, but to do so it must be done well. This article imparts guidance toward this goal. SGRP may greatly enhance the acquisition of critical complex interviewing skills, such as suicide assessment and uncovering domestic violence, in health care providers across all disciplines, an educational goal that has not been achievable to date. Although research is at an early stage of development, the hope represented by SGRP is tangible. Copyright © 2015 Elsevier Inc. All rights reserved.

Assessing Trauma Care Provider Judgement in the Prediction of Need for Life-saving Interventions

DTIC Science & Technology

2015-01-13

suggest that agreement among groups of clinicians is far less dependable. The overall patterns of agreement among provider groups in our study are not...Gabbe BJ, Cameron P, Victorian State Trauma Outcomes Registry and Monitoring Group (VSTORM). Is paramedic judgement useful in prehospital trauma triage...2007;63:1338–46. [13] Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV. Patterns of errors contributing to trauma mortality: lessons learned from

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.

PubMed

Samuel, Cleo A; Turner, Kea; Donovan, Heidi A S; Beckjord, Ellen; Cardy, Alexandra; Dew, Mary Amanda; van Londen, G J

2017-12-01

Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.

Mental health and selection of preferred providers. Experience in three employee groups.

PubMed

Wells, K B; Marquis, M S; Hosek, S D

1991-09-01

While Preferred Provider Organizations (PPOs) are designed to contain the costs of health care, they may not be able to do so if sicker individuals opt not to use PPO providers. This study examined how level of mental health status and prior use of mental health services affected the decision to use or not use PPO providers for mental health care for employees enrolled in fee-for-service plans with a PPO option. Data were obtained from an employee survey and claims data on three large employee groups. It was not possible to examine effects of sickliness on the intent to select PPO providers for mental health care directly because about one half of employees could not identify who they would visit for mental health care or even how they would select a provider for such care. The intent to use PPO or non-PPO providers for general medical care, however, was not significantly associated with mental health status when other factors were controlled. Furthermore, among persons who used mental health services after implementation of the PPO option, those who had previously visited providers who were to become part of the PPO panel tended to stay with PPO providers, while those who previously visited providers who were not to enter the PPO panel subsequently selected away from PPO providers for mental health care. This pattern of results suggests that established individual patient-provider relationships, rather than sickliness, determined the selection of PPO versus non-PPO providers for mental health care for employees enrolled in these optional PPO fee-for-service plans.

Community Clinicians and the Veterans Choice Program for PTSD Care: Understanding Provider Interest During Early Implementation.

PubMed

Finley, Erin P; Noël, Polly H; Mader, Michael; Haro, Elizabeth; Bernardy, Nancy; Rosen, Craig S; Bollinger, Mary; Garcia, Hector; Sherrieb, Kathleen; Pugh, Mary Jo V

2017-07-01

In 2014, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program (VCP) to provide reimbursement for community-based care to eligible veterans. Inadequate networks of participating providers may impact the utility of VCP for veterans with posttraumatic stress disorder (PTSD), a complex condition occurring at lower frequency among civilians. To compare characteristics and attitudes of community-based primary care and mental health providers reporting interest or no interest in VCP participation during early implementation; and to examine perceptions and experiences of VCP among "early adopters." Cross-sectional surveys with 2 samples: a stratified random sample of mental health and primary care prescribers and psychotherapists drawn from state licensing boards (Community Sample); and a stratified random sample of prescribers and psychotherapists identified as VCP-authorized providers (VCP-Authorized). Five hundred fifty-three respondents in the Community Sample and 115 in the VCP-Authorized (total, n=668; 21.1% response). Surveys assessed provider and practice characteristics, attitudes to VA and VCP, and experiences and satisfaction with the VCP; an open-ended survey item assessed providers' reasons for interest or lack of interest in VCP participation. Few providers reported VCP participation during this period. Interest in VCP participation was associated across provider groups with factors including being a veteran and receiving VA reimbursement; currently providing treatment for PTSD was associated with interest in VCP participation among psychotherapists, but not prescribers. Developing networks of VCP providers to serve Veterans with PTSD is likely to require targeting more receptive provider groups, reducing barriers to participation, and more effectively communicating the value of VCP participation to providers.

The importance of social identities in the management of and recovery from 'Diabulimia': A qualitative exploration.

PubMed

Hastings, Amy; McNamara, Niamh; Allan, Jacqueline; Marriott, Mike

2016-12-01

A significant barrier to recovery for individuals with co-morbid eating disorders and type 1 diabetes is the way in which group members self-categorise. Nonetheless, identity issues are neglected during the recovery process. The aim of this paper is to explore how group memberships (and the associated identities) both contribute to and hinder recovery in this cohort. Transcripts from five online focus groups with 13 members of an online support group for individuals with 'Diabulimia' were thematically analysed. Findings suggested that those with whom one shares a recovery identity can be well placed to provide psychological resources necessary for successful recovery although such connections can be damaging if group norms are not managed. Members recognised that other important relationships (including family and friends and health professionals) are also key to recovery; these other group memberships (and the associated identities) can be facilitated through the recovery identity group membership, which allows for external validation of the recovery identity, provides encouragement to disclose the illness to supportive others, and provides information to facilitate positive service interactions. While clinical interventions typically focus on eliminating disordered behaviours, we suggest that these should also include strengthening important group memberships that promote recovery.

Effect of Skin Cancer Training Provided to Maritime High School Students on Their Knowledge and Behaviour.

PubMed

Sümen, Adem; Öncel, Selma

2015-01-01

This study was conducted with the purpose of evaluating the effect of skin cancer training provided to maritime high school students on their knowledge and behaviour. The study had a quasi-experimental design with pre-test and post-test intervention and control groups. Two maritime high schools located in the city of Antalya were included within the scope of the study between March and June 2013, covering a total of 567 students. While the knowledge mean scores of students regarding skin cancer and sun protection did not vary in the pre-test (6.2 ± 1.9) and post-test (6.8 ± 1.9) control group, the knowledge mean scores of students in the experimental group increased from 6.0 ± 2.3 to 10.6 ± 1.2 after the provided training. Some 25.4% of students in the experimental group had low knowledge level and 62.2% had medium knowledge level in the pre-test; whereas no students had low knowledge level and 94.3% had high knowledge level in the post-test. It was determined that tenth grade students, those who had previous knowledge on the subject, who considered themselves to be protecting from the sun better, had higher knowledge levels and their knowledge levels increased as the risk level increased. It was found that the provided training was effective and increased positively the knowledge, attitude and behaviour levels of students in the experimental group in terms of skin cancer and sun protection. Along with the provided training which started to form a lifestyle, appropriate attitudes and behaviours concerning skin cancer and sun protection could be brought to students who will work in outdoor spaces and are members of the maritime profession within the risk group.

The clinical implications of legalizing marijuana: Are physician and non-physician providers prepared?

PubMed

Brooks, Elizabeth; Gundersen, Doris C; Flynn, Erin; Brooks-Russell, Ashley; Bull, Sheana

2017-09-01

Passage of voter-driven marijuana reform laws signals a shift in public attitudes for marijuana use. For providers, legalization may necessitate practice modifications, particularly regarding patient-provider conversations about use and risk. We examined healthcare providers' knowledge of marijuana laws and health implications, professional practice behaviors, and attitudes about training. We surveyed 114 Colorado-based providers who care for children, adolescents, pregnant and breastfeeding women using a Venue-Day-Time survey methodology throughout Colorado. The survey captured providers' (e.g., physicians, nurses, medical assistants) knowledge of state marijuana laws, risk perceptions, counseling practices, and continued training needs. Providers were knowledgeable about marijuana laws, cautious supporting legalization, and perceived moderate to high risks, particularly for certain groups. About 50% of providers working with adolescents and pregnant or breastfeeding women assessed marijuana use "every" or "most" visits; 23% of those working with children reported such behavior. Conversations about specific risks varied between groups. Few providers felt completely knowledgeable about marijuana health risks and lacked confidence talking to patients about this issue. Providers frequently assess patients' marijuana use; however, they are uncomfortable and inconsistent talking to patients about specific marijuana health effects. Additional education is warranted, particularly as it relates to talking to patients about the danger of second hand smoke exposure, underage use, safe storage, and the over-consumption of edibles. Copyright © 2017 Elsevier Ltd. All rights reserved.

24 CFR 214.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., with established curriculum and instructional goals provided in a group or classroom setting, covering... state legislature empowered to finance activities designed to provide housing and related facilities...

Lesson 6: Registration

EPA Pesticide Factsheets

Lesson 6 provides CROMERR checklist items grouped under the Registration Process, where users establish their accounts in the system. This process typically requires users to provide information about them.

Does ear endoscopy provide advantages in the outpatient management of open mastoidectomy cavities?

PubMed

Freire, Gustavo Subtil Magalhães; Sampaio, Andre Luiz Lopes; Lopes, Rafaela Aquino Fernandes; Nakanishi, Márcio; de Oliveira, Carlos Augusto Costa Pires

2018-01-01

To evaluate the use of ear endoscopy in the postoperative management of open mastoidectomy cavities, and to test whether ear endoscopy improves inspection and cleaning compared with ear microscopy. Prospective study. Thirty-two ears were divided into two groups: group 1, examination and cleaning of mastoid cavities under endoscopic visualization after microscopic standard ear cleaning; group 2, examination and cleaning of mastoid cavities under microscopic visualization after endoscope-assisted ear cleaning. We assessed the ability of each method to provide exposure and facilitate cleaning, comparing the benefits of microscopy and endoscopy when used sequentially and vice-versa. Endoscopy provided additional benefits for exposure in 61.1% of cases and cleaning in 66.7%. Microscopy provided no additional benefits in terms of exposure in any case, and provided added benefit for cleaning in only 21.4% of cases. For outpatient postoperative care of open mastoidectomy cavities, ear endoscopy provides greater benefit over ear microscopy than vice-versa. In over half of all cases, endoscopy was able to expose areas not visualized under the microscope. Furthermore, in two-thirds of cases, endoscopy enabled removal of material that could not be cleared under microscopy. Ear endoscopy was superior to microscopy in terms of enabling exposure and cleaning of hard-to-reach sites, due to its wider field of vision. Ear endoscopy is a feasible technique for the postoperative management of open mastoidectomy cavities. Ear endoscopy provided superior advantages in terms of exposure and aural cleaning compared with microscopy.

Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs.

PubMed

Rosen, Amy K; Loveland, Susan A; Rakovski, Carter C; Christiansen, Cindy L; Berlowitz, Dan R

2003-01-01

Although case-mix adjustment is critical for provider profiling, little is known regarding whether different case-mix measures affect assessments of provider efficiency. We examine whether two case-mix measures, Adjusted Clinical Groups (ACGs) and Diagnostic Cost Groups (DCGs), result in different assessments of efficiency across service networks within the Department of Veterans Affairs (VA). Three profiling indicators examine variation in resource use. Although results from the ACGs and DCGs generally agree on which networks have greater or lesser efficiency than average, assessments of individual network efficiency vary depending upon the case-mix measure used. This suggests that caution should be used so that providers are not misclassified based on reported efficiency.

Instrumental and perceptual evaluations of two related singers.

PubMed

Buder, Eugene H; Wolf, Teresa

2003-06-01

The primary goal of this study was to characterize a performer's singing and speaking voice. One woman was not admitted to a premier choral group, but her sister, who was comparable in physical characteristics and background, was admitted and provided a valuable control subject. The perceptual judgment of a vocal coach who conducted the group's auditions was decisive in discriminating these 2 singers. The singer not admitted to the group described a history of voice pathology, lacked a functional head register, and spoke with a voice characterized by hoarseness. Multiple listener judgments and acoustic and aerodynamic evaluations of both singers provided a more systematic basis for determining: 1) the phonatory basis for this judgment; 2) whether similar judgments would be made by groups of vocal coaches and speech-language pathologists; and 3) whether the type of tasks (e.g., sung vs. spoken) would influence these judgments. Statistically significant differences were observed between the ratings of vocal health provided by two different groups of listeners. Significant interactions were also observed as a function of the types of voice samples heard by these listeners. Instrumental analyses provided evidence that, in comparison to her sister, the rejected singer had a compromised vocal range, glottal insufficiencies as assessed aerodynamically and electroglottographically, and impaired acoustic quality, especially in her speaking voice.

The effects of simulated patients and simulated gynecologic models on student anxiety in providing IUD services.

PubMed

Khadivzadeh, Talat; Erfanian, Fatemeh

2012-10-01

Midwifery students experience high levels of stress during their initial clinical practices. Addressing the learner's source of anxiety and discomfort can ease the learning experience and lead to better outcomes. The aim of this study was to find out the effect of a simulation-based course, using simulated patients and simulated gynecologic models on student anxiety and comfort while practicing to provide intrauterine device (IUD) services. Fifty-six eligible midwifery students were randomly allocated into simulation-based and traditional training groups. They participated in a 12-hour workshop in providing IUD services. The simulation group was trained through an educational program including simulated gynecologic models and simulated patients. The students in both groups then practiced IUD consultation and insertion with real patients in the clinic. The students' anxiety in IUD insertion was assessed using the "Spielberger anxiety test" and the "comfort in providing IUD services" questionnaire. There were significant differences between students in 2 aspects of anxiety including state (P < 0.001) and trait (P = 0.024) and the level of comfort (P = 0.000) in providing IUD services in simulation and traditional groups. "Fear of uterine perforation during insertion" was the most important cause of students' anxiety in providing IUD services, which was reported by 74.34% of students. Simulated patients and simulated gynecologic models are effective in optimizing students' anxiety levels when practicing to deliver IUD services. Therefore, it is recommended that simulated patients and simulated gynecologic models be used before engaging students in real clinical practice.

Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.

PubMed

Berendes, Sima; Heywood, Peter; Oliver, Sandy; Garner, Paul

2011-04-01

In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases.

Improving adoption and acceptability of digital health interventions for HIV disease management: a qualitative study.

PubMed

Claborn, Kasey R; Meier, Ellen; Miller, Mary Beth; Leavens, Eleanor L; Brett, Emma I; Leffingwell, Thad

2018-03-01

Disease management remains a challenge for many people living with HIV (PLWH). Digital health interventions (DHIs) may assist with overcoming these challenges and reducing burdens on clinical staff; however, there is limited data regarding methods to improve uptake and acceptability of DHIs among PLWH. This qualitative study aimed to assess patient and provider perspectives on the use of DHIs and strategies to promote uptake among PLWH. Eight focus groups with patients (k = 5 groups; n = 24) and providers (k = 3 groups; n = 12) were conducted May through October of 2014. Focus groups (~90 min) followed a semi-structured interview guide. Data were analyzed using thematic analysis on three main themes: (a) perspectives towards the adoption and use of DHIs for HIV management; (b) perceptions of barriers and facilitators to patient usage; and (c) preferences regarding content, structure, and delivery. Analyses highlighted barriers and facilitators to DHI adoption. Patients and providers agreed that DHIs feel "impersonal" and "lack empathy," may be more effective for certain subpopulations, should be administered in the clinic setting, and should use multimodal delivery methods. Emergent themes among the providers included development of DHIs for providers as the target market and the need for culturally adapted DHIs for patient subpopulations. DHIs have potential to improve HIV management and health outcomes. DHIs should be developed in conjunction with anticipated consumers, including patients, providers, and other key stakeholders. DHIs tailored for specific HIV subpopulations are needed. Future studies should evaluate dissemination methods and marketing strategies to promote uptake.

Calcium requirements from dairy foods in France can be met at low energy and monetary cost.

PubMed

Drewnowski, Adam; Tang, Wesley; Brazeilles, Rémi

2015-12-14

Inadequate Ca intakes are a concern for global public health. In France, most dietary Ca is provided by dairy products: milks, fermented milks (mostly yogurts), dairy desserts and cheeses. The present dairy database (n 837) included milks (n 101), fermented milks, yogurts and other fresh dairy products (n 326), desserts (n 162) and a wide variety of cheeses (n 248). Energy and nutrient values were obtained from industry sources and the French national nutrient composition database. Retail prices were from Paris supermarkets. Products in each group were aggregated into twenty-one categories using clustering analyses. The costs in energy (kJ (kcal)), euros (€), and in SFA, added sugar and Na (defined here as nutrients to LIMit) associated with providing 120 mg of Ca (equivalent to 15 % daily value (15 % DV)) were calculated for each product group and category. The milk group supplied Ca at the lowest energy, monetary and LIM cost. Fresh plain and 'light' yogurts and fermented milks were next, followed by sweetened yogurts and flavoured milks. Light dairy desserts provided Ca with relatively few energy but were more expensive. Cheeses were a heterogeneous group. Hard cheeses (Comté) provided the most Ca per serving. Semi-hard cheeses (Camembert) and cream and blue cheeses (Roquefort) provided Ca at a cost comparable with sweetened yogurts and flavoured milks. Double cream, soft and goat cheeses were not optimal Ca sources. New value metrics can help identify affordable dairy foods that provide Ca without excessive energy or nutrients to limit. These conditions were satisfied by a wide variety of dairy products in France.

26 CFR 54.9801-5 - Evidence of creditable coverage.

Code of Federal Regulations, 2011 CFR

2011-04-01

... reasonable and prompt fashion, can provide the certificate. A certificate is required to be provided under... the plan, acting in a reasonable and prompt fashion, can provide certificates. (ii) Conclusion. In... Secretary to establish rules designed to prevent an individual's subsequent coverage under a group health...

42 CFR 422.205 - Provider antidiscrimination rules.

Code of Federal Regulations, 2010 CFR

2010-10-01

... an MA organization declines to include a given provider or group of providers in its network, it must... or for different practitioners in the same specialty. (3) Implementation of measures designed to maintain quality and control costs consistent with its responsibilities. [65 FR 40324, June 29, 2000] ...

Group interventions for patients with cancer and HIV disease: part IV. Clinical and policy recommendations.

PubMed

Leszcz, Molyn; Sherman, Allen; Mosier, Julie; Burlingame, Gary M; Cleary, Trish; Ulman, Kathleen Hubbs; Simonton, Stephanie; Latif, Umaira; Strauss, Bernhard; Hazelton, Lara

2004-10-01

Group interventions have assumed a growing role in primary prevention and supportive care for cancer and HIV disease. Earlier sections of this Special Report examined empirical findings for these interventions and provided recommendations for future research. The current section offers brief recommendations for service providers, policymakers, and stakeholders. Group services now occupy an increasingly prominent place in primary prevention programs and medical settings. In previous sections of this Special Report (Sherman, Leszcz et al., 2004; Sherman, Mosier et al., 2004a, 2004b) we examined the efficacy of different group interventions at different phases of cancer or HIV disease, considered characteristics of the intervention and the participants that might influence outcomes, and discussed mechanisms of action. Methodological challenges and priorities for future research were highlighted. In this, the final section, we offer brief recommendations for service providers, policymakers, and other stakeholders. We consider some of the barriers that constrain use of empirically-based group interventions and note how these programs might be implemented more widely and effectively.

The Effect of NEXRAD Image Looping and National Convective Weather Forecast Product on Pilot Decision Making in the Use of a Cockpit Weather Information Display

NASA Technical Reports Server (NTRS)

Burgess, Malcolm A.; Thomas, Rickey P.

2004-01-01

This experiment investigated improvements to cockpit weather displays to better support the hazardous weather avoidance decision-making of general aviation pilots. Forty-eight general aviation pilots were divided into three equal groups and presented with a simulated flight scenario involving embedded convective activity. The control group had access to conventional sources of pre-flight and in-flight weather products. The two treatment groups were provided with a weather display that presented NEXRAD mosaic images, graphic depiction of METARs, and text METARs. One treatment group used a NEXRAD image looping feature and the second group used the National Convective Weather Forecast (NCWF) product overlaid on the NEXRAD display. Both of the treatment displays provided a significant increase in situation awareness but, they provided incomplete information required to deal with hazardous convective weather conditions, and would require substantial pilot training to permit their safe and effective use.

Small group experience for socially withdrawn girls.

PubMed

Houck, Gail M; Stember, Lisa

2002-08-01

Social competence is the effectiveness of social interaction behavior. Given its link to mental health outcomes, it is an important consideration in child and adolescent development. Social withdrawal is associated with depression. Socially withdrawn children make few social initiations and tend to be isolated in their play, further limiting their social involvement. To develop effective social behavior, experiences must be provided to learn relationship skills. This practice improvement project provided a small group experience for five socially withdrawn school-age girls. Weekly group meetings provided a social situation in which conversations could occur around a shared snack and craft project. The school nurse facilitated self-assertion and the expression of prosocial behavior in a socially safe (nonrejecting) environment and promoted social problem solving. On completion of the program, the participants not only showed more effective social reasoning and social skills, but developed friendships with each other that lasted beyond the life of the group.

The faces of breastfeeding support: Experiences of mothers seeking breastfeeding support online.

PubMed

Bridges, Nicole

2016-03-01

The aim of this study was to advance understanding of the experiences of mothers using closed Facebook groups attached to the Australian Breastfeeding Association (ABA) and how these mothers find and share breastfeeding support and information using this forum. The study involved members of three closed Facebook groups that were chosen as interesting cases for study, based on the volume and nature of their posts. Members of these three groups then participated in online depth interviews and online semi-structured focus groups. The overarching theme identified was support, with four sub-themes that describe the nature of online breastfeeding support within the Facebook environment. These sub-themes are: community, complementary, immediate and information. It was found that social networking sites (SNSs) provide support from the trusted community. It is immediate, it complements existing support or services that ABA provides and also provides practical and valuable information for its users.

MAGNETIC RECORDING HEAD

DOEpatents

Merrill, L.C.

1958-06-17

An electromagetic recording head is described for simultaneous recording of a plurality of signals within a small space on a magnetically semsitized medium. Basically the head structure comprises a non-magnetic centerpiece provided with only first and second groups of spaced cut-out slots respectively on opposite sides of the centerpiece. The two groups of slots are in parallel alignment and the slots of one group are staggered with respect to the slots of the other group so that one slot is not directly opposite another slot. Each slot has a magnet pole piece disposed therein and cooperating with a second pole and coil to provide a magnetic flux gap at the upper end of the slot. As a tape is drawn over the upper end of the centerpiece the individual magnetic circuits are disposed along its width to provide means for simultaneously recording information on separate portions, tracks. of the tape.

Control groups in recent septic shock trials: a systematic review.

PubMed

Pettilä, Ville; Hjortrup, Peter Buhl; Jakob, Stephan M; Wilkman, Erika; Perner, Anders; Takala, Jukka

2016-12-01

The interpretation of septic shock trial data is profoundly affected by patients, control intervention, co-interventions and selected outcome measures. We evaluated the reporting of control groups in recent septic shock trials. We searched for original articles presenting randomized clinical trials (RCTs) in adult septic shock patients from 2006 to 2016. We included RCTs focusing on septic shock patients with at least two parallel groups and at least 50 patients in the control group. We selected and evaluated data items regarding patients, control group characteristics, and mortality outcomes, and calculated a data completeness score to provide an overall view of quality of reporting. A total of 24 RCTs were included (mean n = 287 patients and 71 % of eligible patients were randomized). Of the 24 studies, 14 (58 %) presented baseline data on vasopressors and 58 % the proportion of patients with elevated lactate values. Five studies (21 %) provided data to estimate the proportion of septic shock patients fulfilling the Sepsis-3 definition. The mean data completeness score was 19 out of 36 (range 8-32). Of 18 predefined control group characteristics, a mean of 8 (range 2-17) were reported. Only 2 (8 %) trials provided adequate data to confirm that their control group treatment represented usual care. Recent trials in septic shock provide inadequate data on the control group treatment and hemodynamic values. We propose a standardized trial dataset to be created and validated, comprising characteristics of patient population, interventions administered, hemodynamic values achieved, surrogate organ dysfunction, and mortality outcomes, to allow better analysis and interpretation of future trial results.

Bed rest and activity restriction for women at risk for preterm birth: a survey of Canadian prenatal care providers.

PubMed

Sprague, Ann E; O'Brien, Beverley; Newburn-Cook, Christine; Heaman, Maureen; Nimrod, Carl

2008-04-01

To explore the practices of Canadian obstetricians, family physicians, and midwives in recommending bed rest or activity restriction for women at risk for preterm birth (PTB) and to assess the decisional conflict experienced by care providers when they recommend these therapies. A self-administered mail survey of prenatal care providers was carried out using Dillman's Tailored Design Method. Analysis included descriptive statistics and analysis of variance. The survey was distributed to 1441 potential participants; of these, 1172 were eligible participants, and 516 (44.2%) completed the survey. For women at risk of PTB, 60 of 170 obstetricians (35%), 88 of 206 family practitioners (42.7%), and 30 of 140 midwives (21.4%) recommended bed rest in hospital; 110 of 170 obstetricians (64.7%), 144 of 206 family practitioners (69.9%), and 73 of 140 midwives (52.1%) recommended bed rest at home. These recommendations occurred despite the response from about two thirds of each professional group that the effectiveness of bed rest was in the fair-to-poor range in helping to prevent PTB. The mean score on the Provider Decision Process Assessment Instrument, measuring decisional conflict for all care provider groups, was 30 (SD 7.4) (possible score range 12-60). There were no significant differences in decisional conflict scores among provider groups (F [2,347] = 2.24; P = 0.11). Care providers have been discouraged from routinely recommending bed rest for women at risk of PTB because of potential adverse side effects. This study demonstrates that most Canadian prenatal care providers have not been persuaded to incorporate these recommendations into practice. Except for women with multiple gestation, there is inconsistent practice in recommending bed rest and activity restriction. Additionally, Canadian prenatal care providers have some decisional conflict about using this therapy. These results provide some of the first Canadian perspectives on the practice of prescribing therapeutic bed rest for PTB.

Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities

PubMed Central

Kim, Bo; Lucatorto, Michelle A; Hawthorne, Kara; Hersh, Janis; Myers, Raquel; Elwy, A Rani; Graham, Glenn D

2015-01-01

Care coordination between the specialty care provider (SCP) and the primary care provider (PCP) is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1) what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2) how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively) to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts. PMID:25653538

Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities.

PubMed

Kim, Bo; Lucatorto, Michelle A; Hawthorne, Kara; Hersh, Janis; Myers, Raquel; Elwy, A Rani; Graham, Glenn D

2015-01-01

Care coordination between the specialty care provider (SCP) and the primary care provider (PCP) is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1) what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2) how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively) to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts.

iMuseumA: an agent-based context-aware intelligent museum system.

PubMed

Ayala, Inmaculada; Amor, Mercedes; Pinto, Mónica; Fuentes, Lidia; Gámez, Nadia

2014-11-10

Currently, museums provide their visitors with interactive tour guide applications that can be installed in mobile devices and provide timely tailor-made multimedia information about exhibits on display. In this paper, we argue that mobile devices not only could provide help to visitors, but also to museum staff. Our goal is to integrate, within the same system, multimedia tour guides with the management facilities required by museums. In this paper, we present iMuseumA (intelligent museum with agents), a mobile-based solution to customize visits and perform context-aware management tasks. iMuseumA follows an agent-based approach, which makes it possible to interact easily with the museum environment and make decisions based on its current status. This system is currently deployed in the Museum of Informatics at the Informatics School of the University of Málaga, and its main contributions are: (i) a mobile application that provides management facilities to museum staff by means of sensing and processing environmental data; (ii) providing an integrated solution for visitors, tour guides and museum staff that allows coordination and communication enrichment among different groups of users; (iii) using and benefiting from group communication for heterogeneous groups of users that can be created on demand.

Dental care providers' and patients' perceptions of the effect of health information technology in the dental care setting.

PubMed

Asan, Onur; Ye, Zhan; Acharya, Amit

2013-09-01

The use of electronic health records (EHRs) in dental care and their effect on dental care provider-patient interaction have not been studied sufficiently. The authors conducted a study to explore dental care providers' interactions with EHRs during patient visits, how these interactions influence dental care provider-patient communication, and the providers' and patients' perception of EHR use in the dental clinic setting during patient visits. The authors collected survey and interview data from patients and providers at three dental clinics in a health care system. The authors used qualitative and quantitative methods to analyze data obtained from patients and dental care providers. The provider survey results showed significant differences in perceptions of EHR use in patient visits across dental care provider groups (dentists, dental hygienists and dental assistants). Patient survey results indicated that some patients experienced a certain level of frustration and distraction because of providers' use of EHRs during the visit. The provider survey results indicated that there are different perceptions across provider groups about EHRs and the effect of computer use on communication with patients. Dental assistants generally reported more negative effects on communication with patients owing to computer use. Interview results also indicated that dental care providers may not feel comfortable interacting with the EHR without having any verbal or eye contact with patients during the patient's dental visit. A new design for dental operatories and locations of computer screens within the operatories should be undertaken to prevent negative nonverbal communication such as loss of eye contact or forcing the provider and patient to sit back to back, as well as to enhance patient education and information sharing.

42 CFR 423.2268 - Standards for Part D marketing.

Code of Federal Regulations, 2011 CFR

2011-10-01

... groups or pharmacies contract. The use of publicly available comparison information is permitted if... all Medicare beneficiaries. (n) Display the names and/or logos of co-branded network providers on the... names and/or logos of provider co-branding partners must clearly indicate that other providers are...

42 CFR 423.2268 - Standards for Part D marketing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... groups or pharmacies contract. The use of publicly available comparison information is permitted if... all Medicare beneficiaries. (n) Display the names and/or logos of co-branded network providers on the... names and/or logos of provider co-branding partners must clearly indicate that other providers are...

42 CFR 423.2268 - Standards for Part D marketing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... groups or pharmacies contract. The use of publicly available comparison information is permitted if... all Medicare beneficiaries. (n) Display the names and/or logos of co-branded network providers on the... names and/or logos of provider co-branding partners must clearly indicate that other providers are...

42 CFR 423.2268 - Standards for Part D marketing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... groups or pharmacies contract. The use of publicly available comparison information is permitted if... all Medicare beneficiaries. (n) Display the names and/or logos of co-branded network providers on the... names and/or logos of provider co-branding partners must clearly indicate that other providers are...

Comparison study of postdischarge care provided to suicide patients by family members in East and South Taiwan.

PubMed

Sun, Fan-Ko; Ko, Chen-Ju; Chang, Shing-Ling; Chiang, Chun-Ying

2012-03-01

Care provided by the families of those who have attempted suicide affects their healing and recovery process. Data on care provided by families to suicidal individuals in different areas of Taiwan are extremely limited. This study explored care provided by families living in eastern and southern Taiwan to relatives admitted to hospitals and subsequently discharged after a suicide attempt. The study used a grounded theory approach. Interviews were conducted in two distinct geographical areas in 3 years and included two sample groups. Group 1 comprised suicidal participants (n = 15) and family caregivers (n = 15) in East Taiwan. Group 2 comprised suicidal participants (n = 15) and family caregivers (n = 15) in South Taiwan. Data were analyzed using open, axial, and selective coding. The East Taiwan group was less prosperous than the South Taiwan group. Suicide attempt methods were more lethal in eastern than in southern Taiwan. Alcohol and family violence were more important factors in suicides in eastern than in southern Taiwan. Consequently, families in East Taiwan focused less on protecting the safety of suicidal family members than families in South Taiwan. Participants in East Taiwan received less support from their families than those in South Taiwan. CONCLUSIONS/IMPLICATION FOR PRACTICE: Suicidal participants in East Taiwan received less care from family caregivers than did participants in South Taiwan. However, all families require education to provide optimal care for suicidal relatives. Study results may help promote more appropriate education for clinical nursing professionals with a responsibility to care for suicidal patients.

Leukemia Support Groups: How Are They Doing?

PubMed

Moss

1997-10-01

BACKGROUND: Support groups help their participants to cope with the emotional and practical impact of their illnesses. METHODS: The effectiveness of the Leukemia Society of America support groups in enhancing the quality of life for their participants is reviewed. The groundwork, purpose, and structure of such groups, as well as alternate sources of support, are presented. Evaluation and future directions for oncology groupwork are discussed. RESULTS: Support groups complement the therapies provided by clinical practitioners and scientists by addressing the additional needs of cancer patients over the course of illness and survival. CONCLUSIONS: New concepts and methods that address the needs of specific age-groups and incorporate the newly generated data on cancer treatments will further enhance the benefits provided by support groups.

Using Sociograms to Enhance Power and Voice in Focus Groups.

PubMed

Baiardi, Janet M; Gultekin, Laura; Brush, Barbara L

2015-01-01

To discuss the use of sociograms in our focus groups with homeless sheltered mothers and to assess facilitator influence and the distribution of power influence. An exploratory, descriptive qualitative design that utilizes both focus groups and sociograms. Two focus groups were conducted in December 2009 (N = 7) and January 2010 (N = 4). Data analysis included a content analysis and a process analysis using sociograms to graphically represent group participant dynamics. Use of the sociogram provided a means to assess the influence of the facilitator as well as quantify the degree to which group participants' voices are included. Using sociograms provides a viable mechanism to complement content analysis and increase the methodological rigor of focus groups in health care research. © 2015 Wiley Periodicals, Inc.

Building the Hot Intra-Group Medium in Spiral-Rich Compact Groups

NASA Astrophysics Data System (ADS)

O'Sullivan, Ewan

2014-11-01

Galaxy groups provide a natural laboratory for investigating the formation of the hot intergalactic medium (IGM). While galaxy clusters gain most of their hot gas through accretion and gravitational shocks, in groups the processes of galaxy evolution (stripping, collisions, star formation) play an important role in the initial build up of the hot halo. We present Chandra and XMM-Newton observations of groups still in the process of forming their IGM, including the well known compact groups HCG 16 and Stephan's Quintet (HCG 92). We show that starburst winds and shock-heating of stripped HI provide important contributions of gas and metals to the IGM, and discuss the impact of gas stripping, enhanced star formation and nuclear activity in the group member galaxies.

Financial reporting.

PubMed

Bachrach, D J; Farrell, N L

1985-01-01

"How are we doing?" Financial reports must provide the answer to this all-important question for every medical group. Although there are some key differences between academic practices and private group practices, good financial reports and statements of activity are essential in all situations. Examples are provided here of how financial information can be communicated to the several organizational levels that need the information, as well as how financial planning, measurement, and control are part of this communication process. Sample formats outline the important ingredients for making your group's reports more useful.

Purine Inhibitors Of Protein Kinases, G Proteins And Polymerases

DOEpatents

Gray, Nathanael S. , Schultz, Peter , Kim, Sung-Hou , Meijer, Laurent

2003-09-09

The invention provides compounds having the structure: ##STR1## where, R.sup.1 is a member selected from the group consisting of H and NH.sub.2 ; R.sup.2 is member selected from the group consisting of H, CO.sub.2 H, OH and halogen; and R.sup.3 is a member selected from the group consisting of CO.sub.2 H, NH.sub.2 and halogen. Also provided are methods of using the compounds and formulations containing the compounds.

THE NON-GROUP SUBSCRIBER—A BLUE SHIELD PROBLEM

PubMed Central

Heyd, Charles Gordon

1951-01-01

The basis of prepaid voluntary medical insurance is to provide adequate medical service with the most inexpensive premium rate that is actuarially sound. This has been accomplished up to date by group enrollment. However, this does not provide for enrollment of a large number of insurable persons who are not members of groups. Experience with nongroup subscribers to United Medical Service, New York, is discussed and suggestions are made for simple, inexpensive means of enrollment and premium payments. PMID:14848725

Patient perspectives on disparities in healthcare from African-American, Asian, Hispanic, and Native American samples including a secondary analysis of the Institute of Medicine focus group data.

PubMed

Gaston-Johansson, Fannie; Hill-Briggs, Felicia; Oguntomilade, Lola; Bradley, Vanessa; Mason, Phyllis

2007-12-01

The existence of racial and ethnic disparities in healthcare in the United States is well recognized. However, often overlooked in the planning and design of initiatives to address those disparities are the patient perspectives regarding the issues of racial and ethnic disparities that directly affect them. The objective of this study was to identify the patient priorities and to provide recommendations for action to improve minority health-care quality. A secondary objective was the qualitative analysis of the Institute of Medicine (IOM) focus group data. Six focus groups were conducted with nine participants in each. These included an African-American focus group in Washington, D.C., an African-American focus group in Los Angeles, an Asian focus group in Los Angeles, an Hispanic focus group in Washington, D.C., an Hispanic focus group in Los Angeles, and a Native American focus group in Albuquerque, NM. The barriers and priorities for action included difficulty in making informed choices when identifying and selecting providers, poor service delivery from medical office staff, the inefficiency of medical visits, provider communication and cultural competence barriers, and stressful treatment settings. Patient recommendations targeted provision of tools to empower patients throughout the process of care, provider and staff training in communication and cultural competence, alternate models of service delivery, and accessible mechanisms for evaluation and oversight. This study concluded that patient-identified priorities and recommendations warranted modification of current explanatory models for minority health-care quality and the provision of greater clarity regarding directions for policy and behavioral initiatives and criteria for performance evaluation be advanced.

Bridging the Research-to-Practice Gap in Education: A Software-Mediated Approach for Improving Classroom Instruction

ERIC Educational Resources Information Center

Weston, Mark E.; Bain, Alan

2015-01-01

This study reports findings from a matched-comparison, repeated-measure for intact groups design of the mediating effect of a suite of software on the quality of classroom instruction provided to students by teachers. The quality of instruction provided by teachers in the treatment and control groups was documented via observations that were…

The Regeneration of Group Selection Openings in Southern Indiana

Treesearch

Dale R. Weigel

1994-01-01

The group selection method combines some of the advantages of even-aged silvicultural methods with those of uneven-aged methods. The method maintains a fairly continuous tree canopy, which provides a more natural appearance to the forest than does any even-aged method. By creating small canopy openings, it also provides the light necessary for the growth of species...

Recommendations to the U.S. Forest Service: Alternative Transportation at El Yunque National Forest Provided by the Interagency Transportation Assistance Group (TAG) Rio Grande, Puerto Rico October 15-19, 2007.

DOT National Transportation Integrated Search

2007-10-15

At the request of the U.S. Department of Agriculture Forest Service (USFS), an inter-agency Transportation Assistance Group (TAG) site review of the status of planning and the options for providing alternative transportation at the El Yunque National...

76 FR 46793 - PJM Interconnection, L.L.C.; PJM Power Providers Group v. PJM Interconnection, L.L.C.; Notice...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-03

...-002; Docket No. EL11-20-001] PJM Interconnection, L.L.C.; PJM Power Providers Group v. PJM Interconnection, L.L.C.; Notice Establishing Post-Technical Comment Period As indicated in the June 29, 2011... issues related to PJM Interconnection, L.L.C. (PJM)'s Minimum Offer Price Rule (MOPR) and resources...

Further Evidence for the Efficacy of an Evidence-Based, Small Group, Literacy Intervention Program for Young Struggling Readers

ERIC Educational Resources Information Center

Wheldall, Kevin; Wheldall, Robyn; Madelaine, Alison; Reynolds, Meree; Arakelian, Sarah

2017-01-01

An earlier series of pilot studies and small-scale experimental studies had previously provided some evidence for the efficacy of a small group early literacy intervention program for young struggling readers. The present paper provides further evidence for efficacy based on a much larger sample of young, socially disadvantaged, at-risk readers.…

Slavic Americans: A Comparative and Critical Analysis of Leading Reference Sources.

ERIC Educational Resources Information Center

Wertsman, Vladimir F.

2002-01-01

Examines how Slavic American groups are treated in a variety of reference sources and what should be done in the future to provide more complete and accurate information to interested researchers. A table compares the 10 reference sources (excluding the U.S. Census) with respect to the information they provide on the 20 Slavic American groups. (SM)

Equity Groups in Total VET Students and Courses 2014: Australian Vocational Education and Training Statistics

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2015

2015-01-01

This publication provides summary information on equity groups in vocational education and training (VET) delivered by 4601 Australian providers in 2014, under the first collection of "total VET activity" data. In 2014, there were: (1) 146,500 Indigenous students (3.7% of all students); (2) 201,000 students with a disability (5.1% of all…

Antiabortion violence in the United States.

PubMed

Russo, Jennefer A; Schumacher, Kristin L; Creinin, Mitchell D

2012-11-01

This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning. We used responses from a July 2010 survey of 357 abortion providers in 50 states to determine their experience of antiabortion harassment and violence. Their responses were grouped and analyzed in relation to a published grading of state laws in the United States (A, B, C, D and F) as they relate to restrictions on family planning services. Group by group comparison of respondents illustrates that the difference in the number of reported incidents of minor vandalism by group is statistically significant (A vs. C, p=.07; A vs. D, p=.017; A vs. F, p=.0002). Incidents of harassment follow a similar pattern. There were no differences noted overall for violence or major vandalism. Major violence, including eight murders, is a new occurrence in the last two decades. Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence. Copyright © 2012 Elsevier Inc. All rights reserved.

Telemedicine Support Groups for Home Parenteral Nutrition Users.

PubMed

Nelson, Eve-Lynn; Yadrich, Donna Macan; Thompson, Noreen; Wright, Shawna; Stone, Kathaleen; Adams, Natasia; Werkowitch, Marilyn; Smith, Carol E

2017-12-01

Patients receiving home parenteral nutrition (HPN), a life-sustaining intravenous (IV) infusion that provides nourishment and hydration to patients with short gut or inflammatory bowel diseases, are often isolated and not in visual contact with peers or health providers. One completed clinical trial (Clinical Trials.gov NCT0190028) and 1 ongoing clinical trial (Clinical Trials.gov NCT02987569) are evaluating a mobile videoconferencing-delivered support group intervention for patients on HPN and their caregivers. This home-based telemedicine intervention uses encrypted tablet-based videoconferencing to connect multiple families in real time. The twice-daily IV regimen is challenging for patients who may experience infusion catheter-related bloodstream infections, difficulties with fatigue, loss of sleep, depressive disorders, and worry over the potential life-threatening side effects and the expenses of this therapy. Using secure telemedicine, the facilitated support group intervention aims to enhance HPN home care, daily functioning, and quality of life. The authors provide the rationale for the telemedicine approach with HPN users and caregivers. They provide "how-to" information about the content and process of the facilitated support group sessions via secure videoconferencing. They share lessons learned from the ongoing evaluation of the telemedicine approach.

Overview of the H.264/AVC video coding standard

NASA Astrophysics Data System (ADS)

Luthra, Ajay; Topiwala, Pankaj N.

2003-11-01

H.264/MPEG-4 AVC is the latest coding standard jointly developed by the Video Coding Experts Group (VCEG) of ITU-T and Moving Picture Experts Group (MPEG) of ISO/IEC. It uses state of the art coding tools and provides enhanced coding efficiency for a wide range of applications including video telephony, video conferencing, TV, storage (DVD and/or hard disk based), streaming video, digital video creation, digital cinema and others. In this paper an overview of this standard is provided. Some comparisons with the existing standards, MPEG-2 and MPEG-4 Part 2, are also provided.

Providing straw to allow exploratory behaviour in a pig experimental system does not modify putative indicators of positive welfare: peripheral oxytocin and serotonin.

PubMed

Marcet Rius, M; Cozzi, A; Bienboire-Frosini, C; Teruel, E; Chabaud, C; Monneret, P; Leclercq, J; Lafont-Lecuelle, C; Pageat, P

2018-01-22

Numerous studies have shown that providing straw to pigs can reduce undesirable behaviours such as aggression, tail biting and stereotypy. The measurement of various neuromodulators can be helpful in assessing the development of positive behaviours and overall animal welfare. The oxytocin release is frequently linked to positive emotions and positive welfare. It has been suggested that oxytocin modulates the serotoninergic system. This study aims to investigate the potential effect of straw provision in pigs on peripheral levels of oxytocin and serotonin. In total, 18 mini-pigs were involved in an exploratory study conducted in two parallel groups, Enriched (n=10) and Control (n=8) groups. Pigs were divided by group and housed in pens of two individuals. Straw was provided continuously only in Enriched group and renewed each day for 2 weeks. Two blood samples were drawn from each animal 5 to 10 min before providing the straw, and 15 min after providing straw, during the 1st week, to analyse peripheral changes in oxytocin and serotonin before and after straw provision, and determine the existence of a putative short-term effect. The same procedure was carried out for Control group, without straw provision. Long-term effects of straw provision were also examined using blood samples drawn at the same hour from each animal in the 2nd and 3rd weeks. During this time, animals had the permanent possibility to explore the straw in Enriched group but not in Control group. At the end of each week, one animal-keeper completed two visual analogue scales for each mini-pig regarding the difficulty/ease to work with and handle it and its trust in humans. Results showed peripheral oxytocin increases in both groups after 2 weeks (P=0.02). Results did not demonstrate any effect of providing straw to allow exploratory behaviour on peripheral serotonin. Other results were not significant. This preliminary study explored the relationship between peripheral oxytocin and serotonin and the presence of straw that allow pigs to perform exploratory behaviour, suggesting that there was no relationship between them. Some future studies may include crossing oxytocin and serotonin with other parameters, such as behavioural measures, to obtain more information about the true state of the animal and any possible relationship with pig welfare.

The use of an online support group for neuromuscular disorders: a thematic analysis of message postings.

PubMed

Meade, Oonagh; Buchanan, Heather; Coulson, Neil

2017-06-08

People affected by neuromuscular disorders can experience adverse psychosocial consequences and difficulties accessing information and support. Online support groups provide new opportunities for peer support. The aim of this study was to understand how contributors used the message board function of a newly available neuromuscular disorders online support group. Message postings (n = 1951) from the first five months of the message board of a newly formed online support group for neuromuscular disorders hosted by a charitable organization were analyzed using inductive thematic analysis. Members created a sense of community through disclosing personal information, connecting with people with similar illness experiences or interests, welcoming others and sharing aspirations for the development of a resourceful community. Experiences, emotional reactions and support were shared in relation to: delayed diagnosis; symptom interpretation; illness management and progression; the isolating impact of rare disorders; and the influence of social and political factors on illness experiences. This study provided a novel insight into individuals' experiences of accessing a newly available online support group for rare conditions hosted by a charitable organization. The findings highlight how the online support group provided an important peer support environment for members to connect with others, exchange information and support and engender discussion on political and social issues unique to living with often-rare neuromuscular disorders. Online support groups may therefore provide an important and easily accessible support outlet for people with neuromuscular disorders as well as a platform for empowering members to raise awareness about the impact of living with these conditions. Further research is needed to examine member motivations for using such groups and any effects of participation in greater detail. Implications for rehabilitation Online support groups may provide a unique forum for information sharing and peer support between people affected by often rare, neuromuscular conditions. Rehabilitation professionals may wish to signpost those affected by neuromuscular disorders to such groups. An advantage is that these groups are freely available and can be accessed from anywhere and at any time. Members may be able to learn about the diagnosis and symptom experiences of others, discuss coping strategies, validate illness experiences and discuss social and political issues relating to living with these conditions. Further research is needed before researchers and clinicians can fully understand participants' motivations for, and experiences of, using such groups and any potential psychosocial benefits.

Perspectives of Somali Bantu refugee women living with circumcision in the United States: a focus group approach.

PubMed

Upvall, Michele J; Mohammed, Khadra; Dodge, Pamela D

2009-03-01

The purpose of this study was to explore healthcare perspectives of Somali Bantu refugees in relation to their status as women who have been circumcised and recently resettled in the United States. These women and their families were already uprooted from Somalia to Kenya for over 10 years, increasing their vulnerability and marginal status beyond that of women who have been circumcised. A purposive, inclusive sample of 23 resettled Somali women in southwestern Pennsylvania of the United States participated in focus group sessions for data collection. A supplemental interview with a physician who provided care to the women was also conducted. Verbatim audio taped transcripts from the focus groups and physician interview were coded into primary and secondary levels. Implications for development of culturally competent healthcare providers include attention to providing explanations for routine clinic procedures and accepting the Somali women regardless of anatomical difference, not focusing on the circumcision. Healthcare providers must also develop their skills in working with interpreters and facilitate trust to minimize suspicion of the health care system. Circumcision is considered a normal part of everyday life for the Somali Bantu refugee woman. Communication skills are fundamental to providing culturally competent care for these women. Finally, healthcare providers must take responsibility for acquiring knowledge of the Somali women's challenges as refugees living with circumcision and as immigrants in need of healthcare services.

Influence of Language and Culture in the Primary Care of Spanish-Speaking Latino Adults with Poorly Controlled Diabetes: A Qualitative Study.

PubMed

Zamudio, Cindy D; Sanchez, Gabriela; Altschuler, Andrea; Grant, Richard W

2017-01-01

We examined the role of language and culture in the interactions between Spanish-speaking Latino patients with poorly controlled diabetes - a fast-growing population in the United States - and their primary care providers. We conducted four focus groups with 36 non-US born Spanish-speaking patients with elevated HbA1c. Participants were insured health plan members with either English-speaking (2 groups) or Spanish-speaking (2 groups) primary care providers. Moderated discussions focused on visit preparation, communication during visit, and role of other care team members. Key themes derived from these discussions were then linked to corresponding Latino cultural constructs. Patients had a mean age of 57.9 (±11.2) years and last measured HbA1c was 8.6% (1.5%). Two communication-related themes (reluctance to switch providers and use of intermediaries) and two visit-related themes (provider-driven visit agendas and problem-based visits) emerged from our analyses. These themes reflected the cultural constructs of confianza (trust), familismo (family), respeto (deference), and simpatía (harmonious relationship). Trust in the patient-provider relationship led many participants to remain with English-speaking providers who treated them well. Patients with either language concordant and discordant providers reported reliance on family or other intermediaries to close communication gaps. Deference to physician expertise and authority led to visit expectations that it is the doctor's job to know what to ask and that visits were intended to address specific, often symptom-driven problems. Spanish-speaking Latino patients' cultural expectations play an important role in framing their primary care interactions. Recognizing culturally influenced visit expectations is an important step toward improving patient-provider communication.

Capturing the superorganism: a formal theory of group adaptation.

PubMed

Gardner, A; Grafen, A

2009-04-01

Adaptation is conventionally regarded as occurring at the level of the individual organism. However, in recent years there has been a revival of interest in the possibility for group adaptations and superorganisms. Here, we provide the first formal theory of group adaptation. In particular: (1) we clarify the distinction between group selection and group adaptation, framing the former in terms of gene frequency change and the latter in terms of optimization; (2) we capture the superorganism in the form of a 'group as maximizing agent' analogy that links an optimization program to a model of a group-structured population; (3) we demonstrate that between-group selection can lead to group adaptation, but only in rather special circumstances; (4) we provide formal support for the view that between-group selection is the best definition for 'group selection'; and (5) we reveal that mechanisms of conflict resolution such as policing cannot be regarded as group adaptations.

UMTRA project list of reportable occurrences

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

Not Available

1994-04-01

This UMTRA Project List of Reportable occurrences is provided to facilitate efficient categorization of reportable occurrences. These guidelines have been established in compliance with DOE minimum reporting requirements under DOE Order 5000.3B. Occurrences are arranged into nine groups relating to US Department of Energy (DOE) Uranium Mill Tailings Remedial Action (UMTRA) Project operations for active sites. These nine groupings are provided for reference to determined whether an occurrence meets reporting requirement criteria in accordance with the minimum reporting requirements. Event groups and significance categories that cannot or will not occur, and that do not apply to UMTRA Project operations, aremore » omitted. Occurrence categorization shall be as follows: Group 1. Facility Condition; Group 2. Environmental; Group 3. Personnel Safety; Group 4. Personnel Radiation Protection; Group 5. Safeguards and Security; Group 6. Transportation; Group 7. Value Basis Reporting; Group 8. Facility Status; and Group 9. Cross-Category Items.« less

Research on Logistics Service Providers Selection Based on AHP and VIKOR

NASA Astrophysics Data System (ADS)

Shan, Lu

The logistics service providers supply a kind of service which is a service product, thus there is a plenty of uncertainty and fuzzy in selecting logistics service providers. AHP is first used to calculate the weights of logistics services providers evaluations and then VIKOR method developed for multi-criteria optimization determining a compromise solution is applied to select the logistics services providers. The latter method provides a maximum "group utility" for the "majority" and minimum of an individual regret for the "opponent". This decision making process of logistics services providers selection is verified to be scientific and feasible through the empirical research.

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes.

PubMed

Cunningham, Shayna D; Lewis, Jessica B; Thomas, Jordan L; Grilo, Stephanie A; Ickovics, Jeannette R

2017-05-18

Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. By bundling prevention and care services into a high-touch, high-tech group prenatal care model, Expect With Me has the potential to result in fundamental changes to the health care system to meet the "triple aim:" better healthcare quality, improved outcomes, and lower costs. Findings from this study will be used to optimize the dissemination and effectiveness of this model. ClinicalTrials.gov, NCT02169024 . Retrospectively registered on June 18, 2014.

Can schooling regulate marine populations and ecosystems?

NASA Astrophysics Data System (ADS)

Maury, Olivier

2017-08-01

Schools, shoals and swarms are pervasive in the oceans. They have to provide very strong advantages to have been selected and generalized in the course of evolution. Auto-organized groups are usually assumed to provide facilitated encounters of reproduction partners, improved protection against predation, better foraging efficiency, and hydrodynamic gains. However, present theories regarding their evolutionary advantages do not provide an unambiguous explanation to their universality. In particular, the mechanisms commonly proposed to explain grouping provide little support to the formation of very large groups that are common in the sea (e.g. Rieucau et al., 2014). From literature review, data analysis and using a simple mathematical model, I show that large auto-organized groups appear at high population density while only small groups or dispersed individuals remain at low population density. Following, an analysis of tuna tagging data and simple theoretical developments show that large groups are likely to expose individuals to a dramatic decrease of individual foraging success and simultaneous increase of predatory and disease mortality, while small groups avoid those adverse feedbacks and provide maximum foraging success and protection against predation, as it is usually assumed. This would create an emergent density-dependent regulation of marine populations, preventing them from outbursts at high density, and protecting them at low density. This would be a major contribution to their resilience and a crucial process of ecosystems dynamics. A two-step evolutionary process acting at the individual level is proposed to explain how this apparently suicidal behaviour could have been selected and generalized. It explains how grouping would have permitted the emergence of extremely high fecundity life histories, despite their notorious propensity to destabilize populations. The potential implications of the ;grouping feedback; on population resilience, ecosystem stability and the persistence of marine biodiversity are discussed. The risk of harvesting marine species with fishing gears that enable catching dispersed individuals (such as longline, gillnet, trawl or using fishing aggregative devices for instance) is underlined. Finally, tropical tunas are used to exemplify the potential importance of schooling in shaping complex life histories and species interaction.

Effectiveness of contextual education for self-management in Thai Muslims with type 2 diabetes mellitus during Ramadan.

PubMed

Susilparat, Prakaitip; Pattaraarchachai, Junya; Songchitsomboon, Sriwatana; Ongroongruang, Savanit

2014-08-01

Fasting in Ramadan has adverse effects on health of Muslims with diabetes. Key strategies to prepare the patients are to provide appropriate health education to the patients prior to Ramadan and to adjust anti-diabetic medicines during Ramadan. To study outcomes of the specific health care services that providing health education in parallel with counseling by Islamic leader The Thai Muslims with type 2 diabetes mellitus were divided into two groups. There were 62patients in experimental group that was provided with specific health care service for Thai Muslims with diabetes in which health education prior to Ramadan and adjustment ofanti-diabetic medicine applied. The other was control group with 28patients that was provided only with original health care service. The results were monitored after Ramadan by interviews, weight and waist measurements, blood pressure measurement and blood tests. Both mean systolic and diastolic blood pressure were well controlled in both groups and slightly decreased after Ramnadan. The mean diastolic blood pressure of the experimental group decreased after Ramadan (p-value = 0.041). From behavior point of view, it was found that the patients in the experimental group had consumed less sweetenedfood (p-value = 0.002). There was no incidence ofsevere hypoglycemia in either experimental or control group. The number and portion of patients with hypoglycemic symptoms in experimental group were lower than those in controlled group (p-value = 0.013). Specific health care service by providing health education prior to Ramadan and adjustment ofanti-diabetic medicine application resulted in a positive effect as the patients tended to consume less sweetenedfood to keep blood sugar level in control. Fasting could affect the patients 'health in apositive way as it helps to control blood pressure, while in parallel, adjustment of anti-diabetic medicine application helps to prevent hypoglycemia. This health care service, which can be achieved in collaboration with a health care team and Islamic leaders, is useful and suitable for Thai Muslims with diabetes mellitus type 2.

Archaeal phylogenomics provides evidence in support of a methanogenic origin of the Archaea and a thaumarchaeal origin for the eukaryotes.

PubMed

Kelly, S; Wickstead, B; Gull, K

2011-04-07

We have developed a machine-learning approach to identify 3537 discrete orthologue protein sequence groups distributed across all available archaeal genomes. We show that treating these orthologue groups as binary detection/non-detection data is sufficient to capture the majority of archaeal phylogeny. We subsequently use the sequence data from these groups to infer a method and substitution-model-independent phylogeny. By holding this phylogeny constrained and interrogating the intersection of this large dataset with both the Eukarya and the Bacteria using Bayesian and maximum-likelihood approaches, we propose and provide evidence for a methanogenic origin of the Archaea. By the same criteria, we also provide evidence in support of an origin for Eukarya either within or as sisters to the Thaumarchaea.

Physical activity programming in family child care homes: providers' perceptions of practices and barriers.

PubMed

Fees, Bronwyn; Trost, Stewart; Bopp, Melissa; Dzewaltowski, David A

2009-01-01

To examine family child care home (FCCH) providers' perceptions of appropriate physical activity (PA), current practices, and perceived barriers to inclusion of PA within their programs. A trained facilitator lead 4 focus group sessions of FCCH providers. Questions addressed providers' planning for PA, resources and barriers, and perceptions of children's engagement. Family child care homes. 32 FCCH providers (100% female) caring for children 6 weeks to 5 years old in predominantly mixed-age programs. Types of and extent to which PA was offered for children and perceived barriers to PA in this setting. Authors coded and analyzed transcriptions based on a socioecological framework using qualitative data analysis software. Majority of providers reported running and dancing to music as the most common PA, generally in an unstructured context. Frequency varied from none to twice a day. Few providers reported planning intentionally for PA; any plans followed children's interests. Barriers to inclusion of PA included personal, programming, parent, environmental, and financial reasons. Providers requested training on PA, particularly ideas for experiences in mixed-age groups. Type, frequency, consistency, and duration of PA among FCCH homes vary widely. Implications include training on PA and resources tailored to the unique characteristics of family child care homes.

Comparison of reproductive protection against bovine viral diarrhea virus provided by multivalent viral vaccines containing inactivated fractions of bovine viral diarrhea virus 1 and 2.

PubMed

Walz, Paul H; Riddell, Kay P; Newcomer, Benjamin W; Neill, John D; Falkenberg, Shollie M; Cortese, Victor S; Scruggs, Daniel W; Short, Thomas H

2018-04-23

Bovine viral diarrhea virus (BVDV) is an important viral cause of reproductive disease, immune suppression and clinical disease in cattle. The objective of this study was to compare reproductive protection in cattle against the impacts of bovine viral diarrhea virus (BVDV) provided by three different multivalent vaccines containing inactivated BVDV. BVDV negative beef heifers and cows (n = 122) were randomly assigned to one of four groups. Groups A-C (n = 34/group) received two pre-breeding doses of one of three commercially available multivalent vaccines containing inactivated fractions of BVDV 1 and BVDV 2, and Group D (n = 20) served as negative control and received two doses of saline prior to breeding. Animals were bred, and following pregnancy diagnosis, 110 cattle [Group A (n = 31); Group B (n = 32); Group C (n = 31); Group D (n = 16)] were subjected to a 28-day exposure to cattle persistently infected (PI) with BVDV (1a, 1b and 2a). Of the 110 pregnancies, 6 pregnancies resulted in fetal resorption with no material for testing. From the resultant 104 pregnancies, BVDV transplacental infections were demonstrated in 73 pregnancies. The BVDV fetal infection rate (FI) was calculated at 13/30 (43%) for Group A cows, 27/29 (93%) for Group B cows, 18/30 (60%) for Group C cows, and 15/15 (100%) for Group D cows. Statistical differences were observed between groups with respect to post-vaccination antibody titers, presence and duration of viremia in pregnant cattle, and fetal infection rates in offspring from BVDV-exposed cows. Group A vaccination resulted in significant protection against BVDV infection as compared to all other groups based upon outcome measurements, while Group B vaccination did not differ in protection against BVDV infection from control Group D. Ability of inactivated BVDV vaccines to provide protection against BVDV fetal infection varies significantly among commercially available products; however, in this challenge model, the inactivated vaccines provided unacceptable levels of BVDV FI protection. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Variability in the American Society of Anesthesiologists Physical Status Classification Scale.

PubMed

Aronson, Wendy L; McAuliffe, Maura S; Miller, Ken

2003-08-01

The American Society of Anesthesiologists (ASA) Physical Status (PS) Classification is used worldwide by anesthesia providers as an assessment of the preoperative physical health of patients. This score also has been used in policy-making, performance evaluation, resource allocation, and reimbursement of anesthesia services and frequently is cited in clinical research. The purpose of this study was to assess interrater reliability and describe sources of variability among anesthesia providers in assigning ASA PS scores. A questionnaire with 10 hypothetical patients scenarios was given to 70 anesthesia providers who were asked to assign ASA PS scores in each scenario and to provide rationale for their decisions. The data were summarized and stratified according to nurse anesthetist or anesthesiologist and military or nonmilitary anesthesia providers. We hypothesized there would be no difference between any of the anesthesia provider groups in assignment of ASA PS scores. A lack of interrater reliability in assigning ASA PS scores was demonstrated. There were no significant differences between the anesthesia provider groups. There was no correlation between ASA PS scoring and years practicing or any of the other demographic variables. Several sources of variability were identified: smoking, pregnancy, nature of the surgery, potential difficult airway, and acute injury.

Fluorinated monomers useful for preparing fluorinated polyquinoline polymers

NASA Technical Reports Server (NTRS)

Hendricks, Neil H. (Inventor)

1994-01-01

A new class of polymers is provided, as well as the monomers used for their preparation. The polymers provided in accordance with practice of the present invention include repeating units comprising one or more quinoline groups, wherein at least a portion of the repeating units includes a hexafluoroisopropylidene (6F) group or a 1-aryl-2,2,2-trifluoroethylidene (3F) group, or both. The hexafluoroisopropylidene group is referred to herein as a 6F group and has the following structure: ##STR1## The 6F group includes a tetravalent carbon atom bound to two trifluoromethyl moieties, with its other two bonds forming linkages in the polymer chain. The 1-aryl-2,2,2-trifluoroethylidene group is referred to herein as a 3F group and has the following structure: ##STR2## wherein Ar' is an aryl group.

Health care provider knowledge and routine management of pre-eclampsia in Pakistan.

PubMed

Sheikh, Sana; Qureshi, Rahat Najam; Khowaja, Asif Raza; Salam, Rehana; Vidler, Marianne; Sawchuck, Diane; von Dadelszen, Peter; Zaidi, Shujat; Bhutta, Zulfiqar

2016-09-30

Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia is due to lack of refresher trainings and written guidelines for management of pre-eclampsia and presentation of fewer pre-eclamptic patients at first and secondary level health care facilities. We suggest to include management of pre-eclampsia in regular trainings of health care providers and to provide management protocols at all health facilities. NCT01911494.

AAC services for multilingual populations: South African service provider perspectives.

PubMed

Tönsing, Kerstin M; van Niekerk, Karin; Schlünz, Georg I; Wilken, Ilana

In South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. The study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. Fifteen AAC service providers were purposefully chosen to participate in one of three focus groups - two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. Four overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. Although service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics. Copyright © 2018 Elsevier Inc. All rights reserved.

The architecture of smart surveys: core issues in why and how to collect patient and referring physician satisfaction data.

PubMed

Lexa, Frank J; Berlin, Jonathan W

2009-02-01

Radiology practices are facing challenges on many fronts. As the field becomes more competitive, leaders must pay more attention to the quality of the service that groups provide to their customers. This need is also being driven by higher expectations from customers, particularly patients, who will likely act much more like consumers in the 21st century. For practices to succeed in providing exemplary service, they must pay attention to the voices of their key customer groups. It is dismaying to see practices that are struggling or even dissolving over issues created by poor service. As much as we are experts in imaging, we are unlikely to be able to provide superlative service by reading books, talking among ourselves, or hiring consultants. Rather, we must do what should be obvious, which is to actually ask our customers how we are doing. Surveys are one of the important tools that can be brought to bear on this issue. For many groups, surveying is the starting point for understanding what their patients, referring physicians, and other key stakeholders want. Groups can also find out what customers like and dislike about their experiences, and how groups compare with their competitors. This article provides a guide on how to get off to a good start in designing and deploying surveys that can help optimize the way groups take care of their patients and help their referring physicians.

Vertical group III-V nanowires on si, heterostructures, flexible arrays and fabrication

DOEpatents

Wang, Deli; Soci, Cesare; Bao, Xinyu; Wei, Wei; Jing, Yi; Sun, Ke

2015-01-13

Embodiments of the invention provide a method for direct heteroepitaxial growth of vertical III-V semiconductor nanowires on a silicon substrate. The silicon substrate is etched to substantially completely remove native oxide. It is promptly placed in a reaction chamber. The substrate is heated and maintained at a growth temperature. Group III-V precursors are flowed for a growth time. Preferred embodiment vertical Group III-V nanowires on silicon have a core-shell structure, which provides a radial homojunction or heterojunction. A doped nanowire core is surrounded by a shell with complementary doping. Such can provide high optical absorption due to the long optical path in the axial direction of the vertical nanowires, while reducing considerably the distance over which carriers must diffuse before being collected in the radial direction. Alloy composition can also be varied. Radial and axial homojunctions and heterojunctions can be realized. Embodiments provide for flexible Group III-V nanowire structures. An array of Group III-V nanowire structures is embedded in polymer. A fabrication method forms the vertical nanowires on a substrate, e.g., a silicon substrate. Preferably, the nanowires are formed by the preferred methods for fabrication of Group III-V nanowires on silicon. Devices can be formed with core/shell and core/multi-shell nanowires and the devices are released from the substrate upon which the nanowires were formed to create a flexible structure that includes an array of vertical nanowires embedded in polymer.

Detecting coached neuropsychological dysfunction: a simulation experiment regarding mild traumatic brain injury.

PubMed

Lau, Lily; Basso, Michael R; Estevis, Eduardo; Miller, Ashley; Whiteside, Douglas M; Combs, Dennis; Arentsen, Timothy J

2017-11-01

Performance validity tests (PVTs) and symptom validity tests (SVTs) are often administered during neuropsychological evaluations. Examinees may be coached to avoid detection by measures of response validity. Relatively little research has evaluated whether graduated levels of coaching has differential effects upon PVT and SVT performance. Accordingly, the present experiment evaluated the effect of graduated levels of coaching upon the classification accuracy of commonly used PVTs and SVTs and the currently accepted criterion of failing two or more PVTs or SVTs. Participants simulated symptoms associated with mild traumatic brain injury (TBI). One group was provided superficial information concerning cognitive, emotional, and physical symptoms. Another group was provided detailed information about such symptoms. A third group was provided detailed information about symptoms and guidance how to evade detection by PVTs. These groups were compared to an honest-responding group. Extending prior experiments, stand-alone and embedded PVT measures were administered in addition to SVTs. The three simulator groups were readily identified by PVTs and SVTs, but a meaningful minority of those provided test-taking strategies eluded detection. The Word Memory Test emerged as the most sensitive indicator of simulated mild TBI symptoms. PVTs achieved more sensitive detection of simulated head injury status than SVTs. Individuals coached to modify test-taking performance were marginally more successful in eluding detection by PVTs and SVTs than those coached with respect to TBI symptoms only. When the criterion of failing two or more PVTs or SVTs was applied, only 5% eluded detection.

Frequent Immediate Knowledge of Results Enhances the Increase of Throwing Velocity in Overarm Handball Performance.

PubMed

Štirn, Igor; Carruthers, Jamie; Šibila, Marko; Pori, Primož

2017-02-01

In the present study, the effect of frequent, immediate, augmented feedback on the increase of throwing velocity was investigated. An increase of throwing velocity of a handball set shot when knowledge of results was provided or not provided during training was compared. Fifty female and seventy-three male physical education students were assigned randomly to the experimental or control group. All participants performed two series of ten set shots with maximal effort twice a week for six weeks. The experimental group received information regarding throwing velocity measured by a radar gun immediately after every shot, whereas the control group did not receive any feedback. Measurements of maximal throwing velocity of an ordinary handball and a heavy ball were performed, before and after the training period and compared. Participants who received feedback on results attained almost a four times greater relative increase of the velocity of the normal ball (size 2) as compared to the same intervention when feedback was not provided (8.1 ± 3.6 vs. 2.7 ± 2.9%). The velocity increases were smaller, but still significant between the groups for throws using the heavy ball (5.1 ± 4.2 and 2.5 ± 5.8 for the experimental and control group, respectively). Apart from the experimental group throwing the normal ball, no differences in velocity change for gender were obtained. The results confirmed that training oriented towards an increase in throwing velocity became significantly more effective when frequent knowledge of results was provided.

EvOligo: A Novel Software to Design and Group Libraries of Oligonucleotides Applicable for Nucleic Acid-Based Experiments.

PubMed

Milewski, Marek C; Kamel, Karol; Kurzynska-Kokorniak, Anna; Chmielewski, Marcin K; Figlerowicz, Marek

2017-10-01

Experimental methods based on DNA and RNA hybridization, such as multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification, or microarray analysis, require the use of mixtures of multiple oligonucleotides (primers or probes) in a single test tube. To provide an optimal reaction environment, minimal self- and cross-hybridization must be achieved among these oligonucleotides. To address this problem, we developed EvOligo, which is a software package that provides the means to design and group DNA and RNA molecules with defined lengths. EvOligo combines two modules. The first module performs oligonucleotide design, and the second module performs oligonucleotide grouping. The software applies a nearest-neighbor model of nucleic acid interactions coupled with a parallel evolutionary algorithm to construct individual oligonucleotides, and to group the molecules that are characterized by the weakest possible cross-interactions. To provide optimal solutions, the evolutionary algorithm sorts oligonucleotides into sets, preserves preselected parts of the oligonucleotides, and shapes their remaining parts. In addition, the oligonucleotide sets can be designed and grouped based on their melting temperatures. For the user's convenience, EvOligo is provided with a user-friendly graphical interface. EvOligo was used to design individual oligonucleotides, oligonucleotide pairs, and groups of oligonucleotide pairs that are characterized by the following parameters: (1) weaker cross-interactions between the non-complementary oligonucleotides and (2) more uniform ranges of the oligonucleotide pair melting temperatures than other available software products. In addition, in contrast to other grouping algorithms, EvOligo offers time-efficient sorting of paired and unpaired oligonucleotides based on various parameters defined by the user.

Group Communication Treatment for Individuals with PPA and Their Partners.

PubMed

Mooney, Aimee; Beale, Naomi; Fried-Oken, Melanie

2018-07-01

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by insidious language deterioration. This young-onset disorder leaves adults with reduced communication skills for participation in social activities. There is limited evidence regarding group treatment for individuals with PPA, though the principles of chronic aphasia groups can be applied to this clinical population. We developed a PPA group treatment model incorporating compensatory strategies from augmentative and alternative communication (AAC), communication partner training from aphasia rehabilitation, and systematic instruction from dementia management. Six modules were designed and delivered to people with PPA and their communication partners in a university clinic setting over a 6-week period. Treatment was provided by graduate clinicians with supervision from a certified speech-language pathologist and faculty member. Primary treatment goals were to provide education about PPA symptoms and progression; to increase practice and use of multimodal communication by people with PPA; and to establish an environment where people with PPA and their partners could connect for training and support. We present pre/post comparisons and satisfaction data provided by five individuals with PPA and their partners in the group. Results suggest that group training is an effective service delivery model. Participants reported gains in both knowledge about PPA and in using many different modalities to communicate. The new compensatory strategies learned provide tools for maintenance and improvement of language use. Participants saw increased confidence and participation in daily activities, and highlighted the value of the PPA group for individuals with this relatively rare condition and their family members. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outsourcing Physical Education in Primary Schools: Evaluating the Impact of Externally Provided Programmes on Generalist Teachers

ERIC Educational Resources Information Center

Whipp, Peter R.; Hutton, Heidi; Grove, J. Robert; Jackson, Ben

2011-01-01

In place of generalist delivery, externally provided physical activity programmes (EPPAPs) are potentially an effective method for offering primary school students specialist physical education (PE) instruction, as well as providing training for generalist classroom teachers. In the present study, a group of generalist teachers were interviewed…

Glycoside hydrolases having multiple hydrolase activities

DOEpatents

Chen, Zhiwei; Friedland, Gregory D.; Chhabra, Swapnil R.; Chivian, Dylan C.; Simmons, Blake A

2017-08-08

Glycoside hydrolases having at least two different hydrolytic activities are provided. In one embodiment, an isolated recombinant hydrolase having at least two activities selected from a group including asparagine derivatives, glutamine derivatives, and histidine derivatives is provided. Further, a method of generating free sugars from a mixture comprising asparagine derivatives, glutamine derivatives, and histidine derivatives is provided.

7 CFR 278.6 - Disqualification of retail food stores and wholesale food concerns, and imposition of civil money...

Code of Federal Regulations, 2011 CFR

2011-01-01

... providers, and shelters for battered women and children which the wholesale food concern was authorized to... addict and alcoholic treatment program, homeless meal providers, or shelters for battered women and... program, group living arrangement, homeless meal provider, meal delivery service, or shelter for battered...

7 CFR 278.6 - Disqualification of retail food stores and wholesale food concerns, and imposition of civil money...

Code of Federal Regulations, 2010 CFR

2010-01-01

... providers, and shelters for battered women and children which the wholesale food concern was authorized to... addict and alcoholic treatment program, homeless meal providers, or shelters for battered women and... program, group living arrangement, homeless meal provider, meal delivery service, or shelter for battered...

Reaching youth through franchise clinics: assessment of Kenyan private sector involvement in youth services.

PubMed

Decker, Martha; Montagu, Dominic

2007-03-01

This paper evaluates the ability of social franchise programs, which use private providers to offer reproductive health services, to provide services to youth in western Kenya. Although franchise clinics have rarely targeted youth, they appear to offer a viable alternative for providing reproductive health services to this age group.

76 FR 82011 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing of Proposed Rule Change To...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-29

... financial incentives, the Exchange is rewarding aggressive liquidity providers in the market. The Exchange... intends to file a proposal to adopt the financial incentives for the Competitive Liquidity Provider... seeking to provide incentives for quoting and to add competition to the existing group of liquidity...

Infections in Children: A Sourcebook for Educators and Child Care Providers. Second Edition.

ERIC Educational Resources Information Center

Andersen, Richard D.; And Others

Noting the rapid changes occurring in the world of infectious diseases, this book provides updated information for care providers, educators, and parents on the increasingly complex issues of childhood infection. The book is organized into two parts. The first part discusses general considerations for group settings. Chapter 1 introduces the…

49 CFR 214.329 - Train approach warning provided by watchmen/lookouts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Train approach warning provided by watchmen... Protection § 214.329 Train approach warning provided by watchmen/lookouts. Roadway workers in a roadway work group who foul any track outside of working limits shall be given warning of approaching trains by one...

Brokering Boundaries: Literacy Change Agents at Work

ERIC Educational Resources Information Center

VanDeusen-MacLeod, Elizabeth A.

2009-01-01

The purpose of this mixed-method descriptive case study is to investigate the role technical assistance providers within the context of one state's large-scale literacy grant program. This study provides an in-depth examination of one state's technical assistance providers known as Reading First Facilitators (RFF) through the study of a group of…

Quality of services and quality of life from service providers' perspectives: analysis with focus groups.

PubMed

Jenaro, C; Vega, V; Flores, N; Cruz, M

2013-06-01

Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this population. The current study aims to identify service providers' perceptions regarding the quality of life of their clients and the quality of services they provide. It also aims to identify similarities and differences of appraisals among professionals, and to identify associations between supports, quality of life and quality of services. Data were collected from 22 service providers who attended three focus groups (professionals, direct support staff, and managers) from whom 424 comments were analysed. Service providers were asked about the required support for users, the meaning of quality of life for those users, and about features that should characterise quality services. Thematic analysis was employed and transcripts of the sessions were coded according to the dimensions of models on supports, quality of life and quality of services. Chi-squared tests were utilised to test for potential differences among groups. Each professional group has its own priorities concerning required supports. Among the organisation different and potentially conflicting perceptions regarding the meaning of experiencing quality of life coexist. Concerning quality of services, only managers mentioned personal outcomes. Finally, institutionalisation has a negative impact on supports, quality of life and quality of services. It is necessary to move beyond a shared awareness of the negative impact of institutionalisation towards the transformation of services in search of personal quality outcomes. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

OA20 The positioning of family, friends, community, and service providers in support networks for caring at end-of-life: a social network analysis.

PubMed

Leonard, Rosemary; Horsfall, Debbie; Rosenberg, John; Noonan, Kerrie

2015-04-01

Although there is ample evidence of the risk to carers from the burden of caring, there is also evidence that a caring network can relieve the burden on the principal carer, strengthen community relationships, and increase 'Death Literacy' in the community. There is often an assumption that, in caring networks, family and service providers are central and friends and community are marginal. We examined whether this is the case in practice using SNA. To identify the relative positioning of family, friends, community, and service providers in caring networks. In interviews with carers (N = 23) and focus groups with caring networks (N = 13) participants were asked to list the people in the caring network and rate the strength of their relationships to them (0 no relationship to 3 strong relationship). SNA in UCInet was used to map the networks, examine density (number and strength of relationships) across time (when caring began to the present) and across relationship types (family, friends, community, and service providers) supplemented by qualitative data. The analysis revealed significant increases in the density of the networks over time. The density of relationships with friends was similar to that other family. Community and service providers had significantly lower density. Qualitative analysis revealed that often service providers were not seen as part of the networks. To avoid carer burnout, it is important not to make assumptions about where carers obtain support but work with each carer to mobilise any support that is available. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Terminology and definitions on groin pain in athletes: building agreement using a short Delphi method.

PubMed

Weir, Adam; Hölmich, Per; Schache, Anthony G; Delahunt, Eamonn; de Vos, Robert-Jan

2015-06-01

Groin pain in athletes occurs frequently and can be difficult to treat, which may partly be due to the lack of agreement on diagnostic terminology. To perform a short Delphi survey on terminology agreement for groin pain in athletes by a group of experts. A selected number of experts were invited to participate in a Delphi questionnaire. The study coordinator sent a questionnaire, which consisted of demographic questions and two 'real-life' case reports of athletes with groin pain. The experts were asked to complete the questionnaire and to provide the most likely diagnosis for each case. Questionnaire responses were analysed by an independent researcher. The Cohen's κ statistic was used to evaluate the level of agreement between the diagnostic terms provided by the experts. Twenty-three experts participated (96% of those invited). For case 1, experts provided 9 different terms to describe the most likely diagnosis; for case 2, 11 different terms were provided to describe the most likely diagnosis. With respect to the terms provided for the most likely diagnosis, the Cohen's κ was 0.06 and 0.002 for case 1 and 2, respectively. This heterogeneous taxonomy reflects only a slight agreement between the various diagnostic terms provided by the selected experts. This short Delphi survey of two 'typical, straightforward' cases demonstrated major inconsistencies in the diagnostic terminology used by experts for groin pain in athletes. These results underscore the need for consensus on definitions and terminology on groin pain in athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies

PubMed Central

Berendes, Sima; Heywood, Peter; Oliver, Sandy; Garner, Paul

2011-01-01

Background In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. Methods and Findings We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. Conclusions Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases. Please see later in the article for the Editors' Summary PMID:21532746

Antiabortion violence: causes and effects.

PubMed

Radford, B; Shaw, G

1993-01-01

Most antiabortion groups objected peacefully to the US Supreme Court decision granting women access to abortion by lobbying, demonstrating, and writing letters. Some groups reacted violently. In 1984, violent acts had climbed to 18 bombings and 6 acts of arson directed against abortion providers. They dropped in 1988-1990 and rose again in 1992-1993. The far rights' disapproval of the Reagan and Bush Administrations' inability to make abortion illegal accounts for these increased acts of violence. The violent antiabortion groups interpreted Reagan's failure to stop the continuing violence as approval of their methods. A former Catholic seminarian, Joseph Scheidler, called for a militant effort to end abortion, thereby unleashing the militant, violent antiabortion movement. He led local grassroots groups nationwide to accomplish the Year of Pain and Fear he called for in his book. Antiabortion zealots understand and use the potency of language. The dehumanize abortion providers. They suggest that followers pray for death or destruction. Their rhetoric of hatred motivates persons to perform violent acts. Little difference exists between clinic blockaders and clinic bombers/arsonists. Antiabortion zealots tend to be financial and social drifters escaping a past of drinking or drugs and from very dysfunctional families. Antiabortion violence has ushered in a new wave--murder of a provider. Abortion providers have adapted to lie with threats, jeering, and bricks thrown through windows. Even though abortion seekers fear personal injury, they fear even more harassment and invasion of privacy. Their tactics have reduced women's access to abortion care. Abortion providers operate in just 17% of US counties. When zealots spew hatred on families, however, providers often stop performing abortions. Nevertheless, communities are starting to stand up to the reactionaries. Neighbors, patients, businesses, and other physicians in Montana supported a clinic after a violent act. This needs to occur more often to stop the violence.

Enabling Community Through Social Media

PubMed Central

Haythornthwaite, Caroline

2013-01-01

Background Social network analysis provides a perspective and method for inquiring into the structures that comprise online groups and communities. Traces from interaction via social media provide the opportunity for understanding how a community is formed and maintained online. Objective The paper aims to demonstrate how social network analysis provides a vocabulary and set of techniques for examining interaction patterns via social media. Using the case of the #hcsmca online discussion forum, this paper highlights what has been and can be gained by approaching online community from a social network perspective, as well as providing an inside look at the structure of the #hcsmca community. Methods Social network analysis was used to examine structures in a 1-month sample of Twitter messages with the hashtag #hcsmca (3871 tweets, 486 unique posters), which is the tag associated with the social media–supported group Health Care Social Media Canada. Network connections were considered present if the individual was mentioned, replied to, or had a post retweeted. Results Network analyses revealed patterns of interaction that characterized the community as comprising one component, with a set of core participants prominent in the network due to their connections with others. Analysis showed the social media health content providers were the most influential group based on in-degree centrality. However, there was no preferential attachment among people in the same professional group, indicating that the formation of connections among community members was not constrained by professional status. Conclusions Network analysis and visualizations provide techniques and a vocabulary for understanding online interaction, as well as insights that can help in understanding what, and who, comprises and sustains a network, and whether community emerges from a network of online interactions. PMID:24176835

SMART lunch box intervention to improve the food and nutrient content of children's packed lunches: UK wide cluster randomised controlled trial.

PubMed

Evans, C E L; Greenwood, D C; Thomas, J D; Cleghorn, C L; Kitchen, M S; Cade, J E

2010-11-01

Government standards are now in place for children's school meals but not for lunches prepared at home. The aim of this trial is to improve the content of children's packed lunches. A cluster randomised controlled trial in 89 primary schools across the UK involving 1291 children, age 8-9 years at baseline. Follow-up was 12 months after baseline. A "SMART" lunch box intervention programme consisted of food boxes, bag and supporting materials. The main outcome measures were weights of foods and proportion of children provided with sandwiches, fruit, vegetables, dairy food, savoury snacks and confectionery in each packed lunch. Levels of nutrients provided including energy, total fat, saturated fat, protein, non-milk extrinsic sugar, sodium, calcium, iron, folate, zinc, vitamin A and vitamin C. Moderately higher weights of fruit, vegetables, dairy and starchy food and lower weights of savoury snacks were provided to children in the intervention group. Children in the intervention group were provided with slightly higher levels of vitamin A and folate. 11% more children were provided with vegetables/salad in their packed lunch, and 13% fewer children were provided with savoury snacks (crisps). Children in the intervention group were more likely to be provided with packed lunches meeting the government school meal standards. The SMART lunch box intervention, targeting parents and children, led to small improvements in the food and nutrient content of children's packed lunches. Further interventions are required to bring packed lunches in line with the new government standards for school meals. Current controlled trials ISRCTN77710993.

Poverty, vulnerability, and provision of healthcare in Afghanistan.

PubMed

Trani, Jean-Francois; Bakhshi, Parul; Noor, Ayan A; Lopez, Dominique; Mashkoor, Ashraf

2010-06-01

This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The 'scaling-up process' is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation. Copyright 2010 Elsevier Ltd. All rights reserved.

Improving Pain Care with Project ECHO in Community Health Centers.

PubMed

Anderson, Daren; Zlateva, Ianita; Davis, Bennet; Bifulco, Lauren; Giannotti, Tierney; Coman, Emil; Spegman, Douglas

2017-10-01

Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers. Quasi-experimental, pre-post intervention, with comparison group. Two large, multisite federally qualified health centers in Connecticut and Arizona. Intervention (N = 10) and comparison (N = 10) primary care providers. Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals. Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group. Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes. © 2017 American Academy of Pain Medicine.

Supply and demand determine the market value of food providers in wild vervet monkeys.

PubMed

Fruteau, Cécile; Voelkl, Bernhard; van Damme, Eric; Noë, Ronald

2009-07-21

Animals neither negotiate verbally nor conclude binding contracts, but nevertheless regularly exchange goods and services without overt coercion and manage to arrive at agreements over exchange rates. Biological market theory predicts that such exchange rates fluctuate according to the law of supply and demand. Previous studies showed that primates pay more when commodities become scarcer: subordinates groomed dominants longer before being tolerated at food sites in periods of shortage; females groomed mothers longer before obtaining permission to handle their infants when there were fewer newborns and males groomed fertile females longer before obtaining their compliance when fewer such females were present. We further substantiated these results by conducting a 2-step experiment in 2 groups of free-ranging vervet monkeys in the Loskop Dam Nature Reserve, South Africa. We first allowed a single low-ranking female to repeatedly provide food to her entire group by triggering the opening of a container and measured grooming bouts involving this female in the hour after she made the reward available. We then measured the shifts in grooming patterns after we added a second food container that could be opened by another low-ranking female, the second provider. All 4 providers received more grooming, relative to the amount of grooming they provided themselves. As biological market theory predicts, the initial gain of first providers was partially lost again after the introduction of a second provider in both groups. We conclude that grooming was fine-tuned to changes in the value of these females as social partners.

Supply and demand determine the market value of food providers in wild vervet monkeys

PubMed Central

Fruteau, Cécile; Voelkl, Bernhard; van Damme, Eric; Noë, Ronald

2009-01-01

Animals neither negotiate verbally nor conclude binding contracts, but nevertheless regularly exchange goods and services without overt coercion and manage to arrive at agreements over exchange rates. Biological market theory predicts that such exchange rates fluctuate according to the law of supply and demand. Previous studies showed that primates pay more when commodities become scarcer: subordinates groomed dominants longer before being tolerated at food sites in periods of shortage; females groomed mothers longer before obtaining permission to handle their infants when there were fewer newborns and males groomed fertile females longer before obtaining their compliance when fewer such females were present. We further substantiated these results by conducting a 2-step experiment in 2 groups of free-ranging vervet monkeys in the Loskop Dam Nature Reserve, South Africa. We first allowed a single low-ranking female to repeatedly provide food to her entire group by triggering the opening of a container and measured grooming bouts involving this female in the hour after she made the reward available. We then measured the shifts in grooming patterns after we added a second food container that could be opened by another low-ranking female, the second provider. All 4 providers received more grooming, relative to the amount of grooming they provided themselves. As biological market theory predicts, the initial gain of first providers was partially lost again after the introduction of a second provider in both groups. We conclude that grooming was fine-tuned to changes in the value of these females as social partners. PMID:19581578

Development of a capitation scale for IDF career soldiers in Israel.

PubMed

Magnezi, Racheli; Weiss, Yossi; Cohen, Yossi; Shmueli, Amir

2007-03-01

The Israeli National Health Insurance Law allocates a national healthcare budget to the sickness funds, which provide medical care to civilian population. Medical care for members of the IDF is financed through the budget of the Ministry of Defense and is not included in the national healthcare budget. Benefits provided to soldiers serving in the permanent forces are far more extensive than those provided to civilians. Because of no co-payments, poor management, and the cost-based budget, military healthcare costs in Israel are expected to exceed civilian healthcare costs, adjusting for age and sex. The present paper derives age- and sex-based capitation rates for military personnel, and compares military and civilian age-based expenditure and capitation rates. The study population comprised career soldiers and civilians aged 21-54 years. Expenses of career soldiers were calculated to provide information on the financial costs of medical services for each age group in 2003. Overall expenses for women were higher than for men in all age groups. As anticipated, the older the group, the higher the total expenditure for both men and women. In-patient care represented a higher percentage of the total costs for men (28.3%) than for women (22.1%). Emergency room care was higher for women in the 22-24 age group but comparable to that of men in higher age groups. Specialist visits represented a significantly higher percentage of the total costs for women than for men in the 22-24 and 25-34 age groups (by 6% and 15%, respectively). The difference decreased to 13% in the 35-44 age groups and, in the 45-54 age group, the difference for men was 14% higher than for women. Military costs were similar to civilian costs in the 22-24 age groups, higher in the following two groups, and lower in the 45-54 age group. Like in other organizations, military healthcare services might benefit from outsourcing. The inequality in medical services to soldiers and civilians, the over-use of the military healthcare system, and the decrease of standards and budgetary resources will compel the establishment of more creative means of providing these services through contracts and agreements, perhaps through the civilian sickness funds.

Public Participation Guide: Briefings

EPA Pesticide Factsheets

Briefings are generally short presentations provided directly to community groups at their existing meetings or locations – such as social and civic clubs – to provide an overview or update on a project.

About Genetic Counselors

MedlinePlus

... While most genetic counseling is provided in-person, access to genetic counselors is expanding, and many now provide consultation services by telephone, videoconferencing , and the internet, or offer education and support in group settings. ...

Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis.

PubMed

Krautter, Markus; Andreesen, Sven; Köhl-Hackert, Nadja; Hoffmann, Katja; Herzog, Wolfgang; Nikendei, Christoph

2014-01-01

Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors. A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor-student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians.

Direct Observation of Treatment Provided by a Family Member as Compared to Non-Family Member among Children with New Tuberculosis: A Pragmatic, Non-Inferiority, Cluster-Randomized Trial in Gujarat, India.

PubMed

Dave, Paresh Vamanrao; Shah, Amar Niranjan; Nimavat, Pankaj B; Modi, Bhavesh B; Pujara, Kirit R; Patel, Pradip; Mehariya, Keshabhai; Rade, Kiran Vaman; Shekar, Soma; Sachdeva, Kuldeep S; Oeltmann, John E; Kumar, Ajay M V

2016-01-01

The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June-September 2012. We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child's DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. Clinical Trials Registry-India, National Institute of Medical Statistics (Indian Council of Medical Research) CTRI/2015/09/006229.

Direct Observation of Treatment Provided by a Family Member as Compared to Non-Family Member among Children with New Tuberculosis: A Pragmatic, Non-Inferiority, Cluster-Randomized Trial in Gujarat, India

PubMed Central

Modi, Bhavesh B.; Pujara, Kirit R.; Patel, Pradip; Mehariya, Keshabhai; Rade, Kiran Vaman; Shekar, Soma; Sachdeva, Kuldeep S.; Oeltmann, John E.; Kumar, Ajay M. V.

2016-01-01

Background The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June–September 2012. Methods We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child’s DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. Results Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. Conclusion DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. Trial Registration Clinical Trials Registry–India, National Institute of Medical Statistics (Indian Council of Medical Research) CTRI/2015/09/006229 PMID:26849442

Disclosing Sex Trading Histories to Providers: Barriers and Facilitators to Navigation of Social Services Among Women Impacted by Commercial Sexual Exploitation.

PubMed

Gerassi, Lara; Edmond, Tonya E; Fabbre, Vanessa; Howard, Abby; Nichols, Andrea J

2017-12-01

Sex trafficking and commercial sexual exploitation (CSE) can lead to devastating health and mental health consequences for women, such as elevated rates of substance use, trauma, posttraumatic stress disorder, depression, sexually transmitted infections (STIs), and HIV. Consequently, engagement with services that address addiction, mental health, and housing, and provide general advocacy is critically important to women's increased safety, stabilization, and quality of life. The purpose of this study is to identify perceived barriers and facilitators to service access and engagement with social services among women involved in CSE. Drawing from a larger grounded theory study that partnered with an anti-trafficking coalition and a substance use treatment center for women, in-depth, semistructured interviews were conducted with 30 adult women who traded sex as adults and 20 service providers who come into contact with this population. Women engaging in services were sampled through maximum variation sampling ( n = 24) and women not engaged with services ( n = 6) were recruited through snowball sampling. Providers were recruited through purposive sampling through the coalition ( n = 10) and nominations sampling ( n = 10). Open and focused coding were conducted. Multiple enhancements to methodological and analytic rigor were taken, including collaboration with multiple key stakeholders, use of nonstigmatizing language, self-reflexivity processes, analytic memo-writing, and member checking. Findings suggest that women experienced judgment when disclosing sex trading in social service intakes, and individual and group sessions from providers and other women in the groups. Although some women saw disclosure as helpful in addressing the complex feelings stemming from sex trading, as well as the desire to help or relate to other women in similar situations, they also identified risk of harm and multiple barriers to disclosing during intake meetings and individual sessions with providers as well as group sessions with providers and other clients. Implications for individual and group practice are discussed.

Your Child and Play/TV. Getting Involved Workshop Guide. A Manual for the Parent Group Trainer. The Best of BES--Basic Educational Skills Materials.

ERIC Educational Resources Information Center

Southwest Educational Development Lab., Austin, TX.

Containing many handouts for parents, this manual for parent group trainers provides guidelines for conducting workshops on the nature and value of young children's play and on regulating children's television viewing. In addition to the guidelines, the manual offers basic information about play, suggests hands-on activities, and provides a list…

The Turn the Tables Technique (T[cube]): A Program Activity to Provide Group Facilitators Insight into Teen Sexual Behaviors and Beliefs

ERIC Educational Resources Information Center

Sclafane, Jamie Heather; Merves, Marni Loiacono; Rivera, Angelic; Long, Laura; Wilson, Ken; Bauman, Laurie J.

2012-01-01

The Turn the Tables Technique (T[cube]) is an activity designed to provide group facilitators who lead HIV/STI prevention and sexual health promotion programs with detailed and current information on teenagers' sexual behaviors and beliefs. This information can be used throughout a program to tailor content. Included is a detailed lesson plan of…

Group Counseling with South Asian Immigrant High School Girls: Reflections and Commentary of a Group Facilitator

ERIC Educational Resources Information Center

Thakore-Dunlap, Ulash; Van Velsor, Patricia

2014-01-01

The diversity of the U.S. school population speaks to a need to provide support for youth from various backgrounds. As a school-based mental health counselor, the first author observed that the South Asian immigrant students at her school did not utilize any of the counseling services provided. Because South Asians are typically collectivistic,…

Group Motivation in a Nutrition Project for Pregnant and Parenting Teens and Their Spouses by Use of an Incentive Plan.

ERIC Educational Resources Information Center

Collins, Gloria

A child care agency located in the southeastern United States serving homeless youth up to the age of 21 years provided pregnant and parenting teenagers with shelter and support services and provided individual and group counseling sessions focusing on health and nutrition, parenting and child care, sexuality and pregnancy, family support services…

The patient perspective: utilizing focus groups to inform care coordination for high-risk medicaid populations.

PubMed

Sheff, Alex; Park, Elyse R; Neagle, Mary; Oreskovic, Nicolas M

2017-07-25

Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination. We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA. Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs. Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.

A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial.

PubMed

Edinger, Jack D; Grubber, Janet; Ulmer, Christi; Zervakis, Jennifer; Olsen, Maren

2016-01-01

To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management. This study used a randomized, parallel group, clinical intervention trial design. A total of 137 adult (29 women) VA outpatients with sleep complaints were enrolled and randomly assigned to (1) an intervention (INT) consisting of a one-time consultation with a sleep specialist who provided diagnostic feedback and treatment recommendations to the patient and the patient's primary care provider; or (2) a control condition consisting of their usual primary care (UPC). Provider-focused outcomes included rates of adherence to recommended diagnostic procedures and sleep-focused interventions. Patient-focused outcomes included measures taken from sleep diaries and actigraphy; Pittsburgh Sleep Quality Index (PSQI) scores; and self-report measures of sleepiness, fatigue, mood, quality of life, and satisfaction with health care. The proportions of provider-initiated sleep-focused interventions were significantly higher in the INT group than in the UPC group for polysomnography referrals (49% versus 6%; P < 0.001) and mental health clinic referrals (19% versus 6%; P = 0.02). At the 10-mo follow up, INT recipients showed greater estimated mean reductions in diary total wake time (-17.0 min; 95% confidence interval [CI]: -30.9, -3.1; P = 0.02) and greater increases in sleep efficiency (+3.7%; 95% CI: 0.8, 6.5; P = 0.01) than did UPC participants. A greater proportion of the INT group showed ≥ 1 standard deviation decline on the PSQI from baseline to the 10-mo follow-up (41% versus 21%; P = 0.02). Moreover, 69% of the INT group had normal (≤ 10) Epworth Sleepiness Scale scores at the 10-mo follow-up, whereas only 50% of the UPC group fell below this clinical cutoff (P = 0.03). A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and resulted in benefits to patients' sleep/wake symptoms. This study is registered with clinicaltrials.gov with identifier # NCT00390572. © 2016 Associated Professional Sleep Societies, LLC.

[Evaluation of the Relapse Prevention Guidance for drug-dependent inmates: the intervention using self-teach workbook and group therapy in a "Private Finance Initiative" prison --the second report].

PubMed

Kobayashi, Ohji; Matsumoto, Toshihiko; Imamura, Fumi; Wada, Kiyoshi; Ozaki, Shiro; Takeuchi, Yoshio; Hasegawa, Masahiko; Imamura, Yoko; Tania, Yuko; Adachi, Yasumori

2011-06-01

There has been no relapse prevention program for drug dependent inmates in Japanese prisons. Recently, "Relapse Prevention Guidance" program is provided to the adult male inmates in Harima Rehabilitation Program Center (HRPC), one of the newly founded "Private Finance Initiative" prisons. To evaluate the effectiveness of the program by comparing the outcomes between groups of inmates with different severity level of dependence. The program was provided to 89 subjects in HRPC. Inmates were classified into 4 groups according to the severity measured by the Drug Abuse Screening Test (DAST). After a month of waiting period, self-teaching workbook was provided to each inmate for 4 weeks. The educational program consisting of 8 weekly psychoeducational group therapies was then provided to each group of 10 inmates. The evaluation was conducted both at the beginning and at the end of the workbook and the educational program intervention by administering 2 self-reporting questionnaires; the Self-efficacy Scale for drug dependence (SES), and the 8th version of the Stages of Change Readiness and Treatment Eagerness Scale for drug dependence (SOCRATES-8D). Only the "mild" group showed significant increase in SES during waiting period. After the workbook intervention, "moderate" group showed significant decrease in SES, and increase in the recognition and the ambivalence subscale of the SOCRATES-8D. The same increase in the subscales of SOCRATES-8D was noted in "Severe" group. Educational program produced increase in the recognition and the taking steps subscales of SOCRATES-8D in "mild" group, increase in SES score and the taking steps subscale in "moderate", increase in SES score and total score of SOCRATES-8D in "severe" group. No significant change was noted in "very severe" group in any of the interventions. The "Relapse Prevention Guidance" is sufficiently effective, improving self-efficacy and motivation for change in drug dependent adult male inmates.

The relationship between primary healthcare providers and their external supervisors in Rwanda

PubMed Central

Itangishaka, Sylvere

2017-01-01

Background External supervision of Rwandan primary healthcare facilities unfolds as an interaction between supervisors and healthcare providers. Their relationship has not been thoroughly studied in Rwanda, and rarely in Africa. Aim To explore perceived characteristics and effects of the relationship between providers in public primary healthcare facilities and their external supervisors in Rwanda. Setting We conducted three focus group discussions with primary healthcare providers (n = 16), three with external supervisors (n = 15) and one mixed (n = 5). Methods Focus groups were facilitated under low-moderator involvement. Findings were extracted thematically and discussed with participating and non-participating providers and supervisors. Results While external supervision is intended as a source of motivation and professional development in addition to its managerial purpose, it appeared linked to excessive evaluation anxiety among Rwandan primary healthcare providers. Supervisors related this mainly to inescapable evaluations within performance-based financing, whereas providers additionally related it to communication problems. Conclusion External supervision appeared driven by systematic performance evaluations, which may prompt a strongly asymmetric supervisory power relation and challenge intentions to explore providers’ experienced work problems. There is a risk that this may harm provider motivation, calling for careful attention to factors that influence the supervisory relationship. It is a dilemma that providers most in need of supervision to improve performance may be most unlikely to benefit from it. This study reveals a need for provider-oriented supportive supervision including constructive attention on providers who have performance difficulties, effective relationship building and communication, objective and diligent evaluation and two-way feedback channels. PMID:29113446

Usefulness of Cochrane Skin Group reviews for clinical practice.

PubMed

Davila-Seijo, P; Batalla, A; Garcia-Doval, I

2013-10-01

Systematic reviews are one of the most important sources of information for evidence-based medicine. However, there is a general impression that these reviews rarely report results that provide sufficient evidence to change clinical practice. The aim of this study was to determine the percentage of Cochrane Skin Group reviews reporting results with the potential to guide clinical decision-making. We performed a bibliometric analysis of all the systematic reviews published by the Cochrane Skin Group up to 16 August, 2012. We retrieved 55 reviews, which were analyzed and graded independently by 2 investigators into 3 categories: 0 (insufficient evidence to support or reject the use of an intervention), 1 (insufficient evidence to support or reject the use of an intervention but sufficient evidence to support recommendations or suggestions), and 2 (sufficient evidence to support or reject the use of an intervention). Our analysis showed that 25.5% (14/55) of the studies did not provide sufficient evidence to support or reject the use of the interventions studied, 45.5% (25/25) provided sufficient but not strong evidence to support recommendations or suggestions, and 29.1% (16/55) provided strong evidence to support or reject the use of 1 or more of the interventions studied. Most of the systematic reviews published by the Cochrane Skin Group provide useful information to improve clinical practice. Clinicians should read these reviews and reconsider their current practice. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

Randomised trial of personalised computer based information for cancer patients

PubMed Central

Jones, Ray; Pearson, Janne; McGregor, Sandra; Cawsey, Alison J; Barrett, Ann; Craig, Neil; Atkinson, Jacqueline M; Gilmour, W Harper; McEwen, Jim

1999-01-01

Objective To compare the use and effect of a computer based information system for cancer patients that is personalised using each patient's medical record with a system providing only general information and with information provided in booklets. Design Randomised trial with three groups. Data collected at start of radiotherapy, one week later (when information provided), three weeks later, and three months later. Participants 525 patients started radical radiotherapy; 438 completed follow up. Interventions Two groups were offered information via computer (personalised or general information, or both) with open access to computer thereafter; the third group was offered a selection of information booklets. Outcomes Patients' views and preferences, use of computer and information, and psychological status; doctors' perceptions; cost of interventions. Results More patients offered the personalised information said that they had learnt something new, thought the information was relevant, used the computer again, and showed their computer printouts to others. There were no major differences in doctors' perceptions of patients. More of the general computer group were anxious at three months. With an electronic patient record system, in the long run the personalised information system would cost no more than the general system. Full access to booklets cost twice as much as the general system. Conclusions Patients preferred computer systems that provided information from their medical records to systems that just provided general information. This has implications for the design and implementation of electronic patient record systems and reliance on general sources of patient information. PMID:10550090

Apolipoprotein nanodiscs with telodendrimer

DOEpatents

Luo, Juntao; He, Wei; Lam, Kit S.; Henderson, Paul; Coleman, Matthew; Cheng, R. Holland; Xing, Li

2017-05-09

The present invention provides a nanodisc with a membrane scaffold protein. The nanodisc includes a membrane scaffold protein, a telodendrimer and a lipid. The membrane scaffold protein can be apolipoprotein. The telodendrimer has the general formula PEG-L-D-(R).sub.n, wherein D is a dendritic polymer; L is a bond or a linker linked to the focal point group of the dendritic polymer; each PEG is a poly(ethylene glycol) polymer; each R is and end group of the dendritic polymer, or and end group with a covalently bound hydrophobic group, hydrophilic group, amphiphilic compound, or drug; and subscript n is an integer from 2 to 20. Cell free methods of making the nanodiscs are also provided.

Using interactive theatre to help fertility providers better understand sexual and gender minority patients.

PubMed

Tarasoff, Lesley A; Epstein, Rachel; Green, Datejie C; Anderson, Scott; Ross, Lori E

2014-12-01

To determine the effectiveness of interactive theatre as a knowledge translation and exchange (KTE) method to educate assisted human reproduction (AHR) service providers about lesbian, gay, bisexual, trans and queer (LGBTQ) patients. We transformed data from the 'Creating Our Families' study, a qualitative, community-based study of LGBTQ peoples' experiences accessing AHR services, into a script for an interactive theatre workshop for AHR service providers. Based on forum theatre principles, our workshop included five scenes illustrating LGBTQ people interacting with service providers, followed by audience interventions to these scenes. Before and after the workshop, service providers completed surveys to assess their knowledge and comfort concerning LGBTQ patients, as well as the modality of the interactive theatre workshop as a KTE strategy. Wilcoxon signed-rank tests were used to determine changes in preworkshop and postworkshop knowledge and comfort scores. Thirty AHR service providers attended the workshop. Twenty-three service providers (76.7%) fully completed the preworkshop and postworkshop evaluation forms. Service providers' knowledge scores significantly improved after the workshop, while their comfort scores minimally decreased. Most agreed that the interactive workshop was an effective KTE method. In comparison with traditional forms of KTE, interactive theatre may be particularly effective in engaging service providers and addressing their attitudes towards marginalised patient populations. Although the evaluation results of our interactive workshop were mostly positive, the long-term impact of the workshop is unknown. Long-term evaluations are needed to determine the effectiveness of arts-based KTE efforts. Other considerations for developing effective arts-based KTE strategies include adequate funding, institutional support, attention to power dynamics and thoughtful collaboration with forum theatre experts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effectiveness of the WHO SCC on improving adherence to essential practices during childbirth, in resource constrained settings.

PubMed

Kumar, Somesh; Yadav, Vikas; Balasubramaniam, Sudharsanam; Jain, Yashpal; Joshi, Chandra Shekhar; Saran, Kailash; Sood, Bulbul

2016-11-08

India accounts for 27 % of world's neonatal deaths. Although more Indian women deliver in facilities currently than a decade ago, early neonatal mortality has not declined, likely because of insufficient quality of care. The WHO Safe Childbirth Checklist (SCC) was developed to support health workers to perform essential practices known to reduce preventable maternal and new-born deaths around the time of childbirth. Despite promising early research many outstanding questions remain about effectiveness of the SCC in low-resource settings. In collaboration with the Ministry of Health SCC was modified for Indian context and introduced in 101 intervention facilities in Rajasthan, India and 99 facilities served as comparison to study if it reduces mortality. This Quasi experimental Observational intervention-comparison was embedded in this larger program to test whether a program for introduction of SCC with simple implementation package was associated with increased adherence to 28 evidence-based practices. This study was conducted in 8 intervention and 8 comparison sites. Program interventions to promote appropriate use of the SCC included orienting providers to the checklist, modest modifications of the SCC to promote provider uptake and accountability, ensuring availability of essential supplies, and providing supportive supervision for helping providers in using the SCC. The SCC was used by providers in 86 % of 240 deliveries observed in the eight intervention facilities. Providers in the intervention group significantly adhered to practices included in the SCC than providers in the comparison group controlling for baseline scores and confounders. Women delivering in the intervention facilities received on an average 11.5 more of the 28 practices included compared with women in the comparison facilities. For selected practices provider performance in the intervention group increased as much as 93 % than comparison sites. Use of the SCC and provider performance of best practices increased in intervention facilities reflecting improvement in quality of facility childbirth care for women and new-born in low resource settings.

Reflections: The Value of Patient Support Groups.

PubMed

Hu, Amanda

2017-04-01

A patient support group is defined as "a group of people with common experiences and concerns who provide emotional and moral support for one another." Support groups fulfill many functions: educating patients/family, sharing the illness experience, providing strength to its members, raising public awareness, and fundraising. Some research has shown an improvement in quality of life of patients with head and neck cancer who have participated in support groups. A wide variety of support groups are available for otolaryngology patients, ranging from head and neck oncology to tinnitus and spasmodic dysphonia. Some support groups are face-to-face, while others use social media and the Internet. Surprisingly, engagement in patient support groups is low-about 10%. Some barriers to accessing support groups are awareness, time constraints, and confrontation of negative aspects of the disease. As otolaryngologists, we can help our patients access support groups so that they can benefit from these resources.

Creating Fantastic PI Workshops

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

Biedermann, Laura B.; Clark, Blythe G.; Colbert, Rachel S.

The goal of this SAND report is to provide guidance for other groups hosting workshops and peerto-peer learning events at Sandia. Thus this SAND report provides detail about our team structure, how we brainstormed workshop topics and developed the workshop structure. A Workshop “Nuts and Bolts” section provides our timeline and check-list for workshop activities. The survey section provides examples of the questions we asked and how we adapted the workshop in response to the feedback.

A qualitative description of service providers' experiences of ethical issues in HIV care.

PubMed

Sabone, Motshedisi B; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther I; Corless, Inge B; Cuca, Yvette P; Holzemer, William L; Dawson-Rose, Carol; Baez, Solymar S Soliz; Rivero-Mendz, Marta; Webel, Allison R; Eller, Lucille Sanzero; Reid, Paula; Johnson, Mallory O; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice K; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, Ellen

2018-01-01

Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Mantis BT Cluster Support

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

Riot, V.

2009-06-05

The software is a modidication to the Mantis BT V1.5 open source application provided by the mantis BT group to support cluster web servers. It also provides various cosmetic modifications used a LLNL.

A neoliberalisation of civil society? Self-help groups and the labouring class poor in rural South India.

PubMed

Pattenden, Jonathan

2010-01-01

This paper notes the prominence of self-help groups (SHGs) within current anti-poverty policy in India, and analyses the impacts of government- and NGO-backed SHGs in rural North Karnataka. It argues that self-help groups represent a partial neoliberalisation of civil society in that they address poverty through low-cost methods that do not challenge the existing distribution of power and resources between the dominant class and the labouring class poor. It finds that intra-group savings and loans and external loans/subsidies can provide marginal economic and political gains for members of the dominant class and those members of the labouring classes whose insecure employment patterns currently provide above poverty line consumption levels, but provide neither material nor political gains for the labouring class poor. Target-oriented SHG catalysts are inattentive to how the social relations of production reproduce poverty and tend to overlook class relations and socio-economic and political differentiation within and outside of groups, which are subject to interference by dominant class local politicians and landowners.

NASA Musculoskeletal Space Medicine and Reconditioning Program

NASA Technical Reports Server (NTRS)

Kerstman, Eric; Scheuring, Richard

2011-01-01

The Astronaut Strength, Conditioning, and Rehabilitation (ASCR) group is comprised of certified strength and conditioning coaches and licensed and certified athletic trainers. The ASCR group works within NASA s Space Medicine Division providing direction and supervision to the astronaut corp with regards to physical readiness throughout all phases of space flight. The ASCR group is overseen by flight surgeons with specialized training in sports medicine or physical medicine and rehabilitation. The goals of the ASCR group include 1) designing and administering strength and conditioning programs that maximize the potential for physical performance while minimizing the rate of injury, 2) providing appropriate injury management and rehabilitation services, 3) collaborating with medical, research, engineering, and mission operations groups to develop and implement safe and effective in-flight exercise countermeasures, and 4) providing a structured, individualized post-flight reconditioning program for long duration crew members. This Panel will present the current approach to the management of musculoskeletal injuries commonly seen within the astronaut corp and will present an overview of the pre-flight physical training, in-flight exercise countermeasures, and post-flight reconditioning program for ISS astronauts.

The health information literacy research project.

PubMed

Shipman, Jean P; Kurtz-Rossi, Sabrina; Funk, Carla J

2009-10-01

This research studied hospital administrators' and hospital-based health care providers' (collectively, the target group) perceived value of consumer health information resources and of librarians' roles in promoting health information literacy in their institutions. A web-based needs survey was developed and administered to hospital administrators and health care providers. Multiple health information literacy curricula were developed. One was pilot-tested by nine hospital libraries in the United States and Canada. Quantitative and qualitative methods were used to evaluate the curriculum and its impact on the target group. A majority of survey respondents believed that providing consumer health information resources was critically important to fulfilling their institutions' missions and that their hospitals could improve health information literacy by increasing awareness of its impact on patient care and by training staff to become more knowledgeable about health literacy barriers. The study showed that a librarian-taught health information literacy curriculum did raise awareness about the issue among the target group and increased both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support. It is hoped that many hospital administrators and health care providers will take the health information literacy curricula and recognize that librarians can educate about the topic and that providers will use related consumer health services and resources.

Perspectives on Wellness Self-Monitoring Tools for Older Adults

PubMed Central

Huh, Jina; Le, Thai; Reeder, Blaine; Thompson, Hilaire J.; Demiris, George

2013-01-01

Purpose Our purpose was to understand different stakeholder perceptions about the use of self-monitoring tools, specifically in the area of older adults’ personal wellness. In conjunction with the advent of personal health records, tracking personal health using self-monitoring technologies shows promising patient support opportunities. While clinicians’ tools for monitoring of older adults have been explored, we know little about how older adults may self-monitor their wellness and health and how their health care providers would perceive such use. Methods We conducted three focus groups with health care providers (n=10) and four focus groups with community-dwelling older adults (n=31). Results Older adult participants’ found the concept of self-monitoring unfamiliar and this influenced a narrowed interest in the use of wellness self-monitoring tools. On the other hand, health care provider participants showed open attitudes towards wellness monitoring tools for older adults and brainstormed about various stakeholders’ use cases. The two participant groups showed diverging perceptions in terms of: perceived uses, stakeholder interests, information ownership and control, and sharing of wellness monitoring tools. Conclusions Our paper provides implications and solutions for how older adults’ wellness self-monitoring tools can enhance patient-health care provider interaction, patient education, and improvement in overall wellness. PMID:24041452

Perspectives on wellness self-monitoring tools for older adults.

PubMed

Huh, Jina; Le, Thai; Reeder, Blaine; Thompson, Hilaire J; Demiris, George

2013-11-01

Our purpose was to understand different stakeholder perceptions about the use of self-monitoring tools, specifically in the area of older adults' personal wellness. In conjunction with the advent of personal health records, tracking personal health using self-monitoring technologies shows promising patient support opportunities. While clinicians' tools for monitoring of older adults have been explored, we know little about how older adults may self-monitor their wellness and health and how their health care providers would perceive such use. We conducted three focus groups with health care providers (n=10) and four focus groups with community-dwelling older adults (n=31). Older adult participants' found the concept of self-monitoring unfamiliar and this influenced a narrowed interest in the use of wellness self-monitoring tools. On the other hand, health care provider participants showed open attitudes toward wellness monitoring tools for older adults and brainstormed about various stakeholders' use cases. The two participant groups showed diverging perceptions in terms of: perceived uses, stakeholder interests, information ownership and control, and sharing of wellness monitoring tools. Our paper provides implications and solutions for how older adults' wellness self-monitoring tools can enhance patient-health care provider interaction, patient education, and improvement in overall wellness. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

An anthropological analysis of the perspectives of Somali women in the West and their obstetric care providers on caesarean birth.

PubMed

Essén, Birgitta; Binder, Pauline; Johnsdotter, Sara

2011-03-01

We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

The Health Information Literacy Research Project*

PubMed Central

Kurtz-Rossi, Sabrina; Funk, Carla J.

2009-01-01

Objectives: This research studied hospital administrators' and hospital-based health care providers' (collectively, the target group) perceived value of consumer health information resources and of librarians' roles in promoting health information literacy in their institutions. Methods: A web-based needs survey was developed and administered to hospital administrators and health care providers. Multiple health information literacy curricula were developed. One was pilot-tested by nine hospital libraries in the United States and Canada. Quantitative and qualitative methods were used to evaluate the curriculum and its impact on the target group. Results: A majority of survey respondents believed that providing consumer health information resources was critically important to fulfilling their institutions' missions and that their hospitals could improve health information literacy by increasing awareness of its impact on patient care and by training staff to become more knowledgeable about health literacy barriers. The study showed that a librarian-taught health information literacy curriculum did raise awareness about the issue among the target group and increased both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support. Conclusions: It is hoped that many hospital administrators and health care providers will take the health information literacy curricula and recognize that librarians can educate about the topic and that providers will use related consumer health services and resources. PMID:19851494

iMuseumA: An Agent-Based Context-Aware Intelligent Museum System

PubMed Central

Ayala, Inmaculada; Amor, Mercedes; Pinto, Mónica; Fuentes, Lidia; Gámez, Nadia

2014-01-01

Currently, museums provide their visitors with interactive tour guide applications that can be installed in mobile devices and provide timely tailor-made multimedia information about exhibits on display. In this paper, we argue that mobile devices not only could provide help to visitors, but also to museum staff. Our goal is to integrate, within the same system, multimedia tour guides with the management facilities required by museums. In this paper, we present iMuseumA (intelligent museum with agents), a mobile-based solution to customize visits and perform context-aware management tasks. iMuseumA follows an agent-based approach, which makes it possible to interact easily with the museum environment and make decisions based on its current status. This system is currently deployed in the Museum of Informatics at the Informatics School of the University of Málaga, and its main contributions are: (i) a mobile application that provides management facilities to museum staff by means of sensing and processing environmental data; (ii) providing an integrated solution for visitors, tour guides and museum staff that allows coordination and communication enrichment among different groups of users; (iii) using and benefiting from group communication for heterogeneous groups of users that can be created on demand. PMID:25390409

My approach to performing a perinatal or neonatal autopsy

PubMed Central

Wainwright, H C

2006-01-01

An opportunity to determine the cause of death, factors that may have a role in it, and the extent and cause of malformations is provided by perinatal autopsy. The family may be assisted in finding closure after the death of their infant by the information obtained. Insight into classifying infants appearing normal into one of three groups, small, appropriate and large for gestational age, has been provided, as each group tends to have specific causes of death. In infants with congenital anomalies, patterns of malformation may lead us to the diagnosis. An accurate diagnosis is required to provide counselling for a subsequent pregnancy. PMID:16803946

Modified carbohydrate-chitosan compounds, methods of making the same and methods of using the same

DOEpatents

Venditti, Richard A; Pawlak, Joel J; Salam, Abdus; El-Tahlawy, Khaled Fathy

2015-03-10

Compositions of matter are provided that include chitosan and a modified carbohydrate. The modified carbohydrate includes a carbohydrate component and a cross linking agent. The modified carbohydrate has increased carboxyl content as compared to an unmodified counterpart carbohydrate. A carboxyl group of the modified carbohydrate is covalently bonded with an amino group of chitosan. The compositions of matter provided herein may include cross linked starch citrate-chitosan and cross linked hemicellulose citrate-chitosan, including foams thereof. These compositions yield excellent absorbency and metal chelation properties. Methods of making cross linked modified carbohydrate-chitosan compounds are also provided.

Early experience with a new model of employer group purchasing in Minnesota.

PubMed

Christianson, J; Feldman, R; Weiner, J P; Drury, P

1999-01-01

The Buyers Health Care Action Group (BHCAG) in the Twin Cities has implemented a new purchasing initiative that offers employees a choice among care systems with nonoverlapping networks of primary care providers. These systems offer a standardized benefit package, submit annual bids, and are paid on a risk-adjusted basis. Employees are provided with information on quality and other differences among systems, and most have financial incentives to choose lower-cost systems. Generally, providers have responded favorably to direct contracting and to risk-adjusted payments but have concerns about the risk-adjustment mechanism used and, more importantly, the strength of employers' commitment to the purchasing model.

Customer advisory groups: another way to listen to the marketplace.

PubMed

Gombeski, William R; Taylor, Jan; Britt, Jason; Riggs, Karen; Wray, Tanya; Springate, Suzanne; Blair, Geoff; Bernard, Phil

2010-01-01

Customer advisory groups (CAGs) are formal groups of customers (referring physicians, patients, health insurance brokers, etc.) who meet regularly to share their ideas and to provide feedback to proposed or existing marketing strategies, programs, and activities. While CAGs are very prevalent in other industries they appear to be relatively underutilized in health care. This article provides an overview of how CAGs work, their advantages and disadvantages, tips on how to make them work better, and insights from interviews with 39 healthcare chief marketing officers on their use of CAGs.

Software for the grouped optimal aggregation technique

NASA Technical Reports Server (NTRS)

Brown, P. M.; Shaw, G. W. (Principal Investigator)

1982-01-01

The grouped optimal aggregation technique produces minimum variance, unbiased estimates of acreage and production for countries, zones (states), or any designated collection of acreage strata. It uses yield predictions, historical acreage information, and direct acreage estimate from satellite data. The acreage strata are grouped in such a way that the ratio model over historical acreage provides a smaller variance than if the model were applied to each individual stratum. An optimal weighting matrix based on historical acreages, provides the link between incomplete direct acreage estimates and the total, current acreage estimate.

Solar Electric Propulsion (SEP) Systems for SMD Mission Needs. Technology Infusion Study.

NASA Technical Reports Server (NTRS)

Anderson, David

2014-01-01

Two presentations for SBAG and OPAG meetings: 1) Solar Electric Propulsion Systems for SMD Missions, and 2) Technology Infusion Study - Draft Findings Recommendation Small Bodies Assessment Group (SBAG) meeting is January 9th in Washington D.C., and the Outer Planets Assessment Group (OPAG) meeting is January 23-14 in Tucson, AZ. NASA sponsors these assessment groups, through the NRC, for the science community to assess and provide advice. These talks are to provide a status of 2 NASA activities, and to seek feedback from the respective science communities.

Analytic Considerations and Design Basis for the IEEE Distribution Test Feeders

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

Schneider, K. P.; Mather, B. A.; Pal, B. C.

For nearly 20 years the Test Feeder Working Group of the Distribution System Analysis Subcommittee has been developing openly available distribution test feeders for use by researchers. The purpose of these test feeders is to provide models of distribution systems that reflect the wide diversity in design and their various analytic challenges. Because of their utility and accessibility, the test feeders have been used for a wide range of research, some of which has been outside the original scope of intended uses. This paper provides an overview of the existing distribution feeder models and clarifies the specific analytic challenges thatmore » they were originally designed to examine. Additionally, the paper will provide guidance on which feeders are best suited for various types of analysis. The purpose of this paper is to provide the original intent of the Working Group and to provide the information necessary so that researchers may make an informed decision on which of the test feeders are most appropriate for their work.« less

Analytic Considerations and Design Basis for the IEEE Distribution Test Feeders

DOE PAGES

Schneider, K. P.; Mather, B. A.; Pal, B. C.; ...

2017-10-10

For nearly 20 years the Test Feeder Working Group of the Distribution System Analysis Subcommittee has been developing openly available distribution test feeders for use by researchers. The purpose of these test feeders is to provide models of distribution systems that reflect the wide diversity in design and their various analytic challenges. Because of their utility and accessibility, the test feeders have been used for a wide range of research, some of which has been outside the original scope of intended uses. This paper provides an overview of the existing distribution feeder models and clarifies the specific analytic challenges thatmore » they were originally designed to examine. Additionally, the paper will provide guidance on which feeders are best suited for various types of analysis. The purpose of this paper is to provide the original intent of the Working Group and to provide the information necessary so that researchers may make an informed decision on which of the test feeders are most appropriate for their work.« less

Development of a recovery education program for inpatient mental health providers.

PubMed

Chen, Shu-Ping; Krupa, Terry; Lysaght, Rosemary; McCay, Elizabeth; Piat, Myra

2014-12-01

Mental health system transformation toward a recovery-orientation has created a demand for education to equip providers with recovery competencies. This report describes the development of a recovery education program designed specifically for inpatient providers. Part 1 of the education is a self-learning program introducing recovery concepts and a recovery competency framework; Part 2 is a group-learning program focusing on real-life dilemmas and applying the Appreciative Inquiry approach to address these clinical dilemmas. A pilot study with a pretest/posttest design was used to evaluate the program. Participants included 26 inpatient multidisciplinary providers from 3 hospitals. The results showed participants' improvement on recovery knowledge (z = -2.55, p = .011) after the self-learning program. Evaluations of the group-learning program were high (4.21 out of 5). These results support continued efforts to refine the program. Inpatient providers could use this program to lead interprofessional practice in promoting recovery. (c) 2014 APA, all rights reserved.

Creating a Regional Healthcare Network: People First.

PubMed

Michel-Verkerke, Margreet B

2016-01-01

Care organizations in the Dutch region Apeldoorn want to collaborate more in order to improve the care provision to elderly and psychiatric patients living independently. In order to support the collaboration they intend to create a regional digital healthcare network. The research was focused on the relevance of a regional healthcare network for care providers. Eleven semi-structured interviews based on the USE IT-model, were conducted with care providers and staff members. Results show that care providers need to tune their activities for this target group and create an agreement on integrated care. The relevance of a digital communication and collaboration platform is high. The regional healthcare network should support the collaboration between care providers by: 1. Offering a communication platform to replace the time consuming communication by telephone; 2. Making patient information available for patient and care provider at patients' homes; 3. Giving insight in who is giving what care to whom; and 4. Giving access to knowledge about the target group: elderly and psychiatric patients living independently.

Current status of psychiatric rehabilitation in Portugal: A national survey.

PubMed

Teixeira, Carina; Santos, Eduardo; Abreu, Manuel Viegas; Rogers, E Sally

2015-09-01

This article reports on the current state of psychiatric rehabilitation in Portugal. A paper-and-pencil survey was sent to 70 institutions to inquire about the provision of psychiatric rehabilitation services and programs. With a response rate of 40%, 14% of institutions indicated that supported education was provided, 36% offered nonmainstream vocational training, and 29% provided supported employment; none provided evidence-based Individual Placement and Support. Permanent group homes in the community (29%) followed by transitional group homes on institutional grounds (18%) were the most common residential services, with supported housing services (14%) offered less frequently. Finally, 93% of institutions offered occupational activities, 61% provided multifamily psychoeducation, and 36% provided single-family psychoeducation. Despite recent national initiatives promoting effective psychiatric rehabilitation services, supported employment, supported education, and supported housing are not widely implemented in Portugal. To achieve better outcomes for clients, it is critical that evidence-based and promising practices be extensively disseminated. (c) 2015 APA, all rights reserved).

Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care

PubMed Central

Hoben, Matthias; Estabrooks, Carole A.; Squires, Janet E.; Behrens, Johann

2016-01-01

We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90–0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group. PMID:27656156

Archaeal phylogenomics provides evidence in support of a methanogenic origin of the Archaea and a thaumarchaeal origin for the eukaryotes

PubMed Central

Kelly, S.; Wickstead, B.; Gull, K.

2011-01-01

We have developed a machine-learning approach to identify 3537 discrete orthologue protein sequence groups distributed across all available archaeal genomes. We show that treating these orthologue groups as binary detection/non-detection data is sufficient to capture the majority of archaeal phylogeny. We subsequently use the sequence data from these groups to infer a method and substitution-model-independent phylogeny. By holding this phylogeny constrained and interrogating the intersection of this large dataset with both the Eukarya and the Bacteria using Bayesian and maximum-likelihood approaches, we propose and provide evidence for a methanogenic origin of the Archaea. By the same criteria, we also provide evidence in support of an origin for Eukarya either within or as sisters to the Thaumarchaea. PMID:20880885

Buffer layers for coated conductors

DOEpatents

Stan, Liliana [Los Alamos, NM; Jia, Quanxi [Los Alamos, NM; Foltyn, Stephen R [Los Alamos, NM

2011-08-23

A composite structure is provided including a base substrate, an IBAD oriented material upon the base substrate, and a cubic metal oxide material selected from the group consisting of rare earth zirconates and rare earth hafnates upon the IBAD oriented material. Additionally, an article is provided including a base substrate, an IBAD oriented material upon the base substrate, a cubic metal oxide material selected from the group consisting of rare earth zirconates and rare earth hafnates upon the IBAD oriented material, and a thick film upon the cubic metal oxide material. Finally, a superconducting article is provided including a base substrate, an IBAD oriented material upon the base substrate, a cubic metal oxide material selected from the group consisting of rare earth zirconates and rare earth hafnates upon the IBAD oriented material, and an yttrium barium copper oxide material upon the cubic metal oxide material.

[Evaluation of a medication self-management education program for elders with hypertension living in the community].

PubMed

Lee, Jong Kyung

2013-04-01

The purpose of this study was to examine the effect of a medication self-management education program on medication awareness, communication with health care provider, medication misuse behavior, and blood pressure in elders with hypertension. The research design for this study was a non-equivalent control group quasi-experimental design. Participants were 23 elders for the control group, and 26 elders for the experimental group. The experimental group participated in the medication self-management education program which included the following, verbal education, 1:1 consultation, practice in medication self-management, and discussion over 5 sessions. Data were analyzed using the SPSS 18.0 program. There were statistically significant differences between the experimental and control group for medication awareness, medication misuse behavior, and communication with health care providers. However, no significant difference was found between the two groups for blood pressure. The results indicate that the education program is effective in improving medication awareness and communication with health care providers and in decreasing medication misuse behavior. Therefore, it is recommended that this education program be used as an effective intervention for improving medication self-management for elders with hypertension.

Interrater reliability of early intervention providers scoring the alberta infant motor scale.

PubMed

Blanchard, Y; Neilan, E; Busanich, J; Garavuso, L; Klimas, D

2004-01-01

This study was designed to examine the interrater reliability of early intervention providers scoring of the Alberta Infant Motor Scale (AIMS) and to examine whether training on the AIMS would improve their interrater reliability. Eight early intervention providers were randomly assigned to two groups. Participants in Group 1 scored the AIMS on seven videotapes of infants prior to receiving training and after training on another set of seven videotapes of infants. Participants in Group 2 scored the AIMS on all 14 videotapes of the infants after receiving training. Overall interrater reliability before and after training was high with intraclass correlation coefficients ranging from 0.98 to 0.99. Detailed examination of the results showed that training improved the reliability of the supine subscale in a subgroup of infants between the ages of five and seven months. Training also had an effect on the classification of infants as normal or abnormal in their motor development based on their percentile rankings. The AIMS manual provides sufficient information to attain high interrater reliability without training, but revisions regarding scoring are strongly recommended.

Visiting Vehicle Ground Trajectory Tool

NASA Technical Reports Server (NTRS)

Hamm, Dustin

2013-01-01

The International Space Station (ISS) Visiting Vehicle Group needed a targeting tool for vehicles that rendezvous with the ISS. The Visiting Vehicle Ground Trajectory targeting tool provides the ability to perform both realtime and planning operations for the Visiting Vehicle Group. This tool provides a highly reconfigurable base, which allows the Visiting Vehicle Group to perform their work. The application is composed of a telemetry processing function, a relative motion function, a targeting function, a vector view, and 2D/3D world map type graphics. The software tool provides the ability to plan a rendezvous trajectory for vehicles that visit the ISS. It models these relative trajectories using planned and realtime data from the vehicle. The tool monitors ongoing rendezvous trajectory relative motion, and ensures visiting vehicles stay within agreed corridors. The software provides the ability to update or re-plan a rendezvous to support contingency operations. Adding new parameters and incorporating them into the system was previously not available on-the-fly. If an unanticipated capability wasn't discovered until the vehicle was flying, there was no way to update things.

An Education Intervention to Enhance Staff Self-Efficacy to Provide Dementia Care in an Acute Care Hospital in Canada

PubMed Central

Gillies, Leslie; Coker, Esther; Pizzacalla, Anne; Montemuro, Maureen; Suva, Grace; McLelland, Victoria

2016-01-01

Education is needed for enhanced capacity of acute hospitals to provide dementia care. A nonrandomized controlled, repeated-measures design was used to evaluate a dementia education program delivered to an intervention group (IG, n = 468), compared to a wait-listed group (n = 277), representing separate sites of a multisite hospital. Participants completed self-efficacy for dementia and satisfaction measures and provided written descriptions of dementia care collected at baseline, postintervention (IG only), and at 8-week follow-up. Oral narratives were gathered from IG participants 8 weeks postintervention. The IG demonstrated significant improvement in self-efficacy scores from baseline to immediately postintervention (P < .001), sustained at 8 weeks. There were no changes from baseline to 8 weeks postintervention evident in the wait-listed group (P = .21). Intervention group participants described positive impacts including implementation of person-centered care approaches. Implementation of dementia care education programs throughout hospital settings is promising for the enhancement of dementia care. PMID:27659392

Porous Cross-Linked Polyimide Networks

NASA Technical Reports Server (NTRS)

Meador, Mary Ann B. (Inventor); Guo, Haiquan (Inventor)

2015-01-01

Porous cross-linked polyimide networks are provided. The networks comprise an anhydride end-capped polyamic acid oligomer. The oligomer (i) comprises a repeating unit of a dianhydride and a diamine and terminal anhydride groups, (ii) has an average degree of polymerization of 10 to 50, (iii) has been cross-linked via a cross-linking agent, comprising three or more amine groups, at a balanced stoichiometry of the amine groups to the terminal anhydride groups, and (iv) has been chemically imidized to yield the porous cross-linked polyimide network. Also provided are porous cross-linked polyimide aerogels comprising a cross-linked and imidized anhydride end-capped polyamic acid oligomer, wherein the oligomer comprises a repeating unit of a dianhydride and a diamine, and the aerogel has a density of 0.10 to 0.333 g/cm.sup.3 and a Young's modulus of 1.7 to 102 MPa. Also provided are thin films comprising aerogels, and methods of making porous cross-linked polyimide networks.

Grooming as a reward? Social function of grooming between females in cooperatively breeding marmosets

PubMed Central

LAZARO-PEREA, CRISTINA; DE FÁTIMA ARRUDA, MARIA; SNOWDON, CHARLES T.

2006-01-01

Classical models of grooming predict that subordinate primates will direct grooming towards dominants to receive coalitionary support from them. In contrast, recent reviews suggest that grooming asymmetries can change with social system and ecological conditions and should reflect asymmetries in services provided by different members of the dyad. We studied grooming patterns between females in six wild groups of common marmosets, Callithrix jacchus, to investigate the relation between social structure and grooming between females in a cooperatively breeding species. We observed grooming frequently and consistently in all study groups. Breeding females groomed nonbreeding females more than vice versa, and grooming between breeding and nonbreeding females was not related to agonistic behaviour. Our results provide some support to the hypothesis that grooming asymmetries are related to differences in services provided by different group members. We suggest that, in cooperatively breeding systems, breeding females may use grooming as an incentive for helper females to stay in the group. PMID:17237884

Facilitators and Barriers to Dental Care Among Mexican Migrant Women and Their Families in North San Diego County.

PubMed

Velez, Diane; Palomo-Zerfas, Ana; Nunez-Alvarez, Arcela; Ayala, Guadalupe X; Finlayson, Tracy L

2017-10-01

To qualitatively examine facilitators and barriers to dental care access and quality services among Mexican migrant women and their families living in North San Diego County, California. Six focus groups were conducted, with 52 participants. Three focus groups were with community residents (average group size of 10), and three were with community health workers/leaders (called Lideres; average group size of 7). The behavioral model for vulnerable populations theoretical framework guided qualitative data analyses. Predisposing factors to dental care access varied and included immigration status, language, and dental care experiences. Barriers to accessing quality dental services included high cost, lack of insurance coverage, dissatisfaction with providers, long wait times and discrimination. Participants expressed a desire for health policy changes, including affordable coverage for immigrants and their families. This study provided insights into how dental care providers, community health centers, and policymakers can improve dental care access and services to migrant populations.

Subsidies and Levies as Policy Instruments to Encourage Employer-Provided Training. OECD Education Working Papers, No. 80

ERIC Educational Resources Information Center

Muller, Normann; Behringer, Friederike

2012-01-01

This paper provides an overview of the available information concerning selected policy instruments intended to promote employer-provided training, including the stated rationale and objectives, the target groups and operational design as well as a at a summary of the evaluative evidence regarding their operation. The analysis focuses on policy…

Practical Strategies for Making Online Library Services and Instruction Accessible to All Patrons

ERIC Educational Resources Information Center

Wray, Christina C.

2013-01-01

Providing accessible library services and instruction to distance users with disabilities can seem daunting. This article, which grew out of a webinar presented by the author to the Health Science Special Interest Group of ACRL, provides practical strategies to help content creators utilize built-in accessibility features and provides a resources…

Public Notice 2017-18: Seagis Property Group

EPA Pesticide Factsheets

EPA is providing notice of a proposed administrative penalty assessment for alleged violations of the Clean Water Act (Act). EPA is also providing notice of opportunity to comment on the proposed penalty assessment.

42 CFR 438.12 - Provider discrimination prohibited.

Code of Federal Regulations, 2012 CFR

2012-10-01

... designed to maintain quality of services and control costs and are consistent with its responsibilities to..., or PAHP declines to include individual or groups of providers in its network, it must give the...

42 CFR 438.12 - Provider discrimination prohibited.

Code of Federal Regulations, 2014 CFR

2014-10-01

... designed to maintain quality of services and control costs and are consistent with its responsibilities to..., or PAHP declines to include individual or groups of providers in its network, it must give the...

Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial.

PubMed

Hoddinott, Pat; Britten, Jane; Prescott, Gordon J; Tappin, David; Ludbrook, Anne; Godden, David J

2009-01-30

To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women. Cluster randomised controlled trial with prospective mixed method embedded case studies to evaluate implementation processes. Primary care in Scotland. Pregnant women, breastfeeding mothers, and babies registered with 14 of 66 eligible clusters of general practices (localities) in Scotland that routinely collect breastfeeding outcome data. Localities set up new breastfeeding groups to provide population coverage; control localities did not change group activity. any breast feeding at 6-8 weeks from routinely collected data for two pre-trial years and two trial years. any breast feeding at birth, 5-7 days, and 8-9 months; maternal satisfaction. Between 1 February 2005 and 31 January 2007, 9747 birth records existed for intervention localities and 9111 for control localities. The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found. Any breast feeding at 6-8 weeks declined from 27% to 26% in intervention localities and increased from 29% to 30% in control localities (P=0.08, adjusted for pre-trial rate). Any breast feeding at 6-8 weeks increased from 38% to 39% in localities not participating in the trial. Women who attended breastfeeding groups were older (P<0.001) than women initiating breast feeding who did not attend and had higher income (P=0.02) than women in the control localities who attended postnatal groups. The locality cost was pound13 400 (euro14 410; $20 144) a year. A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6-8 weeks. The costs of running groups would be similar to the costs of visiting women at home. Current Controlled Trials ISRCTN44857041.

Endocrinologists' Opinions of Diabetology as a Primary Care Subspecialty.

PubMed

Healy, Amber M; Shubrook, Jay H; Schwartz, Frank L; Cummings, Doyle M; Drake, Almond J; Tanenberg, Robert J

2018-04-01

IN BRIEF This study was conducted to ascertain the opinions of endocrinologists about diabetes care as it relates to the health care provider workforce. A survey was administered to endocrinologists in the Planning Research in Inpatient Diabetes and Planning Research in Outpatient Diabetes (PRIDE/PROUD) group and given to attendees of the American Diabetes Association (ADA) Scientific Sessions special interest group whose focus was primary care. The majority of respondents agreed that there is a need for more providers to be trained to take care of patients with diabetes and that more trained providers are needed, and almost half agreed that primary care providers (PCPs) with advanced training in diabetes should be part of the workforce for managing the diabetes pandemic. Expanding diabetes fellowship programs for PCPs remains an important potential solution for addressing workforce development needs in diabetes care.

Amount of kinematic feedback affects learning of speech motor skills.

PubMed

Ballard, Kirrie J; Smith, Heather D; Paramatmuni, Divija; McCabe, Patricia; Theodoros, Deborah G; Murdoch, Bruce E

2012-01-01

Knowledge of Performance (KP) feedback, such as biofeedback or kinematic feedback, is used to provide information on the nature and quality of movement responses for the purpose of guiding active learning or rehabilitation of motor skills. It has been proposed that KP feedback may interfere with long-term learning when provided throughout training. Here, twelve healthy English-speaking adults were trained to produce a trilled Russian [r] in words with KP kinematic feedback using electropalatography (EPG) and without KP (noKP). Five one-hour training sessions were provided over one week with testing pretraining and one day and one week posttraining. No group differences were found at pretraining or one day post training for production accuracy. A group by time interaction supported the hypothesis that providing kinematic feedback continually during skill acquisition interferes with retention.

Health care provider challenges for reaching Hispanic immigrants with HPV vaccination in rural Georgia.

PubMed

Luque, John S; Raychowdhury, Swati; Weaver, Mary

2012-01-01

The objective of this pilot study was to understand, from the Vaccines for Children (VFC) program provider's perspective, issues relating to vaccine access and compliance for Hispanic adolescents in a rural setting. Researchers conducted individual structured interviews with VFC providers and focus groups with Hispanic immigrant parents in rural southern Georgia. Overall, the VFC providers said that their Hispanic patients were very positive toward vaccines in general, but there were cost issues related to stocking the vaccine and reaching the Hispanic population. The focus group discussions revealed that most Hispanic parents were not aware of the existence of the human papilloma virus (HPV) vaccine, nor had they heard about the VFC program. Numerous vaccination barriers continue to impact HPV vaccine uptake in the Hispanic immigrant population in the US South.

HIV treatment in US prisons.

PubMed

Wakeman, Sarah E; Rich, Josiah D

2010-09-03

Arguably one of the most marginalized populations in our society, prisoners bear a disproportionate burden of infectious diseases, particularly HIV. In addition, groups known to be at an inordinately higher risk of HIV, including minorities, the addicted, the mentally ill and the impoverished are overrepresented among incarcerated populations. This concentration of HIV among groups that have been historically difficult to reach, with limited intersections with healthcare, provides an opportunity for testing, diagnosis, treatment, linkage to care and prevention. Providing HIV care within correctional facilities poses unique challenges. Barriers to confidentiality, access to medication and prior records, and lack of comprehensive discharge planning can serve as obstacles to providing optimal care. This article discusses the public health implications and importance of providing HIV care to prisoners, and also discusses the practicalities of working within an environment that poses particular barriers to care.

The mountains hold things in: the use of community research review work groups to address cancer disparities in Appalachia.

PubMed

Hutson, Sadie P; Dorgan, Kelly A; Phillips, Amber N; Behringer, Bruce

2007-11-01

To review regional findings about cancer disparities with grass roots community leaders in Appalachia and to identify perspectives about what makes the cancer experience unique in Appalachia. A community-based participatory approach that includes focus-group methodology. Work groups gathered in well-known community locations in northeastern Tennessee and southwestern Virginia. 22 lay adult community members (12 in Tennessee and 10 in Virginia), all of whom had a personal and community interest in cancer and were reputed as informal community leaders. Work groups engaged in a series of five sequential sessions designed to (a) review regional data about cancer disparities and identify perspectives about what makes the cancer experience unique in Appalachia, (b) promote dialogue between the work group members and healthcare providers to identify methods for improved collaboration, and (c) integrate the work group with regional efforts of the states' comprehensive cancer control plans. Four major themes emerged from the focus group sessions with each work group: cancer storytelling, cancer collectivism, healthcare challenges, and cancer expectations. The community research review work groups proved to be a successful method to disseminate information about regional cancer disparities. Study findings provide a unique foundation so that healthcare providers and researchers can begin to address cancer disparities in the Appalachian region. Nurses are in key positions to partner with trusted community leaders to address disparities across the cancer continuum in Appalachia.

Prediction of User Preference over Shared Control Paradigms for a Robotic Wheelchair

DTIC Science & Technology

2017-07-20

the experimentally -observed changes between subject groups and sessions, while providing unique insight into the relative contribution of task metrics...WHEELCHAIR, including the four tested shared- control paradigms. The correlation model and experimental results are provided in Sections IV and V. Section VI...paradigm-specific models. Moreover, we also observe differences between sub- ject groups —meaning that subjects’ evaluations of a control paradigm are

Problems With Deployment of Multi-Domained, Multi-Homed Mobile Networks

NASA Technical Reports Server (NTRS)

Ivancic, William D.

2008-01-01

This document describes numerous problems associated with deployment of multi-homed mobile platforms consisting of multiple networks and traversing large geographical areas. The purpose of this document is to provide insight to real-world deployment issues and provide information to groups that are addressing many issues related to multi-homing, policy-base routing, route optimization and mobile security - particularly those groups within the Internet Engineering Task Force.

[Multidimensional assessment of public health care services for adolescents in Chile].

PubMed

Williams, Catalina de T; Poblete, Fernando A; Baldrich, Francisca A

2012-09-01

Adolescents are an especially vulnerable age group in terms of behavioral issues and require skilled teams in health centers. To assess the quality of health services provided to teenage users in Primary Health Care. A study of multiple cases was carried out in two family health centers in Puente Alto, Chile. Health services delivered to adolescents were evaluated from the provider's perspective, through qualitative design of focus groups and interviews to the care teams at each centre. For technical quality, comparing electronic records of two tracer conditions (prenatal care and depression) with technical standards established by Delphi methodology and from teenage users perspective, through a survey of service satisfaction. In both centers, providers perceived a lack of training in adolescent care, a deficient preventive approach and a limited access to care. The technical evaluation showed an inappropriate recording of both tracer conditions. The instrument used to assess user satisfaction survey was reliable and showed that the best perceived issue was medical care and treatment, and the least perceived, was the access to the services. Professionals working in these health care facilities, feel unprepared to provide comprehensive approach to adolescents. The surveyed teenagers complained of limited access to care. Therefore this age group continues to be as a non-priority group for health care.

Nominal group technique: a brainstorming tool for identifying areas to improve pain management in hospitalized patients.

PubMed

Peña, Adolfo; Estrada, Carlos A; Soniat, Debbie; Taylor, Benjamin; Burton, Michael

2012-01-01

Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. Qualitative and quantitative group consensus using a brainstorming technique for quality improvement-the nominal group technique (NGT). One medical, 1 medical-surgical, and 1 surgical hospital unit at a large academic medical center. Nurses, resident physicians, patient care technicians, and unit clerks. Responses and ranking to the NGT question: "What causes uncontrolled pain in your unit?" Twenty-seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context-specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers. Copyright © 2011 Society of Hospital Medicine.

Monte Carlo simulations on marker grouping and ordering.

PubMed

Wu, J; Jenkins, J; Zhu, J; McCarty, J; Watson, C

2003-08-01

Four global algorithms, maximum likelihood (ML), sum of adjacent LOD score (SALOD), sum of adjacent recombinant fractions (SARF) and product of adjacent recombinant fraction (PARF), and one approximation algorithm, seriation (SER), were used to compare the marker ordering efficiencies for correctly given linkage groups based on doubled haploid (DH) populations. The Monte Carlo simulation results indicated the marker ordering powers for the five methods were almost identical. High correlation coefficients were greater than 0.99 between grouping power and ordering power, indicating that all these methods for marker ordering were reliable. Therefore, the main problem for linkage analysis was how to improve the grouping power. Since the SER approach provided the advantage of speed without losing ordering power, this approach was used for detailed simulations. For more generality, multiple linkage groups were employed, and population size, linkage cutoff criterion, marker spacing pattern (even or uneven), and marker spacing distance (close or loose) were considered for obtaining acceptable grouping powers. Simulation results indicated that the grouping power was related to population size, marker spacing distance, and cutoff criterion. Generally, a large population size provided higher grouping power than small population size, and closely linked markers provided higher grouping power than loosely linked markers. The cutoff criterion range for achieving acceptable grouping power and ordering power differed for varying cases; however, combining all situations in this study, a cutoff criterion ranging from 50 cM to 60 cM was recommended for achieving acceptable grouping power and ordering power for different cases.

Facilitating social support: member-leader communication in a breast cancer support group.

PubMed

Beck, Stephenson J; Keyton, Joann

2014-01-01

Early detection and treatment have resulted in more women surviving breast cancer; increased survivorship has also increased the need for breast cancer support groups (BCSG). The ostensible goal of such groups is to provide support for the physical and emotional stressors that cancer survivors face, as well as provide information on coping and treatment options. Although scholars have examined the effects of support groups on their group members, the examination of group facilitator messages has been largely neglected. The goal of this study was to extend theory on group leader behavior, specifically investigating how member-leader messages create social support in support groups. The transcribed conversations of weekly meetings of a BCSG were examined using Interaction Process Analysis to discover how the member-leader facilitated the group's enactment and management of social support. Across the meetings, task talk dominated (primarily statements of orientation or information). Furthermore, analysis of interaction sequences between the support group facilitator and other members revealed 2 broad categories of task-oriented facilitation techniques (changing the focus, clarification) and 1 category of socioemotional facilitation techniques (showing support). Support group facilitators need the ability to facilitate both task and relational aspects of social support. Facilitator behaviors were highlighted as being instrumental to the creation of social support. The results from this study indicate that the ability to change the focus of interaction, to provide and require clarification on complex issues, and to show support through relational messages is needed in facilitator training.

Large Independent Primary Care Medical Groups

PubMed Central

Casalino, Lawrence P.; Chen, Melinda A.; Staub, C. Todd; Press, Matthew J.; Mendelsohn, Jayme L.; Lynch, John T.; Miranda, Yesenia

2016-01-01

PURPOSE In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODS We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers—leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTS The groups’ physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale. CONCLUSIONS Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting. PMID:26755779

Connecting Families to Their Health Record and Care Team: The Use, Utility, and Impact of a Client/Family Health Portal at a Children’s Rehabilitation Hospital

PubMed Central

Maxwell, Joanne; Karmali, Amir; Hagens, Simon; Pinto, Madhu; Williams, Laura; Adamson, Keith

2017-01-01

Background Health care portals have the potential to provide consumers with timely, transparent access to health care information and engage them in the care process. Objective The objective was to examine the use, utility, and impact on engagement in care and caregiver-provider communication of a client/family portal providing access to electronic health records (EHRs) and secure, 2-way e-messaging with care providers. Methods We conducted a prospective, mixed-methods study involving collection of caregivers’ portal usage information over a 14-month period (from portal introduction in January 2015 to the end of the study period in March 2016), a Web-based survey for caregivers administered after a minimum of 2 months’ exposure to the portal and repeated 2 months later, and focus groups or individual interviews held with caregivers and service providers at the same points in time. The survey assessed caregivers’ perceptions of the utility of and satisfaction with the EHR and e-messaging, and the portal’s impact on client engagement and perceptions of caregiver-provider communication. A total of 18 caregivers (parents) completed surveys and 6 also took part in focus groups or interviews. In addition, 5 service providers from different disciplines took part in focus groups or interviews. Results Although usage patterns varied, the typical pattern was a steady level of use (2.5 times a month over an average of 9 months), which is higher than typically reported use. The portal pages most frequently accessed were the home page, health record main page, appointment main page, and reports main page. The Web-based survey captured caregivers’ perceptions of usefulness of and satisfaction with the EHR and portal messaging, as well as the portal’s impact on their engagement in care and perceptions of caregiver-provider communication. The surveys indicated a moderate degree of utility of and satisfaction with the portal features, and a low but emerging impact on engagement in care and caregiver-provider communication (survey scales measuring these outcomes displayed excellent internal consistency, with Cronbach alpha ranging from .89 to .95). Qualitative themes from focus groups and interviews supported and extended the survey findings. Caregivers and service providers saw appreciable information benefits and provided recommendations to increase portal use and utility. Caregivers focused on the scope of organizational adoption of the portal system and indicated their hopes for the future of the portal, whereas service providers were concerned about how to best manage their investment of time and effort in preparing client-friendly reports and messaging clients via the portal. Conclusions Overall, the findings show the promise of the portal and the need for ongoing evaluation to show the portal’s ultimate potential in enhancing engagement in care and communication with care providers. PMID:28385680

WIC providers' perspectives on offering smoking cessation interventions.

PubMed

Aquilino, Mary Lober; Goody, Cynthia M; Lowe, John B

2003-01-01

To examine the perspectives of WIC clinic providers on offering smoking cessation interventions for pregnant women. Four focus groups consisting of WIC nurses, dietitians, and social workers (N = 25) were conducted at WIC clinics in eastern Iowa. Researchers developed discussion guidelines to determine how WIC providers currently approached pregnant women who smoke cigarettes and what they considered barriers to providing effective smoking cessation interventions. Code mapping was used to analyze focus group discussions. Factors influencing the ability of WIC staff to provide a smoking cessation intervention for pregnant women included available time, clinic priorities, staff approaches to clients, and staff training. In addition, providers expressed concerns about educational materials for clients as well as additional client issues that prevented smoking cessation. The absence of mechanisms to track clinic outcomes related to smoking cessation was also noted. WIC providers have time limitations that may necessitate minimal or low-intensity interventions for smoking cessation, but did not know that such approaches are actually effective. WIC providers require more education about the entire issue of smoking cessation in order to become more proactive in their attempts to help pregnant women quit. Training that enhances self-efficacy and understanding of the impact of smoking on mothers, infants, and children should be initiated to motivate staff to intervene. Another strategy to motivate WIC staff in this regard could be tracking clinic outcomes in helping women to quit smoking or prevent relapse.

Development of clinical recommendations for progressive return to activity after military mild traumatic brain injury: guidance for rehabilitation providers.

PubMed

McCulloch, Karen L; Goldman, Sarah; Lowe, Lynn; Radomski, Mary Vining; Reynolds, John; Shapiro, Rita; West, Therese A

2015-01-01

Previously published mild traumatic brain injury (mTBI) management guidelines provide very general recommendations to return individuals with mTBI to activity. This lack of specific guidance creates variation in military rehabilitation. The Office of the Army Surgeon General in collaboration with the Defense and Veterans Brain Injury Center, a component center of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, convened an expert working group to review the existing literature and propose clinical recommendations that standardize rehabilitation activity progression following mTBI. A Progressive Activity Working Group consisted of 11 Department of Defense representatives across all service branches, 7 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury representatives, and 8 academic/research/civilian experts with experience assessing and treating individuals with mTBI for return to activity. An expert working group meeting included the Progressive Activity Working Group and 15 additional subject matter experts. In February 2012, the Progressive Activity Working Group was established to determine the need and purpose of the rehabilitation recommendations. Following literature review, a table was created on the basis of the progression from the Zurich consensus statement on concussion in sport. Issues were identified for discussion with a meeting of the larger expert group during a July 2012 conference. Following development of rehabilitation guidance, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury coordinated a similar process for military primary care providers. End products for rehabilitation and primary care providers include specific recommendations for return to activity after concussion. A 6-stage progression specifies activities in physical, cognitive, and balance/vestibular domains and allows for resumption of activity for those with low-level or preinjury symptom complaints. The clinical recommendations for progressive return to activity represent an important effort to standardize activity progression across functional domains and offer providers duty-specific activities to incorporate into intervention. Recommendations were released in January 2014.

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study.

PubMed

Leboul, Danièle; Aubry, Régis; Peter, Jean-Michel; Royer, Victor; Richard, Jean-François; Guirimand, Frédéric

2017-04-11

Despite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation. Data were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives. Health care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients. The uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it.

Engineering practice variation through provider agreement: a cluster-randomized feasibility trial.

PubMed

McCarren, Madeline; Twedt, Elaine L; Mansuri, Faizmohamed M; Nelson, Philip R; Peek, Brian T

2014-01-01

Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning clusters (eg, providers) to "favor" a particular drug, with providers retaining autonomy for specific patients. Patient informed consent might be waived, broadening inclusion. However, it is not known if providers will adhere to the assignment or whether institutional review boards will waive consent. We evaluated the feasibility of this trial design. Agreeable providers were randomized to "favor" either hydrochlorothiazide or chlorthalidone when starting patients on thiazide-type therapy for hypertension. The assignment applied when the provider had already decided to start a thiazide, and providers could deviate from the strategy as needed. Prescriptions were aggregated to produce a provider strategy-adherence rate. All four institutional review boards waived documentation of patient consent. Providers (n=18) followed their assigned strategy for most of their new thiazide prescriptions (n=138 patients). In the "favor hydrochlorothiazide" group, there was 99% adherence to that strategy. In the "favor chlorthalidone" group, chlorthalidone comprised 77% of new thiazide starts, up from 1% in the pre-study period. When the assigned strategy was followed, dosing in the recommended range was 48% for hydrochlorothiazide (25-50 mg/day) and 100% for chlorthalidone (12.5-25.0 mg/day). Providers were motivated to participate by a desire to contribute to a comparative effectiveness study. A study promotional mug, provider information letter, and interactions with the site investigator were identified as most helpful in reminding providers of their study drug strategy. Providers prescribed according to an assigned drug-choice strategy most of the time for the purpose of a comparative effectiveness study. This simple design could facilitate research participation and behavior change in non-research clinicians. Waiver of patient consent can broaden the representation of patients, providers, and settings.

The Effect of Complementary and Alternative Medicine Claims on Risk Adjustment

PubMed Central

Lind, Bonnie K.; Abrams, Chad; Lafferty, William E.; Kiehr, Paula K.; Grembowski, David E.

2006-01-01

Objective To assess how the inclusion of diagnoses from complementary and alternative medicine (CAM) providers affects measures of morbidity burden and expectations of health care resource use for insured patients. Methods Claims data from Washington State were used to create two versions of a case-mix index. One version included claims from all provider types; the second version omitted claims from CAM providers who are covered under commercial insurance. Expected resource use was also calculated. The distribution of expected and actual resource use was then compared for the two indices. Results Inclusion of CAM providers shifts many patients into higher morbidity categories; 54% of 61,914 CAM users had higher risk scores in the index which included CAM providers. When expected resource use categories were defined based on all providers, CAM users in the highest morbidity category had average (± s.d.) annual expenditures of $6661 (± $13,863). This was less than those in the highest morbidity category when CAM providers were not included in the index ($8562 ± $16,354), and was also lower than the highest morbidity patients who did not use any CAM services ($8419 ± $18,885). Conclusions Inclusion of services from CAM providers under third party payment increases risk scores for their patients but expectations of costs for this group are lower than expected had costs been estimated based only on services from traditional providers. Additional work is needed to validate risk adjustment indices when adding services from provider groups not included in the development of the index. PMID:17122711

Leadership Qualities Emerging in an Online Social Support Group Intervention.

PubMed

Kodatt, Stephanie A; Shenk, Jared E; Williams, Mark L; Horvath, Keith J

2014-11-01

Technology-delivered interventions addressing a broad range of problems for which clients present for therapy are proliferating. However, little is known of leadership dynamics that emerge in online group interventions. The purpose of this study was to assess the types of leadership qualities that would emerge in an online social support group intervention to improve medication adherence for men with HIV, and to characterize the demographic and psychosocial profiles of leaders. Written posts ( n =616) from 66 men were coded using an adapted version of the Full Range Model of Leadership. Results showed that 10% ( n =64) of posts reflected one of five leadership types, the most common of which was mentoring/providing feedback (40% of leadership posts). The next most common leadership style were instances in which encouragement was offered (30% of leadership posts). Leaders appeared to have lived with HIV longer and have higher Internet knowledge scores than non-leaders. Results indicate that online group interventions potentially may be useful to supplement traditional face-to-face treatment by providing an additional venue for group members to mentor and provide emotional support to each other. However, additional research is needed to more fully understand leadership qualities and group dynamics in other online group intervention settings.

Physical assistance devices in complex motor skill learning: benefits of a self-controlled practice schedule.

PubMed

Wulf, G; Toole, T

1999-09-01

This study examines the effects of a self-controlled use of physical assistance devices on learning a complex motor skill (i.e., producing slalom-type movements on a ski simulator). Physical assistance was provided by ski poles. One group of learners (self-control) was provided with the poles whenever they requested them, whereas another (yoked) group had no influence on the pole/no-pole schedule. While there were no group differences during the practice phase (Days 1 and 2), clear group differences emerged in the retention test without poles (Day 3). The self-control group produced significantly larger amplitudes than the yoked group. These results extend previous findings by showing learning advantages of the self-controlled use of physical assistance devices in complex motor skill learning.

Providing web-based mental health services to at-risk women

PubMed Central

2011-01-01

Background We examined the feasibility of providing web-based mental health services, including synchronous internet video conferencing of an evidence-based support/education group, to at-risk women, specifically poor lone mothers. The objectives of this study were to: (i) adapt a face-to-face support/education group intervention to a web-based format for lone mothers, and (ii) evaluate lone mothers' response to web-based services, including an online video conferencing group intervention program. Methods Participating mothers were recruited through advertisements. To adapt the face-to-face intervention to a web-based format, we evaluated participant motivation through focus group/key informant interviews (n = 7), adapted the intervention training manual for a web-based environment and provided a computer training manual. To evaluate response to web-based services, we provided the intervention to two groups of lone mothers (n = 15). Pre-post quantitative evaluation of mood, self-esteem, social support and parenting was done. Post intervention follow up interviews explored responses to the group and to using technology to access a health service. Participants received $20 per occasion of data collection. Interviews were taped, transcribed and content analysis was used to code and interpret the data. Adherence to the intervention protocol was evaluated. Results Mothers participating in this project experienced multiple difficulties, including financial and mood problems. We adapted the intervention training manual for use in a web-based group environment and ensured adherence to the intervention protocol based on viewing videoconferencing group sessions and discussion with the leaders. Participant responses to the group intervention included decreased isolation, and increased knowledge and confidence in themselves and their parenting; the responses closely matched those of mothers who obtained same service in face-to-face groups. Pre-and post-group quantitative evaluations did not show significant improvements on measures, although the study was not powered to detect these. Conclusions We demonstrated that an evidence-based group intervention program for lone mothers developed and evaluated in face-to-face context transferred well to an online video conferencing format both in terms of group process and outcomes. PMID:21854563

Providing web-based mental health services to at-risk women.

PubMed

Lipman, Ellen L; Kenny, Meghan; Marziali, Elsa

2011-08-19

We examined the feasibility of providing web-based mental health services, including synchronous internet video conferencing of an evidence-based support/education group, to at-risk women, specifically poor lone mothers. The objectives of this study were to: (i) adapt a face-to-face support/education group intervention to a web-based format for lone mothers, and (ii) evaluate lone mothers' response to web-based services, including an online video conferencing group intervention program. Participating mothers were recruited through advertisements. To adapt the face-to-face intervention to a web-based format, we evaluated participant motivation through focus group/key informant interviews (n = 7), adapted the intervention training manual for a web-based environment and provided a computer training manual. To evaluate response to web-based services, we provided the intervention to two groups of lone mothers (n = 15). Pre-post quantitative evaluation of mood, self-esteem, social support and parenting was done. Post intervention follow up interviews explored responses to the group and to using technology to access a health service. Participants received $20 per occasion of data collection. Interviews were taped, transcribed and content analysis was used to code and interpret the data. Adherence to the intervention protocol was evaluated. Mothers participating in this project experienced multiple difficulties, including financial and mood problems. We adapted the intervention training manual for use in a web-based group environment and ensured adherence to the intervention protocol based on viewing videoconferencing group sessions and discussion with the leaders. Participant responses to the group intervention included decreased isolation, and increased knowledge and confidence in themselves and their parenting; the responses closely matched those of mothers who obtained same service in face-to-face groups. Pre-and post-group quantitative evaluations did not show significant improvements on measures, although the study was not powered to detect these. We demonstrated that an evidence-based group intervention program for lone mothers developed and evaluated in face-to-face context transferred well to an online video conferencing format both in terms of group process and outcomes.

Inter-Rater Reliability of Provider Interpretations of Irritable Bowel Syndrome Food and Symptom Journals

PubMed Central

Chung, Chia-Fang; Xu, Kaiyuan; Dong, Yi; Schenk, Jeanette M.; Cain, Kevin; Munson, Sean; Heitkemper, Margaret M.

2017-01-01

There are currently no standardized methods for identifying trigger food(s) from irritable bowel syndrome (IBS) food and symptom journals. The primary aim of this study was to assess the inter-rater reliability of providers’ interpretations of IBS journals. A second aim was to describe whether these interpretations varied for each patient. Eight providers reviewed 17 IBS journals and rated how likely key food groups (fermentable oligo-di-monosaccharides and polyols, high-calorie, gluten, caffeine, high-fiber) were to trigger IBS symptoms for each patient. Agreement of trigger food ratings was calculated using Krippendorff’s α-reliability estimate. Providers were also asked to write down recommendations they would give to each patient. Estimates of agreement of trigger food likelihood ratings were poor (average α = 0.07). Most providers gave similar trigger food likelihood ratings for over half the food groups. Four providers gave the exact same written recommendation(s) (range 3–7) to over half the patients. Inter-rater reliability of provider interpretations of IBS food and symptom journals was poor. Providers favored certain trigger food likelihood ratings and written recommendations. This supports the need for a more standardized method for interpreting these journals and/or more rigorous techniques to accurately identify personalized IBS food triggers. PMID:29113044

Exploring the Cervical Cancer Screening Experiences of Black Lesbian, Bisexual, and Queer Women: The Role of Patient-Provider Communication.

PubMed

Agénor, Madina; Bailey, Zinzi; Krieger, Nancy; Austin, S Bryn; Gottlieb, Barbara R

2015-01-01

Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes--health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background--as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings.

Mental Health Providers' Attitudes About Criminal Justice-Involved Clients With Serious Mental Illness.

PubMed

Bandara, Sachini N; Daumit, Gail L; Kennedy-Hendricks, Alene; Linden, Sarah; Choksy, Seema; McGinty, Emma E

2018-04-01

Community mental health providers' attitudes toward criminal justice-involved clients with serious mental illness were examined. A total of 627 Maryland psychiatric rehabilitation program providers responded to a survey (83% response rate). Measures assessed providers' experience with, positive regard for, and perceptions of similarity, with their clients with serious mental illness. Chi-square tests were used to compare providers' attitudes toward clients with and without criminal justice involvement. Providers reported lower regard for criminal justice-involved clients than for clients without such involvement. Providers were less likely to report having a great deal of respect for clients with (79%) versus without (95%) criminal justice involvement. On all items that measured providers' perceived similarity with their clients, less than 50% of providers rated themselves as similar, regardless of clients' criminal justice status. Future research should explore how providers' attitudes toward criminal justice-involved clients influence service delivery for this group.

The difference is more than floating: factors affecting breast cancer survivors' decisions to join and maintain participation in dragon boat teams and support groups.

PubMed

McDonough, Meghan H; Patterson, Michelle C; Weisenbach, Beth B; Ullrich-French, Sarah; Sabiston, Catherine M

2018-03-09

Peer support can be helpful in rehabilitation from breast cancer, but participation in peer support groups is low. Groups that provide support opportunities in physical activity contexts are an attractive alternative for some survivors. This study examined survivors' reasons for joining and maintaining participation on a dragon boat team, along with perceptions of barriers and attractions to traditional peer support groups. Seventeen breast cancer survivors were interviewed on five occasions over their first two seasons of a newly formed dragon boating team to explore their perceptions of peer support groups and dragon boating. Data were inductively analyzed using thematic analysis. Categories surrounding physical, psychological, social and community features were identified with several themes emerging within each. Advantages of dragon boating included opportunities to get a combination of physical, psychosocial and community benefits; health improvement and behavior change; and obtaining social support without the focus being on cancer. Peer support groups were identified as having advantages for forming relationships and avoiding barriers associated with physical activity. While neither type of program meets all needs, practical considerations are identified for incorporating advantages of both programs to improve participation. Implications for rehabilitation Further understanding of perceptions, and attractions and challenges to taking part in group programs will inform development of accessible programs that target multiple rehabilitation needs. Physical activity can provide a positive, alternative focus that takes the emphasis off of cancer, which is more accessible to some survivors. Physical activity also provides opportunities to build relationships around a common, positive goal, which can be a foundation for providing support for coping with cancer.

Genetic educational needs and the role of genetics in primary care: a focus group study with multiple perspectives

PubMed Central

2011-01-01

Background Available evidence suggests that improvements in genetics education are needed to prepare primary care providers for the impact of ongoing rapid advances in genomics. Postgraduate (physician training) and master (midwifery training) programmes in primary care and public health are failing to meet these perceived educational needs. The aim of this study was to explore the role of genetics in primary care (i.e. family medicine and midwifery care) and the need for education in this area as perceived by primary care providers, patient advocacy groups and clinical genetics professionals. Methods Forty-four participants took part in three types of focus groups: mono-disciplinary groups of general practitioners and midwives, respectively and multidisciplinary groups composed of a diverse set of experts. The focus group sessions were audio-taped, transcribed verbatim and analysed using content analysis. Recurrent themes were identified. Results Four themes emerged regarding the educational needs and the role of genetics in primary care: (1) genetics knowledge, (2) family history, (3) ethical dilemmas and psychosocial effects in relation to genetics and (4) insight into the organisation and role of clinical genetics services. These themes reflect a shift in the role of genetics in primary care with implications for education. Although all focus group participants acknowledged the importance of genetics education, general practitioners felt this need more urgently than midwives and more strongly emphasized their perceived knowledge deficiencies. Conclusion The responsibilities of primary care providers with regard to genetics require further study. The results of this study will help to develop effective genetics education strategies to improve primary care providers' competencies in this area. More research into the educational priorities in genetics is needed to design courses that are suitable for postgraduate and master programmes for general practitioners and midwives. PMID:21329524

Summary of PhysPAG Activities

NASA Astrophysics Data System (ADS)

Ritz, Steven M.

2013-01-01

The Physics of the Cosmos (PCOS) Program Analysis Group (PhysPAG) provides an important interface between the scientific community and NASA in matters related to PCOS objectives, and also provides opportunities for community discussions. An Executive Committee facilitates the work of several subgroups, including an Inflation Probe Science Analysis Group (IPSAG), an X-ray group (XRSAG) , a gamma-ray,group (GRSAG), a gravitational wave group (GWSAG), and a cosmic-ray group (CRSAG). In addition to identifying opportunities and issues, these groups also help articulate technology needs. Membership in all the SAGs is completely open, with information and newsletter signups available on the PhysPAG pages at the PCOS program website. The PhysPAG reports to the Astrophysics Subcommittee of the NASA Advisory Council. A summary of PhysPAG activities will be given, along with time for questions and discussion.

Combined group and individual model for postbariatric surgery follow-up care.

PubMed

Lorentz, Paul A; Swain, James M; Gall, Margaret M; Collazo-Clavell, Maria L

2012-01-01

The prevalence of bariatric surgery in the United States has increased significantly during the past decade, increasing the number of patients requiring postbariatric surgery follow-up care. Our objective was to develop and implement an efficient, financially viable, postbariatric surgery practice model that would be acceptable to patients. The setting was the Mayo Clinic (Rochester, MN). By monitoring the attendance rates and using patient surveys, we tested patient acceptance of a new, shared medical appointment practice model in the care of postbariatric surgery patients. Efficiency was assessed by comparing differences in time per patient and total provider time required between the former and new care models. Individual-only patient/provider visits were replaced by combined group and individual visits (CGV). Our CGV model was well-attended and accepted. The patient attendance rate was >90% at all postoperative follow-up points. Furthermore, 83%, 85.2%, and 75.7% of the 3-, 6-, and 12-month postbariatric surgery patients, respectively, responded that they would not prefer to have only individual visits with their healthcare providers. The CGV model also resulted in greater time efficiency and cost reduction. On average, 5 patients were seen within 4.9 provider hours compared with 10.4 provider hours with the individual-only patient/provider visit model. Furthermore, the average billable charge for the CGV model's group medical nutrition therapy was 50-64% less than the equivalent individual medical nutrition therapy used in the individual-only patient/provider visit model. Shared medical appointments have a valuable role in the care of the postbariatric surgery population, offering a time- and cost-effective model for healthcare provision that is well-accepted by patients. Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Patient-provider language concordance and colorectal cancer screening.

PubMed

Linsky, Amy; McIntosh, Nathalie; Cabral, Howard; Kazis, Lewis E

2011-02-01

Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES: We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant (spoke English at home, n = 21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n = 1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n = 240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening. Compared to English speakers, non-English speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71). Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.

Impact of health care adversity on providers: Lessons learned from a staff support program.

PubMed

Trent, Maxine; Waldo, Kimberly; Wehbe-Janek, Hania; Williams, Daniel; Hegefeld, Wendy; Havens, Lisa

2016-08-01

Health care providers often experience traumatic events and adversity that can have negative emotional impacts on the profession and on patients. These impacts are typically multifaceted and can result from many different events, such as unanticipated outcomes, licensing board complaints, claims, and litigation. Because health care providers are exposed to diverse situations, they require adequate and timely support, imperative for provider resilience and patient safety. This study evaluated the success of an institution's second victim health care support program and best practices in responding to these traumatic experiences effectively. Twenty faculty and medical residents who utilized the support program at a large hospital system located in Central Texas from 2001 to 2012 participated in 1 of 6 focus groups. Qualitative data were collected from these groups to describe program requirements for the adequate delivery of health care adversity support and necessary program improvements. Responses were first transcribed verbatim. Each research team member analyzed data using a thematic framework approach. This approach helped to characterize traumatic experiences and to design a support system. The results revealed that (1) provider experiences are traumatic, (2) it is necessary to communicate an adverse event in a confidential and timely manner, preferably with a peer, (3) preemptive education regarding risk management and the legal process is helpful, and (4) there is a need for further support of the specific experience of a board complaint. Focus group data indicated the complexity of the emotional impact of traumatic experiences. Specific program components are needed to create best practices for providers affected by health care adversity, including support when providers face board complaints. The program's unique combination of support and education allowed us to expand upon leading national health care adversity programs. © 2016 American Society for Healthcare Risk Management of the American Hospital Association.

Key findings: a qualitative assessment of provider and patient perceptions of HIV/AIDS in South Africa.

PubMed

Ransom, James; Johnson, Anton F

2009-01-01

In 1997, at the Davos International Economic Forum, Nelson Mandela stated that "the poor, the vulnerable, the unschooled, the socially marginalized, the women, and the children, those who bear the burden of colonial legacy-these are the sectors of society which bear the burden of AIDS" (Richter, 2001). Nearly a decade later, that statement still holds true, especially in Mr. Mandela's home country. South Africa continues to have one of the world's highest prevalence ratios of HIV infection (UNAIDS, 2002). This paper explores the significance of perceptions, knowledge, practices, and attitudes toward HIV/AIDS in two important groups in South Africa: health care providers based in public health clinics and their patients. This paper will assess the provider-patient interaction from the perspective of members of the South African HIV/AIDS treatment and prevention community. The analysis will examine the results of in-depth interviews and focus group discussions with providers and patients, respectively, in two of South Africa's nine provinces. Between December 2002 and April 2003 in Guateng and KwaZulu-Natal provinces, we conducted (1) in-depth interviews of a spectrum of health care providers at five local public health clinics and (2) focus groups of patients who patronize those clinics. The results show that there are gaps in the HIV/AIDS knowledge of some of the health care providers and that the participants' health beliefs and practices are embedded in the social conditions in which they live and work, which has a ripple effect on their risk behaviors and trumps any intervention messages from their health care providers and larger public health intervention messages.

Development Of An Educational Video To Improve Patient Knowledge And Communication With Their Healthcare Providers About Colorectal Cancer Screening

PubMed Central

Katz, Mira L.; Heaner, Sarah; Reiter, Paul; van Putten, Julie; Murray, Lee; McDougle, Leon; Cegala, Donald J.; Post, Douglas; David, Prabu; Slater, Michael; Paskett, Electra D.

2009-01-01

Background Low rates of colorectal cancer (CRC) screening persist due to individual, provider and system level barriers. Purpose To develop and obtain initial feedback about a CRC screening educational video from community members and medical professionals. Methods Focus groups of patients were conducted prior to the development of an educational video and focus groups of patients provided initial feedback about the developed CRC screening educational video. Medical personnel reviewed the video and made recommendations prior to final editing of the video. Results Patients identified CRC screening barriers and made suggestions about the information to include in the educational video. Their suggestions included using a healthcare provider to state the importance of completing CRC screening, demonstrate how to complete the fecal occult blood test, and that men and women from diverse ethnic groups and races could be included in the same video. Participants reviewed the developed video and mentioned that their suggestions were portrayed correctly, the video was culturally appropriate, and the information presented in the video was easy to understand. Medical personnel made suggestions on ways to improve the content and the delivery of the medical information prior to final editing of the video. Discussion Participants provided valuable information in the development of an educational video to improve patient knowledge and patient-provider communication about CRC screening. The educational video developed was based on the Protection Motivation Theory and addressed the colon cancer screening barriers identified in this mostly minority and low-income patient population. Future research will determine if CRC screening increases among patients who watch the educational video. Translation to Health Education Practice Educational videos can provide important information about CRC and CRC screening to average-risk adults. PMID:20209024

Introduction to Small Group Discussion.

ERIC Educational Resources Information Center

Millar, Dan Pyle

To bring educational research into focus with tested classroom practice, this booklet provides an introduction to small group discussion. The theory and research section discusses the importance of small group discussion, characteristics of small group discussions, group attraction based on Maslow's hierarchy of basic human needs, group decision…

Telehealth stroke education for rural elderly Virginians.

PubMed

Schweickert, Patricia A; Rutledge, Carolyn M; Cattell-Gordon, David C; Solenski, Nina J; Jensen, Mary E; Branson, Sheila; Gaughen, John R

2011-12-01

Stroke is a prevalent condition found in elderly, rural populations. However, stroke education, which can be effective in addressing the risks, is often difficult to provide in these remote regions. The objective of this study is to evaluate the effectiveness of delivering stroke education to elderly individuals through telehealth versus in-person stroke prevention education methods. A quasi-experimental nonequivalent control group design was used in this study. A convenience sample of 11 elderly adults (36% men, 64% women) with a mean age of 70 was selected from an Appalachian Program for All Inclusive Care for the Elderly (day care) facility. Subjects completed preintervention surveys, received a 20-min group in-person or telehealth delivered education session, and then completed the postintervention surveys. Satisfaction with delivery method and post-education knowledge was equivalent between the two groups. Knowledge increased in both groups after the educational programs. Likelihood of reducing risk factors showed no differences pre-posttest. However, there were significant improvements in the pre-post likelihood scores of the telehealth group in contrast to the in-person group. This project provided a rural, high-risk population access to telehealth stroke education, thus enabling these individuals to receive education at a distance from experts in the field. The telehealth program was found to be equivalent to in-person stroke education in regards to satisfaction, knowledge, and likelihood of making changes to decrease vascular risk factors. The study demonstrated feasibility in providing effective stroke education through telehealth, thus suggesting an often overlooked route for providing patient education at a distance.

The Application of an Evidence-Based Clinical Nursing Path for Improving the Preoperative and Postoperative Quality of Care of Pediatric Retroperitoneal Neuroblastoma Patients: A Randomized Controlled Trial at a Tertiary Medical Institution.

PubMed

Liu, Yang; Mo, Lin; Tang, Yan; Wang, Qiuhong; Huang, Xiaoyan

A clinical nursing path (CNP) that encourages patients and their families to become actively involved in healthcare decision-making processes may improve outcomes of pediatric retroperitoneal neuroblastoma (NB) patients. The aim of this study was to evaluate the utility and value of an evidence-based CNP provided to pediatric retroperitoneal NB patients undergoing resection surgery. One hundred twenty NB cases were assigned to a control group or a CNP group. The control group was provided with standard nursing care. The CNP group was provided with nursing care in accordance with an evidence-based CNP. The utility and value of the CNP were compared with standard nursing care. Outcome measures included rates of postoperative complications, lengths of hospital stay, and cost of hospitalization, as well as preoperative and postoperative quality of care and patient satisfaction with care. The rates of postoperative complications, length of preoperative hospitalization, total length of hospital stay, and costs of hospitalization were significantly lower for patients receiving the CNP compared with the control group. Preoperative and postoperative quality of care and patient satisfaction with care were significantly higher in patients receiving the CNP compared with the control group. Adoption of a CNP for preoperative and postoperative care of pediatric retroperitoneal NB patients undergoing resection surgery improves clinical outcomes and patient satisfaction with care. A CNP can increase families' participation in a patient's recovery process, enhance nurses' understanding of the services they are providing, and improve the quality of healthcare received by patients.

"They don't want anything to do with you": patient views of primary care management of chronic pain.

PubMed

Upshur, Carole C; Bacigalupe, Gonzalo; Luckmann, Roger

2010-12-01

Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and providers report low satisfaction with chronic pain care. This study was designed to explore the views held by a diverse sample of patients with chronic pain complaints about their care experiences to identify ways to improve care. Qualitative analysis of 17 patient focus groups (size 3-7 participants). Groups used structured questions and were tape recorded, transcribed, and coded using qualitative software. Eleven groups were conducted in English, six groups in Spanish. Convenience sample of 72 adult patients (68% female, 44% Latino, mean age=48.1 years) recruited from four diverse primary care practices in Central Massachusetts. Across all 17 groups, and all gender, ethnicity, and age groups, most patients reported suboptimal interactions with their providers when seeking care for chronic pain. Subjects acknowledged feeling disrespected and distrusted, suspected of drug-seeking, and having their symptoms dismissed as trivial and/or not warranting medical care. Patients reported more satisfaction when they felt a provider listened to them, trusted them, was accessible to address pain concerns between visits, and used patient-centered approaches to establish goals and treatment plans. Patients also recommended some management techniques related to the chronic disease management model to improve pain care. Implementing patient-centered approaches in caring for individuals with chronic pain and using principles drawn from the chronic disease management model to improve care systems may improve both patient and provider satisfaction with chronic pain care. Wiley Periodicals, Inc.

HPV Vaccine - Questions and Answers

MedlinePlus

... suggest that HPV vaccine loses any ability to provide protection over time. Data are available for about 10 ... cause most cervical cancers, so HPV vaccination will provide high protection for all racial/ethnic groups. All three licensed ...

A Computerized Family Planning Counseling Aid: A Pilot Study Evaluation of Smart Choices.

PubMed

Koo, Helen P; Wilson, Ellen K; Minnis, Alexandra M

2017-03-01

Resource constraints may make it challenging for family planning clinics to provide comprehensive contraceptive counseling; technological tools that help providers follow recommended practices without straining resources merit evaluation. A pilot study using a two-group, posttest-only experimental design evaluated Smart Choices, a computer-based tool designed to help providers offer more patient-centered counseling and enable patients to participate proactively in the counseling session. In two North Carolina family planning clinics, 214 women received usual counseling in March-May 2013, and 126 women used Smart Choices in May-July 2013. Exit interviews provided data for the evaluation. Multivariate Poisson and multinomial logistic regression analyses were performed to examine group differences in counseling outcomes. Three of 12 hypotheses tested were supported: Compared with controls, women in the intervention group knew more contraceptive methods (adjusted mean, 11.1 vs. 10.7); discussed more topics related to sexual health during counseling (1.2 vs. 0.9 among those reporting any discussion); and rated counseling as more patient-centered, an indication of how well they felt providers understood their family planning circumstances and ideas (3.9 vs. 3.7 on a scale of 1-4). Contrary to another hypothesis, controls were more likely than women in the intervention group to choose IUDs and implants. Computerized counseling aids like Smart Choices are in an early stage of development. Future research is warranted to develop tools that lead to more productive and individualized clinic visits and, ultimately, to more effective contraceptive use and reduced levels of unintended pregnancy. Copyright © 2017 by the Guttmacher Institute.

Culture-broker and medical decoder: contributions of caregivers in American Indian cancer trajectories.

PubMed

Hodge, Felicia Schanche; Cadogan, Mary; Itty, Tracy Line; Williams, Angela; Finney, Arneta

2016-05-01

Caregivers play a special role in the management and control of cancer-related pain. For American Indians with cancer, caregivers can contribute to patient education, medication compliance, and can facilitate communication between the patient and the provider and the patient and the family. To identify the role(s) of caregivers of American Indian cancer survivors. As a part of a large randomized intervention designed to improve barriers to cancer symptom management, 13 focus groups were held among American Indian cancer survivors and their caregivers at Southwest reservations and urban sites. Focus groups, audiotaped and transcribed, used constant comparative methods in the analysis of caregiver dialogues. Caregivers are patient educators and provider culture-brokers and their communication strategies use a combination of cultural and conventional strategies in their care of American Indian cancer patients. Cultural communication styles include "talk stories" (storytelling), group (talking circles), and dialogue to manage cancer pain, educate the patient and community, and to protect the patient from stigma, reduce barriers to care, and provide support to patients and families. Active discussion with providers "re-packaged" the patient's reporting/responses to specific clinical measures (pain measure scores) and identified the need for pain medication and compliance-related issues. Findings are not generalizable to the American Indian population outside of the sites and focus groups from which data were collected. Caregivers are "cultural brokers" who inform providers of the cultural nuances associated with American Indian patient care. However, caregivers voiced that cultural restriction for not discussing illness openly was a sanction and an important barrier. ©2016 Frontline Medical Communications.

Method for fabricating hafnia films

DOEpatents

Hu, Michael Z [Knoxville, TN

2007-08-21

The present invention comprises a method for fabricating hafnia film comprising the steps of providing a substrate having a surface that allows formation of a self-assembled monolayer thereon via covalent bonding; providing an aqueous solution that provides homogeneous hafnium ionic complexes and hafnium nanoclusters wherein the aqueous solution is capable of undergoing homogeneous precipitation under controlled conditions for a desired period of time at a controlled temperature and controlled solution acidity for desired nanocluster nucleation and growth kinetics, desired nanocluster size, desired growth rate of film thickness and desired film surface characteristics. The method further comprising forming the self-assembled monolayer on the surface of the substrate wherein the self-assembled monolayer comprises a plurality of hydrocarbon chains cross-linked together along the surface of the substrate, the hydrocarbon chains being uniformly spaced from one another and wherein each of the hydrocarbon chains having a functional anchoring group at a first end of the chain covalently bonded with the surface of the substrate and each of the hydrocarbon chains having a functional terminating group projected away from the surface wherein the functional terminating group provides a bonding site for the hafnium film to grow; and exposing the substrate to the aqueous solution for a desired period of time at a controlled temperature wherein the hafnium ionic complexes and the hafnium nanoclusters are deposited on the bonding site of the functional terminating group thereby forming the hafnia film wherein the hafnium bonded to the hydrocarbons and to one another provide a uniform ordered arrangement defined by the uniform arrangement of the hydrocarbons.

Disease self-management needs of adolescents with cancer: perspectives of adolescents with cancer and their parents and healthcare providers.

PubMed

Stinson, J N; Sung, L; Gupta, A; White, M E; Jibb, L A; Dettmer, E; Baker, N

2012-09-01

The ability for adolescents with cancer (AWC) to engage in disease self-management may result in improved cancer outcomes and quality-of-life ratings for this group. Despite this, a comprehensive self-management program for this group is yet to be developed. To ensure that self-management programming developed for AWC meets the needs of this group, discussion with key stakeholders (i.e., AWC, parents, and healthcare providers) is required. A descriptive qualitative design was used. Adolescents (n = 29) who varied in age (12 to 18 years) and type of cancer, their parents (n = 30) and their healthcare providers (n = 22) were recruited from one large tertiary-care oncology center. Audio-taped semi-structured individual and focus-group interviews were conducted with participants. Transcribed data were organized into categories that reflected emerging themes. Four major themes, which captured the self-management needs of AWC, emerged from the data. These themes were: (1) disease knowledge and cancer care skills, (2) knowledge and skills to support effective transition to adult healthcare, (3) delivery of AWC-accessible healthcare services, and (4) supports for the adolescent with cancer. In order to provide comprehensive, relevant, and acceptable self-management programs to AWC, the voices of this population, their parents, and healthcare providers should be considered. Findings from this study will be used to develop and evaluate cancer self-management programming for AWC. Self-management represents an important avenue for exploration into improving cancer outcomes and quality of life for survivors of cancers during adolescence.

Effect of maternal supplementation with vitamin E on the concentration of α-tocopherol in colostrum.

PubMed

Melo, Larisse Rayanne Miranda de; Clemente, Heleni Aires; Bezerra, Dalila Fernandes; Dantas, Raquel Costa Silva; Ramalho, Héryka Myrna Maia; Dimenstein, Roberto

To evaluate the effect of maternal supplementation with vitamin E on the concentration of α-tocopherol in colostrum and its supply to the newborn. This randomized clinical trial enrolled 99 healthy adult pregnant women; of these, 39 were assigned to the control group and 60 to the supplemented group. After an overnight fast, 5mL of blood and 2mL of colostrum were collected. After the first sampling (0h milk), the supplemented group received 400IU of supplementary vitamin E. Another 2mL milk aliquot was collected in both groups 24h after supplementation (24h milk). The samples were analyzed by high-performance liquid chromatography. The α-tocopherol content provided by colostrum was calculated by considering a daily intake of 396mL of milk and comparing the resulting value to the recommended daily intake for infants aged 0-6 months (4mg/day). The initial mean concentration of α-tocopherol in colostrum was 1509.3±793.7μg/dL in the control group and 1452.9±808.6μg/dL in the supplemented group. After 24h, the mean α-tocopherol concentration was 1650.6±968.7μg/dL in the control group (p>0.05) and 2346.9±1203.2μg/dL in the supplemented group (p<0.001), increasing the vitamin E supply to the newborn to 9.3mg/day. Initially, 18 women in the supplemented group provided colostrum α-tocopherol contents below 4mg/day; after supplementation only six continued to provide less than the recommended amount. Maternal vitamin E supplementation increases the supply of the vitamin to the infant by providing more than twice the Recommended Daily Intake. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Evaluating the Network: A Workflow for Tracking Twitter Interactions Using Social Networking Analysis

ERIC Educational Resources Information Center

Goodier, Sarah

2018-01-01

Networking plays an important role in research projects to build a community and audience around a research area. Using social media is popular in project communication as it provides the ability to engage with a group of followers daily. Such online networking tools provide the advantage of providing nearrealtime data, which can be used to…

Family Child Care Providers' Perspectives regarding Effective Professional Development and Their Role in the Child Care System: A Qualitative Study

ERIC Educational Resources Information Center

Lanigan, Jane D.

2011-01-01

This study examines family child care providers' perspectives regarding effective professional development and their role in the early learning and care system. Four focus groups were conducted annually for 3 years involving a total of 54 licensed family child care providers. Supportive social relationships emerged as an important dimension of…

The Politics of Another Side: Truth-in-Military-Recruiting Advocacy in an Urban School District

ERIC Educational Resources Information Center

Anderson, Gary L.

2009-01-01

This article provides documentation of the current military presence in U.S. secondary schools and groups that have mobilized to monitor or oppose this presence. This documentation provides the background for a narrative of a multiple-year effort the author engaged in to promote academic freedom for teachers and students and to provide high school…

75 FR 20647 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-20

... Relating to Chapter V, Section 7 (Customer Orders and Order Flow Providers) Date: April 13, 2010. Pursuant... 17 (Customer Orders and Order Flow Providers) of the Rules of the Boston Options Exchange Group, LLC... Exchange is proposing to amend Chapter V, Section 17 (Customer Orders and Order Flow Providers) of the BOX...

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

PubMed

Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

2016-04-01

The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

The Geographic Origins of Ethnic Groups in the Indian Subcontinent: Exploring Ancient Footprints with Y-DNA Haplogroups.

PubMed

Mahal, David G; Matsoukas, Ianis G

2018-01-01

Several studies have evaluated the movements of large populations to the Indian subcontinent; however, the ancient geographic origins of smaller ethnic communities are not clear. Although historians have attempted to identify the origins of some ethnic groups, the evidence is typically anecdotal and based upon what others have written before. In this study, recent developments in DNA science were assessed to provide a contemporary perspective by analyzing the Y chromosome haplogroups of some key ethnic groups and tracing their ancient geographical origins from genetic markers on the Y-DNA haplogroup tree. A total of 2,504 Y-DNA haplotypes, representing 50 different ethnic groups in the Indian subcontinent, were analyzed. The results identified 14 different haplogroups with 14 geographic origins for these people. Moreover, every ethnic group had representation in more than one haplogroup, indicating multiple geographic origins for these communities. The results also showed that despite their varied languages and cultural differences, most ethnic groups shared some common ancestors because of admixture in the past. These findings provide new insights into the ancient geographic origins of ethnic groups in the Indian subcontinent. With about 2,000 other ethnic groups and tribes in the region, it is expected that more scientific discoveries will follow, providing insights into how, from where, and when the ancestors of these people arrived in the subcontinent to create so many different communities.

The Geographic Origins of Ethnic Groups in the Indian Subcontinent: Exploring Ancient Footprints with Y-DNA Haplogroups

PubMed Central

Mahal, David G.; Matsoukas, Ianis G.

2018-01-01

Several studies have evaluated the movements of large populations to the Indian subcontinent; however, the ancient geographic origins of smaller ethnic communities are not clear. Although historians have attempted to identify the origins of some ethnic groups, the evidence is typically anecdotal and based upon what others have written before. In this study, recent developments in DNA science were assessed to provide a contemporary perspective by analyzing the Y chromosome haplogroups of some key ethnic groups and tracing their ancient geographical origins from genetic markers on the Y-DNA haplogroup tree. A total of 2,504 Y-DNA haplotypes, representing 50 different ethnic groups in the Indian subcontinent, were analyzed. The results identified 14 different haplogroups with 14 geographic origins for these people. Moreover, every ethnic group had representation in more than one haplogroup, indicating multiple geographic origins for these communities. The results also showed that despite their varied languages and cultural differences, most ethnic groups shared some common ancestors because of admixture in the past. These findings provide new insights into the ancient geographic origins of ethnic groups in the Indian subcontinent. With about 2,000 other ethnic groups and tribes in the region, it is expected that more scientific discoveries will follow, providing insights into how, from where, and when the ancestors of these people arrived in the subcontinent to create so many different communities. PMID:29410676

A review of group ICA for fMRI data and ICA for joint inference of imaging, genetic, and ERP data

PubMed Central

Calhoun, Vince D.; Liu, Jingyu; Adalı, Tülay

2009-01-01

Independent component analysis (ICA) has become an increasingly utilized approach for analyzing brain imaging data. In contrast to the widely used general linear model (GLM) that requires the user to parameterize the data (e.g. the brain's response to stimuli), ICA, by relying upon a general assumption of independence, allows the user to be agnostic regarding the exact form of the response. In addition, ICA is intrinsically a multivariate approach, and hence each component provides a grouping of brain activity into regions that share the same response pattern thus providing a natural measure of functional connectivity. There are a wide variety of ICA approaches that have been proposed, in this paper we focus upon two distinct methods. The first part of this paper reviews the use of ICA for making group inferences from fMRI data. We provide an overview of current approaches for utilizing ICA to make group inferences with a focus upon the group ICA approach implemented in the GIFT software. In the next part of this paper, we provide an overview of the use of ICA to combine or fuse multimodal data. ICA has proven particularly useful for data fusion of multiple tasks or data modalities such as single nucleotide polymorphism (SNP) data or event-related potentials. As demonstrated by a number of examples in this paper, ICA is a powerful and versatile data-driven approach for studying the brain. PMID:19059344

A review of group ICA for fMRI data and ICA for joint inference of imaging, genetic, and ERP data.

PubMed

Calhoun, Vince D; Liu, Jingyu; Adali, Tülay

2009-03-01

Independent component analysis (ICA) has become an increasingly utilized approach for analyzing brain imaging data. In contrast to the widely used general linear model (GLM) that requires the user to parameterize the data (e.g. the brain's response to stimuli), ICA, by relying upon a general assumption of independence, allows the user to be agnostic regarding the exact form of the response. In addition, ICA is intrinsically a multivariate approach, and hence each component provides a grouping of brain activity into regions that share the same response pattern thus providing a natural measure of functional connectivity. There are a wide variety of ICA approaches that have been proposed, in this paper we focus upon two distinct methods. The first part of this paper reviews the use of ICA for making group inferences from fMRI data. We provide an overview of current approaches for utilizing ICA to make group inferences with a focus upon the group ICA approach implemented in the GIFT software. In the next part of this paper, we provide an overview of the use of ICA to combine or fuse multimodal data. ICA has proven particularly useful for data fusion of multiple tasks or data modalities such as single nucleotide polymorphism (SNP) data or event-related potentials. As demonstrated by a number of examples in this paper, ICA is a powerful and versatile data-driven approach for studying the brain.

Marketing of Group Counseling Services.

ERIC Educational Resources Information Center

Wilson, F. Robert; And Others

1987-01-01

Provides social marketing guidelines for attracting members of appropriate target groups and encouraging their participation in group activities. Includes examination of the personal and social framework of the group counselor, elements of social marketing theory, a case study illustrating difficulties encountered by novice group counselors in…

Integrating Research, Policy, and Practice to Bring Science to the Classroom: New Leaders' Perspectives on the Field of Emotional and Behavioral Disorders

ERIC Educational Resources Information Center

Maggin, Daniel M.; Robertson, Rachel; Oliver, Regina M.; Hollo, Alex; Partin, Tara C. Moore

2010-01-01

In 1991, the Peacock Hill Working Group provided the field of emotional and behavioral disorders (EBD) a roadmap for improving the quality of services provided to students with EBD. The working group considered issues at every level of the educational system, from the classroom to federal policy. Although many strides have been made in the past 20…

Development of a Lifespan-Based Novel Composite Person-Reported Outcome Measure Using Data from the CINRG Duchenne Natural History Study

DTIC Science & Technology

2017-10-01

drug approval. 2. KEYWORDS: Provide a brief list of keywords (limit to 20 words). Duchenne muscular dystrophy Person-reported outcomes Health ...related quality of life Functional health assessment UC Davis / CINRG Duchenne Natural History Study 5 3. ACCOMPLISHMENTS: The PI is reminded...content, we will conduct focus group discussions with an expert advisory group of DMD clinical research professionals, health care providers, parent

Optical waveguides having flattened high order modes

DOEpatents

Messerly, Michael Joseph; Beach, Raymond John; Heebner, John Edward; Dawson, Jay Walter; Pax, Paul Henry

2014-08-05

A deterministic methodology is provided for designing optical fibers that support field-flattened, ring-like higher order modes. The effective and group indices of its modes can be tuned by adjusting the widths of the guide's field-flattened layers or the average index of certain groups of layers. The approach outlined here provides a path to designing fibers that simultaneously have large mode areas and large separations between the propagation constants of its modes.

Opportunities for Next Generation BML: Semantic C-BML

DTIC Science & Technology

2014-06-01

Simulation Interoperability Workshop, 05S- SIW -007, San Diego, CA. 2005. [11] Schade, Ulrich, Bastian Haarmann, and Michael R. Hieb. "A Grammar for...Language (C-BML) Product Development Group.” Paper 06F- SIW -003. In Proceed-ings of the Fall Simulation Interoperability Workshop. Simulation...process – Based on a specification provided by the C-BML product development group (Blais, Curtis, et al; SISO Fall 2011 SIW ) – My work provides insight

Assistive Technology Provision Within the Navajo Nation

PubMed Central

Ripat, Jacquie D.

2014-01-01

In this study we explored the factors that affect assistive technology (AT) provision within the Navajo Nation using a qualitative approach to inquiry. Focus groups were held in which AT users discussed their awareness of AT and their need for, use of, and satisfaction with AT devices and services. Twenty-eight individuals who used wheelchairs, orthotics or prosthetics, hearing aids, communication aids, vision aids, and other AT participated in one of seven focus groups. Seven AT providers discussed the facilitators and barriers that affect AT provision. The findings revealed six themes common to both stakeholder groups and two additional themes for AT users. The central theme for AT users centered on (not) feeling understood; the central theme for AT providers revolved around the processes, activities, and roles the providers engaged in at times for different clients. Activities to increase awareness and to promote successful AT provision and satisfaction with AT devices were proposed. PMID:25147224

Perceptions of homelessness in older homeless veterans, VA homeless program staff liaisons, and housing intervention providers.

PubMed

Molinari, Victor A; Brown, Lisa M; Frahm, Kathryn A; Schinka, John A; Casey, Roger

2013-05-01

To understand the needs and challenges encountered by older homeless veterans. We conducted six focus groups of older veterans, two focus groups, and one semi-structured interview of VA staff liaisons, and two focus groups and one semi-structured interview of housing intervention providers. Major themes for older veterans: 1) negative homelessness experience; 2) benefits of the structured transitional housing program; 3) importance of peer outreach; and 4) need for age-tailored job placement programs. Major themes for VA staff liaison/housing intervention providers: 1) belief that the transitional housing program has made a positive change; 2) need for individualized criteria to address the unique needs of veterans; 3) distinct differences between older and younger homeless veterans; 4) outreach services; 5) permanent housing issues; and 6) coordination of services. Compared with younger veterans, older veterans have less social support, greater employment and health challenges, and, perhaps greater motivation to change.

Domain-General and Domain-Specific Strategies for the Assessment of Distress Intolerance

PubMed Central

McHugh, R. Kathryn; Otto, Michael W.

2011-01-01

Recent research has provided evidence that distress intolerance—the perceived inability to tolerate distressing states—varies based on the domain of distress (e.g., pain, anxiety). Although domain-specific assessment strategies may provide information targeted to specific disorders or maladaptive behaviors, domain-general measures have the potential to facilitate comparisons across studies, disorders, and populations. The current study evaluated the utilization of self-report measures of distress intolerance as domain-general measures by examining their association with indices of behavioral avoidance and substance craving. Two groups of participants (N = 55) were recruited including a substance-dependent group and a comparison group equated based on the presence of an affective disorder. Results provided support for the validity of domain-general measures for assessing distress intolerance across varied domains. The importance of both domain-general and domain-specific measurement of distress intolerance is discussed. PMID:21823763

Strategies to increase breast and cervical cancer screening among Hawaiian, Pacific Islander, and Filipina women in Hawai’i

PubMed Central

Aitaoto, Nia; Tsark, JoAnn U.; Wong, Danette Tomiyasu; Yamashita, Barbara A.; Braun, Kathryn L.

2016-01-01

The Hawai’i Breast and Cervical Cancer Control Program (BCCCP) offers free mammograms and Pap smears to women who are uninsured or underinsured through a statewide provider network. Native Hawaiians, Pacific Islanders and Filipinas are priority populations for this program, and BCCCP providers are required through contract with the Hawaii Department of Health to utilize half of their allotted mammograms and Pap smears for eligible women from these groups. To identify strategies for increasing use by these groups of mammography and Pap smear screening services through BCCCP, we held focus groups with women who could potentially use BCCCP services, and we conducted key informant interviews with 9 of Hawai’i’s 11 BCCCP providers and 9 non-BCCCP outreach workers serving these populations. Findings led to recommendations for promoting awareness of BCCCP and enhancing outreach to Native Hawaiian, Pacific Islander and Filipina communities in Hawai’i. PMID:19842363

Privacy-enhanced electronic mail

NASA Astrophysics Data System (ADS)

Bishop, Matt

1990-06-01

The security of electronic mail sent through the Internet may be described in exactly three words: there is none. The Privacy and Security Research Group has recommended implementing mechanisms designed to provide security enhancements. The first set of mechanisms provides a protocol to provide privacy, integrity, and authentication for electronic mail; the second provides a certificate-based key management infrastructure to support key distribution throughout the internet, to support the first set of mechanisms. These mechanisms are described, as well as the reasons behind their selection and how these mechanisms can be used to provide some measure of security in the exchange of electronic mail.

Patients as partners, patients as problem-solvers.

PubMed

Young, Amanda; Flower, Linda

2002-01-01

This article reports our ongoing work in developing a model of health care communication called collaborative interpretation, which we define as a rhetorical practice that generates building blocks for a more complete and coherent diagnostic story and for a collaborative treatment plan. It does this by situating patients as problem-solvers. Our study begins with an analysis of provider-patient interactions in a specific setting-the emergency department (ED) of an urban trauma-level hospital- where we observed patients and providers miscommunicating in at least 3 distinct areas: over the meaning of key terms, in the framing of the immediate problem, and over the perceived role of the ED in serving the individual and the community. From our observations, we argue that all of these miscommunications and missed opportunities are rooted in mismatched expectations on the part of both provider and patient and the lack of explicit comparison and negotiation of expectations-in other words, a failure to see the patient-provider interaction as a rhetorical, knowledge-building event. In the process of observing interactions, conversing with patients and providers, and working with a team of providers and patients, we have developed an operational model of communication that could narrow the gap between the lay public and the medical profession-a gap that is especially critical in intercultural settings like the one we have studied. This model of collaborative interpretation (CI) provides strategies to help patients to represent their medical problems in the context of their life experiences and to share the logic behind their health care decisions. In addition, CI helps both patient and provider identify their goals and expectations in treatment, the obstacles that each party perceives, and the available options. It is adaptableto various settings, including short, structured conversations in the emergency room, extended dialogue between a health educator and a patient in a clinical setting, and group discussions in support groups, community groups, or health education classrooms.

Use of a facilitated discussion model for antenatal care to improve communication.

PubMed

Lori, Jody R; Munro, Michelle L; Chuey, Meagan R

2016-02-01

Achieving health literacy is a critical step to improving health outcomes and the health of a nation. However, there is a lack of research on health literacy in low-resource countries, where maternal health outcomes are at their worst. To examine the usefulness and feasibility of providing focused antenatal care (FANC) in a group setting using picture cards to improve patient-provider communication, patient engagement, and improve health literacy. An exploratory, mixed methods design was employed to gather pilot data using the Health Literacy Skills Framework. A busy urban district hospital in the Ashanti Region of Ghana was used to gather data during 2014. A facility-driven convenience sample of midwives (n=6) aged 18 years or older, who could speak English or Twi, and had provided antenatal care at the participating hospital during the previous year prior to the start of the study participated in the study. Data were collected using pre-test and post-test surveys, completed three months after the group FANC was implemented. A semi-structured focus group was conducted with four of the participating midwives and the registered nurse providing support and supervision for the study (n=5) at the time of the post-test. Data were analyzed concurrently to gain a broad understanding of patient communication, engagement, and group FANC. There were no significant differences in the mean communication (t(df=3)=0.541, p=0.626) and engagement (t(df=3)=-0.775, p=0.495) scores between the pre- and post-test. However, the focus group revealed the following themes: (a) improved communication through the use of picture cards; (b) enhanced information sharing and peer support through the facilitated group process and; and (c) an improved understanding of patient concerns. The improved communication noted through the use of picture cards and the enhanced information sharing and peer support elicited through the group FANC undoubtedly provided patients with additional tools to invoke self-determination, and carry out the behaviors they thought were most important to improve pregnancy outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Implementation of patient education at first and second dispensing of statins in Dutch community pharmacies: the sequel of a cluster randomized trial

PubMed Central

2011-01-01

Background As a result of the previous part of this trial, many patients with cardiovascular disease were expected to receive a statin for the first time. In order to provide these patients with comprehensive information on statins, as recommended by professional guidance, education at first and second dispensing of statins had to be implemented. This study was designed to assess the effectiveness of an intensive implementation program targeted at pharmacy project assistants on the frequency of providing education at first dispensing (EAFD) and education at second dispensing (EASD) of statins in community pharmacies. Methods The participating community pharmacies were clustered on the basis of local collaboration, were numbered by a research assistant and subsequently an independent statistician performed a block randomization, in which the cluster size (number of pharmacies in each cluster) was balanced. The pharmacies in the control group received a written manual on the implementation of EAFD and EASD; the pharmacies in the intervention group received intensive support for the implementation. The impact of the intensive implementation program on the implementation process and on the primary outcomes was examined in a random coefficient logistic regression model, which took into account that patients were grouped within pharmacy clusters. Results Of the 37 pharmacies in the intervention group, 17 pharmacies (50%) provided EAFD and 12 pharmacies (35.3%) provided EASD compared to 14 pharmacies (45.2%, P = 0.715) and 12 pharmacies (38.7%, P = 0.899), respectively, of the 34 pharmacies in the control group. In the intervention group a total of 72 of 469 new statin users (15.4%) received education and 49 of 393 patients with a second statin prescription (12.5%) compared to 78 of 402 new users (19.4%, P = 0.944) and 35 of 342 patients with a second prescription (10.2%, P = 0.579) in the control group. Conclusion The intensive implementation program did not increase the frequency of providing EAFD and EASD of statins in community pharmacies. Trial Registration clinicaltrials.gov NCT00509717 PMID:22087850

Barriers and Facilitators of a Healthy Lifestyle Among Persons with Serious and Persistent Mental Illness: Perspectives of Community Mental Health Providers

PubMed Central

McKibbin, Christine L.; Kitchen, Katherine A.; Wykes, Thomas L.; Lee, Aaron A.

2014-01-01

The investigators used qualitative methods to examine perspectives of community mental health professionals on obesity management in adults with serious mental illness. Data from 5 focus groups were subjected to constant comparison analysis and grounded theory. Results showed that influences at individual, social, community, and societal levels impact development and maintenance of obesity. Mental health providers desired a collaborative relationship with providers of health promotion program staff. They also believed that frequent, group-based health promotion should include participation incentives for adults with SMI and should occur over durations of at least 6-months to achieve improved health outcomes for this population. PMID:24129587

Growth and development issues in adolescents with ostomies: a primer for the WOC nurses.

PubMed

Mohr, Lynn D

2012-01-01

Caring for the adolescent (13-18 years of age) with an ostomy presents multiple challenges. The purpose of this article is to provide strategies to assist the WOC nurse in minimizing the potential impact on growth and development for this age group with an ostomy. This is relevant to the WOC nurse since it is estimated that between 6% and 14% of all adolescents have symptoms of irritable bowel disease, and many will require an ostomy. Thus the WOC nurse will be called upon to provide care to this age group. This article discusses normal adolescent growth and development and provides strategies to support the normal growth and development.

Key Ingredients-Target Groups, Methods and Messages, and Evaluation-of Local-Level, Public Interventions to Counter Stigma and Discrimination: A Lived Experience Informed Selective Narrative Literature Review.

PubMed

Ashton, Laura J; Gordon, Sarah E; Reeves, Racheal A

2018-04-01

A proliferation of recent literature provides substantial direction as to the key ingredients-target groups, messages and methods, and evaluation-of local-level, public interventions to counter stigma and discrimination. This paper provides a selective narrative review of that literature from the perspective or standpoint of anti-stigma experts with lived experience of mental distress, the key findings of which have been synthesised and presented in diagrammatic overviews (infographics). These are intended to guide providers in planning, delivering and evaluating lived experience-directed local-level, public interventions to counter stigma and discrimination in accord with current best practice.

Logarithmic current measurement circuit with improved accuracy and temperature stability and associated method

DOEpatents

Ericson, M. Nance; Rochelle, James M.

1994-01-01

A logarithmic current measurement circuit for operating upon an input electric signal utilizes a quad, dielectrically isolated, well-matched, monolithic bipolar transistor array. One group of circuit components within the circuit cooperate with two transistors of the array to convert the input signal logarithmically to provide a first output signal which is temperature-dependant, and another group of circuit components cooperate with the other two transistors of the array to provide a second output signal which is temperature-dependant. A divider ratios the first and second output signals to provide a resultant output signal which is independent of temperature. The method of the invention includes the operating steps performed by the measurement circuit.

Platinum and lead markers as indicators of transportation impact.

DOT National Transportation Integrated Search

2009-08-20

The intent of this study was to provide information necessary to characterize the present concentrations of an emerging transportation related contaminant, the platinum group metals (PGM), and to provide background information necessary to explore th...

Caregiving setting and Baby Boomer caregiver stress processes: Findings from the National Study of Caregiving (NSOC).

PubMed

Moon, Heehyul; Rote, Sunshine; Beaty, Jeff A

The aim of this study was to provide a comprehensive understanding of how the caregiving setting relates to caregiving experience among Baby Boomer caregivers (CGs). Based on a secondary data analysis (the National Study of Caregiving, N = 782), compared with CGs providing care to an older adult living in the community, CGs to older adults in non-NH residential care settings reported better emotional well-being, self-rated health, and relationship quality and less provision of assistance older adults with daily activities. While chronic conditions, relationship quality, and financial strain were associated with the health and well-being for both CG groups, degree of informal support was more consequential for the health of CGs providing care to older adults in the community. Our results provide critical information on the risk factors and areas of intervention for both CG groups. Copyright © 2016 Elsevier Inc. All rights reserved.

Response to: 'Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies' by Schuklenk and Smalling.

PubMed

Lyus, Richard John

2017-04-01

Bioethicists commenting on conscientious objection and abortion should consider the empirical data on abortion providers. Abortion providers do not fall neatly into groups of providers and objectors, and ambivalence is a key theme in their experience. Practical details of abortion services further upset the dichotomy. These empirical facts are important because they demonstrate that the way the issue is described in analytical bioethics does not reflect reality. Addressing conscientious objection as a barrier to patient access requires engaging with those who provide the service and those who are able to but do not. The experiences of doctors facing these decisions potentially challenge and expand our understanding of the issue as an ethical concern. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Synthetic Biology Open Language (SBOL) provides a community standard for communicating designs in synthetic biology.

PubMed

Galdzicki, Michal; Clancy, Kevin P; Oberortner, Ernst; Pocock, Matthew; Quinn, Jacqueline Y; Rodriguez, Cesar A; Roehner, Nicholas; Wilson, Mandy L; Adam, Laura; Anderson, J Christopher; Bartley, Bryan A; Beal, Jacob; Chandran, Deepak; Chen, Joanna; Densmore, Douglas; Endy, Drew; Grünberg, Raik; Hallinan, Jennifer; Hillson, Nathan J; Johnson, Jeffrey D; Kuchinsky, Allan; Lux, Matthew; Misirli, Goksel; Peccoud, Jean; Plahar, Hector A; Sirin, Evren; Stan, Guy-Bart; Villalobos, Alan; Wipat, Anil; Gennari, John H; Myers, Chris J; Sauro, Herbert M

2014-06-01

The re-use of previously validated designs is critical to the evolution of synthetic biology from a research discipline to an engineering practice. Here we describe the Synthetic Biology Open Language (SBOL), a proposed data standard for exchanging designs within the synthetic biology community. SBOL represents synthetic biology designs in a community-driven, formalized format for exchange between software tools, research groups and commercial service providers. The SBOL Developers Group has implemented SBOL as an XML/RDF serialization and provides software libraries and specification documentation to help developers implement SBOL in their own software. We describe early successes, including a demonstration of the utility of SBOL for information exchange between several different software tools and repositories from both academic and industrial partners. As a community-driven standard, SBOL will be updated as synthetic biology evolves to provide specific capabilities for different aspects of the synthetic biology workflow.

Family physicians who provide intrapartum care and those who do not: very different ways of viewing childbirth.

PubMed

Klein, Michael C; Kaczorowski, Janusz; Tomkinson, Jocelyn; Hearps, Stephen; Baradaran, Nazli; Brant, Rollin

2011-04-01

To examine FPs' attitudes toward birth for those providing intrapartum care (IPC) and those providing only antepartum care (APC). National, cross-sectional Web- and paper-based survey. Canada. A total of 897 Canadian FPs: 503 providing both IPC and APC (FPIs), 252 providing only APC but who previously provided IPC (FPPs), and 142 providing only APC who never provided IPC (FPNs). Respondents' views (measured on a 5-point Likert scale) on routine electronic fetal monitoring, epidural analgesia, routine episiotomy, doulas, pelvic floor benefits of cesarean section, approaches to reducing cesarean section rates, maternal choice and the mother's role in her own child's birth, care providers' fears of vaginal birth for themselves or their partners, and safety by mode or place of birth. Results showed that FPIs and FPPs were more likely than FPNs were to take additional training or advanced life support courses. The FPIs consistently demonstrated more positive attitudes toward vaginal birth than did the other 2 groups. The FPPs and FPNs showed significantly more agreement with use of routine electronic fetal monitoring and routine epidural analgesia (P < .001). The FPIs displayed significantly more acceptance of doulas (P < .001) and more disagreement with the pelvic floor benefits of cesarean section than other FPs did (P < .001). The FPIs were significantly less fearful of vaginal birth for themselves or their partners than were FPPs and FPNs (P < .001). All FP groups agreed on rejection of elective cesarean section, in the absence of indications, for themselves or their partners and on support for vaginal birth in the presence of uterine scar. While all FP groups supported licensed midwifery, three-quarters thought home birth was more dangerous than hospital birth and showed ambivalence toward birth plans. Only 7.8% of FPIs would choose obstetricians for their own or their partners' maternity care. The FPIs had a more positive, evidence-based view of birth. It is likely that FPs providing only APC are influencing women in their practices toward a relatively negative view of birth before referral to obstetricians, FPIs, or midwives for the actual birth. The relatively negative views of birth held by FPs providing only APC need to be addressed in family practice education and in continuing education.

Short report: Influence of culture and trauma history on autobiographical memory specificity.

PubMed

Humphries, Clare; Jobson, Laura

2012-01-01

This study investigated the influence of culture and trauma history on autobiographical memory specificity. Chinese international and British undergraduate university students (N=64) completed the autobiographical memory test, Hopkins symptom checklist-25, twenty statements test, trauma history questionnaire, and impact of events scale-revised. The results indicated that the British group provided significantly more specific memories than the Chinese group. The high trauma exposure group provided significantly fewer specific autobiographical memories than the low trauma exposure group. The interaction was not significant. The findings suggest that even in cultures where specificity is not as evident in autobiographical remembering style, trauma exposure appears to exert similar influence on autobiographical memory specificity.

Adding Group Psychotherapy to Medication Treatment in Dysthymia

PubMed Central

Hellerstein, David J.; Little, Suzanne A. S.; Samstag, Lisa Wallner; Batchelder, Sarai; Muran, J. Christopher; Fedak, Michael; Kreditor, David; Rosenthal, Richard N.; Winston, Arnold

2001-01-01

Patients with dysthymia have been shown to respond to treatment with antidepressant medications, and to some degree to psychotherapy. Even patients successfully treated with medication often have residual symptoms and impaired psychosocial functioning. The authors describe a prospective randomized 36-week study of dysthymic patients, comparing continued treatment with antidepressant medication (fluoxetine) alone and medication with the addition of group therapy treatment. After an 8-week trial of fluoxetine, medication-responsive subjects were randomly assigned to receive either continued medication only or medication plus 16 sessions of manualized group psychotherapy. Results provide preliminary evidence that group therapy may provide additional benefit to medication-responding dysthymic patients, particularly in interpersonal and psychosocial functioning. PMID:11264333

Creating a library holding group: an approach to large system integration.

PubMed

Huffman, Isaac R; Martin, Heather J; Delawska-Elliott, Basia

2016-10-01

Faced with resource constraints, many hospital libraries have considered joint operations. This case study describes how Providence Health & Services created a single group to provide library services. Using a holding group model, staff worked to unify more than 6,100 nonlibrary subscriptions and 14 internal library sites. Our library services grew by unifying 2,138 nonlibrary subscriptions and 11 library sites and hiring more library staff. We expanded access to 26,018 more patrons. A model with built-in flexibility allowed successful library expansion. Although challenges remain, this success points to a viable model of unified operations.

45 CFR 146.101 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR THE GROUP HEALTH INSURANCE MARKET General Provisions § 146.101 Basis and scope. (a) Statutory... access to group health insurance coverage, to guarantee the renewability of all coverage in the group... group health plan or health insurance issuer offering group health insurance coverage may provide...

Theme-Oriented Group Therapy.

ERIC Educational Resources Information Center

Richards, R. Lynn; And Others

1990-01-01

Describes the three major influences on theme-oriented groups: theme-centered interactional, structured, and behavioral groups. Provides a comparison of the composition and structure of theme groups during the current decade. Summarizes the general principles thought to be important in the construction and development of theme-oriented groups.…

Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

PubMed

De Jesus, Maria; Earl, Tara R

2014-01-01

Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.

Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: Implications for effective patient-centered policies and models of care

PubMed Central

De Jesus, Maria; Earl, Tara R.

2014-01-01

Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care. PMID:24461570

76 FR 4365 - Renewal of the Trinity River Adaptive Management Working Group

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-25

... Management Working Group AGENCY: Office of the Secretary, Interior. ACTION: Notice. SUMMARY: The Secretary of... Trinity River Adaptive Management Working Group (Working Group) for 2 years. The Working Group provides... Road, Arcata, CA 95521; 707-822-7201. SUPPLEMENTARY INFORMATION: The Working Group conducts its...

78 FR 5830 - Renewal of the Trinity River Adaptive Management Working Group

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

... Management Working Group AGENCY: Office of the Secretary, Interior. ACTION: Notice. SUMMARY: The Secretary of... Trinity River Adaptive Management Working Group (Working Group) for 2 years. The Working Group provides... Road, Arcata, CA 95521; 707-822-7201. SUPPLEMENTARY INFORMATION: The Working Group conducts its...

Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study.

PubMed

Sokol, Randi; Albanese, Chiara; Chaponis, Deviney; Early, Jessica; Maxted, George; Morrill, Diana; Poirier, Grace; Puopolo, Fran; Schuman-Olivier, Zev

2018-01-02

Primary care providers are well positioned to respond to the opioid crisis by providing buprenorphine/naloxone (B/N) through shared medical appointments (SMAs). Although quantitative research has been previously conducted on SMAs with B/N, the authors conducted a qualitative assessment from the patients' point of view, considering whether and how group visits provide value for patients. Twenty-five participants with opioid use disorder (OUD) who were enrolled in a weekly B/N group visit at a family medicine clinic participated in either of two 1-hour-long focus groups, which were conducted as actual group visits. Participants were prompted with the question "How has this group changed you as a person?" Data were audio-recorded and professionally transcribed and analyzed using a qualitative thematic approach, identifying common communication behaviors and resulting attitudes about the value of the group visit model. Participants demonstrated several communication behaviors that support group members in their recovery, including offering direct emotional support to others struggling with difficult experiences, making an intentional effort to probe about others' lives, venting about heavy situations, joking to lighten the mood, and expressing feelings of gratitude to the entire group. These communication behaviors appear to act as mechanisms to foster a sense of accountability, a shared identity, and a supportive community. Other demonstrated group behaviors may detract from the value of the group experience, including side conversations, tangential comments, and individual participants disproportionately dominating group time. The group visit format for delivering B/N promotes group-specific communication behaviors that may add unique value in supporting patients in their recovery. Future research should elucidate whether these benefits can be isolated from those achieved solely through medication treatment with B/N and if similar benefits could be achieved in non-primary care sites.

Lost Keys: Understanding Service Providers' Impressions of Frequent Visitors to Psychiatric Emergency Services in Singapore.

PubMed

Poremski, Daniel; Kunjithapatham, Ganesh; Koh, Doris; Lim, Xin Ya; Alexander, Mark; Lee, Cheng

2017-04-01

This study used administrative data to identify characteristics of frequent users of Singapore's largest specialized psychiatric emergency department (ED). Qualitative interviews were conducted to understand staff opinions of frequent visitors. Data were from administrative records of all adult visits to the ED (N=16,123 visits of 10,108 individual users) in 2014. Random-effects logistic regressions were used to identify demographic and diagnostic characteristics of frequent visitors. To facilitate interpretation of administrative data in a convergent mixed-methods study design, interviews were conducted with 26 service providers who worked in the ED. Frequent use was defined as five or more visits in 2014. This cutoff distinguished the top 3% of users (N=331), and this group accounted for 16% of service use. Frequent users were more likely to have a diagnosis of a psychotic disorder, personality disorder, or alcohol use disorder. Service provider groups (for example, physicians, nurses, and assistants) described similar groups of frequent users and noted that frequent use was related to lack of social supports outside the hospital and feelings of belonging within it. The most frequently cited challenges were managing intoxicated service seekers, managing expectations for admission, and dealing with threats of self-harm. The profiles of frequent ED users in Singapore resembled those reported in other large urban centers. The opinions of service providers and their reactions to difficult situations were similar to those of providers in nonpsychiatric settings. The service providers' perspectives highlight how societal pressures influence the way in which individuals with mental illnesses use services.

Healthcare service problems reported in a national survey of South Africans.

PubMed

Hasumi, Takahiro; Jacobsen, Kathryn H

2014-08-01

To identify common types of health service problems reported by South African adults during their most recent visit to a healthcare provider. Secondary analysis of South Africa's cross-sectional General Household Survey (GHS). Nationally representative weighted sample of households in South Africa. 23,562 household representatives interviewed during the 2010 GHS. Problems experienced during the most recent visit to the usual healthcare provider. In total, 43.8% of participants reported experiencing at least one problem during their last visit; 19.1% reported multiple problems. The most common problems experienced were a long waiting time (34.8% of household representatives), needed drugs not being available (14.1%) and staff who were rude or uncaring or turned patients away (10.1%). Of the 73.6% of participants using public providers, 54.9% reported at least one problem; of the 26.4% of participants using private providers, only 18.0% reported a problem, usually cost. Similar differences in reported problems at public and private providers were reported for all racial/ethnic groups and income groups. Black Africans reported more problems than other population groups due in large part to being significantly more likely to use public providers. Addressing commonly reported problem areas-in particular, long waiting times, unavailable medications and staff who are perceived as being unfriendly-might help prevent delayed care seeking, increase the acceptability of healthcare services and reduce remaining health disparities in South Africa. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Time, timing, talking and training: findings from an exploratory action research study to improve quality of end of life care for minority ethnic kidney patients.

PubMed

Wilkinson, Emma; Randhawa, Gurch; Brown, Edwina; Da Silva Gane, Maria; Stoves, John; Warwick, Graham; Mir, Tahira; Magee, Regina; Sharman, Sue; Farrington, Ken

2017-06-01

Background. With an ageing and increasingly diverse population at risk from rising levels of obesity, diabetes and cardiovascular disease, including kidney complications, there is a need to provide quality care at all stages in the care pathway including at the end of life and to all patients. Aim . This study purposively explored South Asian patients' experiences of kidney end of life care to understand how services can be delivered in a way that meets diverse patient needs. Methods. Within an action research design 14 focus groups (45 care providers) of kidney care providers discussed the recruitment and analysis of individual interviews with 16 South Asian kidney patients (eight men, eight women). Emergent themes from the focus groups were analysed thematically. The research took place at four UK centres providing kidney care to diverse populations: West London, Luton, Leicester and Bradford. Results. Key themes related to time and the timing of discussions about end of life care and the factors that place limitations on patients and providers in talking about end of life care. Lack of time and confidence of nurses in areas of kidney care, individual attitudes and workforce composition influence whether and how patients have access to end of life care through kidney services. Conclusion. Training, team work and time to discuss overarching issues (including timing and communication about end of life) with colleagues could support service providers to facilitate access and delivery of end of life care to this group of patients.

Evaluation of health-care providers' knowledge of childhood tuberculosis in Lima, Peru.

PubMed

Chiang, Silvia S; Cruz, Andrea T; Del Castillo, Hernán; Contreras, Carmen; Becerra, Mercedes C; Lecca, Leonid

2015-02-01

As most national tuberculosis programmes (NTPs) focus on adult tuberculosis (TB), NTP providers may not appreciate differences in the pathophysiology and presentation of childhood TB. This study aimed to identify strengths and weaknesses in knowledge of childhood TB among the 326 NTP providers in Lima Ciudad and Lima Este--two of the Peruvian capital's four health districts. 310 providers--103 physicians, 106 nurses, 101 nursing technicians--accepted personal invitations to complete self-administered surveys, which included 14 childhood TB questions grouped into five sections: transmission, symptoms, diagnosis, prevention and treatment. Physicians were asked ten additional questions targeting their NTP diagnostic and management responsibilities. All three groups scored 97-99% on the transmission section and 83-85% on the treatment section; however, no group scored above 66% on any other section. Fewer than 50% of nurses and technicians recognised young children's high risk of extrapulmonary TB, extrapulmonary TB symptoms or the causes of false negative tuberculin skin tests. Twenty-three per cent of physicians correctly identified gastric aspirate culture sensitivity, and 42% the radiographical findings of pulmonary TB. Less than two-thirds of providers recognised the definition of latent TB infection (LTBI), young children's high risk of progression from LTBI to disease or indications for isoniazid preventive therapy. Providers at the frontline of Peru's TB control efforts demonstrated weaknesses in the areas of extrapulmonary disease, diagnosis and prevention. These knowledge gaps are likely to have resulted in delayed or missed diagnoses and lost opportunities for prevention. Educational interventions targeting NTP personnel may improve childhood TB care and outcomes.

Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world: part II. Ethical considerations.

PubMed

Schneider, William J; Migliori, Mark R; Gosain, Arun K; Gregory, George; Flick, Randall

2011-09-01

Many international volunteer groups provide free reconstructive plastic surgery for the poor and underserved in developing countries. An essential issue in providing this care is that it meets consistent guidelines for both quality and safety-a topic that has been addressed previously. An equally important consideration is how to provide that care in an ethical manner. No literature presently addresses the various issues involved in making those decisions. With these ethical considerations in mind, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Foundation undertook a project to create a comprehensive set of guidelines for volunteer groups planning to provide this type of reconstructive plastic surgery in developing countries. The committee worked in conjunction with the Society for Pediatric Anesthesia on this project. The Board of the American Society of Plastic Surgeons/Plastic Surgery Foundation has approved the ethical guidelines created for the delivery of care in developing countries. The guidelines address the variety of ethical decisions that may be faced by a team working in an underdeveloped country. These guidelines make it possible for a humanitarian effort to anticipate the types of ethical decisions that are often encountered and be prepared to deal with them appropriately. Any group seeking to undertake an international mission trip in plastic surgery should be able to go to one source to find a detailed discussion of the perceived needs in providing ethical humanitarian care. This document was created to satisfy that need and is a companion to our original guidelines addressing safety and quality.

Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

PubMed

Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

2018-05-15

Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

Health Transportation Working Group 2016 Annual Report

DOT National Transportation Integrated Search

2017-06-30

The Health in Transportation Working Group 2016 Annual Report provides an overview of the Working Groups activities and accomplishments in 2016, summarizes other USDOT health-related accomplishments, and documents its progress toward the recommend...

Concurrent validity of the Wheeler signs of homosexuality in the Rorschach: P (Ci/Rj).

PubMed

Stone, N M; Schneider, R E

1975-12-01

The Rorschach protocols of 43 males consecutively admitted to a university outpatient clinic were scored for frequency of the 20 Wheeler signs of homosexuality. Based on case history data, patients were assigned to homosexual, sex-role disturbed, or normal-control groups. In addition to the traditional group comparison the results were analyzed to yield P (Ci/Rj); that is, the probability of criterion group membership given test indicator. Both the homosexual and sex-role disturbed group displayed significantly more Wheeler signs than normals. Furthermore, given a Wheeler sign score of 15%, .75 of the predicted-homosexual group would be correctly classified compared to a .21 baserate prediction. It was suggested that expressing results as P (Ci/Rj) provides information more relevant to the clinician than is provided by the traditional practice of reporting significant differences between groups.

The prophylactic and therapeutic effects of glutamine- and arginine-enriched diets on radiation-induced enteritis in rats.

PubMed

Ersin, S; Tuncyurek, P; Esassolak, M; Alkanat, M; Buke, C; Yilmaz, M; Telefoncu, A; Kose, T

2000-04-01

Recent studies indicated that glutamine and arginine support the mucosal barrier in several ways. This experimental study hypothesized that administration of glutamine- and arginine-enriched diets before abdominal radiation therapy would provide a radioprotective effect on intestinal mucosa, and this would augment the therapeutic effectiveness provided by postirradiation administration. A rat model of radiation enteritis was designed with a single dose of 1100 cGy to the abdomen. Thirty-five rats were randomized into five groups of seven. A 7-day glutamine-enriched diet for Group I and a 7-day arginine-enriched diet for Group II were administered both pre- and postradiation. For Groups III and IV, the same glutamine and arginine diets were given, respectively, postradiation only. Group V was fed a glutamine- and arginine-free diet and was the control group. The rats underwent laparotomy for culture of mesenteric lymph nodes and removal of segments of ileum, jejenum, and colon for microscopic examination. Bacterial translocation was significantly higher in Group V (P < 0.05), while intestinal villus count and villus height were significantly higher in all of the groups fed glutamine and arginine when compared with the control group (P < 0.0001 and P < 0.05, respectively). Both arginine- and glutamine-enriched diets have protective effects on gut mucosa in the postirradiation state; however, pre- and postirradiation administration together does not provide superior protection versus postradiation administration alone. Copyright 2000 Academic Press.

Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: a randomized prospective study.

PubMed

Türk, Hacer Şebnem; Aydoğmuş, Meltem; Ünsal, Oya; Işıl, Canan Tülay; Citgez, Bülent; Oba, Sibel; Açık, Mehmet Eren

2014-12-01

Different drug combinations are used for sedation in colonoscopy procedures. A ketamine-propofol (ketofol) mixture provides effective sedation and has minimal adverse effects. Alfentanil also provides anesthesia for short surgical procedures by incremental injection as an adjunct. However, no study has investigated the use of ketofol compared with an opioid-propofol combination in colonoscopic procedures. A total of 70 patients, ASA physical status I-II, scheduled to undergo elective colonoscopy, were enrolled in this prospective randomized study and allocated to two groups. After premedication, sedation induction was performed with 0.5 mg/kg ketamine +1 mg/kg propofol in Group KP, and 10 mg/kg alfentanil +1 mg/kg propofol in Group AP. Propofol was added when required. Demographic data, colonoscopy duration, recovery time, discharge time, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, Ramsey Sedation Scale values, colonoscopy patients' satisfaction scores, and complications were recorded. The need for additional propofol doses was significantly higher in Group AP than in Group KP. MAP at minute 1 and 5, Ramsey Sedation Scale at minute 5, and discharge time were significantly higher in Group KP than in Group AP. Additional propofol doses and total propofol dose were significantly lower in Group KP than in Group AP. Ketofol provided better hemodynamic stability and quality of sedation compared with alfentanil-propofol combination in elective colonoscopy, and required fewer additional propofol; however, it prolonged discharge time. Both combinations can safely be used in colonoscopy sedation.

Effect of providing risk information on undergoing cervical cancer screening: a randomized controlled trial.

PubMed

Fujiwara, Hiroyuki; Shimoda, Akihiro; Ishikawa, Yoshiki; Taneichi, Akiyo; Ohashi, Mai; Takahashi, Yoshifumi; Koyanagi, Takahiro; Morisawa, Hiroyuki; Takahashi, Suzuyo; Sato, Naoto; Machida, Shizuo; Takei, Yuji; Saga, Yasushi; Suzuki, Mitsuaki

2015-01-01

In Japan, the cervical cancer screening rate is extremely low. Towards improving the cervical cancer screening rate, encouraging eligible people to make an informed choice, which is a decision-making process that relies on beliefs informed by adequate information about the possible benefits and risks of screening, has attracted increased attention in the public health domain. However, there is concern that providing information on possible risks of screening might prevent deter from participating. In total, 1,912 women aged 20-39 years who had not participated in screening in the fiscal year were selected from a Japanese urban community setting. Participants were randomly divided into 3 groups. Group A received a printed reminder with information about the possible benefits of screening, group B received a printed reminder with information about possible benefits and risks, and group C received a printed reminder with simple information only (control group). Out of 1,912 participants, 169 (8.8%) participated in cervical cancer screening. In the intervention groups, 137 (10.9%) participated in cervical cancer screening, compared to only 32 (4.9%) of the control group (p < 0.001). In addition, logistic regression analysis revealed that there was no significant difference in screening rate between group A and group B (p = 0.372). Providing information on the possible risks of screening may not prevent people from taking part in cervical cancer screening among a Japanese non-adherent population.

Perceptions on evaluative and formative functions of external supervision of Rwandan primary healthcare facilities: A qualitative study.

PubMed

Schriver, Michael; Cubaka, Vincent Kalumire; Itangishaka, Sylvere; Nyirazinyoye, Laetitia; Kallestrup, Per

2018-01-01

External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. Qualitative, exploratory study. Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.

Interest in the use of computerized patient portals: role of the provider-patient relationship.

PubMed

Zickmund, Susan L; Hess, Rachel; Bryce, Cindy L; McTigue, Kathleen; Olshansky, Ellen; Fitzgerald, Katharine; Fischer, Gary S

2008-01-01

Bioinformatics experts are developing interactive patient portals to help those living with diabetes and other chronic diseases to better manage their conditions. However, little is known about what influences patients' desires to use this technology. To discern the impact of the provider-patient relationship on interest in using a web-based patient portal. Qualitative analysis of focus groups. Ten focus groups involving 39 patients (range 2-7) recruited from four primary care practices. A qualitative approach was used, which involved reading transcribed texts until a consensus was reached on data interpretation. An intercoder reliability kappa score (0.89) was determined by comparing the provider-patient relationship talk selected by the two coders. A conceptual framework was developed, which involved the development and refinement of a codebook and the application of it to the transcripts. Interest in the portal was linked to dissatisfaction with the provider-patient relationship, including dissatisfaction with provider communication/responsiveness, the inability to obtain medical information, and logistical problems with the office. Disinterest in the portal was linked to satisfaction with the provider-patient relationship, including provider communication/responsiveness, difficulty in using the portal, and fear of losing relationships and e-mail contact with the provider. No patient identified encrypted e-mail communication through the portal as an advantage. Promoting the use of computerized portals requires patient-based adaptations. These should include ease of use, direct provider e-mail, and reassurances that access and interpersonal relationships will not be lost. Education is needed about privacy concerns regarding traditional e-mail communication.

Surgical Outcomes of Newly Trained ShangRing Circumcision Providers.

PubMed

Awori, Quentin D; Lee, Richard K; Li, Philip S; Zulu, Robert; Agot, Kawango; Combes, Stephanie; Simba, Raymond O; Hart, Catherine; Lai, Jaim Jou; Zyambo, Zude; Goldstein, Marc; Feldblum, Paul J; Barone, Mark A

2016-06-01

Devices can potentially accelerate scale-up of voluntary medical male circumcision in sub-Saharan Africa. Studies have demonstrated advantages of the ShangRing device over conventional circumcision. With the need to train providers rapidly for scale-up, concerns arise about the transferability of techniques and the expertise of new trainees. We compared outcomes of ShangRing circumcisions conducted in Kenya by experienced providers (experience with more than 100 ShangRing circumcisions) and newly trained providers (trained in Kenya by the experienced providers before the study began). During training, trainees performed at least 7 ShangRing circumcisions and 3 removals. Newly trained providers received intermittent clinical mentoring initially during the study but otherwise conducted circumcisions on their own. Four hundred six and 115 ShangRing procedures were performed by the new trainees and the experienced providers, respectively. The mean duration of circumcisions was 6.2 minutes for both trained and experienced provider groups (P = 0.45), whereas the mean pain score (on an 11-point scale) was 2.5 and 3.2, respectively (P = 0.65). There was no difference in the proportion of participants healed by the day 42 visit (P = 0.13) nor in the incidence of moderate and severe adverse events observed (P = 0.16). Participants in both groups were equally satisfied with final wound cosmesis. Results demonstrate that the ShangRing circumcision technique is easy to learn and master. Newly trained providers can safely conduct ShangRing circumcisions in routine service settings. The ShangRing can facilitate rapid rollout of voluntary medical male circumcision for HIV prevention in sub-Saharan Africa.

Serving some and serving all: how providers navigate the challenges of providing racially targeted health services.

PubMed

Zhou, Amy

2017-10-01

Racially targeted healthcare provides racial minorities with culturally and linguistically appropriate health services. This mandate, however, can conflict with the professional obligation of healthcare providers to serve patients based on their health needs. The dilemma between serving a particular population and serving all is heightened when the patients seeking care are racially diverse. This study examines how providers in a multi-racial context decide whom to include or exclude from health programs. This study draws on 12 months of ethnographic fieldwork at an Asian-specific HIV organization. Fieldwork included participant observation of HIV support groups, community outreach programs, and substance abuse recovery groups, as well as interviews with providers and clients. Providers managed the dilemma in different ways. While some programs in the organization focused on an Asian clientele, others de-emphasized race and served a predominantly Latino and African American clientele. Organizational structures shaped whether services were delivered according to racial categories. When funders examined client documents, providers prioritized finding Asian clients so that their documents reflected program goals to serve the Asian population. In contrast, when funders used qualitative methods, providers could construct an image of a program that targets Asians during evaluations while they included other racial minorities in their everyday practice. Program services were organized more broadly by health needs. Even within racially targeted programs, the meaning of race fluctuates and is contested. Patients' health needs cross cut racial boundaries, and in some circumstances, the boundaries of inclusion can expand beyond specific racial categories to include racial minorities and underserved populations more generally.

A case series of an off-the-shelf online health resource with integrated nurse coaching to support self-management in COPD.

PubMed

Early, Frances; Young, Jane S; Robinshaw, Elizabeth; Mi, Emma Z; Mi, Ella Z; Fuld, Jonathan P

2017-01-01

COPD has significant psychosocial impact. Self-management support improves quality of life, but programs are not universally available. IT-based self-management interventions can provide home-based support, but have mixed results. We conducted a case series of an off-the-shelf Internet-based health-promotion program, The Preventive Plan (TPP), coupled with nurse-coach support, which aimed to increase patient activation and provide self-management benefits. A total of 19 COPD patients were recruited, and 14 completed 3-month follow-up in two groups: groups 1 and 2 with more and less advanced COPD, respectively. Change in patient activation was determined with paired t -tests and Wilcoxon signed-rank tests. Benefits and user experience were explored in semistructured interviews, analyzed thematically. Only group 1 improved significantly in activation, from a lower baseline than group 2; group 1 also improved significantly in mastery and anxiety. Both groups felt significantly more informed about COPD and reported physical functioning improvements. Group 1 reported improvements in mood and confidence. Overall, group 2 reported fewer benefits than group 1. Both groups valued nurse-coach support; for group 1, it was more important than TPP in building confidence to self-manage. The design of TPP and lack of motivation to use IT were barriers to use, but disease severity and poor IT skills were not. Our findings demonstrate the feasibility of combining nurse-coach support aligned to an Internet-based health resource, TPP, in COPD and provide learning about the challenges of such an approach and the importance of the nurse-coach role.

Comparison of individual answer and group answer with and without structured peer assessment

NASA Astrophysics Data System (ADS)

Kablan, Zeynel

2014-09-01

Background:Cooperative learning activities provide active participation of students leading to better learning. The literature suggests that cooperative learning activities need to be structured for a more effective and productive interaction. Purpose: This study aimed to test the differences among three instructional conditions in terms of science achievement. Sample:A total of 79 fifth-grade students, 42 males (53%) and 37 females (47%), participated in the study. Design and Methods:In the first condition, students answered the teacher's questions individually by raising hands. In the second condition, students discussed the answer in groups and came up with a single group answer. In this condition, the teacher provided only verbal directions to the groups without using any strategy or material. In the third condition, students used a 'peer assessment form' before giving the group answer. A pre-/post-test experimental design was used. Multiple-choice and open-ended tests were used for data collection. One-way analysis of variance (ANOVA) was conducted to test the differences in the test scores between the three groups (individual answer, unstructured group answer and structured group answer). Results:Results showed that there were no significant differences among the three learning conditions in terms of their multiple-choice test scores. In terms of the open-ended test scores, students in the structured group answer condition scored significantly higher than the students in the individual answer condition. Conclusions:Structuring the group work through peer assessment helped to monitor the group discussion, provided a better learning compared to the individual answer condition, and helped students to participate in the activity equally.

How can social network analysis contribute to social behavior research in applied ethology?

PubMed

Makagon, Maja M; McCowan, Brenda; Mench, Joy A

2012-05-01

Social network analysis is increasingly used by behavioral ecologists and primatologists to describe the patterns and quality of interactions among individuals. We provide an overview of this methodology, with examples illustrating how it can be used to study social behavior in applied contexts. Like most kinds of social interaction analyses, social network analysis provides information about direct relationships (e.g. dominant-subordinate relationships). However, it also generates a more global model of social organization that determines how individual patterns of social interaction relate to individual and group characteristics. A particular strength of this approach is that it provides standardized mathematical methods for calculating metrics of sociality across levels of social organization, from the population and group levels to the individual level. At the group level these metrics can be used to track changes in social network structures over time, evaluate the effect of the environment on social network structure, or compare social structures across groups, populations or species. At the individual level, the metrics allow quantification of the heterogeneity of social experience within groups and identification of individuals who may play especially important roles in maintaining social stability or information flow throughout the network.

"It is the 'starting over' part that is so hard": Using an online group to support hospice bereavement.

PubMed

Wittenberg-Lyles, Elaine; Washington, Karla; Oliver, Debra Parker; Shaunfield, Sara; Gage, L Ashley; Mooney, Megan; Lewis, Alexandria

2015-04-01

Although hospice agencies are required to provide informal caregivers (family or friends of the patient) with formal bereavement support when their loved one passes, most bereavement interventions lack standardization and remain untested. We employed the Dual Processing Model of Bereavement as a theoretical framework for assessing the potential of a secret Facebook group for bereaved hospice caregivers. A mixed-methods approach was utilized to analyze online communication (posts and comments) in the secret Facebook group, and self-reported outcome measures on depression and anxiety were compared pre- and post-intervention. Sixteen caregivers participated in the secret Facebook group over a period of nine months. The majority of online talk was oriented to restoration, revealing abrupt and anticipated triggers that evoked feelings of loss. Caregivers also shared loss orientation through storytelling, sharing and giving advice, and encouraging others to manage the challenges of coping. Caregiver anxiety and depression were lower after the intervention. This pilot study provides insight into the use of a secret Facebook group to facilitate bereavement support to caregivers. Findings highlight the promise of Facebook for hospice bereavement support. Providers and researchers are encouraged to explore the positive outcomes associated with bereavement support.

The Influences of Landscape Features on Visitation of Hospital Green Spaces-A Choice Experiment Approach.

PubMed

Chang, Kaowen Grace; Chien, Hungju

2017-07-05

Studies have suggested that visiting and viewing landscaping at hospitals accelerates patient's recovery from surgery and help staff's recovery from mental fatigue. To plan and construct such landscapes, we need to unravel landscape features desirable to different groups so that the space can benefit a wide range of hospital users. Using discrete choice modeling, we developed experimental choice sets to investigate how landscape features influence the visitations of different users in a large regional hospital in Taiwan. The empirical survey provides quantitative estimates of the influence of each landscape feature on four user groups, including patients, caregivers, staff, and neighborhood residents. Our findings suggest that different types of features promote visits from specific user groups. Landscape features facilitating physical activities effectively encourage visits across user groups especially for caregivers and staff. Patients in this study specify a strong need for contact with nature. The nearby community favors the features designed for children's play and family activities. People across user groups value the features that provide a mitigated microclimate of comfort, such as a shelter. Study implications and limitations are also discussed. Our study provides information essential for creating a better healing environment in a hospital setting.

Increasing Discussions of Intimate Partner Violence in Prenatal Care Using Video Doctor Plus Provider Cueing: A Randomized Controlled Trial

PubMed Central

Tsoh, Janice Y.; Kohn, Michael A.; Gerbert, Barbara

2010-01-01

Purpose To report the effectiveness of a prenatal intervention and to provide evidence that prenatal visits provide an opportune time for health assessment and counseling with abused women. Methods Fifty ethnically diverse pregnant women who presented for routine prenatal care and who also reported being at risk for intimate partner violence (IPV) were recruited to the study. Participants were assigned to either usual care or the Video Doctor plus Provider Cueing intervention. At baseline and 1-month later at another routine prenatal visit, intervention group participants received a 15-minute Video Doctor assessment and interactive tailored counseling. Their providers received a printed Cue Sheet alert and suggested counseling statements. Main findings Participants in the intervention group were significantly more likely to report provider-patient discussions of IPV compared to participants receiving usual care at baseline (81.8% vs. 16.7%, p < 0.001) and at the 1-month follow-up (70.0% vs. 23.5%, p = 0.005). Summing the number of patient-provider discussions across the two visits at baseline and one month later, intervention participants were significantly more likely to have IPV risk discussion with their providers at one or both visits (90.0% vs. 23.6%, p< 0.001) compared to the participants who received usual care. When specifically asked about the helpfulness of these IPV-related discussions, 20 out of 22 (90.9%) participants rated the discussion as helpful or very helpful at baseline and all 18 (100%) participants rated the discussion as helpful or very helpful at the 1-month follow-up. Conclusions Video Doctor plus Provider Cueing intervention significantly increases the likelihood of provider-patient IPV discussion with pregnant women with a history of abuse. PMID:21185737

Osler-Weber-Rendu syndrome

MedlinePlus

... your provider what other precautions you should take. Support Groups These resources can provide more information on HHT: Centers for Disease Control and Prevention -- www.cdc.gov/ncbddd/hht Cure HHT -- curehht.org National Organization for Rare Disorders -- rarediseases.org/rare-diseases/hereditary- ...

Progress report of the IAU Commission 4 Working Group on Ephemeris Access and the comparison of high accuracy planetary ephemerides

NASA Astrophysics Data System (ADS)

Hilton, J. L.

2012-12-01

In September 2010 IAU Commission 4, Ephemerides, organized a working group to provide a recommendation for a preferred format for solar system ephemerides. The purpose of this recommendation is to provide easy access to a wide range of solar system ephemerides for users. The working group, chaired by Hilton, includes representatives from each of the major planetary ephemeris groups and representatives from the satellite and asteroid ephemeris communities. The working group has tentatively decided to recommend the SPK format developed by the Jet Propulsion Laboratory's Navigation and Ancillary Information Facility for use with its SPICE Toolkit. Certain details, however, must still be resolved before a final recommendation is made by the working group. An update is also provided to ongoing analysis comparing the three high accuracy planetary ephemerides, DE421, EPM2008, and INPOP10a. The principal topics of this update are: replacing the INPOP08 ephemeris with the INPOP10a ephemeris, making the comparisons with respect to DE421 rather than DE405, and comparing the TT - TDB values determined in EPM2008 and INPOP10a with the Fairhead & Bretagnon (1990, A&A, 229, 240) model used in DE421 as T_eph.

Exploring the changing learning environment of the gross anatomy lab.

PubMed

Hopkins, Robin; Regehr, Glenn; Wilson, Timothy D

2011-07-01

The objective of this study was to assess the impact of virtual models and prosected specimens in the context of the gross anatomy lab. In 2009, student volunteers from an undergraduate anatomy class were randomly assigned to study groups in one of three learning conditions. All groups studied the muscles of mastication and completed identical learning objectives during a 45-minute lab. All groups were provided with two reference atlases. Groups were distinguished by the type of primary tools they were provided: gross prosections, three-dimensional stereoscopic computer model, or both resources. The facilitator kept observational field notes. A prepost multiple-choice knowledge test was administered to evaluate students' learning. No significant effect of the laboratory models was demonstrated between groups on the prepost assessment of knowledge. Recurring observations included students' tendency to revert to individual memorization prior to the posttest, rotation of models to match views in the provided atlas, and dissemination of groups into smaller working units. The use of virtual lab resources seemed to influence the social context and learning environment of the anatomy lab. As computer-based learning methods are implemented and studied, they must be evaluated beyond their impact on knowledge gain to consider the effect technology has on students' social development.

The Finite Lamplighter Groups: A Guided Tour

ERIC Educational Resources Information Center

Siehler, Jacob A.

2012-01-01

In this article, we present a family of finite groups, which provide excellent examples of the basic concepts of group theory. To work out the center, conjuagacy classes, and commutators of these groups, all that's required is a bit of linear algebra.