Science.gov

Sample records for reached practical results

  1. Does a one-day educational training session influence primary care pediatricians' mental health practice procedures in response to a community disaster? Results from the reaching children initiative (RCI).

    PubMed

    Adams, Richard E; Laraque, Danielle; Chemtob, Claude M; Jensen, Peter S; Boscarino, Joseph A

    2013-01-01

    Although many children and adolescents need assessment and treatment for psychological problems, few get such treatment from mental health specialists after a community disaster Research suggests that a very large proportion of children are seen in pediatric primary care settings and that pediatricians can provide appropriate care for many social and emotional problems in children. However few pediatricians have received training in providing this help. The focus of this study was to assess whether brief training to increase the capacity of primary care pediatricians (PCPs) to respond to the social or emotional problems of children after the World Trade Center terrorist attacks improved the quality of services to disaster-affected children. Pediatricians (N = 137) attended a one-day training workshop covering best practice treatments for mental health problems with an emphasis on trauma, bereavement, and medication use. We surveyed attendees prior to training, immediately post-intervention, and 1- and 6-months later. At 6-months post-intervention, 64% of the primary care clinicians reported instituting practice changes recommended during training. Reported use of formal mental health screening instruments increased, but greater use of medications was more limited. Although participants in the immediate post-intervention survey indicated strong agreement with the desirability to implement specific practice changes, the perceived desirability of such changes declined substantially at the 6-month follow-up. Changes in PCPs 'mental health related practice procedures can be facilitated by brief educational interventions, but continued training and support may be needed. We discuss these results relative to preparedness for community disasters.

  2. Teacher Evaluation in Practice: Implementing Chicago's REACH Students

    ERIC Educational Resources Information Center

    Sporte, Susan E.; Stevens, W. David; Healey, Kaleen; Jiang, Jennie; Hart, Holly

    2013-01-01

    This report focuses on the perceptions and experiences of teachers and administrators during the first year of REACH implementation, which was in many ways a particularly demanding year. These experiences can be helpful to Chicago Public Schools (CPS) and to other districts across the country as they work to restructure and transform teacher…

  3. Reaching Boys: An International Study of Effective Teaching Practices

    ERIC Educational Resources Information Center

    Reichert, Michael; Hawley, Richard

    2010-01-01

    Despite a continuing stream of concern on the part of researchers, demographers, and cultural pundits about a crisis in boys' social development and schooling, surprisingly little attention has been paid to what is perhaps the richest pool of data: current, observable teaching practices that clearly work with boys. In schools of all types in all…

  4. Reaching Boys: An International Study of Effective Teaching Practices

    ERIC Educational Resources Information Center

    Reichert, Michael; Hawley, Richard

    2010-01-01

    Despite a continuing stream of concern on the part of researchers, demographers, and cultural pundits about a crisis in boys' social development and schooling, surprisingly little attention has been paid to what is perhaps the richest pool of data: current, observable teaching practices that clearly work with boys. In schools of all types in all…

  5. Aiming for Accountability: Lessons Learned from Eight States. Reaching Results.

    ERIC Educational Resources Information Center

    Harvard Family Research Project, Cambridge, MA.

    Interest is growing in planning and implementing new systems of holding child and family services accountable for results. The Results-Based Accountability (RBA) Project at the Harvard Family Research Project (HFRP) has supported and built upon recent state efforts to develop these new accountability systems for child and family services. This…

  6. Global Reach and Local Practice: The Promise of MOOCs

    ERIC Educational Resources Information Center

    Godwin-Jones, Robert

    2014-01-01

    Robert Goodwin-Jones opens his discussion with the thought "If you want to attract attention to a new online course, the foolproof strategy today is to label it a MOOC, a massive open online course." The hype surrounding MOOCs has resulted in substantial interest--from the general public to university presidents--in online learning, as…

  7. Global Reach and Local Practice: The Promise of MOOCs

    ERIC Educational Resources Information Center

    Godwin-Jones, Robert

    2014-01-01

    Robert Goodwin-Jones opens his discussion with the thought "If you want to attract attention to a new online course, the foolproof strategy today is to label it a MOOC, a massive open online course." The hype surrounding MOOCs has resulted in substantial interest--from the general public to university presidents--in online learning, as…

  8. Preparing Every Teacher to Reach English Learners: A Practical Guide for Teacher Educators

    ERIC Educational Resources Information Center

    Nutta, Joyce W., Ed.; Mokhtari, Kouider, Ed.; Strebel, Carine, Ed.

    2012-01-01

    "Preparing Every Teacher to Reach English Learners" presents a practical, flexible model for infusing English learner (EL) instruction into teacher education courses. The editors outline the key steps involved in this approach--winning faculty support, assessing needs, and developing capacity--and share strategies for avoiding pitfalls. The…

  9. Preparing Every Teacher to Reach English Learners: A Practical Guide for Teacher Educators

    ERIC Educational Resources Information Center

    Nutta, Joyce W., Ed.; Mokhtari, Kouider, Ed.; Strebel, Carine, Ed.

    2012-01-01

    "Preparing Every Teacher to Reach English Learners" presents a practical, flexible model for infusing English learner (EL) instruction into teacher education courses. The editors outline the key steps involved in this approach--winning faculty support, assessing needs, and developing capacity--and share strategies for avoiding pitfalls. The…

  10. How to Reach and Teach English Language Learners: Practical Strategies to Ensure Success

    ERIC Educational Resources Information Center

    Syrja, Rachel Carrillo

    2011-01-01

    This book provides practical strategies and tools for assessing and teaching even the most hard to reach English language learners across the content areas. Syrja offers educators the latest information on working with ELLs (including using formative assessments) and provides a wealth of classroom-tested models and measures. These tools have…

  11. How to Reach and Teach English Language Learners: Practical Strategies to Ensure Success

    ERIC Educational Resources Information Center

    Syrja, Rachel Carrillo

    2011-01-01

    This book provides practical strategies and tools for assessing and teaching even the most hard to reach English language learners across the content areas. Syrja offers educators the latest information on working with ELLs (including using formative assessments) and provides a wealth of classroom-tested models and measures. These tools have…

  12. [How do Prevention Projects Reach their Target Groups? Results of a Survey with Prevention Projects].

    PubMed

    Brand, T; Böttcher, S; Jahn, I

    2015-12-01

     The aim of this study was to assess methods used to access target groups in prevention projects funded within the prevention research framework by the German Federal Ministry of Education and Research.  A survey with prevention projects was conducted. Access strategies, communication channels, incentives, programme reach, and successful practical recruitment strategies were explored.  38 out of 60 projects took part in the survey. Most projects accessed their target group within structured settings (e. g., child day-care centers, schools, workplaces). Multiple communication channels and incentives were used, with written information and monetary incentives being used most frequently. Only few projects were able to report their programme reach adequately; programme reach was highest for programmes accessing the target groups in structured settings. The respondents viewed active recruitment via personal communication with the target group and key persons in the settings as the most successful strategy.  The paper provides an overview on recruitment strategies used in current preven-tion projects. More systematic research on programme reach is necessary. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Taking a Multi-pronged Approach to Expand the Reach of Climate Research Results

    NASA Astrophysics Data System (ADS)

    Hauser, R.; Unger, M.; Eastburn, T.; Rockwell, A.; Laursen, K. K.; National CenterAtmospheric Research

    2011-12-01

    Recognizing the importance of tailoring content to a variety of audiences, the National Center for Atmospheric Research (NCAR) takes a multi-pronged approach to expand the reach of climate research results. The center's communications and education and outreach teams leverage Web 1.0 and 2.0 functionality - Google searches, Twitter, Facebook, YouTube - as well as face-to-face interactions and traditional media outlets to ensure climate change messages effectively connect with multiple audiences. Key to these efforts, NCAR seeks to frame messages that emphasize cultural cognition, that is, in a manner that recognizes and resonates with different audiences' values and thus their identities. Among the basic communications approaches NCAR uses to engage the public are one-on-one interactions with the visiting public, which ranges from school children and tourists, to dignitaries and journalists. As an example, the NCAR Journalism Fellowship brings a competitively selected group of internatoinal journalists to NCAR. During a week-long visit and ongoing contact, journalists are provided with a close-up, nuanced view of the science and individuals working on the bigger-picture research that drives climate-related sound bites reported by the press. NCAR provides media training for its scientists, giving them tools and practice in effectively handling interviews for print, Web and radio outlets. The institution hosts public events like "Super Science Saturday," and NCAR staff participate in external activities such as school science fairs, community events and continuing education sessions. In addition to interactive displays that allow the public to "experience" science directly and informally, NCAR develops educational programs and curricula targeted to specific age groups and levels of expertise. We will explore the importance of analogies, images and anecdotes in explaining complicated subjects to such a varied set of audiences, and identify key concepts in simplifying

  14. Reaching out for patients: public relations and events with real results.

    PubMed

    Kuechel, Marie Czenko

    2010-02-01

    In today's market, the aesthetic physician needs to connect with patients using methods that are personal, educational, and that will glean the interest of prospective patients whose attention and dollars are sought by countless facial plastic surgery competitors near and far. Public relations, or reaching your prospective patient without a direct solicitation (advertising) for services, are traditional means that include media relations and charitable and social events. With the added component of social media, today the opportunities to reach out for new patients and garner real results are more varied and more affordable than ever before.

  15. Unpredictable elbow joint perturbation during reaching results in multijoint motor equivalence

    PubMed Central

    Mattos, D. J. S.; Latash, M. L.; Park, E.; Kuhl, J.

    2011-01-01

    Motor equivalence expresses the idea that movement components reorganize in the face of perturbations to preserve the value of important performance variables, such as the hand's position in reaching. A formal method is introduced to evaluate this concept quantitatively: changes in joint configuration due to unpredictable elbow perturbation lead to a smaller change in performance variables than expected given the magnitude of joint configuration change. This study investigated whether motor equivalence was present during the entire movement trajectory and how magnitude of motor equivalence was affected by constraints imposed by two different target types. Subjects pointed to spherical and cylindrical targets both with and without an elbow joint perturbation produced by a low- or high-stiffness elastic band. Subjects' view of their arm was blocked in the initial position, and the perturbation condition was randomized to avoid prediction of the perturbation or its magnitude. A modification of the uncontrolled manifold method variance analysis was used to investigate how changes in joint configuration on perturbed vs. nonperturbed trials (joint deviation vector) affected the hand's position or orientation. Evidence for motor equivalence induced by the perturbation was present from the reach onset and increased with the strength of the perturbation after 40% of the reach, becoming more prominent as the reach progressed. Hand orientation was stabilized more strongly by motor equivalent changes in joint configuration than was three-dimensional position regardless of the target condition. Results are consistent with a recent model of neural control that allows for flexible patterns of joint coordination while resisting joint configuration deviations in directions that affect salient performance variables. The observations also fit a general scheme of synergic control with referent configurations defined across different levels of the motor hierarchy. PMID:21676927

  16. Unpredictable elbow joint perturbation during reaching results in multijoint motor equivalence.

    PubMed

    Mattos, D J S; Latash, M L; Park, E; Kuhl, J; Scholz, J P

    2011-09-01

    Motor equivalence expresses the idea that movement components reorganize in the face of perturbations to preserve the value of important performance variables, such as the hand's position in reaching. A formal method is introduced to evaluate this concept quantitatively: changes in joint configuration due to unpredictable elbow perturbation lead to a smaller change in performance variables than expected given the magnitude of joint configuration change. This study investigated whether motor equivalence was present during the entire movement trajectory and how magnitude of motor equivalence was affected by constraints imposed by two different target types. Subjects pointed to spherical and cylindrical targets both with and without an elbow joint perturbation produced by a low- or high-stiffness elastic band. Subjects' view of their arm was blocked in the initial position, and the perturbation condition was randomized to avoid prediction of the perturbation or its magnitude. A modification of the uncontrolled manifold method variance analysis was used to investigate how changes in joint configuration on perturbed vs. nonperturbed trials (joint deviation vector) affected the hand's position or orientation. Evidence for motor equivalence induced by the perturbation was present from the reach onset and increased with the strength of the perturbation after 40% of the reach, becoming more prominent as the reach progressed. Hand orientation was stabilized more strongly by motor equivalent changes in joint configuration than was three-dimensional position regardless of the target condition. Results are consistent with a recent model of neural control that allows for flexible patterns of joint coordination while resisting joint configuration deviations in directions that affect salient performance variables. The observations also fit a general scheme of synergic control with referent configurations defined across different levels of the motor hierarchy.

  17. Promoting early literacy in pediatric practice: twenty years of reach out and read.

    PubMed

    Zuckerman, Barry

    2009-12-01

    Reach Out and Read (ROR) is the first pediatric, evidence-based strategy to prevent problems of early childhood development and learning. With a start in a single clinic in Boston City Hospital in 1989, doctors working in >4000 clinics and practices gave approximately 5.7 million new books to >3.5 million children in all 50 states in 2008. ROR also has become a model for a different way of thinking about parent education during primary care encounters, based less on telling and more on creating real-time learning experiences. ROR flourished because of (1) the growth of pediatric interest in child development, (2) local leadership of pediatric champions as well as nonmedical supporters, coordinators, and volunteers, (3) evidence of effectiveness, and (4) public financial support attributable to strong bipartisan support in Congress, led by Senator Edward Kennedy. Since ROR started, an increasing amount of research confirms the importance of reading aloud for the development of language and other emergent literacy skills, which in turn helps children get ready for school and leads to later success in reading. Future goals include continued growth until all low-income children are reached with pediatric advice and books, a national campaign led by physicians encouraging all parents to read to their children every day, additional evidence-based, parent information to increase the effectiveness of parents reading to children, quality-improvement efforts to achieve the full potential, and global expansion.

  18. Mental workload and motor performance dynamics during practice of reaching movements under various levels of task difficulty.

    PubMed

    Shuggi, Isabelle M; Oh, Hyuk; Shewokis, Patricia A; Gentili, Rodolphe J

    2017-09-30

    The assessment of mental workload can inform attentional resource allocation during task performance that is essential for understanding the underlying principles of human cognitive-motor behavior. While many studies have focused on mental workload in relation to human performance, a modest body of work has examined it in a motor practice/learning context without considering individual variability. Thus, this work aimed to examine mental workload by employing the NASA TLX as well as the changes in motor performance resulting from the practice of a novel reaching task. Two groups of participants practiced a reaching task at a high and low nominal difficulty during which a group-level analysis assessed the mental workload, motor performance and motor improvement dynamics. A secondary cluster analysis was also conducted to identify specific individual patterns of cognitive-motor responses. Overall, both group- and cluster-level analyses revealed that: (i) all participants improved their performance throughout motor practice, and (ii) an increase in mental workload was associated with a reduction of the quality of motor performance along with a slower rate of motor improvement. The results are discussed in the context of the optimal challenge point framework and in particular it is proposed that under the experimental conditions employed here, functional task difficulty: (i) would possibly depend on an individuals' information processing capabilities, and (ii) could be indexed by the level of mental workload which, when excessively heightened can decrease the quality of performance and more generally result in delayed motor improvements. Copyright © 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

  19. Act on the Registration and Evaluation of Chemicals (K-REACH) and replacement, reduction or refinement best practices

    PubMed Central

    2016-01-01

    Objectives Korea’s Act on the Registration and Evaluation of Chemicals (K-REACH) was enacted for the protection of human health and the environment in 2015. Considering that about 2000 new substances are introduced annually across the globe, the extent of animal testing requirement could be overwhelming unless regulators and companies work proactively to institute and enforce global best practices to replace, reduce or refine animal use. In this review, the way to reduce the animal use for K-REACH is discussed. Methods Background of the enforcement of the K-REACH and its details was reviewed along with the papers and regulatory documents regarding the limitation of animal experiments and its alternatives in order to discuss the regulatory adoption of alternative tests. Results Depending on the tonnage of the chemical used, the data required ranges from acute and other short-term studies for a single exposure route to testing via multiple exposure routes and costly, longer-term studies such as a full two-generation reproducibility toxicity. The European Registration, Evaluation, Authorization and Restriction of Chemicals regulation provides for mandatory sharing of vertebrate test data to avoid unnecessary duplication of animal use and test costs, and obligation to revise data requirements and test guidelines “as soon as possible” after relevant, validated replacement, reduction or refinement (3R) methods become available. Furthermore, the Organization for Economic Cooperation and Development actively accepts alternative animal tests and 3R to chemical toxicity tests. Conclusions Alternative tests which are more ethical and efficient than animal experiments should be widely used to assess the toxicity of chemicals for K-REACH registration. The relevant regulatory agencies will have to make efforts to actively adopt and uptake new alternative tests and 3R to K-REACH. PMID:28118702

  20. A Practical Genome Scan for Population-Specific Strong Selective Sweeps That Have Reached Fixation

    PubMed Central

    Kimura, Ryosuke; Fujimoto, Akihiro; Tokunaga, Katsushi; Ohashi, Jun

    2007-01-01

    Phenotypic divergences between modern human populations have developed as a result of genetic adaptation to local environments over the past 100,000 years. To identify genes involved in population-specific phenotypes, it is necessary to detect signatures of recent positive selection in the human genome. Although detection of elongated linkage disequilibrium (LD) has been a powerful tool in the field of evolutionary genetics, current LD-based approaches are not applicable to already fixed loci. Here, we report a method of scanning for population-specific strong selective sweeps that have reached fixation. In this method, genome-wide SNP data is used to analyze differences in the haplotype frequency, nucleotide diversity, and LD between populations, using the ratio of haplotype homozygosity between populations. To estimate the detection power of the statistics used in this study, we performed computer simulations and found that these tests are relatively robust against the density of typed SNPs and demographic parameters if the advantageous allele has reached fixation. Therefore, we could determine the threshold for maintaining high detection power, regardless of SNP density and demographic history. When this method was applied to the HapMap data, it was able to identify the candidates of population-specific strong selective sweeps more efficiently than the outlier approach that depends on the empirical distribution. This study, confirming strong positive selection on genes previously reported to be associated with specific phenotypes, also identifies other candidates that are likely to contribute to phenotypic differences between human populations. PMID:17356696

  1. Inhibition in Clark's nutcrackers (Nucifraga columbiana): results of a detour-reaching test.

    PubMed

    Vernouillet, A; Anderson, J; Clary, D; Kelly, D M

    2016-05-01

    Inhibition (i.e. the ability to restrain ineffective responses to a given stimulus) is a good indicator of complex cognitive abilities in animals. Inhibition has been demonstrated in a broad range of mammals with foraging style and social group size identified as potential influences of this ability. Whether these ecological factors also apply to birds has not been well studied. Corvids, a family of birds well known for being able to accomplish difficult cognitive tasks often requiring inhibition, are a good model for studying inhibitory control. During this study, we measured the ability of Clark's nutcrackers (Nucifraga columbiana), a relatively non-social, food specialist corvid to exercise inhibitory control during a detour-reaching test. Individuals had to retrieve a pine nut inserted into a transparent tube through one of the side openings without pecking directly at the nut from the front of the tube. Overall, nutcrackers were able to inhibit pecking directly at the food (i.e. prepotent response), instead detouring to the side to retrieve the reward. However, the nutcrackers first required a learning period before showing inhibitory control. The nutcrackers' ability to inhibit was lower than other corvids studied to date, and we discuss the implications of this result for the role of sociality and dietary breadth for the evolution of inhibitory control.

  2. Teacher Evaluation in Practice: Year 3 Teacher and Administrator Perceptions of REACH. Research Brief

    ERIC Educational Resources Information Center

    Sporte, Susan E.; Jiang, Jennie Y.

    2016-01-01

    Three years after the launch of Chicago's redesigned teacher evaluation system, Recognizing Educators Advancing Chicago Students (REACH) Students, most teachers and administrators continue to report they believe REACH has the potential to improve instruction and student learning, and they remain negative about the use of student growth in…

  3. Hydraulic alterations resulting from hydropower development in the Bonneville Reach of the Columbia River

    USGS Publications Warehouse

    Hatten, James R.; Batt, Thomas R.

    2010-01-01

    We used a two-dimensional (2D) hydrodynamic model to simulate and compare the hydraulic characteristics in a 74-km reach of the Columbia River (the Bonneville Reach) before and after construction of Bonneville Dam. For hydrodynamic modeling, we created a bathymetric layer of the Bonneville Reach from single-beam and multi-beam echo-sounder surveys, digital elevation models, and navigation surveys. We calibrated the hydrodynamic model at 100 and 300 kcfs with a user-defined roughness layer, a variable-sized mesh, and a U.S. Army Corps of Engineers backwater curve. We verified the 2D model with acoustic Doppler current profiler (ADCP) data at 14 transects and three flows. The 2D model was 88% accurate for water depths, and 77% accurate for velocities. We verified a pre-dam 2D model run at 126 kcfs using pre-dam aerial photos from September 1935. Hydraulic simulations indicated that mean water depths in the Bonneville Reach increased by 34% following dam construction, while mean velocities decreased by 58%. There are numerous activities that would benefit from data output from the 2D model, including biological sampling, bioenergetics, and spatially explicit habitat modeling.

  4. Videos Designed to Watch but Audience Required Telling stories is a cliché for best practice in videos. Frontier Scientists, a NSF project titled Science in Alaska: using Multimedia to Support Science Education stressed story but faced audience limitations. FS describes project's story process, reach results, and hypothesizes better scenarios.

    NASA Astrophysics Data System (ADS)

    O'Connell, E. A.

    2016-12-01

    Telling stories is a cliché for best practice in science videos. It's upheld as a method to capture audience attention in many fields. Findings from neurobiology research show character-driven stories cause the release of the neurochemical oxytocin in the brain. Oxytocin motivates cooperation with others and enhances a sense of empathy, in particular the ability to experience others' emotions. Developing character tension- as in our video design showcasing scientists along with their work- holds the viewers' attention, promotes recall of story, and has the potential to clearly broadcast the feelings and behaviors of the scientists. The brain chemical change should help answer the questions: Why should a viewer care about this science? How does it improve the world, or our lives? Is just a story-driven video the solution to science outreach? Answer: Not in our multi-media world. Frontier Scientists (FS) discovered in its three year National Science Foundation project titled 'Science in Alaska: using Multimedia to Support Science Education': the storied video is only part of the effort. Although FS created from scratch and drove a multimedia national campaign throughout the project, major reach was not achieved. Despite FS' dedicated web site, YouTube channel, weekly blog, monthly press release, Facebook and G+ pages, Twitter activity, contact with scientists' institutions, and TV broadcast, monthly activity on the web site seemed to plateau at about 3000 visitors to the FS website per month. Several factors hampered the effort: Inadequate funding for social media limited the ability of FS to get the word to untapped markets: those whose interest might be sparked by ad campaigns but who do not actively explore unfamiliar agencies' science education content. However, when institutions took advantage of promoting their scientists through the FS videos we saw an uptick in video views and the participating scientists were often contacted for additional stories or were

  5. A haptic-robotic platform for upper-limb reaching stroke therapy: Preliminary design and evaluation results

    PubMed Central

    Lam, Paul; Hebert, Debbie; Boger, Jennifer; Lacheray, Hervé; Gardner, Don; Apkarian, Jacob; Mihailidis, Alex

    2008-01-01

    Background It has been shown that intense training can significantly improve post-stroke upper-limb functionality. However, opportunities for stroke survivors to practice rehabilitation exercises can be limited because of the finite availability of therapists and equipment. This paper presents a haptic-enabled exercise platform intended to assist therapists and moderate-level stroke survivors perform upper-limb reaching motion therapy. This work extends on existing knowledge by presenting: 1) an anthropometrically-inspired design that maximizes elbow and shoulder range of motions during exercise; 2) an unobtrusive upper body postural sensing system; and 3) a vibratory elbow stimulation device to encourage muscle movement. Methods A multi-disciplinary team of professionals were involved in identifying the rehabilitation needs of stroke survivors incorporating these into a prototype device. The prototype system consisted of an exercise device, postural sensors, and a elbow stimulation to encourage the reaching movement. Eight experienced physical and occupational therapists participated in a pilot study exploring the usability of the prototype. Each therapist attended two sessions of one hour each to test and evaluate the proposed system. Feedback about the device was obtained through an administered questionnaire and combined with quantitative data. Results Seven of the nine questions regarding the haptic exercise device scored higher than 3.0 (somewhat good) out of 4.0 (good). The postural sensors detected 93 of 96 (97%) therapist-simulated abnormal postures and correctly ignored 90 of 96 (94%) of normal postures. The elbow stimulation device had a score lower than 2.5 (neutral) for all aspects that were surveyed, however the therapists felt the rehabilitation system was sufficient for use without the elbow stimulation device. Conclusion All eight therapists felt the exercise platform could be a good tool to use in upper-limb rehabilitation as the prototype was

  6. Increasing reach by offering choices: Results from an innovative model for statewide services for smoking cessation.

    PubMed

    Keller, Paula A; Schillo, Barbara A; Kerr, Amy N; Lien, Rebecca K; Saul, Jessie; Dreher, Marietta; Lachter, Randi B

    2016-10-01

    Although state quitlines provide free telephone counseling and often include nicotine replacement therapy (NRT), reach remains limited (1-2% in most states). More needs to be done to engage all smokers in the quitting process. A possible strategy is to offer choices of cessation services through quitlines and to reduce registration barriers. In March 2014, ClearWay Minnesota(SM) implemented a new model for QUITPLAN® Services, the state's population-wide cessation services. Tobacco users could choose the QUITPLAN® Helpline or one or more Individual QUITPLAN® Services (NRT starter kit, text messaging, email program, or quit guide). The program website was redesigned, online enrollment was added, and a new advertising campaign was created and launched. In 2014-2015, we evaluated whether these changes increased reach. We also assessed quit attempts, quit outcomes, predictors of 30-day abstinence, and average cost per quit via a seven-month follow-up survey. Between March 2014-February 2015, 15,861 unique tobacco users registered, which was a 169% increase over calendar year 2013. The majority of participants made a quit attempt (83.7%). Thirty-day point prevalence abstinence rates (responder rates) were 26.1% for QUITPLAN Services overall, 29.6% for the QUITPLAN Helpline, and 25.5% for Individual QUITPLAN Services. Several variables predicted quit outcomes, including receiving only one call from the Helpline and using both the Helpline and the NRT starter kit. Providing greater choice of cessation services and reducing registration barriers have the potential to engage more tobacco users, foster more quit attempts, and ultimately lead to long-term cessation and reductions in prevalence.

  7. The Challenges Never Stop! Two Decades of Reaching for the Best in Clinical Practice

    ERIC Educational Resources Information Center

    Field, Bruce E.; Van Scoy, Irma J.

    2014-01-01

    The University of South Carolina Professional Development School (USC PDS) Network has been engaged in designing and redesigning school-university partnerships for more than 20 years with a focus on ensuring that school-based practice lies at the heart of candidate preparation. In 2012-2013, the USC PDS Network once again reexamined their program…

  8. Reaching the Adult Learner: Teaching Information Technology Infrastructure Library (ITIL) to Practicing Technology Managers

    ERIC Educational Resources Information Center

    Adade, Anthony Kwasi

    2012-01-01

    A great deal has been written about adult learning in terms of approaches and strategies. However, very little has been published on best practices for teaching Information Technology Infrastructure Library ® (ITIL) certification course to IT professionals. This dearth of research, along with five years of experience teaching the course sparked my…

  9. Reaching for Rigor: Identifying Practices of Effective High Schools. Research Report

    ERIC Educational Resources Information Center

    Cannata, Marisa; Haynes, Katherine Taylor; Smith, Thomas M.

    2013-01-01

    What distinguishes high schools that "beat the odds" for students from traditionally lower-performing groups from schools that struggle to improve the achievement and graduation rates of these student populations? What types of programs, practices, and processes support better than expected outcomes for students at risk of failure? How…

  10. What Is the Best Way to Achieve Broader Reach of Improved Practices in Higher Education?

    ERIC Educational Resources Information Center

    Kezar, Adrianna

    2011-01-01

    This article examines a common problem in higher education--how to create more widespread use of improved practices, often commonly referred to as innovations. I argue that policy models of scale-up are often advocated in higher education but that they have a dubious history in community development and K-12 education and that higher education…

  11. Defining Best Practices in Boating, Fishing, and Stewardship Education: Challenges and Opportunities for Reaching Diverse Audiences.

    ERIC Educational Resources Information Center

    Floyd, Myron F.

    Minority groups encounter barriers to participation in boating and fishing and may not have equal access to these activities. Racial and ethnic influences on outdoor recreation participation are viewed from four theoretical perspectives. For each perspective, practices are presented that would remove or lessen socioeconomic barriers that constrain…

  12. Reaching the Adult Learner: Teaching Information Technology Infrastructure Library (ITIL) to Practicing Technology Managers

    ERIC Educational Resources Information Center

    Adade, Anthony Kwasi

    2012-01-01

    A great deal has been written about adult learning in terms of approaches and strategies. However, very little has been published on best practices for teaching Information Technology Infrastructure Library ® (ITIL) certification course to IT professionals. This dearth of research, along with five years of experience teaching the course sparked my…

  13. The Challenges Never Stop! Two Decades of Reaching for the Best in Clinical Practice

    ERIC Educational Resources Information Center

    Field, Bruce E.; Van Scoy, Irma J.

    2014-01-01

    The University of South Carolina Professional Development School (USC PDS) Network has been engaged in designing and redesigning school-university partnerships for more than 20 years with a focus on ensuring that school-based practice lies at the heart of candidate preparation. In 2012-2013, the USC PDS Network once again reexamined their program…

  14. Sun exposure in young adult cancer survivors on and off the beach: results from Project REACH.

    PubMed

    Zwemer, Eric K; Mahler, Heike I M; Werchniak, Andrew E; Recklitis, Christopher J

    2012-03-01

    Although cancer survivors are at risk for future skin cancers, many do not practice recommended sun protection. Studies have demonstrated poor adherence to specific behaviors (e.g., sunscreen, artificial tanning) during sunbathing, but less is known about survivors' typical amount of sun exposure during activities other than sunbathing. We conducted a mailed survey of 153 adults (median age = 26.1) diagnosed with a non-skin cancer before age 30. Information on recent sunbathing and incidental sun exposures, protective behaviors, and perceived vulnerability was collected. Analyses focused on characterizing survivors with the lowest levels of recommended sun protection. Twenty-nine percent of participants exhibited low sun protection adherence during sunbathing and 31% during incidental exposure. Younger age was associated with low adherence, but this difference was significant only for sunbathing (OR=0.4; 95% CI, 0.2-0.9). Women were more likely than men to have low adherence during sunbathing (34.0% vs. 20.3%; OR = 2.44; 95% CI, 1.1-5.5). Survivors treated with radiation did not differ on exposures, adherence, or perceived vulnerability to the sun, despite feeling more susceptible to skin cancers (p = 0.03). Despite known skin cancer risks, many young cancer survivors receive significant sun exposure. Assessment of sunbathing alone fails to capture sun exposure behaviors, particularly in men. Survivors treated with radiation may recognize their increased risk of skin cancer, but not the role of sun protection in modifying that risk.

  15. Progressive abduction loading therapy targeting flexion synergy to regain reaching function in chronic stroke: Preliminary results from an RCT.

    PubMed

    Ellis, Michael D; Carmona, Carolina; Drogos, Justin; Traxel, Stuart; Dewald, Julius P A

    2016-08-01

    Reaching function is impaired following stroke due to abnormal coupling of shoulder abduction and elbow flexion. This phenomenon is commonly referred to as flexion synergy, loss of independent joint control, or impaired joint individuation. We have been successful in treating individuals with chronic stroke with moderate to severe motor impairments through the employment of targeted rehabilitation robotics and identified progressive abduction loading as a key element to the rehabilitation of reaching. Here we expand upon the investigation of progressive abduction loading therapy by testing two variants of the exercise in a larger sample and including a 3-month follow-up. Furthermore, we attempt to glean additional insights into the mechanisms underlying improvements by not only assessing reaching distance as a function of abduction loading but, for the first time, assessing peak reaching velocity, a combined measure of dynamic elbow and shoulder strength. Thirty-one participants with severe stroke were randomized to two intervention variants. Preliminary analysis has been performed and results are presented for blinded combined-group data. Following the intervention, there was a significant improvement in both reaching distance and peak reaching velocity. Mechanisms for improvement are briefly discussed.

  16. Cognitive and Kidney Function: Results from a British Birth Cohort Reaching Retirement Age

    PubMed Central

    Silverwood, Richard J.; Richards, Marcus; Pierce, Mary; Hardy, Rebecca; Sattar, Naveed; Ferro, Charles; Savage, Caroline; Kuh, Diana; Nitsch, Dorothea

    2014-01-01

    Background Previous studies have found associations between cognitive function and chronic kidney disease. We aimed to explore possible explanations for this association in the Medical Research Council National Survey of Health and Development, a prospective birth cohort representative of the general British population. Methods Cognitive function at age 60–64 years was quantified using five measures (verbal memory, letter search speed and accuracy, simple and choice reaction times) and glomerular filtration rate (eGFR) at the same age was estimated using cystatin C. The cross-sectional association between cognitive function and eGFR was adjusted for background confounding factors (socioeconomic position, educational attainment), prior cognition, and potential explanations for any remaining association (smoking, diabetes, hypertension, inflammation, obesity). Results Data on all the analysis variables were available for 1306–1320 study members (depending on cognitive measure). Verbal memory and simple and choice reaction times were strongly associated with eGFR. For example, the lowest quartile of verbal memory corresponded to a 4.1 (95% confidence interval 2.0, 6.2) ml/min/1.73 m2 lower eGFR relative to the highest quartile. Some of this association was explained by confounding due to socioeconomic factors, but very little of it by prior cognition. Smoking, diabetes, hypertension, inflammation and obesity explained some but not all of the remaining association. Conclusions These analyses support the notion of a shared pathophysiology of impaired cognitive and kidney function at older age, which precedes clinical disease. The implications of these findings for clinical care and research are important and under-recognised, though further confirmatory studies are required. PMID:24482683

  17. Nitrate reduction by denitrifying anaerobic methane oxidizing microorganisms can reach a practically useful rate.

    PubMed

    Cai, Chen; Hu, Shihu; Guo, Jianhua; Shi, Ying; Xie, Guo-Jun; Yuan, Zhiguo

    2015-12-15

    Methane in biogas has been proposed to be an electron donor to facilitate complete nitrogen removal using denitrifying anaerobic methane oxidizing (DAMO) microorganisms in an anaerobic ammonium oxidation (anammox) reactor, by reducing the nitrate produced. However, the slow growth and the low activity of DAMO microorganisms cast a serious doubt about the practical usefulness of such a process. In this study, a previously established lab-scale membrane biofilm reactor (MBfR), with biofilms consisting of a coculture of DAMO and anammox microorganisms, was operated to answer if the DAMO reactor can achieve a nitrate reduction rate that can potentially be applied for wastewater treatment. Through progressively increasing nitrate and ammonium loading rates to the reactor, a nitrate removal rate of 684 ± 10 mg-N L(-1) d(-1) was achieved after 453 days of operation. This rate is, to our knowledge, by far the highest reported for DAMO reactors, and far exceeds what is predicted to be required for nitrate removal in a sidestream (5.6-135 mg-N L(-1) d(-1)) or mainstream anammox reactor (3.2-124 mg-N L(-1) d(-1)). Mass balance analysis showed that the nitrite produced by nitrate reduction was jointly reduced by anammox bacteria at a rate of 354 ± 3 mg-N L(-1) d(-1), accompanied by an ammonium removal rate of 268 ± 2 mg-N L(-1) d(-1), and DAMO bacteria at a rate of 330 ± 9 mg-N L(-1) d(-1). This study shows that the nitrate reduction rate achieved by the DAMO process can be high enough for removing nitrate produced by anammox process, which would enable complete nitrogen removal from wastewater.

  18. A haptic-robotic platform for upper-limb reaching stroke therapy: preliminary design and evaluation results.

    PubMed

    Lam, Paul; Hebert, Debbie; Boger, Jennifer; Lacheray, Hervé; Gardner, Don; Apkarian, Jacob; Mihailidis, Alex

    2008-05-22

    It has been shown that intense training can significantly improve post-stroke upper-limb functionality. However, opportunities for stroke survivors to practice rehabilitation exercises can be limited because of the finite availability of therapists and equipment. This paper presents a haptic-enabled exercise platform intended to assist therapists and moderate-level stroke survivors perform upper-limb reaching motion therapy. This work extends on existing knowledge by presenting: 1) an anthropometrically-inspired design that maximizes elbow and shoulder range of motions during exercise; 2) an unobtrusive upper body postural sensing system; and 3) a vibratory elbow stimulation device to encourage muscle movement. A multi-disciplinary team of professionals were involved in identifying the rehabilitation needs of stroke survivors incorporating these into a prototype device. The prototype system consisted of an exercise device, postural sensors, and a elbow stimulation to encourage the reaching movement. Eight experienced physical and occupational therapists participated in a pilot study exploring the usability of the prototype. Each therapist attended two sessions of one hour each to test and evaluate the proposed system. Feedback about the device was obtained through an administered questionnaire and combined with quantitative data. Seven of the nine questions regarding the haptic exercise device scored higher than 3.0 (somewhat good) out of 4.0 (good). The postural sensors detected 93 of 96 (97%) therapist-simulated abnormal postures and correctly ignored 90 of 96 (94%) of normal postures. The elbow stimulation device had a score lower than 2.5 (neutral) for all aspects that were surveyed, however the therapists felt the rehabilitation system was sufficient for use without the elbow stimulation device. All eight therapists felt the exercise platform could be a good tool to use in upper-limb rehabilitation as the prototype was considered to be generally well designed

  19. Medical Simulation Practices 2010 Survey Results

    NASA Technical Reports Server (NTRS)

    McCrindle, Jeffrey J.

    2011-01-01

    Medical Simulation Centers are an essential component of our learning infrastructure to prepare doctors and nurses for their careers. Unlike the military and aerospace simulation industry, very little has been published regarding the best practices currently in use within medical simulation centers. This survey attempts to provide insight into the current simulation practices at medical schools, hospitals, university nursing programs and community college nursing programs. Students within the MBA program at Saint Joseph's University conducted a survey of medical simulation practices during the summer 2010 semester. A total of 115 institutions responded to the survey. The survey resus discuss overall effectiveness of current simulation centers as well as the tools and techniques used to conduct the simulation activity

  20. Differences between late preterm and full-term infants: comparing effects of a short bout of practice on early reaching behavior.

    PubMed

    de Almeida Soares, Daniele; Cunha, Andréa Baraldi; Tudella, Eloisa

    2014-11-01

    This study compared the effects of a short bout of practice on reaching behavior between late preterm and full-term infants at the onset of goal-directed reaching. Twelve late preterm infants and twelve full-term infants received reaching practice based on a serial schedule. Late preterm and full-term infants were assessed in 3.3±1.4 and 2.6±1.0 days after the onset of goal-directed reaching in two measures in a single day: immediately before practice (pre-test) and immediately after practice (post-test). During the assessments, the infants were placed in a baby chair and a rubber toy was presented at their midline within reaching distance for 2 min. Between assessments, the infants received practice of toy-oriented reaching in 3 activities repeated for approximately 4 min. The activities were elicited in a pre-established serial sequence and were applied by a physical therapist. During the pre-test, late preterm infants presented lower range of proximal adjustments, greater proportion of reaches with semi-open hand, and greater proportion of reaches without grasping than the full-term infants. During the post-test, late preterm infants presented greater motor variability of proximal adjustments, but explored and selected distal control and grasping outcomes less compared to the full-term group. Differences in reaching and gross motor behavior between late preterm and full-term infants can be found at the age of reaching onset. Practice provided new opportunities for late preterm infants to improve perception-action coupling to reach; however, relative to full-terms, they seemed less advanced in benefiting from the experience for more refined manual tasks. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Changes Resulting from Reflection Dialogues on Nursing Practice

    PubMed Central

    Okuda, Reiko; Fukada, Mika

    2014-01-01

    Background Reflection is defined here as a process by which, through self-conversation, one’s self and one’s behavior acquire meaning. However, people have limitations in terms of what they can express and be aware of during reflection. This finding points to the importance of facilitators. The purpose of this study was to determine what changes can be brought about through reflection dialogues on nursing practice. Methods The Participants were 9 nurses who worked at three institutions in City A, each with about 200 beds. Workplace topics were examined through self-reflections and reflection dialogues. The depth of reflection was assessed using the three levels of reflection described by Mezirow—{reflecting on the content}, {reflecting on the process} and {reflecting on the assumptions}. Results In reflecting on nursing practice, the participants were also divided into those who had already reached the highest level, {reflecting on assumptions}, via self-reflection, and those who remained at the level of {reflecting on processes}, despite the use of reflection dialogues. Conclusion The development of reflective thinking on nursing practice was connected not only to the participants’ desire to explore ways of accepting their individual experiences, but may also be connected to whether or not they are able to question themselves about their thoughts and preconceptions about nursing work. PMID:25067874

  2. How Does the Geomorphic Influence of Large Wood Vary With Channel Size? Results from a Stochastic Reach Scale Channel Simulator

    NASA Astrophysics Data System (ADS)

    Eaton, B. C.; Hassan, M. A.

    2012-12-01

    Using a numerical model that stochastically simulates wood loads, jam formation and bed material sediment storage by the instream wood, we investigate how the influence of large wood on sediment storage changes with the channel size. In small and intermediate sized streams, the interaction between wood and bed material transport often dominates the storage and release of sediment, while in large channels the effect of wood is less pronounced. We model this phenomenon using the Reach-Scale Channel Simulator (RSCS) that represents a channel reach having a specified width and length, which is supplied with wood from a riparian area defined by the channel length and the average tree height. In the model, LW pieces are produced and modified over time as a result of random tree-fall, LW breakage, LW movement, and piece interaction to form LW jams. The RSCS tracks the length, diameter and orientation of each piece. Each LW piece traps a portion of the annual bed material transport entering the reach, and releases the stored sediment when the LW piece is entrained and moved. The equations governing sediment storage are based on a set of flume experiments that were scaled to Fishtrap Creek, British Columbia. The model has been calibrated against Fishtrap Creek, which is an intermediate stream (bankfull width ~ 10 m) with a steep (gradient ~ 0.02 m/m) gravel bed (D50 ~ 50 mm), and then used to describe smaller and larger systems. For intermediate sized streams, the RSCS predicts wood loads that are consistent with field data from streams with similar riparian forest types and climate. It also predicts jam spacing that is consistent with field data.

  3. The linking of the upper-middle and lower reaches of the Yellow River as a result of fluvial entrenchment

    NASA Astrophysics Data System (ADS)

    Hu, ZhenBo; Pan, BaoTian; Bridgland, David; Vandenberghe, Jef; Guo, LianYong; Fan, YunLong; Westaway, Rob

    2017-06-01

    The upper-middle Yellow River flows through the Fenwei graben, a structure resulting from extensional tectonism that was formed and repeatedly extended during the Cenozoic. The drainage system within this graben was formerly isolated from the lower reaches of the Yellow River system by the Xiaoshan mountains, an actively growing ∼ NW-SE trending range. The modern course of the Yellow River takes it through this range along the Sanmen gorge, the formation of which was of great significance in that it initiated through-going drainage between the upper-middle and lower reaches of the system. The timing of this event, which was clearly a critical point in the evolution of the Yellow River, can be established by dating the terraces in the gorge. Intermittent deepening of this gorge by the Yellow River from a high-level planation surface capping the mountain range has resulted in the formation of five terraces. Magnetostratigraphic records from aeolian deposits accumulated on these surfaces provide a geochronological sequence for this geomorphic archive, in which the ages of the planation surface and of terraces T5, T4, T3, T2, and T1 have been determined as ∼3.63 Ma, ∼1.24 Ma, ∼0.86 Ma, ∼0.62 Ma, ∼129 ka, and ∼12 ka, respectively. Under the constraint of this chronological framework, a model for landscape evolution is proposed here. Uplift of the inner Fenwei graben and of the surrounding mountain ranges led to dissection of the 3.63 Ma old planation surface in conjunction with the formation of the Sanmen gorge. Drainage of the lake previously occupying the basin would have promoted incision into the fluvio-lacustrine graben sediments; indeed, gorge formation through the Xiaoshan may have been initiated or intensified by lake overflow. The ages obtained for the planation surface and uppermost terrace suggest that the formation of the Sanmen gorge and the initiation of the through-going eastward drainage of the Yellow River occurred between 3.63 and 1.24 Ma

  4. Predicting results of daily-practice cystoscopies.

    PubMed

    García-Velandria, F; Sánchez-García, J F; Rodríguez-Toves, L A; Alvarez-Buitrago, L; Conde-Redondo, C; Rodríguez-Tesedo, V; Amón-Sesmero, J H; Cepeda-Delgado, M; Cobos-Carbó, A; Alonso-Fernández, D; Martínez-Sagarra, J M

    2014-10-01

    Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours. In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  5. Aligning Theory and Design: The Development of an Online Learning Intervention to Teach Evidence-based Practice for Maximal Reach.

    PubMed

    Delagran, Louise; Vihstadt, Corrie; Evans, Roni

    2015-09-01

    Online educational interventions to teach evidence-based practice (EBP) are a promising mechanism for overcoming some of the barriers to incorporating research into practice. However, attention must be paid to aligning strategies with adult learning theories to achieve optimal outcomes. We describe the development of a series of short self-study modules, each covering a small set of learning objectives. Our approach, informed by design-based research (DBR), involved 6 phases: analysis, design, design evaluation, redesign, development/implementation, and evaluation. Participants were faculty and students in 3 health programs at a complementary and integrative educational institution. We chose a reusable learning object approach that allowed us to apply 4 main learning theories: events of instruction, cognitive load, dual processing, and ARCS (attention, relevance, confidence, satisfaction). A formative design evaluation suggested that the identified theories and instructional approaches were likely to facilitate learning and motivation. Summative evaluation was based on a student survey (N=116) that addressed how these theories supported learning. Results suggest that, overall, the selected theories helped students learn. The DBR approach allowed us to evaluate the specific intervention and theories for general applicability. This process also helped us define and document the intervention at a level of detail that covers almost all the proposed Guideline for Reporting Evidence-based practice Educational intervention and Teaching (GREET) items. This thorough description will facilitate the interpretation of future research and implementation of the intervention. Our approach can also serve as a model for others considering online EBP intervention development.

  6. Aligning Theory and Design: The Development of an Online Learning Intervention to Teach Evidence-based Practice for Maximal Reach

    PubMed Central

    Vihstadt, Corrie; Evans, Roni

    2015-01-01

    Background: Online educational interventions to teach evidence-based practice (EBP) are a promising mechanism for overcoming some of the barriers to incorporating research into practice. However, attention must be paid to aligning strategies with adult learning theories to achieve optimal outcomes. Methods: We describe the development of a series of short self-study modules, each covering a small set of learning objectives. Our approach, informed by design-based research (DBR), involved 6 phases: analysis, design, design evaluation, redesign, development/implementation, and evaluation. Participants were faculty and students in 3 health programs at a complementary and integrative educational institution. Results: We chose a reusable learning object approach that allowed us to apply 4 main learning theories: events of instruction, cognitive load, dual processing, and ARCS (attention, relevance, confidence, satisfaction). A formative design evaluation suggested that the identified theories and instructional approaches were likely to facilitate learning and motivation. Summative evaluation was based on a student survey (N=116) that addressed how these theories supported learning. Results suggest that, overall, the selected theories helped students learn. Conclusion: The DBR approach allowed us to evaluate the specific intervention and theories for general applicability. This process also helped us define and document the intervention at a level of detail that covers almost all the proposed Guideline for Reporting Evidence-based practice Educational intervention and Teaching (GREET) items. This thorough description will facilitate the interpretation of future research and implementation of the intervention. Our approach can also serve as a model for others considering online EBP intervention development. PMID:26421233

  7. Infection control practice across Europe: results of the EPD.

    PubMed

    De Vos, J Y; Elseviers, M; Harrington, M; Zampieron, A; Vlaminck, H; Ormandy, P; Kafkia, T

    2006-01-01

    The European Practice Database (EPD) project, developed by the EDTNA/ERCA Research Board, collects data on renal practice at centre level in different European countries. Results presented in this paper focus on infection control practice in haemodialysis centres from 8 different European countries or regions following data collection from 2002 up to 2004. The prevalence of hepatitis B (HBV), hepatitis C (HCV), human immune deficiency (HIV) and methicillin-resistant staphylococcus Aureus (MRSA) was studied as well as the use of screening and preventive actions. These results will enable international comparison in practice and will stimulate further research and the development of new practice recommendations.

  8. How to Reach and Teach Children with ADD/ADHD: Practical Techniques, Strategies, and Interventions. Third Edition

    ERIC Educational Resources Information Center

    Rief, Sandra F.

    2016-01-01

    The third edition of "How to Reach and Teach Children and Teens with ADD/ADHD" has been completely revised to offer the most updated and comprehensive guidance to everyone engaged in the positive education of children and teens who have been diagnosed with ADHD or show signs and symptoms of the disorder. This valuable resource contains…

  9. How to Reach and Teach Children with ADD/ADHD: Practical Techniques, Strategies, and Interventions. Third Edition

    ERIC Educational Resources Information Center

    Rief, Sandra F.

    2016-01-01

    The third edition of "How to Reach and Teach Children and Teens with ADD/ADHD" has been completely revised to offer the most updated and comprehensive guidance to everyone engaged in the positive education of children and teens who have been diagnosed with ADHD or show signs and symptoms of the disorder. This valuable resource contains…

  10. Effects of Mental Practice, Physical Practice, and Knowledge of Results on Piano Performance.

    ERIC Educational Resources Information Center

    Coffman, Don D.

    1990-01-01

    Investigates how different practice techniques (physical, mental, and alternating physical/mental) and aural knowledge of results improve the piano performance of 40 graduate and undergraduate music students. Reveals all three practice modes, especially physical practice, improved performance, whereas aural knowledge of results had little effect.…

  11. REACH Presentation.

    ERIC Educational Resources Information Center

    Bucklee, Joanne

    In an effort to provide support for employees and their families, Red Deer College (RDC) developed the Resources, Employees, Assistance, Counselling, and Health (REACH) program. The program is administered by a committee of five people who represent the five major employee groups at the college (i.e., senior administration, middle administration,…

  12. Reliability of the Functional Reach Test and the influence of anthropometric characteristics on test results in subjects with hemiparesis.

    PubMed

    Martins, Emerson Fachin; de Menezes, Lidiane Teles; de Sousa, Pedro Henrique Côrtes; de Araujo Barbosa, Paulo Henrique Ferreira; Costa, Abraão Souza

    2012-01-01

    First designed as an alternative method of assessing balance and susceptibility to falls among elderly, the Functional Reach Test (FR) has also been used among patients with hemiparesis. Then this study aimed to describe the intra- and inter-rater and the test/re-test reliability of the FR measure in subjects with and without hemiparesis while verifying anthropometric influences on the measurements. The FR was administered to a sample of subjects with hemiparesis and to a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-rater reliability. It was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. Associations were analyzed using Pearson's correlation coefficient. In general, the intra-rater analysis did not show significant differences between the measures for the single, double or triple trials. Excellent ICC values were observed, and there were no significant associations with anthropometric parameters for the hemiparesis and control subjects. FR showed good reliability for patients with and without hemiparesis and the test measurements were not significantly associated with the anthropometric characteristics of the subjects.

  13. [From the production to the use of research results in care practice: a consolidating experience].

    PubMed

    de Carvalho, Emília Campos; Laus, Ana Maria; Caliri, Maria Helena Larcher; Rossi, Luci Grupioni

    2010-01-01

    Although it is desirable that professionals use research results, often they are not prepared for that. This article aims to present the process of development and establishment of innovations, based on Rogers' model, through strategies to train nurses to use the best evidences for a quality clinical practice. It is a partnership between a educational institution and a hospital care institution. Following identification of problems from nurses' own practice in a health institution research proposals were developed to search for evidences and to test interventions. Results of this experience evidenced the viability of use of a model presented as a methodological framework what contributed to reach the institutions' goal.

  14. Lean practices for quality results: a case illustration.

    PubMed

    Hwang, Pauline; Hwang, David; Hong, Paul

    2014-01-01

    Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific

  15. Changes resulting from reflection dialogues on nursing practice.

    PubMed

    Okuda, Reiko; Fukada, Mika

    2014-03-01

    Reflection is defined here as a process by which, through self-conversation, one's self and one's behavior acquire meaning. However, people have limitations in terms of what they can express and be aware of during reflection. This finding points to the importance of facilitators. The purpose of this study was to determine what changes can be brought about through reflection dialogues on nursing practice. The Participants were 9 nurses who worked at three institutions in City A, each with about 200 beds. Workplace topics were examined through self-reflections and reflection dialogues. The depth of reflection was assessed using the three levels of reflection described by Mezirow-{reflecting on the content}, {reflecting on the process} and {reflecting on the assumptions}. In reflecting on nursing practice, the participants were also divided into those who had already reached the highest level, {reflecting on assumptions}, via self-reflection, and those who remained at the level of {reflecting on processes}, despite the use of reflection dialogues. The development of reflective thinking on nursing practice was connected not only to the participants' desire to explore ways of accepting their individual experiences, but may also be connected to whether or not they are able to question themselves about their thoughts and preconceptions about nursing work.

  16. Examining the reach of a brief alcohol intervention service in routine practice at a level 1 trauma center.

    PubMed

    Turner, Brianna J; McCann, Barbara S; Dunn, Christopher W; Darnell, Doyanne A; Beam, Christopher R; Kleiber, Blair; Nelson, Kimberly M; Fukunaga, Rena

    2017-08-01

    The American College of Surgeons requires Level I and II trauma centers to provide brief intervention services to traumatically injured patients who screen positive for alcohol. Despite evidence supporting substantial cost savings and reduced re-injury associated with these services, brief interventions may not be uniformly delivered owing to a variety of demographic, clinical and operational characteristics. To inform service adjustments that may improve the reach of such services, we compared trauma patients who did and did not receive brief alcohol intervention services during their hospitalizations. Electronic medical records of injured patients admitted to a Level I trauma center between September 27, 2013 and March 11, 2014 with a positive blood alcohol concentration (N=189) were coded for demographic and clinical variables. Records of those who did not receive a brief intervention during their admission were reviewed for possible reasons why interventions were not delivered. Of the total sample, 115 patients (60.8%) received brief interventions. Patients who did and did not receive brief interventions did not differ on age, sex, race, blood alcohol concentration at admission, or mechanism of injury, indicating that patient characteristics were unlikely to bias service delivery. Instead, common features of patients who were referred but did not receive SBIRT interventions included admissions lasting fewer than two working days (12.7%) and persistent cognitive impairment following injury (9.0%). These findings align with previous studies suggesting that service reach could be improved by promoting dedicated and flexible staffing and adapting services to allow for SBIRT delivery in follow-up care settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Reaching Girls

    ERIC Educational Resources Information Center

    Jacobs, Charlotte E.; Kuriloff, Peter J.; Cox, Amanda B.

    2014-01-01

    If educators want to engage girls in learning, they must align teaching practices with girls' specific needs. In a study modeled after Reichert and Hawley's study of boys, the authors learned that lessons with hands-on learning, elements of creativity, multimodal projects, and class discussions all worked to stimulate girls'…

  18. Reaching Girls

    ERIC Educational Resources Information Center

    Jacobs, Charlotte E.; Kuriloff, Peter J.; Cox, Amanda B.

    2014-01-01

    If educators want to engage girls in learning, they must align teaching practices with girls' specific needs. In a study modeled after Reichert and Hawley's study of boys, the authors learned that lessons with hands-on learning, elements of creativity, multimodal projects, and class discussions all worked to stimulate girls'…

  19. Reaching a consensus on management practices and vaccine development targets for mitigation of infectious diarrhoea among deployed US military forces.

    PubMed

    Riddle, Mark S; Tribble, David R

    2008-04-01

    This study is part of a research effort to identify and quantify factors related to the cost-effectiveness of a vaccine acquisition strategy to reduce the burden of infectious diarrhoea on US military personnel deployed overseas. Where evidence is lacking in the scientific literature, or considerable uncertainty exists, it is often necessary to develop best estimates with ranges of certainty. To this end, a modified 'Delphi' survey technique to obtain the best estimates for uncertain parameters including clinical care-seeking behaviour for acute diarrhoea, routine diarrhoea management in a deployed setting, and vaccine development time frames and costs were developed from a diverse panel of experts. The study was conducted in three survey iterations. During each iteration, participants were contacted and given 2-3 weeks to complete a web-based survey designed to ascertain estimates, ranges of variability, and level of certainty for these estimates. In all, 25 of 43 solicited experts agreed to participate in the study. These included three (12%) experts who identified themselves primarily as being currently involved in Vaccine Industry, six (24%) Academic/Military Diarrheal Vaccine Development, five (20%) Military Product Acquisition, five (20%) Military Preventive Medicine, two (8%) Tropical/Travel Medicine and four (16%) Military Clinical Infectious Disease. Management practices in deployed military populations (for both provider and self-treatment) were consistent with recently published literature. Similar target time frames for vaccine licensure were established for Enterotoxigenic E. coli, Campylobacter, Shigella and Norovirus of around 9-11 years. Targets for vaccine efficacy appear to be lower than currently licensed travel vaccines (60-80%), and there was consensus on more conservative adverse event rates. These data should prove useful to researchers and policy makers working in the area of vaccine acquisition for the US military and provide continued

  20. Comparing REACH Chemical Safety Assessment information with practice-a case-study of polymethylmethacrylate (PMMA) in floor coating in The Netherlands.

    PubMed

    Spee, Ton; Huizer, Daan

    2017-10-01

    On June 1st, 2007 the European regulation on Registration, Evaluation and Restriction of Chemical substances (REACH) came into force. Aim of the regulation is safe use of chemicals for humans and for the environment. The core element of REACH is chemical safety assessment of chemicals and communication of health and safety hazards and risk management measures throughout the supply chain. Extended Safety Data Sheets (Ext-SDS) are the primary carriers of health and safety information. The aim of our project was to find out whether the actual exposure to methyl methacrylate (MMA) during the application of polymethylmethacrylate (PMMA) in floor coatings as assessed in the chemical safety assessment, reflect the exposure situations as observed in the Dutch building practice. Use of PMMA flooring and typical exposure situations during application were discussed with twelve representatives of floor laying companies. Representative situations for exposure measurements were designated on the basis of this inventory. Exposure to MMA was measured in the breathing zone of the workers at four construction sites, 14 full shift samples and 14 task based samples were taken by personal air sampling. The task-based samples were compared with estimates from the Targeted Risk Assessment Tool (v3.1) of the European Centre for Ecotoxicology and Toxicology of Chemicals (ECETOC-TRA) as supplied in the safety assessment from the manufacturer. For task-based measurements, in 12 out of 14 (86%) air samples measured exposure was higher than estimated exposure. Recalculation with a lower ventilation rate (50% instead of 80%) together with a higher temperature during mixing (40°C instead of 20°C) in comparison with the CSR, reduced the number of underestimated exposures to 10 (71%) samples. Estimation with the EMKG-EXPO-Tool resulted in unsafe exposure situations for all scenarios, which is in accordance with the measurement outcomes. In indoor situations, 5 out of 8 full shift exposures (62

  1. A Practical Method of Monitoring the Results of Health Care

    PubMed Central

    Daugharty, G. D.

    1979-01-01

    To meet our goal of improving health care through more productive use of the data we are collecting about the delivery of health care we need to define our concepts of health and quality. The WHO definition of health allows the design of useful functional outcome criteria which give us measurable standards for the outcome of the health care. By recording, retrieving, and reviewing pertinent information from the structure and the process of health care for a valid comparison with its outcome, the most effective and efficient health care is identified. A practical system is presented which identifies the better methods of management and produces the motivation for change that results in improved care. The successful use of this system in a private practice supports its universal adaptability for health care providers. The initial encouraging results suggest that future trials in other types of practices will be even more encouraging.

  2. The views of general practitioners and practice nurses towards the barriers and facilitators of proactive, internet-based chlamydia screening for reaching young heterosexual men.

    PubMed

    Lorimer, Karen; Martin, Susan; McDaid, Lisa M

    2014-06-27

    Chlamydia trachomatis is a common bacterial sexually transmitted infection (STI), which disproportionately affects young people under 25 years. Commonly, more women are offered screening than men. This study obtained the views of general practitioners and practice nurses towards Internet-based screening and assessed levels of support for the development of proactive screening targeting young heterosexual men via the Internet. Semi-structured telephone interviews with 10 general practitioners and 8 practice nurses, across Central Scotland. Topics covered: experience of screening heterosexual men for chlamydia, views on the use of the Internet as a way to reach young men for chlamydia screening, beliefs about the potential barriers and facilitators to Internet-based screening. Transcripts from audio recordings were analysed with Framework Analysis, using QSR NVivo10. Experiences of chlamydia screening were almost exclusively with women, driven by the nature of consultations and ease of raising sexual health issues with female patients; few practice nurses reported seeing men during consultations. All participants spoke in favour of Internet-based screening for young men. Participants reported ease of access and convenience as potential facilitators of an Internet-based approach but anonymity and confidentiality could be potential barriers and facilitators to the success of an Internet approach to screening. Concerns over practical issues as well as those pertaining to gender and socio-cultural issues were raised. Awareness of key barriers and facilitators, such as confidentiality, practicality and socio-cultural influences, will inform the development of an Internet-based approach to screening. However, this approach may have its limits in terms of being able to tackle wider social and cultural barriers, along with shifts in young people's and health professionals' attitudes towards screening. Nevertheless, employing innovative efforts as part of a multi

  3. Academic Advising Assessment Practices: Results of a National Study

    ERIC Educational Resources Information Center

    Powers, Keith L.; Carlstrom, Aaron H.

    2014-01-01

    Best practices of academic advising assessment involve identification of student learning outcomes, the development and use of multiple measures of student learning, and sound professional judgment to understand the information gathered and to improve student learning. However, the assessment results often come from minimal, narrow, and…

  4. Best Practices for Reduction of Uncertainty in CFD Results

    NASA Technical Reports Server (NTRS)

    Mendenhall, Michael R.; Childs, Robert E.; Morrison, Joseph H.

    2003-01-01

    This paper describes a proposed best-practices system that will present expert knowledge in the use of CFD. The best-practices system will include specific guidelines to assist the user in problem definition, input preparation, grid generation, code selection, parameter specification, and results interpretation. The goal of the system is to assist all CFD users in obtaining high quality CFD solutions with reduced uncertainty and at lower cost for a wide range of flow problems. The best-practices system will be implemented as a software product which includes an expert system made up of knowledge databases of expert information with specific guidelines for individual codes and algorithms. The process of acquiring expert knowledge is discussed, and help from the CFD community is solicited. Benefits and challenges associated with this project are examined.

  5. Reaching the hard to reach.

    PubMed

    Bhiwandi, P; Campbell, M; Potts, M

    1994-01-01

    The 1994 International Conference on Population and Development proposed increasing contraceptive couple protection from 550 million in 1995 to 880 million in 2015. The task for family planning (FP) programs is to provide access to services for, sometimes, inaccessible rural populations. FP need based on desire for no more children has ranged from under 20% in Senegal to almost 80% in Peru. Socioeconomic development was found not to be a prerequisite for fertility change. Gender inequalities in education and social autonomy must be changed. FP access is very important among women with a disadvantaged background or among women unsure about FP. Bangladesh is a good example of a country with increased contraceptive prevalence despite low income. The rule of thumb is that contraception increases of 15% contribute to a drop in family size of about one child. Program effectiveness is related to a variety of factors: contraceptive availability at many locations, acceptable price of contraception, delivery of the oral contraceptives without prescriptions, and other strategies. FP is a service not a medical treatment. A range of methods must be promoted and available from a range of facilities. Contraceptive use is dependent on the woman's stage in her lifecycle and is dependent on informed choice. Community-based distribution systems are effective, whereas free distribution by poorly-trained field workers is not always very effective because patient payment of all or part of the cost assures quality and freedom of choice. Effective programs for underprivileged groups involve aggressive, easy to manage programs that can be replicated rapidly. FP serves a useful function in depressing maternal mortality among the poor in Africa, who have no access to quality health services. Social marketing is an effective strategy for reaching remote areas. Political will and robust management are necessary commodities.

  6. Evaluation of the Effects of Chromium to Fall Chinook Salmon in the Hanford Reach of the Columbia River: Integration of Recent Toxicity Test Results

    SciTech Connect

    Dauble, Dennis D. ); Patton, Gregory W. ); Poston, Ted M. ); Peterson, Robert E. )

    2003-05-01

    The objective of this report was to summarize results of a series of recent laboratory studies conducted to evaluate the effects of chromium on chinook salmon. Individual studies focused on determining the relationship between exposure concentration and toxicological response for a range of life stages including fertilization, egg through swim-up (early life history), parr health, and avoidance-preference of juveniles. Study designs were representative of possible exposure scenarios in the Hanford Reach of the Columbia River.

  7. Professionally Responsible Disclosure of Genomic Sequencing Results in Pediatric Practice.

    PubMed

    McCullough, Laurence B; Brothers, Kyle B; Chung, Wendy K; Joffe, Steven; Koenig, Barbara A; Wilfond, Benjamin; Yu, Joon-Ho

    2015-10-01

    Genomic sequencing is being rapidly introduced into pediatric clinical practice. The results of sequencing are distinctive for their complexity and subsequent challenges of interpretation for generalist and specialist pediatricians, parents, and patients. Pediatricians therefore need to prepare for the professionally responsible disclosure of sequencing results to parents and patients and guidance of parents and patients in the interpretation and use of these results, including managing uncertain data. This article provides an ethical framework to guide and evaluate the professionally responsible disclosure of the results of genomic sequencing in pediatric practice. The ethical framework comprises 3 core concepts of pediatric ethics: the best interests of the child standard, parental surrogate decision-making, and pediatric assent. When recommending sequencing, pediatricians should explain the nature of the proposed test, its scope and complexity, the categories of results, and the concept of a secondary or incidental finding. Pediatricians should obtain the informed permission of parents and the assent of mature adolescents about the scope of sequencing to be performed and the return of results.

  8. Dentists’ practice patterns regarding caries prevention: results from a dental practice-based research network

    PubMed Central

    Yokoyama, Yoko; Kakudate, Naoki; Sumida, Futoshi; Matsumoto, Yuki; Gilbert, Gregg H; Gordan, Valeria V

    2013-01-01

    Objective The purposes of this study were to (1) quantify dentists' practice patterns regarding caries prevention and (2) test the hypothesis that certain dentists' characteristics are associated with these practice patterns. Design The study used a cross-sectional study design consisting of a questionnaire survey. Participants The study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan, which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n=282). Measurement Dentists were asked about their practice patterns regarding caries preventive dentistry. Background data on patients, practice and dentist were also collected. Results 38% of dentists (n=72) provided individualised caries prevention to more than 50% of their patients. Overall, 10% of the time in daily practice was spent on caries preventive dentistry. Dentists who provided individualised caries prevention to more than 50% of their patients spent significantly more time on preventive care and less time on removable prosthetics treatment, compared to dentists who did not provide individualised caries prevention. Additionally, they provided oral hygiene instruction, patient education, fluoride recommendations, intraoral photographs taken and diet counselling to their patients significantly more often than dentists who did not provide individualised caries prevention. Multiple logistic regression analysis suggested that the percentage of patients interested in caries prevention and the percentage of patients who received hygiene instruction, were both associated with the percentage of patients who receive individualised caries prevention. Conclusions We identified substantial variation in dentists' practice patterns regarding preventive dentistry. Individualised caries prevention was significantly related to provision of other preventive services and to having a higher percentage

  9. Gingival displacement: Survey results of dentists' practice procedures.

    PubMed

    Ahmed, Sumitha N; Donovan, Terry E

    2015-07-01

    A high percentage of fixed prosthodontic restorations require a subgingival margin placement, which requires the practice of gingival displacement or a deflection procedure to replicate the margins in impression. The purpose of this study was to learn the different gingival displacement techniques that are currently used by dentists in their practice and to compare the current concepts of gingival displacement with previously published articles. A survey of questions pertaining to gingival deflection methods was distributed as part of continuing education (CE) course material to dentists attending CE meetings in 7 states in the U.S. and 1 Canadian province. Question topics included initial patient assessment procedures, gingival displacement methods, dentist's knowledge and assessment of systemic manifestations, and brand names of materials used. Ninety-four percent of the participants were general practitioners with 24.11 ± 12.5 years of experience. Ninety-two percent used gingival displacement cords, while 20.2% used a soft tissue laser and 32% used electrosurgery as an adjunct. Sixty percent of the dentists used displacement cords impregnated with a medicament. Of the preimpregnated cords, 29% were impregnated with epinephrine, 13% with aluminum chloride, and 18% with aluminum potassium sulfate. The study showed a steady decrease compared with results of previously published articles in the use of epinephrine as a gingival deflection medicament. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  10. Interpretation of cytogenetic results in multiple myeloma for clinical practice.

    PubMed

    Rajan, A M; Rajkumar, S V

    2015-10-30

    The interpretation of cytogenetic abnormalities in multiple myeloma (MM) is often a challenging task. MM is characterized by several cytogenetic abnormalities that occur at various time points in the disease course. The interpretation of cytogenetic results in MM is complicated by the number and complexity of the abnormalities, the methods used to detect them and the disease stage at which they are detected. Specific cytogenetic abnormalities affect clinical presentation, progression of smoldering multiple myeloma (SMM) to MM, prognosis of MM and management strategies. The goal of this paper is to provide a review of how MM is classified into specific subtypes based on primary cytogenetic abnormalities and to provide a concise overview of how to interpret cytogenetic abnormalities based on the disease stage to aid clinical practice and patient management.

  11. Interpretation of cytogenetic results in multiple myeloma for clinical practice

    PubMed Central

    Rajan, A M; Rajkumar, S V

    2015-01-01

    The interpretation of cytogenetic abnormalities in multiple myeloma (MM) is often a challenging task. MM is characterized by several cytogenetic abnormalities that occur at various time points in the disease course. The interpretation of cytogenetic results in MM is complicated by the number and complexity of the abnormalities, the methods used to detect them and the disease stage at which they are detected. Specific cytogenetic abnormalities affect clinical presentation, progression of smoldering multiple myeloma (SMM) to MM, prognosis of MM and management strategies. The goal of this paper is to provide a review of how MM is classified into specific subtypes based on primary cytogenetic abnormalities and to provide a concise overview of how to interpret cytogenetic abnormalities based on the disease stage to aid clinical practice and patient management. PMID:26517360

  12. [Psychological care demand in clinical practice: treatment and results].

    PubMed

    Labrador, Francisco Javier; Estupiñá, Francisco José; García Vera, María Paz

    2010-11-01

    With the aim of describing the usual clinical context as opposed to the academic or research context, the characteristics of patients and psychological treatments applied in a sample of 856 patients from the Clinic of Psychology of the Complutense University is analyzed. The disorders that require attention, the characteristics of the therapists and their interventions are identified. Out of the total patients, 24.3% withdrew from treatment; 68.3% of the patients who started treatment completed it with therapeutic success. 83% of patients were assessed in 4 sessions or fewer (median=4). 75.3% of patients who finished the treatment received 18 or fewer treatment sessions (median=11). The generalization of the results and their implications for professional clinical practice and for training clinical psychologists are discussed.

  13. Good practices and health policy analysis in European sports stadia: results from the 'Healthy Stadia' project.

    PubMed

    Drygas, Wojciech; Ruszkowska, Joanna; Philpott, Matthew; Björkström, Olav; Parker, Mike; Ireland, Robin; Roncarolo, Federico; Tenconi, Maria

    2013-06-01

    Sport plays an important role within society and sports stadia provide significant settings for public health strategies. In addition to being places of mass gathering, stadia are often located in less affluent areas and are traditionally attended by 'harder to reach' communities. Unfortunately sports stadia and the clubs they host are rarely perceived as places that promote healthy lifestyles. Fast food, alcohol and tobacco are commonly advertized, served and consumed during sports games giving the spectators and TV fans contradictory messages concerning healthy choices. As part of a wider programme of work part-funded by the European Union, a study was therefore designed to explore current 'good practice' relating to positive health interventions in sports stadia across a number of European countries. Using a specially designed questionnaire, information about health policies and good practices relating to food offerings in stadia, physical activity promotion among local communities, tobacco policy, positive mental health initiatives, environmental sustainability practices and social responsibility policies were collected in 10 European countries (England and Northern Ireland, Finland, Georgia, Greece, Ireland, Italy, Latvia, Poland, Spain and Sweden) involving 88 stadia. The audit results show that stadia health policies differ considerably between specific countries and sports. Based on the literature analysed, the examples of good practices collected through the study, and the subsequent instigation of a European Healthy Stadia Network, it shows that there is considerable potential for stadia to become health promoting settings.

  14. [Eslicarbazepine acetate in clinical practice. Efficacy and safety results].

    PubMed

    Serrano-Castro, Pedro J; Payán-Ortiz, Manuel; Cimadevilla, José M; Quiroga-Subirana, Pablo; Fernández-Pérez, Javier

    2013-03-16

    INTRODUCTION. Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED) licensed in Spain in February 2011 as an adjunctive therapy in adults with partial seizures with or without secondary generalization. Clinical trials with ESL have demonstrated acceptable efficacy and safety. AIM. To evaluate the results of ESL in our epilepsy unit during its first year of clinical experience with this AED. PATIENTS AND METHODS. We included all patients who started treatment with ESL at our epilepsy unit from March 2011 to May 2012. We collected the following variables: gender, aetiology of epilepsy, epileptogenic area, reason for switch to ESL, clinical response after initiation of ESL, adverse effects of ESL, refractoriness criteria and treatment discontinuation. A bivariate factor-to-factor correlation study was carried out to establish associations between the independent variables and the clinical response. RESULTS. We recruited 105 patients (51.4% male). 20,7% of patients remained seizure-free and 58.4% showed > 50% improvement after introduction of ESL. At 6 months, 18.1% had experienced some type of side effect, with cognitive disorders being the most common, and 11.5% had discontinued treatment. Combination with lacosamide proved to be significantly less effective in the control of seizures. Combination of ESL with the rest of sodium channel inhibitors was similar in efficacy to others combinations. CONCLUSIONS. ESL is a well-tolerated and effective AED when is used as adjunctive treatment with most of other AED in clinical practice.

  15. ';Best' Practices for Aggregating Subset Results from Archived Datasets

    NASA Astrophysics Data System (ADS)

    Baskin, W. E.; Perez, J.

    2013-12-01

    In response to the exponential growth in science data analysis and visualization capabilities Data Centers have been developing new delivery mechanisms to package and deliver large volumes of aggregated subsets of archived data. New standards are evolving to help data providers and application programmers deal with growing needs of the science community. These standards evolve from the best practices gleaned from new products and capabilities. The NASA Atmospheric Sciences Data Center (ASDC) has developed and deployed production provider-specific search and subset web applications for the CALIPSO, CERES, TES, and MOPITT missions. This presentation explores several use cases that leverage aggregated subset results and examines the standards and formats ASDC developers applied to the delivered files as well as the implementation strategies for subsetting and processing the aggregated products. The following topics will be addressed: - Applications of NetCDF CF conventions to aggregated level 2 satellite subsets - Data-Provider-Specific format requirements vs. generalized standards - Organization of the file structure of aggregated NetCDF subset output - Global Attributes of individual subsetted files vs. aggregated results - Specific applications and framework used for subsetting and delivering derivative data files

  16. Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process.

    PubMed

    Hawk, Cheryl; Schneider, Michael; Ferrance, Randy J; Hewitt, Elise; Van Loon, Meghan; Tanis, Lora

    2009-10-01

    There has been much discussion about the role of chiropractic care in the evaluation, management, and treatment of pediatric patients. To date, no specific guidelines have been adopted that address this issue from an evidence based perspective. Previous systematic reviews of the chiropractic literature concluded that there is not yet a substantial body of high quality evidence from which to develop standard clinical guidelines. The purpose of this project was to develop recommendations on "best practices" related primarily to the evaluation and spinal manipulation aspects of pediatric chiropractic care; nonmanipulative therapies were not addressed in detail. Based on both clinical experience and the results of an extensive literature search, a set of seed documents was compiled to inform development of the seed statements. These were circulated electronically to the Delphi panel until consensus was reached, which was considered to be present when there was agreement by at least 80% of the panelists. A multidisciplinary panel of 37 was made up primarily of doctors of chiropractic with a mean of 18 years in practice, many with post-graduate training in pediatrics. The panel represented 5 countries and 17 states; there were members of the American Chiropractic Association, the International Chiropractors Association, and the International Chiropractic Pediatric Association. The panel reached a minimum of 80% consensus on the 51 seed statements after 4 rounds. A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to clinical evaluation, management, and manual treatment for pediatric patients, based on both scientific evidence and clinical experience.

  17. Assessment of skin sensitization under REACH: A case report on vehicle choice in the LLNA and its crucial role preventing false positive results.

    PubMed

    Watzek, Nico; Berger, Franz; Kolle, Susanne Noreen; Kaufmann, Tanja; Becker, Matthias; van Ravenzwaay, Bennard

    2017-04-01

    In the EU, chemicals with a production or import volume in quantities of one metric ton per year or more have to be tested for skin sensitizing properties under the REACH regulation. The murine Local Lymph Node Assay (LLNA) and its modifications are widely used to fulfil the data requirement, as it is currently considered the first-choice method for in vivo testing to cover this endpoint. This manuscript describes a case study highlighting the importance of understanding the chemistry of the test material during testing for 'skin sensitization' of MCDA (mixture of 2,4- and 2,6-diamino-methylcyclohexane) with particular focus on the vehicle used. While the BrdU-ELISA modification of the LLNA using acetone/olive oil (AOO) as vehicle revealed expectable positive results. However, the concentration control analysis unexpectedly revealed an instability of MCDA in the vehicle AOO. Further studies on the reactivity showed MCDA to rapidly react with AOO under formation of various imine structures, which might have caused the positive LLNA result. The repetition of the LLNA using propylene glycol (PG) as vehicle did not confirm the positive results of the LLNA using AOO. Finally, a classification of MCDA as skin sensitizer according to the Globally Harmonized System (GHS) was not justified. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Changes in context and perception of maximum reaching height.

    PubMed

    Wagman, Jeffrey B; Day, Brian M

    2014-01-01

    Successfully performing a given behavior requires flexibility in both perception and behavior. In particular, doing so requires perceiving whether that behavior is possible across the variety of contexts in which it might be performed. Three experiments investigated how (changes in) context (ie point of observation and intended reaching task) influenced perception of maximum reaching height. The results of experiment 1 showed that perceived maximum reaching height more closely reflected actual reaching ability when perceivers occupied a point of observation that was compatible with that required for the reaching task. The results of experiments 2 and 3 showed that practice perceiving maximum reaching height from a given point of observation improved perception of maximum reaching height from a different point of observation, regardless of whether such practice occurred at a compatible or incompatible point of observation. In general, such findings show bounded flexibility in perception of affordances and are thus consistent with a description of perceptual systems as smart perceptual devices.

  19. Installing a Practical Research Project and Interpreting Research Results

    Treesearch

    Kasten R. Dumroese; David L. Wenny

    2003-01-01

    The basic concepts of the scientific method and research process are reviewed. An example from a bareroot nursery demonstrates how a practical research project can be done at any type of nursery, meshing sound statistical principles with the limitations of busy nursery managers.

  20. THE USE OF RESEARCH RESULTS IN TEACHING SOCIAL WORK PRACTICE.

    ERIC Educational Resources Information Center

    LAWRENCE, RICHARD G.

    BECAUSE THE SUCCESS OF INTERVENTION DEPENDS UPON THE VALIDITY OF THE PROPOSITIONS EMPLOYED, AND BECAUSE SCIENTIFIC RESEARCH ASSURES VALIDITY BY PROVIDING THE MOST SYSTEMATIC AND RIGOROUS ATTENTION TO PROBLEMS, THE UTILIZATION OF RESEARCH IS IMPORTANT TO SOCIAL WORK PRACTICE. SEVERAL FACTORS LIMIT ITS USE--(1) ALTHOUGH CONCEPTS ARE CLEARLY DEFINED…

  1. Installing a practical research project and interpreting research results

    Treesearch

    R. Kasten Dumroese; David L. Weny

    2002-01-01

    We review the basic concepts of science and research and the scientific process. Using an example from a bareroot nursery, we show how a practical research project can be done at any type of nursery, meshing sound statistical principles with limitations of busy nursery managers.

  2. Nanosafety practices: results from a national survey at research facilities

    NASA Astrophysics Data System (ADS)

    Díaz-Soler, Beatriz María; López-Alonso, Mónica; Martínez-Aires, María Dolores

    2017-05-01

    The exposure to engineered nanomaterials (ENMs) is a new emerging risk at work due to an increase in the number of workers potentially exposed to them and the current lack of data on their health and safety risks. This paper reports the findings of a survey designed to study the safety practices employed by workers in Spanish research facilities performing tasks involving the use of ENMs at research level. A questionnaire pretested and validated by an expert panel was sent by e-mail to the target audience. The 425 surveys completed show that most of the respondents handled up to 5 different ENMs, in suspension, in small amounts during short periods of exposure. The implementation of common hygienic practices, such as the use of protection for hands and the implementation of fume hoods, is widely indicated. The selection of the preventive and protective measures does not depend on the characteristics of ENMs handled. Also, the risks posed by ENMs are widely ignored. Besides the performance of risk assessment, hygienic monitoring and the conducting of a specific health surveillance are practically non-existent although some accidents relating to ENMs were identified. In conclusion, workers' exposure to ENMs seems to be low. Even though the best practices and preventive and protective measures reported were employed, most of the respondents could not be correctly protected. Moreover, workers do not associate the measures implemented with the nanorisks. Finally, there is a lack of proactive action underway to protect the workers, and concerns about safety are weakly evidenced.

  3. Trip Staff Training Practices: Survey and Discussion Results.

    ERIC Educational Resources Information Center

    Zwaagstra, Lynn

    A discussion group and survey examined trip-staff training practices among outdoor and adventure recreation/education programs. Of the 40 participants, 80 percent worked with university noncredit programs, with the remaining participants representing university for-credit, military recreation, nonprofit, and for-profit programs. Although the…

  4. Ramucirumab as Second-Line Treatment in Patients With Advanced Hepatocellular Carcinoma: Analysis of REACH Trial Results by Child-Pugh Score.

    PubMed

    Zhu, Andrew X; Baron, Ari David; Malfertheiner, Peter; Kudo, Masatoshi; Kawazoe, Seiji; Pezet, Denis; Weissinger, Florian; Brandi, Giovanni; Barone, Carlo A; Okusaka, Takuji; Wada, Yoshiyuki; Park, Joon Oh; Ryoo, Baek-Yeol; Cho, Jae Yong; Chung, Hyun Cheol; Li, Chung-Pin; Yen, Chia-Jui; Lee, Kuan-Der; Chang, Shao-Chun; Yang, Ling; Abada, Paolo B; Chau, Ian

    2016-09-22

    incidence of grade 3 or higher treatment-emergent adverse events, including ascites and asthenia, and special-interest events, including liver injury and/or failure and bleeding, compared with patients with Child-Pugh scores of 5 or 6. In unselected patients, a trend for ramucirumab survival benefit was observed only for patients with a Child-Pugh score of 5. In patients with baseline αFP levels of 400 ng/mL or more, a ramucirumab survival benefit was observed for Child-Pugh scores of 5 and 6. Ramucirumab had a manageable toxic effect profile. These results support the ongoing REACH-2 study of ramucirumab in patients with advanced HCC with underlying Child-Pugh A cirrhosis and baseline αFP levels of 400 ng/mL or more. clinicaltrials.gov Identifier: NCT01140347.

  5. What results when firms implement practices: the differential relationship between specific practices, firm financial performance, customer service, and quality.

    PubMed

    Gibson, Cristina B; Porath, Christine L; Benson, George S; Lawler, Edward E

    2007-11-01

    Previous research on organizational practices is replete with contradictory evidence regarding their effects. Here, the authors argue that these contradictory findings may have occurred because researchers have often examined complex practice combinations and have failed to investigate a broad variety of firm-level outcomes. Thus, past research may obscure important differential effects of specific practices on specific firm-level outcomes. Extending this research, the authors develop hypotheses about the effects of practices that (a) enable information sharing, (b) set boundaries, and (c) enable teams on 3 different firm-level outcomes: financial performance, customer service, and quality. Relationships are tested in a sample of observations from over 200 Fortune 1000 firms. Results indicate that information-sharing practices were positively related to financial performance 1 year following implementation of the practices, boundary-setting practices were positively related to firm-level customer service, and team-enabling practices were related to firm-level quality. No single set of practices predicted all 3 firm-level outcomes, indicating practice-specific effects. These findings help resolve the theoretical tension in the literature regarding the effects of organizational practices and offer guidance as to how to best target practices to increase specific work-related outcomes. Implications for theory, research, and practice are discussed.

  6. Reaching for the Unreachable: Reorganization of Reaching with Walking

    PubMed Central

    Grzyb, Beata J.; Smith, Linda B.; del Pobil, Angel P.

    2015-01-01

    Previous research suggests that reaching and walking behaviors may be linked developmentally as reaching changes at the onset of walking. Here we report new evidence on an apparent loss of the distinction between the reachable and nonreachable distances as children start walking. The experiment compared nonwalkers, walkers with help, and independent walkers in a reaching task to targets at varying distances. Reaching attempts, contact, leaning, and communication behaviors were recorded. Most of the children reached for the unreachable objects the first time it was presented. Nonwalkers, however, reached less on the subsequent trials showing clear adjustment of their reaching decisions with the failures. On the contrary, walkers consistently attempted reaches to targets at unreachable distances. We suggest that these reaching errors may result from inappropriate integration of reaching and locomotor actions, attention control and near/far visual space. We propose a reward-mediated model implemented on a NAO humanoid robot that replicates the main results from our study showing an increase in reaching attempts to nonreachable distances after the onset of walking. PMID:26110046

  7. 27 CFR 8.52 - Practices which result in exclusion.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of distilled spirits, wine or malt beverages by a retailer as a result, directly or indirectly, of a threat or act of physical or economic harm by the selling industry member. (b) Contracts between an industry member and a retailer which require the retailer to purchase distilled spirits, wine, or malt...

  8. Enzymatic but not compensated Jaffe methods reach the desirable specifications of NKDEP at normal levels of creatinine. Results of the French multicentric evaluation.

    PubMed

    Boutten, Anne; Bargnoux, Anne-Sophie; Carlier, Marie-Christine; Delanaye, Pierre; Rozet, Eric; Delatour, Vincent; Cavalier, Etienne; Hanser, Anne-Marie; Froissart, Marc; Cristol, Jean-Paul; Piéroni, Laurence

    2013-04-18

    The French Society of Clinical Biochemistry conducted this study to compare the accuracy and performances of the best creatinine enzymatic assays and the compensated Jaffe methods from the same manufacturers. Creatinine was measured in 3 serum pools with creatinine levels of 35.9±0.9 μmol/L, 74.4±1.4 μmol/L, and 97.9±1.7 μmol/L (IDMS determination). The performances of the assays (total error that includes the contribution of bias and imprecision) were evaluated using Monte-Carlo simulations and compared against desirable NKDEP criteria. The enzymatic assays always fell within the desirable total Error of 7.6%. By contrast, this requirement was never obtained for the compensated Jaffe methods at the critical level of 74.4±1.4 μmol/L. Only the compensated Jaffe creatinine on Olympus analyzer reached this specification at 35.9±0.9 and 97.9±1.7 μmol/L levels. This study demonstrates that, despite substantial improvement regarding traceability to the IDMS reference method and precision, compensated Jaffe creatinine methods, by contrast to enzymatic ones, do not reach the desirable specifications of NKDEP at normal levels of creatinine. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. Are SOFT and TEXT results practice changing and how?

    PubMed

    Pagani, Olivia; Regan, Meredith M; Francis, Prudence A

    2016-06-01

    Optimal adjuvant endocrine therapy for premenopausal women with hormone-receptor positive breast cancer has long been debated. In particular, the role of ovarian function suppression in addition to standard tamoxifen divided oncologists worldwide, and more recently, the role of aromatase inhibitors as an alternative to tamoxifen in the setting of ovarian suppression became a key question. In 2014, the long awaited results of the International Breast Cancer Study Group (IBCSG) led randomized, phase 3 trials, Suppression of Ovarian Function Trial (SOFT) and Tamoxifen and Exemestane Trial (TEXT), provided additional evidence to inform the discussion. The interpretation of the SOFT and TEXT trial data can facilitate better selection of appropriate endocrine therapy according to individual disease characteristics, recognizing the complexity of the puzzle, which is still not complete. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. EPA Reaches Settlement with Two N.H. Companies for Failure to Disclose Lead Paint Information or Follow Lead-Safe Work Practices at Residential Property in Manchester

    EPA Pesticide Factsheets

    The U.S. EPA finalized a settlement agreement with two N.H. companies for their alleged failure to follow lead-safe work practices and provide proper lead paint disclosure to tenants at a residential property in Manchester, N.H.

  11. Conducting Outreach to Transition-Aged Youth: Strategies for Reaching out to Youth with Disabilities, Their Families, and Agencies that Serve Them. Policy and Practice Brief

    ERIC Educational Resources Information Center

    Sheldon, James R., Jr.; Golden, Thomas P.

    2012-01-01

    The purpose of this policy and practice brief is to provide readers with a resource for planning outreach to transition-aged youth, their parents, and the service providers who work with them (i.e., the authors' "target group"). The authors will first provide a summary of the laws governing how three key agencies--school districts, state…

  12. CBOs: Reaching the Hardest to Reach.

    ERIC Educational Resources Information Center

    BCEL Newsletter for the Business Community, 1986

    1986-01-01

    The agents most successful in reaching and teaching those most in need of basic skills instruction are the community-based organizations (CBOs). They come into being in response to social and economic problems faced by their constituents--disadvantaged minorities, the poor, the unemployed, and the alienated. Because of their close ties to the…

  13. Pharmacogenetics of smoking cessation in general practice: results from the patch II and patch in practice trials.

    PubMed

    David, Sean P; Johnstone, Elaine C; Churchman, Michael; Aveyard, Paul; Murphy, Michael F G; Munafò, Marcus R

    2011-03-01

    Cigarette smoking remains the leading cause of preventable death worldwide. However, the efficacy of available first-line therapies remains low, particularly in primary care practice where most smokers seek and receive treatment. These observations reinforce the notion that 'one size fits all' smoking cessation therapies may not be optimal. Therefore, a translational research effort was launched by the Imperial Cancer Research Fund (later Cancer Research UK) General Practice Research Group, who led a decade-long research enterprise that examined the influence of pharmacological hypothesis-driven research into genetic influences on drug response for smoking cessation with transdermal nicotine replacement therapy in general practice. New and previously published smoking cessation genetic association results of 30 candidate gene polymorphisms genotyped for participants in two transdermal nicotine replacement clinical trials based in UK general practices, which employed an intention to analyze approach. By this high bar, one of the polymorphisms (COMT rs4680) was robust to correction for multiple comparisons. Moreover, future research directions are outlined; and lessons learned as well as best-practice models for designing, analyzing, and translating results into clinical practice are proposed. The results and lessons learned from this general practice-based pharmacogenetic research programme provide transportable insights at the transition to the second generation of pharmacogenetic and genomic investigations of smoking cessation and its translation to primary care.

  14. Reach Address Database (RAD)

    EPA Pesticide Factsheets

    The Reach Address Database (RAD) stores the reach address of each Water Program feature that has been linked to the underlying surface water features (streams, lakes, etc) in the National Hydrology Database (NHD). (A reach is the portion of a stream between two points of confluence. A confluence is the location where two or more streams flow together.)

  15. Increased Uptake of HCV Testing through a Community-Based Educational Intervention in Difficult-to-Reach People Who Inject Drugs: Results from the ANRS-AERLI Study

    PubMed Central

    Roux, Perrine; Rojas Castro, Daniela; Ndiaye, Khadim; Debrus, Marie; Protopopescu, Camélia; Le Gall, Jean-Marie; Haas, Aurélie; Mora, Marion; Spire, Bruno; Suzan-Monti, Marie; Carrieri, Patrizia

    2016-01-01

    Aims The community-based AERLI intervention provided training and education to people who inject drugs (PWID) about HIV and HCV transmission risk reduction, with a focus on drug injecting practices, other injection-related complications, and access to HIV and HCV testing and care. We hypothesized that in such a population where HCV prevalence is very high and where few know their HCV serostatus, AERLI would lead to increased HCV testing. Methods The national multisite intervention study ANRS-AERLI consisted in assessing the impact of an injection-centered face-to-face educational session offered in volunteer harm reduction (HR) centers (“with intervention”) compared with standard HR centers (“without intervention”). The study included 271 PWID interviewed on three occasions: enrolment, 6 and 12 months. Participants in the intervention group received at least one face-to-face educational session during the first 6 months. Measurements The primary outcome of this analysis was reporting to have been tested for HCV during the previous 6 months. Statistical analyses used a two-step Heckman approach to account for bias arising from the non-randomized clustering design. This approach identified factors associated with HCV testing during the previous 6 months. Findings Of the 271 participants, 127 and 144 were enrolled in the control and intervention groups, respectively. Of the latter, 113 received at least one educational session. For the present analysis, we selected 114 and 88 participants eligible for HCV testing in the control and intervention groups, respectively. In the intervention group, 44% of participants reported having being tested for HCV during the previous 6 months at enrolment and 85% at 6 months or 12 months. In the control group, these percentages were 51% at enrolment and 78% at 12 months. Multivariable analyses showed that participants who received at least one educational session during follow-up were more likely to report HCV testing

  16. Motor planning poststroke: impairment in vector-coded reach plans.

    PubMed

    Rizzo, John-Ross; Hudson, Todd E; Abdou, Andrew; Rashbaum, Ira G; George, Ajax E; Raghavan, Preeti; Landy, Michael S

    2015-12-01

    Healthy individuals appear to use both vector-coded reach plans that encode movements in terms of their desired direction and extent, and target-coded reach plans that encode the desired endpoint position of the effector. We examined whether these vector and target reach-planning codes are differentially affected after stroke. Participants with stroke and healthy controls made blocks of reaches that were grouped by target location (providing target-specific practice) and by movement vector (providing vector-specific practice). Reach accuracy was impaired in the more affected arm after stroke, but not distinguishable for target- versus vector-grouped reaches. Reach velocity and acceleration were not only impaired in both the less and more affected arms poststroke, but also not distinguishable for target- versus vector-grouped reaches. As previously reported in controls, target-grouped reaches yielded isotropic (circular) error distributions and vector-grouped reaches yielded error distributions elongated in the direction of the reach. In stroke, the pattern of variability was similar. However, the more affected arm showed less elongated error ellipses for vector-grouped reaches compared to the less affected arm, particularly in individuals with right-hemispheric stroke. The results suggest greater impairment to the vector-coded movement-planning system after stroke, and have implications for the development of personalized approaches to poststroke rehabilitation: Motor learning may be enhanced by practice that uses the preserved code or, conversely, by retraining the more impaired code to restore function. © 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

  17. Clinical Practices and Outcomes in Elderly Hemodialysis Patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

    PubMed Central

    Tong, Lin; Tentori, Francesca; Akiba, Takashi; Karaboyas, Angelo; Gillespie, Brenda; Akizawa, Tadao; Pisoni, Ronald L.; Bommer, Juergen; Port, Friedrich K.

    2011-01-01

    Summary Background and objectives Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Design, setting, participants, & measurements Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007. Results Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Conclusions Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice. PMID:21734085

  18. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices.

    PubMed

    Robinson, Bruce M; Akizawa, Tadao; Jager, Kitty J; Kerr, Peter G; Saran, Rajiv; Pisoni, Ronald L

    2016-07-16

    More than 2 million people worldwide are being treated for end-stage kidney disease (ESKD). This Series paper provides an overview of incidence, modality use (in-centre haemodialysis, home dialysis, or transplantation), and mortality for patients with ESKD based on national registry data. We also present data from an international cohort study to highlight differences in haemodialysis practices that affect survival and the experience of patients who rely on this therapy, which is both life-sustaining and profoundly disruptive to their quality of life. Data illustrate disparities in access to renal replacement therapy of any kind and in the use of transplantation or home dialysis, both of which are widely considered preferable to in-centre haemodialysis for many patients with ESKD in settings where infrastructure permits. For most patients with ESKD worldwide who are treated with in-centre haemodialysis, overall survival is poor, but longer in some Asian countries than elsewhere in the world, and longer in Europe than in the USA, although this gap has reduced. Commendable haemodialysis practice includes exceptionally high use of surgical vascular access in Japan and in some European countries, and the use of longer or more frequent dialysis sessions in some countries, allowing for more effective volume management. Mortality is especially high soon after ESKD onset, and improved preparation for ESKD is needed including alignment of decision making with the wishes of patients and families.

  19. Out of the reach of children? Young people's health-seeking practices and agency in Africa's newly-emerging therapeutic landscapes.

    PubMed

    Hampshire, Kate R; Porter, Gina; Owusu, Samuel Asiedu; Tanle, Augustine; Abane, Albert

    2011-09-01

    Despite a dominant view within Western biomedicine that children and medicines should be kept apart, a growing literature suggests that children and adolescents often take active roles in health-seeking. Here, we consider young people's health-seeking practices in Ghana: a country with a rapidly-changing therapeutic landscape, characterised by the recent introduction of a National Health Insurance Scheme, mass advertising of medicines, and increased use of mobile phones. Qualitative and quantitative data are presented from eight field-sites in urban and rural Ghana, including 131 individual interviews, focus groups, plus a questionnaire survey of 1005 8-to-18-year-olds. The data show that many young people in Ghana play a major role in seeking healthcare for themselves and others. Young people's ability to secure effective healthcare is often constrained by their limited access to social, economic and cultural resources and information; however, many interviewees actively generated, developed and consolidated such resources in their quest for healthcare. Health insurance and the growth of telecommunications and advertising present new opportunities and challenges for young people's health-seeking practices. We argue that policy should take young people's medical realities as a starting point for interventions to facilitate safe and effective health-seeking. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Assessing representativeness of sampling methods for reaching men who have sex with men: a direct comparison of results obtained from convenience and probability samples.

    PubMed

    Schwarcz, Sandra; Spindler, Hilary; Scheer, Susan; Valleroy, Linda; Lansky, Amy

    2007-07-01

    Convenience samples are used to determine HIV-related behaviors among men who have sex with men (MSM) without measuring the extent to which the results are representative of the broader MSM population. We compared results from a cross-sectional survey of MSM recruited from gay bars between June and October 2001 to a random digit dial telephone survey conducted between June 2002 and January 2003. The men in the probability sample were older, better educated, and had higher incomes than men in the convenience sample, the convenience sample enrolled more employed men and men of color. Substance use around the time of sex was higher in the convenience sample but other sexual behaviors were similar. HIV testing was common among men in both samples. Periodic validation, through comparison of data collected by different sampling methods, may be useful when relying on survey data for program and policy development.

  1. Generalized Motor Program (GMP) Learning: Effects of Reduced Frequency of Knowledge of Results and Practice Variability.

    PubMed

    Lai, Q; Shea, C H

    1998-03-01

    The effects of reduced frequency of presentation of relative-liming knowledge of results (KR) on constant and serial practice and whether response stability is associated with increased generalized motor program (GMP) learning were examined. Participants (N = 40) were asked to sequentially depress 4 keys (2, 4, 8, and 6) on the numeric pad portion of the computer keyboard by using the index fingers of their right hands. The frequency (50% and 100%) with which relative-timing KR was presented was manipulated in constant and in serial practice conditions. The tasks used in both the constant and the serial conditions had the same relative-timing structure, but serial practice had 3 different absolute-timing requirements. The results, which indicated that reduced KR frequency enhances GMP learning in the serial practice condition, replicate the findings of Wulf, Lee, and Schmidt (1994). The reduced frequency of KR effect was not evident for the constant practice groups, however. More interesting was the finding that constant practice was significantly better than serial practice for the development and learning of the GMP. The data also showed that after either constant practice or reduced frequency of KR, response stability was enhanced in comparison with the stability of responses following serial practice and frequent KR. Those findings suggest that when response stability is improved either by reducing the frequency with which KR is presented or by reducing the number of task variations practiced, the development of the GMP is enhanced but parameter specification in transfer tasks tends to be degraded.

  2. Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare.

    PubMed

    Richter Sundberg, Linda; Garvare, Rickard; Nyström, Monica Elisabeth

    2017-05-11

    The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease. A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data. The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status

  3. Frequency of yoga practice predicts health: results of a national survey of yoga practitioners.

    PubMed

    Ross, Alyson; Friedmann, Erika; Bevans, Margaret; Thomas, Sue

    2012-01-01

    Background. Yoga shows promise as a therapeutic intervention, but relationships between yoga practice and health are underexplored. Purpose. To examine the relationship between yoga practice and health (subjective well-being, diet, BMI, smoking, alcohol/caffeine consumption, sleep, fatigue, social support, mindfulness, and physical activity). Methods. Cross-sectional, anonymous internet surveys distributed to 4307 randomly selected from 18,160 individuals at 15 US Iyengar yoga studios; 1045 (24.3%) surveys completed. Results. Mean age 51.7 (± 11.7) years; 84.2% female. Frequency of home practice favorably predicted (P < .001): mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue. Each component of yoga practice (different categories of physical poses, breath work, meditation, philosophy study) predicted at least 1 health outcome (P < .05). Conclusions. Home practice of yoga predicted health better than years of practice or class frequency. Different physical poses and yoga techniques may have unique health benefits.

  4. Current Trends in Grades and Grading Practices in Higher Education: Results of the 2004 AACRAO Survey

    ERIC Educational Resources Information Center

    Brumfield, Cody

    2005-01-01

    AACRAO's new publication "Current Trends in Grades and Grading Practices in Higher Education: Results of the 2004 AACRAO Survey" continues the tradition of surveying grading practices in higher education first begun in 1920. Although much has changed in the world of academia since, grades have remained a central feature. This consistent importance…

  5. An official multi-society statement: the role of clinical research results in the practice of critical care medicine.

    PubMed

    Tonelli, Mark R; Curtis, J Randall; Guntupalli, Kalpalatha K; Rubenfeld, Gordon D; Arroliga, Alejandro C; Brochard, Laurent; Douglas, Ivor S; Gutterman, David D; Hall, Jesse R; Kavanagh, Brian P; Mancebo, Jordi; Misak, Cheryl J; Simpson, Steven Q; Slutsky, Arthur S; Suffredini, Anthony F; Thompson, B Taylor; Ware, Lorraine B; Wheeler, Arthur P; Levy, Mitchell M

    2012-05-15

    While the results of clinical research are clearly valuable in the care of critically ill patients, the limitations of such information and the role of other forms of medical knowledge for clinical decision making have not been carefully examined. The leadership of three large professional societies representing critical care practitioners convened a diverse group representing a wide variety of views regarding the role of clinical research results in clinical practice to develop a document to serve as a basis for agreement and a framework for ongoing discussion. Consensus was reached on several issues. While the results of rigorous clinical research are important in arriving at the best course of action for an individual critically ill patient, other forms of medical knowledge, including clinical experience and pathophysiologic reasoning, remain essential. No single source of knowledge is sufficient to guide clinical decisions, nor does one kind of knowledge always take precedence over others. Clinicians will find clinical research compelling for a variety of reasons that go beyond study design. While clinical practice guidelines and protocols based upon clinical research may improve care and decrease variability in practice, clinicians must be able to understand and articulate the rationale as to why a particular protocol or guideline is used or why an alternative approach is taken. Making this clinical reasoning explicit is necessary to understand practice variability. Understanding the strengths and weaknesses of different kinds of medical knowledge for clinical decision making and factors beyond study design that make clinical research compelling to clinicians can provide a framework for understanding the role of clinical research in practice.

  6. Global reach and engagement

    NASA Astrophysics Data System (ADS)

    2016-09-01

    Popular culture reflects both the interests of and the issues affecting the general public. As concerns regarding climate change and its impacts grow, is it permeating into popular culture and reaching that global audience?

  7. Quartermaster Reach Restoration Project

    EPA Pesticide Factsheets

    Information about the SFBWQP Quartermaster Reach Restoration Project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  8. Reaching affects saccade trajectories.

    PubMed

    Tipper, S P; Howard, L A; Paul, M A

    2001-01-01

    The pre-motor theory suggests that, when attention is oriented to a location, the motor systems that are involved in achieving current behavioural goals are activated. For example, when a task requires accurate reaching, attention to a location activates the motor circuits controlling saccades and manual reaches. These actions involve separate neural systems for the control of eye and hand, but we believe that the selection processes acting on neural population codes within these systems are similar and can affect each other. The attentional effect can be revealed in the subsequent movement. The present study shows that the path the eye takes as it saccades to a target is affected by whether a reach to the target is also produced. This effect is interpreted as the influence of a hand-centred frame used in reaching on the spatial frame of reference required for the saccade.

  9. Test result communication in primary care: a survey of current practice

    PubMed Central

    Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

    2015-01-01

    Background The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. Methods We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Results Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. Conclusions The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for

  10. Test result communication in primary care: a survey of current practice.

    PubMed

    Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

    2015-11-01

    The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the

  11. Transfer Paths of Research Results to the Practice: Observations From the Receiving End

    NASA Astrophysics Data System (ADS)

    Findikakis, A. N.

    2005-12-01

    A non-scientific poll of fellow practicing professionals suggests that there is a range of opinions regarding the effectiveness of different ways of becoming acquainted with and using the results of academic research in their practice. Journal articles remain the dominant path for transferring research results to the profession, even though accessing them is becoming more difficult with time. Driven primarily by cost considerations personal and corporate subscriptions seem to be on the decline. Libraries are one of the first victims of cost cutting measures in the industry. Even though the availability of journal articles in electronic form facilitates their availability, their prices are prohibitive. This is especially true during when a professional is searching for a solution to a problem and may have to review several papers on the subject. One colleague suggested that the professional organizations and other publishers of research articles could learn from the experience of the music industry, by lowering the cost of downloading individual papers to something like a dollar per article, recovering thus their production costs through the increase in the volume of purchased articles. The posting on the internet of special reports and dissertations by research institutions is viewed as very useful by those working in practice. The distribution through the internet of reports by federal organizations conducting or sponsoring research, such as the U.S. Geological Survey and the U.S. Environmental Protection Agency is greatly appreciated by the practicing professionals. The use of leading researchers as consultants provides a direct path for bringing research results to the practice, but it is limited to a small number of cases where bringing in a consultant can be justified. Short courses are viewed as an effective way of familiarizing professionals with the latest research findings on specific subjects. The notes distributed in such courses are considered

  12. Always Connected, but Hard to Reach

    ERIC Educational Resources Information Center

    Rishi, Raju

    2007-01-01

    Students seem to be always connected through their computers, personal digital assistants (PDAs), or mobile phones, making it easy to reach them--if you are a peer. For colleges and universities, reaching students with timely and relevant information often proves a challenge. With rapid changes in both technology and social practices, what should…

  13. Pediatric nurse practitioner salary and practice: results of a Midwest metropolitan area survey.

    PubMed

    Loman, Deborah G; Hung, Shu-Ling

    2007-01-01

    The St. Louis Association of Pediatric Nurse Practitioners has conducted a local biennial salary, practice, and benefits survey since the mid 1990s. This cross-sectional, descriptive study investigated demographic characteristics, salary, benefits, and practice patterns of pediatric nurse practitioners (PNPs) in the St. Louis area in fall, 2005. The survey was sent to 199 PNPs who lived within 100 miles of Saint Louis, with a return rate of 60%. The mean salary for full time PNPs engaged in practice was $72,788, which was a 6.3% increase from the 2003 survey results. PNPs with more years of experience received significantly higher salaries than those with less experience; however, there was no difference in salary based on type of practice (primary versus specialty care) or type of practice setting. Increasing numbers of PNPs are reporting their practice focus as specialty care (53%) rather than primary care (47%) in this region, with 70% of full time PNPs indicating specialty care. PNPs with less than 3 years experience were working equally in primary and specialty care. Practice challenges such as reimbursement and prescriptive issues were identified. Only 37% of PNPs indicated that they were credentialed by insurance plans. Nurse practitioners may find a local survey helpful as they negotiate changes in their salaries and benefits. Members of advance practice nursing organizations and educators may find the survey process useful as they observe local practice trends over time. It is essential that nursing education and continuing education conferences address the basic and continuing education needs of PNPs in both primary care and common specialty practices.

  14. Towards Harmonisation of Critical Laboratory Result Management - Review of the Literature and Survey of Australasian Practices

    PubMed Central

    Campbell, CA; Horvath, AR

    2012-01-01

    Timely release and communication of critical test results may have significant impact on medical decisions and subsequent patient outcomes. Laboratories therefore have an important responsibility and contribution to patient safety. Certification, accreditation and regulatory bodies also require that laboratories follow procedures to ensure patient safety, but there is limited guidance on best practices. In Australasia, no specific requirements exist in this area and critical result reporting practices have been demonstrated to be heterogeneous worldwide. Recognising the need for agreed standards and critical limits, the AACB started a quality initiative to harmonise critical result management throughout Australasia. The first step toward harmonisation is to understand current laboratory practices. Fifty eight Australasian laboratories responded to a survey and 36 laboratories shared their critical limits. Findings from this survey are compared to international practices reviewed in various surveys conducted elsewhere. For the successful operation of a critical result management system, critical tests and critical limits must be defined in collaboration with clinicians. Reporting procedures must include how critical results are identified; who can report and who can receive critical results; what is an acceptable timeframe within which results must be delivered or, if reporting fails, what escalation procedures should follow; what communication channels or systems should be used; what should be recorded and how; and how critical result procedures should be maintained and evaluated to assess impact on outcomes. In this paper we review the literature of current standards and recommendations for critical result management. Key elements of critical result reporting are discussed in view of the findings of various national surveys on existing laboratory practices, including data from our own survey in Australasia. Best practice recommendations are made that laboratories

  15. Towards harmonisation of critical laboratory result management - review of the literature and survey of australasian practices.

    PubMed

    Campbell, Ca; Horvath, Ar

    2012-11-01

    Timely release and communication of critical test results may have significant impact on medical decisions and subsequent patient outcomes. Laboratories therefore have an important responsibility and contribution to patient safety. Certification, accreditation and regulatory bodies also require that laboratories follow procedures to ensure patient safety, but there is limited guidance on best practices. In Australasia, no specific requirements exist in this area and critical result reporting practices have been demonstrated to be heterogeneous worldwide.Recognising the need for agreed standards and critical limits, the AACB started a quality initiative to harmonise critical result management throughout Australasia. The first step toward harmonisation is to understand current laboratory practices. Fifty eight Australasian laboratories responded to a survey and 36 laboratories shared their critical limits. Findings from this survey are compared to international practices reviewed in various surveys conducted elsewhere. For the successful operation of a critical result management system, critical tests and critical limits must be defined in collaboration with clinicians. Reporting procedures must include how critical results are identified; who can report and who can receive critical results; what is an acceptable timeframe within which results must be delivered or, if reporting fails, what escalation procedures should follow; what communication channels or systems should be used; what should be recorded and how; and how critical result procedures should be maintained and evaluated to assess impact on outcomes.In this paper we review the literature of current standards and recommendations for critical result management. Key elements of critical result reporting are discussed in view of the findings of various national surveys on existing laboratory practices, including data from our own survey in Australasia. Best practice recommendations are made that laboratories

  16. Reaching for the Stars.

    ERIC Educational Resources Information Center

    Roper-Davis, Sharon

    1999-01-01

    Describes "Reaching for the Stars," a program which develops teaming and mentoring skills in senior physics students. Phase 1 requires student pairs to design a rocket; Phase 2 pairs seniors with gifted second graders who build the rocket from written instructions; and in Phase 3, pairs of seniors create a children's storybook explaining…

  17. REACH. Refrigeration Units.

    ERIC Educational Resources Information Center

    Snow, Rufus; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of refrigeration. The instructional units focus on refrigeration fundamentals, tubing and pipe, refrigerants, troubleshooting, window air conditioning, and…

  18. REACH. Major Appliance.

    ERIC Educational Resources Information Center

    English, Charles; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of major appliances. The instructional units focus on installation of appliances, troubleshooting washing machines, troubleshooting electric dryers,…

  19. Reaching for the Stars.

    ERIC Educational Resources Information Center

    Roper-Davis, Sharon

    1999-01-01

    Describes "Reaching for the Stars," a program which develops teaming and mentoring skills in senior physics students. Phase 1 requires student pairs to design a rocket; Phase 2 pairs seniors with gifted second graders who build the rocket from written instructions; and in Phase 3, pairs of seniors create a children's storybook explaining…

  20. "Brown's" Far Reaching Impact

    ERIC Educational Resources Information Center

    Chinn, Philip C.

    2004-01-01

    Although the 1954 "Brown v. Board of Education" U.S. Supreme Court decision changed the face of American education forever, few individuals at that time could have fully realized its far-reaching implications. Certainly, the National Association for the Advancement of Colored People Legal Director Thurgood Marshall in his arguments was…

  1. Reaching for the Stars

    ERIC Educational Resources Information Center

    Terry, Dorothy Givens

    2012-01-01

    Dr. Mae Jemison is the world's first woman astronaut of color who continues to reach for the stars. Jemison was recently successful in leading a team that has secured a $500,000 federal grant to make interstellar space travel a reality. The Dorothy Jemison Foundation for Excellence (named after Jemison's mother) was selected in June by the Defense…

  2. Reaching into Pictorial Spaces

    NASA Astrophysics Data System (ADS)

    Volcic, Robert; Vishwanath, Dhanraj; Domini, Fulvio

    2014-02-01

    While binocular viewing of 2D pictures generates an impression of 3D objects and space, viewing a picture monocularly through an aperture produces a more compelling impression of depth and the feeling that the objects are "out there", almost touchable. Here, we asked observers to actually reach into pictorial space under both binocular- and monocular-aperture viewing. Images of natural scenes were presented at different physical distances via a mirror-system and their retinal size was kept constant. Targets that observers had to reach for in physical space were marked on the image plane, but at different pictorial depths. We measured the 3D position of the index finger at the end of each reach-to-point movement. Observers found the task intuitive. Reaching responses varied as a function of both pictorial depth and physical distance. Under binocular viewing, responses were mainly modulated by the different physical distances. Instead, under monocular viewing, responses were modulated by the different pictorial depths. Importantly, individual variations over time were minor, that is, observers conformed to a consistent pictorial space. Monocular viewing of 2D pictures thus produces a compelling experience of an immersive space and tangible solid objects that can be easily explored through motor actions.

  3. "Brown's" Far Reaching Impact

    ERIC Educational Resources Information Center

    Chinn, Philip C.

    2004-01-01

    Although the 1954 "Brown v. Board of Education" U.S. Supreme Court decision changed the face of American education forever, few individuals at that time could have fully realized its far-reaching implications. Certainly, the National Association for the Advancement of Colored People Legal Director Thurgood Marshall in his arguments was…

  4. REACH. Electricity Units. Secondary.

    ERIC Educational Resources Information Center

    Smith, Gene; Sappe, Hoyt

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of electricity. The instructional units focus on electricity fundamentals and electric motors. Each unit follows a typical format that includes a unit sheet,…

  5. REACH. Heating Units.

    ERIC Educational Resources Information Center

    Stanfield, Carter; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized units in the area of heating. The instructional units focus on electric heating systems, gas heating systems, and oil burning systems. Each unit follows a typical format that includes a unit…

  6. REACH. Air Conditioning Units.

    ERIC Educational Resources Information Center

    Garrison, Joe; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of air conditioning. The instructional units focus on air conditioning fundamentals, window air conditioning, system and installation, troubleshooting and…

  7. REACH. Electricity Units. Secondary.

    ERIC Educational Resources Information Center

    Smith, Gene; Sappe, Hoyt

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of electricity. The instructional units focus on electricity fundamentals and electric motors. Each unit follows a typical format that includes a unit sheet,…

  8. REACH. Heating Units.

    ERIC Educational Resources Information Center

    Stanfield, Carter; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized units in the area of heating. The instructional units focus on electric heating systems, gas heating systems, and oil burning systems. Each unit follows a typical format that includes a unit…

  9. REACH. Major Appliance.

    ERIC Educational Resources Information Center

    English, Charles; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of major appliances. The instructional units focus on installation of appliances, troubleshooting washing machines, troubleshooting electric dryers,…

  10. REACH. Air Conditioning Units.

    ERIC Educational Resources Information Center

    Garrison, Joe; And Others

    As a part of the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this student manual contains individualized instructional units in the area of air conditioning. The instructional units focus on air conditioning fundamentals, window air conditioning, system and installation, troubleshooting and…

  11. Reaching for the Stars

    ERIC Educational Resources Information Center

    Terry, Dorothy Givens

    2012-01-01

    Dr. Mae Jemison is the world's first woman astronaut of color who continues to reach for the stars. Jemison was recently successful in leading a team that has secured a $500,000 federal grant to make interstellar space travel a reality. The Dorothy Jemison Foundation for Excellence (named after Jemison's mother) was selected in June by the Defense…

  12. Reaching the Target Audience

    DTIC Science & Technology

    2014-06-13

    REACHING THE TARGET AUDIENCE A thesis presented to the Faculty of the U.S. Army Command and General Staff College in...partial fulfillment of the requirements for the degree MASTER OF MILITARY ART AND SCIENCE General Studies by MARK S. FLITTON, MAJOR, USAR...NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) U.S. Army Command and General Staff College ATTN: ATZL-SWD-GD Fort

  13. Survey of Sterile Admixture Practices in Canadian Hospital Pharmacies: Part 1. Methods and Results

    PubMed Central

    Warner, Travis; Nishi, Cesilia; Checkowski, Ryan; Hall, Kevin W.

    2009-01-01

    Background: The 1996 Guidelines for Preparation of Sterile Products in Pharmacies of the Canadian Society of Hospital Pharmacists (CSHP) represent the current standard of practice for sterile compounding in Canada. However, these guidelines are practice recommendations, not enforceable standards. Previous surveys of sterile compounding practices have shown that actual practice deviates markedly from voluntary practice recommendations. In 2004, the United States Pharmacopeia (USP) published its “General Chapter <797> Pharmaceutical Compounding—Sterile Preparations”, which set a more rigorous and enforceable standard for sterile compounding in the United States. Objectives: To assess sterile compounding practices in Canadian hospital pharmacies and to compare them with current CSHP recommendations and USP chapter <797> standards. Methods: An online survey, based on previous studies of sterile compounding practices, the CSHP guidelines, and the chapter <797> standards, was created and distributed to 193 Canadian hospital pharmacies. Results: A total of 133 pharmacies completed at least part of the survey, for a response rate of 68.9%. All respondents reported the preparation of sterile products. Various degrees of deviation from the practice recommendations were noted for virtually all areas of the CSHP guidelines and the USP standards. Low levels of compliance were most notable in the areas of facilities and equipment, process validation, and product testing. Availability in the central pharmacy of a clean room facility meeting or exceeding the criteria of International Organization for Standardization (ISO) class 8 is a requirement of the chapter <797> standards, but more than 40% of responding pharmacies reported that they did not have such a facility. Higher levels of compliance were noted for policies and procedures, garbing requirements, aseptic technique, and handling of hazardous products. Part 1 of this series reports the survey methods and results

  14. Survey of Sterile Admixture Practices in Canadian Hospital Pharmacies: Part 2. More Results and Discussion

    PubMed Central

    Warner, Travis; Nishi, Cesilia; Checkowski, Ryan; Hall, Kevin W

    2009-01-01

    Background: The 1996 Guidelines for Preparation of Sterile Products in Pharmacies of the Canadian Society of Hospital Pharmacists (CSHP) represent the current standard of practice for sterile compounding in Canada. However, these guidelines are practice recommendations, not enforceable standards. Previous surveys of sterile compounding practices have shown that actual practice deviates markedly from voluntary practice recommendations. In 2004, the United States Pharmacopeia (USP) published its “General Chapter <797> Pharmaceutical Compounding—Sterile Preparations”, which set a more rigorous and enforceable standard for sterile compounding in the United States. Objectives: To assess sterile compounding practices in Canadian hospital pharmacies and to compare them with current CSHP recommendations and USP chapter <797> standards. Methods: An online survey, based on previous studies of sterile compounding practices, the CSHP guidelines, and the chapter <797> standards, was created and distributed to 193 Canadian hospital pharmacies. Results: A total of 133 pharmacies completed at least part of the survey, for a response rate of 68.9%. All respondents reported the preparation of sterile products. Various degrees of deviation from the practice recommendations were noted for virtually all areas of the CSHP guidelines and the USP standards. Low levels of compliance were most notable in the areas of facilities and equipment, process validation, and product testing. Availability in the central pharmacy of a clean room facility meeting or exceeding the criteria of International Organization for Standardization (ISO) class 8 is a requirement of the chapter <797> standards, but more than 40% of responding pharmacies reported that they did not have such a facility. Higher levels of compliance were noted for policies and procedures, garbing requirements, aseptic technique, and handling of hazardous products. The survey methods for this study and results relating to

  15. Statutory Reform is Associated with Improved Court Practice: Results of a Tri-State Comparison

    PubMed Central

    Moye, Jennifer; Wood, Erica; Edelstein, Barry; Wood, Stacey; Bower, Emily H.; Harrison, Julie A.; Armesto, Jorge C.

    2016-01-01

    Purpose This study investigates the impact of statutory reform in adult guardianship on court practice. Methods Case files for 298 cases of adult guardianship were reviewed in three states with varying degrees of statutory reform: MA (no reform), PA (major amendments in 1992), and CO (full re-enactment of statute per UGPPA in 2000). Five court practices associated with progressive statutory reform were studied: (1) diversion to less restrictive alternatives; (2) minimal and appropriate use of emergency procedures; (3) presence of the alleged incapacitated person at the hearing; (4) use of functional evaluation; (5) use of limited orders. Results CO more frequently utilized all five practices, whereas PA used diversion to less restrictive alternatives and less frequent emergency procedures, but not other practices. MA files rarely showed evidence for use of any of these reforms. Implications Statutory reform may improve court practice. More study of the effects of reform on court practices, and the vulnerable adults served by these courts, is needed. PMID:17506075

  16. Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium†

    PubMed Central

    Kennedy, Ann B.; Cambron, Jerrilyn A.; Sharpe, Patricia A.; Travillian, Ravensara S.; Saunders, Ruth P.

    2016-01-01

    Background Massage therapists are at times unclear about the definition of massage therapy, which creates challenges for the profession. It is important to investigate the current definitions and to consider the field as a whole in order to move toward clarity on what constitutes the constructs within the profession. Purpose To determine how a sample of experts understand and describe the field of massage therapy as a step toward clarifying definitions for massage and massage therapy, and framing the process of massage therapy practice. Setting A two-day symposium held in 2010 with the purpose of gathering knowledge to inform and aid in the creation of massage therapy best practice guidelines for stress and low back pain. Participants Thirty-two experts in the field of massage therapy from the United States, Europe, and Canada. Design Qualitative analysis of secondary cross-sectional data using a grounded theory approach. Results Three over-arching themes were identified: 1) What is massage?; 2) The multidimensional nature of massage therapy; and 3) The influencing factors on massage therapy practice. Discussion The data offered clarifying definitions for massage and massage therapy, as well as a framework for the context for massage therapy practice. These clarifications can serve as initial steps toward the ultimate goal of creating new theory for the field of massage therapy, which can then be applied in practice, education, research, and policy. Conclusions Foundational research into how experts in the profession understand and describe the field of massage therapy is limited. Understanding the potential differences between the terms massage and massage therapy could contribute to a transformation in the profession in the areas of education, practice, research, policy and/or regulation. Additionally, framing the context for massage therapy practice invites future discussions to further clarify practice issues. PMID:27648109

  17. Contemporary training practices in elite British powerlifters: survey results from an international competition.

    PubMed

    Swinton, Paul A; Lloyd, Ray; Agouris, Ioannis; Stewart, Arthur

    2009-03-01

    The primary objective of this study was to investigate current powerlifting training methods in light of anecdotal evidence purporting increased similarity with the explosive training practices of weightlifters. The study also assessed the prevalence of contemporary training practices frequently recommended for powerlifters in the popular literature. A 20-item survey was distributed to 32 elite British powerlifters at an International competition. The subject group included multiple national, international, and commonwealth champions and record holders. Based on 2007 competition results, the average Wilks score of the group was 450.26 +/- 34.7. The response rate for the surveys was 88% (28 of 32). The survey was sectioned into 6 areas of inquiry: a) repetition speed, b) explosive training load, c) resistance materials used, d) adjunct power training methods, e) exercise selection, and f) training organization. The results demonstrate that the majority of powerlifters train with the intention to explosively lift maximal and submaximal loads (79 and 82%, respectively). Results revealed that 39% of the lifters regularly used elastic bands and that 57% incorporated chains in their training. Evidence for convergence of training practices between powerlifters and weightlifters was found when 69% of the subjects reported using the Olympic lifts or their derivatives as part of their powerlifting training. Collectively, the results demonstrate that previous notions of how powerlifters train are outdated. Contemporary powerlifters incorporate a variety of training practices that are focused on developing both explosive and maximal strength.

  18. Soil health: an emergent set of soil properties that result from synergy among agricultural management practices

    USDA-ARS?s Scientific Manuscript database

    The responses of a selected soil microbial property to a single agricultural management practice are often inconsistent among field studies, possibly reflecting the site-specific nature of field studies. An equally compelling explanation is that in complex systems where outcomes are the result of n...

  19. Some results and problems encountered in the practical implementation of a Shack-Fizeau interferometer

    NASA Astrophysics Data System (ADS)

    Garcia-Marquez, Jorge L.; Malacara-Hernandez, Daniel; Malacara-Doblado, Daniel

    1995-06-01

    A Shack-Fizeau interferometer has been designed and constructed to test concave conical telescope mirrors. Many interesting practical problems and results were found on the way. Some of these problems are, for example, the design of each optical element and the imaging of the interference pattern on the detector, etc. Here, we describe the design parameters with some detail.

  20. Reaching the Disadvantaged Learner.

    ERIC Educational Resources Information Center

    Passow, A. Harry, Ed.

    This collection of articles, first presented at the Sixth Annual Work Conference on Urban Education at Teachers College, Columbia University, includes critiques on compensatory education programs, a report on a study of nonwhite child rearing practices and parental concern with education, a survey of preschool programs, a report of a study…

  1. Proprioceptive Body Illusions Modulate the Visual Perception of Reaching Distance

    PubMed Central

    Petroni, Agustin; Carbajal, M. Julia; Sigman, Mariano

    2015-01-01

    The neurobiology of reaching has been extensively studied in human and non-human primates. However, the mechanisms that allow a subject to decide—without engaging in explicit action—whether an object is reachable are not fully understood. Some studies conclude that decisions near the reach limit depend on motor simulations of the reaching movement. Others have shown that the body schema plays a role in explicit and implicit distance estimation, especially after motor practice with a tool. In this study we evaluate the causal role of multisensory body representations in the perception of reachable space. We reasoned that if body schema is used to estimate reach, an illusion of the finger size induced by proprioceptive stimulation should propagate to the perception of reaching distances. To test this hypothesis we induced a proprioceptive illusion of extension or shrinkage of the right index finger while participants judged a series of LEDs as reachable or non-reachable without actual movement. Our results show that reach distance estimation depends on the illusory perceived size of the finger: illusory elongation produced a shift of reaching distance away from the body whereas illusory shrinkage produced the opposite effect. Combining these results with previous findings, we suggest that deciding if a target is reachable requires an integration of body inputs in high order multisensory parietal areas that engage in movement simulations through connections with frontal premotor areas. PMID:26110274

  2. [The medical education and the extended general practice: results of a Brazilian experiment].

    PubMed

    Hafner, Maria de Lourdes Marmorato Botta; Moraes, Magali Aparecida Alves de; Marvulo, Marilda Marques Luciano; Braccialli, Luzmarina Aparecida Doretto; Carvalho, Maria Helena Ribeiro de; Gomes, Romeu

    2010-06-01

    This is a qualitative study that is part of an evaluation research of a medicine course with the use of active teaching-learning methodologies based on the triangulation of methods. The aim is to evaluate the results related to the extended general practice concept. The sources of information used in the study include 17 semi-structured interviews with ex-prisoners and a situation that simulated the medical practice, of which seven ex-prisoners and a simulated patient participated. The analysis of the information and the production of the data were based on the method of interpretation of senses, according to the referential hermeneutic-dialectic system. The results point to aspects that justify the extended general practice, evidenced in two themes: the doctor-patient relationship and the patient approach. In conclusion, it is observed that the evaluated medical course brings together the education of the general, humanist, critical and reflexive doctor that may intervene in the different levels of health attention as well as in the individual and collective approach. It is also concluded that there are limits in operating an extended general practice in diverse health situations.

  3. Infants and adults reaching in the dark.

    PubMed

    Babinsky, Erin; Braddick, Oliver; Atkinson, Janette

    2012-03-01

    It has been shown that infants over the age of 6 months will reach for an object in complete darkness. This experiment measured the reaching movements of 9- to 16-month-old infants and adults under several different conditions of illumination to investigate the role of vision and stored visual representations in reach control. In one condition, participants reached for an object with the lights on. In a second condition, participants reached for an object glowing in the dark (glowing condition). This allowed us to measure the effects of vision of the arm and vision of the reach space. We also looked at the effect of removing vision of the object on reach control: in the final two conditions, participants reached for an object in complete darkness (0-s dark) and in complete darkness after a 4-s delay (4-s dark). We compared the kinematics of a reach (e.g. average speed, reach straightness) between the four illumination conditions. The results showed that infants reached faster and decelerated for a shorter period of time in the dark (0- and 4-s dark) than in the light. By comparison, adults reached slower and decelerated for a longer period of time in the dark (0- and 4-s dark) than in the light. We did not find any effect of the glowing condition compared to full vision on infant reaching movements. These results suggest that infant reaching movements only become compromised when the target is not visible, whereas vision of the hand and the reach space are less significant. Without online visual feedback, an infant reach in the dark appears to be driven by feedforward mechanisms and control may be affected by an immature ability to form and/or retain visual spatial memory.

  4. A Standards-Based Professional Development Program and the Resulting Impact on Two Sixth Grade Teachers' Classroom Practices

    NASA Astrophysics Data System (ADS)

    Bereki, Debra Lynn

    In 2000, California introduced science content standards as part of an across the curriculum reform. This presented a special challenge for elementary teachers due to an increased emphasis on math and language arts, and limited science background and resources. This two year qualitative study looks at a professional development program that resulted from collaboration between a university and an elementary school district. The program brought sixth grade elementary teachers together with scientists (geologists) and a science educator to develop a quality sixth grade science curriculum aligned to the California content standards. This multiple-case embedded study included an analysis of how these standards were addressed during the program, and the impact of this professional development on two teachers' classroom practices. The results of this study indicate that the geologists and the science educator played different but complementary roles in the professional development program. Furthermore, the professional development disproportionately focused on the Earth science standards, and this correlated to a disproportionate focus on these standards in the classrooms of the two teachers studied. Finally, the results indicate that as these two teachers implemented their new science units, they progressed through the initial stages of teacher change as outlined by change models described in the literature. However, they did not reach the final stage of change that involves complete confidence in their knowledge and being satisfied with the implementation of their science units.

  5. [Achievement of the therapeutic goals for dyslipidemia in clinical practice: results of a survey among general practice physicians from Lombardy].

    PubMed

    Tragni, Elena; Catapano, Alberico L; Bertelli, Alessandra; Poli, Andrea

    2003-12-01

    Currently available guidelines suggest that hypolipidemic drugs should be used in subjects at high risk for coronary heart disease (CHD). Very often, however, physicians fail to comply with the targets (total or LDL cholesterol) that are proposed by the Consensus Panels. The aim of this survey was to evaluate the efficacy of a hypocholesterolemic treatment in achieving the therapeutic target according to Adult Treatment Panel II guidelines in a sample of general practitioners from Lombardy, a region of northern Italy. Eighty-five general practitioners reported in a standardized manner data on the presence of major and minor coronary risk factors from at least 15 patients from their database for a total of 1275 patients. Treatment targets for LDL cholesterol were 100 mg/dl in patients with existing cardiovascular disease (class I), 130 mg/dl for patients with > or = 2 CHD risk factors (class II), and 160 mg/dl for the others (class III). Results on the efficacy of the therapy were divided into the following categories: 1) to target, 2) failure to reach the target by < or = 30 mg/dl, 3) failure to reach the target by > 30 mg/dl. Data were analyzed by means of the CSS statistical software. Overall 58.2% of the patients were males and the average age of the population was 59.2 +/- 10.1 years; 20.4% were diabetics, 34.5% smokers, 48.8% hypertensives, 16.9% had a previous myocardial infarction, 14.9% were suffering of stable angina, and 8.1% had undergone coronary artery bypass grafting and/or coronary angioplasty. Moreover 33.9% had a positive family history for CHD. Class I patients were 31.7% of the population, class II 52.9%, and class III 15.4%. Plasma lipid levels before treatment were on average 294 +/- 37 mg/dl for total cholesterol, 211 +/- 37 mg/dl for LDL cholesterol, 45 +/- 16 mg/dl for HDL cholesterol, and 195 +/- 104 mg/dl for plasma triglycerides. Of the patients 78.8% received dietary counseling, while 94.7% received hypolipidemic treatment (89.9% were

  6. Europe reaches the Moon

    NASA Astrophysics Data System (ADS)

    2004-11-01

    A complex package of tests on new technologies was successfully performed during the cruise to the Moon, while the spacecraft was getting ready for the scientific investigations which will come next. These technologies pave the way for future planetary missions. SMART-1 reached its closest point to the lunar surface so far - its first ‘perilune’ - at an altitude of about 5000 kilometres at 18:48 Central European Time (CET) on 15 November. Just hours before that, at 06:24 CET, SMART-1’s solar-electric propulsion system (or ‘ion engine’) was started up and is now being fired for the delicate manoeuvre that will stabilise the spacecraft in lunar orbit. During this crucial phase, the engine will run almost continuously for the next four days, and then for a series of shorter burns, allowing SMART-1 to reach its final operational orbit by making ever-decreasing loops around the Moon. By about mid-January, SMART-1 will be orbiting the Moon at altitudes between 300 kilometres (over the lunar south pole) and 3000 kilometres (over the lunar north pole), beginning its scientific observations. The main purpose of the first part of the SMART-1 mission, concluding with the arrival at the Moon, was to demonstrate new spacecraft technologies. In particular, the solar-electric propulsion system was tested over a long spiralling trip to the Moon of more than 84 million kilometres. This is a distance comparable to an interplanetary cruise. For the first time ever, gravity-assist manoeuvres, which use the gravitational pull of the approaching Moon, were performed by an electrically-propelled spacecraft. The success of this test is important to the prospects for future interplanetary missions using ion engines. SMART-1 has demonstrated new techniques for eventually achieving autonomous spacecraft navigation. The OBAN experiment tested navigation software on ground computers to determine the exact position and velocity of the spacecraft using images of celestial objects taken

  7. Has publication of the results of the ORACLE Children Study changed practice in the UK?

    PubMed

    Kenyon, S; Pike, K; Jones, D; Brocklehurst, P; Marlow, N; Salt, A; Taylor, D

    2010-10-01

      To investigate whether publication of the results of the ORACLE Children's Study, a 7-year follow-up of the ORACLE trial, changed practice with regard to the routine prescription of antibiotics to women with preterm rupture of membranes or spontaneous preterm labour (intact membranes).   A comparative questionnaire survey of clinical practice in November 2007 (before publication) and March 2009 (after publication).   Lead obstetricians for labour wards of all maternity units in the UK.   Self-administered questionnaires requested information about the routine prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour (intact membranes).   Change in practice for prescription of antibiotics.   The response rate was 166/214 (78%) in 2007 and 158/209 (76%) in 2009. In total, 120 maternity units responded on both occasions. For women with preterm rupture of membranes, 162/214 (98%) in 2007 and 151/158 (96%) in 2009 maternity units reported that they prescribed antibiotics, with the majority using erythromycin (98%). For women with spontaneous preterm labour (intact membranes), 35/166 (21%) in 2007 and 25/158 (16%) in 2009 maternity units reported that they routinely prescribed antibiotics. The findings from units who responded on both occasions are similar.   There has been little change in the reported prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour following publication of the ORACLE Children's Study. This suggests that current practice may require updated guidance.

  8. Reaching Beyond The Stars

    NASA Astrophysics Data System (ADS)

    Baker, Mariah; Rosenthal, L.; Gaughan, A.; Hopkins, E.

    2014-01-01

    Strawbridge Observatory at Haverford College is home to a undergraduate-led public observing program. Our program holds ~once monthly public events throughout the academic year that take advantage of eyepiece observing on our 16-inch and 12-inch telescopes as well as of the classroom, library, and projection system. These resources allow us to organize a variety of astronomy related activities that are engaging for individuals of all ages: accessible student talks, current film screenings and even arts and crafts for the families who attend with young children. These events aim to spark curiosity in others about scientific discovery and about the remarkable nature of the world in which we live. In addition to exciting local families about astronomy, this program has excited Haverford students from a range of disciplines about both science and education. Being entirely student led means that we are able to take the initiative in planning, coordinating and running all events, fostering an atmosphere of collaboration, experimentation and commitment amongst our volunteers. Additionally, this program is one of the few at Haverford that regularly reaches beyond the campus walls to promote and build relationships with the outside community. In light of this, our program presents a distinctive and enlightening opportunity for student volunteers: we get to use our scientific backgrounds to educate a general audience, while also learning from them about how to communicate and inspire in others the excitement we feel about the subject of astronomy. The work on this project has been supported by NSF AST-1151462.

  9. GAP-REACH

    PubMed Central

    Lewis-Fernández, Roberto; Raggio, Greer A.; Gorritz, Magdaliz; Duan, Naihua; Marcus, Sue; Cabassa, Leopoldo J.; Humensky, Jennifer; Becker, Anne E.; Alarcón, Renato D.; Oquendo, María A.; Hansen, Helena; Like, Robert C.; Weiss, Mitchell; Desai, Prakash N.; Jacobsen, Frederick M.; Foulks, Edward F.; Primm, Annelle; Lu, Francis; Kopelowicz, Alex; Hinton, Ladson; Hinton, Devon E.

    2015-01-01

    Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-itemGAP-REACH© checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (κ = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article. PMID:24080673

  10. Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel.

    PubMed

    Mohandas, Anita; Summa, Chris; Worthington, W Bradley; Lerner, Jason; Foley, Kevin T; Bohinski, Robert J; Lanford, Gregory B; Holden, Carol; Wohns, Richard N W

    2017-06-01

    Delphi Panel expert panel consensus and narrative literature review. To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)). Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings are lacking. A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Predetermined consensus was set at 70% for each best-practice statement. A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and subcategories) achieved consensus, including preoperative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6). This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same

  11. Research Priorities in Correctional Nursing Practice: Results of a Three-Round Delphi Study.

    PubMed

    Schoenly, Lorry

    2015-10-01

    Correctional nursing has been recognized as a specialty since 1985, but research to describe and support nursing practice in the criminal justice system has been sparse. The development of a research agenda can stimulate the research necessary to provide an evidence base for specialty practice development. A three-round Delphi study was undertaken to elicit a prioritized list of research topics to guide future research efforts for meaningful results. Six predominant themes emerged from an analysis of top research questions generated by a panel of 18 correctional nursing experts. Research priorities include critical thinking and clinical judgment, competency and educational level, assessment, nursing protocols, effect on patient outcomes, and the environment of care. © The Author(s) 2015.

  12. Metasurface holograms reaching 80% efficiency.

    PubMed

    Zheng, Guoxing; Mühlenbernd, Holger; Kenney, Mitchell; Li, Guixin; Zentgraf, Thomas; Zhang, Shuang

    2015-04-01

    Surfaces covered by ultrathin plasmonic structures--so-called metasurfaces--have recently been shown to be capable of completely controlling the phase of light, representing a new paradigm for the design of innovative optical elements such as ultrathin flat lenses, directional couplers for surface plasmon polaritons and wave plate vortex beam generation. Among the various types of metasurfaces, geometric metasurfaces, which consist of an array of plasmonic nanorods with spatially varying orientations, have shown superior phase control due to the geometric nature of their phase profile. Metasurfaces have recently been used to make computer-generated holograms, but the hologram efficiency remained too low at visible wavelengths for practical purposes. Here, we report the design and realization of a geometric metasurface hologram reaching diffraction efficiencies of 80% at 825 nm and a broad bandwidth between 630 nm and 1,050 nm. The 16-level-phase computer-generated hologram demonstrated here combines the advantages of a geometric metasurface for the superior control of the phase profile and of reflectarrays for achieving high polarization conversion efficiency. Specifically, the design of the hologram integrates a ground metal plane with a geometric metasurface that enhances the conversion efficiency between the two circular polarization states, leading to high diffraction efficiency without complicating the fabrication process. Because of these advantages, our strategy could be viable for various practical holographic applications.

  13. How similar are the changes in neural activity resulting from mindfulness practice in contrast to spiritual practice?

    PubMed

    Barnby, Joseph M; Bailey, Neil W; Chambers, Richard; Fitzgerald, Paul B

    2015-11-01

    Meditation and spiritual practices are conceptually similar, eliciting similar subjective experiences, and both appear to provide similar benefits to the practicing individuals. However, no research has examined whether the mechanism of action leading to the beneficial effects is similar in both practices. This review examines the neuroimaging research that has focused on groups of meditating individuals, groups who engage in religious/spiritual practices, and research that has examined groups who perform both practices together, in an attempt to assess whether this may be the case. Differences in the balance of activity between the parietal and prefrontal cortical activation were found between the three groups. A relative prefrontal increase was reflective of mindfulness, which related to decreased anxiety and improved well-being. A relative decrease in activation of the parietal cortex, specifically the inferior parietal cortex, appears to be reflective of spiritual belief, whether within the context of meditation or not. Because mindful and spiritual practices differ in focus regarding the 'self' or 'other' (higher being), these observations about neurological components that reflect spirituality may continue work towards understanding how the definition of 'self' and 'other' is represented in the brain, and how this may be reflected in behaviour. Future research can begin to use cohorts of participants in mindfulness studies which are controlled for using the variable of spirituality to explicitly examine how functional and structural similarities and differences may arise.

  14. Surprising results: HIV testing and changes in contraceptive practices among young women in Malawi

    PubMed Central

    Sennott, Christie; Yeatman, Sara

    2015-01-01

    This study uses eight waves of data from the population-based Tsogolo la Thanzi study (2009–2011) in rural Malawi to examine changes in young women’s contraceptive practices, including the use of condoms, non-barrier contraceptive methods, and abstinence, following positive and negative HIV tests. The analysis factors in women’s prior perceptions of their HIV status that may already be shaping their behaviour and separates surprise HIV test results from those that merely confirm what was already believed. Fixed effects logistic regression models show that HIV testing frequently affects the contraceptive practices of young Malawian women, particularly when the test yields an unexpected result. Specifically, women who are surprised to test HIV positive increase their condom use and are more likely to use condoms consistently. Following an HIV negative test (whether a surprise or expected), women increase their use of condoms and decrease their use of non-barrier contraceptives; the latter may be due to an increase in abstinence following a surprise negative result. Changes in condom use following HIV testing are robust to the inclusion of potential explanatory mechanisms including fertility preferences, relationship status, and the perception that a partner is HIV positive. The results demonstrate that both positive and negative tests can influence women’s sexual and reproductive behaviours, and emphasise the importance of conceptualizing of HIV testing as offering new information only insofar as results deviate from prior perceptions of HIV status. PMID:26160156

  15. Patient preferences for and satisfaction with methods of communicating test results in a primary care practice.

    PubMed

    Leekha, Surbhi; Thomas, Kris G; Chaudhry, Rajeev; Thomas, Matthew R

    2009-10-01

    Appropriate and timely communication of test results is an important element of high-quality health care. Patients' preferences regarding and satisfaction with test result notification methods in a primary care practice were evaluated. Some 1,458 consecutive patients were surveyed for whom routine blood tests were performed in the primary care internal medicine division at the Mayo Clinic Rochester (Minnesota) between January and March 2006. Among 888 respondents, test result notification occurred by telephone call (43%), return visit (35%), letter (3%), e-mail (0.1%), or a combination of methods (19%). Most (60%) telephone calls were handled by nurses. Patient preferences for notification method were telephone call (55%), return visit (20%), letter (19%), e-mail (5%), and automated answering mechanism (1%). Among patients reporting preference for telephone call, 67% wanted a call from a physician or nurse practitioner. Overall, 44% of patients received results by their preferred method; patients who did not were more likely to be dissatisfied with the communication method than those who did (10% vs. 5%, p = 0.01). A majority of patients were at least somewhat anxious to learn their test results, and patients greatly valued timeliness in test-result notification. The results describe primary care patients preferences for communication from their providers. Disparities exist between current practice and patient preferences in this important care delivery process. A telephone call from a physician or nurse practitioner was used to deliver test results for fewer than half of the patients who preferred to receive their results by this method. Future work should explore reimbursement of patient-preferred options and assess ways to improve resource-conscious test result communication methods.

  16. Human Papillomavirus Genotyping Testing Practice in 2014: Results of a College of American Pathologists National Survey.

    PubMed

    Zhao, Chengquan; Crothers, Barbara A; Ghofrani, Mohiedean; Li, Zaibo; Souers, Rhona J; Hussain, Mujtaba; Fan, Fang; Ocal, Idris Tolgay; Goodrich, Kelly; Shen, Rulong; Davey, Diane D

    2016-12-01

    - College of American Pathologists (CAP) surveys are used to establish national benchmarks for laboratories. - To investigate human papillomavirus (HPV) genotyping testing practice patterns in laboratories in 2014. - Data were analyzed from the CAP HPV Genotyping Practices Supplemental Questionnaire distributed to 749 laboratories participating in the CAP Human Papillomavirus (High Risk) for Cytology Program. - Six hundred four of 749 laboratories (80.6%) responded to the survey. More laboratories offered HPV genotyping testing and performed in-house HPV genotyping testing as compared to previous surveys. The Roche cobas HPV test was the most commonly used genotyping method (37.0%; 160 of 433), followed by Hologic Aptima HPV16 18/45 (26.1%; 113 of 433) and Hologic Cervista HPV16/18 (14.3%; 62 of 433). Most laboratories (287 of 399; 71.9%) offered HPV genotyping for high-risk HPV cases regardless of Papanicolaou (Pap) test results and patient age; this pattern was more common in laboratories using cobas. The remaining laboratories specifically offered testing to women with a negative Pap test result at age 30 years and older (65.2%, 73 of 112) or all ages (37.5%, 42 of 112). The median reporting rates of HPV16 and/or HPV18 positivity were 20.6%, 25.7%, 21.1%, and 57.4% for women with positive high-risk HPV adjunctive negative Pap results, atypical squamous cells of undermined significance, low-grade squamous intraepithelial lesion, and high-grade squamous lesion, respectively. - Human papillomavirus genotyping testing has increased. Roche cobas and Hologic Aptima genotype methods were the most common, and laboratories using cobas usually offered genotyping regardless of Pap test result and age. The data provide a baseline and trend of HPV genotyping test practices in 2014.

  17. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey.

    PubMed

    Ye, Zhiqiu; Mukamel, Dana B; Huang, Susan S; Li, Yue; Temkin-Greener, Helena

    2015-07-01

    OBJECTIVE To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs). METHODS In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. RESULTS A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. CONCLUSION Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure.

  18. Translating research into practice: criteria for applying literature search results to your work.

    PubMed

    Foster, Margaret; Shurtz, Suzanne; Smith, Matthew Lee

    2014-03-01

    Evidence-based practices in the fields of health education and health promotion require evaluating the validity and reliability of relevant and timely research. Skills associated with effectively assessing and applying research findings are essential when researchers and practitioners are developing a new program, writing a grant, or completing a research project. This Tool outlines steps and resources with which health educators and health promotion specialists can critically appraise the literature before deciding to apply a concept or practice. It also includes descriptions of "levels of evidence" for determining level of academic rigor, and questions to guide critical appraisals of published literature and other resources for determining their relevance to the work at hand. Assessing the evidence involves two steps: synthesizing selected articles and then applying their content to a certain situation, population, or need. This Tool is intended to advance the profession by offering tips for assessing and applying the results of literature searches, which involves evaluating the quality of the articles and determining how to best put the research into practice.

  19. Workforce characteristics of privately practicing nurse practitioners in Australia: Results from a national survey.

    PubMed

    Currie, Jane; Chiarella, Mary; Buckley, Thomas

    2016-10-01

    Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients' access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years. ©2016 American Association of Nurse Practitioners.

  20. Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey (.).

    PubMed

    Young, J Christopher; Roper, Brad L; Arentsen, Timothy J

    2016-05-01

    A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias. Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams. Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported. Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA's role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.

  1. Perceived practice change in Australian doctors as a result of medicolegal concerns.

    PubMed

    Nash, Louise M; Walton, Merrilyn M; Daly, Michele G; Kelly, Patrick J; Walter, Garry; van Ekert, Elizabeth H; Willcock, Simon M; Tennant, Christopher C

    2010-11-15

    To explore the perceived impact of medicolegal concerns on how Australian doctors practise medicine and to compare doctors who have experienced a medicolegal matter with those who have not. Cross-sectional survey (posted in September 2007, with reminder 4 weeks later) of Australian doctors from all major specialty groups, trainees and a sample of general practitioners who were insured with a medical insurance company. 2999 respondents of 8360 who were sent the survey. Perceived practice changes due to concerns about medicolegal issues, beliefs about medicolegal issues, and the influence of medicolegal issues on both career choices and how doctors relate to their patients. Respondents reported changes in practice behaviour due to medicolegal concerns, with 43% of doctors stating that they referred patients more than usual, 55% stating that they ordered tests more than usual, and 11% stating that they prescribed medications more than usual. Respondents also reported improved communication of risk (66%), increased disclosure of uncertainty (44%), developed better systems for tracking results (48%) and better methods for identifying non-attenders (39%) and for auditing clinical practice (35%). Concerns about medicolegal issues led to 33% considering giving up medicine, 32% considering reducing their working hours and 40% considering retiring early. These proportions were all significantly greater for doctors who had previously experienced a medicolegal matter compared with those who had not. This Australian study, like international studies, confirms that doctors' concerns about medicolegal issues impact on their practice in a variety of ways. There is a greater perceived impact on those doctors who have previously experienced a medicolegal matter.

  2. Abnormal ovarian cancer screening test result: women's informational, psychological and practical needs.

    PubMed

    Ryan, Patricia Y; Graves, Kristi D; Pavlik, Edward J; Andrykowski, Michael A

    2007-01-01

    Considerable effort has been devoted to the identification of cost-effective approaches to screening for ovarian cancer (OC). Transvaginal ultrasound (TVS) is one such screening approach. Approximately 5-7% of routine TVS screening tests yield abnormal results. Some women experience significant distress after receipt of an abnormal TVS screening test. Four focus groups provided in-depth, qualitative data regarding the informational, psychological, and practical needs of women after the receipt of an abnormal TVS result. Through question and content analytic procedures, we identified four themes: anticipation, emotional response, role of the screening technician, and impact of prior cancer experiences. Results provide initial guidance toward development of interventions to promote adaptive responses after receipt of an abnormal cancer screening test result.

  3. Current practice patterns in conservative thumb CMC joint care: survey results.

    PubMed

    O'Brien, Virginia H; McGaha, Jamie L

    2014-01-01

    Cross-sectional descriptive survey Best practice for conservative clinical care pathways is not well outlined in the literature for patients with thumb carpometacarpal joint (CMCJ) pain. This self-report survey investigated the current practice patterns of assessments and conservative interventions for the painful thumb CMCJ among hand therapists. An online survey was distributed to members of the American Society of Hand Therapists (ASHT). Questions were included about evaluation measures and intervention techniques used for this population. A descriptive analysis was completed of the results. A total of 23.5% of the ASHT membership responded to the survey. Results were categorized using the International Classification of Functioning and Disability domains as a framework. The survey results report varying use of evaluation measures, therapeutic interventions, including orthotic fabrication, joint protection and patient education all therapeutic interventional techniques, and modalities. Therapists use a comprehensive array of evaluation measures and interventions for body functions and structures in the care of thumb CMC pain. In contrast, more consistent use is needed of psychometrically-sound functional outcome measures that show change in activities and participation. This survey highlights areas to employ current evidence, as well as, future research should address environmental factors and personal factors for this population Not applicable. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  4. A method for obtaining practical flutter-suppression control laws using results of optimal control theory

    NASA Technical Reports Server (NTRS)

    Newson, J. R.

    1979-01-01

    The results of optimal control theory are used to synthesize a feedback filter. The feedback filter is used to force the output of the filtered frequency response to match that of a desired optimal frequency response over a finite frequency range. This matching is accomplished by employing a nonlinear programing algorithm to search for the coefficients of the feedback filter that minimize the error between the optimal frequency response and the filtered frequency response. The method is applied to the synthesis of an active flutter-suppression control law for an aeroelastic wind-tunnel model. It is shown that the resulting control law suppresses flutter over a wide range of subsonic Mach numbers. This is a promising method for synthesizing practical control laws using the results of optimal control theory.

  5. Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department.

    PubMed

    Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Puigoriol-Juvanteny, Emma; Nubó-Puntí, Núria; Chabrera-Sanz, Carolina; Subirana-Casacuberta, Mireia

    2017-06-02

    To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  6. Impact of agricultural management practices on DOC leaching - results of a long-term lysimeter study

    NASA Astrophysics Data System (ADS)

    Wagner, A.; Ollesch, G.; Seeger, J.; Meißner, R.; Rode, M.

    2009-04-01

    Dissolved organic carbon (DOC) fluxes are recently increasing in surface waters of humid climate regions. Due to its substantial importance for leaching processes, aquatic foodwebs, and drinking water purification a better understanding of sources and pathways of DOC is needed. Therefore this study aims to analyse and simulate DOC fluxes in agricultural ecosystems with selected crop rotations. A data set of 24 lysimeters of the UFZ Lysimeter station at Falkenberg (Saxony-Anhalt) covering nine years of DOC investigation has been selected and examined. The data set covers a wide range of climatic conditions with deviating management practices for grasslands and agricultural crop rotations. The monthly DOC concentrations assessed in the leached water range from 2.4 to 34.1 mg /l. DOC concentrations depend on temperature, precipitation and discharge. The type of crop grown on the lysimeter is an important trigger for DOC leaching - especially lysimeters used as pasture, or planted with rape and carrots exhibit high DOC concentrations. Management practices and fertilizer application modify the leaching of DOC and offer potentials to reduce DOC losses. The results form the basis of further process simulation studies and upscaling of the results to the small catchment scale.

  7. The Reach Address Database (RAD)

    EPA Pesticide Factsheets

    The Reach Address Database (RAD) stores reach address information for each Water Program feature that has been linked to the underlying surface water features (streams, lakes, etc) in the National Hydrology Database (NHD) Plus dataset.

  8. Control of a Shunt Active Power Filter with Neural Networks—Theory and Practical Results

    NASA Astrophysics Data System (ADS)

    Villalva, Marcelo G.; Filho, Ernesto Ruppert

    This paper presents theoretical studies and practical results obtained with a four-wire shunt active power filter fully controlled with neural networks. The paper is focused on a current compensation method based on adaptive linear elements (adalines), which are powerful and easy-to-use neural networks. The reader will find here an introduction about these networks, an explanatory section about the achievement of Fourier series with adalines, and the full description of an adaline-based selective current compensator. The paper also brings a quick discussion about the use of a feedforward neural network in the current controller of the active filter, as well as simulation and experimental results obtained with the prototype of an active power filter.

  9. Practice-Based Research Priorities for Palliative Care: Results From a Research-to-Practice Consensus Workshop

    PubMed Central

    Chen, Emily K.; Riffin, Catherine; Prigerson, Holly; Reid, MC; Schultz, Leslie

    2015-01-01

    We employed the research-to-practice consensus workshop (RTP; workshops held in New York City and Tompkins County, New York, in 2013) model to merge researcher and practitioner views of translational research priorities in palliative care. In the RTP approach, a diverse group of frontline providers generates a research agenda for palliative care in collaboration with researchers. We have presented the major workshop recommendations and contrasted the practice-based research priorities with those of previous consensus efforts. We uncovered notable differences and found that the RTP model can produce unique insights into research priorities. Integrating practitioner-identified needs into research priorities for palliative care can contribute to addressing palliative care more effectively as a public health issue. PMID:26378859

  10. Practice-Based Research Priorities for Palliative Care: Results From a Research-to-Practice Consensus Workshop.

    PubMed

    Pillemer, Karl; Chen, Emily K; Riffin, Catherine; Prigerson, Holly; Reid, M C

    2015-11-01

    We employed the research-to-practice consensus workshop (RTP; workshops held in New York City and Tompkins County, New York, in 2013) model to merge researcher and practitioner views of translational research priorities in palliative care. In the RTP approach, a diverse group of frontline providers generates a research agenda for palliative care in collaboration with researchers. We have presented the major workshop recommendations and contrasted the practice-based research priorities with those of previous consensus efforts. We uncovered notable differences and found that the RTP model can produce unique insights into research priorities. Integrating practitioner-identified needs into research priorities for palliative care can contribute to addressing palliative care more effectively as a public health issue.

  11. Managing Appalachian hardwood stands using four regeneration practices--34 year results

    Treesearch

    H. Clay Smith; Gary W. Miller

    1987-01-01

    Adjacent Appalachian hardwood stands in West Virginia established on excellent growing sites were managed for a 34-year period using four regeneration practices. These practices included a commercial clearcut, 15.5-in diameter-limit, and two single-tree selection practices. An uncut area was maintained as a control. Stand development, growth response, and some stumpage...

  12. Europe reaches the Moon

    NASA Astrophysics Data System (ADS)

    2004-11-01

    During the long cruise, consisting of a spiralling orbit around the Earth that brought the spacecraft close to the lunar capture point, SMART-1 achieved all the technology demonstration goals of the first part of the mission. The exciting final manoeuvres to enter a stable lunar orbit, the challenges of the journey and the results of the SMART-1 technology tests paving the way for future interplanetary missions, will be presented at a press conference on 16 November at ESA/ESOC in Darmstadt (Germany), starting at 08h00. Media representatives can also follow the press conference by videoconference from ESA/HQ in Paris, France, ESA/ESTEC (Noordwijk - the Netherlands) and ESA/ESRIN (Frascati - Italy). Please return the attached accreditation form to the establishment of your choice.

  13. Information preferences and practices among people living with HIV/AIDS: results from a nationwide survey

    PubMed Central

    Hogan, Timothy P.; Palmer, Carole L.

    2005-01-01

    Objectives: This study was designed to reach many segments of the diverse HIV/AIDS community and broaden understanding of how information can better assist people living with HIV/AIDS. Methods: Data were collected through a self-administered mail survey distributed nationwide at clinics, drug treatment centers, and other AIDS service organizations. Results: The 662 respondents preferred getting information from people—including health professionals, family, and friends—and considered people the most trustworthy, useful, understandable, and available information sources. Forty-three percent selected doctors as their most preferred source. The Internet was not rated highly overall but was preferred by those with more education or living in metropolitan areas. Seventy-two percent said they actively search for HIV/AIDS-related information, and 80% said they give advice or tell others where to get such information. However, 71% agreed that it is easy to feel overwhelmed by information, and 31% agreed that not seeking information can be beneficial. Conclusions: Overall, information seeking is an important activity for this sample of people living with HIV/AIDS. Many sources are widely available to them but, together, can be overwhelming. They rely on health professionals far more than print or media sources and receive encouragement and support from family and friends. PMID:16239938

  14. Benchmarking the burden of 100 diseases: results of a nationwide representative survey within general practices

    PubMed Central

    Begaud, Bernard; Lert, France; Rouillon, Frederic; Massol, Jacques; Guillemot, Didier; Avouac, Bernard; Duru, Gerard; Magnier, Anne-Marie; Rossignol, Michel; Abenhaim, Lucien

    2011-01-01

    Objective To assess the burden of diseases and quality of life (QOL) of patients for a large variety of diseases within general practice. Design In a representative nationwide cross-sectional study, a total of 825 general practitioners (GPs) were randomly selected from across France. Independent investigators recruited 8559 patients attending the GPs' practices. Data on QOL (12-Item Short Form questionnaire) and other individual characteristics were documented by the independent investigators for all participants in the waiting room. Medical information was recorded by GPs. Sampling was calibrated to national standards using the CALMAR (CALage sur MARges) weighting procedure. Associations of lower scores (ie, below vs above the first quartile) of physical and mental component scores (physical component summary score (PCS) and mental component summary score (MCS), respectively) with main diseases and patients characteristics were estimated using multivariate logistic regression. Weighted morbidity rates, PCS and MCS were computed for 100 diagnoses using the International Classification of Diseases (9th version). Results Overall mental impairment was observed among patients in primary care with an average MCS of 41.5 (SD 8.6), ranging from 33.0 for depressive disorders to 45.3 for patients exhibiting fractures or sprains. Musculoskeletal diseases were found to have the most pronounced effect on impaired physical health (OR=2.31; 95% CI 2.08 to 2.57) with the lowest PCS (45.6 (SD 8.8)) and ranked first (29.0%) among main diagnoses experienced by patients followed by cardiovascular diseases (26.7%) and psychological disorders (22.0%). When combining both prevalence and QOL, musculoskeletal diseases represented the heaviest burden in general practice. Conclusions Etude épidémiologique de l'Impact de santé public sur 3 groupes de pathologies (EPI3) is the first study to provide reference figures for burden of disease in general practice across a wide range of

  15. Implementation of study results in guidelines and adherence to guidelines in clinical practice

    PubMed Central

    Waldfahrer, Frank

    2016-01-01

    Guidelines were introduced in hospital- and practice-based otorhinolaryngology in the 1990ies, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head & Neck Surgery. The society has cooperated in further 34 guidelines. The quality of the guidelines has been continuously improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF). Since increasing digitalization has made access to scientific publications quicker and simpler, relevant study results can be incorporated in guidelines more easily today than in the analog world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines. PMID:28025601

  16. [Implementation of Study Results in Guidelines and Adherence to Guidelines in Clinical Practice].

    PubMed

    Waldfahrer, F

    2016-04-01

    Guidelines were introduced in hospital and practice-based otorhinolaryngology in the 1990s, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. The Society has cooperated in a further 34 guidelines. The quality of the guidelines has been continually improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany [Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.]. Since increasing digitalisation has made access to scientific publications quicker and more simple, relevant study results can be incorporated in guidelines more easily today than in the analogue world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Getting clinical trial results into practice: design, implementation, and process evaluation of the ALLHAT Dissemination Project

    PubMed Central

    Bartholomew, L Kay; Cushman, William C; Cutler, Jeffrey A; Davis, Barry R; Dawson, Glenna; Einhorn, Paula T; Graumlich, James F; Piller, Linda B; Pressel, Sara; Roccella, Edward J; Simpson, Lara; Whelton, Paul K; Williard, Angela

    2009-01-01

    Background Conventional dissemination of clinical trial results has inconsistent impact on physician practices. A more comprehensive plan to influence determinants of prescribing practices is warranted. Purpose To report the response from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial to the National Heart, Lung, and Blood Institute’s requirement for dissemination and evaluation of trials with potential immediate public health applicability. Methods ALLHAT’s dissemination plan had two-components: 1) a traditional approach of media coverage, scientific presentation and publication; and 2) a theory-based approach targeting determinants of clinician behavior. Strategies included (1) academic detailing, in which physicians approach colleagues regarding blood pressure management, (2) direct patient messages to stimulate communication with physicians regarding blood pressure control, (3) approaches to formulary systems to use educational and economic incentives for evidence-based prescription, and (4) direct professional organization appeals to clinicians. Results One hundred and forty-seven Investigator Educators reported 1698 presentations to 18,524 clinicians in 41 states and the District of Columbia. The pre- and post-test responses of 1709 clinicians in the face-to-face meetings indicated significant changes in expectations for positive patient outcomes and intention to prescribe diuretics. Information was mailed to 55 individuals representing 20 professional organizations and to eight formulary systems. Direct-to-patient messages were provided to 14 sites that host patient newsletters and Web sites such as health plans and insurance companies, 62 print mass media outlets, and 12 broadcast media sites. Limitations It was not within the scope of the project to conduct a randomized trial of the impact of the dissemination. However, impact evaluation using quasi-experimental designs is ongoing. Conclusions A large multi

  18. Infrastructure for Reaching Disadvantaged Consumers

    PubMed Central

    Hovenga, Evelyn J. S.; Hovel, Joe; Klotz, Jeanette; Robins, Patricia

    1998-01-01

    Both consumers and health service providers need access to up-to-date information, including patient and practice guidelines, that allows them to make decisions in partnership about individual and public health in line with the primary health care model of health service delivery. Only then is it possible for patient preferences to be considered while the health of the general population is improved. The Commonwealth Government of Australia has allocated $250 million over five years, starting July 1, 1997, to support activities and projects designed to meet a range of telecommunication needs in regional, rural, and remote Australia. This paper defines rural and remote communities, then reviews rural and remote health services, information, and telecommunication technology infrastructures and their use in Australia to establish the current state of access to information tools by rural and remote communities and rural health workers in Australia today. It is argued that a suitable telecommunication infrastructure is needed to reach disadvantaged persons in extremely remote areas and that intersectoral support is essential to build this infrastructure. In addition, education will make its utilization possible. PMID:9609497

  19. Arctic Landscape Within Reach

    NASA Technical Reports Server (NTRS)

    2008-01-01

    This image, one of the first captured by NASA's Phoenix Mars Lander, shows flat ground strewn with tiny pebbles and marked by small-scale polygonal cracking, a pattern seen widely in Martian high latitudes and also observed in permafrost terrains on Earth. The polygonal cracking is believed to have resulted from seasonal contraction and expansion of surface ice.

    Phoenix touched down on the Red Planet at 4:53 p.m. Pacific Time (7:53 p.m. Eastern Time), May 25, 2008, in an arctic region called Vastitas Borealis, at 68 degrees north latitude, 234 degrees east longitude.

    This image was acquired at the Phoenix landing site by the Surface Stereo Imager on day 1 of the mission on the surface of Mars, or Sol 0, after the May 25, 2008, landing.

    The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  20. Oncolytic virotherapy reaches adolescence.

    PubMed

    Hammill, Adrienne M; Conner, Joseph; Cripe, Timothy P

    2010-12-15

    Lytic viruses kill cells as a consequence of their normal replication life cycle. The idea of harnessing viruses to kill cancer cells arose over a century ago, before viruses were even discovered, from medical case reports of infections associated with cancer remissions. Since then, there has been no shortage of hype, hope, or fear regarding the prospect of oncolytic virotherapy for cancer. Early developments in the field included encouraging antitumor efficacy both in animal studies in the 1920s-1940s and in human clinical trials in the 1950s-1970s. Despite its long-standing history, oncolytic virotherapy was an idea ahead of its time. Without needed advances in molecular biology, virology, immunology, and clinical research ethics, early clinical trials resulted in infectious complications and were fraught with controversial research conduct, so that enthusiasm in the medical community waned. Oncolytic virotherapy is now experiencing a major growth spurt, having sustained numerous laboratory advances and undergone multiple encouraging adult clinical trials, and is now witnessing the emergence of pediatric trials. Here we review the history and salient biology of the field, including preclinical and clinical data, with a special emphasis on those agents now being tested in pediatric cancer patients.

  1. Mexican agencies reach teenagers.

    PubMed

    Brito Lemus, R; Beamish, J

    1992-08-01

    The Gente Joven project of the Mexican Foundation for Family Planning (MEXFAM) trains young volunteers in 19 cities to spread messages about sexually transmitted diseases and population growth to their peers. They also distribute condoms and spermicides. It also uses films and materials to spread its messages. The project would like to influence young men's behavior, but the Latin image of machismo poses a big challenge. It would like to become more responsible toward pregnancy prevention. About 50% of adolescents have sexual intercourse, but few use contraceptives resulting in a high adolescent pregnancy rate. Many of these pregnant teenagers choose not to marry. Adolescent pregnancy leads to girls leaving school, few marketable skills, and rearing children alone. Besides women who began childbearing as a teenager have 1.5 times more children than other women. Male involvement in pregnancy prevention should improve these statistics. As late as 1973, the Health Code banned promotion and sales of contraceptives, but by 1992 about 50% of women of reproductive age use contraceptives. The Center for the Orientation of Adolescents has organized 8 Young Men's Clubs in Mexico City to involve male teenagers more in family planning and to develop self-confidence. It uses a holistic approach to their development through discussions with their peers. A MEXFAM study shows that young men are not close with their fathers who tend to exude a machismo attitude, thus the young men do not have a role model for responsible sexual behavior. MEXFAM's work is cut out for them, however, since the same study indicates that 50% of the young men believe it is fine to have 1 girlfriend and 33% think women should earn more than men. A teenager volunteer reports, however, that more boys have been coming to him for contraception and information than girls in 1992 while in other years girls outnumbered the boys.

  2. Exploring implementation practices in results-based financing: the case of the verification in Benin.

    PubMed

    Antony, Matthieu; Bertone, Maria Paola; Barthes, Olivier

    2017-03-14

    Results-based financing (RBF) has been introduced in many countries across Africa and a growing literature is building around the assessment of their impact. These studies are usually quantitative and often silent on the paths and processes through which results are achieved and on the wider health system effects of RBF. To address this gap, our study aims at exploring the implementation of an RBF pilot in Benin, focusing on the verification of results. The study is based on action research carried out by authors involved in the pilot as part of the agency supporting the RBF implementation in Benin. While our participant observation and operational collaboration with project's stakeholders informed the study, the analysis is mostly based on quantitative and qualitative secondary data, collected throughout the project's implementation and documentation processes. Data include project documents, reports and budgets, RBF data on service outputs and on the outcome of the verification, daily activity timesheets of the technical assistants in the districts, as well as focus groups with Community-based Organizations and informal interviews with technical assistants and district medical officers. Our analysis focuses on the actual practices of quantitative, qualitative and community verification. Results show that the verification processes are complex, costly and time-consuming, and in practice they end up differing from what designed originally. We explore the consequences of this on the operation of the scheme, on its potential to generate the envisaged change. We find, for example, that the time taken up by verification procedures limits the time available for data analysis and feedback to facility staff, thus limiting the potential to improve service delivery. Verification challenges also result in delays in bonus payment, which delink effort and reward. Additionally, the limited integration of the verification activities of district teams with their routine tasks

  3. Reach the sky

    NASA Astrophysics Data System (ADS)

    Mariana Peicuti, Cristina

    2017-04-01

    I am working as primary teacher at Scoala Gimnaziala Dumbrava,Timis County, Romania & my pupils has 6 to 10 years old. I was&I am a main pillar in my community, always disseminating knowledge and experience to students, other teachers in the school area &Timis County.Astronomy is the must favorite subject of my students from my classes. They are very courious & always come to me with questions about Earth and Sky because Curriculum scientific disciplines provides too little information about Earth and Sky.I need to know more about how to teach space contents into my classes&what competencies can form in elementary school and also to share my experience to the others.As a result of participation at this meeting I want to attract as many students to astronomy,science/STEM disciplines&space technologies, to astronomy topics and exploration of outer space.Schools needs to be prepared for social life needs,new generations needs,on science/space technologies,which are one of the key points for developing the knowledge society.I intend to introduce new scientific activities as part of the existing curriculum.I am passionate about astronomy,I need to know new approaches and new ideas for primary because I think Science is very important in daily life. Here are some developed activities with pupils from K-2 grade levels wich I wish share with colleagues in Viena. Subject: MATHEMATICS. Primary Topic: MEASUREMENT : -+=<> ☼ Rockets by Size. Students cut out,color and sequence paper rockets/Read the information on the International Space Station and rockets/Gather pictures of different types of rockets/Print/cut out/color&laminate rocket drawings/Find objects in the room to put in order by height. ☼ Oil Spot Photometer - Measure the brightness of the sun using cooking oil and a white card. A smear of oil on a white card becomes a powerful tool for comparing the brightness of two light sources, including the sun. ☼ The Sundial & Making Shadows-device to measure time by the

  4. [New techniques in childbirth assistance. Experience and results of theoretical and practical training].

    PubMed

    Surico, N; Grimaldi, G

    2001-02-01

    In 1995, the Course on Integrated Obstetrical and Gynaecological Techniques was added to the training program of the Obstetrics and Gynaecology Clinic and to the Midwife Diploma School, at the Faculty of Medicine of the A. Avogadro University of East Piemonte. This addition was due to the demand to create a service to train young medical doctors and student midwives on the basis of the requirements of the World Health Organisation, concerning a more natural way of giving birth. In this paper the results obtained after a four years practical application of these clinical techniques are presented. The factors considered were the type of assistance offered in correlation with different outcomes for both mother and child. The study demonstrates a general improvement in the quality of assistance and a decrease of costs for the National Health Service. The data have been compared with those of the neighbour Hospital Division, where deliveries are assisted with traditional techniques.

  5. Practices and perspectives on building integrated data repositories: results from a 2010 CTSA survey

    PubMed Central

    Wyatt, Matt C; Schuff, Robert; Tenenbaum, Jessica D; Anderson, Nick

    2012-01-01

    Clinical integrated data repositories (IDRs) are poised to become a foundational element of biomedical and translational research by providing the coordinated data sources necessary to conduct retrospective analytic research and to identify and recruit prospective research subjects. The Clinical and Translational Science Award (CTSA) consortium's Informatics IDR Group conducted a survey of 2010 consortium members to evaluate recent trends in IDR implementation and use to support research between 2008 and 2010. A web-based survey based in part on a prior 2008 survey was developed and deployed to 46 national CTSA centers. A total of 35 separate organizations completed the survey (74%), representing 28 CTSAs and the National Institutes of Health Clinical Center. Survey results suggest that individual organizations are progressing in their approaches to the development, management, and use of IDRs as a means to support a broad array of research. We describe the major trends and emerging practices below. PMID:22437072

  6. Surgical, antiseptic, and antibiotic practice in cataract surgery: Results from the European Observatory in 2013.

    PubMed

    Behndig, Anders; Cochener-Lamard, Beatrice; Güell, José; Kodjikian, Laurent; Mencucci, Rita; Nuijts, Rudy; Pleyer, Uwe; Rosen, Paul; Szaflik, Jacek; Tassignon, Marie-Jose

    2015-12-01

    To report the results from the first iteration of the European Observatory of Cataract Surgery, which was initiated to track changes in surgical, antiseptic, and antibiotic practices in cataract surgery over the coming years. Practicing European cataract surgeons (n = 479). Internet-based declarative questionnaire or telephone questionnaire. The questionnaire comprised 37 questions divided into 8 categories as follows: screening, surgeon profile, surgical procedure used, product use before arrival at the operating room, techniques for mydriasis and anesthesia, product use during the surgery, product use after the patient leaves the operating room, and surgeon's attitude to guidelines. Cataract surgeons (n = 2700) were initially contacted, of whom 479 (17.7%) were included in the survey. The current baseline survey revealed considerable variation between countries in their implementation of infectious postoperative endophthalmitis (IPOE) prophylaxis. In some countries, adoption of intracameral cefuroxime is almost universal, whereas in others, the use of such prophylaxis is below one half. When intracameral cefuroxime is used, it is generally cefuroxime powder designed for parenteral use. A preparation specifically registered for intracameral use is now available, and this formulation is more commonly used in countries in which intracameral cefuroxime was most widely adopted. The baseline results from this ongoing survey suggest a considerable level of heterogeneity between European countries in IPOE prophylaxis. Further iterations of this survey will monitor whether a consensus begins to emerge. This work was supported by Laboratoires Théa, under the supervision of the expert group. Members of the expert group were remunerated by Laboratoires Théa. J.F. Stolz, MD, PhD, provided editorial assistance in manuscript preparation, for which he was remunerated by Laboratoires Théa. Anders Behndig, Rita Mencucci, and Jacek P. Szaflik report no relevant conflicts of

  7. Student Threat Assessment as a Standard School Safety Practice: Results From a Statewide Implementation Study.

    PubMed

    Cornell, Dewey; Maeng, Jennifer L; Burnette, Anna Grace; Jia, Yuane; Huang, Francis; Konold, Timothy; Datta, Pooja; Malone, Marisa; Meyer, Patrick

    2017-08-17

    Threat assessment has been widely endorsed as a school safety practice, but there is little research on its implementation. In 2013, Virginia became the first state to mandate student threat assessment in its public schools. The purpose of this study was to examine the statewide implementation of threat assessment and to identify how threat assessment teams distinguish serious from nonserious threats. The sample consisted of 1,865 threat assessment cases reported by 785 elementary, middle, and high schools. Students ranged from pre-K to Grade 12, including 74.4% male, 34.6% receiving special education services, 51.2% White, 30.2% Black, 6.8% Hispanic, and 2.7% Asian. Survey data were collected from school-based teams to measure student demographics, threat characteristics, and assessment results. Logistic regression indicated that threat assessment teams were more likely to identify a threat as serious if it was made by a student above the elementary grades (odds ratio 0.57; 95% lower and upper bound 0.42-0.78), a student receiving special education services (1.27; 1.00-1.60), involved battery (1.61; 1.20-2.15), homicide (1.40; 1.07-1.82), or weapon possession (4.41; 2.80-6.96), or targeted an administrator (3.55; 1.73-7.30). Student race and gender were not significantly associated with a serious threat determination. The odds ratio that a student would attempt to carry out a threat classified as serious was 12.48 (5.15-30.22). These results provide new information on the nature and prevalence of threats in schools using threat assessment that can guide further work to develop this emerging school safety practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  8. The BirthPlace collaborative practice model: results from the San Diego Birth Center Study.

    PubMed

    Swartz; Jackson; Lang; Ecker; Ganiats; Dickinson; Nguyen

    1998-07-01

    birth center and $5,535 for the traditional care group. Final results based on the full study sample (full data available February 1998) details of payor costs such as provider, facility, NICU, and ancillary along with costs from the health care system perspective and patient satisfaction results will be presented.Conclusion: Current results suggest similar morbidity and mortality between the birth center program and traditional care groups, with less resource utilization translating to lower costs in the collaborative practice model. Results suggest that collaborative practice using a freestanding birth center as an adjunct to an integrated perinatal health care system may provide a quality, lower-cost alternative for the provision of perinatal services.

  9. Off-Label Baclofen Prescribing Practices among French Alcohol Specialists: Results of a National Online Survey

    PubMed Central

    Rolland, Benjamin; Paille, François; Fleury, Benoit; Cottencin, Olivier; Benyamina, Amine; Aubin, Henri-Jean

    2014-01-01

    Objective To evaluate, among alcohol specialists belonging to the Société Française d’Alcoologie (SFA), i.e., the French Alcohol Society, the proportion of physicians who prescribed off-label baclofen for alcohol use disorders (AUDs). The secondary objective was to depict the features of individual prescribing and monitoring practices. Methods On-line survey among 484 French alcohol specialists. Physicians were asked whether they prescribed baclofen for AUDs. If they did not, the reasons for this choice were investigated. If they did, the features of the physician’s prescribing practice were explored, including the number of patients treated, the mean and maximum doses, the monitoring precautions and the pharmacovigilance reporting. Participants were also asked about their empirical findings on HDB’s efficacy and safety. Results In total, 302 physicians (response rate of 62.4%) participated in the survey. Data from 296 participants were analysed, representing 59.4% of all active prescribing physicians belonging to the SFA. HDB use was declared by 74.6% of participants (mean dose 109.5±43.6 mg/d; maximum dose 188±93.3 mg/d). However, 79.2% of prescribers had treated less than 30 patients, and 67.8% used HDB as a second-line medication. Although HDB was perceived as more efficacious than approved drugs by 54.3% of prescribers, it was also declared less safe by 62.8%. Nonetheless, 79.7% of prescribers had never filed any pharmacovigilance report. Non-prescribers (25.6%) were primarily deterred by the current lack of scientific data and official regulation. Conclusion A majority of French alcohol specialists reported using HDB, although often on a limited number of their patients. HDB was considered efficacious but also potentially hazardous. Despite this, physicians reported minimal safety data to the health security system. While French health authorities are planning to draft a specific regulatory measure for framing off-label HDB prescribing practices

  10. Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit.

    PubMed

    Weiss, Katja; Simon, Arne; Graf, Norbert; Schöpe, Jakob; Oertel, Joachim; Linsler, Stefan

    2017-01-01

    Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting. All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA). In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected. This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.

  11. Perceived future career prospects in general practice: quantitative results from questionnaire surveys of UK doctors

    PubMed Central

    Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

    2016-01-01

    Background There are more studies of current job satisfaction among GPs than of their views about their future career prospects, although both are relevant to commitment to careers in general practice. Aim To report on the views of GPs compared with clinicians in other specialties about their future career prospects. Design and setting Questionnaire surveys were sent to UK medical doctors who graduated in selected years between 1974 and 2008. Method Questionnaires were sent to the doctors at different times after graduation, ranging from 3 to 24 years. Results Based on the latest survey of each graduation year of the 20 940 responders, 66.2% of GPs and 74.2% of hospital doctors were positive about their prospects and 9.7% and 8.3%, respectively, were negative. However, with increasing time since graduation and increasing levels of seniority, GPs became less positive about their prospects; by contrast, over time, surgeons became more positive. Three to 5 years after graduation, 86.3% of those training in general practice were positive about their prospects compared with 52.9% of surgical trainees: in surveys conducted 12–24 years after graduation, 60.2% of GPs and 76.6% of surgeons were positive about their prospects. Conclusion GPs held broadly positive views of their career prospects, as did other doctors. However, there was an increase in negativity with increasing time since graduation that was not seen in hospital doctors. Research into the causes of this negativity and policy measures to ameliorate it would contribute to the continued commitment of GPs and may help to reduce attrition. PMID:27578813

  12. Primary care providers’ knowledge, beliefs and treatment practices for gout: results of a physician questionnaire

    PubMed Central

    Mazor, Kathleen M.; Negron, Amarie; Ogarek, Jessica; Firneno, Cassandra; Yood, Robert A.

    2013-01-01

    Objective. We sought to examine primary care providers’ gout knowledge and reported treatment patterns in comparison with current treatment recommendations. Methods. We conducted a national survey of a random sample of US primary care physicians to assess their treatment of acute, intercritical and tophaceous gout using published European and American gout treatment recommendations and guidelines as a gold standard. Results. There were 838 respondents (response rate of 41%), most of whom worked in private practice (63%) with >16 years experience (52%). Inappropriate dosing of medications in the setting of renal disease and lack of prophylaxis when initiating urate-lowering therapy (ULT) accounted for much of the lack of compliance with treatment recommendations. Specifically for acute podagra, 53% reported avoidance of anti-inflammatory drugs in the setting of renal insufficiency, use of colchicine at a dose of ≤2.4 mg/day and no initiation of a ULT during an acute attack. For intercritical gout in the setting of renal disease, 3% would provide care consistent with the recommendations, including initiating a ULT at the appropriate dose with dosing titration to a serum urate level of ≤6 mg/dl and providing prophylaxis. For tophaceous gout, 17% reported care consistent with the recommendations, including ULT use with dosing titration to a serum urate level of ≤6 mg/dl and prophylaxis. Conclusion. Only half of primary care providers reported optimal treatment practices for the management of acute gout and <20% for intercritical or tophaceous gout, suggesting that care deficiencies are common. PMID:23620554

  13. An analysis of current pharmaceutical industry practices for making clinical trial results publicly accessible.

    PubMed

    Viereck, Christopher; Boudes, Pol

    2009-07-01

    We compared the clinical trial transparency practices of US/European pharma by analyzing the publicly-accessible clinical trial results databases of major drugs (doripenem, varenicline, lapatinib, zoledronic acid, adalimumab, insulin glargine, raltegravir, gefitinib). We evaluated their accessibility and utility from the perspective of the lay public. We included databases on company websites, http://www.clinicalstudyresults.org, http://www.clinicaltrials.gov and http://clinicaltrials.ifpma.org. Only 2 of 8 company homepages provide a direct link to the results. While the use of common terms on company search engines led to results for 5 of the 8 drugs following 2-4 clicks, no logical pathway was identified. The number of clinical trials in the databases was inconsistent: 0 for doripenem to 45 for insulin glargine. Results from all phases of clinical development were provided for 2 (insulin glargine and gefitinib) of the 8 drugs. Analyses of phase III reports revealed that most critical elements of the International Conference of Harmonization E3 Structure and Content of Synopses for Clinical Trial Reports were provided for 2 (varenicline, lapatinib) of the 8 drugs. For adalimumab and zoledronic acid, only citations were provided, which the lay public would be unable to access. None of the clinical trial reports was written in lay language. User-friendly support, when provided, was of marginal benefit. Only 1 of the databases (gefitinib) permitted the user to find the most recently updated reports. None of the glossaries included explanations for adverse events or statistical methodology. In conclusion, our study indicates that the public faces significant hurdles in finding and understanding clinical trial results databases.

  14. Cell-free DNA screening in clinical practice: abnormal autosomal aneuploidy and microdeletion results.

    PubMed

    Valderramos, Stephanie G; Rao, Rashmi R; Scibetta, Emily W; Silverman, Neil S; Han, Christina S; Platt, Lawrence D

    2016-11-01

    Since its commercial release in 2011 cell-free DNA screening has been rapidly adopted as a routine prenatal genetic test. However, little is known about its performance in actual clinical practice. We sought to investigate factors associated with the accuracy of abnormal autosomal cell-free DNA results. We conducted a retrospective cohort study of 121 patients with abnormal cell-free DNA results from a referral maternal-fetal medicine practice from March 2013 through July 2015. Patients were included if cell-free DNA results for trisomy 21, trisomy 18, trisomy 13, or microdeletions (if reported by the laboratory) were positive or nonreportable. The primary outcome was confirmed aneuploidy or microarray abnormality on either prenatal or postnatal karyotype or microarray. Secondary outcomes were identifiable associations with in vitro fertilization, twins, ultrasound findings, testing platform, and testing laboratory. Kruskal-Wallis or Fisher exact tests were used as appropriate. A total of 121 patients had abnormal cell-free DNA results for trisomy 21, trisomy 18, trisomy 13, and/or microdeletions. In all, 105 patients had abnormal cell-free DNA results for trisomy 21, trisomy 18, and trisomy 13. Of these, 92 (87.6%) were positive and 13 (12.4%) were nonreportable. The results of the 92 positive cell-free DNA were for trisomy 21 (48, 52.2%), trisomy 18 (22, 23.9%), trisomy 13 (17, 18.5%), triploidy (2, 2.2%), and positive for >1 parameter (3, 3.3%). Overall, the positive predictive value of cell-free DNA was 73.5% (61/83; 95% confidence interval, 63-82%) for all trisomies (by chromosome: trisomy 21, 83.0% [39/47; 95% confidence interval, 69-92%], trisomy 18, 65.0% [13/20; 95% confidence interval, 41-84%], and trisomy 13, 43.8% [7/16; 95% confidence interval, 21-70%]). Abnormal cell-free DNA results were associated with positive serum screening (by group: trisomy 21 [17/48, 70.8%]; trisomy 18 [7/22, 77.8%]; trisomy 13 [3/17, 37.5%]; nonreportable [2/13, 16.7%]; P

  15. Height, selected genetic markers and prostate cancer risk: results from the PRACTICAL consortium

    PubMed Central

    Lophatananon, Artitaya; Stewart-Brown, Sarah; Kote-Jarai, Zsofia; Olama, Ali Amin Al; Garcia, Sara Benlloch; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L; Giles, Graham G; Fitzgerald, Liesel M; Southey, Melissa C; Pharoah, Paul; Pashayan, Nora; Gronberg, Henrik; Wiklund, Fredrik; Aly, Markus; Stanford, Janet L; Brenner, Hermann; Dieffenbach, Aida K; Arndt, Volker; Park, Jong Y; Lin, Hui-Yi; Sellers, Thomas; Slavov, Chavdar; Kaneva, Radka; Mitev, Vanio; Batra, Jyotsna; Spurdle, Amanda; Clements, Judith A; Schleutker, Johanna; Nordestgaard, BØrge G; Wiklund, Fredrik; Travis, Ruth C; Haiman, Christopher A; Thibodeau, Stephen N; Maier, Christiane; Walther, Vogel; Blot, William J; Kibel, Adam S; Cybulski, Cezary; Cannon-Albright, Lisa; Pandha, Hardev; Teixeira, Manuel R; Cook, Margaret; Govindasami, Koveela; Guy, Michelle; Leongamornlert, Daniel; Sawyer, Emma J; Wilkinson, Rosemary; Morgan, Angela; Fisher, Cyril; Saunders, Edward J; Tymrakiewicz, Malgorzata; Livni, Naomi; Hazel, Steve; Dadaev, Tokhir; Cox, Angela; George, Anne; Lane, Athene; Marsden, Gemma; Davis, Michael; Brown, Paul; Pedersen, John; Hopper, John L; Karlsson, Ami; Cavalli-Bjoerkman, Carin; Adolfson, Jan; Johansson, Jan-Erik; Broms, Michael; Stattin, Paer; Kolb, Suzanne; Stegmaier, Christa; Zachariah, Babu; Park, Hyun; Haley, James; Pow-Sang, Julio; Rincon, Maria; Radlein, Selina; Vlahova, Aleksandrina; Mitkova, Atanaska; Kachakova, Darina; Popov, Elenko; Christova, Svetlana; Dikov, Tihomir; Eckert, Allison; Collins, Angus; Wood, Glenn; Malone, Greg; Alexander, Kimberly; Kerr, Kris; Kedda, Mary-Anne; Turner, Megan; Saunders, Pamela; Heathcote, Peter; Srinivasan, Srilakshmi; Omara, Tracy; Yeadon, Trina; Lose, Felicity; Easton, Douglas; Eeles, Rosalind A; Muir, Kenneth

    2017-01-01

    Background: Evidence on height and prostate cancer risk is mixed, however, recent studies with large data sets support a possible role for its association with the risk of aggressive prostate cancer. Methods: We analysed data from the PRACTICAL consortium consisting of 6207 prostate cancer cases and 6016 controls and a subset of high grade cases (2480 cases). We explored height, polymorphisms in genes related to growth processes as main effects and their possible interactions. Results: The results suggest that height is associated with high-grade prostate cancer risk. Men with height >180 cm are at a 22% increased risk as compared to men with height <173 cm (OR 1.22, 95% CI 1.01–1.48). Genetic variants in the growth pathway gene showed an association with prostate cancer risk. The aggregate scores of the selected variants identified a significantly increased risk of overall prostate cancer and high-grade prostate cancer by 13% and 15%, respectively, in the highest score group as compared to lowest score group. Conclusions: There was no evidence of gene-environment interaction between height and the selected candidate SNPs. Our findings suggest a role of height in high-grade prostate cancer. The effect of genetic variants in the genes related to growth is seen in all cases and high-grade prostate cancer. There is no interaction between these two exposures. PMID:28765617

  16. Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices.

    PubMed

    Cloitre, Marylene; Courtois, Christine A; Charuvastra, Anthony; Carapezza, Richard; Stolbach, Bradley C; Green, Bonnie L

    2011-12-01

    This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow-up would advance knowledge about both the speed and durability of treatment effects. Copyright © 2011 International Society for Traumatic Stress Studies.

  17. Daylighting practices of the architectural industry (baseline results of a national survey)

    SciTech Connect

    Hattrup, M.P.

    1990-05-01

    A national survey of over 300 commercial design architects was conducted to develop baseline information on their knowledge, perceptions, and use of daylighting in commercial building designs. Pacific Northwest Laboratory conducted the survey for the US Department of Energy's (DOE) Office of Building and Community Systems (BCS). In the survey daylighting was defined as the intentional use of natural light as a partial substitute for artificially generated light. The results suggested that architects need to be educated about the true benefits of daylighting and the impacts it can have on a building's energy performance. Educational programs that will increase the architects' understanding and awareness of modern daylighting technologies and practices should be developed by utilities, stage agencies, and the federal government. If more architects can be made aware of the true effectiveness and positive attributes of daylighting systems and technologies, daylighting may be used in more commercial buildings. The results of the survey show that the more familiar architects feel they are with daylighting, the more they use daylighting. 3 refs., 19 tabs.

  18. Out of your hand's reach, out of my eyes' reach.

    PubMed

    Costantini, Marcello; Ambrosini, Ettore; Sinigaglia, Corrado

    2012-01-01

    When witnessing another's action, people recruit the same motor resources that enable them to efficiently perform that action, thus gazing at its target well before the agent's hand. But just to what extent does this recruitment help people in grabbing another's action target? If the latter seems to be out of the agent's reach, will this impact on people's gaze behaviour? We recorded proactive eye movements while participants witnessed someone else trying to reach for and grasp objects located either within or outside his reach. Proactivity of gaze was impaired when the targets were just out of the agent's reach. This effect is likely to be due to an interpersonal bodily space representation that allows one to map another's reaching space, thus prompting proactive eye movements towards the target just in case the agent is in the position to act upon it.

  19. Credit for Prior Learning Practices: Results of the AACRAO December 2014 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2015

    2015-01-01

    The American Association of Collegiate Registrars and Admissions Officers (AACRAO) initiated a series of surveys designed to capture member institutional practice snapshots in 60 seconds or less. The December 2014 "AACRAO 60 Second Survey" asked respondents to indicate their institutions' credit for prior learning practices (CPL). To…

  20. Implementation Integrity of Practice-Based Coaching: Preliminary Results from the BEST in CLASS Efficacy Trial

    ERIC Educational Resources Information Center

    Sutherland, Kevin S.; Conroy, Maureen A.; Vo, Abigail; Ladwig, Crystal

    2015-01-01

    The purpose of this article is to describe the practice-based coaching model used in BEST in CLASS, a Tier-2 classroom-based intervention comprised of evidence-based instructional practices designed to prevent and ameliorate the chronic problem behaviors of young children at risk for the development of emotional/behavioral disorders. Following a…

  1. Core Practices for Teaching History: The Results of a Delphi Panel Survey

    ERIC Educational Resources Information Center

    Fogo, Bradley

    2014-01-01

    Recent education literature and research has focused on identifying effective core teaching practices to inform and help shape teacher education and professional development. Although a rich literature on the teaching and learning of history has continued to develop over the past decade, core practice research has largely overlooked…

  2. Implementation Integrity of Practice-Based Coaching: Preliminary Results from the BEST in CLASS Efficacy Trial

    ERIC Educational Resources Information Center

    Sutherland, Kevin S.; Conroy, Maureen A.; Vo, Abigail; Ladwig, Crystal

    2015-01-01

    The purpose of this article is to describe the practice-based coaching model used in BEST in CLASS, a Tier-2 classroom-based intervention comprised of evidence-based instructional practices designed to prevent and ameliorate the chronic problem behaviors of young children at risk for the development of emotional/behavioral disorders. Following a…

  3. What Is Evidence-Based Practice? Research-to-Results Brief. Publication #2007-14

    ERIC Educational Resources Information Center

    Metz, Allison J. R.; Espiritu, Rachele; Moore, Kristin A.

    2007-01-01

    This brief represents part 1 in a series on fostering the adoption of evidence-based practices in out-of-school time programs. The lag between discovering effective practices and using them "on the ground" can be unnecessarily long, sometimes taking 15 to 20 years! The purpose of this brief is to provide practitioners with a better understanding…

  4. Practices that Support the Transition to Public Preschool Programs: Results from a National Survey

    ERIC Educational Resources Information Center

    Rous, Beth; Hallam, Rena; McCormick, Katherine; Cox, Megan

    2010-01-01

    The number of children participating in public school preschool programs has steadily increased over the last two decades. While the use of specific practices to support the transition to kindergarten has received a great deal of attention, there are little data on the use of transition practices by public school preschool teachers to support…

  5. Core Practices for Teaching History: The Results of a Delphi Panel Survey

    ERIC Educational Resources Information Center

    Fogo, Bradley

    2014-01-01

    Recent education literature and research has focused on identifying effective core teaching practices to inform and help shape teacher education and professional development. Although a rich literature on the teaching and learning of history has continued to develop over the past decade, core practice research has largely overlooked…

  6. Embedding evidence-based practice among nursing undergraduates: Results from a pilot study.

    PubMed

    André, Beate; Aune, Anne G; Brænd, Jorunn A

    2016-05-01

    Evidence-based practice is currently one of the most important developments in health care. Research in nursing science is rapidly growing; however, translating the knowledge based on this research into clinical practice is often hampered, and may be dependent on reflective skills. The aim of this study was to see how undergraduate nursing students in nursing should increase their skills and knowledge related to evidence-based practice through participation in clinical research projects. A qualitative approach was used in collecting and analyzing the data. Students participated in a pilot clinical research project and a received guidance related to their bachelor thesis. After the project was completed, all students filled in a questionnaire. The students' motivation to participate in this study was reported to be high, but they reported low knowledge related to evidence-based practice. All students reported that their attitude towards evidence-based practice changed in a positive direction during their participation in the project. Evidence-based practice influenced nursing practices by putting more focus on critical thinking, increasing pride and giving a sense of ownership in the clinical field. The curricula and the pedagogical perspectives in nursing education can influence the attitude towards evidence-based practice and skills among nursing bachelor students.

  7. Scoliosis short-term rehabilitation (SSTR) according to 'Best Practice' standards-are the results repeatable?

    PubMed

    Borysov, Maksym; Borysov, Artem

    2012-01-17

    Claims have been made in a pilot study that a new form of short-term rehabilitation according to 'Best Practice' standards would change signs and symptoms of patients with scoliosis in the short-term. Aim of this study is to repeat the study published 2010 with a larger sample of patients using the same protocol. Both authors have undergone training in this special approach to scoliosis rehabilitation in 2010. 34 patients with Adolescent Idiopathic Scoliosis (AIS), 32 girls and 2 boys, average age 13.7 years and an average Cobb angle of 28.7 degrees (21-43 degrees) underwent Scoliosis Short-Term Rehabilitation (SSTR) of seven days. Two days with an intensity of 3 × 90 min sessions/day, and five days with an intensity of 2 × 60 min sessions/day. Angle of trunk rotation (ATR) was measured before and after the time of treatment as well as the active correctability of the ATR after the programme as it has been done in the pilot investigation. Additionally to that, we also recorded the changes in Vital Capacity (VC) before and after the programme. ATR was reduced significantly from 11,5 degrees to 8,4 degrees, the active correctability as measured with the Scoliometer (TM) was also reduced significantly from the ATR after treatment 8,9 degrees to 6,5 degrees in the patients with thoracic curves. VC improved significantly (P < 0,05) from 2073 ml to 2326 ml. The results achieved in the pilot investigation published previously are repeatable. The deformity of the trunk can be reduced significantly after SSTR. During the pilot study VC was not investigated. In our study VC improved significantly. Therefore, also shorter rehabilitation times with an appropriate programme seem to be able to change signs and symptoms of a patient with scoliosis. Like the out-patient Schroth programme as described in a study from Turkey, the SSTR provides benefits leading to an improvement of the condition. Out-patient rehabilitation following the Scoliologic (TM) 'Best Practice' standards

  8. News Outreach: Polish physics club reaches out with practical demonstrations Networking: Online workspace helps teachers to share ideas Mauritius: Telescope inspires science specification Fusion: EFDA sparks resources Olympiad: British team enjoys success at the International Physics Olympiad 2009 Nanoscience: 'Quietest' building in the world opens in Bristol, UK Conference: University of Leicester hosts the GIREP EPEC 2009 international conference

    NASA Astrophysics Data System (ADS)

    2009-11-01

    Outreach: Polish physics club reaches out with practical demonstrations Networking: Online workspace helps teachers to share ideas Mauritius: Telescope inspires science specification Fusion: EFDA sparks resources Olympiad: British team enjoys success at the International Physics Olympiad 2009 Nanoscience: 'Quietest' building in the world opens in Bristol, UK Conference: University of Leicester hosts the GIREP EPEC 2009 international conference

  9. Summarising and validating test accuracy results across multiple studies for use in clinical practice.

    PubMed

    Riley, Richard D; Ahmed, Ikhlaaq; Debray, Thomas P A; Willis, Brian H; Noordzij, J Pieter; Higgins, Julian P T; Deeks, Jonathan J

    2015-06-15

    Following a meta-analysis of test accuracy studies, the translation of summary results into clinical practice is potentially problematic. The sensitivity, specificity and positive (PPV) and negative (NPV) predictive values of a test may differ substantially from the average meta-analysis findings, because of heterogeneity. Clinicians thus need more guidance: given the meta-analysis, is a test likely to be useful in new populations, and if so, how should test results inform the probability of existing disease (for a diagnostic test) or future adverse outcome (for a prognostic test)? We propose ways to address this. Firstly, following a meta-analysis, we suggest deriving prediction intervals and probability statements about the potential accuracy of a test in a new population. Secondly, we suggest strategies on how clinicians should derive post-test probabilities (PPV and NPV) in a new population based on existing meta-analysis results and propose a cross-validation approach for examining and comparing their calibration performance. Application is made to two clinical examples. In the first example, the joint probability that both sensitivity and specificity will be >80% in a new population is just 0.19, because of a low sensitivity. However, the summary PPV of 0.97 is high and calibrates well in new populations, with a probability of 0.78 that the true PPV will be at least 0.95. In the second example, post-test probabilities calibrate better when tailored to the prevalence in the new population, with cross-validation revealing a probability of 0.97 that the observed NPV will be within 10% of the predicted NPV.

  10. Practical applicability and preliminary results of the Baltic Environmental Satellite Remote Sensing System (SatBaltic)

    NASA Astrophysics Data System (ADS)

    Wozniak, B.; Ostrowska, M.; Bradtke, K.; Darecki, M.; Dera, J.; Dudzinska-Nowak, J.; Dzierzbicka, L.; Ficek, D.; Furmanczyk, K.; Kowalewski, M.; Krezel, A.; Majchrowski, R.; Paszkuta, M.; Ston-Egiert, J.; Stramska, M.; Zapadka, T.

    2012-04-01

    SatBaltic (Satellite Monitoring of the Baltic Sea Environment) project is being realized in Poland by the SatBaltic Scientific Consortium, specifically appointed for this purpose, which associates four scientific institutions: the Institute of Oceanology PAN in Sopot - coordinator, the University of Gdańsk (Institute of Oceanography), the Pomeranian Academy in Słupsk (Institute of Physics) and the University of Szczecin (Institute of Marine Sciences). We present the first the results of the first year and a half of SatBaltic's implementation. The final result of the project is to be the creation and setting in motion of the SatBaltic Operational System (SBOS), the aim of which is to monitor effectively and comprehensively the state of the Baltic Sea environment using remote sensing techniques. Various aspects of the practical applicability of SBOS to the monitoring of the Baltic ecosystem are discussed. We present some examples of the maps of the various characteristics of the Baltic obtained using the current version of SBOS, including algorithms and models that are still in an unfinished state. At the current stage of research, these algorithms apply mainly to the characteristics of the solar energy influx and the distribution of this energy among the various processes taking place in the atmosphere-sea system, and also to the radiation balance of the sea surface, the irradiance conditions for photosynthesis and the condition of plant communities in the water, sea surface temperature distributions and some other marine phenomena correlated with this temperature. Also given are results of preliminary inspections of the accuracy of the magnitudes shown on the maps.

  11. Design considerations &practical results with long duration systems for manned flight: cryogenic helium and superpressure balloons.

    NASA Astrophysics Data System (ADS)

    Nott, J.

    The paper will describe two manned flights made in polyethylene zero pressure balloons with liquid helium carried to provide all in-flight buoyancy adjustment. These balloons were of 1,600 and 8,000 cubic meter volumes. Two flights have been made, both lasting 24 hours. The first flight cruised and flew through the sunset at 18,000 feet / 5,500 meters. The second flight using a pressurized cabin included flying through the night at about 32,000 feet / 10,000 meters. These flights highlight a wide range of theoretical and practical design concerns. For a craft carrying a crew, structural integrity and manageability &control in flight are naturally important. These flights demonstrated the complete feasibility of this system which will be described in detail. In addition the author constructed a 1,600 cubic meter pumpkin balloon used for a two day fight across Australia with a crew of two. Considerable problems were discovered during construction with distortion of the balloon. Although this work was done some time ago, the results have not been published in detail. The reason for publications at this time is that the work is very relevant to the problems recently encountered with the ULDB pumpkin design. The author, who is a physicist as well as a member of the Society of Experimental Test Pilots, was the principal desig ner as well as pilot of these craft. Ends...

  12. Cold Chain and Consumers’ Practices: Exploratory Results of Focus Group Interviews

    PubMed Central

    Fasolato, Luca; Cardazzo, Barbara; Berti, Giulia; Novelli, Enrico

    2014-01-01

    The aim of this qualitative survey was to gain an insight into the ways consumers purchase, transport and storage fresh and frozen food. In particular, this paper considered consumers’ behaviour and the knowledge they have about cold chain. An explorative study was held using focus group interviews (n. 4) as the method for data collection. The sampling group was composed of 24 consumers (4 males and 20 females) and the age ranged from 33 to 78. Data revealed that food safety knowledge is at a fairly good level, however consumer practices in certain cases were inappropriate particularly with respect to transport from the store to home, storage and thaw. Consumers were particularly concerned about frozen food that should not be thawed during shopping or transportation. Knowledge about eggs storage seemed to be dodgy as well. Due to the restricted extent of the sample survey the results cannot be generalized to the whole Italian population; still, this method is particularly useful for discovering not only what people think but why they think that way. PMID:27800367

  13. Sociodemographic Correlates of Dietary Practices among Asian-Americans: Results from the California Health Interview Survey.

    PubMed

    Sarwar, Evangel; Arias, Devin; Becerra, Benjamin J; Becerra, Monideepa Bhattacharya

    2015-12-01

    Studies show that Asian-American subgroups do not always meet dietary recommendations and are at high risk of cardiovascular diseases. The purpose of our research is to illustrate the various sociodemographic correlates of dietary habits for six subgroups of Asian-Americans in California. The 2005 California Health Interview Survey (CHIS) was utilized. A total of 3772 Asian-Americans were included in this study, with the largest subgroup being Chinese (n = 1280; N = 913,798). The outcome variable for this study was dietary behavior defined as consuming five or more fruits and vegetables per day (5-a-day), provided by CHIS. Univariate and multivariable regression analyses were conducted accounting for complex survey design. Being a female (Chinese, Filipina, Korean, and Vietnamese), not being married (Chinese), not being a college graduate (Chinese), living in poverty (South Asian), and speaking only English language at home (Chinese and Japanese) were associated with higher odds of not meeting a 5-a-day requirement. Results highlighted several sociodemographic correlates to not meeting 5-a-day requirement among six Asian-American subgroups. Targeted health promotion measures for such at-risk groups should be implemented to improve dietary practices.

  14. Height, selected genetic markers and prostate cancer risk: results from the PRACTICAL consortium.

    PubMed

    Lophatananon, Artitaya; Stewart-Brown, Sarah; Kote-Jarai, Zsofia; Olama, Ali Amin Al; Garcia, Sara Benlloch; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L; Giles, Graham G; Fitzgerald, Liesel M; Southey, Melissa C; Pharoah, Paul; Pashayan, Nora; Gronberg, Henrik; Wiklund, Fredrik; Aly, Markus; Stanford, Janet L; Brenner, Hermann; Dieffenbach, Aida K; Arndt, Volker; Park, Jong Y; Lin, Hui-Yi; Sellers, Thomas; Slavov, Chavdar; Kaneva, Radka; Mitev, Vanio; Batra, Jyotsna; Spurdle, Amanda; Clements, Judith A; Easton, Douglas; Eeles, Rosalind A; Muir, Kenneth

    2017-08-22

    Evidence on height and prostate cancer risk is mixed, however, recent studies with large data sets support a possible role for its association with the risk of aggressive prostate cancer. We analysed data from the PRACTICAL consortium consisting of 6207 prostate cancer cases and 6016 controls and a subset of high grade cases (2480 cases). We explored height, polymorphisms in genes related to growth processes as main effects and their possible interactions. The results suggest that height is associated with high-grade prostate cancer risk. Men with height >180 cm are at a 22% increased risk as compared to men with height <173 cm (OR 1.22, 95% CI 1.01-1.48). Genetic variants in the growth pathway gene showed an association with prostate cancer risk. The aggregate scores of the selected variants identified a significantly increased risk of overall prostate cancer and high-grade prostate cancer by 13% and 15%, respectively, in the highest score group as compared to lowest score group. There was no evidence of gene-environment interaction between height and the selected candidate SNPs.Our findings suggest a role of height in high-grade prostate cancer. The effect of genetic variants in the genes related to growth is seen in all cases and high-grade prostate cancer. There is no interaction between these two exposures.

  15. Reprocessing practice in digestive endoscopy units of district hospitals: results of a Portuguese National Survey.

    PubMed

    Soares, João-Bruno; Gonçalves, Raquel; Banhudo, António; Pedrosa, José

    2011-11-01

    An inadequate disinfection of endoscopes and associated accessories can result in the transmission of infections to patients. The aim of this study was to access reprocessing practice in the endoscopy units of Portuguese district general hospitals. An anonymous questionnaire on cleaning and disinfection methods was sent to all endoscopy units of Portuguese district general hospitals. A total of 25 units responded (93%). All endoscopy units performed manual cleaning (including brushing of accessible channels) before disinfection. Automated endoscope reprocessing machines were available in all units. Manual disinfection was performed in only one unit. In 48% of the surveyed units, endoscopes were systematically disinfected before each session, whereas in 16% this was performed only occasionally. The most commonly used disinfectant was peracetic acid (32%). Disposable papillotomes, biopsy forceps, and polipectomy snares were used in nine (36%), six (24%), and 14 (56%) units, respectively. Disposable papillotomes, forceps, and snares were reused in three (12%), two (8%), and three (12%) units, respectively, always after sterilization. Most units did not perform regular evaluation of reprocessing staff competence (60%), regular microbiological inspection (56%), or registry of reprocessing (56%). The data collected suggest that there is a good compliance with standard guidelines. Nevertheless, there is still room for improvement mainly in quality assurance.

  16. Pelvic floor complaints in gastroenterology practice: results of a survey in the netherlands

    PubMed Central

    Nicolai, Melianthe P J; Fidder, Herma H; Bekker, Milou D; Putter, Hein; Pelger, Rob C M; Elzevier, Henk W

    2012-01-01

    Objective The pelvic floor is an integrated structure; dysfunctions may lead to a wide range of symptoms, involving voiding, defecation and sexual functioning (SF). Functional symptoms such as constipation and lower abdominal pain are often caused by pelvic floor dysfunction (PFD), and they highly impact the quality of life. Multiple specialists are responsible for a specific part of the pelvic floor, but its treatment asks for a holistic approach. The authors are still unaware of gastroenterologists' knowledge on PFD or whether they are addressing pelvic floor complaints in their daily practice. Design A 42-itemed anonymous questionnaire was mailed to all 402 members of the Dutch Society of Gastroenterology (gastroenterologists and residents-in-training). Results 169 (42%) questionnaires were analysed. Most gastroenterologists address lower urinary tract symptoms in their history-taking, 92% in female patients and 84% in male patients. When patients indicate irritable bowel syndrome-like complaints, more than 60% of the physicians inquire about SF to their female patients, compared with 38% inquiries to male patients (p<0.001). A reason not to inquire about SF is a lack of knowledge about female and male sexuality (19% and 23%, respectively). Forty-six per cent of the respondents regard it rather important to receive more training on PFD in male patients versus 61% in female patients. Conclusion Awareness of PFD is not yet routinely integrated into the history taken by gastroenterologists. PMID:24124626

  17. [Results of a structural diagnosis of patients with chronic dyspnoea recruited from two cardiological practices].

    PubMed

    Ewert, R; Obst, A; Bahr, C; Weirich, C; Henschel, F; Rink, A

    2013-01-01

    While well validated algorithms exist for the diagnosis of patients with acute dyspnoea, such generally valid procedural instructions are lacking for patients with chronic dyspnoea. The diagnostic approach presented here is based on investigations of 246 patients with chronic dyspnoea recruited from two cardiological practices using a self-developed multi-level procedure. Besides anamnestic and clinical examinations, different diagnostic procedures, available in the ambulant range, are included. The results suggest that in over 50 % of the cases the cause of chronic dyspnoea can be determined from anamnestic and clinical examinations as well as from electrocardiogram and echocardiography. Additional inclusion of lung function and capillary blood gas analysis permitted a sufficient clarification in over 80 % of the cases. In a further step, cardiopulmonary exercise testing clarified the reasons for chronic dyspnoea in approximately 10 % of the remaining patients. Threshold values of lung function parameters as used for the differentiation of acute dyspnoea, do not seem suitable for the diagnosis of patients with chronic dyspnoea. By means of a simple step-wise diagnostic algorithm, applicable under ambulant conditions, the cause of chronic dyspnoea could sufficiently be clarified in more than 95 % of the cases.

  18. Practical guidelines for reporting results in single- and multi-component analytical calibration: a tutorial.

    PubMed

    Olivieri, Alejandro C

    2015-04-08

    Practical guidelines for reporting analytical calibration results are provided. General topics, such as the number of reported significant figures and the optimization of analytical procedures, affect all calibration scenarios. In the specific case of single-component or univariate calibration, relevant issues discussed in the present Tutorial include: (1) how linearity can be assessed, (2) how to correctly estimate the limits of detection and quantitation, (2) when and how standard addition should be employed, (3) how to apply recovery studies for evaluating accuracy and precision, and (4) how average prediction errors can be compared for different analytical methodologies. For multi-component calibration procedures based on multivariate data, pertinent subjects here included are the choice of algorithms, the estimation of analytical figures of merit (detection capabilities, sensitivity, selectivity), the use of non-linear models, the consideration of the model regression coefficients for variable selection, and the application of certain mathematical pre-processing procedures such as smoothing. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Mandatory internal mobility in French hospitals: the results of imposed management practices.

    PubMed

    van Schingen, Edith; Dariel, Odessa; Lefebvre, Hélène; Challier, Marie-Pierre; Rothan-Tondeur, Monique

    2017-01-01

    To describe the impact of a mandatory internal mobility policy on nurses working in French state-funded health establishments. Public hospitals in France rely on the internal mobility of nursing staff to respond to organisational needs, to reduce costs and to increase productivity. However, there is very little data on the impact of such management practices on the nurses themselves. A cross-sectional study, including 3077 nurses from 35 hospitals in the region of Paris, was conducted. Data were collected using a validated self-assessment questionnaire. Forty per cent of French nurses are required to work in different units. This mobility differs according to individual characteristics [age (P = 0.04), length of service (P = 0.017)] and type of environment [hospital (P < 0.0001), specialty (P < 0.0001)]. We can distinguish two types of approaches for implementing a mandatory staff nurse mobility policy. The first is an event that is regular, planned and lasts for several days. The second is an event that is irregular, short and organised the day before or the day of the change. Overall, while nurses are dissatisfied with all types of mandatory unit changes, this dissatisfaction is primarily a result of the irregular mobility events. This study demonstrates the importance of implementing a planned inter-unit mobility event and proposes recommendations for this type of implementation. © 2016 John Wiley & Sons Ltd.

  20. Results of an initiative to charge for previously uncompensated care in an academic primary care practice.

    PubMed

    Dunham, Daniel P; Marcelo, Karen; Baker, David W

    2013-01-01

    Increasing clinical workload with dwindling compensation has challenged primary care medical practices over the past decade. This has led to more physicians leaving and fewer medical trainees entering primary care. In an effort to make primary care practices viable, many groups routinely charge for providing care that was uncompensated in the past. We initiated a program in our practice that charged for certain after-hour and electronic communications, completion of forms outside of office visits, and failure to show for appointments. We assessed the effect on workload, patient adherence to appointments, and financial outcomes. This initiative decreased our physicians' workload, increased physicians' satisfaction, and produced a modest increase in revenues.

  1. Instructional Practices in Introductory Geoscience Courses: Results of a National Faculty Survey

    NASA Astrophysics Data System (ADS)

    MacDonald, R.; Manduca, C. A.; Mogk, D. W.; Tewksbury, B. J.

    2004-12-01

    The NAGT professional development program "On the Cutting Edge" recently surveyed 7000 geoscience faculty in the United States to develop a snapshot of current instructional practices in undergraduate geoscience courses, faculty strategies for learning new content and new teaching approaches, and faculty involvement in the geoscience education community. Over 2200 faculty responded to the survey which was conducted by the American Institute of Physics. Results for introductory courses (814 responses) indicate that lecture is the most common teaching strategy used in courses of all sizes. Many faculty incorporate some interactive activities in their courses. Most commonly, they use questioning, demonstrations, discussions, and in-class exercises. Less common, but not rare, are small group discussion or think-pair-share and classroom debates or role-playing. Activities involving problem solving, using quantitative skills, working with data and primarily literature, and structured collaboration are incorporated by many faculty in introductory courses, suggesting efforts to teach the process of science. Activities in which students address a problem of national or local interest, analyze their own data, or address problems of their own design are less common but not rare. Field experiences are common but not ubiquitous for students in introductory courses. A wide variety of assessment strategies are used in introductory courses of all sizes, including exams, quizzes, problem sets, papers, oral presentations, and portfolios. While papers are used for assessment more extensively in small classes, a significant number of faculty use papers in large classes (greater than 81 students). A majority of faculty use rubrics in grading. Faculty report that in the past two years, approximately one-third have made changes in the content of their introductory courses while just under half have changed the teaching methods they use. While faculty learn about both new content and

  2. The contemporary practice of psychiatric surgery: results from a global survey of functional neurosurgeons.

    PubMed

    Mendelsohn, Daniel; Lipsman, Nir; Lozano, Andres M; Taira, Takaomi; Bernstein, Mark

    2013-01-01

    Interest in neurosurgery for psychiatric diseases (NPD) has grown globally. We previously reported the results of a survey of North American functional neurosurgeons that evaluated general attitudes towards NPD and the future directions of the field. The purpose of this study was to expand on our previous work and obtain a snapshot in time of global attitudes towards NPD among practicing functional neurosurgeons. We measure general and regional trends in functional neurosurgery and focus specifically on surgery for mind and mood, while exploring the future prospects of the field. We designed an online survey and distributed it electronically to 881 members of the following international organizations: World Society for Stereotactic and Functional Neurosurgery, European Society for Stereotactic and Functional Neurosurgery, Asian-Australasian Society for Stereotactic Functional Neurosurgery and the South and Latin American Society for Stereotactic and Functional Neurosurgery. Subsequent statistical and thematic analysis was performed on the data obtained. Of 881 surveys distributed, 106 were returned (12.8%). Eighty-two percent of functional neurosurgeon respondents were fellowship trained, with movement disorders and pain making up the majority of their practice. Psychiatric indications are the most frequently treated conditions for 34% of survey respondents, and over half of participants (51%) perform epilepsy surgery. Of the psychiatric conditions, obsessive-compulsive disorder and depression are the most common disorders treated. The majority of respondents (90%) felt optimistic about the future of NPD. Two thirds cited the reluctance of psychiatrists to refer patients as the greatest obstacle facing the field, and a majority reported that a cultural stigma surrounding psychiatric diseases exists in their community. In response to hypothetical situations involving cognitive and personality enhancement, opinions varied, but the majority opposed enhancement

  3. Levodopa therapy with entacapone in daily clinical practice: results of a post-marketing surveillance study.

    PubMed

    Kupsch, Andreas; Trottenberg, Thomas; Bremen, Dirk

    2004-01-01

    The catechol-O-methyl transferase inhibitor entacapone is given in combination with levodopa/dopa decarboxylase inhibitor for Parkinson's disease (PD) patients experiencing end-of-dose wearing-off. This 4-week post-marketing surveillance study was undertaken to assess patients' responses to levodopa combined with entacapone in a real clinical practice setting. Overall, 466 patients with idiopathic PD treated with levodopa and experiencing symptoms of wearing-off were recruited. Both physicians and patients recorded the response to therapy, including improvements and side-effects. Following initiation of entacapone treatment, the average daily levodopa dose was reduced from 510 to 453 mg. Physician assessment of entacapone efficacy was judged to be "very good" or "good" in 77.6% of the patients, and tolerability was considered to be "very good" or "good" in 92.4% of patients, with only 12 patients (2.6%) withdrawing from the study. Compared with baseline, there was a decrease in the mean duration of daily 'off' time from 3.0 to 1.3 h per day during the treatment period. Adverse events were in line with those previously reported, with diarrhoea being the most frequent event. The percentage of patients suffering from dyskinesia decreased from 46 to 34%, and of those patients still suffering from dyskinesia, the average daily duration of dyskinesia was reduced from 2.2 to 1.7 h. The use of adjunct dopamine agonists decreased from 67 to 59%. At study end, the percentage of patients who rated their quality of life (QoL) as "very good" or "good" increased from 12.1 to 51.7% and the percentage of patients who rated their QoL as "bad" or "very bad" decreased from 40 to 10.7%. In summary, the results of this survey conducted in real clinical practice support the findings of previous clinical trials demonstrating the efficacy and tolerability of entacapone, as well as the benefits of improved QoL, for patients achieved with entacapone.

  4. Physical Therapist Practice in the Intensive Care Unit: Results of a National Survey

    PubMed Central

    Ridgeway, Kyle; Nordon-Craft, Amy; Moss, Parker; Schenkman, Margaret; Moss, Marc

    2015-01-01

    Background Early rehabilitation improves outcomes, and increased use of physical therapist services in the intensive care unit (ICU) has been recommended. Little is known about the implementation of early rehabilitation programs or physical therapists' preparation and perceptions of care in the United States. Objective A national survey was conducted to determine the current status of physical therapist practice in the ICU. Design This study used a cross-sectional, observational design. Methods Self-report surveys were mailed to members of the Acute Care Section of the American Physical Therapy Association. Questions addressed staffing, training, barriers, and protocols, and case scenarios were used to determine perceptions about providing rehabilitation. Results The response rate was 29% (667/2,320). Staffing, defined as the number of physical therapists per 100 ICU beds, was highest in community hospitals (academic: median=5.4 [range=3.6–9.2]; community: median=6.7 [range=4.4–10.0]) and in the western United States (median=7.5 [range=4.2–12.9]). Twelve percent of physical therapists reported no training. Barriers to providing ICU rehabilitation included insufficient staffing and training, departmental prioritization policies, and inadequate consultation criteria. Responses to case scenarios demonstrated differences in the likelihood of consultation and physical therapists' prescribed frequency and intensity of care based on medical interventions rather than characteristics of patients. Physical therapists in academic hospitals were more likely to be involved in the care of patients in each scenario and were more likely to perform higher-intensity mobilization. Limitations Members of the Acute Care Section of the American Physical Therapy Association may not represent most practicing physical therapists, and the 29% return rate may have contributed to response bias. Conclusions Although staffing was higher in community hospitals, therapists in academic and

  5. Bioactive maca (Lepidium meyenii) alkamides are a result of traditional Andean postharvest drying practices.

    PubMed

    Esparza, Eliana; Hadzich, Antonella; Kofer, Waltraud; Mithöfer, Axel; Cosio, Eric G

    2015-08-01

    Maca, Lepidium meyenii Walpers (Brassicaceae), is an annual herbaceous plant native to the high plateaus of the Peruvian central Andes. Its underground storage hypocotyls have been a traditional medicinal agent and dietary staple since pre-Columbian times. Reported properties include energizing and fertility-enhancing effects. Published reports have focused on the benzylalkamides (macamides) present in dry hypocotyls as one of the main bioactive components. Macamides are secondary amides formed by benzylamine and a fatty acid moiety, with varying hydrocarbon chain lengths and degree of unsaturation. Although it has been assumed that they are usually present in fresh undamaged tissues, analyses show them to be essentially absent from them. However, hypocotyls dried by traditional Andean postharvest practices or industrial oven drying contain up to 800μgg(-1) dry wt (2.3μmolg(-1) dry wt) of macamides. In this study, the generation of macamides and their putative precursors were studied during nine-week traditional drying trials at 4200m altitude and in ovens under laboratory conditions. Freeze-thaw cycles in the open field during drying result in tissue maceration and release of free fatty acids from storage and membrane lipids up to levels of 1200μgg(-1) dry wt (4.3μmolg(-1) dry wt). Endogenous metabolism of the isothiocyanates generated from glucosinolate hydrolysis during drying results in maximal benzylamine values of 4300μgg(-1) dry wt (40.2μmolg(-1) dry wt). Pearson correlation coefficients of the accumulation profiles of benzylamine and free fatty acid to that of macamides showed good values of 0.898 and 0.934, respectively, suggesting that both provide sufficient substrate for amide synthesis during the drying process.

  6. Genetic diversity, inbreeding and breeding practices in dogs: results from pedigree analyses.

    PubMed

    Leroy, Grégoire

    2011-08-01

    Pedigree analysis constitutes a classical approach for the study of the evolution of genetic diversity, genetic structure, history and breeding practices within a given breed. As a consequence of selection pressure, management in closed populations and historical bottlenecks, many dog breeds have experienced considerable inbreeding and show (on the basis of a pedigree approach) comparable diversity loss compared to other domestic species. This evolution is linked to breeding practices such as the overuse of popular sires or mating between related animals. The popular sire phenomenon is the most problematic breeding practice, since it has also led to the dissemination of a large number of inherited defects. The practice should be limited by taking measures such as restricting the number of litters (or offspring) per breeding animal. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Emergency management of acute urinary retention: results from an all-Ireland urologist practice survey.

    PubMed

    Cullen, I M; Dowling, C M; Thornhill, J A; Grainger, R

    2013-06-01

    Anecdotal evidence suggests that current service restrictions and operative cancellations are resulting in increased numbers of catheterized men in the community awaiting definitive management of their bladder outlet obstruction. We wished to analyse current admission policies and management strategies of acute urinary retention (AUR) secondary to benign prostatic enlargement (BPE) in Ireland. A total of 58 consultant urologists practicing in Ireland were sent a questionnaire about their management of AUR secondary to BPE. Data was collected relating to initial emergency management, timing of trial without catheter (TWOC), their use of alpha-blockers and follow-up policy. Urethral catheterization is the initial management of choice by all 42 respondents. The patient is routinely admitted after catheterization by 20/42 consultants (48 %) and 22/42 (52 %) discharge the patient home with a urinary catheter (UC). TWOC is performed on day 2 in 11/20 (55 %) and on day 3 in 9/20 (45 %). In terms of individuals who admit patients presenting with AUR one failed TWOC is an indication for transurethral resection of the prostate in 10/20 (50 %), with 6/20 (30 %) performing a second TWOC on the same admission and 4/20 (20 %) discharging the patient for interval TURP. A total of 83 % of respondents, all of whom work in public institutions, expressed concerns relating to elective admission difficulties for definitive management of catheterized patients following AUR. There is variation in the admission policy for AUR in Ireland. Elective admission and operative restrictions for catheterized patients following episodes of AUR are causing concern to the urologists in Ireland.

  8. Foreign exam management in practice: seamless access to foreign images and results in a regional environment.

    PubMed

    Nagels, Jason; MacDonald, David; Parker, David

    2015-04-01

    A challenge for many clinical users is that a patient may receive a diagnostic imaging (DI) service at a number of hospitals or private imaging clinics. The DI services that patients receive at other locations could be clinically relevant to current treatments, but typically, there is no seamless method for a clinical user to access longitudinal DI results for their patient. Radiologists, and other specialists that are intensive users of image data, require seamless ingestion of foreign exams into the picture archiving and communication system (PACS) to achieve full clinical value. Most commonly, a clinical user will depend on the patient to bring in a CD that contains imaging from another location. However, a number of issues can arise when using this type of solution. Firstly, a CD will not provide the clinical user with the full longitudinal record of the patient. Secondly, a CD often will not contain the report associated with the images. Finally, a CD is not seamless, due to the need to manually import the contents of the CD into the local PACS. In order to overcome these limitations, and provide clinical users with a greater benefit related to a patient's longitudinal DI history, the implementation of foreign exam management (FEM) at the local site level is required. This paper presents the experiences of FEM in practice. By leveraging industry standards and edge devices to support FEM, multiple sites with disparate PACS and radiology information system (RIS) vendors are able to seamlessly ingest foreign exams within their local PACS as if they are local exams.

  9. Renegotiating cultural practices as a result of HIV in the eastern region of Malawi.

    PubMed

    Banda, Felix; Kunkeyani, Thokozani E

    2015-01-01

    A number of studies have shown that HIV awareness is very high among Malawians and yet infection rates are rising. Local cultural practices have been identified as contributing to this contradictory situation. Using data from 12 focus-group discussions collected in Balaka, Zomba, Machinga and Mangochi, the paper explores the reformulation of nine cultural practices as a preventive measure against HIV. The study reveals that cultural practices that involve sexual acts for completion are mediated through condoms and HIV tests. The study also shows that traditional herbs known for healing ailments are repurposed to symbolise sexual acts. We conclude that the idea of repurposing offers an avenue in which initiation and cleansing rites that involve sexual acts are replaced by other semiotics such as a traditional medicine called mtela. We also conclude that the modifications to cultural practices do not indicate complete abandonment of associated traditions, rather, they constitute the renegotiation of cultural practices and meanings associated with particular rites of passage. Lastly, we propose that a comprehensive prevention programme needs to be part of a wider national HIV-prevention effort combining a women and child rights and empowerment agenda and, critically, lifestyle lessons in a process of cultural renegotiation.

  10. [Frequency of congenital anomalies in cattle: results from the practice in comparison with literature].

    PubMed

    Bähr, C; Distl, O

    2005-04-01

    The study gives a short survey of the literature of frequently observed congenital anomalies in cattle and refers to data on cases of congenital anomalies registered in a veterinary practice over a period of 8 years and in an AI (artificial insemination) station of the Rinder-Union West (RUW) during 4 years. The frequency of congenital anomalies was estimated at 0.013% in the area of the RUW. In the veterinary practice a frequency of 0.51% was found. The most prevalent anomalies were seen in legs (39% in the veterinary practice and 21% in RUW) followed by congenital anomalies of the spine (9% in the veterinary practice and 17% in RUW). Arthrogryposes were most frequent among the anomalies of the legs with 65% (veterinary practice) and 39% (RUW), respectively, of all cases of registered leg anomalies in the respective area. Umbilical hernia and atresia of segments of the intestinum were seen in 8-30% of all registered cases. The frequency of congenital anomalies differed not significantly among paternal half sib groups. A questionnaire was proposed for the registration of congenital anomalies in progeny tests of AI bulls. A series of photographs showing the most prevalent congenital anomalies is supporting the registration form.

  11. Current practices in percutaneous nephrolithotomy in Mexico: results of a nation-wide electronic survey.

    PubMed

    Sandoval, Christian I Villeda; Roca, Benjamin E Montaño; Molina, Ricardo A Castillejos; Mendez-Probst, Carlos E

    2015-11-01

    Practice patterns and choice of technological instruments in PCNL are not always standardized. There are no previous reports on the PCNL practice tendencies and patterns in Latin America. The aim of the study is to describe the current practice patterns of PCNL among the members of the Mexican Society of Urology ("Sociedad Mexicana de Urologia"). Observational and descriptive study. A 9-item closed questionnaire on PCNL practice patterns was answered by members of the Mexican Society of Urology in a secure website hosted survey after e-mail invitation. A descriptive numerical and graphical analysis was performed. A total of 90 contestants were registered out of 492 potential participants. PCNL is performed by 80% of the participants, with an average of 16 procedures per year. Percutaneous tracts are commonly obtained by urologists on the same day of the procedure. Sequential and telescopic dilators are equally preferred over balloons. The pneumatic litotriptor is the most common choice and CT scan and X-ray are equally used as follow-up. The practice patterns of PCNL from Mexican urologists are different from other international reports. Influence of socio-economic circumstances is inferred.

  12. Innovative community-based educational face-to-face intervention to reduce HIV, hepatitis C virus and other blood-borne infectious risks in difficult-to-reach people who inject drugs: results from the ANRS-AERLI intervention study.

    PubMed

    Roux, Perrine; Le Gall, Jean-Marie; Debrus, Marie; Protopopescu, Camélia; Ndiaye, Khadim; Demoulin, Baptiste; Lions, Caroline; Haas, Aurelie; Mora, Marion; Spire, Bruno; Suzan-Monti, Marie; Carrieri, Maria Patrizia

    2016-01-01

    To study the effectiveness of an educational intervention on risks associated with drug injection, comparing primary [unsafe HIV-hepatitis C virus (HCV) practices] and secondary (local complications at injecting site) end-points in harm reduction (HR) programmes offering this intervention versus HR programmes not offering it. This non-random clustered intervention study was conducted in nine intervention groups (programmes offering the intervention) and eight control groups (programmes not offering it). Each participant was followed-up through a telephone interview at enrolment and at 6 and 12 months. The study took place in 17 cities throughout France. Of the 271 participants, 144 were enrolled into the intervention group and 127 in the control group. Of the latter, 113 received at least one educational session. A series of participant-centred face-to-face educational sessions. Each session included direct observation by trained non-governmental organization (NGO) staff or volunteers of participants' self-injecting the psychoactive product they used habitually; analysis by the trained NGO staff or volunteers of the participant's injecting practices, identification of injection-related risks and explanation of safer injecting practices; and an educational exchange on the individual participant's injection practices and the questions he or she asked. Primary and secondary outcomes were 'at least one unsafe HIV-HCV practice' and at least one injection-related complication (derived from a checklist). The proportion of participants with at least one unsafe HIV-HCV practice in the intervention group decreased significantly, from 44% at M0 to 25% at M6, as well as complications at the injection site (from 66 to 39% at M12), while in the control group it remained mainly stable. Multivariate probit analyses showed that the intervention group experienced a significant reduction in unsafe HIV-HCV practices at M6 [coefficient, 95% confidence interval (CI) = -0.73 (-1

  13. The database for reaching experiments and models.

    PubMed

    Walker, Ben; Kording, Konrad

    2013-01-01

    Reaching is one of the central experimental paradigms in the field of motor control, and many computational models of reaching have been published. While most of these models try to explain subject data (such as movement kinematics, reaching performance, forces, etc.) from only a single experiment, distinct experiments often share experimental conditions and record similar kinematics. This suggests that reaching models could be applied to (and falsified by) multiple experiments. However, using multiple datasets is difficult because experimental data formats vary widely. Standardizing data formats promises to enable scientists to test model predictions against many experiments and to compare experimental results across labs. Here we report on the development of a new resource available to scientists: a database of reaching called the Database for Reaching Experiments And Models (DREAM). DREAM collects both experimental datasets and models and facilitates their comparison by standardizing formats. The DREAM project promises to be useful for experimentalists who want to understand how their data relates to models, for modelers who want to test their theories, and for educators who want to help students better understand reaching experiments, models, and data analysis.

  14. Assessment of handwashing practices with chemical and microbiologic methods: preliminary results from a prospective crossover study.

    PubMed

    Marena, Carlo; Lodola, Lorenzo; Zecca, Marco; Bulgheroni, Anna; Carretto, Edoardo; Maserati, Renato; Zambianchi, Luigina

    2002-10-01

    Handwashing (HW) by clinical staff is the single most important measure for preventing transmission of nosocomial infection (NI). The primary objectives of this study were to improve the motivation and awareness of the importance of HW practices among health care workers (HCWs) and to assess the effectiveness of a new chemical system in checking HW compliance. In addition, we evaluated the efficacy and tolerability of 2 soap solutions used during regular working hours by HCWs at our institution. A preliminary short training course was performed to promote HW compliance and awareness. We chose 2 surgical wards at our 1200-bed teaching hospital. Sampling of hands was conducted weekly during routine activities of HCWs without advance warning. We used the staff list as a sampling frame to select subjects. Data were collected anonymously. On the basis of a crossover study design, a plain soap and one containing 4% chlorhexidine gluconate (CHG) were used alternatively in each ward for 4 consecutive months. Hand samples were evaluated with microbiologic cultures and with a commercially available kit that measures adenosine triphosphate (ATP) bioluminescence. As additional process indicators, we examined the amount of hand soap and CHG solution distributed and rate of NIs. A total of 74 HCWs were evaluated for hand contamination. During the 4-month study, we found a significant reduction in colony-forming unit counts (P <.008) and ATP levels (P <.002) compared with baseline values. The results showed a positive correlation (r = 0.68, P <.0001) between the microbial counts detected by standard culture and ATP levels measured with the commercial kit. Plain soap (P <.003) was more effective than CHG in reducing colony-forming unit counts among HCWs in the vascular surgery ward. We documented a reduction in the NI rate and an increase in the consumption of soap and paper towels. HW compliance improved during the study period among HCWs. The method to measure ATP

  15. Elder Mediation in Theory and Practice: Study Results From a National Caregiver Mediation Demonstration Project

    PubMed Central

    Crampton, Alexandra

    2014-01-01

    Mediation is a process through which a third party facilitates discussion among disputing parties to help them identify interests and ideally reach an amicable solution. Elder mediation is a growing subspecialty to address conflicts involving older adults, primarily involving caregiving or finances. Mediation is theorized to empower participants but critics argue that it can exacerbate power imbalances among parties and coerce consensus. These contested claims are examined through study of a national caregiver mediation demonstration project. Study implications underscore the importance of gerontological social work expertise to ensure the empowerment of vulnerable older adults in mediation sessions. PMID:23767767

  16. Elder mediation in theory and practice: study results from a national caregiver mediation demonstration project.

    PubMed

    Crampton, Alexandra

    2013-01-01

    Mediation is a process through which a third party facilitates discussion among disputing parties to help them identify interests and ideally reach an amicable solution. Elder mediation is a growing subspecialty to address conflicts involving older adults, primarily involving caregiving or finances. Mediation is theorized to empower participants but critics argue that it can exacerbate power imbalances among parties and coerce consensus. These contested claims are examined through study of a national caregiver mediation demonstration project. Study implications underscore the importance of gerontological social work expertise to ensure the empowerment of vulnerable older adults in mediation sessions.

  17. FERPA Training Practices: Results of the AACRAO January 2016 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2016

    2016-01-01

    The January 2016 American Association of Collegiate Registrars and Admissions Officers (AACRAO) "60 Second Survey" focused on institutional Family Educational Rights and Privacy Act (FERPA) training practices and measuring the level of interest in an AACRAO-developed online FERPA training module. The survey received 878 usable responses.…

  18. Managing Appalachian hardwood stands using four management practices: 60-year results

    Treesearch

    Thomas M. Schuler; Melissa Thomas-Van Gundy; John P. Brown; Jan Wiedenbeck

    2017-01-01

    A long-term forest management case study on the Fernow Experimental Forest in West Virginia referred to as the Cutting Practice Level study is evaluated after 60 years. Treatments include a commercial clearcut (one time application), a 39 cm diameter-limit (applied 4 times), uneven-aged management using two variations of single-tree selection (applied 7 and 8 times,...

  19. Does Professional Development Change Teaching Practice? Results from a Three-Year Study.

    ERIC Educational Resources Information Center

    Porter, Andrew C.; Garet, Michael S.; Desimone, Laura; Yoon, Kwang Suk; Birman, Beatrice F.

    This report, the third in a series of reports from the longitudinal evaluation of the Eisenhower Professional Development Program, examines the effects of professional development on improving classroom teaching practice. The Eisenhower Professional Development Program, Title II of the Elementary and Secondary Education Act, is the federal…

  20. Factors associated with general practice specialty training satisfaction - results from the Finnish Physician Study.

    PubMed

    Aine, Tiina; Sumanen, Markku; Heikkilä, Teppo; Hyppölä, Harri; Halila, Hannu; Vänskä, Jukka; Kujala, Santero; Virjo, Irma O; Mattila, Kari

    2014-07-01

    In Finland, achieving licensure as a specialist in general practice takes six years, with four years of training in primary care. Usually training arrangements are evaluated by trainees and their trainers. In this study the opinions of licensed GPs with experience of working in practice were specifically addressed. Our aim was to evaluate Finnish general practitioners' satisfaction with their specialty training and with the training programme. Correlations between these evaluations were investigated using logistic regression analyses. Participants comprised 416 GPs and 131 GP trainees, who responded to the Finnish Physician 2008 Study (response rate 53.7%). The respondents were asked how satisfied they were with their own specialty training in general, how satisfied they were with 12 items in their specialty training programme, and how well specialty training matched the requirements of GP work. Two-thirds of GPs and GP trainees were satisfied with their specialty training. Almost three in four felt that GP training succeeded in matching the requirements of work in general practice. Good ratings of diagnostic skill learning during GP training were predictive of overall training satisfaction. Clinical training relevant to GP work is the key element in ensuring satisfaction with general practice specialty training. The views of qualified GPs with experience gained in work provide a valuable addition to the total transformational quality management of GP training.

  1. College and University Dining Services Administrators' Intention to Adopt Sustainable Practices: Results from US Institutions

    ERIC Educational Resources Information Center

    Chen, Chao-Jung; Gregoire, Mary B.; Arendt, Susan; Shelley, Mack C.

    2011-01-01

    Purpose: The purpose of this paper is to examine college and university dining services administrators' (CUDSAs) intention to adopt sustainable practices. Design/methodology/approach: The theory of planned behavior (TPB) including constructs of subjective norm (SN), attitude, perceived behavior control, and personal norm (PN), formed the…

  2. College and University Dining Services Administrators' Intention to Adopt Sustainable Practices: Results from US Institutions

    ERIC Educational Resources Information Center

    Chen, Chao-Jung; Gregoire, Mary B.; Arendt, Susan; Shelley, Mack C.

    2011-01-01

    Purpose: The purpose of this paper is to examine college and university dining services administrators' (CUDSAs) intention to adopt sustainable practices. Design/methodology/approach: The theory of planned behavior (TPB) including constructs of subjective norm (SN), attitude, perceived behavior control, and personal norm (PN), formed the…

  3. International Student Recruitment Practices. Summary Results of the AACRAO January 2015 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2015

    2015-01-01

    The January 2015 American Association of Collegiate Registrars and Admissions Officers (AACRAO) "60 Second Survey" asked respondents to indicate their institutions' international student recruiting practices. As with other 60 Second Surveys, the survey was distributed through the FluidSurveys platform to all AACRAO members. After…

  4. FERPA Training Practices: Results of the AACRAO January 2016 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2016

    2016-01-01

    The January 2016 American Association of Collegiate Registrars and Admissions Officers (AACRAO) "60 Second Survey" focused on institutional Family Educational Rights and Privacy Act (FERPA) training practices and measuring the level of interest in an AACRAO-developed online FERPA training module. The survey received 878 usable responses.…

  5. Distance Education Practices: Summary Results of the AACRAO February 2015 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2015

    2015-01-01

    The February 2015 American Association of Collegiate Registrars and Admissions Officers (AACRAO) "60 Second Survey" asked respondents to identify whether or not their institution offers distance education, and if so, to answer additional questions about distance education course practices. The survey received 838 unique institutional…

  6. Projecting the bird community response resulting from the adoption of shelterbelt agroforestry practices in Eastern Nebraska

    Treesearch

    R. A., II Pierce; D. T. Farrand; W. B. Kurtz

    2001-01-01

    Evolving agricultural policies have influenced management practices within agroecosystems, impacting available habitats for many species of wildlife. Enhancing wildlife habitat has become an explicit objective of existing agricultural policy. Thus, there is renewed focus on field borders and the use of shelterbelt agroforestry systems to achieve conservation goals in...

  7. ICU Attending Handoff Practices: Results from a National Survey of Academic Intensivists

    PubMed Central

    Lane-Fall, Meghan B.; Collard, Meredith L.; Turnbull, Alison E.; Halpern, Scott D.; Shea, Judy A.

    2016-01-01

    Objective To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs. Design Cross-sectional electronic survey administered in 2014. Setting One hundred sixty nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education. Subjects Academic intensivists recruited via e-mail invitation from a database of 1,712 eligible academic intensivists. Interventions None. Measurements and Main Results 661 intensivists completed the survey (completion rate 38.6%). Responses were received from at least one individual at 147 of 169 (87.0%) unique hospitals represented in the study database. 573 (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0-100 (SD 22.6). 55.4% of respondents said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 (11.5%) respondents expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. 200 respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, death) attributable to inadequate attending handoffs. Conclusions ICU attending handoffs in the United States exhibit marked

  8. When Outcome Definition Determines the Result in Impact Evaluations: An Illustration Using the Swedish Work-Practice Programme

    ERIC Educational Resources Information Center

    Månsson, Jonas; Lundin, Christofer

    2017-01-01

    In this paper we investigate the effect of difference in outcome definitions on the result of impact evaluations. The Swedish workplace practice programme is evaluated, using matching methods. The key findings are that changing how the outcome is defined has a considerable influence on the results of the impact assessment. From the results of this…

  9. When Outcome Definition Determines the Result in Impact Evaluations: An Illustration Using the Swedish Work-Practice Programme

    ERIC Educational Resources Information Center

    Månsson, Jonas; Lundin, Christofer

    2017-01-01

    In this paper we investigate the effect of difference in outcome definitions on the result of impact evaluations. The Swedish workplace practice programme is evaluated, using matching methods. The key findings are that changing how the outcome is defined has a considerable influence on the results of the impact assessment. From the results of this…

  10. A collaborative accountable care model in three practices showed promising early results on costs and quality of care.

    PubMed

    Salmon, Richard B; Sanderson, Mark I; Walters, Barbara A; Kennedy, Karen; Flores, Robert C; Muney, Alan M

    2012-11-01

    Cigna's Collaborative Accountable Care initiative provides financial incentives to physician groups and integrated delivery systems to improve the quality and efficiency of care for patients in commercial open-access benefit plans. Registered nurses who serve as care coordinators employed by participating practices are a central feature of the initiative. They use patient-specific reports and practice performance reports provided by Cigna to improve care coordination, identify and close care gaps, and address other opportunities for quality improvement. We report interim quality and cost results for three geographically and structurally diverse provider practices in Arizona, New Hampshire, and Texas. Although not statistically significant, these early results revealed favorable trends in total medical costs and quality of care, suggesting that a shared-savings accountable care model and collaborative support from the payer can enable practices to take meaningful steps toward full accountability for care quality and efficiency.

  11. Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire.

    PubMed

    Mylvaganam, Senthurun; Conroy, Elizabeth; Williamson, Paula R; Barnes, Nicola L P; Cutress, Ramsey I; Gardiner, Matthew D; Jain, Abhilash; Skillman, Joanna M; Thrush, Steven; Whisker, Lisa J; Blazeby, Jane M; Potter, Shelley; Holcombe, Christopher

    2017-10-01

    The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. A questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. 81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50-80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0-3.0) and 2.0 plastic surgeons (IQR:1.0-3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Practice.

    PubMed

    Chambers, David W

    2008-01-01

    Practice refers to a characteristic way professionals use common standards to customize solutions to a range of problems. Practice includes (a) standards for outcomes and processes that are shared with one's colleagues, (b) a rich repertoire of skills grounded in diagnostic acumen, (c) an ability to see the actual and the ideal and work back and forth between them, (d) functional artistry, and (e) learning by doing that transcends scientific rationality. Communities of practice, such as dental offices, are small groups that work together in interlocking roles to achieve these ends.

  13. A primer on selected aspects of evidence-based practice to questions of treatment. Part 2: interpreting results, application to clinical practice, and self-evaluation.

    PubMed

    Noteboom, J Timothy; Allison, Stephen C; Cleland, Joshua A; Whitman, Julie M

    2008-08-01

    The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This second commentary in a 2-part series will review principles relating to steps 3 through 5 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in interpreting results, applying the evidence to patient care, and evaluating proficiency with EBP skills in studies of interventions for orthopaedic and sports physical therapy.

  14. Prison in-reach mental health nursing.

    PubMed

    Armitage, Claire; Fitzgerald, Carole; Cheong, Paula

    Surveys have shown that over 90 per cent of the prison population have a diagnosable mental illness, substance abuse problem, or both (ONS 1998). There is general agreement that although there are areas where practice is excellent, practice is not consistent across England and Wales, and often does not equate to standards in the NHS. In 2001 the Department of Health and the prison service set out their joint approach to the modernization of mental health services in prisons (DoH 2001), and proposed mental health in-reach as a means of improving services and achieving the objectives of the NHS Plan (DoH 2000). This article looks at the one of the first prison in-reach services that was launched at HMP Leicester early in 2002, and considers the effect these nurses have had on the care of mentally ill adults at the prison. A case study outlining the in-reach team's approach to one of the prison's greatest challenges, self-harm, is also included.

  15. New circuit theory of multiconductor transmission lines resulting from a new practice of noise reduction.

    PubMed

    Toki, Hiroshi; Sato, Kenji

    2014-01-01

    In modern life, we are surrounded by and filled with electromagnetic noise caused by the dominant use of energy in the form of electricity. This situation is brought about by the fact that the noise is not understood theoretically. A new practice of noise reduction was introduced for the construction of Heavy Ion Medical Accelerator in Chiba (HIMAC). The key concept is a symmetric three-line circuit that arranges power supplies, noise filters and magnets around a third central ground line. A continuous theoretical effort forced us to find a new circuit theory involving a multiconductor transmission-line system starting from Maxwell's equations without any approximation. We discuss the essence of all of these experimental and theoretical developments with the hope to remove unnecessary electromagnetic noise not only from power supplies, but also from all electric devices. The newly derived circuit theory of multiconductor transmission lines is universal, and establishes the validity of the practice of noise reduction.

  16. Chronic disease management for depression in US medical practices: results from the Health Tracking Physician Survey.

    PubMed

    Zafar, Waleed; Mojtabai, Ramin

    2011-07-01

    Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs). To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use. Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression. CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11). The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.

  17. [Pharmacists' Behavior in Clinical Practice: Results from a Questionnaire Survey of Pharmacy Students].

    PubMed

    Nakada, Akiko; Akagawa, Keiko; Yamamoto, Hitomi; Kato, Yasuhisa; Yamamoto, Toshinori

    2016-01-01

    A questionnaire survey was performed to obtain pharmacy students' impressions of pharmacists' behavior, to classify these based on professionalism, and to analyze the relationship between these experiences and students' satisfaction with their clinical practice in Japan. The questionnaire was answered by 327 5th-year pharmacy school students upon completing clinical practice at community pharmacies from 2011 to 2012. They rated their satisfaction with their clinical practice using a 6-point Likert scale, and provided descriptions of their experience such as, "This health provider is professional", or "What a great person he/she is as a health provider". We counted the words and then categorized the responses into 10 traits, as defined by the American Pharmaceutical Association Academy of Students of Pharmacy-American Association of Colleges of Pharmacy, Council of Deans Task Force on Professionalism 1999, using text mining. We analyzed the relationship between their experiences with respectful persons, and satisfaction, using the Mann-Whitney U-test (significance level<0.05). Most students (337 of 364, 92.6%) reported experiences with respectful health providers. These students experienced significantly more satisfaction than did other students (p<0.001). We analyzed 343 sentences written by 261 students, using text mining analysis after excluding unsuitable responses. The word most used was "patient" (121 times). Many students noted their impression that the pharmacists had answered patients' questions. Of the 10 trait categories, "professional knowledge and skills" was mentioned most often (151 students).

  18. Relative professional roles in antenatal care: results of a survey in Scottish rural general practice.

    PubMed

    Farmer, Jane; Stimpson, Paul; Tucker, Janet

    2003-11-01

    There is evidence of variation and some ambiguity about self-perceived relative professional roles in antenatal care in the UK. There is little information about models of antenatal care provision in UK rural areas. In rural areas, in particular, women have limited choice in accessing health care professionals or alternative primary care delivery settings. In the light of a recent review of Scottish maternity services, it is important and timely to examine models of care and interprofessional working in antenatal care in rural areas. This study explores midwives' and GPs' perceptions about their relative professional roles in remote and rural general practice in Scotland. A questionnaire survey involving all 174 Scottish remote and rural general practices (using one definition of rurality) was conducted, followed by 20 interviews. At least one professional returned a completed questionnaire from 91% of rural practices. A number of areas of dissonance were noted between GPs' and midwives' perceptions of their roles in maternity care and, given the context of service provision, these may impact upon rural patients. Findings are relevant to wider debates on extending the primary care team and strengthening inter-disciplinary working, particularly in rural areas.

  19. 49 CFR 385.321 - What failures of safety management practices disclosed by the safety audit will result in a...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... disclosed by the safety audit will result in a notice to a new entrant that its USDOT new entrant... MOTOR CARRIER SAFETY REGULATIONS SAFETY FITNESS PROCEDURES New Entrant Safety Assurance Program § 385.321 What failures of safety management practices disclosed by the safety audit will result in a...

  20. Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey.

    PubMed

    Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Godwin, Sandria; Chambers, Delores

    2015-07-01

    Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection.

  1. Putting patient participation into practice in pediatrics-results from a qualitative study in pediatric oncology.

    PubMed

    Ruhe, Katharina Maria; Wangmo, Tenzin; De Clercq, Eva; Badarau, Domnita Oana; Ansari, Marc; Kühne, Thomas; Niggli, Felix; Elger, Bernice Simone

    2016-09-01

    Adequate participation of children and adolescents in their healthcare is a value underlined by several professional associations. However, little guidance exists as to how this principle can be successfully translated into practice. A total of 52 semi-structured interviews were carried out with 19 parents, 17 children, and 16 pediatric oncologists. Questions pertained to participants' experiences with patient participation in communication and decision-making. Applied thematic analysis was used to identify themes with regard to participation. Three main themes were identified: (a) modes of participation that captured the different ways in which children and adolescents were involved in their healthcare; (b) regulating participation, that is, regulatory mechanisms that allowed children, parents, and oncologists to adapt patient involvement in communication and decision-making; and (c) other factors that influenced patient participation. This last theme included aspects that had an overall impact on how children participated. Patient participation in pediatrics is a complex issue and physicians face considerable challenges in facilitating adequate involvement of children and adolescents in this setting. Nonetheless, they occupy a central role in creating room for choice and guiding parents in involving their child. Adequate training of professionals to successfully translate the principle of patient participation into practice is required. •Adequate participation of pediatric patients in communication and decision-making is recommended by professional guidelines but little guidance exists as to how to translate it into practice. What is New: •The strategies used by physicians, parents, and patients to achieve participation are complex and serve to both enable and restrict children's and adolescents' involvement.

  2. Characteristics of medicine-pediatrics practices: results from the national ambulatory medical care survey.

    PubMed

    Fortuna, Robert J; Ting, David Y; Kaelber, David C; Simon, Steven R

    2009-03-01

    Combined medicine-pediatrics (med-peds) training has existed for 40 years, yet little is known about national med-peds practices. A more comprehensive understanding of med-peds practices is important to inform medical students and guide evolving curricula and accreditation standards. The authors used data from the National Ambulatory Medical Care Survey from 2000 to 2006 to characterize the age distribution and types of visits seen by med-peds, internal medicine, pediatric, and family physicians. Forty-three percent of visits to med-peds physicians were from children < or = 18 years of age. Compared with family physicians, med-peds physicians saw a higher proportion of infants and toddlers < or = 2 years of age (21.0% versus 3.7%; P = .002) and children < or = 18 years of age (42.9% versus 15.5%; P = .002), but they treated fewer adults age 65 or older (13.8% versus 21.3%; P = .013). Compared with internists, med-peds physicians saw a greater percentage of visits from adults 19 to 64 years of age (75.8% versus 61.2%) and fewer visits from patients age 65 or older (24.2% versus 38.8%; P = .006). Med-peds physicians, like family physicians and pediatricians, most commonly treated patients for acute problems and reported high levels of continuity of care for patients-pediatric (93.6%) and adult (94.6%). Med-peds physicians care for a considerable proportion of pediatric patients while maintaining high levels of continuity of care for adult and pediatric patients. Within their practices, med-peds physicians treat a larger percentage of pediatric patients than do family physicians, but they see a smaller percentage of elderly patients.

  3. Integration of Complementary and Alternative Medicine into Family Practices in Germany: Results of a National Survey

    PubMed Central

    Joos, Stefanie; Musselmann, Berthold; Szecsenyi, Joachim

    2011-01-01

    More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners (“Heilpraktiker”). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned. PMID:19293252

  4. The Private Pilot Practical Test: Survey Results From Designated Pilot Examiners and Newly Certificated Private Pilots

    DTIC Science & Technology

    2007-06-01

    surveys to include only those who had conducted at least one first-time private Pilot Airplane Single-Engine-Land (P- ASEL ) practical test in the previous...pilot examiners conducted an average of 30 first-time private P- ASEL category and class rating tests, with 59% indicating that at least 81% of their...certificated on or after August 1, 2005 for the P- ASEL category and class rating. Returned surveys were screened to include only pilots who were tested by an

  5. The use of augmented auditory feedback to improve arm reaching in stroke: a case series

    PubMed Central

    Schlaug, Gottfried

    2016-01-01

    Purpose After practice, augmented feedback is the most important factor that facilitates motor learning. We assess the potential effectiveness of two types of augmented auditory feedback on the re-learning of arm reaching in individuals with stroke: (a) real-time knowledge of performance (KP) feedback and (b) rhythmic cueing in the form of knowledge of results (KR) feedback. Method Five participants with stroke underwent short-term practice, reaching with their affected arm with KP, KR and no feedback, on separate days. We assessed range of motion of the upper extremity (shoulder, elbow) and trunk, mean error and variability of the performed trajectory, and movement time, before and after training. Results All participants benefitted from practice with feedback, though the effects varied across participants and feedback type. In three participants, KP feedback increased elbow extension and reduced compensatory trunk flexion. In four participants, KR feedback reduced movement time taken to perform the reach. Of note, one participant benefitted mostly from KP feedback, which increased shoulder flexion and elbow extension, and decreased compensatory trunk flexion and mean error. Conclusions Within day practice with augmented auditory feedback improves reaching in individuals with stroke. This warrants further investigation with longer practice periods in a larger sample size. PMID:26314746

  6. New circuit theory of multiconductor transmission lines resulting from a new practice of noise reduction

    PubMed Central

    TOKI, Hiroshi; SATO, Kenji

    2014-01-01

    In modern life, we are surrounded by and filled with electromagnetic noise caused by the dominant use of energy in the form of electricity. This situation is brought about by the fact that the noise is not understood theoretically. A new practice of noise reduction was introduced for the construction of Heavy Ion Medical Accelerator in Chiba (HIMAC). The key concept is a symmetric three-line circuit that arranges power supplies, noise filters and magnets around a third central ground line. A continuous theoretical effort forced us to find a new circuit theory involving a multiconductor transmission-line system starting from Maxwell’s equations without any approximation. We discuss the essence of all of these experimental and theoretical developments with the hope to remove unnecessary electromagnetic noise not only from power supplies, but also from all electric devices. The newly derived circuit theory of multiconductor transmission lines is universal, and establishes the validity of the practice of noise reduction. PMID:24522153

  7. Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

    PubMed

    Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

    2014-01-01

    The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

  8. School health promotion providers' roles in practice and theory: results from a case study.

    PubMed

    Teutsch, Friedrich; Gugglberger, Lisa; Dür, Wolfgang

    2015-01-01

    Implementation is critical to the success of health promotion (HP) in schools, but little is known about how schools can best be assisted during this process. This article focuses on Austrian HP providers and aspects their roles incorporate. To investigate the providers' role in the practice of HP implementation and how it differs from its official description. On the basis of these findings, implications are suggested. The data were gathered within the framework of an explorative case study of complex HP interventions. We draw on four interviews with HP organisation staff, five documents from the providers' organisations and seven interviews with school staff from three schools. In practice, providers took up different responsibilities, e.g., acting as emotional support to school staff and supporting the documentation of projects, guided more by the schools' needs than by the programmes they are helping to implement. Providers focused mostly on the implementation of single activities and did little to emphasize the necessity of organisational change. Our findings suggest that providers' background in health should be complemented by a deeper understanding of the importance of organisational change to further support HP implementation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Practices and challenges in community aphasia groups in Australia: Results of a national survey.

    PubMed

    Rose, Miranda L; Attard, Michelle C

    2015-06-01

    This study reports on practices and challenges in developing community aphasia groups in Australia. A 24-item web-based survey addressed the structure of existing community aphasia groups, funding models, group activities, facilitator satisfaction, challenges to group development and maintenance and suggestions for improvement. A total of 156 surveys were completed, mostly by speech-language pathologists (SLPs), with 66% urban and 34% regional/rural/remote participants representing all Australian states/territories consistent with their populations. Seventy respondents indicated running a total of 86 groups, reflecting a substantial under-representation of service in proportion to the population of people with aphasia. Further, 23.6% of respondents reported dissatisfaction with aspects of their groups. The primary barriers to achieving satisfaction relate to limited resources and staffing, inability to run sufficient numbers of groups and to tailor them effectively, dispersed populations beyond major cities, group dynamics and a lack of group promotion and referral to groups. Respondents suggested means for improvement including changes to group structure, improved SLP training, dedicated funding and staffing, development of specific resources and better liaison and promotion. The major features differentiating the community aphasia groups run in Australia from those running overseas are discussed and practical ways to achieve service improvement are suggested.

  10. Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study.

    PubMed

    Politiek, Klaziena; Christoffers, Wietske Andrea; Coenraads, Pieter-Jan; Schuttelaar, Marie-Louise Anna

    2016-09-01

    Acitretin has been used off-label for years to treat chronic hand eczema, but acitretin is less often prescribed as alitretinoïne was approved. This study evaluates both retinoids in a daily practice cohort of patients with severe chronic hand eczema in terms of drug survival and reasons for discontinuation. Patients using alitretinoin or acitretin between 01-01-1994 and 01-08-2015 were included in this retrospective daily practice study and analyzed by Kaplan-Meier drug survival curves. Potential determinants were analyzed by Cox regression analyses. Ninety-five patients were treated with alitretinoin and 109 patients with acitretin. The main reasons for discontinuation were adverse events and cleared hand eczema, 29.5 and 27.4% in alitretinoin versus 43.1 and 23.9% in acitretin. Patients with hyperkeratotic hand eczema had most often a good effect of treatment: 68.3% in alitretinoin and 50.7% in acitretin treatment. The drug survival rates of alitretinoin and acitretin after 12, 24, 36, and 52 weeks were 69.3, 45.1, 19.6, 7.0% and 74.3, 45.5, 33.8, 23.2%, respectively. Alitretinoin and acitretin are effective treatment options for patients with hand eczema. However, both treatments were more effective in patients with hyperkeratotic hand eczema. Fewer patients discontinued alitretinoin compared with acitretin due to adverse events.

  11. Primary care providers' knowledge, beliefs and treatment practices for gout: results of a physician questionnaire.

    PubMed

    Harrold, Leslie R; Mazor, Kathleen M; Negron, Amarie; Ogarek, Jessica; Firneno, Cassandra; Yood, Robert A

    2013-09-01

    We sought to examine primary care providers' gout knowledge and reported treatment patterns in comparison with current treatment recommendations. We conducted a national survey of a random sample of US primary care physicians to assess their treatment of acute, intercritical and tophaceous gout using published European and American gout treatment recommendations and guidelines as a gold standard. There were 838 respondents (response rate of 41%), most of whom worked in private practice (63%) with >16 years experience (52%). Inappropriate dosing of medications in the setting of renal disease and lack of prophylaxis when initiating urate-lowering therapy (ULT) accounted for much of the lack of compliance with treatment recommendations. Specifically for acute podagra, 53% reported avoidance of anti-inflammatory drugs in the setting of renal insufficiency, use of colchicine at a dose of ≤2.4 mg/day and no initiation of a ULT during an acute attack. For intercritical gout in the setting of renal disease, 3% would provide care consistent with the recommendations, including initiating a ULT at the appropriate dose with dosing titration to a serum urate level of ≤6 mg/dl and providing prophylaxis. For tophaceous gout, 17% reported care consistent with the recommendations, including ULT use with dosing titration to a serum urate level of ≤6 mg/dl and prophylaxis. Only half of primary care providers reported optimal treatment practices for the management of acute gout and <20% for intercritical or tophaceous gout, suggesting that care deficiencies are common.

  12. Reaching the "iBored"

    ERIC Educational Resources Information Center

    Bauleke, Debra S.; Herrmann, Kathleen E.

    2010-01-01

    As teachers, they are always looking for creative ways to engage their students. They start the school year determined to bring to the classroom creative projects that generate student interest and foster critical thinking skills. Reaching today's Gen M student is challenging and changing the way they teach. The idea of using music to teach…

  13. Reaching the "iBored"

    ERIC Educational Resources Information Center

    Bauleke, Debra S.; Herrmann, Kathleen E.

    2010-01-01

    As teachers, they are always looking for creative ways to engage their students. They start the school year determined to bring to the classroom creative projects that generate student interest and foster critical thinking skills. Reaching today's Gen M student is challenging and changing the way they teach. The idea of using music to teach…

  14. Microgravity Science Glovebox - Interior Reach

    NASA Technical Reports Server (NTRS)

    1997-01-01

    This photo shows the interior reach in the Microgravity Science Glovebox (MSG) being developed by the European Space Agency (ESA) and NASA for use aboard the International Space Station (ISS). Scientists will use the MSG to carry out multidisciplinary studies in combustion science, fluid physics and materials science. The MSG is managed by NASA's Marshall Space Flight Center (MSFC). Photo Credit: NASA/MSFC

  15. Schools Reaching Out: An Introduction.

    ERIC Educational Resources Information Center

    Heleen, Owen

    1990-01-01

    Introduces an issue devoted to the Schools Reaching Out projects at David A. Ellis School in Roxbury (MA) and Adolph S. Ochs School in New York City. Projects attempt to link the schools with parents and their communities to promote the students' academic and social success. (DM)

  16. Reaching All Students with Mathematics.

    ERIC Educational Resources Information Center

    Cuevas, Gilbert, Ed.; Driscoll, Mark, Ed.

    The National Council of Teachers of Mathematics'"Curriculum and Evaluation Standards for School Mathematics" and "Professional Standards for Teaching Mathematics" reflect the belief that all students can learn a significant core of high-quality mathematics. Recognizing the magnitude of the task of reaching all students, this…

  17. Temporal-spatial reach parameters derived from inertial sensors: Comparison to 3D marker-based motion capture.

    PubMed

    Cahill-Rowley, Katelyn; Rose, Jessica

    2017-02-08

    Reaching is a well-practiced functional task crucial to daily living activities, and temporal-spatial measures of reaching reflect function for both adult and pediatric populations with upper-extremity motor impairments. Inertial sensors offer a mobile and inexpensive tool for clinical assessment of movement. This research outlines a method for measuring temporal-spatial reach parameters using inertial sensors, and validates these measures with traditional marker-based motion capture. 140 reaches from 10 adults, and 30 reaches from nine children aged 18-20 months, were recorded and analyzed using both inertial-sensor and motion-capture methods. Inertial sensors contained three-axis accelerometers, gyroscopes, and magnetometers. Gravitational offset of accelerometer data was measured when the sensor was at rest, and removed using sensor orientation measured at rest and throughout the reach. Velocity was calculated by numeric integration of acceleration, using a null-velocity assumption at reach start. Sensor drift was neglected given the 1-2s required for a reach. Temporal-spatial reach parameters were calculated independently for each data acquisition method. Reach path length and distance, peak velocity magnitude and timing, and acceleration at contact demonstrated consistent agreement between sensor- and motion-capture-based methods, for both adult and toddler reaches, as evaluated by intraclass correlation coefficients from 0.61 to 1.00. Taken together with actual difference between method measures, results indicate that these functional reach parameters may be reliably measured with inertial sensors.

  18. Pressure on communication of results of clinical research: potential for improper practice. Proceedings of a meeting. London, October 13, 1993.

    PubMed

    1995-01-01

    In earlier times, clinical researchers published the results of their studies as seemed most appropriate to them. In an increasingly computerized and communicative environment this is no longer satisfactory, since now there are a number of other groups whose interests need to be taken into account. These include patients, medical journals, the Stock Exchange, the media and the law. This supplement arises out of a meeting established to describe the methods used to communicate clinical research results, the timing and the needs of other groups in an attempt to improve understanding and to identify preferred practice. Avoidance by clinical investigators of conflict of interest and accusations of improper practice clearly merit discussion.

  19. Physician, Practice, and Patient Characteristics Related to Primary Care Physician Physical and Mental Health: Results from the Physician Worklife Study

    PubMed Central

    Williams, Eric S; Konrad, Thomas R; Linzer, Mark; McMurray, Julia; Pathman, Donald E; Gerrity, Martha; Schwartz, Mark D; Scheckler, William E; Douglas, Jeff

    2002-01-01

    Objective To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Data Sources Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. Study Design A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. Principle Findings The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. Conclusions These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both “physician friendly” and “family friendly” seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

  20. Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study.

    PubMed

    Williams, Eric S; Konrad, Thomas R; Linzer, Mark; McMurray, Julia; Pathman, Donald E; Gerrity, Martha; Schwartz, Mark D; Scheckler, William E; Douglas, Jeff

    2002-02-01

    To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both "physician friendly" and "family friendly" seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

  1. Reaching Patients Across the Web.

    PubMed

    Berlin, Joey

    2015-12-01

    The explosion of social media and the expectations of frequently refreshed content have changed the rules for physicians and practices looking to market themselves and bolster their online reputation. Just as static websites have become a relatively archaic part of the online equation, the marketing expectations for physician and practice websites have changed substantially.

  2. The effect of quality management practices on operational and business results in the petroleum industry in Iran

    NASA Astrophysics Data System (ADS)

    Mellat Parast, Mahour

    The trend toward globalization has challenged management thinking, organizational practices, and the ways companies interact with their customers and suppliers as well as with other segments of society. One such practice, Total Quality Management (TQM), has emerged as a management paradigm for enhancing organizational performance and profitability, to the extent that it has been regarded as "the second industrial revolution" (Kanji, 1990). Despite extensive research in quality management, little empirical research has been done on this in an international context, especially in the Middle East. This study attempts to investigate: (1) the relationship among quality management constructs based on the Malcolm Baldrige National Quality Award; and (2) the effect of quality management practices on operational and business results in the petroleum industry. A validated and reliable survey instrument was used for the study to collect data from 31 project managers/consultants in the petroleum industry in Iran. The results of the correlation analysis show that top management support is the major driver of quality management, which significantly correlates with other quality management practices. It was also found that customer orientation is not significantly correlated with external quality results (profitability). A regression analysis indicated top management support, employee training, and employee involvement as the three statistically significant variables in explaining the variability in internal quality results. Furthermore, it was found that internal quality results was statistically significant in explaining the variability of external quality results.

  3. Is it possible and worth keeping track of deaths within general practice? Results of a 15 year observational study

    PubMed Central

    Beaumont, B; Hurwitz, B

    2003-01-01

    Aim: To assess the value of maintaining a death register in a general practice with particular reference to monitoring quality of care. Design of study: Observational study. Setting: Inner London general practice. Method: The practice maintained a manual death register, retained medical records of all deceased patients, and requested information on cause of death from health authorities and coroners for 15 years. Main outcome measures: Number and causes of deaths; 3 yearly age standardised death rates; proportion of deaths formally notified to the practice; place of death; source of cause of death information. Results: During the study period 578 patients died. Practice age standardised death rates fell significantly from 35.59 to 27.12/1000. 498 (86.2%) deaths were formally notified to the practice, 392 within 7 days of death. Of 143 deaths reported to the coroner, only 45 coroners' reports were received. 360 (64.1%) died in hospital, 139 (24.8%) at home, and 38 (6.8%) in a hospice. Death certificate cause of death information was obtained from patients' records in 33.6% (n=194) of cases and from health authority sources for 50% (n=289). The pattern of ascertained causes of deaths was similar to the national pattern. Conclusion: A death register can examine trends in practice deaths by age and place of death and comparisons undertaken with nationally published mortality data. An accurate picture of cause of death cannot be generated from routine data flows alone. There is delay in informing GPs of patient deaths. Meaningful and timely monitoring of deaths cannot be undertaken by individual practices. National Statistics should provide routine analysis of GP death certificate information. PMID:14532364

  4. Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the Medicare population.

    PubMed

    Cross, Summer; Kelly, Patricia

    2015-01-01

    To examine access to care in the Medicare population based on state nurse practitioner (NP) practice regulation. Secondary data analysis of the Medicare Current Beneficiary Survey Access to Care 2011 dataset. Items used to measure access to care were usual source of care, appointment waiting times, and difficulties encountered. States were designated as full, reduced, or restricted NP practice based on data from the American Association of Nurse Practitioners State Regulatory Map. Self-reported usual source of care (N = 1,496,251) was not significantly affected by state regulation (p > .05); however, these results were based on only 3% of the sample answering the question. Significant differences were seen in sites for care across state groups (N = 41,650,566, p ≤ .01). Participants in reduced (B = -1.86) and restricted (B = -2.82) states reported lower waiting times than those in full practice states (N = 371,166, p < .01). Participants in reduced practice states had 67% lower odds of having trouble accessing care than participants in full practice states (N = 5,568,495, p = .01). More participants in restricted and reduced states reported cost as a difficulty (N = 1180, p = .03). Access to care based on state NP practice regulation is an important area of study because of the changing nature of health care and the growing support for full practice. This study examined access to care in states with different levels of NP practice regulation, but did not directly measure outcomes in individuals based on NP care. Additional research is needed to examine the impact of state regulation in different patient populations (self-insured, Medicaid, uninsured), and changes in access to care over time as state regulations change. ©2014 American Association of Nurse Practitioners.

  5. Results.

    ERIC Educational Resources Information Center

    Zemsky, Robert; Shaman, Susan; Shapiro, Daniel B.

    2001-01-01

    Describes the Collegiate Results Instrument (CRI), which measures a range of collegiate outcomes for alumni 6 years after graduation. The CRI was designed to target alumni from institutions across market segments and assess their values, abilities, work skills, occupations, and pursuit of lifelong learning. (EV)

  6. Reaching Success through Involvement--Implementation Strategy for Creating and Maintaining Effective Schools.

    ERIC Educational Resources Information Center

    Furtwengler, Willis J.

    The educational change strategy termed "reaching success through involvement" (RSI) has yielded promising results in creating school effectiveness. This paper analyzes the theoretical bases and practical applications of RSI strategy among 14 schools over an 8-year period. RSI theory assumes that educational organizations are dynamic social systems…

  7. Chronic disease management in general practice: results from a national study.

    PubMed

    Darker, C; Martin, C; O'Dowd, T; O'Kelly, F; O'Shea, B

    2012-04-01

    The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380/527).The majority of GPs (240/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267/380; 71%), asthma / COPD (279/380; 74%) and hypertension (297/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379/380; 99%), lack of appropriate funding (286/380; 76%), with GPs interested in targeted payments (244/380; 68%). This study provides baseline data to assess future changes in CDM.

  8. Complementary and Alternative Medicine Use among Allergy Practices: Results of a Nationwide Survey of Allergists.

    PubMed

    Land, Michael H; Wang, Julie

    2017-03-25

    The use of complementary and alternative practices in the field of Allergy/Immunology is growing. A recent survey of American Academy of Allergy, Asthma, and Immunology members examining patterns of complementary and alternative medicine (CAM) use and adverse effects from CAM revealed that a majority of practitioners (81% of respondents) had patients who are using CAM therapies over conventional treatments and many practitioners (60% of survey respondents) have encountered patients experiencing adverse reactions. During routine office visits, a majority of practitioners do not ask patients about CAM use, and when they do, most do not have a standard intake form to take a CAM history. There is a strong need to increase knowledge and improve measures to prevent adverse reactions to CAMs. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  9. Risk management policies and practices regarding radio frequency electromagnetic fields: results from a WHO survey.

    PubMed

    Dhungel, Amit; Zmirou-Navier, Denis; van Deventer, Emilie

    2015-04-01

    This study aims to describe current risk management practices and policies across the world in relation to personal exposures from devices emitting radiofrequency fields, environmental exposures from fixed installations and exposures in the work environment. Data from 86 countries representing all WHO regions were collected through a survey. The majority of countries (76.8 %) had set exposure limits for mobile devices, almost all (90.7 %) had set public exposure limits for fixed installations and 76.5 % had specified exposure limits for personnel in occupational settings. A number of other policies had been implemented at the national level, ranging from information provisions on how to reduce personal exposures and restrictions of usage for certain populations, such as children or pregnant women to prevention of access around base stations. This study suggests that countries with higher mobile subscriptions tend to have set radiofrequency exposure limits for mobile devices and to have provisions on exposure measurements about fixed installations.

  10. 'Bolam' to 'Montgomery' is result of evolutionary change of medical practice towards 'patient-centred care'.

    PubMed

    Lee, Albert

    2017-01-01

    The Supreme Court judgement in 'Montgomery v Lanarkshire Health Board' has caused a change in the law concerning the duty of doctors on disclosure of information to patients regarding risks. The law now requires a doctor to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments. Are doctors totally removed from the protective shield even if the practice is accepted by a reasonable body of medical opinion previously laid down by 'Bolam' with the recent Supreme Court decision in the 'Montgomery' case? This paper questions whether the 'Bolam' principle needs to be discarded or re-interpreted in the modern context of health care. Adopting 'patient-centred' care to unfold the 'significant risks' attached to patients would align with the evolving changes in medical law. It should be the changing context of health care driving the evolving change of law.

  11. Risk management policies and practices regarding radio frequency electromagnetic fields: results from a WHO survey

    PubMed Central

    Dhungel, Amit; Zmirou-Navier, Denis; van Deventer, Emilie

    2015-01-01

    This study aims to describe current risk management practices and policies across the world in relation to personal exposures from devices emitting radiofrequency fields, environmental exposures from fixed installations and exposures in the work environment. Data from 86 countries representing all WHO regions were collected through a survey. The majority of countries (76.8 %) had set exposure limits for mobile devices, almost all (90.7 %) had set public exposure limits for fixed installations and 76.5 % had specified exposure limits for personnel in occupational settings. A number of other policies had been implemented at the national level, ranging from information provisions on how to reduce personal exposures and restrictions of usage for certain populations, such as children or pregnant women to prevention of access around base stations. This study suggests that countries with higher mobile subscriptions tend to have set radiofrequency exposure limits for mobile devices and to have provisions on exposure measurements about fixed installations. PMID:25394650

  12. Estimation of catchment-scale evapotranspiration from baseflow recession data: Numerical model and practical application results

    NASA Astrophysics Data System (ADS)

    Szilagyi, Jozsef; Gribovszki, Zoltan; Kalicz, Peter

    2007-03-01

    SummaryBy applying a nonlinear reservoir approach for groundwater drainage, catchment-scale evapotranspiration (ET) during flow recessions can be expressed with the help of the lumped version of the water balance equation for the catchment. The attractiveness of the approach is that ET, in theory, can be obtained by the sole use of observed flow values for which relatively abundant and long records are available. A 2D finite element numerical model of subsurface flow in the unsaturated and saturated zones, capable of simulating moisture removal by vegetation, was first successfully employed to verify the water balance approach under ideal conditions. Subsequent practical applications over four catchments with widely varying climatic conditions however showed large disparities in comparison with monthly ET estimates of Morton's WREVAP model.

  13. The integration of complementary therapies in Australian general practice: results of a national survey.

    PubMed

    Cohen, Marc M; Penman, Stephen; Pirotta, Marie; Da Costa, Cliff

    2005-12-01

    Australian general practitioners' (GPs) attitudes toward and use of a range of complementary therapies (CTs) were determined through a self-administered postal survey sent to a random sample of 2000 Australian GPs. The survey canvassed GPs' opinions as to the harmfulness and effectiveness of CTs; current levels of training and interest in further training; personal use of, and use in practice of, CTs; referrals to CT; practitioners; appropriateness for GPs to practice and for government regulation; perceived patient demand and the need for undergraduate education. The response rate was 33.2%. Based on GPs' responses, complementary therapies could be classified into: nonmedicinal and nonmanipulative therapies, such as acupuncture, massage, meditation, yoga, and hypnosis, that were seen to be highly effective and safe; medicinal and manipulative therapies, including chiropractic, Chinese herbal medicine, osteopathy, herbal medicine, vitamin and mineral therapy, naturopathy, and homeopathy, which more GPs considered potentially harmful than potentially effective; and esoteric therapies, such as spiritual healing, aromatherapy, and reflexology, which were seen to be relatively safe yet also relatively ineffective. The risks of CTs were seen to mainly arise from incorrect, inadequate, or delayed diagnoses and interactions between complementary medications and pharmaceuticals, rather than the specific risks of the therapies themselves. Nonmedicinal therapies along with chiropractic are widely accepted in Australia and can be considered mainstream. GPs are open to training in complementary therapies, and better communication between patients and GPs about use of CTs is required to minimize the risk of adverse events. There is also a need to prioritize and provide funding for further research into the potential adverse events from these therapies and other therapies currently lacking an evidence base.

  14. Children in day surgery: clinical practice and routines. The results from a nation-wide survey.

    PubMed

    Segerdahl, M; Warrén-Stomberg, M; Rawal, N; Brattwall, M; Jakobsson, J

    2008-07-01

    Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking. We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail. The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1-6-year-olds, and in 7-16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1-6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1-3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy. In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.

  15. Client-centred practices and work in inpatient rehabilitation teams: results from four case studies.

    PubMed

    Papadimitriou, Christina; Cott, Cheryl

    2015-01-01

    To explore the relationship between client-centredness (CC) and work in teams in inpatient rehabilitation. Case study, mixed-method design, with strong qualitative component. Methods include ethnographic observations of team and clinical encounters for 6 months; healthcare professional (HCP) interviews. HCP n=45; Observations = 40 encounters & meetings. Based on HCP perceptions, intra-team and organizational factors were identified that influence client-centred practice in rehabilitation. Team factors included relational and communication dimensions affecting work that can hinder or facilitate CC. These dimensions are presented in detail. HCP perceived organizational factors such as workload, schedules and hospital culture to influence their work on teams and with clients. CC is not a "one size fits all". It is affected by similar factors that affect work in teams such as organizational policies, team characteristics and culture. CC can be seen as an outcome of team performance. Implications for Rehabilitation Client-centred practice (CCP) is influenced by client, provider and organizational factors. CCP is not just about client-provider communication. How inter-professional teams work together is an important aspect of CCP. Shared knowledge, shared goals and mutual respect characterize the relationships among members in a team. These three dimensions influence, and are influenced by, the nature of team members' communication and the organizational structures and culture in which they take place. Effective teamwork does not automatically lead to enhanced client-centredness. Strategies are needed that ensure teamwork does not merely perpetuate the health professionals' control of the patient or that decisions are the "right" decisions from the health care professionals' perspectives.

  16. Pesticide Knowledge and Safety Practices among Farm Workers in Kuwait: Results of a Survey.

    PubMed

    Jallow, Mustapha F A; Awadh, Dawood G; Albaho, Mohammed S; Devi, Vimala Y; Thomas, Binson M

    2017-03-24

    The unsafe and indiscriminate use of pesticides in agriculture represents a major hazard to the environment and human health. The aim of this study was to assess the levels of knowledge, attitude and practices of Kuwaiti farmers regarding the safe use of pesticides. A total of 250 farmers participated in this study through in-depth interviews and observations on-farm. The majority of the farmers acknowledged that pesticides were harmful to their health (71%) and the environment (65%). However, farmers' level of knowledge of pesticide safety is insufficient. Over 70% of the farmers did not read or follow pesticide label instructions, and 58% did not use any personal protective equipment (PPE) when handling pesticides. Educated farmers were significantly more likely to use PPE compared with famers with limited formal education (χ² = 9.89, p < 0.05). Storage of pesticides within living areas was reported by 20% of farmers. When disposing of pesticide wastes, respondents adopted unsafe practices such as discarding, incinerating, or burying empty pesticide containers on-farm, or reusing the containers. Farmers also reported disposing leftover pesticide solution or old pesticide stocks on-farm or in the sewer. A significant number (82%) of the farmers reported at least one symptom of acute pesticide poisoning. Although farmers' knowledge of pesticide hazards was high, the reported safety measures were poor. Comprehensive intervention measures to reduce the health and environmental risks of pesticides are needed, including pesticide safety training programs for farmers, stringent enforcement of pesticide laws, and promoting integrated pest management and non-synthetic methods of pest control.

  17. Variation in high-resolution esophageal manometry methodology in clinical practice: Results from an international survey.

    PubMed

    Sweis, R; Heinrich, H; Fox, M

    2017-09-25

    Advances in clinical measurement of esophageal motility and function have improved the assessment of swallowing disorders and reflux symptoms. Variation in data acquisition, analysis, and reporting exists and impacts on diagnosis and management. This study examined variation in esophageal manometry methodology between institutions to establish the status in current practice. A structured survey was distributed through international NGM societies using an Internet-based platform. Questions explored infrastructure, technology, analysis, and reporting. Responses were received from 91 centers from 29 countries. Eighteen (20%) centers used "conventional" manometry, 75 (82%) high-resolution manometry, and 53 (58%) HR impedance manometry. All centers documented motility for single water swallows. The Chicago Classification was applied by 65 (71.4%) centers. In contrast, analysis of EGJ morphology varied widely. Adjunctive testing was often applied: multiple rapid swallows (77%), rapid drink challenge (77%), single solid swallows (63%), and a standard test meal (18%). Of 86 (94.5%) units that offered pH impedance (pH-Z) studies, approximately half (53.5%) performed tests on acid-suppressant medication in patients with a high pretest probability (eg, erosive esophagitis). Most (75.6%) centers manually reviewed every reflux event. Others examined pH-Z data only prior to symptoms. To assess symptom association with reflux events, 73.6% centers analyzed each symptom separately, whereas 29.7% centers pooled symptoms. There is marked variation in the data acquisition, analysis, and reporting of esophageal manometry studies. Further efforts to improve quality and uniformity in testing and reporting are required. This survey provides information upon which best-practice guidelines can be developed. © 2017 John Wiley & Sons Ltd.

  18. DAS steered therapy in clinical practice; cross-sectional results from the METEOR database.

    PubMed

    Gvozdenović, Emilia; Wolterbeek, Ron; van der Heijde, Désirée; Huizinga, Tom; Allaart, Cornelia; Landewé, Robert

    2016-01-16

    Little is known on how well targeted treatment, for instance targeting towards low DAS, is implemented in clinical practice. Our aim was to evaluate treatment adjustments in response to DAS in RA patients in clinical practice. We used data from one referral centre, multiple rheumatologists, from the METEOR database. Generalized Estimating Equations (GEE) were used to assess whether in case of non-low disease activity (DAS > 2.4) treatment intensifications in DMARD therapy occurred ((change or increase in dose or number of DMARDs, including synthetic (s)DMARDs, biologic (b)DMARDs and corticosteroids compared to the visit before)). Determinants of not intensifying the treatment when DAS > 2.4 were investigated using GEE. Five thousand one hundred fifty-seven registered visits of 1202 patients were available for the analyses. A DAS > 2.4 was weakly (OR: 1.19; 95% CI 1.07-1.33) associated with a treatment intensification. In 69% (n = 3577) of the visits patients were in low disease activity. In 66% (n = 1028) of the visits with DAS > 2.4 treatment was not intensified. These patients had a higher tender joint count and received more often methotrexate plus a bDMARD, or csDMARD monotherapy, as compared to patients that received treatment intensification. In the majority of visits in the METEOR database patients were already in a state of low disease activity, reflecting appropriate treatment intensity. When DAS was greater than 2.4, treatment was often not intensified due to high tender joint count or specific treatment combinations. This data suggest that while aiming for low DAS, physicians per patient weigh whether all DAS elements indicate disease activity or will respond to DMARD adjustment or not, and make treatment decisions accordingly.

  19. Results of a survey on albumin use in clinical practice in intensive care units.

    PubMed

    Estébanez-Montiel, M B; Quintana-Díaz, M; García de Lorenzo y Mateos, A; Blancas Gomez-Casero, R; Acosta-Escribano, J; Marcos-Neira, P

    2014-10-01

    Human albumin solutions are used in a number of disorders, though their indications are not clear in all circumstances. These solutions are costly, and their benefit has not been established in all settings. It is therefore interesting to assess the presence of albumin solutions in the daily clinical practice of critical care professionals. To report the standard clinical practices and to describe the variability of albumin solutions use in critically ill patients. A survey sent by e-mail to Spanish and South American Intensive Care Units (ICUs) Planning and execution during the year 2012. A questionnaire comprising 35 questions. Fifty-seven surveys were analyzed. The use of albumin solutions was sporadic or negligible in critically ill patients (96.5%). The exceptions were patients with liver disease (87.7% of the responders administered albumin to these patients). A high percentage of professionals claimed to know the available scientific evidence on the use of albumin in patients with liver disease (82.5%) and in patients without liver disease (77.2%). Only 5.3% of the responders preferred to rely on their own experience to establish the indications of albumin use. The use of albumin solutions is infrequent in ICUs, except in patients with liver disease. Evidence-based knowledge on albumin use is declared to be extensive in ICUs. As a rule, opinions on the use of albumin solutions are based on the scientific recommendations, especially in patients with liver disease. Professional experience rarely prevails over the published clinical guidelines. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  20. Ramucirumab as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib: Patient-focused outcome results from the randomised phase III REACH study.

    PubMed

    Chau, Ian; Peck-Radosavljevic, Markus; Borg, Christophe; Malfertheiner, Peter; Seitz, Jean Francois; Park, Joon Oh; Ryoo, Baek-Yeol; Yen, Chia-Jui; Kudo, Masatoshi; Poon, Ronnie; Pastorelli, Davide; Blanc, Jean-Frederic; Chung, Hyun Cheol; Baron, Ari D; Okusaka, Takuji; Bowman, L; Cui, Zhanglin Lin; Girvan, Allicia C; Abada, Paolo B; Yang, Ling; Zhu, Andrew X

    2017-08-01

    To report patient-focused outcomes as measured by quality of life (QoL) and performance status (PS) in REACH, a phase III placebo-controlled randomised study, assessing ramucirumab in advanced hepatocellular carcinoma (HCC) patients who received prior sorafenib. Eligible patients had advanced HCC, Child-Pugh A, PS 0 or 1 and prior sorafenib. Patients received ramucirumab (8 mg/kg) or placebo (1:1) on day 1 of a 2-week cycle. QoL was assessed by FACT Hepatobiliary Symptom Index (FHSI)-8 and EuroQoL (EQ-5D) at baseline; cycles 4, 10, and 16; and end of treatment. PS was assessed at baseline, each cycle, and end of treatment. Deterioration in FHSI-8 was defined as a ≥3-point decrease from baseline and PS deterioration was defined as a change of ≥2. Both intention-to-treat and pre-specified subgroup of patients with baseline serum alpha-fetoprotein (AFP) ≥400 ng/mL were assessed. There were 565 patients randomised to ramucirumab and placebo. Compliance with FHSI and EQ-5D was high and similar between groups. In the ITT population, deterioration in FHSI-8, EQ-5D, and PS was similar between ramucirumab and placebo. In patients with baseline AFP ≥400 ng/mL, ramucirumab significantly reduced deterioration in FHSI-8 at the end of treatment compared with placebo (P = 0.0381), and there was a trend towards a delay in the deterioration of symptoms in FHSI-8 (HR 0.690; P = 0.054) and PS (HR 0.642; P = 0.057) in favour of ramucirumab. We report one of the most comprehensive data sets of QoL and symptom burden in patients undergoing systemic therapy for advanced HCC. Ramucirumab was associated with no worsening of QoL. In patients with baseline AFP ≥400 ng/mL, the significant survival benefit observed in patients treated with ramucirumab was coupled with a trend in patient-focused outcome benefits. NCT01140347. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. The Sustainability of Change in Teacher Beliefs and Practices as a Result of an Overseas Professional Development Course

    ERIC Educational Resources Information Center

    Wong, Ruth

    2013-01-01

    This article examines whether there are changes in students' teaching practices as a result of their experiencing an overseas professional development course (PDC); the process of any such changes; and whether any changes found are sustainable in the long term. Three forms of data gathering are used, lesson observation, in-depth interviews, and…

  2. School Policies and Practices to Improve Health and Prevent Obesity: National Secondary School Survey Results. Volume 2

    ERIC Educational Resources Information Center

    Johnston, Lloyd D.; O'Malley, Patrick M.; Terry-McElrath, Yvonne; Colabianchi, Natalie

    2012-01-01

    This report provides updated results from one of the most comprehensive studies of health-related policies and practices in U.S. public middle and high schools to date, which was released in August 2011. The major findings and trends presented in this report describe issues relevant to childhood obesity for four school years, from 2006-07 to…

  3. [A double-blind nomifensine-nortriptyline trial in ambulatory patients conducted by psychiatrists in private practice: results and comments].

    PubMed

    Coudray, J P; Dufour, H; Garello, J L; Mollo, Y; Pascal, F; Poisson, D; Scotto, J C; Simart, G; Sormani, J; Tourame, G

    1978-06-28

    Nomifensine and nortriptyline were compared in a collaborative trial by psychiatrists in private practice. The trial impiled:--selection of ambulatory depressed patients--randomization in parallel groups (respectively 31 and 34 subjects)--administration in double-blind condition of 4 capsuels daily of either compound during 4 weeks--quotation of depressvie syndrom with Hamilton depression scale before treatment after 2 and 4 weeks. The analysis of results shows clear improvment of depression scores, equivalent in both groups (non significant difference and posterior rejection of an alternative hypothesis). Practical problems encountered in controlled trials in psychiatrist's outpatients are discussed.

  4. Four Years of Practical Arrangements between IAEA and Moscow SIA 'Radon': Preliminary Results - 13061

    SciTech Connect

    Batyukhnova, O.G.; Karlina, O.K.; Neveikin, P.P.

    2013-07-01

    The International Education Training Centre (IETC) at Moscow State Unitary Enterprise Scientific and Industrial Association 'Radon' (SIA 'Radon'), in co-operation with the International Atomic Energy Agency (IAEA), has developed expertise and provided training to waste management personnel for the last 15 years. Since 1997, the educational system of the enterprise with the support of the IAEA has acquired an international character: more than 470 experts from 35 countries- IAEA Member States completed the professional development. Training is conducted at various thematic courses or fellowships for individual programs and seminars on IAEA technical projects. In June 2008 a direct agreement (Practical Arrangements) was signed between SIA 'Radon' and the IAEA on cooperation in the field of development of new technologies, expert's advice to IAEA Member States, and, in particular, the training of personnel in the field of radioactive waste management (RWM), which opens up new perspectives for fruitful cooperation of industry professionals. The paper summarizes the current experience of the SIA 'Radon' in the organization and implementation of the IAEA sponsored training and others events and outlines some of strategic educational elements, which IETC will continue to pursue in the coming years. (authors)

  5. EGFR mutation testing practices within the Asia Pacific region: results of a multicenter diagnostic survey.

    PubMed

    Yatabe, Yasushi; Kerr, Keith M; Utomo, Ahmad; Rajadurai, Pathmanathan; Tran, Van Khanh; Du, Xiang; Chou, Teh-Ying; Enriquez, Ma Luisa D; Lee, Geon Kook; Iqbal, Jabed; Shuangshoti, Shanop; Chung, Jin-Haeng; Hagiwara, Koichi; Liang, Zhiyong; Normanno, Nicola; Park, Keunchil; Toyooka, Shinichi; Tsai, Chun-Ming; Waring, Paul; Zhang, Li; McCormack, Rose; Ratcliffe, Marianne; Itoh, Yohji; Sugeno, Masatoshi; Mok, Tony

    2015-03-01

    The efficacy of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors in EGFR mutation-positive non-small-cell lung cancer (NSCLC) patients necessitates accurate, timely testing. Although EGFR mutation testing has been adopted by many laboratories in Asia, data are lacking on the proportion of NSCLC patients tested in each country, and the most commonly used testing methods. A retrospective survey of records from NSCLC patients tested for EGFR mutations during 2011 was conducted in 11 Asian Pacific countries at 40 sites that routinely performed EGFR mutation testing during that period. Patient records were used to complete an online questionnaire at each site. Of the 22,193 NSCLC patient records surveyed, 31.8% (95% confidence interval: 31.2%-32.5%) were tested for EGFR mutations. The rate of EGFR mutation positivity was 39.6% among the 10,687 cases tested. The majority of samples were biopsy and/or cytology samples (71.4%). DNA sequencing was the most commonly used testing method accounting for 40% and 32.5% of tissue and cytology samples, respectively. A pathology report was available only to 60.0% of the sites, and 47.5% were not members of a Quality Assurance Scheme. In 2011, EGFR mutation testing practices varied widely across Asia. These data provide a reference platform from which to improve the molecular diagnosis of NSCLC, and EGFR mutation testing in particular, in Asia.

  6. Practice improvement as a result of an end of life care programme for care homes.

    PubMed

    Springett, Angela

    2017-03-31

    This article explores practice outcomes from a Six Steps+ programme for end of life care (EoLC) delivered in care homes in the south of England. The education programme aims to increase staff's knowledge, skills and confidence to counter-balance their anxiety about EoLC. The Six Steps+ programme promotes a culture of high quality, compassionate, person-centred and dignified holistic care to meet the needs of residents who may have increasing complex requirements throughout their last year or more of life. Through integrated working and a reduction in avoidable hospital admissions, residents are enabled to die in their place of choice where possible. Case studies show that participating in the Six Steps+ programme increases care home staff's knowledge, skills and confidence and enhances the quality of EoLC for residents. With the cost of the education and support required essentially covered by six avoided hospital admissions throughout the one-year course, the Six Steps+ programme is an attractive and cost-effective approach to improving EoLC.

  7. [Ambulatory medical practice in the French-speaking region of Switzerland (1981-1987). Preliminary results].

    PubMed

    Amport, P; Hausser, D; Lehmann, P; Martin, J; Gutzwiller, F

    1989-01-01

    Between 1981 and 1987, population in the two "cantons" of Vaud and Fribourg increased by 4.5 percent (from 709200 to 740700) but private medical practitioners increased by 26.1 percent (from 971 to 1,224). How did the medical profession adjust itself to such a challenge? The average weekly number of visits reduced (e.g. from 118 to 109 in paediatrics, from 96 to 85 in internal medicine...). Nevertheless, the average duration of each visit did not significantly increase. Consequently, the weekly time devoted to contacts with patients in the office decreased in most specialities (e.g. from 33.9 hours to 31.1 hours in general practice). But the most salient feature was the reduction of time spent by private practitioners in institutions, hospitals or other "medical/social" organizations. The reduction was obvious among internists, surgeons, paediatricians... It was probably caused by the increased number of practitioners. However, "cohort effect" might have played a role in the matter: as the physicians aged, they were less attracted by activities outside their private office. It is noteworthy that all the above figures were observed among the same practitioners, in 1981 and 1987. Moreover, the proportion of patients invited to come back to the physician's office did not grow, the behaviour of the practitioners remaining unchanged during the period. The study also displayed data about a new group of physicians, who were surveyed for the first time in 1987.

  8. Do working environment interventions reach shift workers?

    PubMed

    Nabe-Nielsen, Kirsten; Jørgensen, Marie Birk; Garde, Anne Helene; Clausen, Thomas

    2016-01-01

    Shift workers are exposed to more physical and psychosocial stressors in the working environment as compared to day workers. Despite the need for targeted prevention, it is likely that workplace interventions less frequently reach shift workers. The aim was therefore to investigate whether the reach of workplace interventions varied between shift workers and day workers and whether such differences could be explained by the quality of leadership exhibited at different times of the day. We used questionnaire data from 5361 female care workers in the Danish eldercare sector. The questions concerned usual working hours, quality of leadership, and self-reported implementation of workplace activities aimed at stress reduction, reorganization of the working hours, and participation in improvements of working procedures or qualifications. Compared with day workers, shift workers were less likely to be reached by workplace interventions. For example, night workers less frequently reported that they had got more flexibility (OR 0.5; 95 % CI 0.3-0.7) or that they had participated in improvements of the working procedures (OR 0.6; 95 % CI 0.5-0.8). Quality of leadership to some extent explained the lack of reach of interventions especially among fixed evening workers. In the light of the evidence of shift workers' stressful working conditions, we suggest that future studies focus on the generalizability of results of the present study and on how to reach this group and meet their needs when designing and implementing workplace interventions.

  9. Use of the NHS Choices website for primary care consultations: results from online and general practice surveys

    PubMed Central

    Murray, Joanna; Majeed, Azeem; Khan, Muhammad Saleem; Lee, John Tayu; Nelson, Paul

    2011-01-01

    Objectives To determine the effect of using the NHS Choices website on primary care consultations in England and Wales. We examined the hypothesis that using NHS Choices may reduce the frequency of primary care consultations among young, healthy users. Design Two cross-sectional surveys of NHS Choices users. Setting Survey of NHS Choices users using an online pop-up questionnaire on the NHS Choices website and a snapshot survey of patients in six general practices in London. Participants NHS Choices website users and general practice patients. Main outcome measures For both surveys, we measured the proportion of people using NHS Choices when considering whether to consult their GP practice and on subsequent frequency of primary care consultations. Results Around 59% (n = 1559) of online and 8% (n = 125) of general practice survey respondents reported using NHS Choices in relation to their use of primary care services. Among these, 33% (n = 515) of online and 18% (n = 23) of general practice respondents reported reduced primary care consultations as a result of using NHS Choices. We estimated the equivalent capacity savings in primary care from reduced consultations as a result of using NHS Choices to be approximately £94 million per year. Conclusions NHS Choices has been shown to alter healthcare-seeking behaviour, attitudes and knowledge among its users. Using NHS Choices results in reduced demand for primary care consultations among young, healthy users for whom reduced health service use is likely to be appropriate. Reducing potentially avoidable consultations can result in considerable capacity savings in UK primary care. PMID:21847438

  10. Motion Plan Changes Predictably in Dyadic Reaching

    PubMed Central

    Burdet, Etienne

    2016-01-01

    Parents can effortlessly assist their child to walk, but the mechanism behind such physical coordination is still unknown. Studies have suggested that physical coordination is achieved by interacting humans who update their movement or motion plan in response to the partner’s behaviour. Here, we tested rigidly coupled pairs in a joint reaching task to observe such changes in the partners’ motion plans. However, the joint reaching movements were surprisingly consistent across different trials. A computational model that we developed demonstrated that the two partners had a distinct motion plan, which did not change with time. These results suggest that rigidly coupled pairs accomplish joint reaching movements by relying on a pre-programmed motion plan that is independent of the partner’s behaviour. PMID:27911938

  11. Control of Integrated Task Sequences Shapes Components of Reaching.

    PubMed

    Viswanathan, Priya; Whitall, Jill; Kagerer, Florian A

    2016-01-01

    Reaching toward an object usually consists of a sequence of elemental actions. Using a reaching task sequence, the authors investigated how task elements of that sequence affected feedforward and feedback components of the reaching phase of the movement. Nine right-handed adults performed, with their dominant and nondominant hands, 4 tasks of different complexities: a simple reaching task; a reach-to-grasp task; a reach-to-grasp and lift object task; and a reach-to-grasp, lift, and place object task. Results showed that in the reach-to-grasp and lift object task more time was allocated to the feedforward component of the reach phase, while latency between the task elements decreased. We also found between-hand differences, supporting previous findings of increased efficiency of processing planning-related information in the preferred hand. The presence of task-related modifications supports the concept of contextual effects when planning a movement.

  12. Promoting mammography: results of a randomized trial of telephone counseling and a medical practice intervention.

    PubMed

    Costanza, M E; Stoddard, A M; Luckmann, R; White, M J; Spitz Avrunin, J; Clemow, L

    2000-07-01

    Despite widespread promotion of mammography screening, a distinct minority of women have remained underusers of this effective preventive measure. We sought to measure the effects of barrier-specific telephone counseling (BSTC) and a physician-based educational intervention (MD-ED) on mammography utilization among underusers of mammography screening. This was a randomized controlled trial. Women meeting criteria for mammography underuse at baseline (grouped by practice affiliation) were randomized to a reminder control condition (RC group received annual mailed reminders), BSTC or MD-ED interventions and followed for 3 years. Underuse was defined by failure to get two annual or biannual mammograms over a 2- to 4-year period prior to a baseline survey. The study included 1655 female underusers of mammography aged 50-80 years who were members of two health maintenance organizations (HMO) in central Massachusetts. BSTC consisted of periodic brief, scripted calls from trained counselors to women who had not had a mammogram in the preceding 15 months. Women could receive up to three annual calls during the study. MD-ED consisted of physician and office staff trainings aimed at improving counseling skills and office reminder systems. Self-report of mammography use during the study period was the main outcome measure. Regular use was defined as > or =1 mammogram every 24 months. Forty-four percent in each intervention group became regular users compared to 42% in the RC group. Among subjects who had prior but not recent mammograms at baseline, BSTC was effective (OR=1.48; 95% CI=1.04; 2. 10), and MD-ED marginally effective (OR=1.28; 95% CI=0.88, 1.85). Most recent users at baseline and few never users became regular users (61% and 17%, respectively) regardless of intervention status. Among mammography underusers BSTC modestly increases utilization for former users at a reasonable cost ($726 per additional regular user).

  13. ST-segment Elevation Myocardial Infarction Resulting from Stent Thrombosis in Contemporary Real-World Practice.

    PubMed

    Kanei, Yumiko; Nallu, Kishore; Makker, Parth; Behuria, Supreeti; Fox, John

    2017-03-01

    Stent thrombosis (ST) is a rare but devastating complication after percutaneous coronary intervention. Newer generation drug-eluting stents (DES) and newer antiplatelet therapies have been shown to decrease the incidence of ST, but we continue to observe ST-segment elevation myocardial infarction (STEMI) due to ST in contemporary practice. A retrospective analysis of 527 patients who presented with STEMI was performed; 57 patients (11%) with angiographically confirmed ST were compared with the patients with STEMI due to de novo lesion. The type of previous stent, the timing of ST, and the use of antiplatelet therapy were reviewed in patients with ST. Patients with ST had higher prevalence of comorbid conditions, such as hypertension, diabetes mellitus, and coronary artery disease, and had lower left ventricular ejection fraction (37 ± 5 vs. 44 ± 16%, p = 0.0011). There was no difference in in-hospital mortality (2 vs. 4%, p = 0.7082). ST was seen most commonly as "very late" (56%), and with previous second-generation DES (40%). Eighty-two percent of patients among early ST, compared with 22% of patients with very late ST were on dual antiplatelet therapy (DAPT). In 12% of patients, ST happened after DAPT was stopped by physician for procedures. ST is seen in a variety of clinical settings with the most common presentation being very late ST and in second-generation DES, which most likely represent the growing population with previous second-generation stents.

  14. Buprenorphine/naloxone treatment practices in Malaysia: Results of national surveys of physicians and patients.

    PubMed

    Vicknasingam, B; Dazali, M N M; Singh, D; Schottenfeld, R S; Chawarski, M C

    2015-07-01

    Medication assisted treatment with buprenorphine/naloxone (Bup/Nx), including prescribing and dispensing practices of general practitioners (GPs) in Malaysia and their patients' experiences with this treatment have not been systematically examined. The current study surveyed GPs providing Bup/Nx treatment and patients receiving office-based Bup/Nx treatment in Malaysia. Two cross-sectional surveys of GPs (N=115) providing outpatient Bup/Nx maintenance treatment and of patients (N=253) currently receiving Bup/Nx treatment throughout peninsular Malaysia. Physicians prescribed Bup/Nx dosages in the range of 2-4mg daily for 70% of patients and conducted urine testing in the past month on approximately 16% of their patients. In the patient survey, 79% reported taking daily Bup/Nx doses of 2mg or less; 82% reported that no urine toxicology testing had been conducted on them in the past month, 36% had an opiate positive urine test at the time of the survey, 43% reported illicit opiate use, 15% reported injection of heroin and 22% reported injection of Bup/Nx in the past month. Low daily Bup/Nx doses, lack of behavioral monitoring or counseling, and high rates of continued drug use, including injection of drugs and medications during Bup/Nx treatment in Malaysia, indicate continuing problems with implementation and less than optimal treatment effectiveness. High cost of Bup/Nx in Malaysia may deter patients from seeking treatment and contribute to taking low Bup/Nx dosages. Improved training of physicians and establishing standards for Bup/Nx dosing, routine toxicology testing, and counseling may be needed to improve care and treatment response. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. STRATEGIES OF USING SURFACTANT: RESULTS OF THE FIRST POLISH NATIONAL SURVEY OF DAILY PRACTICE.

    PubMed

    Borszewska-Kornacka, Maria Katarzyna; Kostuch, Marzena; Korbal, Piotr; Krajewski, Paweł

    2015-01-01

    The efficiency of routine practices in the management of neonatal respiratory distress syndrome (RDS) have never been systematically investigated in Poland. To evaluate RDS treatment policies and short-term outcomes in neonatal intensive care units (NICUs). We retrospectively analyzed medical records of premature neonates ≤ 32 weeks' gestation, diagnosed with RDS in level-2 and level-3 referral centers. Collected data: comprised clinical variables, antenatal corticosteroids, respiratory support, surfactant (SFT) policies and short-term outcomes. Data of 987 infants from 53 NICUs were analyzed. The median gestational age was 29 weeks (range 22-32) and birth weight 1190 g (range 340-2860). Infants requiring SFT had significantly lower exposure to antenatal corticosteroids (75%) vs. those managed without SFT (83%, p = 0.006). SFT was given to 59% infants in level-3 NICUs and 40% in level-2. There was significant variability of SFT use between level 2 and level 3 NICU. (9% to 100%). Poractant alfa was most commonly used (97%) in the median initial dose of 170 mg/kg (IQR 120-200). Single application was most frequent (79.8%). SFT administration methods were endotracheal instillation in babies maintained on mechanical ventilation (68.0%), INSURE (27.6%) and minimally-invasive delivery (MIST) 4.4%. Early rescue treatment remained core SFTstrategy (57.4% cases), while prophylaxis accounted for only 13.3% cases. There is considerable variation in the frequency of use of surfactant in Polish neonatal centers. Traditional intratracheal instillation with subsequent mechanical ventilation dominates, although newer methods INSURE and MIST are becoming increasingly popular. Early rescue SFT is a predominant strategy, which conforms to current standards. The rate of antenatal corticosteroids remains too low.

  16. Metastatic colorectal cancer KRAS genotyping in routine practice: results and pitfalls.

    PubMed

    Lamy, Aude; Blanchard, France; Le Pessot, Florence; Sesboüé, Richard; Di Fiore, Frédéric; Bossut, Jessie; Fiant, Elodie; Frébourg, Thierry; Sabourin, Jean-Christophe

    2011-08-01

    KRAS genotyping is mandatory before anti-epidermal growth factor receptor monoclonal antibody therapy in metastatic colorectal cancer, which is the second leading cause of cancer-related death in the United States and in Europe. Thus, large-scale KRAS mutation screening is needed for efficient patient management and in the future metastatic colorectal cancer genotyping might also include the detection of the BRAF V600E mutation, which is a very strong negative prognostic factor in colorectal cancer. We report our experience of routine KRAS/BRAF mutation screening practice performed on 1130 formalin-fixed paraffin-embedded tumor samples from 992 colorectal cancer patients. DNA was extracted from macrodissected tumor areas highlighted by a pathologist, KRAS codons 12/13 and BRAF V600E mutations were assessed in a single SNaPshot® multiplex assay and each mutation was confirmed by an independent analysis. KRAS and BRAF mutations were, respectively, present in 41.8 and 6.5% of the tumor samples. If KRAS and BRAF mutations were mutually exclusive, four samples presented two concomitant KRAS mutations. Genotyping of paired primary tumors and metastases from 44 patients indicated that 5 patients (11.4%) presented discordant KRAS mutational status. KRAS genotype heterogeneity was also observed within primary tumor sites in seven cases. Non-reproducible KRAS artefactual mutations were detected in 53 samples (4.7%). We found that the prominent mechanism leading to these artefactual mutations was the fragmentation of DNA occurring during tissue processing. Routine KRAS genotyping performed on formalin-fixed paraffin-embedded tissues requires, therefore, the development of quality control scheme for molecular pathology, especially because of DNA damages induced by formalin fixation. The tumor heterogeneity observed in some patients indicates that it should be more appropriate to perform KRAS genotyping on metastases if sample is available.

  17. Gynecologic oncologists' attitudes and practices relating to integrative medicine: results of a nationwide AGO survey.

    PubMed

    Klein, Evelyn; Beckmann, Matthias W; Bader, Werner; Brucker, Cosima; Dobos, Gustav; Fischer, Dorothea; Hanf, Volker; Hasenburg, Annette; Jud, Sebastian M; Kalder, Matthias; Kiechle, Marion; Kümmel, Sherko; Müller, Andreas; Müller, Myrjam-Alice T; Paepke, Daniela; Rotmann, Andre-Robert; Schütz, Florian; Scharl, Anton; Voiss, Petra; Wallwiener, Markus; Witt, Claudia; Hack, Carolin C

    2017-08-01

    The growing popularity and acceptance of integrative medicine is evident both among patients and among the oncologists treating them. As little data are available regarding health-care professionals' knowledge, attitudes, and practices relating to the topic, a nationwide online survey was designed. Over a period of 11 weeks (from July 15 to September 30, 2014) a self-administered, 17-item online survey was sent to all 676 members of the Research Group on Gynecological Oncology (Arbeitsgemeinschaft Gynäkologische Onkologie) in the German Cancer Society. The questionnaire items addressed the use of integrative therapy methods, fields of indications for them, advice services provided, level of specific qualifications, and other topics. Of the 104 respondents (15.4%) using integrative medicine, 93% reported that integrative therapy was offered to breast cancer patients. The second most frequent type of tumor in connection with which integrative therapy methods were recommended was ovarian cancer, at 80% of the participants using integrative medicine. Exercise, nutritional therapy, dietary supplements, herbal medicines, and acupuncture were the methods the patients were most commonly advised to use. There is considerable interest in integrative medicine among gynecological oncologists, but integrative therapy approaches are at present poorly implemented in routine clinical work. Furthermore there is a lack of specific training. Whether future efforts should focus on extending counseling services on integrative medicine approaches in gynecologic oncology or not, have to be discussed. Evidence-based training on integrative medicine should be implemented in order to safely guide patients in their wish to do something by themselves.

  18. California Achievement Tests: A Practical Guide for Using and Interpreting the Results.

    ERIC Educational Resources Information Center

    Pruett, Kathy E.

    The booklet was designed to help each recipient of the California Achievement Test (CAT) reports to understand the general format of the reports, the abbreviations and symbols used, and the types of scores presented. It was also intended to assist in interpreting CAT results and using these results at each level of the educational process to best…

  19. Practice and Repetition during Exam Preparation in Blended Learning Courses: Correlations with Learning Results

    ERIC Educational Resources Information Center

    Andergassen, Monika; Mödritscher, Felix; Neumann, Gustaf

    2014-01-01

    Learner-centric research on factors influencing learning results has focused, among other things, on student characteristics, demographic data, and usage patterns in learning management systems (LMSs). This paper complements the existing research by investigating potential correlations between learning results and LMS usage during exam…

  20. Nuclear Cardiology Practice in Asia: Analysis of Radiation Exposure and Best Practice for Myocardial Perfusion Imaging - Results From the IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS).

    PubMed

    Pascual, Thomas N B; Mercuri, Mathew; El-Haj, Noura; Bom, Henry Hee-Sung; Lele, Vikram; Al-Mallah, Mouaz H; Luxenburg, Osnat; Karthikeyan, Ganesan; Vitola, Joao; Mahmarian, John J; Better, Nathan; Shaw, Leslee J; Rehani, Madan M; Kashyap, Ravi; Paez, Diana; Dondi, Maurizio; Einstein, Andrew J

    2017-03-24

    This paper examines the current status of radiation exposure to patients in myocardial perfusion imaging (MPI) in Asia.Methods and Results:Laboratories voluntarily provided information on MPI performed over a 1-week period. Eight best practice criteria regarding MPI were predefined by an expert panel. Implementation of ≥6 best practices (quality index [QI] ≥6) was pre-specified as a desirable goal for keeping radiation exposure at a low level. Radiation effective dose (ED) in 1,469 patients and QI of 69 laboratories in Asia were compared against data from 239 laboratories in the rest of the world (RoW). Mean ED was significantly higher in Asia (11.4 vs. 9.6 mSv; P<0.0001), with significantly lower doses in South-East vs. East Asia (9.7 vs. 12.7 mSv; P<0.0001). QI in Asia was lower than in RoW. In comparison with RoW, Asian laboratories used thallium more frequently, used weight-based technetium dosing less frequently, and trended towards a lower rate of stress-only imaging. MPI radiation dose in Asia is higher than that in the RoW and linked to less consistent use of laboratory best practices such as avoidance of thallium, weight-based dosing, and use of stress-only imaging. Given that MPI is performed in Asia within a diverse array of medical contexts, laboratory-specific adoption of best practices offers numerous opportunities to improve quality of care.

  1. ICU Attending Handoff Practices: Results From a National Survey of Academic Intensivists.

    PubMed

    Lane-Fall, Meghan B; Collard, Meredith L; Turnbull, Alison E; Halpern, Scott D; Shea, Judy A

    2016-04-01

    To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs. Cross-sectional electronic survey administered in 2014. One hundred sixty-nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education. Academic intensivists were recruited via e-mail invitation from a database of 1,712 eligible academic intensivists. None. Six hundred sixty-one intensivists completed the survey (completion rate, 38.6%). Responses were received from at least one individual at 147 of 169 unique hospitals (87.0%) represented in the study database. Five hundred seventy-three (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs, including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0 to 100 (SD, 22.6). Respondents (55.4%) said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 respondents (11.5%) expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. Two hundred respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, and death) attributable to inadequate attending handoffs. ICU attending handoffs in the United States exhibit marked heterogeneity, and

  2. Modelling Study at Kutlular Copper FIELD with Spat This Study, Evaluation Steps of Copper Mine Field SP Data Are Shown How to Reach More Accurate Results for SP Inversion Method.

    NASA Astrophysics Data System (ADS)

    Sahin, O. K.; Asci, M.

    2014-12-01

    At this study, determination of theoretical parameters for inversion process of Trabzon-Sürmene-Kutlular ore bed anomalies was examined. Making a decision of which model equation can be used for inversion is the most important step for the beginning. It is thought that will give a chance to get more accurate results. So, sections were evaluated with sphere-cylinder nomogram. After that, same sections were analyzed with cylinder-dike nomogram to determine the theoretical parameters for inversion process for every single model equations. After comparison of results, we saw that only one of them was more close to parameters of nomogram evaluations. But, other inversion result parameters were different from their nomogram parameters.

  3. Use of hyperlinks in electronic test result communication: a survey study in general practice

    PubMed Central

    2012-01-01

    Background Information is essential in healthcare. Recording, handling and sharing healthcare information is important in order to ensure high quality of delivered healthcare. Information and communication technology (ICT) may be a valuable tool for handling these challenges. One way of enhancing the exchange of information could be to establish a link between patient-specific and general information sent to the general practitioner (GP). The aim of the present paper is to study GPs' use of a hyperlink inserted into electronic test result communication. Methods We inserted a hyperlink into the electronic test result communication sent to the patients’ GPs who participated in a regional, systematic breast cancer screening program. The hyperlink target was a web-site with information on the breast cancer screening program and breast cancer in general. Different strategies were used to increase the GPs’ use of this hyperlink. The outcome measure was the GPs’ self-reported use of the link. Data were collected by means of a one-page paper-based questionnaire. Results The response rate was 73% (n=242). In total, 108 (45%) of the GPs reported to have used the link. In all, 22% (n=53) of the GPs used the web-address from a paper letter and 37% (n=89) used the hyperlink in the electronic test result communication (Δ = 15%[95%confidence  int erval(CI) = 8 − 22%P < 0.001]). We found no statistically significant associations between use of the web-address/hyperlink and the GP’s gender, age, or attitude towards mammography screening. Conclusions The results suggest that hyperlinks in electronic test result communication could be a feasible strategy for combining and sharing different types of healthcare information. PMID:23035761

  4. Unconstrained reaching modulates eye-hand coupling

    PubMed Central

    Lee, Dongpyo; Poizner, Howard; Corcos, Daniel M.; Henriques, Denise Y.

    2013-01-01

    Eye-hand coordination is a crucial element of goal-directed movements. However, few studies have looked at the extent to which unconstrained movements of the eyes and hand made to targets influence each other. We studied human participants who moved either their eyes, or both their eyes and hand to one of three static or flashed targets presented in 3D space. The eyes were directed and hand located at a common start position on either the right or left side of the body. We found that the velocity and scatter of memory-guided saccades (flashed targets) differed significantly when produced in combination with a reaching movement than when produced alone. Specifically, when accompanied by a reach, peak saccadic velocities were lower than when the eye moved alone. Peak saccade velocities, as well as latencies, were also highly correlated with those for reaching movements, especially for the briefly flashed targets compared to the continuous visible target. The scatter of saccade endpoints was greater when the saccades were produced with the reaching movement than when produced without, and the size of the scatter for both saccades and reaches were weakly correlated. These findings suggest that the saccades and reaches made to 3D targets are weakly to moderately coupled both temporally and spatially, and that this is partly the result of the arm movement influencing the eye movement. Taken together this study provides further evidence that the oculomotor and arm motor systems interact above and beyond any common target representations shared by the two motor systems. PMID:24121521

  5. Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study.

    PubMed

    Carbajal, Ricardo; Eriksson, Mats; Courtois, Emilie; Boyle, Elaine; Avila-Alvarez, Alejandro; Andersen, Randi Dovland; Sarafidis, Kosmas; Polkki, Tarja; Matos, Cristina; Lago, Paola; Papadouri, Thalia; Montalto, Simon Attard; Ilmoja, Mari-Liis; Simons, Sinno; Tameliene, Rasa; van Overmeire, Bart; Berger, Angelika; Dobrzanska, Anna; Schroth, Michael; Bergqvist, Lena; Lagercrantz, Hugo; Anand, Kanwaljeet J S

    2015-10-01

    assessments were recorded in 1250 (58%) of 2138, 672 (45%) of 1493, and 916 (30%) of 3017 neonates in the TV, NIV, and SV groups, respectively (p<0.0001). In the univariate analysis, neonates given O-SH-GA in the TV group needed a longer duration of TV than did those who were not given O-SH-GA (mean 136.2 h [SD 173.1] vs 39.8 h [94.7] h; p<0.0001). Multivariable and propensity score analyses confirmed this association (p<0.0001). Wide variations in sedation and analgesia practices occur between NICUs and countries. Widespread use of O-SH-GA in intubated neonates might prolong their need for mechanical ventilation, but further research is needed to investigate the therapeutic and adverse effects of O-SH-GA in neonates, and to develop new and safe approaches for sedation and analgesia. European Community's Seventh Framework Programme. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years

    PubMed Central

    Samos, Franziska-Antonia; Heise, Marcus; Fuchs, Stephan; Mittmann, Susanne; Bauer, Alexander; Klement, Andreas

    2017-01-01

    Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project

  7. Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years.

    PubMed

    Samos, Franziska-Antonia; Heise, Marcus; Fuchs, Stephan; Mittmann, Susanne; Bauer, Alexander; Klement, Andreas

    2017-01-01

    Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project

  8. Incentive Pay Programs Do Not Affect Teacher Motivation or Reported Practices: Results from Three Randomized Studies

    ERIC Educational Resources Information Center

    Yuan, Kun; Le, Vi-Nhuan; McCaffrey, Daniel F.; Marsh, Julie A.; Hamilton, Laura S.; Stecher, Brian M.; Springer, Matthew G.

    2013-01-01

    This study drew on teacher survey responses from randomized experiments exploring three different pay-for-performance programs to examine the extent to which these programs motivated teachers to improve student achievement and the impact of such programs on teachers' instruction, number of hours worked, job stress, and collegiality. Results showed…

  9. Analyzing data in aquaculture: practical significance, a new paradigm for determining the importance of results

    USDA-ARS?s Scientific Manuscript database

    Analyzing data and interpreting results is often the most difficult and yet important part of the scientific research process. Currently, aquaculture researchers almost exclusively employ null hypothesis significance testing (NHST), a synthesis of the Fisher test of significance and the Neyman-Pears...

  10. Practical Model and Protocol for Interpreting MCMI-III Results to Clients.

    ERIC Educational Resources Information Center

    Staley, Joy D.; Brown, Nathan C.

    One ethical dilemma for psychologists is finding methods to share test results with their clients in such a way that the client is not deleteriously labeled, but is encouraged by the knowledge of assessed strength and growth areas. This paper offers one answer by presenting a structured protocol that draws on an iceberg metaphor for categorizing…

  11. Practical implementation issues and challenges for biobanks in the return of individual research results

    PubMed Central

    Bledsoe, Marianna J.; Grizzle, William E.; Clark, Brian J.; Zeps, Nikolajs

    2012-01-01

    Whether or not to give research results back to individuals whose specimens are used for biomedical research is a subject of considerable controversy. Much of the debate has been focused around the ethical and legal concerns with some consideration of broader social issues such as whether or not people will be affected by such information for employment or health care. Much less attention has been paid to biobanks that collect the specimens used to generate the research findings and the issues and operational requirements for implementing return of individual research results. In this article, we give the biobanks’ perspective and highlight that given the diversity among the types of biobanks, it may be difficult to design and implement a blanket policy in this complex area. We discuss the variability in the types of biobanks and some important issues that should be considered in determining whether or not research results should be provided to individuals whose specimens are used in biomedical research. We also discuss challenges that should be considered in implementing any approaches to the return of research results. PMID:22323073

  12. Changes in the genetic diversity of eastern hemlock as a result of different forest management practices

    Treesearch

    Gary J. Hawley; Donald H. DeHayes; John C. Brissette

    2000-01-01

    Loss of populations and individuals within species to human-induced selective forces can result in loss of specific genes and overall genetic diversity upon which productivity, ecosystem stability, long-term survival, and evolution depend. This is particularly true for long-lived organisms, such as forest trees, because genetic diversity confers adaptability necessary...

  13. Enabling a Community of Practice: Results of the LSCHE Web Portal Survey

    ERIC Educational Resources Information Center

    Hoff, Meagan A.; Hodges, Russ; Lin, Yuting; McConnell, Michael C.

    2017-01-01

    The study explored usage patterns of the Learning Support Centers in Higher Education (LSCHE) web portal, an open educational resource (OER) that serves learning support center professionals. Results of an online survey taken by LSCHE users (N = 41) tracked their self-reported usage and perceived value of resources on the web portal, which…

  14. Challenging Segregational Practices in a Spanish Secondary School: Results from an Ethnographic Research

    ERIC Educational Resources Information Center

    Sanchez-Valero, Joan-Anton; Padilla-Petry, Paulo

    2016-01-01

    This article presents partial results of a multi-sited ethnographic study about the role of multiple literacies in young people's learning in and outside school. In one of the five participant secondary schools, fourth grade students were segregated in groups according to their special needs. We start with a critical review on segregated and…

  15. Migration of Blacks and Resulting Discriminatory Practices in Washington State between 1940 and 1950.

    ERIC Educational Resources Information Center

    Taylor, Quintard

    1978-01-01

    The migration of Blacks into the state of Washington brought about an increase in Black political influence, the strengthening of Black rights organizations and social service groups, and the passage of civil rights legislation. It also resulted in increased racial tension in many cities and overcrowding in Black residential areas. (Author/MC)

  16. Policy Impacts on Pedagogical Practice and ICT Use: An Exploration of the Results from Sites 2006

    ERIC Educational Resources Information Center

    Law, N.; Lee, M. W.; Chan, A.

    2010-01-01

    The Second Information Technology in Education Study (SITES) 2006 results reveal that principals' perceived presence of lifelong learning-related pedagogical activities in their schools had changed markedly since the same data was collected in 1998 in SITES-M1. More intriguing was the fact that the directions of the changes were quite different…

  17. Practical experience and results with an advanced on-line gasoline blend optimization system

    SciTech Connect

    Serpemen, Y.; Baumeister, K.H.; Hubel, A.; Raichel, P. )

    1989-01-01

    Refinery profit margins increased significantly by using the on-line gasoline blend optimization system which allows considerable savings resulting from octane give-away reduction, appreciably enhanced butane utilization, optimum use of the available blend components, and increased operating flexibility by elimination of reblends. The experience with this advanced on-line blending system is described in this paper.

  18. Publication and non-publication of drug trial results: a 10-year cohort of trials in Norwegian general practice

    PubMed Central

    Brænd, Anja Maria; Straand, Jørund; Jakobsen, Rune Bruhn; Klovning, Atle

    2016-01-01

    Objectives Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998–2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. Design Cohort study of trials with systematic searches for published results. Setting Clinical drug trials in Norwegian general practice. Methods We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. Main outcome measures We determined the frequency of publication of trial results and trial characteristics associated with publication of results. Results Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ2 test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. Conclusions We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published. PMID:27067893

  19. Publication and non-publication of drug trial results: a 10-year cohort of trials in Norwegian general practice.

    PubMed

    Brænd, Anja Maria; Straand, Jørund; Jakobsen, Rune Bruhn; Klovning, Atle

    2016-04-11

    Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998-2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. Cohort study of trials with systematic searches for published results. Clinical drug trials in Norwegian general practice. We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. We determined the frequency of publication of trial results and trial characteristics associated with publication of results. Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ(2) test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  20. The Intego database: background, methods and basic results of a Flemish general practice-based continuous morbidity registration project.

    PubMed

    Truyers, Carla; Goderis, Geert; Dewitte, Harrie; Akker, Marjan vanden; Buntinx, Frank

    2014-06-06

    Intego is the only operational computerized morbidity registration network in Belgium based on general practice data. Intego collects data from over 90 general practitioners. All the information is routinely collected in the electronic health record during daily practice. In this article we describe the design and methods used within the Intego network together with some of its basic results. The collected data, the quality control procedures, the ethical-legal aspects and the statistical procedures are discussed. Intego contains longitudinal information on 285 357 different patients, corresponding to over 2.3% of the Flemish population representative in terms of age and sex. More than 3 million diagnoses, 12 million drug prescriptions and 29 million laboratory tests have been recorded. Intego enables us to present and compare data on health parameters, incidence and prevalence rates, laboratory results, and prescribed drugs for all relevant subgroups on a routine basis and is unique in Belgium.

  1. Components of patient satisfaction with a dental restorative visit: results from The Dental Practice- Based Research Network

    PubMed Central

    Riley, Joseph L.; Rindal, D. Brad; Fellows, Jeffrey L.; Qvist, Vibeke; Patel, Sagar; Foy, Pat; Williams, O. Dale; Gilbert, Gregg H.

    2011-01-01

    Objectives Identify components of patient satisfaction with a dental restorative visit; and test the hypothesis that certain dentist, patient, and procedural factors are associated with patient satisfaction. Methods 197 practices in The Dental Practice-Based Research Network (DPBRN) recruited consecutive patients with defective restorations that were replaced or repaired in permanent teeth. At the end of the treatment visit, each subject was asked to complete a satisfaction survey and mail it directly to the DPBRN Regional Coordinators. Results Analysis of 5,879 satisfaction surveys revealed three satisfaction components which were interpersonal relationship-comfort attributes; material choice-value factors; and sensory-evaluative features. Satisfaction was highest among patients who received care in a private practice model; when the restoration was repaired rather than replaced; or when the restored tooth was not a molar. Conclusion These data suggest that a patient’s judgments of dentist’s skills and quality of care are based on personal interactions with the dentist, the level of comfort, and post-treatment sensitivity. These conclusions have direct implications for patient management before, during and after the procedure. Practice implications When taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the service provided, facilitating a focus on what each patient values most. PMID:22942147

  2. Cardiological biopharmaceuticals in the conception of drug targeting delivery: practical results and research perspectives.

    PubMed

    Maksimenko, A V

    2012-07-01

    The results of the clinical use of thrombolytic and antithrombotic preparations developed on the basis of protein conjugates obtained within the framework of the conception of drug targeting delivery in the organism are considered. A decrease has been noted in the number of biomedical projects focused on these derivatives as a result of various factors: the significant depletion of financial and organizational funds, the saturation of the pharmaceutical market with preparations of this kind, and the appearance of original means for interventional procedures. Factors that actively facilitate the conspicuous potentiation of the efficacy of bioconjugates were revealed: the biomedical testing of protein domains and their selected combinations, the optimization of molecular sizes for the bioconjugates obtained, the density of target localization, the application of cell adhesion molecules as targets, and the application of connected enzyme activities. Enzyme antioxidants and the opportunity for further elaboration of the drug delivery conception via the elucidation and formation of therapeutic targets for effective drug reactions by means of pharmacological pre- and postconditioning of myocardium arouse significant interest.

  3. [Biofeedback for urinary bladder dysfunctions in childhood. Indications, practice and the results of therapy].

    PubMed

    Hoang-Böhm, J; Lusch, A; Sha, W; Alken, P

    2004-07-01

    In children, abnormal behavior during micturition, i.e. detrusor/sphincter dyscoordination, causes persistent voiding problems, urinary incontinence and/or recurrent urinary tract infections in up to 15% of cases. Contractions of the external urethral sphincter during micturition lead to functional subvesical obstruction. Nowadays, biofeedback training is the most suitable therapy. Biofeedback training for children is based on the assumption that relaxation and contraction of the urinary external sphincter is a habitual phenomenon and can be restored. With specially developed, computer-assisted biofeedback programs, sphincter contraction and relaxation can be transformed into acoustic or visual signals. Acoustic or optical feedback indicates relaxation and contraction control to the patient. The residual urine volume should subsequently be assessed. The results should be reviewed after each micturition. Poor compliance sometimes makes biofeedback training impossible. Further biofeedback training at home is a reasonable suggestion. Good results-a response rate of up to 90%-demonstrates that biofeedback training is successful in the treatment of detrusor-sphincter dyscoordination. After effective therapy, associated urinary tract infections and vesicoureterorenal reflux may disappear.

  4. [Practice report: the process-based indicator dashboard. Visualising quality assurance results in standardised processes].

    PubMed

    Petzold, Thomas; Hertzschuch, Diana; Elchlep, Frank; Eberlein-Gonska, Maria

    2014-01-01

    Process management (PM) is a valuable method for the systematic analysis and structural optimisation of the quality and safety of clinical treatment. PM requires a high motivation and willingness to implement changes of both employees and management. Definition of quality indicators is required to systematically measure the quality of the specified processes. One way to represent comparable quality results is the use of quality indicators of the external quality assurance in accordance with Sect. 137 SGB V—a method which the Federal Joint Committee (GBA) and the institutions commissioned by the GBA have employed and consistently enhanced for more than ten years. Information on the quality of inpatient treatment is available for 30 defined subjects throughout Germany. The combination of specified processes with quality indicators is beneficial for the information of employees. A process-based indicator dashboard provides essential information about the treatment process. These can be used for process analysis. In a continuous consideration of these indicator results values can be determined and errors will be remedied quickly. If due consideration is given to these indicators, they can be used for benchmarking to identify potential process improvements.

  5. Automated antibody structure prediction using Accelrys tools: results and best practices.

    PubMed

    Fasnacht, Marc; Butenhof, Ken; Goupil-Lamy, Anne; Hernandez-Guzman, Francisco; Huang, Hongwei; Yan, Lisa

    2014-08-01

    We describe the methodology and results from our participation in the second Antibody Modeling Assessment experiment. During the experiment we predicted the structure of eleven unpublished antibody Fv fragments. Our prediction methods centered on template-based modeling; potential templates were selected from an antibody database based on their sequence similarity to the target in the framework regions. Depending on the quality of the templates, we constructed models of the antibody framework regions either using a single, chimeric or multiple template approach. The hypervariable loop regions in the initial models were rebuilt by grafting the corresponding regions from suitable templates onto the model. For the H3 loop region, we further refined models using ab initio methods. The final models were subjected to constrained energy minimization to resolve severe local structural problems. The analysis of the models submitted show that Accelrys tools allow for the construction of quite accurate models for the framework and the canonical CDR regions, with RMSDs to the X-ray structure on average below 1 Å for most of these regions. The results show that accurate prediction of the H3 hypervariable loops remains a challenge. Furthermore, model quality assessment of the submitted models show that the models are of quite high quality, with local geometry assessment scores similar to that of the target X-ray structures.

  6. [The results of the practical use of the destructive peritonitis' standartized treatment].

    PubMed

    Miller, S V; Vinnik, Iu S; Tepliakova, O V

    2012-01-01

    The results of inspection and treatment 117 patients with an acute destructive pancreatitis from 1998 to 2010 are presented. Distinguishing features of management approach of the patients, which was hospitalized in clinic from 2005 to 2010, were high frequency of octreotide use, de-escalated orientation of antibacterial therapy, without early laparotomy interventions and expansion of indications to program sanitation by development of widespread forms of infected pancreatic necrosis. Achievements of intensive therapy of last years and change of surgical tactics have allowed to reduce postoperative mortality by sterile necrosis from 21.1 to 11.8%, to reduce frequency of infected pancreatic necrosis from 68.3 to 40.4%. Development of the infected pancreatic necrosis accompanied by statistically significant growth of frequency of local purulent complications and the tendency to increase--extended.

  7. Consumer home refrigeration practices: results of a web-based survey.

    PubMed

    Kosa, Katherine M; Cates, Sheryl C; Karns, Shawn; Godwin, Sandria L; Chambers, Delores

    2007-07-01

    To reduce bacterial growth and to ensure the quality and safety of food products, the U.S. Department of Agriculture and the U.S. Food and Drug Administration advise consumers to clean their refrigerators regularly, use a refrigerator thermometer, and keep refrigerator temperatures at 40 degrees F (4.4 degrees C) or below. We conducted a nationally representative Web-enabled survey (n = 2,060) to collect data on refrigerator thermometer ownership, home refrigerator temperatures, and the frequency of home refrigerator cleaning. We stratified the sample to provide results for pregnant women, older adults (60 years or older), and the remaining population. About half of all respondents had cleaned their refrigerators at least 1 month before the survey. Only 11% of all respondents had a thermometer in their refrigerator before the survey. Older adults (77.5%) were more likely than the remaining population (70.4%) to have their refrigerators at the recommended temperature (P < 0.01). Older adults who were not married and who lived alone were less likely to have refrigerator thermometers and to have their refrigerators at a recommended temperature (P < 0.05). For all respondents, those who had previously owned a refrigerator thermometer were more likely to have their refrigerators at the recommended temperature than were respondents who did not previously own a thermometer (P < 0.01). Food safety educators can use the survey findings and results of previous research to target educational materials and help consumers, especially those at risk for listeriosis, to safely store refrigerated foods at home.

  8. Adoption potential of conservation agriculture practices in sub-Saharan Africa: results from five case studies.

    PubMed

    Ndah, Hycenth Tim; Schuler, Johannes; Uthes, Sandra; Zander, Peter; Traore, Karim; Gama, Mphatso-S; Nyagumbo, Isaiah; Triomphe, Bernard; Sieber, Stefan; Corbeels, Marc

    2014-03-01

    Despite the reported benefits of conservation agriculture (CA), its wider up-scaling in Sub-Saharan Africa (SSA) has remained fairly limited. This paper shows how a newly developed qualitative expert assessment approach for CA adoption (QAToCA) was applied to determine its adoption potential in SSA. CA adoption potential is not a predictor of observed adoption rates. Instead, our aim was to systematically check relevant factors that may be influencing its adoption. QAToCA delivers an assessment of how suitable conditions "and thus the likelihood for CA adoption" are. Results show that the high CA adoption potentials exhibited by the Malawi and Zambia case relate mostly to positive institutional factors. On the other hand, the low adoption potential of the Zimbabwe case, in spite of observed higher estimates, is attributed mainly to unstable and less secured market conditions for CA. In the case of Southern Burkina Faso, the potential for CA adoption is determined to be high, and this assessment deviates from lower observed figures. This is attributed mainly to strong competition of CA and livestock for residues in this region. Lastly, the high adoption potential found in Northern Burkina Faso is explained mainly by the fact that farmers here have no alternative other than to adopt the locally adapted CA system-Zaï farming. Results of this assessment should help promoters of CA in the given regions to reflect on their activities and to eventually adjust or redesign them based on a more explicit understanding of where problems and opportunities are found.

  9. Downstream consequences of melanoma screening in a community practice setting: First results.

    PubMed

    Weinstock, Martin A; Ferris, Laura K; Saul, Melissa I; Geller, Alan C; Risica, Patricia M; Siegel, Julia A; Solano, Francis X; Kirkwood, John M

    2016-10-15

    Population-based screening for the early detection of melanoma holds great promise for reducing melanoma mortality, but evidence is needed to determine whether benefits outweigh risks. Skin surgeries and dermatology visits after screening were assessed to indicate potential physical, psychological, and financial consequences. Targeted primary care providers (PCPs) at the University of Pittsburgh Medical Center were trained to detect early melanoma using the INFORMED (INternet course FOR Melanoma Early Detection) program. The authors analyzed aggregated administrative data describing 3 groups of patients aged ≥35 years who had received an annual physical examination by PCPs: group A1 included patients of PCPs from the group with the highest percentage of INFORMED-trained providers, group A2 included patients of PCPs from the group with a lower percentage of INFORMED-trained providers, and group B included patients of PCPs without INFORMED training. INFORMED-trained PCPs screened 1572 of 16,472 patients in groups A1 or A2 and none of the 56,261 patients in group B. In group A1, there was a 79% increase (95% confidence interval, 15%-138%) in melanoma diagnoses noted; no increase was observed for the other groups, and no substantial increase in skin surgeries or dermatology visits occurred in any group. A large-scale melanoma screening using the INFORMED program was conducted in Pennsylvania. To the best of the authors' knowledge, the current study is the first analysis of downstream results and the findings indicate increased melanoma diagnoses but little impact on skin surgeries or dermatology visits. This result provides some reassurance that such efforts can be conducted without major adverse consequences, at least as measured by these parameters, and therefore should be considered for more widespread use. Cancer 2016;122:3152-6. © 2016 American Cancer Society. © 2016 American Cancer Society.

  10. Adoption Potential of Conservation Agriculture Practices in Sub-Saharan Africa: Results from Five Case Studies

    NASA Astrophysics Data System (ADS)

    Ndah, Hycenth Tim; Schuler, Johannes; Uthes, Sandra; Zander, Peter; Traore, Karim; Gama, Mphatso-S.; Nyagumbo, Isaiah; Triomphe, Bernard; Sieber, Stefan; Corbeels, Marc

    2014-03-01

    Despite the reported benefits of conservation agriculture (CA), its wider up-scaling in Sub-Saharan Africa (SSA) has remained fairly limited. This paper shows how a newly developed qualitative expert assessment approach for CA adoption (QAToCA) was applied to determine its adoption potential in SSA. CA adoption potential is not a predictor of observed adoption rates. Instead, our aim was to systematically check relevant factors that may be influencing its adoption. QAToCA delivers an assessment of how suitable conditions "and thus the likelihood for CA adoption" are. Results show that the high CA adoption potentials exhibited by the Malawi and Zambia case relate mostly to positive institutional factors. On the other hand, the low adoption potential of the Zimbabwe case, in spite of observed higher estimates, is attributed mainly to unstable and less secured market conditions for CA. In the case of Southern Burkina Faso, the potential for CA adoption is determined to be high, and this assessment deviates from lower observed figures. This is attributed mainly to strong competition of CA and livestock for residues in this region. Lastly, the high adoption potential found in Northern Burkina Faso is explained mainly by the fact that farmers here have no alternative other than to adopt the locally adapted CA system—Zaï farming. Results of this assessment should help promoters of CA in the given regions to reflect on their activities and to eventually adjust or redesign them based on a more explicit understanding of where problems and opportunities are found.

  11. Survey results of the training, nutrition, and mental preparation of triathletes: practical implications of findings.

    PubMed

    Dolan, Shawn H; Houston, Melinda; Martin, Scott B

    2011-07-01

    Although triathlon is growing in popularity at a remarkable rate, it has not been extensively studied. The aims of this research were to identify preparation strategies used by triathletes and to categorize these strategies according to gender and consultation with triathlon coaches. Survey data collected from 401 triathletes (207 males, 194 females) revealed training, nutritional, and mental preparation habits. Most participants engaged in strength training, consumed food and/or fluids during and after training, set training and competition goals, and applied mental preparation strategies during training and the hour before racing. Water was the most commonly consumed fluid; positive self-talk was the most used mental strategy. Participants were more likely to consult with a triathlon coach than a nutrition or sport psychology professional. Athletes with more years of experience in triathlon and those competing in longer distances were more likely to consult a triathlon coach. Female triathletes were more likely than male triathletes to train with others, use mental preparation strategies, and report feeling anxious before competitions. More male triathletes reported using nutritional supplements during training than their female counterparts. These findings add to the limited research base on triathletes' training habits, and hopefully will help guide practitioners who work with this group. The results provide guidance for collaborative efforts among training, nutrition, and mental health professionals to best support triathletes.

  12. The role of natural health products (NHPs) in dietetic practice: results from a survey of Canadian dietitians

    PubMed Central

    2013-01-01

    Background Registered dietitians (RDs) play a key role in disseminating information about nutrition and intervening in nutrition-related disorders in the Canadian context. Natural health products (NHPs) are increasingly associated with nutrition in patient and health professional discussions. For this study, NHPs were divided into three categories: nutritional supplements (NS); functional foods/nutraceuticals (FF/N); and herbal preparations (HP). The objective was to explore RDs’ perceptions about their professional roles and responsibilities with respect to three categories of natural health products (NHPs). Methods This research consisted of an on-line survey of registered dietitians (RDs) in Ontario. Surveys were distributed electronically to all practicing RDs in Ontario by the College of Dietitians of Ontario. There were 558 survey respondents, a response rate of 20%. Results The vast majority of RDs reported being consulted by clients about all product categories (98% for NS; 94% for FF/N; 91% for HP), with RDs receiving the most frequent questions about NS and the least frequent about HP. 74% of RDs believed that NS are included within the current scope of practice, compared to 59% for FF/N and 14% for HP. Even higher numbers believed that these products should be included: 97% for NS, 91% for FF/N and 47% for HP. RDs who report personally ingesting FF/N and HP were significantly more likely to report that these products should be in the dietetic scope of practice. In contrast, RDs who provide one-on-one counselling services or group-level counselling/workshops were significantly less likely to believe HP should be in the dietetic scope of practice. Conclusions Opinions of RDs indicated that NS and FF/N (and possibly HP) fall within, or should fall within, RDs’ scope of practice. Opportunity exists for RDs to undertake a professional role with respect to NHPs. Policy clarification regarding RD roles is needed. PMID:23819488

  13. Decadal changes in aerosol absorption across Brazil resulting from changes in biomass burning practices

    NASA Astrophysics Data System (ADS)

    Coe, H.; Morgan, W.; Darbyshire, E.; Allan, J. D.; Flynn, M.; Liu, D.; Langridge, J.; Johnson, B. T.; Haywood, J. M.; Longo, K.; Artaxo, P.; Highwood, E.; Mollard, J.

    2015-12-01

    Open biomass burning makes a substantial contribution to the global budget of black carbon, yet models significantly underestimate absorption aerosol optical depth compared to observations by approximately a factor of two over South America. These large differences need to be addressed. Recent work has shown that the number of deforestation fires has decreased across Amazonia over the last decade, giving rise to a decrease in the abundance of biomass burning aerosol across the region. At the same time there has been an increase in the frequency of agricultural burning across regions that have previously been deforested, as well as increased burning in the east of Brazil in the Cerrado regions. We sampled both of these types of open burning extensively during a recent aircraft experiment. Significant concentrations of organic carbon as well as black carbon were observed, with this ratio providing the main control on the single scattering albedo (SSA).Deforestation fires and wild forest fires are prevalent across the south west of the Amazon Basin, where smouldering burning dominates. In the east of Brazil, agricultural burning proceeds via a much more efficient form of combustion and as a result, black carbon is a much larger fraction of the aerosol mass and SSAs are much lower than in the west. We have analysed MISR data across the region to show that whilst aerosol optical depths have decreased during the dry season over the last decade, with greater rates of reduction occurring over the south western margins of Amazonia, absorption aerosol optical depths have significantly increased over the Cerrado and remained constant over south western Amazonia. This has led to a decline in SSA across the whole of the region with greater reductions occurring over the eastern states. This finding is consistent with our aircraft measurements. We will discuss the implications of these changes for air quality and climate across the region.

  14. Performance of genotypic tropism testing in clinical practice using the enhanced sensitivity version of Trofile as reference assay: results from the OSCAR Study Group.

    PubMed

    Svicher, Valentina; D'Arrigo, Roberta; Alteri, Claudia; Andreoni, Massimo; Angarano, Gioacchino; Antinori, Andrea; Antonelli, Guido; Bagnarelli, Patrizia; Baldanti, Fausto; Bertoli, Ada; Borderi, Marco; Boeri, Enzo; Bonn, Isabella; Bruzzone, Bianca; Callegaro, Anna Paola; Cammarota, Roberta; Canducci, Filippo; Ceccherini-Silberstein, Francesca; Clementi, Massimo; Monforte, Antonella D'Arminio; De Luca, Andrea; Di Biagio, Antonio; Di Gianbenedetto, Simona; Di Perri, Giovanni; Di Pietro, Massimo; Fabeni, Lavinia; Fadda, Giovanni; Galli, Massimo; Gennari, William; Ghisetti, Valeria; Giacometti, Andrea; Gori, Andrea; Leoncini, Francesco; Maggiolo, Franco; Maserati, Renato; Mazzotta, Francesco; Micheli, Valeria; Meini, Genny; Monno, Laura; Mussini, Cristina; Nozza, Silvia; Paolucci, Stefania; Parisi, Saverio; Pecorari, Monica; Pizzi, Daniele; Quirino, Tiziana; Re, Maria Carla; Rizzardini, Giuliano; Santangelo, Rosaria; Soria, Alessandro; Stazi, Francesca; Sterrantino, Gaetana; Turriziani, Ombretta; Viscoli, Claudio; Vullo, Vincenzo; Lazzarin, Adriano; Perno, Carlo Federico

    2010-07-01

    The goal of the OSCAR programme is to evaluate the performances of genotypic HIV-1 tropism testing in clinical practice using the enhanced sensitivity version of Trofile (ESTA) as reference-assay. HIV-1 coreceptor-usage was assessed using plasma samples from 406 HIV-1 infected patients by ESTA and by gp120 V3 population-sequencing followed by Geno2pheno (set at a False Positive Rate [FPR] of 10% and 5%). ESTA was successful in 365 (89.9%) samples indicating R5 in 254 (69.6%), and DM/X4 in 111 (30.4% of samples (104 [28.5%] DM and 7 [1.9%] X4). Genotypic-testing successfully assessed viral tropism for all 406 samples, including the 41 with undetermined result by ESTA. Genotypic-tropism testing at a FPR of 5% and 10% was 81.1% and 78.4% concordant with ESTA, respectively. Despite a sensitivity of 48.7% and 55.9% at a FPR of 5% and 10%, respectively, a high concordance (specificity: 95.3% for FPR of 5% and 88.2% for FPR of 10%) between genotypic-tropism testing and ESTA was reached in the detection of R5-tropic viruses. Our results are in line with other European studies, and support the routine use of genotypic tropism testing in clinical-settings for monitoring of HIV-1 infected patients candidate to or failing CCR5-antagonists.

  15. Chemotherapy drug handling in first opinion small animal veterinary practices in the United Kingdom: results of a questionnaire survey.

    PubMed

    Edery, E G

    2017-03-07

    To investigate how first opinion small animal veterinary surgeons in the UK handled chemotherapeutic agents, a questionnaire was distributed at the 2014 British Small Animal Veterinary Association congress and by internet. Chemotherapy was regularly offered by 70.4 per cent of the respondents. Gold standards defined according to available guidelines for safe handling of antineoplastic drugs were poorly followed by general practitioners with only 2 per cent of respondents complying with all of them. Dedicated facilities for preparation and administration of cytotoxic drugs were variably available among participants. The level of training of staff indirectly involved in handling chemotherapy was appropriate in less than 50 per cent of practices. No association was found between demographic characteristics of the sampled population and the decision to perform chemotherapy. The results of this study raise concerns about the safety of the veterinary staff in first opinion practices involved in handling chemotherapy.

  16. Reach-scale stream restoration in agricultural streams of southern Minnesota alters structural and functional responses of macroinvertebrates

    USGS Publications Warehouse

    Dolph, Christine L.; Eggert, Susan L.; Magner, Joe; Ferrington, Leonard C.; Vondracek, Bruce C.

    2015-01-01

    Recent studies suggest that stream restoration at the reach scale may not increase stream biodiversity, raising concerns about the utility of this conservation practice. We examined whether reach-scale restoration in disturbed agricultural streams was associated with changes in macroinvertebrate community structure (total macroinvertebrate taxon richness, total macroinvertebrate density, Ephemeroptera, Plecoptera, Trichoptera [EPT] taxon richness, % abundance of EPT taxa) or secondary production (macroinvertebrate biomass over time). We collected macroinvertebrate samples over the course of 1 y from restored and unrestored reaches of 3 streams in southern Minnesota and used generalized least-square (GLS) models to assess whether measures of community structure were related to reach type, stream site, or sampling month. After accounting for effects of stream site and time, we found no significant difference in total taxon richness or % abundance of EPT taxa between restored and unrestored reaches. However, the number of EPT taxa and macroinvertebrate density were significantly higher in restored than in unrestored reaches. We compared secondary production estimates among study reaches based on 95th-percentile confidence intervals generated via bootstrapping. In each study stream, secondary production was significantly (2–3×) higher in the restored than in the unrestored reach. Higher productivity in the restored reaches was largely a result of the disproportionate success of a few dominant, tolerant taxa. Our findings suggest that reach-scale restoration may have ecological effects that are not detected by measures of total taxon richness alone.

  17. Motives of former interns in general practice for speciality-choice − Results of a cross-sectional study among graduates 2007 to 2012

    PubMed Central

    Abendroth, Jens; Schnell, Ute; Lichte, Thomas; Oemler, Matthias; Klement, Andreas

    2014-01-01

    Background: The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates’ choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g. work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality. Method: A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau. Results: The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r=-.5; p<.01). However, if the IGP had an influence on speciality choice, it was correlated with a new perception of general practice (r=.36; p<.01). This new perception was associated with a positive influence of the medical teacher during the IGP. Conclusion: The final-year IGP is an opportunity to change the perception of general practice in students who are still undecided. This can lead to different speciality choices in a subgroup. Personal attitudes and concepts of personal life and career were also important factors affecting speciality choice. The

  18. Rapid Plasticity of Motor Corticospinal system with Robotic Reach Training

    PubMed Central

    Kantak, Shailesh S.; Jones-Lush, Lauren M.; Narayanan, Priya; Judkins, Timothy N.; Wittenberg, George F.

    2013-01-01

    Goal-directed reaching is important for activities of daily living. Populations of neurons in the primary motor cortex (M1) that project to spinal motor circuits are known to represent kinematics of reaching movements. We investigated whether repetitive practice of goal-directed reaching movements induces use-dependent plasticity of those kinematic characteristics, in a manner similar to finger movements, as had been shown previously. Transcranial magnetic stimulation (TMS) was used over the scalp to evoke upper extremity movements while the forearm was resting in a robotic cradle. Plasticity was measured by the change in kinematics of these evoked movements following goal-directed reaching practice. Baseline direction of TMS-evoked arm movements was determined for each subject. Subjects then practiced 3 blocks of 160 goal-directed reaching movements in a direction opposite to the baseline direction (14 cm reach 180° from baseline direction) against a 75 N·m spring field. Changes in TMS-evoked whole arm movements were assessed after each practice block and after 5 minutes following the end of practice. Direction and the position of the point of peak velocity of TMS-evoked movements were significantly altered following training and at a 5-minute interval following training, while amplitude did not show significant changes. This was accompanied by changes in the motor evoked potentials (MEPs) of the shoulder and elbow agonist muscles that partly explained the change in direction, mainly by increase in agonist MEP, without significant changes in antagonists. These findings demonstrate that the arm representation accessible by motor cortical stimulation demonstrates rapid plasticity induced by goal-directed robotic reach training in healthy subjects. PMID:23669007

  19. Rapid plasticity of motor corticospinal system with robotic reach training.

    PubMed

    Kantak, S S; Jones-Lush, L M; Narayanan, P; Judkins, T N; Wittenberg, G F

    2013-09-05

    Goal-directed reaching is important for the activities of daily living. Populations of neurons in the primary motor cortex that project to spinal motor circuits are known to represent the kinematics of reaching movements. We investigated whether repetitive practice of goal-directed reaching movements induces use-dependent plasticity of those kinematic characteristics, in a manner similar to finger movements, as had been shown previously. Transcranial magnetic stimulation (TMS) was used to evoke upper extremity movements while the forearm was resting in a robotic cradle. Plasticity was measured by the change in kinematics of these evoked movements following goal-directed reaching practice. Baseline direction of TMS-evoked arm movements was determined for each subject. Subjects then practiced three blocks of 160 goal-directed reaching movements in a direction opposite to the baseline direction (14 cm reach 180° from baseline direction) against a 75-Nm spring field. Changes in TMS-evoked whole arm movements were assessed after each practice block and after 5 min following the end of practice. Direction and the position of the point of peak velocity of TMS-evoked movements were significantly altered following training and at a 5-min interval following training, while amplitude did not show significant changes. This was accompanied by changes in the motor-evoked potentials (MEPs) of the shoulder and elbow agonist muscles that partly explained the change in direction, mainly by increase in agonist MEP, without significant changes in antagonists. These findings demonstrate that the arm representation accessible by motor cortical stimulation under goes rapid plasticity induced by goal-directed robotic reach training in healthy subjects. Published by Elsevier Ltd.

  20. Reaching for the red planet

    PubMed

    David, L

    1996-05-01

    The distant shores of Mars were reached by numerous U.S. and Russian spacecraft throughout the 1960s to mid 1970s. Nearly 20 years have passed since those successful missions which orbited and landed on the Martian surface. Two Soviet probes headed for the planet in July, 1988, but later failed. In August 1993, the U.S. Mars Observer suddenly went silent just three days before it was to enter orbit around the planet and was never heard from again. In late 1996, there will be renewed activity on the launch pads with three probes departing for the red planet: 1) The U.S. Mars Global Surveyor will be launched in November on a Delta II rocket and will orbit the planet for global mapping purposes; 2) Russia's Mars '96 mission, scheduled to fly in November on a Proton launcher, consists of an orbiter, two small stations which will land on the Martian surface, and two penetrators that will plow into the terrain; and finally, 3) a U.S. Discovery-class spacecraft, the Mars Pathfinder, has a December launch date atop a Delta II booster. The mission features a lander and a microrover that will travel short distances over Martian territory. These missions usher in a new phase of Mars exploration, setting the stage for an unprecedented volley of spacecraft that will orbit around, land on, drive across, and perhaps fly at low altitudes over the planet.

  1. Measuring the economic value of alternative clam fishing management practices in the Venice Lagoon: results from a conjoint valuation application

    NASA Astrophysics Data System (ADS)

    Nunes, Paulo A. L. D.; Rossetto, Luca; de Blaeij, Arianne

    2004-11-01

    This article focuses on the economic valuation of alternative clam management practices in the Venice Lagoon. The proposed valuation method is characterized by the design of a survey questionnaire applied to the fishermen population. In each questionnaire, two fishing alternatives are described. The respondent is asked to choose one of them. This valuation method, referred in the article as conjoint valuation, gives sufficient flexibility to set, alter, and combine the valuation of different clam management practices. Furthermore, this approach presents an important advantage to the well-known contingent valuation method since it makes the monetary valuation of each management attribute possible. Estimation results show that all three attributes used in the questionnaire to describe and value different clam management practices—price of the annual permit and fishing technological system—are statistically robust, indicating that fishermen bear a utility change whenever these attributes change. In particular, fishermen's willingness to pay for a larger clam fishing area ranges between 568 and 811 € per year. In addition, an individual's willingness to pay for a fishing practice exclusively based on the vibrant rake system ranges between 1005 and 2456 €. Finally, the adoption of a clam fish management practice in the Venice Lagoon that is exclusively based on the use of manual rakes, which is associated with the lowest damage to the lagoon ecosystem, will represent a welfare loss of 5904 € per fisherman per year. Combining such a value estimate with the total number of fishermen currently operating in the Lagoon of Venice, the welfare loss associated with the adoption of this type of clam management policy amounts to 11.8 € million per year. This figure can be regarded as an upper bound to the cost of implementation of a clam fishing system anchored in the use of manual, ecosystem friendly rakes.

  2. An Examination of Growing Trends in Land Tenure and Conservation Practice Adoption: Results from a Farmer Survey in Iowa

    NASA Astrophysics Data System (ADS)

    Varble, Sarah; Secchi, Silvia; Druschke, Caroline Gottschalk

    2016-02-01

    Tenants and part-owners are farming an increasing number of acres in the United States, while full-owners are farming fewer acres. This shift in ownership is a potential cause for concern because some previous research indicated that tenant and part-owner farmers were less likely to adopt conservation practices than farmers who owned the land they farmed. If that trend persists, ownership changes would signal a national drop in conservation adoption. Here we examine this issue using a survey of agricultural operators in the Clear Creek watershed in Iowa, a state with intensive agricultural production. We compare adoption of conservation practices, and preferences for conservation information sources and communication channels, between farmers who rent some portion of the land they farm (tenants and part-owners) and farmers who own all of the land they farm (full-owners). We find that renters are more likely to practice conservation tillage than full-owners, though they are less likely to rotate crops. In addition, renters report using federal government employees (specifically, Natural Resource Conservation Service and Farm Service Agency) as their primary sources of conservation information, while full-owners most frequently rely on neighbors, friends, and County Extension. These findings are significant for conservation policy because, unlike some past research, they indicate that renters are not resistant to all types of conservation practices, echoing recent studies finding an increase in conservation adoption among non-full-owners. Our results emphasize the importance of government conservation communication and can inform outreach efforts by helping tailor effective, targeted conservation strategies for owners and renters.

  3. An Examination of Growing Trends in Land Tenure and Conservation Practice Adoption: Results from a Farmer Survey in Iowa.

    PubMed

    Varble, Sarah; Secchi, Silvia; Druschke, Caroline Gottschalk

    2016-02-01

    Tenants and part-owners are farming an increasing number of acres in the United States, while full-owners are farming fewer acres. This shift in ownership is a potential cause for concern because some previous research indicated that tenant and part-owner farmers were less likely to adopt conservation practices than farmers who owned the land they farmed. If that trend persists, ownership changes would signal a national drop in conservation adoption. Here we examine this issue using a survey of agricultural operators in the Clear Creek watershed in Iowa, a state with intensive agricultural production. We compare adoption of conservation practices, and preferences for conservation information sources and communication channels, between farmers who rent some portion of the land they farm (tenants and part-owners) and farmers who own all of the land they farm (full-owners). We find that renters are more likely to practice conservation tillage than full-owners, though they are less likely to rotate crops. In addition, renters report using federal government employees (specifically, Natural Resource Conservation Service and Farm Service Agency) as their primary sources of conservation information, while full-owners most frequently rely on neighbors, friends, and County Extension. These findings are significant for conservation policy because, unlike some past research, they indicate that renters are not resistant to all types of conservation practices, echoing recent studies finding an increase in conservation adoption among non-full-owners. Our results emphasize the importance of government conservation communication and can inform outreach efforts by helping tailor effective, targeted conservation strategies for owners and renters.

  4. Knowledge, attitudes and practices of HIV-positive patients regarding disclosure of HIV results at Betesda Clinic in Namibia

    PubMed Central

    2013-01-01

    Abstract Background This study examined the practices, knowledge, attitudes, and the reasons for disclosure and non-disclosure of HIV-positive patients with regard to the disclosure of HIV results at Betesda Clinic in Windhoek, Namibia. Objectives The objectives of the study were to determine knowledge, attitudes, and practices of HIV-positive patients regarding the disclosure of HIV status at Betesda Clinic in Namibia, and to determine the reasons for disclosure and non-disclosure. Methods This was a cross-sectional descriptive study and 263 HIV-positive patients were enrolled in the study. Results Analyses revealed that knowledge on disclosure was good, with 68% who thought it was important. The majority (73%) have disclosed and 60% disclosed within 1 week of receiving their results. The most common reasons for disclosure were that 32% needed help, 25% wanted his or her partner to go for testing, and 20% wanted to let relatives know. Reasons for non-disclosure were mainly the fear of gossip (79%). Seventy-three per cent had disclosed to their partners, and 23% had disclosed to more than one person. People's reactions were supportive in 43%, whereas 29% understood, 9% accepted and 6% were angry. Upon disclosure 40% received help, 24% of partners were tested, 23% received psychological support and 5% were stigmatised. Disclosure was higher amongst the married and cohabitating. Conclusion The attitude was positive with regard to knowledge of disclosure, with most participants thinking that disclosure was important and good. The attitudes and actual practices of disclosure were encouraging; however, people are disclosing only to trusted individuals in the society and the fear of stigma is still present although the actual stigma was very low.

  5. A qualitative analysis of Emergency Department physicians' practices and perceptions in relation to test result follow-up.

    PubMed

    Callen, Joanne; Georgiou, Andrew; Prgomet, Mirela; Paoloni, Richard; Westbrook, Johanna

    2010-01-01

    Follow-up of abnormal test results for discharged Emergency Department (ED) patients is a critical safety issue. This study aimed to explore ED physicians' perceptions, practices, and suggestions for improvements of test result follow-up when using an electronic provider order entry system to order all laboratory and radiology tests and view results. Interviews were conducted with seven ED physicians and one clinical information system support person. Interviews were analyzed to elicit key concepts relating to physicians' perceptions of test result follow-up and how the process could be improved. Results described the current electronic test result follow-up system with two paper-based manual back-up systems for microbiology and radiology results. The key issues for physicians were: responsibility for test follow-up; the unique ED environment and time pressures, and the role of the family physician in test result follow-up. The key suggestion for improvement was a complete integrated electronic information system with on-line result endorsement. The study highlighted the complexity of the test result follow-up process and the importance of engaging clinicians in devising solutions for improvements.

  6. A case study in technology utilization: Industrial products and practices. [summary of benefits to national economy resulting from space programs

    NASA Technical Reports Server (NTRS)

    1973-01-01

    In pursuit of such missions as Apollo, the National Aeronautics and Space Administration has called into being unique equipment that obviously has little direct application beyond the achievement of mission objectives. Yet, to assume that further direct application of space program hardware is somehow a measure of the industrial benefits accruing to the nation is to misunderstand how the creation of new technology affects modern industrial capability. This document presents a profile of the significant ways in which technological developments in response to aerospace mission requirements have been coupled into industrial practice, with the result being that improved products and processes are now being utilized to benefit the nation.

  7. Maximal lateral reaching distance on the affected side using the multi-directional reach test in persons with stroke

    PubMed Central

    Hwang, Won-Jeong; Kim, Jung-Hyun; Jeon, Seo-Hyun; Chung, Yijung

    2015-01-01

    [Purpose] This study aimed to examine the relationship between maximal lateral reaching distance on the affected side and weight shifting using the Multi-directional Reach Test in persons with stoke. [Subjects] Fifty-one chronic stroke participants were recruited from two rehabilitation hospitals. This study administered the Berg Balance Scale, Timed Up-and-Go, Trunk Impairment Scale, Modified Barthel Index and measured different maximal reaching distances. [Results] The maximal lateral reaching distance on the affected side was correlated with the BBS (r=0.571), TUG (r=−0.478), TIS (r=0.561), and MBI scores (r=0.499), the lateral reaching distance in all directions on the non-affected side (r=0.785), the maximal backward reaching distance (r=0.723), and the maximal forward reaching distance (r=0.673). The maximal reaching distance on the affected side was also affected by that on the non-affected side, in addition to the maximal backward reaching distance and MBI score. The final step model of stepwise multiple regression was explained 69.5%. [Conclusion] Maximal lateral reaching distance on the affected side as determined by the Multi-directional Reach Test is a good method of assessing functional performance in stroke patients. Data regarding maximal reaching distance on the non-affected side can be used to measure functional impairment on the affected side in clinical settings. PMID:26504275

  8. REACH Report to the Rockefeller Foundation. Revised.

    ERIC Educational Resources Information Center

    Blodgett, Jack

    This document summarizes the activities of REACH, the Rural Education Alliance for Collaborative Humanities. REACH is an effort to strengthen rural education in South Carolina through writing and the study of local history and culture. Among REACH projects are the REACH School Programs, fostering student created research on the history and…

  9. Switching mechanism in resistive random access memory by first-principles calculation using practical model based on experimental results

    NASA Astrophysics Data System (ADS)

    Moriyama, Takumi; Yamasaki, Takahiro; Hida, Sohta; Ohno, Takahisa; Kishida, Satoru; Kinoshita, Kentaro

    2017-04-01

    For the practical use of resistive random access memory (ReRAM), many formation/rupture models of conductive paths are proposed. In this paper, we report both the probability of conductive path formation on grain surfaces and the marked drastic change in conductivity caused by a small number of atoms migrating on grain surfaces, determined by using experimental and calculation results complementarily. Experimental results of resistive switching operating modes suggest that resistance changes at grain boundaries, to which our calculation results can give an explanation. The energy for the conductive change from a low-resistance state to a high-resistance state is estimated to be about 0.05 eV per surface atom, which is much smaller than the formation and migration energies of vacancies (1.44-4.42 eV) and is comparable to the estimated temperature of the conductive path in the reset process.

  10. Trends in Pap test practices and results: An 11-year review of the annual ACHA Pap Test and STI Survey.

    PubMed

    Eastman-Mueller, Heather P; Oswalt, Sara B

    2017-10-01

    To conduct a trend analysis of Pap test practices, Pap test results and related women's services and guidelines of college health centers. College health centers who participated in the annual ACHA Pap Test and STI (sexually transmitted infection) Survey years 2004-2014 (n ranged from 127 to 181 depending on year). Descriptive analyses are presented with ANOVAs (Analysis of Variance) and chi-square tests calculated to examine trends over time. The number of Pap tests significantly decreased over time; however, the percentage of normal and HSIL (high-grade squamous intraepithelial lesion) results did not vary. Availability of conventional cytology slides and cryotherapy were significantly associated with year. Over time, college health centers' guidelines related to initiation of Pap testing evolved to consistently conform to national recommendations for cervical screening. The results indicate most college health centers are following the current national guidelines regarding Pap testing for young adult women.

  11. Intracompartmental pressure testing: results of an international survey of current clinical practice, highlighting the need for standardised protocols.

    PubMed

    Hislop, Matthew; Tierney, Paul

    2011-09-01

    Despite more recent non-invasive modalities generating some credence in the literature, intracompartmental pressure testing is still considered the 'gold standard' for investigating chronic exertional compartment syndrome (CECS). Intracompartmental pressure testing, when used correctly, has been shown to be accurate and reliable. However, it is a user-dependent investigation, and the manner in which the investigation is conducted plays a large role in the outcome of the test. Despite this, a standard, reproducible protocol for intracompartmental pressure testing has not been described. This results in confusion regarding interpretation of results and reduces the tests' reliability. A summary of the current understanding of CECS is presented, along with the results of a survey of specialists in Australia and New Zealand who perform intracompartmental pressure testing, which confirms that a uniform approach is currently not used in clinical practice. This highlights the need for a consensus and standardised approach to intracompartmental pressure testing.

  12. Spiking and LFP activity in PRR during symbolically instructed reaches.

    PubMed

    Hwang, Eun Jung; Andersen, Richard A

    2012-02-01

    The spiking activity in the parietal reach region (PRR) represents the spatial goal of an impending reach when the reach is directed toward or away from a visual object. The local field potentials (LFPs) in this region also represent the reach goal when the reach is directed to a visual object. Thus PRR is a candidate area for reading out a patient's intended reach goals for neural prosthetic applications. For natural behaviors, reach goals are not always based on the location of a visual object, e.g., playing the piano following sheet music or moving following verbal directions. So far it has not been directly tested whether and how PRR represents reach goals in such cognitive, nonlocational conditions, and knowing the encoding properties in various task conditions would help in designing a reach goal decoder for prosthetic applications. To address this issue, we examined the macaque PRR under two reach conditions: reach goal determined by the stimulus location (direct) or shape (symbolic). For the same goal, the spiking activity near reach onset was indistinguishable between the two tasks, and thus a reach goal decoder trained with spiking activity in one task performed perfectly in the other. In contrast, the LFP activity at 20-40 Hz showed small but significantly enhanced reach goal tuning in the symbolic task, but its spatial preference remained the same. Consequently, a decoder trained with LFP activity performed worse in the other task than in the same task. These results suggest that LFP decoders in PRR should take into account the task context (e.g., locational vs. nonlocational) to be accurate, while spike decoders can robustly provide reach goal information regardless of the task context in various prosthetic applications.

  13. Spiking and LFP activity in PRR during symbolically instructed reaches

    PubMed Central

    Andersen, Richard A.

    2012-01-01

    The spiking activity in the parietal reach region (PRR) represents the spatial goal of an impending reach when the reach is directed toward or away from a visual object. The local field potentials (LFPs) in this region also represent the reach goal when the reach is directed to a visual object. Thus PRR is a candidate area for reading out a patient's intended reach goals for neural prosthetic applications. For natural behaviors, reach goals are not always based on the location of a visual object, e.g., playing the piano following sheet music or moving following verbal directions. So far it has not been directly tested whether and how PRR represents reach goals in such cognitive, nonlocational conditions, and knowing the encoding properties in various task conditions would help in designing a reach goal decoder for prosthetic applications. To address this issue, we examined the macaque PRR under two reach conditions: reach goal determined by the stimulus location (direct) or shape (symbolic). For the same goal, the spiking activity near reach onset was indistinguishable between the two tasks, and thus a reach goal decoder trained with spiking activity in one task performed perfectly in the other. In contrast, the LFP activity at 20–40 Hz showed small but significantly enhanced reach goal tuning in the symbolic task, but its spatial preference remained the same. Consequently, a decoder trained with LFP activity performed worse in the other task than in the same task. These results suggest that LFP decoders in PRR should take into account the task context (e.g., locational vs. nonlocational) to be accurate, while spike decoders can robustly provide reach goal information regardless of the task context in various prosthetic applications. PMID:22072511

  14. Practice patterns and perceived impact of clinical nurse specialist roles in Canada: results of a national survey.

    PubMed

    Kilpatrick, Kelley; DiCenso, Alba; Bryant-Lukosius, Denise; Ritchie, Judith A; Martin-Misener, Ruth; Carter, Nancy

    2013-11-01

    Clinical nurse specialists are recognized internationally for providing an advanced level of practice. They positively impact the delivery of healthcare services by using specialty-specific expert knowledge and skills, and integrating competencies as clinicians, educators, researchers, consultants and leaders. Graduate-level education is recommended for the role but many countries do not have formal credentialing mechanisms for clinical nurse specialists. Previous studies have found that clinical nurse specialist roles are poorly understood by stakeholders. Few national studies have examined the utilization of clinical nurse specialists. To identify the practice patterns of clinical nurse specialists in Canada. A descriptive cross-sectional survey. Self-identified clinical nurse specialists in Canada. A 50-item self-report questionnaire was developed, pilot-tested in English and French, and administered to self-identified clinical nurse specialists from April 2011 to August 2011. Data were analyzed using descriptive and inferential statistics and content analysis. The actual number of clinical nurse specialists in Canada remains unknown. The response rate using the number of registry-identified clinical nurse specialists was 33% (804/2431). Of this number, 608 reported working as a clinical nurse specialist. The response rate for graduate-prepared clinical nurse specialists was 60% (471/782). The practice patterns of clinical nurse specialists varied across clinical specialties. Graduate-level education influenced their practice patterns. Few administrative structures and resources were in place to support clinical nurse specialist role development. The lack of title protection resulted in confusion around who identifies themselves as a clinical nurse specialist and consequently made it difficult to determine the number of clinical nurse specialists in Canada. This is the first national survey of clinical nurse specialists in Canada. A clearer understanding of

  15. What does standard rehabilitation practice after total hip replacement in the UK entail? results of a mixed methods study

    PubMed Central

    2013-01-01

    Background There is evidence of prolonged poor function in patients following total hip replacement (THR). Studies of progressive resistance training (PRT) interventions to improve function are often compared to ‘standard’ practice which is not well defined. This study aimed to investigate ‘standard’ rehabilitation care in the UK after total hip replacement (THR) as well as determine whether PRT was part of ‘standard’ care. Methods After ethical approval, questionnaire item development about rehabilitation practice was guided by a focus group interview (after informed consent) with physiotherapists (n = 4; >5 years post-qualification) who regularly treated THR patients. An online questionnaire investigating the exercises prescribed and rehabilitation practice following THR was developed and sent to physiotherapists working in hospitals in the UK. The survey was performed from January to May 2011. The survey results were analysed (frequency (%) of responses) focusing on the exercises the physiotherapists considered important, as well as their use of PRT in prescribed regimes. Results 106 responses were obtained from physiotherapists in the UK. The survey respondents considered that the most important muscles to target in all phases of rehabilitation were the hip abductors (62.2%), followed by the quadriceps (16.9%), and other muscles (21%). Exercise type prescribed revealed no consensus, with weight bearing (42%), functional (45%) and Bed-based/Bridging/Postural exercises (13%) favoured. 83.7% were able to define the basis of progressive resistance training (PRT), but only 33% prescribed it. Conclusions Standard physiotherapy rehabilitation in the UK after THR is variable, and appears to rarely include PRT. This may be a factor in prolonged poor function in some patients after this common operation. PMID:23496875

  16. Action Sounds Modulate Arm Reaching Movements

    PubMed Central

    Tajadura-Jiménez, Ana; Marquardt, Torsten; Swapp, David; Kitagawa, Norimichi; Bianchi-Berthouze, Nadia

    2016-01-01

    Our mental representations of our body are continuously updated through multisensory bodily feedback as we move and interact with our environment. Although it is often assumed that these internal models of body-representation are used to successfully act upon the environment, only a few studies have actually looked at how body-representation changes influence goal-directed actions, and none have looked at this in relation to body-representation changes induced by sound. The present work examines this question for the first time. Participants reached for a target object before and after adaptation periods during which the sounds produced by their hand tapping a surface were spatially manipulated to induce a representation of an elongated arm. After adaptation, participants’ reaching movements were performed in a way consistent with having a longer arm, in that their reaching velocities were reduced. These kinematic changes suggest auditory-driven recalibration of the somatosensory representation of the arm morphology. These results provide support to the hypothesis that one’s represented body size is used as a perceptual ruler to measure objects’ distances and to accordingly guide bodily actions. PMID:27695430

  17. Intelligence Reach for Expertise (IREx)

    NASA Astrophysics Data System (ADS)

    Hadley, Christina; Schoening, James R.; Schreiber, Yonatan

    2015-05-01

    IREx is a search engine for next-generation analysts to find collaborators. U.S. Army Field Manual 2.0 (Intelligence) calls for collaboration within and outside the area of operations, but finding the best collaborator for a given task can be challenging. IREx will be demonstrated as part of Actionable Intelligence Technology Enabled Capability Demonstration (AI-TECD) at the E15 field exercises at Ft. Dix in July 2015. It includes a Task Model for describing a task and its prerequisite competencies, plus a User Model (i.e., a user profile) for individuals to assert their capabilities and other relevant data. These models use a canonical suite of ontologies as a foundation for these models, which enables robust queries and also keeps the models logically consistent. IREx also supports learning validation, where a learner who has completed a course module can search and find a suitable task to practice and demonstrate that their new knowledge can be used in the real world for its intended purpose. The IREx models are in the initial phase of a process to develop them as an IEEE standard. This initiative is currently an approved IEEE Study Group, after which follows a standards working group, then a balloting group, and if all goes well, an IEEE standard.

  18. Patient Decisions to Receive Secondary Pharmacogenomic Findings and Development of a Multidisciplinary Practice Model to Integrate Results Into Patient Care.

    PubMed

    Hicks, J Kevin; Shealy, Amy; Schreiber, Allison; Coleridge, Marissa; Noss, Ryan; Natowicz, Marvin; Moran, Rocio; Moss, Timothy; Erwin, Angelika; Eng, Charis

    2017-07-27

    Whole exome sequencing (WES) has the potential of identifying secondary findings that are predictive of poor pharmacotherapy outcomes. The purpose of this study was to investigate patients' wishes regarding the reporting of secondary pharmacogenomic findings. WES results (n = 106 patients) were retrospectively reviewed to determine the number of patients electing to receive secondary pharmacogenomic results. Phenotypes were assigned based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. The percent of patients with a predicted phenotype associated with a gene-based CPIC dosing recommendation was determined. Ninety-nine patients (93.4%) elected to receive secondary pharmacogenomic findings. For each gene-drug pair analyzed, the number of patients with an actionable phenotype ranged from two (2%) to 43 patients (43.4%). Combining all gene-drug pairs, 84 unique patients (84.8%) had an actionable phenotype. A prospective multidisciplinary practice model was developed for integrating secondary pharmacogenomic findings into clinical practice. Our model highlights a unique collaboration between physician-geneticists, pharmacists, and genetic counselors. © 2017 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

  19. The long-term results and changing patterns of biological valves at the mitral position in contemporary practice in Japan

    PubMed Central

    Abe, Tomonobu; Ito, Hideki; Mutsuga, Masato; Fujimoto, Kazuro; Terazawa, Sachie; Narita, Yuji; Oshima, Hideki; Usui, Akihiko

    2016-01-01

    ABSTRACT Mitral valve surgery has changed with the wide acceptance of mitral valve repair. The aim of this study is to obtain the long-term results of patients who underwent mitral valve replacement (MVR) using a biological prosthesis in contemporary practice in Japan. From January 1990 to December 2013, 76 patients underwent MVR using a biological prosthesis with or without concomitant surgery. Data were obtained by means of a questionnaire and a telephone interview. The mean follow-up period was 4.26 years. The etiologies of the patients included dilated cardiomyopathy (DCM) (n=20 [26.3%]), ischemic mitral regurgitation (n=7 [9.2%]). There is a trend towards decreasing number of rheumatic and degenerative disease and increasing number of DCM and ischemic mitral regurgitation. Three patients (3.9%) died in the perioperative period. The 5- and 10-year overall survival rates were 69.6% and 31.7%, respectively. The 5- and 10-year freedom from valve related death were 95.6% and 80.6 %, respectively. The linearized rates of valve-related complications were as follows: thromboembolism (0.63%/patient/year), bleeding (1.25%/patient/year). One patient underwent reoperation for structural degeneration 13 years after the first operation. The present study shows the long-term results of mitral valve replacement with bioproshtesis in a contemporary case series. The practice pattern is changing. The low rate of valve-related complication justify the current patient selection. PMID:28008192

  20. Results from three years of the world's largest interlaboratory comparison for total mercury and methylmercury: Method performance and best practices

    NASA Astrophysics Data System (ADS)

    Creswell, J. E.; Engel, V.; Carter, A.; Davies, C.

    2013-12-01

    Brooks Rand Instruments has conducted the world's largest interlaboratory comparison study for total mercury and methylmercury in natural waters annually for three years. Each year, roughly 50 laboratories registered to participate and the majority of participants submitted results. Each laboratory was assigned a performance score based on the distance between its results and the consensus mean, as well as the precision of its replicate analyses. Participants were also asked to provide detailed data on their analytical methodology and equipment. We used the methodology data and performance scores to assess the performance of the various methods reported and equipment used. Although the majority of methods in use show no systematic trend toward poor analytical performance, there are noteworthy exceptions. We present results from each of the three years of the interlaboratory comparison exercise, as well as aggregated method performance data. We compare the methods used in this study to methods from other published interlaboratory comparison studies and present a list of recommended best practices. Our goals in creating a list of best practices are to maximize participation, ensure inclusiveness, minimize non-response bias, guarantee high data quality, and promote transparency of analysis. We seek to create a standardized methodology for interlaboratory comparison exercises for total mercury and methylmercury analysis in water, which will lead to more directly comparable results between studies. We show that in most cases, the coefficient of variation between labs measuring replicates of the same sample is greater than 20% after the removal of outlying data points (e.g. Figure 1). It is difficult to make comparisons between studies and ecosystems with such a high variability between labs. We highlight the need for regular participation in interlaboratory comparison studies and continuous analytical method improvement in order to ensure accurate data. Figure 1

  1. Reaching the community in Guatemala.

    PubMed

    1996-08-01

    A knowledge, attitude, and practices (KAP) survey in the area near San Lucas Toliman, Solola State, where JOICFP is implementing its integrated project (IP) in Guatemala, will target the ethnic Mayan people living in the area. The IP is promoted by the Family Planning Association of Guatemala (APROFAM) and uses community participation with the support of women's clubs and traditional birth attendants (TBAs). The survey of about 1000 women of reproductive age will gauge progress in family planning, maternal and child health, reproductive health, and environmental sanitation using a method sensitive to the Mayan culture. A JOICFP mission to Guatemala, which included Saeko Ichikawa (Global Link Management) and Ayumi Shingo (a public health nurse serving with the Japan Overseas Cooperation Volunteers in Guatemala) pretested the survey. The team also discussed the work plan for the approved JOICFP/UNFPA Latin American regional project RLA/96//P02 and the country-level Integrated Reproductive Health/Family Planning with IEC for Adolescents Project. The mission met three volunteers at the IP laboratory, which provides basic examinations for a fee and uses volunteers who learn skills for future employment. The team discussed the laboratory as a model for the 13 new laboratories planned by APROFAM throughout the country. Another IP activity is the Chilam Balam education center in Aldea Panimatzalam, San Andres Semetabaj. Covering a population of 4616 in 8 communities, the center provides literacy education, vocational training, and education on adolescent health and environmental protection. The team discussed plans to start a revolving fund and received a request for typewriters for skills training. The team donated 8 typewriters to the women's club.

  2. Impact of National Institutes of Health Gastrointestinal PROMIS® Measures in Clinical Practice: Results of a Multicenter Controlled Trial

    PubMed Central

    Almario, Christopher V.; Chey, William D.; Khanna, Dinesh; Mosadeghi, Sasan; Ahmed, Shahzad; Afghani, Elham; Whitman, Cynthia; Fuller, Garth; Reid, Mark; Bolus, Roger; Dennis, Buddy; Encarnacion, Rey; Martinez, Bibiana; Soares, Jennifer; Modi, Rushaba; Agarwal, Nikhil; Lee, Aaron; Kubomoto, Scott; Sharma, Gobind; Bolus, Sally; Spiegel, Brennan M.R.

    2016-01-01

    OBJECTIVE The National Institutes of Health (NIH) created the Patient Reported Outcomes Measurement Information System (PROMIS®) to allow efficient, online measurement of patient-reported outcomes (PROs), but it remains untested whether PROMIS improves outcomes. Here, we aimed to compare the impact of gastrointestinal (GI) PROMIS measures vs. usual care on patient outcomes. METHODS We performed a pragmatic clinical trial with an off-on study design alternating weekly between intervention (GI PROMIS) and control arms at one Veterans Affairs (VA) and three university-affiliated specialty clinics. Adults with GI symptoms were eligible. Intervention patients completed GI PROMIS symptom questionnaires on an e-portal one week before their visit; PROs were available for review by patients and their providers prior to and during the clinic visit. Usual care patients were managed according to customary practices. Our primary outcome was patient satisfaction as determined by the Consumer Assessment of Healthcare Providers & Systems (CAHPS) questionnaire. Secondary outcomes included provider interpersonal skills (Doctors’ Interpersonal Skills Questionnaire [DISQ]) and shared decision-making (9-item Shared Decision Making Questionnaire [SDM-Q-9]). RESULTS There were 217 and 154 patients in the GI PROMIS and control arms, respectively. Patient satisfaction was similar between groups (p>.05). Intervention patients had similar assessments of their providers’ interpersonal skills (DISQ 89.4±11.7 vs. 89.8±16.0, p=.79) and shared decision-making (SDM-Q-9 79.3±12.4 vs. 79.0±22.0, p=.85) vs. controls. CONCLUSIONS This is the first controlled trial examining the impact of NIH PROMIS in clinical practice. One-time use of GI PROMIS did not improve patient satisfaction or assessment of provider interpersonal skills and shared decision-making. Future studies examining how to optimize PROs in clinical practice are encouraged before widespread adoption. PMID:27481311

  3. Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001--results from two national surveys.

    PubMed

    Koning, S; Mohammedamin, R S A; van der Wouden, J C; van Suijlekom-Smit, L W A; Schellevis, F G; Thomas, S

    2006-02-01

    Impetigo is a common skin infection in children. The epidemiology is relatively unknown, and the choice of treatment is subject to debate. The objective of our study was to determine the incidence and treatment of impetigo in Dutch general practice, and to assess trends between 1987 and 2001. We used data from the first (1987) and second (2001) Dutch national surveys of general practice. All diagnoses, prescriptions and referrals were registered by the participating general practitioners (GPs), 161 and 195, respectively. The incidence rate of impetigo increased from 16.5 (1987) to 20.6 (2001) per 1000 person years under 18 years old (P < 0.01). In both years, the incidence was significantly higher in summer, in rural areas and in the southern region of the Netherlands, compared with winter, urban areas and northern region, respectively. Socioeconomic status was not associated with the incidence rate. From 1987 to 2001, there was a trend towards treatment with a topical antibiotic (from 43% to 64%), especially fusidic acid cream and mupirocin cream. Treatment with oral antibiotics (from 31% to 14%) and antiseptics (from 11% to 3%) was prescribed less often. We have shown an increased incidence of impetigo in the past decade, which may be the result of an increased tendency to seek help, or increased antibiotic resistance and virulence of Staphylococcus aureus. Further microbiological research on the marked regional difference in incidence may contribute to understanding the factors that determine the spread of impetigo. Trends in prescribing for impetigo generally follow evidence-based knowledge on the effectiveness of different therapies, rather than the national practice guideline.

  4. Practices to "Avoid" in Out-of-School Time Programs. Research-to-Results Brief. Publication #2010-03

    ERIC Educational Resources Information Center

    Moore, Kristin Anderson; Collins, Ashleigh; Bronte-Tinkew, Jacinta

    2010-01-01

    Perhaps one of the fastest ways to improve the quality of out-of-school time programs would be to replace practices that individuals know do not work with practices that appear to be more effective. In this brief, the authors highlight lessons from an expanding body of knowledge about specific program practices that should be avoided or minimized…

  5. Four sexually transmitted infections (STIs) in Belgian general practice: first results (2013–2014) of a nationwide continuing surveillance study

    PubMed Central

    Boffin, N; Moreels, S; Deblonde, J; Van Casteren, V

    2017-01-01

    Objectives To describe and explore data from the surveillance of chlamydia, syphilis, gonorrhoea and genital warts by the Belgian Network of Sentinel General Practices (SGP) over the first 2 years (2013 and 2014) and to estimate the incidence of these 4 sexually transmitted infections (STIs). A special focus is put on data quality. Design Retrospective observational study. Setting General practices from the nationwide representative SGP network. Outcome measures Agreement between data distributions by year, agreement between SGP-based incidence and incidence based on mandatory notification, missingness of patient age or gender and incompleteness of sexual risk history of patients. Results 306 new STI episodes were reported from 298 patients, corresponding with an episode-based incidence of 91.9/100 000 (95% CI 81.9 to 102.8) general practice patients, with almost half of it due to chlamydia. The incidence of chlamydia in men was significantly higher in 2014 than in 2013. Population characteristics were similarly distributed in 2013 and 2014. The SGP-based incidence of gonorrhoea and syphilis in Flanders were in agreement with the incidence based on mandatory notification of cases. Patient age or gender was missing from 35 episodes (11.4%). Independent determinants of missingness of patient age or gender were the Flemish region (OR 3.46; 95% CI 1.02 to 11.73) and genital warts infection (OR 2.23; 95% CI 1.07 to 4.63). An incomplete sexual risk history was reported for 54.6% STI episodes. The odds for an incomplete sexual history were higher for older patients (OR 1.72; 95% CI 1.06 to 2.76) and for patients infected with syphilis, gonorrhoea or co-infection(s) (OR 1.71; 95% CI 1.03 to 2.83). Conclusions Incompleteness of reports about patients with STI sexual risk histories is important from the perspective of quality of data and of quality of care. Together with the low rates of both HIV testing and discussion of partner notification, this suggests that a

  6. Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England

    PubMed Central

    Krakower, Douglas S.; Oldenburg, Catherine E.; Mitty, Jennifer A.; Wilson, Ira B.; Kurth, Ann E.; Maloney, Kevin M.; Gallagher, Donna; Mayer, Kenneth H.

    2015-01-01

    Background Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited. Methods Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices. Results Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01–1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98–11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06–1.34), whereas female gender (aOR 0.26, 95% CI 0.10–0.71) was associated

  7. Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football

    PubMed Central

    Kerr, Zachary Y.; Yeargin, Susan; Valovich McLeod, Tamara C.; Nittoli, Vincent C.; Mensch, James; Dodge, Thomas; Hayden, Ross; Dompier, Thomas P.

    2015-01-01

    Background: Research evaluating the effect of comprehensive coach education and practice contact restriction in youth football injury rates is sparse. In 2012, USA Football released their Heads Up Football coaching education program (HUF), and Pop Warner Football (PW) instituted guidelines to restrict contact during practice. Purpose: To compare injury rates among youth football players aged 5 to 15 years by whether their leagues implemented HUF and/or were PW-affiliated. Study Design: Cohort study; Level of evidence, 2. Methods: Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2014 youth football season. Players were drawn from 10 leagues across 4 states. The non–Heads Up Football (NHUF) group consisted of 704 players (none of whom were PW-affiliated) from 29 teams within 4 leagues. The HUF+PW group consisted of 741 players from 27 teams within 2 leagues. The HUF-only group consisted of 663 players from 44 teams within 4 leagues. Injury rates and injury rate ratios (IRRs) were reported with 95% CIs. Results: A total of 370 injuries were reported during 71,262 athlete-exposures (AEs) (rate, 5.19/1000 AEs). Compared with the NHUF group (7.32/1000 AEs), the practice injury rates were lower for the HUF+PW group (0.97/1000 AEs; IRR, 0.13; 95% CI, 0.08-0.21) and the HUF-only group (2.73/1000 AEs; IRR, 0.37; 95% CI, 0.26-0.53). Compared with the NHUF group (13.42/1000 AEs), the game injury rate was lower for the HUF+PW group (3.42/1000 AEs; IRR, 0.25; 95% CI, 0.15-0.44) but not for the HUF-only group (13.76/1000 AEs; IRR, 1.02; 95% CI, 0.73-1.43). Also, the HUF+PW game injury rate was lower than that of HUF-only (IRR, 0.20; 95% CI, 0.12-0.36). Higher injury rates were typically found in those aged 11 to 15 years compared with those aged 5 to 10 years. However, stronger effects related to HUF implementation and PW affiliation were seen among 11- to 15-year-olds. When restricted to concussions only, the sole difference was found

  8. [Improvement of quality of practices for the preparation of cytotoxic drugs: results of a "before-after" study].

    PubMed

    Gilles, L; Favier, B; Catillon, F; Dussart, C; Peyron, F; Simoens, X; Latour, J-F; Farsi, F; Biron, P

    2009-09-01

    Despite the publication of guidelines for handling antineoplastic agents, measurable amounts of these drugs are still found at various hospital sites. In this context, the French cancer network ONCORA supported the present study to assess the impact of environmental contamination controls on the quality of practices during the preparation of cytotoxic drugs. The first part of the study was conducted at five voluntary hospitals. A total of 65 wipe samples of objects and surfaces were taken in the drug preparation rooms and analyzed for the presence of 5-fluorouracil (5-FU). Measurable amounts of 5-FU were detected in 21 samples (32%). Many surfaces within Biological Safety Cabinets and isolators were found contaminated (36%). The worse results were obtained on gloves and on the outside of infusion bags. The same method was applied during the second part of the study, conducted six months after the end of the first audit. Global contamination was reduced to 17%. This study shows that appropriate handling helps decrease the number of samples contaminated, making it possible to recommend these controls for evaluating and improving the quality of practices. Since 2007, the network's laboratory has extended its activities to all French hospitals interested in this quality assurance programme.

  9. ALMA Telescope Reaches New Heights

    NASA Astrophysics Data System (ADS)

    2009-09-01

    ball at a distance of nine miles, and to keep their smooth reflecting surfaces accurate to less than the thickness of a human hair. Once the transporter reached the high plateau it carried the antenna to a concrete pad -- a docking station with connections for power and fiber optics -- and positioned it with an accuracy of a small fraction of an inch. The transporter is guided by a laser steering system and, just like some cars, also has ultrasonic collision detectors. These sensors ensure the safety of the state-of-the-art antennas as the transporter drives them across what will soon be a rather crowded plateau. Ultimately, ALMA will have at least 66 antennas distributed over about 200 pads, spread over distances of up to 11.5 miles and operating as a single, giant telescope. Even when ALMA is fully operational, the transporters will be used to move the antennas between pads to reconfigure the telescope for different kinds of observations. This first ALMA antenna at the high site will soon be joined by others, and the ALMA team looks forward to making their first observations from the Chajnantor plateau. They plan to link three antennas by early 2010, and to make the first scientific observations with ALMA in the second half of 2011. ALMA will help astronomers answer important questions about our cosmic origins. The telescope will observe the Universe using light with millimeter and submillimeter wavelengths, between infrared light and radio waves in the electromagnetic spectrum. Light at these wavelengths comes from some of the coldest, and from some of the most distant objects in the cosmos. These include cold clouds of gas and dust where new stars are being born, or remote galaxies towards the edge of the observable universe. The Universe is relatively unexplored at submillimeter wavelengths, as the telescopes need extremely dry atmospheric conditions, such as those at Chajnantor, and advanced detector technology. The Atacama Large Millimeter/submillimeter Array

  10. ALMA telescope reaches new heights

    NASA Astrophysics Data System (ADS)

    2009-09-01

    of the Array Operations Site. This means surviving strong winds and temperatures between +20 and -20 Celsius whilst being able to point precisely enough that they could pick out a golf ball at a distance of 15 km, and to keep their smooth reflecting surfaces accurate to better than 25 micrometres (less than the typical thickness of a human hair). Once the transporter reached the high plateau it carried the antenna to a concrete pad - a docking station with connections for power and fibre optics - and positioned it with an accuracy of a few millimetres. The transporter is guided by a laser steering system and, just like some cars today, also has ultrasonic collision detectors. These sensors ensure the safety of the state-of-the-art antennas as the transporter drives them across what will soon be a rather crowded plateau. Ultimately, ALMA will have at least 66 antennas distributed over about 200 pads, spread over distances of up to 18.5 km and operating as a single, giant telescope. Even when ALMA is fully operational, the transporters will be used to move the antennas between pads to reconfigure the telescope for different kinds of observations. "Transporting our first antenna to the Chajnantor plateau is a epic feat which exemplifies the exciting times in which ALMA is living. Day after day, our global collaboration brings us closer to the birth of the most ambitious ground-based astronomical observatory in the world", said Thijs de Graauw, ALMA Director. This first ALMA antenna at the high site will soon be joined by others and the ALMA team looks forward to making their first observations from the Chajnantor plateau. They plan to link three antennas by early 2010, and to make the first scientific observations with ALMA in the second half of 2011. ALMA will help astronomers answer important questions about our cosmic origins. The telescope will observe the Universe using light with millimetre and submillimetre wavelengths, between infrared light and radio waves in

  11. A venue-based analysis of the reach of a targeted outreach service to deliver opportunistic community NHS Health Checks to 'hard-to-reach' groups.

    PubMed

    Roberts, D J; de Souza, V C

    2016-08-01

    Opportunistic outreach services have been commissioned to overcome potential barriers to uptake, by offering health checks in accessible community venues. This study aimed to evaluate the ability of an outreach health check service to reach key target groups: men, people of South Asian ethnicity and people from deprived areas. The comparator was the health check service provided by GP practices. One aim was to investigate whether the addition of an outreach service would result in a higher percentage of health checks being done for people from the target groups compared to a GP-based service alone. The second aim was to assess which types of venues used for outreach health checks were most effective in reaching these groups. Evaluation of Public Health Programme with retrospective control group comparison. The percentages of completed health checks in men, people of South Asian ethnicity, and participants registered at general practices with lowest quintile area-level deprivation status were compared between all opportunistic community checks conducted by the Outreach Service over a ten month period and checks conducted in general practice in a partially-overlapping time period of the same financial year. For the venue-based comparison of Outreach Service checks, the number of checks per visit and percentage of checks in each target group were calculated for each venue. Of 3849 Outreach Service checks, 38% were in men (compared to 50% of checks conducted in Primary Care), and 11% were in people of South Asian ethnicity (compared to 3% in Primary Care). 3558 Outreach check participants were registered with a general practice in the County (92%), and of these, 32% of checks were in people registered with a general practice in the lowest deprivation quintile (compared to 13% of checks in Primary Care). There were 519 visits by the outreach service to 23 different types of venue. Certain venues recorded large numbers of checks e.g. supermarkets and libraries, but they

  12. EFNEP Reaches Refugee Youth Using a Mobile Van

    ERIC Educational Resources Information Center

    Gossett, Linda S.

    2012-01-01

    New groups of refugees settled in apartments far from city services. Their children lacked access to organized after-school activities and the opportunity to practice English. The Expanded Food and Nutrition Education Program (EFNEP) wanted to reach and teach the young refugees but lacked the staff and budget to do so. This article discusses how…

  13. Our Global Reach: UNESCO and ICAE as Catalysts

    ERIC Educational Resources Information Center

    Boucouvalas, Marcie

    2012-01-01

    Globalization has become a household word, permeating workplaces and communities, while internationalizing the curriculum has become common practice, not just in higher education, but also reaching into the primary grades and outward into program planning efforts in the non-formal sector. Few fields, however, can claim two international bodies…

  14. EFNEP Reaches Refugee Youth Using a Mobile Van

    ERIC Educational Resources Information Center

    Gossett, Linda S.

    2012-01-01

    New groups of refugees settled in apartments far from city services. Their children lacked access to organized after-school activities and the opportunity to practice English. The Expanded Food and Nutrition Education Program (EFNEP) wanted to reach and teach the young refugees but lacked the staff and budget to do so. This article discusses how…

  15. Reaching Teenagers with Sex Information.

    ERIC Educational Resources Information Center

    Feldman, Margaret

    The problem of teenage pregnancy can be viewed as endemic, a part of American culture not easy to change. Although the number of girls under 15 who are becoming pregnant is not very large (13,000 in 1978), the cost of pregnancy to the girls themselves, their families, and society is very great. Results of data analyses from action research,…

  16. [Treatment of depressive patients in private practice--empirical results, health political and social conditions and recommendations].

    PubMed

    Goesmann, Cornelia; Bühren, Astrid; Neuy-Bartmann, Astrid

    2007-09-01

    Although depression and symptoms of depression belong to the most common disorders in private practice, affected patients are not always diagnosed as early as possible in Germany and often not sufficiently treated. In order to improve the care for persons with depression it is necessary that family doctors are prepared to guide these patients with empathy, treat them adequately pharmacologically both in respect to the depression and to all other somatic aspects and to refer them in time to specialists for psychiatry, psychosomatic medicine or psychotherapy. Political and social conditions that have pathogenic effects should be changed and the shortage of psychotherapy needs to be overcome. In future, the integrated care in ambulant and clinical settings will probably be successful, first trials and test setups have shown good results.

  17. Action plans can interact to hinder or facilitate reach performance.

    PubMed

    Fournier, Lisa R; Wiediger, Matthew D; Taddese, Ezana F

    2015-11-01

    Executing a reach action can be delayed while retaining another action in working memory (WM) if the two action plans partly overlap rather than do not overlap. This delay (partial repetition cost) occurs when reach responses are under cognitive control. In this study, we investigated whether facilitation (a partial repetition benefit) occurs when reach responses are automatic. We also examined whether the hemisphere controlling the limb or selection of the preferred limb (based on a free-reach task) influences reach performance when the actions partly overlap. Left- and right-handers reached to different stimulus locations to the left and right of body midline with their ipsilateral hand while maintaining an action plan in WM that required the same or the different hand. The results showed a partial repetition benefit for spatially compatible reaches to left and right stimulus locations far from the body midline, but not for those near the body midline. Also, no partial repetition cost was found at any of the stimulus-reach locations. This indicates that automatic reach responses that partly overlap with an action plan maintained in WM are not delayed, but instead can be facilitated (partial repetition benefit). The roles of hemisphere and reach-hand preference in action control and the importance of the degree of feature overlap in obtaining a partial repetition benefit (and cost) are discussed.

  18. Postural control during standing reach in children with Down syndrome.

    PubMed

    Chen, Hao-Ling; Yeh, Chun-Fu; Howe, Tsu-Hsin

    2015-03-01

    The purpose of the present study was to investigate the dynamic postural control of children with Down syndrome (DS). Specifically, we compared postural control and goal-directed reaching performance between children with DS and typically developing children during standing reach. Standing reach performance was analyzed in three main phases using the kinematic and kinetic data collected from a force plate and a motion capture system. Fourteen children with DS, age and gender matched with fourteen typically developing children, were recruited for this study. The results showed that the demand of the standing reach task affected both dynamic postural control and reaching performance in children with DS, especially in the condition of beyond arm's length reaching. More postural adjustment strategies were recruited when reaching distance was beyond arm's length. Children with DS tended to use inefficient and conservative strategies for postural stability and reaching. That is, children with DS perform standing reach with increased reaction and execution time and decreased amplitudes of center of pressure displacements. Standing reach resembled functional balance that is required in daily activities. It is suggested to be considered as a part of strength and balance training program with graded task difficulty. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Knowledge, Attitudes, and Practices Concerning Malaria in Pregnancy: Results from a Qualitative Study in Madang, Papua New Guinea

    PubMed Central

    Andrew, Erin V. W.; Pell, Christopher; Angwin, Angeline; Auwun, Alma; Daniels, Job; Mueller, Ivo; Phuanukoonnon, Suparat; Pool, Robert

    2015-01-01

    Background Malaria is the leading cause of illness and death in Papua New Guinea (PNG). Infection during pregnancy with falciparum or vivax malaria, as occurs in PNG, has health implications for mother and child, causing complications such as maternal anemia, low birth weight and miscarriage. This article explores knowledge, attitudes and practices concerning malaria during pregnancy and it’s prevention in Madang, PNG, a high prevalence area. Methods As part of a qualitative study in Madang, exploring MiP, participatory techniques (free-listing and sorting) were conducted along with focus group discussions, in-depth interviews (with pregnant women, health staff and other community members) and observations in the local community and health facilities. Results The main themes explored were attitudes towards and knowledge of MiP, its risks, and prevention. Although there was a general awareness of the term “malaria”, it was often conflated with general sickness or with pregnancy-related symptoms. Moreover, many preventive methods for MiP were related to practices of general healthy living. Indeed, varied messages from health staff about the risks of MiP were observed. In addition to ideas about the seriousness and risk of MiP, other factors influenced the uptake of interventions: availability and perceived comfort of sleeping under insecticide-treated mosquito nets were important determinants of usage, and women’s heavy workload influenced Chloroquine adherence. Conclusion The non-specific symptoms of MiP and its resultant conflation with symptoms of pregnancy that are perceived as normal have implications for MiP prevention and control. However, in Madang, PNG, this was compounded by the inadequacy of health staff’s message about MiP. PMID:25893405

  20. Knowledge, attitude and practice of urban and rural households towards principles of nutrition in Iran: results of NUTRIKAP survey.

    PubMed

    Ahadi, Zeinab; Heshmat, Ramin; Sanaei, Maryam; Shafiee, Gita; Ghaderpanahi, Maryam; Rezaei Homami, Mohsen; Salehi, Forouzan; Abdollahi, Zahra; Azemati, Bahar; Larijani, Bagher

    2014-01-01

    The aim of this study was to assess knowledge, attitude and practice of urban and rural households toward principles of nutrition in Iran. The study population was Iranian households who live in rural and urban areas in all provinces of the country. The sampling method at households' level in each province was single stage cluster sampling with equal size clusters. The incumbent data was collected by a structured questionnaire and through the interview with the eligible subject in each household. A total of 14,136 Iranian households were selected as total sample size, 9,149 urban households, and 4,987 rural households. Around 57.2% of urban and 49.5% of rural households was aware of food groups. Respectively in urban and rural households, about 35.1% and 39.7% had correct knowledge toward roles of food groups. Approximately 41.5% and 39.9% of households had accurate knowledge about reason of food eating in urban and rural areas, respectively. The results showed that 79.6% of them had favorable attitudes. The most of the households consumed red meat and poultry weekly whereas fish was eaten rarely. Fruits, vegetables and dairy were consumed daily in the most of households. Sugar intake was daily in the most of households and cream and butter intake was weekly. The most of households had moderate knowledge and good attitudes. Practice of families about food consumption was good. The results of this study can be used for proper intervention for improving of health society.

  1. [Current hygiene status in endoscopic practice. Results from monitoring the reprocessing of flexible endoscopes in hospitals and private practices in Frankfurt on the Main, Germany, 2003/4].

    PubMed

    Heudorf, U; Hofmann, H; Kutzke, G; Otto, U; Exner, M

    2005-11-01

    Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.

  2. Diagnostic and management practices for phenylketonuria in 19 countries of the South and Eastern European Region: survey results.

    PubMed

    Giżewska, Maria; MacDonald, Anita; Bélanger-Quintana, Amaya; Burlina, Alberto; Cleary, Maureen; Coşkun, Turgay; Feillet, François; Muntau, Ania C; Trefz, Friedrich K; van Spronsen, Francjan J; Blau, Nenad

    2016-02-01

    To avoid potentially severe outcomes, phenylketonuria (PKU) must be detected as soon as possible after birth and managed with life-long treatment. A questionnaire-based survey was performed to document diagnosis and management practices for PKU in a region of Southern and Eastern Europe. Prevalence and management data were obtained from 37/59 (63 %) centres within 19/22 (86%) contacted countries (N = 8600 patients). The main results' analysis was based on completed questionnaires obtained from 31 centres (53%) within 15 countries (68%). A median of 10 % of patients per centre had been diagnosed after the newborn period. Metabolic dieticians and specialised adult PKU clinics were lacking in 36 and 84% of centres, respectively. In 26% of centres, treatment initiation was delayed until >15 days of life. Blood phenylalanine (Phe) thresholds to start treatment and upper Phe targets were inconsistent across centres. Ten percent of centres reported monitoring Phe every 2 weeks for pregnant women with PKU, which is insufficient to minimise risk of neonatal sequalae. Sapropterin dihydrochloride treatment was available in 48% of centres, with 24-h responsiveness tests most common (36%). Only one centre among the five countries lacking newborn screening provided a completed questionnaire. Targeted efforts by health care professionals and governments are needed to optimise diagnostic and management approaches for PKU in Southern and Eastern Europe. PKU must be detected early and optimally managed throughout life to avoid poor outcomes, yet newborn screening is not universal and diagnostic and management practices for PKU are known to vary widely between different centres and countries. Targeted efforts by health care professionals and governments are needed to optimise diagnostic and management approaches. PKU management practices are documented in 19 South and Eastern European countries indicating a heterogeneous situation across the region. Key areas for improvement

  3. Designing Health Apps to Support Dietetic Professional Practice and Their Patients: Qualitative Results From an International Survey

    PubMed Central

    Lieffers, Jessica; Bauman, Adrian; Hanning, Rhona; Allman-Farinelli, Margaret

    2017-01-01

    Background Dietitians are engaging with mobile health (mHealth) technologies, particularly with diet and nutrition apps in their patient care. Despite the plethora of apps available, the majority are not designed with a dietitian’s input. Objective The aim of this study was to identify the user preferences of dietitians in relation to tools, resources, and design features for smartphone health apps that would support their dietetic professional practice and their patients. Methods As part of a larger international Web-based survey of health-app use among dietitians, three open-ended responses were included for specific exploration of app design features and additional resources or tools that could guide the development of apps for use in dietetic practice and patient care. Inductive thematic analysis of responses was conducted using the qualitative data analysis program, NVivo version 11 (QSR International Pty Ltd), to understand the design preferences and features valued by dietitians. Results The responses from 381 dietitian respondents were analyzed. Five key themes were identified. Dietitians wanted access to credible apps, suggesting that dietetic associations should have greater involvement in reviewing and endorsing evidence-based apps for use in dietary counseling. Improvements to the usability of apps, relating to their ease of use and design, were also raised, as self-monitoring of dietary behaviors using existing nutrition apps was deemed to be burdensome. Furthermore, apps providing dietitian-oriented support were favored, for example, those with the ability to streamline the dietary assessment process, so that dietitians could spend more time on dietary counseling and negotiating patient goals for dietary and lifestyle behavior change. Provision of patient-oriented support, such as functionality to tailor apps to patient-specific needs, was also considered important. Finally, respondents valued apps that could integrate into their work systems to

  4. Current prescribing practices and opinions about growth hormone therapy: results of a nationwide survey of paediatric endocrinologists.

    PubMed

    Hardin, Dana S; Woo, Jason; Butsch, Robert; Huett, Beverley

    2007-01-01

    With the advent of several new treatment indications for recombinant hGH, endocrinologists are being asked to make some difficult decisions regarding eligibility for treatment. The purpose of this study was to summarize prevailing attitudes about GH diagnosis and treatment among paediatric endocrinologists. We sent surveys to all active US members of the Lawson Wilkins Pediatric Endocrine Society (LWPES) listed in the 2004-05 directory (excluding our own group of physicians). Thirty-eight per cent of the surveys were returned and 182 met eligibility for analysis. Surveys were divided into four parts: demographic data, answers reflecting current diagnosis practices for GH deficiency and treatment with GH, attitudes and clinical practice for the idiopathic short stature (ISS) diagnosis, and four case studies. Through a series of questions, we elicited the influence towards prescribing GH of current height, growth velocity, predicted height, pubertal progression and other variables. Results were entered into a Microsoft Access database and statistical evaluation was conducted. Eighty-eight per cent of respondents answered 'no' to the statement that there is good consensus on who should be treated with GH and over 90% answered 'no' to the statement that secretagogue testing was the best way to determine if a child would benefit from GH. Factors listed by respondents as important for prescribing GH include: growth velocity less than the 25th percentile, target height less than the 5th percentile and pubertal stage greater than Tanner 2. Current height was also important; however, answers varied as to what height percentile indicated the need for treatment. When queried about prescribing practices for nonstraightforward cases, 62% of respondents answered that the cost of GH influenced their decision to treat, 55% responded that concerns of future unknown side-effects affected their decision and 37% noted family persistence influenced their decision. In response to

  5. Breastfeeding Progression in Preterm Infants Is Influenced by Factors in Infants, Mothers and Clinical Practice: The Results of a National Cohort Study with High Breastfeeding Initiation Rates

    PubMed Central

    Maastrup, Ragnhild; Hansen, Bo Moelholm; Kronborg, Hanne; Bojesen, Susanne Norby; Hallum, Karin; Frandsen, Annemi; Kyhnaeb, Anne; Svarer, Inge; Hallström, Inger

    2014-01-01

    Background and Aim Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. Methods The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24–36 weeks. Results Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4–2.8) and 1.2 days (95% CI 0.1–2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1–7.0) later establishment of exclusive breastfeeding. Conclusion Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding. PMID:25251690

  6. Reaching the Next Generation of Marine Scientists

    NASA Astrophysics Data System (ADS)

    Joyce, J.

    2009-04-01

    The next generation of marine scientists are today at primary school, secondary school or at college. To encourage them in their career, and to introduce those who are as yet undecided to the wonders of marine science, the Irish Marine Institute has devised a series of three overlapping outreach programmes to reach children at all three levels. Beginning at primary school, the "Explorers" programme offers a range of resources to teachers to enable them to teach marine-related examples as part of the science or geography modules of the SESE curriculum. These include teacher training, expert visits to schools, the installation and stocking of aquaria, field trips and downloadable lesson plans. For older pupils, the "Follow the Fleet" programme is a web-based education asset that allows users to track individual merchant ships and research vessels across the world, to interact with senior crew members of ships and to learn about their cargoes, the ports they visit and the sea conditions along the way. Finally, the "Integrated Marine Exploration Programme (IMEP)" takes secondary school pupils and university students to sea aboard the Marine Institute's research vessels to give them a taste of life as a marine scientist or to educate them in the practical day-to-day sampling and data processing tasks that make up a marine scientist's job.

  7. Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results

    PubMed Central

    2013-01-01

    Background Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear. Methods GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (http://www.decide-collaboration.eu/), which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines. Discussion Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems

  8. Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE): protocol and preliminary results.

    PubMed

    Treweek, Shaun; Oxman, Andrew D; Alderson, Philip; Bossuyt, Patrick M; Brandt, Linn; Brożek, Jan; Davoli, Marina; Flottorp, Signe; Harbour, Robin; Hill, Suzanne; Liberati, Alessandro; Liira, Helena; Schünemann, Holger J; Rosenbaum, Sarah; Thornton, Judith; Vandvik, Per Olav; Alonso-Coello, Pablo

    2013-01-09

    Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear. GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (http://www.decide-collaboration.eu/), which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines. Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally.

  9. Ophthalmologists' practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey

    PubMed Central

    Kyari, Fatima; Nolan, Winifred; Gilbert, Clare

    2016-01-01

    Purpose of the study Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged ≥40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists’ practice patterns and their constraints in managing glaucoma. Study design Ophthalmologists were sent a semistructured questionnaire on how they manage glaucoma, their training in glaucoma care, where they practice, their access to equipment for diagnosis and treatment, whether they use protocols and the challenges they face in managing patients with glaucoma. Results 153/250 ophthalmologists in 80 centres completed questionnaires. Although 79% felt their training was excellent or good, 46% needed more training in glaucoma diagnosis and surgery. All had ophthalmoscopes, 93% had access to applanation tonometers, 81% to visual field analysers and 29% to laser machines (in 19 centres). 3 ophthalmologists had only ophthalmoscopes and schiøtz tonometers. For 85%, a glaucomatous optic disc was the most important feature that would prompt glaucoma work-up. Only 56% routinely performed gonioscopy and 61% used slit-lamp stereoscopic biomicroscopy for disc assessment. Trabeculectomy (with/without antimetabolites) was the only glaucoma surgery performed with one mention of canaloplasty. Poor compliance with medical treatment (78%) and low acceptance of surgery (71%) were their greatest challenges. Conclusions This study indicates that a systems-oriented approach is required to enhance ophthalmologist's capability for glaucoma care. Strategies to improve glaucoma management include strengthening poorly equipped centres including provision of lasers and training, and improving patients’ awareness and education on glaucoma. PMID:27729348

  10. Patterns of Radiotherapy Practice for Pancreatic Cancer in Japan: Results of the Japanese Radiation Oncology Study Group (JROSG) Survey

    SciTech Connect

    Ogawa, Kazuhiko; Ito, Yoshinori; Karasawa, Katsuyuki; Ogawa, Yoshihiro; Onishi, Hiroshi; Kazumoto, Tomoko; Shibuya, Keiko; Shibuya, Hitoshi; Okuno, Yoshishige; Nishino, Shigeo; Ogo, Etsuyo; Uchida, Nobue; Karasawa, Kumiko; Nemoto, Kenji; Nishimura, Yasumasa

    2010-07-01

    Purpose: To determine the patterns of radiotherapy practice for pancreatic cancer in Japan. Methods and Materials: A questionnaire-based national survey of radiotherapy for pancreatic cancer treated between 2000 and 2006 was conducted by the Japanese Radiation Oncology Study Group (JROSG). Detailed information on 870 patients from 34 radiation oncology institutions was accumulated. Results: The median age of all patients was 64 years (range, 36-88), and 80.2% of the patients had good performance status. More than 85% of patients had clinical Stage T3-T4 disease, and 68.9% of patients had unresectable disease at diagnosis. Concerning radiotherapy (RT), 49.8% of patients were treated with radical external beam RT (EBRT) (median dose, 50.4 Gy), 44.4% of patients were treated with intraoperative RT (median dose, 25 Gy) with or without EBRT (median dose, 45 Gy), and 5.9% of patients were treated with postoperative radiotherapy (median dose, 50 Gy). The treatment field consisted of the primary tumor (bed) only in 55.6% of the patients. Computed tomography-based treatment planning and conformal RT was used in 93.1% and 83.1% of the patients treated with EBRT, respectively. Chemotherapy was used for 691 patients (79.4%; before RT for 66 patients; during RT for 531; and after RT for 364). Gemcitabine was the most frequently used drug, followed by 5-fluorouracil. Conclusion: This study describes the general patterns of RT practice for pancreatic cancer in Japan. Most patients had advanced unresectable disease, and radical EBRT, as well as intraoperative RT with or without EBRT, was frequently used. Chemotherapy with gemcitabine was commonly used in conjunction with RT during the survey period.

  11. Prevention of episodic migraines with topiramate: results from a non-interventional study in a general practice setting.

    PubMed

    Nelles, Gereon; Schmitt, Lukas; Humbert, Thomas; Becker, Veit; Sandow, Petra; Bornhoevd, Karin; Fritzsche, Dirk; Schäuble, Barbara

    2010-02-01

    The majority of patients with migraine headaches are treated in non-specialized institutions though data on treatment outcomes are largely derived from tertiary care centers. The current non-interventional study explores efficacy and tolerability outcomes of patients with episodic migraines receiving topiramate as preventive agent in a general practice setting. A total of 366 patients (87% female, mean age 41.8 +/- 11.6 years) were eligible for migraine prevention and treated with flexible dose topiramate for 6 months (core phase), and optionally for a total of 12 months (follow-up phase). Overall, 261 patients (77.7% of safety analysis set, SAF) completed the core phase. Reasons for discontinuation included adverse events (2.1%), lost to follow-up (1.8%), other reasons (1.5%), and end of therapy (0.3%) though in the majority of patients who discontinued no reasons were listed. The median daily dose at endpoint was 50 mg/day (range, 25-187.5 mg/day). The median days with migraine headaches decreased from 6.0 to 1.2 days (p < 0.001), median pain intensity score decreased from 17.0 to 3.2 points (p < 0.001). In women with reported menstruation-associated migraine, the median number of migraine attacks decreased from 4.0 to 0.9 (p < 0.001). Absenteeism as well as triptan use decreased significantly, and significant improvements in activities of daily living and quality of life were reported. The most frequently reported AEs were paraesthesia (4.2%) and nausea (3%). Results suggest that migraine prevention with topiramate in a general practice is generally well tolerated and associated with a significant improvement in migraine headaches and related functional impairment.

  12. The representations of reach endpoints in posterior parietal cortex depend on which hand does the reaching

    PubMed Central

    Snyder, Lawrence H.

    2012-01-01

    Neurons in the parietal reach region (PRR) have been implicated in the sensory-to-motor transformation required for reaching toward visually defined targets. The neurons in each cortical hemisphere might be specifically involved in planning movements of just one limb, or the PRR might code reach endpoints generically, independent of which limb will actually move. Previous work has shown that the preferred directions of PRR neurons are similar for right and left limb movements but that the amplitude of modulation may vary greatly. We now test the hypothesis that frames of reference and eye and hand gain field modulations will, like preferred directions, be independent of which hand moves. This was not the case. Many neurons show clear differences in both the frame of reference as well as in direction and strength of gain field modulations, depending on which hand is used to reach. The results suggest that the information that is conveyed from the PRR to areas closer to the motor output (the readout from the PRR) is different for each limb and that individual PRR neurons contribute either to controlling the contralateral-limb or else bimanual-limb control. PMID:22298831

  13. The Transition to Reaching: Mapping Intention and Intrinsic Dynamics.

    ERIC Educational Resources Information Center

    Thelen, Esther; And Others

    1993-01-01

    Weekly observations of 4 infants in a standard arm-extended reaching task demonstrated that the infants first reached at ages ranging from 12 to 22 weeks. Results suggest that the infant central nervous system does not contain programs that detail hand trajectory or muscle activation patterns; rather, these patterns are the consequence of the…

  14. Infants' Predictive Reaching for Moving Objects in the Dark.

    ERIC Educational Resources Information Center

    Robin, Daniel J.; And Others

    1996-01-01

    Thirteen infants were presented with a moving object under two lighting conditions to investigate the role of vision in early reaching. Infants were tested twice, at 5 and 7.5 months of age. The results suggest that proprioceptive feedback and sight of the target allowed for successful reaching with limited visual information, even in relatively…

  15. Evidence-Based Practice Knowledge, Use, and Factors that Influence Decisions: Results from an Evidence-Based Practice Survey of Providers in American Indian/Alaska Native Communities

    ERIC Educational Resources Information Center

    Sheehan, Angela; Walrath-Greene, Christine; Fisher, Sylvia; Crossbear, Shannon; Walker, Joseph

    2007-01-01

    Data from the Evidence-based Treatment Survey were used to compare providers serving families in American Indian and Alaska Native communities to their counterparts in non-American Indian/Alaska Native communities on provider characteristics and factors that influence their decision to use evidence-based practices (N = 467). The findings suggest…

  16. REACH: impact on the US cosmetics industry?

    PubMed

    Pouillot, Anne; Polla, Barbara; Polla, Ada

    2009-03-01

    The Registration, Evaluation, Authorization and restriction of Chemicals (REACH) is a recent European regulation on chemical substances meant to protect human health and the environment. REACH imposes the "precautionary principle" where additional data and definitive action are required when uncertainty is identified. The cosmetics industry is only partially concerned by REACH: while the stages of registration and evaluation apply to cosmetics, those of authorization and restriction most likely will not, as cosmetic ingredients are already subject to regulation by various agencies and directives. REACH has potential benefits to the industry including the possibility of reassuring consumers and improving their image of chemicals and cosmetics. However, REACH also has potential disadvantages, mainly with regard to impeding innovation. The American cosmetics industry will be affected by REACH, because all US manufacturers who export substances to Europe will have to fully comply with REACH.

  17. [Practical experience on improving activities of daily living competence in Parkinson's patients treated with ropinirole. Results of a applied study].

    PubMed

    Reichmann, H; Angersbach, D; Buchwald, B

    2005-10-01

    Ropinirole is a non-ergot-selective D2 dopamine agonist. Its efficacy, tolerability, and safety have been extensively proven in controlled, double-blind trials. The present prospective, multicentre, postmarketing surveillance study tested whether the results of controlled clinical trials are also valid in routine clinical practice. For evaluation, international rating scales for tremor and activities of daily living were applied in a slightly modified manner. In 172 German centres, 453 parkinsonian patients (272 men, 174 women, average age 67 years) in advanced stages of the disease were treated with ropinirole alone or in combination with L-dopa. Activities of daily living and tremor significantly improved. This is the first prospective study which demonstrates beneficial effects of ropinirole on PD tremor. The dosage of L-dopa could be reduced in 31% of the patients. Side effects were reported in only 7.6%. The results of this postmarketing study corroborate the good clinical efficacy of ropinirole together with high safety under routine clinical conditions.

  18. Validating CAR - A comparison study of experimentally-derived and computer-generated reach envelopes. [Crewstation Assessment of Reach

    NASA Technical Reports Server (NTRS)

    Harris, R.; Bennett, J.; Stokes, J.

    1982-01-01

    In the present investigation, Crewstation Assessment of Reach (CAR) results in the form of male hand reach envelopes were generated and compared with an anthropometric survey performed by Kennedy (1978) to determine the extent of the validity of the CAR model with respect to experimentally-derived anthropometric data. The CAR-generated reach envelopes extensively matched the Kennedy envelopes. The match was particularly good in the areas to the front and side from which the reach originated. Attention is given to the crewstation model, the operator sample population, the CAR analysis, aspects of validation methodology, and the modeling of experimental parameters.

  19. Understanding Dutch practice nurses' adherence to evidence-based smoking cessation guidelines and their needs for web-based adherence support: results from semistructured interviews

    PubMed Central

    de Ruijter, D; Smit, E S; de Vries, H; Goossens, L; Hoving, C

    2017-01-01

    Objectives Practice nurses in general practices suboptimally adhere to smoking cessation guidelines. Since the effectiveness of their smoking cessation support is greatest when full adherence to these guidelines is achieved, interventions need to be developed to improve practice nurses' guideline adherence, for example, by tailoring their content to adherence determinants. However, the sociocognitive determinants explaining adherence have not yet been investigated. Therefore, this qualitative needs assessment aimed to explore practice nurses' current counselling practices, as well as their sociocognitive beliefs related to their smoking cessation guideline adherence and their needs regarding web-based adherence support. Setting Primary care; general practices in the Netherlands. Participants 19 practice nurses, actively involved in smoking cessation counselling. Methods Semistructured individual interviews, based on the I-Change Model and the Diffusion of Innovations Theory, were conducted from May to September 2014. Data were systematically analysed using the Framework Method and considered reliable (κ 0.77; % agreement 99%). Results Respondents felt able to be empathic and collaborative during smoking cessation consultations. They also reported psychological (eg, low self-efficacy to increase patient motivation and arranging adequate follow-up consultations) and practical barriers (eg, outdated information on quit support compensation and a perceived lack of high-quality trainings for practice nurses) to smoking cessation guideline adherence. Most respondents were interested in web-based adherence support to overcome these barriers. Conclusions Sociocognitive determinants influence practice nurses' smoking cessation guideline adherence. To improve their adherence, web-based tailored adherence support can provide practice nurses with personally relevant feedback tailored to individually perceived barriers to smoking cessation guideline adherence. More

  20. Using a Class to Conduct a Carbon Inventory: A Case Study with Practical Results at Macalester College

    ERIC Educational Resources Information Center

    Wells, Christopher W.; Savanick, Suzanne; Manning, Christie

    2009-01-01

    Purpose: The purpose of this paper is to discuss the practical realities of using a college seminar to fulfill the carbon audit requirement for signatories to the American College and University Presidents Climate Commitment (ACUPCC) and presents evidence of this approach's advantages as an educational and practical tool.…

  1. A Study of the Results of the Implementation of a Non-Punitive Grading Practice at Mattatuck Community College.

    ERIC Educational Resources Information Center

    Maxwell, James

    Mattatuck Community College implemented non-punitive grading practices into its grading system in the Fall 1973 semester. These practices centered about the elimination of plus and minus grades, elimination of the grade of F, and liberalizing the course withdrawal policy to allow for withdrawal without penalty throughout the semester. A comparison…

  2. Using a Class to Conduct a Carbon Inventory: A Case Study with Practical Results at Macalester College

    ERIC Educational Resources Information Center

    Wells, Christopher W.; Savanick, Suzanne; Manning, Christie

    2009-01-01

    Purpose: The purpose of this paper is to discuss the practical realities of using a college seminar to fulfill the carbon audit requirement for signatories to the American College and University Presidents Climate Commitment (ACUPCC) and presents evidence of this approach's advantages as an educational and practical tool.…

  3. Crossing New Uncharted Territory: Shifts in Academic Identity as a Result of Modifying Teaching Practice in Undergraduate Mathematics

    ERIC Educational Resources Information Center

    Kensington-Miller, Barbara; Sneddon, Jamie; Stewart, Sepideh

    2014-01-01

    The changes in academic identity a teacher may undergo, as they modify their teaching practice, will vary depending on their experiences and the support they receive. In this paper, we describe the shifts in academic identity of two lecturers, a mathematician and a mathematics educator, as they both made changes to their teaching practice by…

  4. A model for learning human reaching movements.

    PubMed

    Karniel, A; Inbar, G F

    1997-09-01

    Reaching movement is a fast movement towards a given target. The main characteristics of such a movement are straight path and a bell-shaped speed profile. In this work a mathematical model for the control of the human arm during ballistic reaching movements is presented. The model of the arm contains a 2 degrees of freedom planar manipulator, and a Hill-type, non-linear mechanical model of six muscles. The arm model is taken from the literature with minor changes. The nervous system is modeled as an adjustable pattern generator that creates the control signals to the muscles. The control signals in this model are rectangular pulses activated at various amplitudes and timings, that are determined according to the given target. These amplitudes and timings are the parameters that should be related to each target and initial conditions in the work-space. The model of the nervous system consists of an artificial neural net that maps any given target to the parameter space of the pattern generator. In order to train this net, the nervous system model includes a sensitivity model that transforms the error from the arm end-point coordinates to the parameter coordinates. The error is assessed only at the termination of the movement from knowledge of the results. The role of the non-linearity in the muscle model and the performance of the learning scheme are analysed, illustrated in simulations and discussed. The results of the present study demonstrate the central nervous system's (CNS) ability to generate typical reaching movements with a simple feedforward controller that controls only the timing and amplitude of rectangular excitation pulses to the muscles and adjusts these parameters based on knowledge of the results. In this scheme, which is based on the adjustment of only a few parameters instead of the whole trajectory, the dimension of the control problem is reduced significantly. It is shown that the non-linear properties of the muscles are essential to achieve

  5. US Urban Elementary Teachers' Knowledge and Practices in Teaching Science to English Language Learners: Results from the first year of a professional development intervention

    NASA Astrophysics Data System (ADS)

    Santau, Alexandra O.; Secada, Walter; Maerten-Rivera, Jaime; Cone, Neporcha; Lee, Okhee

    2010-10-01

    The study examined US elementary teachers' knowledge and practices in four key domains of science instruction with English language learning (ELL) students. The four domains included: (1) teachers' knowledge of science content, (2) teaching practices to promote scientific understanding, (3) teaching practices to promote scientific inquiry, and (4) teaching practices to support English language development during science instruction. The study was part of a larger five-year research and development intervention aimed at promoting science and literacy achievement of ELL students in urban elementary schools. It involved 32 third grade, 21 fourth grade, and 17 fifth grade teachers participating in the first-year implementation of the intervention. Based on teachers' questionnaire responses and classroom observation ratings, results indicated that (1) teachers' knowledge and practices were within the bounds of acceptability but short of reform-oriented practices and (2) grade-level differences existed, especially between Grades 3 and 5.

  6. The Reach Ratio—A New Indicator for Comparing Quitline Reach Into Smoking Subgroups

    PubMed Central

    2014-01-01

    Introduction: There is growing concern about population disparities in tobacco-related morbidity and mortality. This paper introduces the reach ratio as a complementary measure to reach for monitoring whether quitline interventions are reaching high risk groups of smokers proportionate to their prevalence in the population. Methods: Data on smokers were collected at intake by 7 Canadian provincial quitlines from 2007 to 2009 and grouped to identify 4 high risk subgroups: males, young adults, heavy smokers, and those with low education. Provincial data are from the Canadian Tobacco Use Monitoring Survey. Reach ratios (ReRas), defined as the proportion of quitline callers from a subgroup divided by the proportion of the smoking population in the subgroup, and 95% confidence intervals were calculated for the subgroups. A ReRa of 1.0 indicates proportionate representation. Results: ReRas for male smokers and young adults are consistently less than 1.0 across all provinces, indicating that a lower proportion of these high-risk smokers were receiving evidence-based smoking cessation treatment from quitlines. Those with high levels of tobacco addiction and less than high school education have ReRas greater than 1.0, indicating that a greater proportion of these smokers were receiving cessation treatments. Conclusion: ReRas complement other measures of reach and provide a standardized estimate of the extent to which subgroups of interest are benefiting from available cessation interventions. This information can help quitline operators, funders, and policymakers determine the need for promotional strategies targeted to high risk subgroups, and allocate resources to meet program and policy objectives. PMID:24311698

  7. Perspectives of women with disabilities on reaching those who are hard to reach.

    PubMed

    Smeltzer, Suzanne C; Sharts-Hopko, Nancy C; Ott, Barbara B; Zimmerman, Vanessa; Duffin, Janice

    2007-06-01

    Healthcare needs of women with disabilities are often neglected, even for women who are well connected to the community and to the healthcare system. So-called "hard-to-reach" women, whose degree of disability impedes use of community resources, have even greater difficulty obtaining health care. The purpose of this study was to gain insight into the perceptions of women with mobility and sensory limitations about several healthcare issues that may affect them: barriers to obtaining care, sources of information about health issues, ways to improve access to care, and ways to help hard-to-reach women overcome barriers to health care and health information. Researchers conducted six focus groups, comprising 43 women with limitations of mobility, hearing, or vision. To validate the women's input, researchers conducted two additional focus groups: the first comprised female physicians with special interest in the health care of women with disabilities, and the second included professional administrative staff of agencies that provide services for people with disabilities. In several cases, members of the physician and agency focus groups were themselves women with disabilities. In addition, 16 women with disabilities participated in an online survey; their responses were used to validate the findings of the face-to-face focus groups. Transcribed data were content analyzed and 10 themes identified. Seven of those themes are discussed in this article: communication barriers; lack of knowledge and awareness among healthcare providers; access issues; working the system; system issues; outreach to healthcare providers; and reaching hard-to-reach women. The findings of this study can provide direction to development of more effective outreach to hard-to-reach women with disabilities, resulting in better integration of healthcare services for this population.

  8. Education, Out-reach and In-reach Infrastructure Support for the Hydrologic Sciences

    NASA Astrophysics Data System (ADS)

    Hannigan, R.; McCaffrey, M.

    2002-05-01

    The Consortium of Universities for the Advancement of Hydrologic Science, incorporated (CUAHSI) is designed as an infrastructure support mechanism for research in the hydrologic sciences. Education, Out-reach and In-reach (EOI) is one of the five support thrusts of CUAHSI. EOI interfaces intimately with the other four thrusts (Hydrologic Science, Hydrologic Observatories, Hydrologic Information Systems, Hydrologic Measurement Technology). In addition, the EOI infrastructure will provide additional support to the scientific and educational communities as well as the general public. The EOI infrastructure aims to support scientists, educators, students and other interested parties through a variety of mechanisms including summer institutes, instrumentation training, student fellowships and institutional linkages. EOI's overall goal is to develop strategies, which have a broad impact and national significance. All EOI programs will link to CUAHSI science driven initiatives and will be evaluated in the basis of the impact of the program to the intended audience(s) and attainment of measurable outcomes. EOI, in addition to providing opportunities to the hydrologic science community, the broader scientific and education communities and the general public, will consistently interact with key members of pertinent communities to make them aware of available programs and to insure their participation by the interactive development of programs and opportunities. Potential activities include summer institutes at CUAHSI member universities for scientists, educators and students to exchange new ideas and learn new techniques. Potential exists for graduate student fellowships in support of research activities linked to CUAHSI science plans. Outreach to the general public and policy-makers may include distinguished speakers presenting general hydrologic science information and highlighting CUAHSI related research initiatives. In-reach is also a priority for EOI, and opportunities

  9. Guideline and preliminary clinical practice results for dose specification and target delineation for postoperative radiotherapy for oral cavity cancer.

    PubMed

    Liu, Shih-Hua; Chao, K S Clifford; Leu, Yi-Shing; Lee, Jehn-Chuan; Liu, Chung-Ji; Huang, Yu-Chuen; Chang, Yi-Fang; Chen, Hong-Wen; Tsai, Jo-Ting; Chen, Yu-Jen

    2015-07-01

    Surgery followed by radiotherapy (RT) is indicated for patients with high-risk oral cavity cancer (OCC). Based on multi-institutional reports, we developed a guideline for postoperative RT for patients with OCC. A multidisciplinary OCC team was recruited to develop a questionnaire concerning details of risk-factor categorization, target delineation, and dose specification. Thirty-one radiation oncologists from 18 institutions completed the questionnaire, and data were subjected to extensive review to establish the guideline by expert meeting. In this study, we also report the results for patients treated in accordance with the guideline at our institution between 2007 and 2011. Forty-one patients received RT compatible with this guideline with a median 26.8-month follow-up. Thirty-two patients (78%) remained disease-free, 6 (15%) developed locoregional recurrence (4 in-field, 1 marginal, and 1 out-field) and 4 (10%) developed distant metastasis. The overall 2-year survival rate was 86.7%. This guideline is promising and should be validated and refined in further clinical practice. © 2014 Wiley Periodicals, Inc.

  10. [A case of long thoracic nerve palsy, with winged scapula, as a result of prolonged exertion on practicing archery].

    PubMed

    Shimizu, J; Nishiyama, K; Takeda, K; Ichiba, T; Sakuta, M

    1990-08-01

    Reports of isolated long thoracic nerve palsy are rare in Japan. We reported a case of isolated long thoracic nerve palsy, resulted from recurrent injury to the nerve. Muscle CT and electrodiagnostic study were useful for confirming diagnosis of this cases. This patient was a student aged 20 years, with nothing of importance in his family or past history. After he started practicing archery, winging of left scapula was gradually developed. Physical examination revealed weakness and atrophy of left serratus anterior muscle. There was no wasting and weakness of other should girdle muscles. Hematochemical tests were normal, except slight hyperthyroidism. Radiography and myelography of the cervical spine were normal. Muscle CT of upper thoracic level demonstrated atrophy of left serratus anterior muscle, and no abnormality were found in other muscles. Electromyogram of the left serratus anterior revealed discrete activity of reduced amplitude, and fibrillation potentials and positive sharp waves. Conduction time for left long thoracic nerve was prolonged, and amplitude of the evoked response was small and there were temporal dispersion. Muscle CT and electrodiagnostic studies were suggestive of neuroapraxia of left long thoracic nerve. Over stretching or compression during exercises may be responsible for the damage to the long thoracic nerve.

  11. Hatha Yoga Practice Improves Attention and Processing Speed in Older Adults: Results from an 8-Week Randomized Control Trial.

    PubMed

    Gothe, Neha P; Kramer, Arthur F; McAuley, Edward

    2017-01-01

    Age-related cognitive decline is well documented across various aspects of cognitive function, including attention and processing speed, and lifestyle behaviors such as physical activity play an important role in preventing cognitive decline and maintaining or even improving cognitive function. The purpose of this study was to evaluate the effects of an 8-week Hatha yoga intervention on attention and processing speed among older adults. Participants (n = 118; mean age, 62 ± 5.59) were randomly assigned to an 8-week Hatha yoga group or a stretching control group and completed cognitive assessments-Attention Network Task, Trail Making Test parts A and B, and Pattern Comparison Test-at baseline and after the 8-week intervention. Analyses of covariance revealed significantly faster reaction times for the yoga group on the Attention Network Task's neutral, congruent, and incongruent conditions (p ≤ 0.04). The yoga intervention also improved participants' visuospatial and perceptual processing on the Trail Making Test part B (p = 0.002) and pattern comparison (p < 0.001) tests. These results suggest that yoga practice that includes postures, breathing, and meditative exercises lead to improved attentional and information processing abilities. Although the underlying mechanisms remain largely speculative, more systematic trials are needed to explore the extent of cognitive benefits and their neurobiological mechanisms.

  12. Vascular Access Specialist Training, Experience, and Practice in the United States: Results From the National PICC1 Survey.

    PubMed

    Chopra, Vineet; Kuhn, Latoya; Ratz, David; Shader, Scarlett; Vaughn, Valerie M; Saint, Sanjay; Krein, Sarah L

    Vascular access specialists are increasingly responsible for insertion and care of peripherally inserted central catheters in the United States. Despite proliferation of the specialty, little is known about the training, practice patterns, and experiences of these clinicians. In partnership with a vascular access and an infusion nursing organization, a Web-based survey of 1698 clinicians was conducted. Substantial variation in practices related to insertion, use of technology, dressing and flushing, and management of complications was observed. Some reported practices were inconsistent with available evidence-based recommendations. Therefore, opportunities to improve patient care and further explore reasons driving such variation exist and should be explored.

  13. The correlation of controlled attenuation parameter results with ultrasound-identified steatosis in real-world clinical practice.

    PubMed

    Yen, Yi-Hao; Chen, Jung-Fu; Wu, Cheng-Kun; Lin, Ming-Tsung; Chang, Kuo-Chin; Tseng, Po-Lin; Tsai, Ming-Chao; Lin, Jung-Ting; Hu, Tsung-Hui

    2017-09-06

    Controlled attenuation parameter (CAP) is a method for measuring steatosis based on FibroScan. Despite observer dependency, ultrasound (US) robustly diagnoses moderate and severe steatosis. Here, we aimed to evaluate the correlation of CAP with US-identified steatosis in real-world clinical practice. CAP and US were performed for 1554 chronic liver disease (CLD) patients. CAP was performed by two technicians, and US was performed by 30 hepatologists. The performance of the CAP as compared with the US results was assessed using the area under the receiver operating characteristic curve (AUROC). 532 (34.2%) of the patients had hepatitis C virus (HCV) infection, 723 (46.5%) of the patients had hepatitis B virus (HBV) infection, and the rest were patients with metabolic risk factors. CAP values were significantly correlated with the steatosis grades identified by US for all the patients (ρ = 0.497, P < 0.001), for the HBV-infected patients (ρ = 0.495, P < 0.001), for the HCV-infected patients (ρ = 0.343, P < 0.001), and for the patients with metabolic risk factors (ρ = 0.515, P < 0.001). Using CAP, the AUROC values were 0.759, 0.795, 0.715, and 0.716 for ≥moderate steatosis identified by US in, respectively, all the patients, the HBV-infected patients, the HCV-infected patients, and the patients with metabolic risk factors. The AUROC values were 0.791, 0.868, 0.807 and 0.701 for severe steatosis identified by US in, respectively, all the patients, the HBV-infected patients, the HCV-infected patients, and the patients with metabolic risk factors. CAP values were well correlated with the steatosis grades assessed by US in real-world clinical practice. Copyright © 2017. Published by Elsevier B.V.

  14. Soil management practice in Croatian vineyard affect CO2 fluxes and soil degradation in trafficking zones. First results

    NASA Astrophysics Data System (ADS)

    Bogunovic, Igor; Bilandzija, Darija; Andabaka, Zeljko; Stupic, Domagoj; Cacic, Marija; Brezinscak, Luka; Maletic, Edi; Pereira, Paulo; Kisic, Ivica

    2017-04-01

    Vineyards represent one of the most degradation prone types of intensively managed land on Earth. Steep slopes encourage grape producers to adopt environmental friendly soil management like mulching or continuous no-tillage. In this context, producers have concerns about efficient fertilisation practices and water competitions between vine and grasses in continuous no-tillage inter rows. Vineyards in semi-humid areas like Continental Croatia mostly not suffer from water deficit during growth. Nevertheless, lack of research of different soil management practices open dilemma about soil compaction concerns in intensively trafficked soils in vineyard of semi-humid areas. Soil compaction, determined by bulk density (BD), soil water content (SWC) and CO2 fluxes from trafficked inter row positions were recorded in 2016 in an experiment in which four different soil management systems were compared in a vineyard raised on a silty clay loam soil, near Zagreb, Croatia: No-tillage (NT) system, continuous tillage (CT) and yearly inversed grass covered (INV-GC) and tillage managed (INV-T) inter rows are subjected to intensive traffic. Grape yield and must quality of grape variety Chardonnay was also monitored. Tractor traffic increased the soil BD at 0-10 and 10-20 cm, but especially at the 0-10 cm depth. CT treatment record lowest compaction at 0-10 cm because of tillage. Soil water content showed better conservation possibilities of INV-GC in drier period. In wet period SWC possibilities are similar between treatments. The results of soil compaction under different management indicate that vineyard soil differently response to traffic intensity and impact on microfauna activity and CO2 emissions. INV-GC and NT managed soils record lower CO2 fluxes from vineyard soil compared to CT and INV-T treatments. Management treatments did not statistically influenced on grape yields. Several years of investigation is needed to confirm the overall impact of different management

  15. Postural responses to unexpected perturbations of balance during reaching

    PubMed Central

    Trivedi, Hari; Leonard, Julia A.; Ting, Lena H.; Stapley, Paul J.

    2014-01-01

    To study the interaction between feedforward and feedback modes of postural control, we investigated postural responses during unexpected perturbations of the support surface that occurred during forward reaching in a standing position. We examined postural responses in lower limb muscles of 9 human subjects. Baseline measures were obtained when subjects executed reaching movements to a target placed in front of them (R condition) and during postural responses to forward and backward support-surface perturbations (no reaching, P condition) during quiet stance. Perturbations were also given at different delays after the onset of reaching movements (RP conditions) as well as with the arm extended in the direction of the target, but not reaching (P/AE condition). Results showed that during perturbations to reaching (RP), the initial automatic postural response, occurring around 100 ms after the onset of perturbations, was relatively unchanged in latency or amplitude compared to control conditions (P and P/AE). However, longer latency postural responses were modulated to aid in the reaching movements during forward perturbations but not during backward perturbations. Our results suggest that the nervous system prioritizes the maintenance of a stable postural base during reaching, and that later components of the postural responses can be modulated to ensure the performance of the voluntary task. PMID:20035321

  16. Neural coordination during reach-to-grasp

    PubMed Central

    Vaidya, Mukta; Kording, Konrad; Saleh, Maryam; Takahashi, Kazutaka

    2015-01-01

    When reaching to grasp, we coordinate how we preshape the hand with how we move it. To ask how motor cortical neurons participate in this coordination, we examined the interactions between reach- and grasp-related neuronal ensembles while monkeys reached to grasp a variety of different objects in different locations. By describing the dynamics of these two ensembles as trajectories in a low-dimensional state space, we examined their coupling in time. We found evidence for temporal compensation across many different reach-to-grasp conditions such that if one neural trajectory led in time the other tended to catch up, reducing the asynchrony between the trajectories. Granger causality revealed bidirectional interactions between reach and grasp neural trajectories beyond that which could be attributed to the joint kinematics that were consistently stronger in the grasp-to-reach direction. Characterizing cortical coordination dynamics provides a new framework for understanding the functional interactions between neural populations. PMID:26224773

  17. Results from a survey of national immunization programmes on home-based vaccination record practices in 2013

    PubMed Central

    Young, Stacy L.; Gacic-Dobo, Marta; Brown, David W.

    2015-01-01

    Background Data on home-based records (HBRs) practices within national immunization programmes are non-existent, making it difficult to determine whether current efforts of immunization programmes related to basic recording of immunization services are appropriately focused. Methods During January 2014, WHO and the United Nations Children's Fund sent a one-page questionnaire to 195 countries to obtain information on HBRs including type of record used, number of records printed, whether records were provided free-of-charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013. Results A total of 140 countries returned a completed HBR questionnaire. Two countries were excluded from analysis because they did not use a HBR during 2013. HBR types varied across countries (vaccination only cards, 32/138 [23.1%]; vaccination plus growth monitoring records, 31/138 [22.4%]; child health books, 48/138 [34.7%]; combination of these, 27/138 [19.5%] countries). HBRs were provided free-of-charge in 124/138 (89.8%) respondent countries. HBRs were required for school entry in 62/138 (44.9%) countries. Nearly a quarter of countries reported HBR stock-outs during 2013. Computed printing cost per record was results provide a basis for national immunization programmes to develop, implement and monitor corrective activities to improve the availability and utilization of HBRs. Much work remains to improve forecasting where appropriate, to prevent HBR stock-outs, to identify and improve sustainable financing options and to explore viable market shaping opportunities. PMID:25733540

  18. Trends in prevalence, knowledge, attitudes, and practices of helmet use in Cambodia: results from a two year study

    PubMed Central

    Bachani, Abdulgafoor M.; Branchini, Casey; Ear, Chariya; Roehler, Douglas R.; Parker, Erin M.; Tum, Sotheary; Ballesteros, Michael F.; Hyder, Adnan A.

    2015-01-01

    Introduction Road traffic injuries (RTIs) are a major cause of both morbidity and mortality globally. Relative to countries with similar economic patterns both within and outside of South-East Asia, Cambodia's road traffic fatality rate is high, with motorcyclists accounting for more than half of all fatalities as a result of head injuries. Despite the initiation of national motorcycle helmet legislation for Cambodian drivers in 2009, helmet use among both drivers and passengers remains low. Methods This study adopted a two-pronged approach to assess the current status of and knowledge, attitudes, and practices (KAPs) towards helmet use among drivers and passengers in five provinces in Cambodia. The objective was to better understand helmet use over a two year period since the introduction of the 2009 legislation. Researchers conducted both (1) direct observation of daytime and nighttime helmet use (January 2011–January 2013) and (2) roadside KAP interviews with motorcyclists (November 2010–November 2012). Results The observed helmet rate across all study sites was 33% during nighttime and 48% during daytime, with proportions up to ten times higher among drivers compared with passengers. Self-reported helmet use was higher than observed use. Within the past 30 days, 60% of respondents reported that they “always” wore a helmet when they were drivers while only 24% reported they “always” wore a helmet as a passenger. Reported barriers for use among drivers included: “driving route”, “forgetfulness”, and “inconvenience/discomfort.” Conclusion Despite awareness of the protective value of helmets, motorcycle helmet use rates remain low in Cambodia. Many misconceptions remain in Cambodia regarding helmet use, including that they are unnecessary for short distance or at low speeds. These serve as an important barrier to helmet use, which, if dispelled and coupled with visible and regular enforcement, may significantly reduce the number of

  19. Translating Evidence-Based Falls Prevention into Clinical Practice in Nursing Facilities: Results and Lessons from a Quality Improvement Collaborative

    PubMed Central

    Colón-Emeric, Cathleen; Schenck, Anna; Gorospe, Joel; McArdle, Jill; Dobson, Lee; DePorter, Cindy; McConnell, Eleanor

    2007-01-01

    OBJECTIVES To describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities. DESIGN Natural experiment with nonparticipating facilities serving as controls. SETTING Community nursing homes. PARTICIPANTS Thirty-six participating and 353 non-participating nursing facilities in North Carolina. INTERVENTION Two in-person learning sessions, monthly teleconferences, and an e-mail discussion list over 9 months. The change package emphasized screening, labeling, and risk-factor reduction. MEASUREMENTS Compliance was measured using facility self-report and chart abstraction (n = 832) before and after the intervention. Fall rates as measured using the Minimum Data Set (MDS) were compared with those of nonparticipating facilities as an exploratory outcome. RESULTS Self-reported compliance with screening, labeling, and risk-factor reduction approached 100%. Chart abstraction revealed only modest improvements in screening (51% to 68%, P<.05), risk-factor reduction (4% to 7%, P = .30), and medication assessment (2% to 6%, P = .34). There was a significant increase in vitamin D prescriptions (40% to 48%, P = .03) and decrease in sedative-hypnotics (19% to 12%, P = .04) but no change in benzodiazepine, neuroleptic, or calcium use. No significant changes in proportions of fallers or fall rates were observed according to chart abstraction (28.6% to 37.5%, P = .17), MDS (18.2% to 15.4%, P = .56), or self-report (6.1–5.6 falls/1,000 bed days, P = .31). CONCLUSON Multiple-risk-factor reduction tasks are infrequently implemented, whereas screening tasks appear more easily modifiable in a real-world setting. Substantial differences between self-reported practice and medical record documentation require that additional data sources be used to assess the change-in-care processes resulting from quality improvement programs. Interventions to improve interdisciplinary collaboration need to be developed. PMID

  20. Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh123

    PubMed Central

    Saha, Kuntal K; Frongillo, Edward A; Alam, Dewan S; Arifeen, Shams E; Persson, Lars Åke; Rasmussen, Kathleen M

    2008-01-01

    Background The World Health Organization and the United Nations International Children’s Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health. Objective We evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh. Design The prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change. Results Mean (±SD) birth weight was 2697 ± 401 g; 30% weighed < 2500 g. Mean body weight at 12 and 24 mo was 7.9 ± 1.1 kg and 9.7 ± 1.3 kg, respectively. More appropriate IFPs were associated (P < 0.001) with greater gain in weight and length during infancy. Prior IFPs were also positively associated (P < 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P < 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales. Conclusions Our results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries. PMID:18541577

  1. Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice

    PubMed Central

    Rietveld, Remco P; ter Riet, Gerben; Bindels, Patrick JE; Schellevis, François G; van Weert, Henk CPM

    2007-01-01

    Background In 1996 the guideline 'The Red Eye' was first published by the Dutch College of General Practitioners. The extent to which general practitioners adhere to this guideline is unclear. Recently, data on the management of infectious conjunctivitis by general practitioners became available from the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis, described its management by Dutch general practitioners, and then compared these findings with the recommendations made in the guideline. Methods In 2001, over a 12-month period, data from all patient contacts with 195 general practitioners were taken from electronic medical records. Registration was episode-oriented; all consultations dealing with the same health problem were grouped into disease episodes. Data concerning all episodes of infectious conjunctivitis (ICPC-code F70 and sub codes) were analysed. Results Over one year, 5,213 new and recurrent episodes of infectious conjunctivitis were presented to general practitioners from a population of N = 375,899, resulting in an overall incidence rate of 13.9 per 1000 person-years, varying from more than 80/1000 py in children up to one-year old, to less than 12/1000 py in children over the age of 4. Topical ophthalmic ointments were prescribed in 87% of the episodes, of which 80% was antibiotic treatment. Fusidic acid gel was most frequently prescribed (69%). In most episodes general practitioners did not adhere to the guideline. Conclusion In 2001, the management of infectious conjunctivitis by Dutch general practitioners was not in accordance with the recommendations of the consensus-based guideline published five years previously, despite its wide distribution. In 2006 this guideline was revised. Its successful implementation requires more than distribution alone. Probably the most effective way to achieve this is by following a model for systemic implementation. PMID:17868475

  2. REVERSE AUCTION RESULTS FOR IMPLEMENTATION OF DECENTRALIZED RETROFIT BEST MANAGEMENT PRACTICES IN A SMALL URBAN WATERSHED (CINCINNATI OH)

    EPA Science Inventory

    Although urban stormwater is typically conveyed to centralized infrastructure, there is great potential for reducing stormwater runoff quantity through decentralization. In this case we hypothesize that smaller-scale retrofit best management practices (BMPs) such as rain gardens ...

  3. REVERSE AUCTION RESULTS FOR IMPLEMENTATION OF DECENTRALIZED RETROFIT BEST MANAGEMENT PRACTICES IN A SMALL URBAN WATERSHED (CINCINNATI OH)

    EPA Science Inventory

    Although urban stormwater is typically conveyed to centralized infrastructure, there is great potential for reducing stormwater runoff quantity through decentralization. In this case we hypothesize that smaller-scale retrofit best management practices (BMPs) such as rain gardens ...

  4. From Hard to Reach to How to Reach: A Systematic Review of the Literature on Hard-to-Reach Families

    ERIC Educational Resources Information Center

    Boag-Munroe, Gill; Evangelou, Maria

    2012-01-01

    This paper presents a review of the literature relating to hard-to-reach families which has been published over the last 12 years in the UK, USA, Canada and Australia. The purpose of the review was twofold: to gain insights to understandings of the term "hard-to-reach" within these services--education, health and social--which might be…

  5. Use of Bloodborne Pathogens Exposure Control Plans in Private Dental Practices: Results and Clinical Implications of a National Survey.

    PubMed

    Laramie, Angela K; Bednarsh, Helene; Isman, Beverly; Boiano, James M; McCrone, Susan H

    2016-06-01

    Dental healthcare workers (DHWs) are at risk for occupational exposure to bloodborne pathogens (BBPs). The Occupational Safety and Health Administration Bloodborne Pathogens Standard requires employers to have a written exposure control plan (ECP) detailing methods and means to reduce and manage occupational BBP exposures. Because little information is available on whether ECPs are created and used, the National Institute for Occupational Safety and Health and the Organization for Safety, Asepsis and Prevention conducted an online survey to determine if dental practices had an ECP, whether present ECPs had the necessary components, and if impediments existed to prevent having an ECP in place. Respondents were primarily from nonfranchised practices (69%) and dentists who owned the practice (63%). Seventy-two percent of survey participants had an ECP, and 20% were unaware of any federal requirements for an ECP prior to the survey. Engineering controls were used by many practices, although the type varied. Fifteen percent of practices did not offer the hepatitis B vaccine for employees. The survey revealed many dental practices were unaware of or were lacking required elements of the ECP. Findings from this survey indicate DHWs would benefit from increased education regarding methods to prevent occupational exposures to BBPs.

  6. The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice.

    PubMed

    Grant, Suzanne; Checkland, Katherine; Bowie, Paul; Guthrie, Bruce

    2017-04-27

    The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners. Non-participant observation was conducted of high-volume organisational routines across eight UK general practices with diverse organisational characteristics. Sixty-two semi-structured interviews were also conducted with the key practice staff alongside the analysis of relevant documents. While formal results handling routines were described similarly across the eight study practices, the everyday structure of how the routine should be enacted in practice was informally understood. Results handling safety took a range of local forms depending on how different aspects of safety were prioritised, with practices varying in terms of how they balanced thoroughness (i.e. ensuring the high-quality management of results by the most appropriate clinician) and efficiency (i.e. timely management of results) depending on a range of factors (e.g. practice history, team composition). Each approach adopted created its own potential risks, with demands for thoroughness reducing productivity and demands for efficiency reducing handling quality. Irrespective of the practice-level approach adopted, staff also regularly varied what they did for individual patients depending on the specific context (e.g. type of result, patient circumstances). General practices variably prioritised a legitimate range of results handling safety processes and outcomes, each with differing strengths and trade-offs. Future safety

  7. Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS).

    PubMed

    Karaboyas, Angelo; Zee, Jarcy; Brunelli, Steven M; Usvyat, Len A; Weiner, Daniel E; Maddux, Franklin W; Nissenson, Allen R; Jadoul, Michel; Locatelli, Francesco; Winkelmayer, Wolfgang C; Port, Friedrich K; Robinson, Bruce M; Tentori, Francesca

    2017-02-01

    Sudden death is a leading cause of death in patients on maintenance hemodialysis therapy. During hemodialysis sessions, the gradient between serum and dialysate levels results in rapid electrolyte shifts, which may contribute to arrhythmias and sudden death. Controversies exist about the optimal electrolyte concentration in the dialysate; specifically, it is unclear whether patient outcomes differ among those treated with a dialysate potassium concentration of 3 mEq/L compared to 2 mEq/L. Prospective cohort study. 55,183 patients from 20 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 1 to 5 (1996-2015). Dialysate potassium concentration at study entry. Cox regression was used to estimate the association between dialysate potassium concentration and both all-cause mortality and an arrhythmia composite outcome (arrhythmia-related hospitalization or sudden death), adjusting for potential confounders. During a median follow-up of 16.5 months, 24% of patients died and 7% had an arrhythmia composite outcome. No meaningful difference in clinical outcomes was observed for patients treated with a dialysate potassium concentration of 3 versus 2 mEq/L (adjusted HRs were 0.96 [95% CI, 0.91-1.01] for mortality and 0.98 [95% CI, 0.88-1.08] for arrhythmia composite). Results were similar across predialysis serum potassium levels. As in prior studies, higher serum potassium level was associated with adverse outcomes. However, dialysate potassium concentration had only minimal impact on serum potassium level measured predialysis (+0.09 [95% CI, 0.05-0.14] mEq/L serum potassium per 1 mEq/L greater dialysate potassium concentration). Data were not available for delivered (vs prescribed) dialysate potassium concentration and postdialysis serum potassium level; possible unmeasured confounding. In combination, these results suggest that approaches other than altering dialysate potassium concentration (eg, education on dietary potassium sources and

  8. Organizational and Physician Perspectives about Facilitating Handheld Computer Use in Clinical Practice: Results of a Cross-Site Qualitative Study

    PubMed Central

    McAlearney, Ann Scheck; Schweikhart, Sharon B.; Medow, Mitchell A.

    2005-01-01

    Objective: To describe strategies that organizations select to support physicians' use of handheld computers (HHCs) in clinical practice and to explore issues about facilitating HHC use. Design: A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data. Measurements: Answers to questions about strategies for HHC support and themes about (1) how to facilitate physician adoption and use and (2) organizational concerns. Results: Three main organizational strategies for HHC support were characterized among sites: (1) active support for broad-based use, (2) active support for niche use, and (3) basic support for individual physician users. Three high-level themes emerged around how to best facilitate physician adoption and use of HHCs: (1) improving usability and usefulness, (2) promoting HHCs and device use, and (3) providing training and support. However, four major themes also emerged related to organizations' concerns about HHC use: (1) security-related concerns, (2) economic concerns, (3) technical concerns, and (4) strategic concerns. Conclusion: An organizational approach to HHC support that involves individualized attention to existing and potential physician users rather than one-size-fits-all, organization-wide implementation efforts was an important facilitator promoting physician use of HHCs. Health care organizations interested in supporting HHC use must consider issues related to security, economics, and IT strategy that may not be prominent concerns for physician users. PMID:15905482

  9. Trends in prevalence, knowledge, attitudes, and practices of helmet use in Cambodia: results from a two year study.

    PubMed

    Bachani, Abdulgafoor M; Branching, Casey; Ear, Chariya; Roehler, Douglas R; Parker, Erin M; Tum, Sotheary; Ballesteros, Michael F; Hyder, Adnan A

    2013-12-01

    Road traffic injuries (RTIs) are a major cause of both morbidity and mortality globally. Relative to countries with similar economic patterns both within and outside of South-East Asia, Cambodia's road traffic fatality rate is high, with motorcyclists accounting for more than half of all fatalities as a result of head injuries. Despite the initiation of national motorcycle helmet legislation for Cambodian drivers in 2009, helmet use among both drivers and passengers remains low. This study adopted a two-pronged approach to assess the current status of and knowledge, attitudes, and practices (KAPs) towards helmet use among drivers and passengers in five provinces in Cambodia. The objective was to better understand helmet use over a two year period since the introduction of the 2009 legislation. Researchers conducted both (1) direct observation of daytime and nighttime helmet use (January 2011-January 2013) and (2) roadside KAP interviews with motorcyclists (November 2010-November 2012). The observed helmet rate across all study sites was 33% during nighttime and 48% during daytime, with proportions up to ten times higher among drivers compared with passengers. Self-reported helmet use was higher than observed use. Within the past 30 days, 60% of respondents reported that they "always" wore a helmet when they were drivers while only 24% reported they "always" wore a helmet as a passenger. Reported barriers for use among drivers included: "driving route", "forgetfulness", and "inconvenience/discomfort." Despite awareness of the protective value of helmets, motorcycle helmet use rates remain low in Cambodia. Many misconceptions remain in Cambodia regarding helmet use, including that they are unnecessary for short distance or at low speeds. These serve as an important barrier to helmet use, which, if dispelled and coupled with visible and regular enforcement, may significantly reduce the number of motorcycle-related injuries and fatalities. Copyright © 2013 Elsevier

  10. Practices, perceptions and expectations for carbohydrate counting in patients with type 1 diabetes - Results from an online survey.

    PubMed

    Fortin, Andréanne; Rabasa-Lhoret, Rémi; Roy-Fleming, Amélie; Desjardins, Katherine; Brazeau, Anne-Sophie; Ladouceur, Martin; Gingras, Véronique

    2017-04-01

    Characterize adult patients with diabetes on intensive insulin therapy in terms of: (a) practices and perceived difficulties relative to carbohydrate counting (CC) and diabetes treatment, and (b) their perceptions and expectations relative to CC. Participants completed a 30-question web-based questionnaire. Participants with type 1 diabetes (T1D) and using CC as part of their treatment plan (n=180) were included in this analysis. Participants were predominantly women (64%), aged 42±13years old and had diabetes for 22±13years. A large proportion of participants reported being confident in applying CC (78%) and considered precise CC as being important for glycemic control (91%), while only 17% reported finding CC difficult. Despite the low perceived difficulty associated with CC, many specific difficulties were encountered by patients such as the perception that glycemia fluctuates even with appropriate CC and that CC complicates the management of diabetes. A larger proportion of participants with a lower level of education (results highlight that patients with a lower level of education and with a history or current depression could benefit from specific CC education strategies. Future studies should examine the efficacy of technology tools to facilitate CC. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. How are pharmacists in Ontario adapting to practice change? Results of a qualitative analysis using Kotter's change management model.

    PubMed

    Teixeira, Beatriz; Gregory, Paul A M; Austin, Zubin

    2017-01-01

    The pace of practice change in community pharmacy over the past decade has been significant, yet there is little evidence documenting implementation of change in the profession. Kotter's change management model was selected as a theoretical framework for this exploratory qualitative study. Community pharmacists were interviewed using a semistructured protocol based on Kotter's model. Data were analyzed and coded using a constant-comparative iterative method aligned with the stages of change management outlined by Kotter. Twelve community pharmacists were interviewed. Three key themes emerged: 1) the profession has successfully established the urgency to, and created a climate conducive for, change; 2) the profession has been less successful in engaging and enabling the profession to actually implement change; and 3) legislative changes (for example, expansion of pharmacists' scope of practice) may have occurred prematurely, prior to other earlier stages of the change process being consolidated. As noted by most participants, allowing change is not implementing change: pharmacists reported feeling underprepared and lacking confidence to actually make change in their practices and believe that more emphasis on practical, specific implementation tactics is needed. Change management is complex and time and resource intensive. There is a need to provide personalized, detailed, context-specific implementation strategies to pharmacists to allow them to take full advantage of expanded scope of practice.

  12. Forecasting the Effect of the Change in Timing of the ABR Diagnostic Radiology Examinations: Results of the ACR Survey of Practice Leaders.

    PubMed

    Bluth, Edward I; Muroff, Lawrence R; Cernigliaro, Joseph G; Moore, Arl V; Smith, Geoffrey G; Flug, Jonathan; DeStigter, Kristen K; Allen, Bibb; Thorwarth, William T; Roberts, Anne C

    2015-05-01

    The results of a survey sent to practice leaders in the ACR Practice of Radiology Environment Database show that the majority of responding groups will continue to hire recently trained residents and fellows even though they have been unable to take the final ABR diagnostic radiology certifying examination. However, a significant minority of private practice groups will not hire these individuals. The majority of private practices expect the timing change for the ABR certifying examinations to affect their groups' function. In contrast, the majority of academic medical school practices expect little or no impact. Residents and fellows should not expect work time off or protected time to study for the certifying examination or for their maintenance of certification examinations in the future.

  13. Calibrating Reach Distance to Visual Targets

    ERIC Educational Resources Information Center

    Mon-Williams, Mark; Bingham, Geoffrey P.

    2007-01-01

    The authors investigated the calibration of reach distance by gradually distorting the haptic feedback obtained when participants grasped visible target objects. The authors found that the modified relationship between visually specified distance and reach distance could be captured by a straight-line mapping function. Thus, the relation could be…

  14. Reach preparation enhances visual performance and appearance.

    PubMed

    Rolfs, Martin; Lawrence, Bonnie M; Carrasco, Marisa

    2013-10-19

    We investigated the impact of the preparation of reach movements on visual perception by simultaneously quantifying both an objective measure of visual sensitivity and the subjective experience of apparent contrast. Using a two-by-two alternative forced choice task, observers compared the orientation (clockwise or counterclockwise) and the contrast (higher or lower) of a Standard Gabor and a Test Gabor, the latter of which was presented during reach preparation, at the reach target location or the opposite location. Discrimination performance was better overall at the reach target than at the opposite location. Perceived contrast increased continuously at the target relative to the opposite location during reach preparation, that is, after the onset of the cue indicating the reach target. The finding that performance and appearance do not evolve in parallel during reach preparation points to a distinction with saccade preparation, for which we have shown previously there is a parallel temporal evolution of performance and appearance. Yet akin to saccade preparation, this study reveals that overall reach preparation enhances both visual performance and appearance.

  15. Policies and practices in the delivery of HIV services in correctional agencies and facilities: results from a multisite survey.

    PubMed

    Belenko, Steven; Hiller, Matthew; Visher, Christy; Copenhaver, Michael; O'Connell, Daniel; Burdon, William; Pankow, Jennifer; Clarke, Jennifer; Oser, Carrie

    2013-10-01

    HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of correctional agency partners from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) revealed that HIV policies and practices in prevention, detection, and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections.

  16. Prognosis of Mild Cognitive Impairment in General Practice: Results of the German AgeCoDe Study

    PubMed Central

    Kaduszkiewicz, Hanna; Eisele, Marion; Wiese, Birgitt; Prokein, Jana; Luppa, Melanie; Luck, Tobias; Jessen, Frank; Bickel, Horst; Mösch, Edelgard; Pentzek, Michael; Fuchs, Angela; Eifflaender-Gorfer, Sandra; Weyerer, Siegfried; König, Hans-Helmut; Brettschneider, Christian; van den Bussche, Hendrik; Maier, Wolfgang; Scherer, Martin; Riedel-Heller, Steffi G.

    2014-01-01

    PURPOSE The concept of mild cognitive impairment (MCI) has recently been introduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as mild neurocognitive disorder, making it a formal diagnosis. We investigated the prognostic value of such a diagnosis and analyzed the determinants of the future course of MCI in the AgeCoDe study (German Study on Ageing, Cognition, and Dementia in Primary Care Patients). METHODS We recruited 357 patients with MCI aged 75 years or older from primary care practices and conducted follow-up with interviews for 3 years. Depending on the course of impairment over time, the patients were retrospectively split into 4 groups representing remittent, fluctuating, stable, and progressive courses of MCI. We performed ordinal logistic regression analysis and classification and regression tree (CART) analysis. RESULTS Overall, 41.5% of the patients had remission of symptoms with normal cognitive function 1.5 and 3 years later, 21.3% showed a fluctuating course, 14.8% had stable symptoms, and 22.4% had progression to dementia. Patients were at higher risk for advancing from one course to the next along this spectrum if they had symptoms of depression, impairment in more than 1 cognitive domain, or more severe cognitive impairment, or were older. The result on a test of the ability to learn and reproduce new material 10 minutes later was the best indicator at baseline for differentiating between remittent and progressive MCI. Symptoms of depression modified the prognosis. CONCLUSIONS In primary care, about one-quarter of patients with MCI have progression to dementia within the next 3 years. Assessments of memory function and depressive symptoms are helpful in predicting a progressive vs a remittent course. When transferring the concept of MCI into clinical diagnostic algorithms (eg, DSM-5), however, we should not forget that three-quarters of patients with MCI stayed cognitively stable or even improved within 3

  17. Prospectively ECG-triggered high-pitch spiral acquisition for cardiac CT angiography in routine clinical practice: initial results.

    PubMed

    Kröpil, Patric; Rojas, Carlos A; Ghoshhajra, Brian; Lanzman, Rotem S; Miese, Falk R; Scherer, Axel; Kalra, Mannudeep; Abbara, Suhny

    2012-05-01

    This study was conducted to evaluate the mode of application, image quality (IQ), and radiation exposure resulting from introduction of a prospectively electrocardiogram-triggered high-pitch cardiac computed tomography angiography (CTA) acquisition mode into routine clinical practice. A total of 42 prospectively triggered cardiac CTAs were conducted on 34 patients (11 female, 23 male; mean age 56 ± 15 y) using a high-pitch mode (pitch 3.4) on a dual-source CT. In 8 of these patients with higher heart rates or occasional premature ventricular contractions, 2 immediately subsequent CTAs were performed ("double flash protocol"). Subjective IQ was assessed for coronary arteries using a 4-point scale (1=unevaluable to 4=excellent). Contrast-to-noise ratio (CNR) was measured in 9 locations. CT Dose Index and dose-length product were obtained, and the patients' effective dose was calculated. Mean effective doses were 2.6 ± 1.4 mSv (range: 1.1 to 6.4) for the entire cardiac examination and 1.4 ± 0.7 mSv (0.4 to 3.1) for individual high-pitch cardiac CTA. z-coverage ranged from 9.9 cm in a native coronary CTA to 31.4 cm in a bypass graft case. The overall subjective IQ was good to excellent (mean score: 3.5), with 1.5% unevaluable coronary segments. The "double flash protocol" resulted in a fully diagnostic CT study in all cases just after taking both scans into consideration. The mean CNR of all locations was 19.7 ± 2.6. Prospectively electrocardiograph-triggered high-pitch-mode cardiac CTA is a feasible and promising technique in clinical routine, allowing for evaluation of coronaries at good-to-excellent IQ and providing high CNR and minimal radiation doses. The "double flash protocol" might become a more robust tool in patients with elevated heart rates or premature ventricular contractions.

  18. Variation in reach-scale bankfull discharge of the Jingjiang Reach undergoing upstream and downstream boundary controls

    NASA Astrophysics Data System (ADS)

    Xia, Junqiang; Zhou, Meirong; Lin, Fenfen; Deng, Shanshan; Lu, Jinyou

    2017-04-01

    Remarkable channel degradation has occurred in the Jingjiang Reach of the Middle Yangtze River, since the operation of the Three Gorges Project, which has caused significant geomorphic adjustments, including the variation in bankfull discharge. Bankfull discharge is a key indicator of flood-discharge capacity in the Jingjiang Reach, which can adjust in response to the altered water and sediment conditions and local base-level changes. Therefore, it is important to investigate the variation in reach-scale bankfull discharge, because of longitudinal variability in channel geometry and bankfull discharge in the study reach. In this study, a general method to calculate the section-scale bankfull discharge using the simulated stage-discharge relation is outlined briefly, and an integrated method is then presented for estimating the reach-scale bankfull discharge. The post-flood reach-scale bankfull discharges in the study reach from 2002 to 2015 were calculated, using the proposed method, based on surveyed post-flood profiles at 171 sections and measured hydrological data at three hydrometric sections and eight water gauge sections. The calculated results indicate that: (i) the reach-scale bankfull discharge in the Jingjiang Reach ranged between 32,731 and 38,949 m3/s over this period, with the average bankfull discharge in the Upper Jingjiang Reach being generally greater than the value in the Lower Jingjiang Reach; (ii) the magnitude of the reach-scale bankfull discharge responded well to the cumulative effect of incoming flow and sediment conditions at the inlet boundary, as well as the change of local base level at the outlet boundary; and (iii) the flood-discharge capacity of the reach was controlled by both the upstream and downstream boundary conditions, and the reach-scale bankfull discharge was expressed by an empirical function of the previous five-year average fluvial erosion intensity during flood seasons at Zhicheng, and the difference between the flood

  19. Decoding Movement Goals from the Fronto-Parietal Reach Network

    PubMed Central

    Gertz, Hanna; Lingnau, Angelika; Fiehler, Katja

    2017-01-01

    During reach planning, fronto-parietal brain areas need to transform sensory information into a motor code. It is debated whether these areas maintain a sensory representation of the visual cue or a motor representation of the upcoming movement goal. Here, we present results from a delayed pro-/anti-reach task which allowed for dissociating the position of the visual cue from the reach goal. In this task, the visual cue was combined with a context rule (pro vs. anti) to infer the movement goal. Different levels of movement goal specification during the delay were obtained by presenting the context rule either before the delay together with the visual cue (specified movement goal) or after the delay (underspecified movement goal). By applying functional magnetic resonance imaging (fMRI) multivoxel pattern analysis (MVPA), we demonstrate movement goal encoding in the left dorsal premotor cortex (PMd) and bilateral superior parietal lobule (SPL) when the reach goal is specified. This suggests that fronto-parietal reach regions (PRRs) maintain a prospective motor code during reach planning. When the reach goal is underspecified, only area PMd but not SPL represents the visual cue position indicating an incomplete state of sensorimotor integration. Moreover, this result suggests a potential role of PMd in movement goal selection. PMID:28286476

  20. Environmental stressors afflicting tailwater stream reaches across the United States

    USGS Publications Warehouse

    Miranda, Leandro E.; Krogman, R. M.

    2014-01-01

    The tailwater is the reach of a stream immediately below an impoundment that is hydrologically, physicochemically and biologically altered by the presence and operation of a dam. The overall goal of this study was to gain a nationwide awareness of the issues afflicting tailwater reaches in the United States. Specific objectives included the following: (i) estimate the percentage of reservoirs that support tailwater reaches with environmental conditions suitable for fish assemblages throughout the year, (ii) identify and quantify major sources of environmental stress in those tailwaters that do support fish assemblages and (iii) identify environmental features of tailwater reaches that determine prevalence of key fish taxa. Data were collected through an online survey of fishery managers. Relative to objective 1, 42% of the 1306 reservoirs included in this study had tailwater reaches with sufficient flow to support a fish assemblage throughout the year. The surface area of the reservoir and catchment most strongly delineated reservoirs maintaining tailwater reaches with or without sufficient flow to support a fish assemblage throughout the year. Relative to objective 2, major sources of environmental stress generally reflected flow variables, followed by water quality variables. Relative to objective 3, zoogeography was the primary factor discriminating fish taxa in tailwaters, followed by a wide range of flow and water quality variables. Results for objectives 1–3 varied greatly among nine geographic regions distributed throughout the continental United States. Our results provide a large-scale view of the effects of reservoirs on tailwater reaches and may help guide research and management needs.

  1. Practices to "Foster" in Out-of-School Time Programs. Research-to-Results Brief. Publication #2010-02

    ERIC Educational Resources Information Center

    Moore, Kristin Anderson; Bronte-Tinkew, Jacinta; Collins, Ashleigh

    2010-01-01

    A lot has been learned about effective approaches to realizing intended out-of-school time program outcomes. As program practitioners consider fostering evidence-based practices, program administrators, staff, and stakeholders must keep in mind that it is difficult to change behavior overnight, even among children. Efforts to improve outcomes for…

  2. Results from an Exploratory Study of Sun Protection Practice: Implications for the Design of Health Promotion Messages

    ERIC Educational Resources Information Center

    Eadie, Douglas; MacAskill, Susan

    2007-01-01

    Purpose: The primary aim of the research reported here is to provide strategic guidance for the development of a national communication strategy to improve sun protection practice amongst young people. Design/methodology/approach: The research adopted an exploratory approach, employing qualitative focus groups to represent three population groups,…

  3. Teaching Practice of Life Study Lesson of Classroom Teacher Candidates Analysis of the Results of Peer Assessment

    ERIC Educational Resources Information Center

    Bektas, Mustafa

    2013-01-01

    The purpose of this study is to examine peer assessments that the classroom candidates applied at teaching practice on life study lesson. The cross sectional survey method which is one of the survey methods has been used in the research. In this study the sampling criteria, one of the purposive sampling methods, is used. Thus, in the fall semester…

  4. Relationships between Electronic Information Media and Records Management Practices: Results of a Survey of United Nations Organizations. A Rand Note.

    ERIC Educational Resources Information Center

    Bikson, T. K.; Schieber, L.

    A Technical Panel on Electronic Records Management (TP/REM), which was established by the Advisory Committee for the Co-ordination of Information Systems (ACCIS), conducted a survey of existing electronic records management practices and standards related to new information and communication technologies and their interrelationships within the…

  5. Use of Alternate Assessment Results in Reporting and Accountability Systems: Conditions for Use Based on Research and Practice. Synthesis Report.

    ERIC Educational Resources Information Center

    Quenemoen, Rachel; Rigney, Susan; Thurlow, Martha

    State assessment systems must address both technical and policy issues as assessments and accountability practices are developed and implemented. These technical and policy issues have been expanded from traditional large-scale assessment to new alternative assessment approaches required by law and developed in every state. The primary purpose of…

  6. Teaching Practice of Life Study Lesson of Classroom Teacher Candidates Analysis of the Results of Peer Assessment

    ERIC Educational Resources Information Center

    Bektas, Mustafa

    2013-01-01

    The purpose of this study is to examine peer assessments that the classroom candidates applied at teaching practice on life study lesson. The cross sectional survey method which is one of the survey methods has been used in the research. In this study the sampling criteria, one of the purposive sampling methods, is used. Thus, in the fall semester…

  7. The Development of Inclusive Practices as a Result of the Process of Integrating Deaf/Hard of Hearing Students

    ERIC Educational Resources Information Center

    Angelides, Panayiotis; Aravi, Christiana

    2007-01-01

    In recent years there has been a significant debate regarding the ways in which different educational systems throughout the world could develop more inclusive practices in their schools. Based on the notion that the education of children considered as having special needs should be considered as part of a wider process of school development, in…

  8. Plantation productivity in the Douglas-fir region under intensive silvicultural practices: results from research and operations.

    Treesearch

    Cheryl Talbert; David. Marshall

    2005-01-01

    This article reviews major plantation silvicultural practices used in the westside Douglas-fir region of Oregon and Washington: origin, growth and yield impacts, and the region's global competitive status for productivity, tree-growing costs, and returns. Two main messages emerge: (1) there has been great progress in the region to increase wood yield and shorten...

  9. Changes in nurses' views and practices concerning nurse prescribing between 2006 and 2012: results from two national surveys.

    PubMed

    Kroezen, Marieke; de Veer, Anke; Francke, Anneke; Groenewegen, Peter; van Dijk, Liset

    2014-11-01

    To assess changes in the prescribing practices and views about nurse prescribing of Registered Nurses in the Netherlands between 2006 and 2012. Considering the developments that took place in the Netherlands between 2006 and 2012, such as increased opportunities for nurse prescribing education and stricter control of nurses' prescribing practices, this study examines the extent to which nurses' prescribing practices and views have changed in the intervening years. In both years, nurses were not legally allowed to prescribe. Survey study. Surveys were conducted in 2006 and 2012. Questionnaires were sent to a national sample of nurses. The questionnaires addressed nurses' views on nurse prescribing and the extent to which nurse prescribing took place in the respondents' work setting. There were 386 and 644 respondents to the 2006 and 2012 surveys respectively. The proportion of nurses who said that they felt adequately equipped to prescribe medicines remained constant around 12%. Insufficient knowledge to prescribe remained the most important reason for feelings of inadequacy. More than a quarter of the nurses in both surveys stated that nurses in their team sometimes write prescriptions. There were few changes in views on the consequences of nurse prescribing for nurses' practice. Overall, nurses' support for nurse prescribing remained stable at a fairly cautious level, while the number of nurses feeling inadequately equipped to prescribe remained high. As nurse prescribing is expected to improve the quality and continuity of care, this should be taken into account in policy expectations. © 2014 John Wiley & Sons Ltd.

  10. Results from an Exploratory Study of Sun Protection Practice: Implications for the Design of Health Promotion Messages

    ERIC Educational Resources Information Center

    Eadie, Douglas; MacAskill, Susan

    2007-01-01

    Purpose: The primary aim of the research reported here is to provide strategic guidance for the development of a national communication strategy to improve sun protection practice amongst young people. Design/methodology/approach: The research adopted an exploratory approach, employing qualitative focus groups to represent three population groups,…

  11. Effects of Selected Timber Management Practices on Forest Birds in Missouri Oak-Hickory Forests: Pre-treatment Results

    Treesearch

    Rich L. Clawson; John Faaborg; Elena. Seon

    1997-01-01

    Our goal is to understand the repercussions of two different forest management techniques on Neotropical migrant birds in the heavily forested landscape of the Missouri Ozarks. Our objectives are to determine breeding densities of forest birds under even-aged and uneven-aged management regimes and to determine the effects of these practices on songbird demographics....

  12. The Development of Inclusive Practices as a Result of the Process of Integrating Deaf/Hard of Hearing Students

    ERIC Educational Resources Information Center

    Angelides, Panayiotis; Aravi, Christiana

    2007-01-01

    In recent years there has been a significant debate regarding the ways in which different educational systems throughout the world could develop more inclusive practices in their schools. Based on the notion that the education of children considered as having special needs should be considered as part of a wider process of school development, in…

  13. Federal-State partnership yields success in remote sensing evaluation of conservation practice effectiveness: Results from the Choptank river CEAP

    USDA-ARS?s Scientific Manuscript database

    The use of winter cover crops to sequester residual soil nitrogen (N) following the summer row-crop growing season has been identified as an important and successful conservation practice in the Chesapeake Bay watershed. Nitrogen losses to groundwater are reduced during the winter season, provided ...

  14. Institutional Policies and Practices: Results from the 1999 National Study of Postsecondary Faculty (NSOPF:99), Institution Survey. Statistical Analysis Report.

    ERIC Educational Resources Information Center

    Berger, Andrea; Kirshstein, Rita; Rowe, Elizabeth

    This report presents findings from the "Institution Survey" of the 1999 National Study of Postsecondary Faculty (NSOPF). Institutions were asked about their policies and practices related to faculty as of fall 1998. The distribution of faculty across U.S. degree-granting postsecondary institutions reflects the diversity of postsecondary…

  15. Health campaign channels: tradeoffs among reach, specificity, and impact.

    PubMed

    Schooler, C; Chaffee, S H; Flora, J A; Roser, C

    1998-03-01

    Stanford University's Five-City Multifactor Risk Reduction Project (FCP) was a 14-year trial of community-wide cardiovascular disease (CVD) risk reduction through integrated programs of community organization and mass media health promotion. The project was launched in 1978 in 5 central California cities, including Monterey, Salinas, Modesto, and San Luis Obispo. TV public service announcements (PSAs), TV shows, booklets, printed tip sheets with brief health suggestions on 7 topics, and newspaper coverage were the types of mass media approaches used in the FCP. These strategies are compared with regard to reach, specificity, and impact for a 5-year study period from 1979/80. Reach is measured as the number of messages intervention community residents remembered, specificity was assessed by examining whether the campaign differentially reached people who were already knowledgeable and practicing cardiovascular disease risk reduction, and impact is defined as the amount of knowledge gained during the course of the campaign. Reach was highest for tip sheets, while specificity was highest for booklets followed by TV programs. Newspaper messages had the most impact, followed by booklets and TV PSAs, tip sheets, and TV programs. Communication channels varied according to reach, specificity, and impact, with each criterion being distinct. No channel was optimal for all 3 of the outcome measures.

  16. The role of natural health products (NHPs) in dietetic practice: results from a survey of Canadian dietitians.

    PubMed

    Hirschkorn, Kristine; Walji, Rishma; Boon, Heather

    2013-07-03

    Registered dietitians (RDs) play a key role in disseminating information about nutrition and intervening in nutrition-related disorders in the Canadian context. Natural health products (NHPs) are increasingly associated with nutrition in patient and health professional discussions. For this study, NHPs were divided into three categories: nutritional supplements (NS); functional foods/nutraceuticals (FF/N); and herbal preparations (HP). The objective was to explore RDs' perceptions about their professional roles and responsibilities with respect to three categories of natural health products (NHPs). This research consisted of an on-line survey of registered dietitians (RDs) in Ontario.Surveys were distributed electronically to all practicing RDs in Ontario by the College of Dietitians of Ontario. There were 558 survey respondents, a response rate of 20%. The vast majority of RDs reported being consulted by clients about all product categories (98% for NS; 94% for FF/N; 91% for HP), with RDs receiving the most frequent questions about NS and the least frequent about HP. 74% of RDs believed that NS are included within the current scope of practice, compared to 59% for FF/N and 14% for HP. Even higher numbers believed that these products should be included: 97% for NS, 91% for FF/N and 47% for HP. RDs who report personally ingesting FF/N and HP were significantly more likely to report that these products should be in the dietetic scope of practice. In contrast, RDs who provide one-on-one counselling services or group-level counselling/workshops were significantly less likely to believe HP should be in the dietetic scope of practice. Opinions of RDs indicated that NS and FF/N (and possibly HP) fall within, or should fall within, RDs' scope of practice. Opportunity exists for RDs to undertake a professional role with respect to NHPs. Policy clarification regarding RD roles is needed.

  17. Testing the direction of effects between child body composition and restrictive feeding practices: results from a population-based cohort.

    PubMed

    Derks, Ivonne Pm; Tiemeier, Henning; Sijbrands, Eric Jg; Nicholson, Jan M; Voortman, Trudy; Verhulst, Frank C; Jaddoe, Vincent Wv; Jansen, Pauline W

    2017-09-01

    Background: Parental restrictive feeding (i.e., limiting food intake of children) has been linked to childhood overweight. However, the directionality of the causal pathway remains unknown.Objective: The objectives of this study were to examine the bidirectional association of maternal restrictive feeding with children's weight and body composition across childhood and to explore a possible mediating role of maternal concern about child weight.Design: Data were available for 4689 mother-child dyads participating in Generation R, a prospective birth cohort in the Netherlands. At ages 4 and 10 y, restrictive feeding was assessed with the parent-reported Child Feeding Questionnaire, and children's body mass index (BMI) was measured. At age 6 y, fat mass index (FMI) and fat-free mass index (FFMI) were measured with dual-energy X-ray absorptiometry. Both directions of the relation between restriction and child body composition were examined with multivariable linear regression analyses and cross-lagged modeling. Mediation analyses were performed to examine concern about child weight (mother reported at child age of 10 y) as a potential mediator.Results: Higher child sex- and age-adjusted BMI SD scores (zBMI) at age 4 y predicted more restrictive feeding at age 10 y (B = 0.15; 95% CI: 0.11, 0.18). Both sex- and age-adjusted FMI SD scores (zFMI) and sex-and age-adjusted FFMI SD scores (zFFMI) at 6 y were also positively associated with restrictive feeding at 10 y. Maternal concern about child weight partially mediated these associations from child body composition to restrictive feeding (e.g., for zBMI at 4 y: Bindirect = 0.10; 95% CI: 0.07, 0.13). There was no temporal association from restrictive feeding at age 4 y to child zBMI at age 10 y after adjustment for baseline zBMI.Conclusions: The continued use of restrictive feeding practices at age 10 y appeared to be primarily a response of mothers to an unhealthy weight of their child rather than a cause of children

  18. Practice patterns, satisfaction, and demographics of reproductive endocrinologists: results of the 2014 Society for Reproductive Endocrinology and Infertility Workforce Survey.

    PubMed

    Barnhart, Kurt T; Nakajima, Steven T; Puscheck, Elizabeth; Price, Thomas M; Baker, Valerie L; Segars, James

    2016-05-01

    To identify the current and future state of the practice of reproductive medicine. Cross-sectional survey. Not applicable. None. Not applicable. The survey included 57 questions designed to assess practice patterns/metrics and professional satisfaction and morale. A total of 336/1,100 (31%) responded, and they were 38% women, 61% men, and 76% Caucasian, with a mean age of 54. Respondents averaged 2.3 jobs and averaged 53 hours of work per week: 44% work in academia and 50% in private groups. Average practice size was 5.5, with an average of 470 fresh IVF cycles performed per year. Percent effort included 63% infertility, 10% endocrinology, 10% surgery, and 9% research. Respondents performed an average of 13 major surgeries, 69 minor surgeries, and 128 oocyte retrievals per year. A total of 60% were salaried, and 40% were equity partners. Compensation was highly skewed. Greater than 84% had a positive morale and had a positive view of the future, and 92% would again choose REI as a career. The most satisfying areas of employment were patient interactions, intellectual stimulation, interactions with colleagues, and work schedule. The least satisfying areas were work schedule and financial compensation. Training was felt to be too focused on female factor infertility and basic research with insufficient training on embryology, genetics, male factor infertility, and clinical research. In the next 5 years, 57% suggested that the need for specialists would stay the same, while 20% predicted a decrease. A total of 58% felt we are training the correct number of fellows (37% felt we are training a surplus). Compared with academia, those in private practice reported higher compensation, less major surgery, more IVF, less endocrinology, and less research. Men worked more hours, conducted more surgery and IVF cycles, and had higher compensation than women. Morale was similar across age, gender, practice type, and geography. Our subspecialty has an extremely high morale. We

  19. Reach tracking reveals dissociable processes underlying cognitive control.

    PubMed

    Erb, Christopher D; Moher, Jeff; Sobel, David M; Song, Joo-Hyun

    2016-07-01

    The current study uses reach tracking to investigate how cognitive control is implemented during online performance of the Stroop task (Experiment 1) and the Eriksen flanker task (Experiment 2). We demonstrate that two of the measures afforded by reach tracking, initiation time and reach curvature, capture distinct patterns of effects that have been linked to dissociable processes underlying cognitive control in electrophysiology and functional neuroimaging research. Our results suggest that initiation time reflects a response threshold adjustment process involving the inhibition of motor output, while reach curvature reflects the degree of co-activation between response alternatives registered by a monitoring process over the course of a trial. In addition to shedding new light on fundamental questions concerning how these processes contribute to the cognitive control of behavior, these results present a framework for future research to investigate how these processes function across different tasks, develop across the lifespan, and differ among individuals. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. The impact of REACH on classification for human health hazards.

    PubMed

    Oltmanns, J; Bunke, D; Jenseit, W; Heidorn, C

    2014-11-01

    The REACH Regulation represents a major piece of chemical legislation in the EU and requires manufacturers and importers of chemicals to assess the safety of their substances. The classification of substances for their hazards is one of the crucial elements in this process. We analysed the effect of REACH on classification for human health endpoints by comparing information from REACH registration dossiers with legally binding, harmonised classifications. The analysis included 142 chemicals produced at very high tonnages in the EU, the majority of which have already been assessed in the past. Of 20 substances lacking a harmonised classification, 12 chemicals were classified in REACH registration dossiers. More importantly, 37 substances with harmonised classifications for human health endpoints had stricter classifications in registration dossiers and 29 of these were classified for at least one additional endpoint not covered by the harmonised classification. Substance-specific analyses suggest that one third of these additional endpoints emerged from experimental studies performed to fulfil information requirements under REACH, while two thirds resulted from a new assessment of pre-REACH studies. We conclude that REACH leads to an improved hazard characterisation even for substances with a potentially good data basis.

  1. Multicentre study on hand hygiene facilities and practice in the Mediterranean area: results from the NosoMed Network.

    PubMed

    Amazian, K; Abdelmoumène, T; Sekkat, S; Terzaki, S; Njah, M; Dhidah, L; Caillat-Vallet, E; Saadatian-Elahi, M; Fabry, J

    2006-03-01

    Hand hygiene literature is scarce in the southern Mediterranean area. In order to establish a baseline position, a study was performed in four Mediterranean countries. Seventy-seven hospital wards in 22 hospitals were enrolled and information on hand hygiene practice and facilities were collected. The overall compliance rate was very low (27.6%), and was significantly higher where the perceived risk was considered to be high. Intensive care units showed the highest level of compliance. Analysis by country indicated higher compliance in Egypt (52.8%) and Tunisia (32.3%) compared with Algeria (18.6%) and Morocco (16.9%). Facilities for hand hygiene, particularly consumables, were shown to be deficient. Multi-approach programmes combining the production of official local recommendations, education and regular evaluation of hand hygiene practice are much needed to improve the present situation.

  2. Clinical practice pattern in management of diabetic macular edema in Japan: survey results of Japanese retinal specialists.

    PubMed

    Ogura, Yuichiro; Shiraga, Fumio; Terasaki, Hiroko; Ohji, Masahito; Ishida, Susumu; Sakamoto, Taiji; Hirakata, Akito; Ishibashi, Tatsuro

    2017-01-01

    To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy. Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME. Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A. Most specialists (70.6 %) use three modalities for detecting DME: optical coherence tomography, fluorescein angiography, and fundus examination. For focal macular edema, focal laser is used as first-line therapy by 70.3 % of specialists, whereas 21.6 % use medical treatment in combination with focal/grid laser. For diffuse macular edema, anti-VEGF therapy is the first choice (72.5 %), irrespective of visual acuity, whereas 17.5 % select off-label sub-Tenon's steroid injections. Vitrectomy is often performed for vitreomacular traction (86.5 %) or when anti-VEGF agent/laser therapy is ineffective (73.2 %). For persistent DME after vitrectomy, anti-VEGF agents (46.3 %) or steroids (intravitreal injections, 14.6 %; sub-Tenon's injections, 36.6 %) are selected. When applying anti-VEGF treatment regimen, most specialists continue loading injections until central retinal thickness stabilized (51.4 %) or both visual acuity and central retinal thickness stabilized (24.3 %). In the maintenance phase, many specialists provide injections with pro re nata (76.3 %), whereas 50.0 % responded that the treat-and-extend regimen is ideal. Our survey presents the current views about the DME management and practice patterns of anti-VEGF therapy by one part of the retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.

  3. Epidemiology of alcohol dependence in UK primary care: Results from a large observational study using the Clinical Practice Research Datalink

    PubMed Central

    Wright, Alison K.; Ashcroft, Darren M.; van Staa, Tjeerd P.; Pirmohamed, Munir

    2017-01-01

    This study aims to investigate the incidence and annual presentation rates of alcohol dependence in general practice in the UK, and examine age-, gender-, socioeconomic-, and region-specific variation. We conducted a retrospective 'open' cohort study using the Clinical Practice Research Datalink (CPRD), an anonymised primary care database. Prior to data extraction, a case definition for alcohol dependence in CPRD was established using 47 Read codes, which included primary alcohol dependence and consequences of alcohol dependence. Directly standardised rates for incidence and annual presentation were calculated for each year between 1990 and 2013. Rates were compared by gender, age, UK home nation, and practice-level Index of Multiple Deprivation. The directly standardised annual incidence rates were 8.3 and 3.7 per 10,000 male and female patients, respectively. The estimated annual rates of presentation per 10,000 were 17.1 for males and 7.6 for females. Female to male rate ratios were: 0.40 (95% CI: 0.39–0.41) for incident cases; and 0.37 (95% CI: 0.36–0.39) for annual presentation. Rates were highest in those aged 35–54 for both measures and across genders, and lowest in those aged over 75 years. With England as the reference nation, Northern Ireland and Scotland had significantly higher rates for both measures. Patients from the most deprived areas had the highest incidence and annual presentation rates. There is unequal distribution of patients with severe alcohol dependence across population subgroups in general practice. Given the health and economic burden associated with dependent drinking, these data will be useful in informing future public health initiatives. PMID:28362848

  4. [New oral anticoagulants for prophylaxis of stroke. Results of an expert conference on practical use in geriatric patients].

    PubMed

    Bahrmann, Philipp; Harms, Fred; Schambeck, Christian Martin; Wehling, Martin; Flohr, Jürgen

    2016-04-01

    Geriatric patients with non-valvular atrial fibrillation (AF) are increasingly being treated with novel oral anticoagulants (NOAC) to prevent ischemic stroke. This article highlights the outcome of an expert meeting on the practical use of NOAC in elderly patients. An interdisciplinary group of experts discussed the current situation of stroke prevention in geriatric patients and its practical management in daily clinical practice. The topic was examined through focused impulse presentations and critical analyses as the basis for the expert consensus. The key issues are summarized in this paper. The European Society of Cardiology (ESC) guidelines from 2012 for the management of patients with non-valvular AF recommend NOAC as the preferred treatment and vitamin K antagonists (VKA) only as an alternative option. Currently, the NOAC factor Xa inhibitors apixaban and rivaroxaban and the thrombin inhibitor dabigatran are more commonly used in clinical practice for patients with AF. Although these drugs have many similarities and are often grouped together it is important to recognize that the pharmacology and dose regimes differ between compounds. Especially n elderly patients NOAC drugs have some advantages compared to VKA, e.g. less drug-drug interactions with concomitant medication and a more favorable risk-benefit ratio mostly driven by the reduction of bleeding. Treatment of anticoagulation in geriatric patients requires weighing the serious risk of stroke against an equally high risk of major bleeding and pharmacoeconomic considerations. Geriatric patients in particular have the greatest benefit from NOAC, which can also be administered in cases of reduced renal function. Regular control of the indications is indispensable, as also for all other medications of the patient. The use of NOAC should certainly not be withheld from geriatric patients who have a clear need for oral anticoagulation.

  5. Changing practice with changing research: results of two UK national surveys of intensive insulin therapy in intensive care patients.

    PubMed

    Paddle, J J; Eve, R L; Sharpe, K A

    2011-02-01

    We conducted two telephone surveys of all United Kingdom adult intensive care units in 2007/8 and 2010 to assess practice with regard to intensive insulin therapy for glycaemic control in critically ill patients, and to assess the change in practice following publications in 2008 and 2009 that challenged the evidence for this therapy. Of 243 units that had a written policy for intensive insulin therapy in 2007/8, 232 (96%) still had a policy in 2010. One hundred and six (46%) units had updated their policy in response to new evidence, whereas 126 (54%) stated that it had remained the same. Where intensive care units had changed their policy, we found a significant increase in target limits and a wider target range. Regional variations in practice were also seen. Across seven regions, the percentage of units where the glycaemic control policy had been updated since 2007/8 varied from nil to 78.9%. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  6. Current practice trends in allergy: results of a united states survey of otolaryngologists, allergist-immunologists, and primary care physicians.

    PubMed

    Ryan, Matthew W; Marple, Bradley F; Leatherman, Bryan; Mims, J Whit; Fornadley, John; Veling, Maria; Lin, Sandra Y

    2014-10-01

    Clinical practices for the diagnosis and treatment of allergic disease evolve over time in response to a variety of forces. The techniques used by various physician specialties are not clearly defined and may vary from published descriptions or recommendations in the literature. This work is a Web-based survey enrolling 250 U.S. physicians in the following specialties: otolaryngology (ENT), allergy-immunology (A/I), and primary care (PCP). Respondents reported that skin-prick testing is the most common diagnostic testing method, followed by in vitro specific immunoglobulin E (IgE) testing. ENTs were more likely to use intradermal testing compared to other specialties (p = 0.0003 vs A/I; p < 0.0001 vs PCP). Respondents reported a wide distribution in number of allergens tested, regardless of testing method (range, 11 to >60). Significant use of home immunotherapy injections (defined as >10% of immunotherapy patients) ranged from 27% to 36% of physicians, with no statistically significant difference noted based upon specialty. PCPs reported greater use of sublingual immunotherapy (PCP, 68%; A/I, 45%; otolaryngology, 35%; A/I vs PCP, p = 0.005; ENT vs PCP p < 0.001)). A variety of allergy testing and treatment methods are employed by U.S. physicians, with some differences noted based upon specialty. Home immunotherapy continues to be employed in allergy practices, and sublingual immunotherapy is a common form of delivery, especially in primary care practices. © 2014 ARS-AAOA, LLC.

  7. Television Project to Reach the Handicapped Deaf.

    ERIC Educational Resources Information Center

    Hertzler, Ann A.; And Others

    1981-01-01

    Describes a project designed to use television public service announcements to present basic nutrition concepts and the nutritional choices in the marketplace in a format that would reach the handicapped deaf and the nonhandicapped as well. (CT)

  8. Reaching the Overlooked Student in Physical Education

    ERIC Educational Resources Information Center

    Esslinger, Keri; Esslinger, Travis; Bagshaw, Jarad

    2015-01-01

    This article describes the use of live action role-playing, or "LARPing," as a non-traditional activity that has the potential to reach students who are not interested in traditional physical education.

  9. Reaching the Overlooked Student in Physical Education

    ERIC Educational Resources Information Center

    Esslinger, Keri; Esslinger, Travis; Bagshaw, Jarad

    2015-01-01

    This article describes the use of live action role-playing, or "LARPing," as a non-traditional activity that has the potential to reach students who are not interested in traditional physical education.

  10. ReachScan - an Exposure Assessment Model

    EPA Pesticide Factsheets

    ReachScan estimates surface water concentrations downstream from industrial sites to assess impacts on the aquatic environment and potential dose rates for humans exposed via ingestion of drinking water and fish.

  11. Intra-reach headwater fish assemblage structure

    USGS Publications Warehouse

    McKenna, James E.

    2017-01-01

    Large-scale conservation efforts can take advantage of modern large databases and regional modeling and assessment methods. However, these broad-scale efforts often assume uniform average habitat conditions and/or species assemblages within stream reaches.

  12. Television Project to Reach the Handicapped Deaf.

    ERIC Educational Resources Information Center

    Hertzler, Ann A.; And Others

    1981-01-01

    Describes a project designed to use television public service announcements to present basic nutrition concepts and the nutritional choices in the marketplace in a format that would reach the handicapped deaf and the nonhandicapped as well. (CT)

  13. New symmetry of intended curved reaches

    PubMed Central

    2010-01-01

    Background Movement regularities are inherently present in automated goal-directed motions of the primate's arm system. They can provide important signatures of intentional behaviours driven by sensory-motor strategies, but it remains unknown if during motor learning new regularities can be uncovered despite high variability in the temporal dynamics of the hand motions. Methods We investigated the conservation and violation of new movement regularity obtained from the hand motions traced by two untrained monkeys as they learned to reach outwardly towards spatial targets while avoiding obstacles in the dark. The regularity pertains to the transformation from postural to hand paths that aim at visual goals. Results In length-minimizing curves the area enclosed between the Euclidean straight line and the curve up to its point of maximum curvature is 1/2 of the total area. Similar trend is found if one examines the perimeter. This new movement regularity remained robust to striking changes in arm dynamics that gave rise to changes in the speed of the reach, to changes in the hand path curvature, and to changes in the arm's postural paths. The area and perimeter ratios characterizing the regularity co-varied across repeats of randomly presented targets whenever the transformation from posture to hand paths was compliant with the intended goals. To interpret this conservation and the cases in which the regularity was violated and recovered, we provide a geometric model that characterizes arm-to-hand and hand-to-arm motion paths as length minimizing curves (geodesics) in a non-Euclidean space. Whenever the transformation from one space to the other is distance-metric preserving (isometric) the two symmetric ratios co-vary. Otherwise, the symmetric ratios and their co-variation are violated. As predicted by the model we found empirical evidence for the violation of this movement regularity whenever the intended goals mismatched the actions. This was manifested in

  14. Sensitivity to prediction error in reach adaptation

    PubMed Central

    Haith, Adrian M.; Harran, Michelle D.; Shadmehr, Reza

    2012-01-01

    It has been proposed that the brain predicts the sensory consequences of a movement and compares it to the actual sensory feedback. When the two differ, an error signal is formed, driving adaptation. How does an error in one trial alter performance in the subsequent trial? Here we show that the sensitivity to error is not constant but declines as a function of error magnitude. That is, one learns relatively less from large errors compared with small errors. We performed an experiment in which humans made reaching movements and randomly experienced an error in both their visual and proprioceptive feedback. Proprioceptive errors were created with force fields, and visual errors were formed by perturbing the cursor trajectory to create a visual error that was smaller, the same size, or larger than the proprioceptive error. We measured single-trial adaptation and calculated sensitivity to error, i.e., the ratio of the trial-to-trial change in motor commands to error size. We found that for both sensory modalities sensitivity decreased with increasing error size. A reanalysis of a number of previously published psychophysical results also exhibited this feature. Finally, we asked how the brain might encode sensitivity to error. We reanalyzed previously published probabilities of cerebellar complex spikes (CSs) and found that this probability declined with increasing error size. From this we posit that a CS may be representative of the sensitivity to error, and not error itself, a hypothesis that may explain conflicting reports about CSs and their relationship to error. PMID:22773782

  15. Reaching Agreement in Quantum Hybrid Networks.

    PubMed

    Shi, Guodong; Li, Bo; Miao, Zibo; Dower, Peter M; James, Matthew R

    2017-07-20

    We consider a basic quantum hybrid network model consisting of a number of nodes each holding a qubit, for which the aim is to drive the network to a consensus in the sense that all qubits reach a common state. Projective measurements are applied serving as control means, and the measurement results are exchanged among the nodes via classical communication channels. In this way the quantum-opeartion/classical-communication nature of hybrid quantum networks is captured, although coherent states and joint operations are not taken into consideration in order to facilitate a clear and explicit analysis. We show how to carry out centralized optimal path planning for this network with all-to-all classical communications, in which case the problem becomes a stochastic optimal control problem with a continuous action space. To overcome the computation and communication obstacles facing the centralized solutions, we also develop a distributed Pairwise Qubit Projection (PQP) algorithm, where pairs of nodes meet at a given time and respectively perform measurements at their geometric average. We show that the qubit states are driven to a consensus almost surely along the proposed PQP algorithm, and that the expected qubit density operators converge to the average of the network's initial values.