Healthcare technologies, quality improvement programs and hospital organizational culture in Canadian hospitals

PubMed Central

2013-01-01

Background Healthcare technology and quality improvement programs have been identified as a means to influence healthcare costs and healthcare quality in Canada. This study seeks to identify whether the ability to implement healthcare technology by a hospital was related to usage of quality improvement programs within the hospital and whether the culture within a hospital plays a role in the adoption of quality improvement programs. Methods A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items. Results Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption. Conclusions Healthcare technologies each have different levels of difficulty. As a consequence, hospitals need to understand their current level of capability before selecting a particular technology in order to assess the level of resources needed. Further the usage of quality improvement programs is related to the ability to implement technology and the culture within a hospital. PMID:24119419

Atopic dermatitis: current treatment guidelines. Statement of the experts of the Dermatological Section, Polish Society of Allergology, and the Allergology Section, Polish Society of Dermatology.

PubMed

Nowicki, Roman; Trzeciak, Magdalena; Wilkowska, Aleksandra; Sokołowska-Wojdyło, Małgorzata; Ługowska-Umer, Hanna; Barańska-Rybak, Wioletta; Kaczmarski, Maciej; Kowalewski, Cezary; Kruszewski, Jerzy; Maj, Joanna; Silny, Wojciech; Śpiewak, Radosław; Petranyuk, Andriy

2015-08-01

Atopic dermatitis (AD) is a condition frequently encountered in medical practices across the country. More than 60% of children with AD are at risk to develop allergic rhinitis or asthma (the atopic march). Patients with AD have a unique predisposition to colonization or infection by Staphylococcus aureus. Treatments for AD need to rapidly control symptoms of the disease, improve quality of life and prevent exacerbations. Given the chronic and relapsing nature of the disease, therapies need to encourage good compliance and be well tolerated.

New Information Technology Directions for American Education. Improving Science and Mathematics Education. Final Report.

ERIC Educational Resources Information Center

Melmed, Arthur S.; Burnham, Robert A.

This report is an analysis of the findings of four workshops exploring the ways interactive technology can be considered an option for improving American education after 25 years of research and development. Sections include: (1) "Manpower Needs and School Problems"; (2) "Science and Technology Option"; (3) "Barriers and Strategy"; and (4) "To…

Effective Schooling in Rural Africa Report 2: Key Issues Concerning School Effectiveness and Improvement.

ERIC Educational Resources Information Center

Saunders, Lesley

This report presents an overview of the literature on school/teacher effectiveness and improvement, with a focus on implications for developing countries. Sections 1-2 discuss the trend toward site-based management, which has increased pressures on individual schools and their staff; eight key domains of school effectiveness; and the need to…

Modeling the Earth system in the Mission to Planet Earth era

NASA Technical Reports Server (NTRS)

Unninayar, Sushel; Bergman, Kenneth H.

1993-01-01

A broad overview is made of global earth system modeling in the Mission to Planet Earth (MTPE) era for the multidisciplinary audience encompassed by the Global Change Research Program (GCRP). Time scales of global system fluctuation and change are described in Section 2. Section 3 provides a rubric for modeling the global earth system, as presently understood. The ability of models to predict the future state of the global earth system and the extent to which their predictions are reliable are covered in Sections 4 and 5. The 'engineering' use of global system models (and predictions) is covered in Section 6. Section 7 covers aspects of an increasing need for improved transform algorithms and better methods to assimilate this information into global models. Future monitoring and data requirements are detailed in Section 8. Section 9 covers the NASA-initiated concept 'Mission to Planet Earth,' which employs space and ground based measurement systems to provide the scientific basis for understanding global change. Section 10 concludes this review with general remarks concerning the state of global system modeling and observing technology and the need for future research.

Speckle-field digital holographic microscopy.

PubMed

Park, YongKeun; Choi, Wonshik; Yaqoob, Zahid; Dasari, Ramachandra; Badizadegan, Kamran; Feld, Michael S

2009-07-20

The use of coherent light in conventional holographic phase microscopy (HPM) poses three major drawbacks: poor spatial resolution, weak depth sectioning, and fixed pattern noise due to unwanted diffraction. Here, we report a technique which can overcome these drawbacks, but maintains the advantage of phase microscopy - high contrast live cell imaging and 3D imaging. A speckle beam of a complex spatial pattern is used for illumination to reduce fixed pattern noise and to improve optical sectioning capability. By recording of the electric field of speckle, we demonstrate high contrast 3D live cell imaging without the need for axial scanning - neither objective lens nor sample stage. This technique has great potential in studying biological samples with improved sensitivity, resolution and optical sectioning capability.

FY16 Status Report on NEAMS Neutronics Activities

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

Lee, C. H.; Shemon, E. R.; Smith, M. A.

2016-09-30

The goal of the NEAMS neutronics effort is to develop a neutronics toolkit for use on sodium-cooled fast reactors (SFRs) which can be extended to other reactor types. The neutronics toolkit includes the high-fidelity deterministic neutron transport code PROTEUS and many supporting tools such as a cross section generation code MC 2-3, a cross section library generation code, alternative cross section generation tools, mesh generation and conversion utilities, and an automated regression test tool. The FY16 effort for NEAMS neutronics focused on supporting the release of the SHARP toolkit and existing and new users, continuing to develop PROTEUS functions necessarymore » for performance improvement as well as the SHARP release, verifying PROTEUS against available existing benchmark problems, and developing new benchmark problems as needed. The FY16 research effort was focused on further updates of PROTEUS-SN and PROTEUS-MOCEX and cross section generation capabilities as needed.« less

Promoting National Book Strategies in Asia and the Pacific--Problems and Perspectives. Studies on Books and Reading No. 4.

ERIC Educational Resources Information Center

Hasan, Abul

Focusing on the present state of book development in the Asia-Pacific region, where countries are separated by vast distances, this report examines measures that might improve local book industries and meet the needs for endogenous literature. The various sections of the report discuss (1) the book situation and needs in the Asia-Pacific region;…

Needs assessment final report

NASA Technical Reports Server (NTRS)

Sepulveda, Jose A.

1992-01-01

The stated purposes of the Management Science Faculty Fellowship Project were to: (1) provide a comprehensive analysis of KSC management training for engineers and other management professionals from project/program lead through executive levels; and (2) development of evaluation methodologies which can be used to perform ongoing program-wide course-to-course assessments. This report will focus primarily in the first stated purpose for the project. Ideally, the analysis of KSC management training will build in the current system and efficiently propose improvements to achieve existing goals and objectives while helping to identify new visions and new outcomes for the Center's Management Training Mission. Section 2 describes the objectives, approach, and specific tasks used to analyze KSC's Management training System. Section 3 discusses the main conclusions derived from an analysis of the available training data. Section 4 discusses the characteristics and benefits envisioned for a Management Training System. Section 5 proposes a Training System as identified by the results of a Needs Assessment exercise conducted at KSC this summer. Section 6 presents a number of recommendations for future work.

Students' perceptions of the flipped classroom model in an engineering course: a case study

NASA Astrophysics Data System (ADS)

Baytiyeh, Hoda; Naja, Mohamad K.

2017-11-01

The flipped classroom model is an innovative educational trend that has been widely adopted in the social sciences but not engineering education. In this model, an active instructional approach shifts the educational strategy from a teacher- to a student-centred approach. The purpose of this study is to compare the learning outcomes of engineering students attending a flipped-model section of the Dynamics of Structures course with students attending a traditional, lecture-based section of the same course taught by the same instructor. The results confirm previous research showing that test scores in the flipped course sections were slightly higher than traditional sections. Although the improvement in test scores was statistically insignificant, student statements indicated that the flipped model promoted a deeper, broader perspective on learning, facilitated problem-solving strategies and improved critical-thinking abilities, self-confidence and teamwork skills, which are needed for a successful engineering career.

School Improvement Grants. Guidance and Tools for the 2015 Amended Regulations: Maximizing the Optional Planning/Pre-Implementation Year

ERIC Educational Resources Information Center

Redding, Sam; Dunn, Lenay; McCauley, Carlas

2015-01-01

School Improvement Grants (SIGs) are authorized under section 1003(g) of Title I of the Elementary and Secondary Education Act (ESEA). The grants are made to state education agencies (SEAs), and the SEAs award competitive subgrants to local education agencies (LEAs) that demonstrate: (1) the greatest need for the funds; and (2) the strongest…

Perfectionnement des enseignants des ecoles de langue francaise: Identification et evaluation des besoins (The Improvement of Teachers in French-Language Schools: Identification and Evaluation of Needs).

ERIC Educational Resources Information Center

Poirier, Pierre; And Others

A research project was undertaken to make an inventory of the needs in the training and professional development of directors, assistant directors, and teachers in elementary and secondary French-language schools in Ontario. The report is divided into three sections and a conclusion. The first chapter reviews the literature on the evaluation of…

The Next Phase of Title VII Funding for Training Primary Care Physicians for America’s Health Care Needs

PubMed Central

Phillips, Robert L.; Turner, Barbara J.

2012-01-01

Health care reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training. Title VII, Section 747 of the Public Health Service Act previously supported the growth of the health care workforce but has been severely cut over the past 2 decades. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. To accomplish these goals, Congress should act on the Council on Graduate Medical Education’s recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk. PMID:22412009

The next phase of Title VII funding for training primary care physicians for America's health care needs.

PubMed

Phillips, Robert L; Turner, Barbara J

2012-01-01

Health care reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training. Title VII, Section 747 of the Public Health Service Act previously supported the growth of the health care workforce but has been severely cut over the past 2 decades. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. To accomplish these goals, Congress should act on the Council on Graduate Medical Education's recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk.

Charter on continuing medical education/continuing professional development approved by the UEMS Specialist Section and European Board of Anaesthesiology.

PubMed

Alahuhta, S; Mellin-Olsen, J; Blunnie, W P; Knape, J T A

2007-06-01

The mission of the Section and Board of Anaesthesiology of the European Union of Medical Specialists (EUMS/UEMS) is to harmonize training and medical practice in all European countries to continuously improve the quality of care. The need for continuous medical education in the field of anaesthesiology has long been recognized. However, specialty-based competencies are not the only requirements for successful medical practice. The need to acquire medical, managerial, ethical, social and personal communication skills on top of specialty-based competencies has developed into the principle of continuous professional development, which embraces both objectives. The Section and Board of Anaesthesiology of the EUMS/UEMS has approved a proposal of its Standing Committee on Continuous Medical Education/Continuous Professional Development to adopt the following charter on the subject.

Systems Measures of Water Distribution System Resilience

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

Klise, Katherine A.; Murray, Regan; Walker, La Tonya Nicole

2015-01-01

Resilience is a concept that is being used increasingly to refer to the capacity of infrastructure systems to be prepared for and able to respond effectively and rapidly to hazardous events. In Section 2 of this report, drinking water hazards, resilience literature, and available resilience tools are presented. Broader definitions, attributes and methods for measuring resilience are presented in Section 3. In Section 4, quantitative systems performance measures for water distribution systems are presented. Finally, in Section 5, the performance measures and their relevance to measuring the resilience of water systems to hazards is discussed along with needed improvements tomore » water distribution system modeling tools.« less

Design and Characterization of the UTIAS Anechoic Wind Tunnel

NASA Astrophysics Data System (ADS)

Chow, Derrick H. F.

The anechoic open-jet wind tunnel facility at the University of Toronto Institute for Aerospace Studies was updated and characterized to meet the needs of current and future aeroacoustic experiments. The wind tunnel inlet was resurfaced and flow-conditioning screens were redesigned to improve the freestream turbulence intensity to below 0.4% in the test section. The circular nozzle was replaced with a square secondary contraction that increased the maximum test section velocity to 75 m/s and improved flow uniformity to over 99% across a usable cross-sectional area of 500 mm x 500 mm. Acoustic baffles were installed in front of the wind tunnel inlet and foam wedges were installed in the anechoic chamber. The overall background sound pressure levels in the chamber were improved by 8-18 db over the range of operational freestream velocities. The anechoic chamber cut-off frequency is 170 Hz and the reverberation time for a 60 dB sound power decay is 0.032 s.

7 CFR 1710.251 - Construction work plans-distribution borrowers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... generation facilities; (11) Load management equipment, automatic sectionalizing facilities, and centralized... transmission plant, and improvements replacements, and retirements of any generation plant. Construction of new generation capacity need not be included in a CWP but must be specified and supported by specific engineering...

Excitation of vibrational quanta in furfural by intermediate-energy electrons

NASA Astrophysics Data System (ADS)

Jones, D. B.; Neves, R. F. C.; Lopes, M. C. A.; da Costa, R. F.; Varella, M. T. do N.; Bettega, M. H. F.; Lima, M. A. P.; García, G.; Blanco, F.; Brunger, M. J.

2015-12-01

We report cross sections for electron-impact excitation of vibrational quanta in furfural, at intermediate incident electron energies (20, 30, and 40 eV). The present differential cross sections are measured over the scattered electron angular range 10°-90°, with corresponding integral cross sections subsequently being determined. Furfural is a viable plant-derived alternative to petrochemicals, being produced via low-temperature plasma treatment of biomass. Current yields, however, need to be significantly improved, possibly through modelling, with the present cross sections being an important component of such simulations. To the best of our knowledge, there are no other cross sections for vibrational excitation of furfural available in the literature, so the present data are valuable for this important molecule.

ERIC First Analysis: 1976-77 National High School Debate Resolutions (How Can the Criminal Justice System in the United States Best Be Improved?)

ERIC Educational Resources Information Center

Huber, Robert B.

The goal of this booklet is to assist debaters in developing problem-solving skills as represented in the 1976-77 debate topic: How can the criminal justice system in the United States best be improved? The sections of this document focus on the need for criminal justice reform; procedural steps in the criminal justice system; discussing or…

How to Apply Feedback to Improve Subjective Wellbeing of Government Servants Engaged in Environmental Protection in China?

PubMed

Gong, Zhenxing; Wang, Xinmeng; Zhang, Na; Li, Miaomiao

2018-01-01

In order to improve subjective wellbeing of government servants engaged in environmental protection who work in high power distance in China, it is important to understand the impact mechanism of feedback. This study aims to analyze how feedback environment influences subjective wellbeing through basic psychological needs satisfaction and analyzing the moderating role of power distance. The study was designed as a cross-sectional study of 492 government servants engaged in environment protection in Shandong, China. Government servants who agreed to participate answered self-report questionnaires concerning demographic conditions, supervisor feedback environment, basic psychological need satisfaction, and power distance as well as subjective wellbeing. Employees in higher levels of supervisor feedback environment were more likely to experience subjective wellbeing. Full mediating effects were found for basic psychological needs satisfaction. Specifically, supervisor feedback environment firstly led to increased basic psychological needs satisfaction, which in turn resulted in increased subjective wellbeing. Additional analysis showed that the mediating effect of basic psychological needs satisfaction was stronger for employees who work in high power distance than in low power distance. The results from the study indicate that supervisor feedback environment plays a vital role in improving subjective wellbeing of government servants engaged in environmental protection through basic psychological needs satisfaction, especially in high power distance.

Introduction to special section: Science and technology of over-the-horizon radar

NASA Astrophysics Data System (ADS)

Berkey, F. Tom

1998-07-01

The rationale for the development of over-the-horizon (OTH) radar systems operating at frequencies in the HF band arose out of a perceived need for an early-warning defense network. That need changed with the end of the Cold War; however, today OTH radars play a major role in the CounterDrug Program for the interdiction of drug-smuggling aircraft. This special section of Radio Science is devoted to a review of OTH radar technology, with emphasis on contemporary developments in this field. The collection of papers presented here has evolved largely from research and development efforts directed to improving the performance of OTH radar systems deployed both in the United States and in Australia.

Designing a Social Environment for Human-Robot Cooperation.

ERIC Educational Resources Information Center

Amram, Fred M.

Noting that work is partly a social activity, and that workers' psychological and emotional needs influence their productivity, this paper explores avenues for improving human-robot cooperation and for enhancing worker satisfaction in the environment of flexible automation. The first section of the paper offers a brief overview of the…

Corrective Strategies in Reading for At-Risk Community College Students.

ERIC Educational Resources Information Center

Yevoli, Carole

Focusing on corrective strategies for improving reading skills of at-risk community college students, this document reviews the history of such strategies, highlights current efforts, and assesses future needs. The first section traces the history of remedial reading programs at community colleges, beginning with small individualized sections…

Project Aprendizaje, 1988-89. Evaluation Section Report. OREA Report.

ERIC Educational Resources Information Center

Berney, Tomi D.; Velasquez, Clara

In it's first year, Project Aprendizaje served 250 students from the Dominican Republic and Puerto Rico at Seward Park High School in Manhattan (New York). Project objectives were to improve participants' language skills in Spanish and English, help participants successfully complete content area courses needed for graduation, and provide career…

Recent Advances in Resonance Region Nuclear Data Measurements and Analyses for Supporting Nuclear Energy Applications

NASA Astrophysics Data System (ADS)

Dunn, Michael

2008-10-01

For over 30 years, the Oak Ridge National Laboratory (ORNL) has performed research and development to provide more accurate nuclear cross-section data in the resonance region. The ORNL Nuclear Data (ND) Program consists of four complementary areas of research: (1) cross-section measurements at the Oak Ridge Electron Linear Accelerator; (2) resonance analysis methods development with the SAMMY R-matrix analysis software; (3) cross-section evaluation development; and (4) cross-section processing methods development with the AMPX software system. The ND Program is tightly coupled with nuclear fuel cycle analyses and radiation transport methods development efforts at ORNL. Thus, nuclear data work is performed in concert with nuclear science and technology needs and requirements. Recent advances in each component of the ORNL ND Program have led to improvements in resonance region measurements, R-matrix analyses, cross-section evaluations, and processing capabilities that directly support radiation transport research and development. Of particular importance are the improvements in cross-section covariance data evaluation and processing capabilities. The benefit of these advances to nuclear science and technology research and development will be discussed during the symposium on Nuclear Physics Research Connections to Nuclear Energy.

Aerothermal modeling program, phase 2. Element B: Flow interaction experiment

NASA Technical Reports Server (NTRS)

Nikjooy, M.; Mongia, H. C.; Murthy, S. N. B.; Sullivan, J. P.

1986-01-01

The design process was improved and the efficiency, life, and maintenance costs of the turbine engine hot section was enhanced. Recently, there has been much emphasis on the need for improved numerical codes for the design of efficient combustors. For the development of improved computational codes, there is a need for an experimentally obtained data base to be used at test cases for the accuracy of the computations. The purpose of Element-B is to establish a benchmark quality velocity and scalar measurements of the flow interaction of circular jets with swirling flow typical of that in the dome region of annular combustor. In addition to the detailed experimental effort, extensive computations of the swirling flows are to be compared with the measurements for the purpose of assessing the accuracy of current and advanced turbulence and scalar transport models.

Cross sections for n+{sup 14}N from an R-matrix analysis of the {sup 15}N system

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

Hale, G.M.; Young, P.G.; Chadwick, M.B.

1994-06-01

As part of the Hiroshima-Nagasaki Dose Reevaluation Program, a new evaluation of the neutron cross sections for {sup 14}N was made for ENDF/B-VI, based at energies below 2.5 MeV on a multichannel R-matrix analysis of reactions in the {sup 15}N system. The types of data used in the analysis, and the resulting cross sections and resonance structure for {sup 15}N are briefly described. The resonant features of the neutron cross sections were especially well determined by including precise, high-resolution neutron total cross section measurements from ORNL. While the new evaluated cross section appear to be significant improvements over the earliermore » ones, they still need to be tested more extensively against recent measurements of the differential elastic cross section from Oak Ridge.« less

Significant unmet oral health needs of homebound elderly adults.

PubMed

Ornstein, Katherine A; DeCherrie, Linda; Gluzman, Rima; Scott, Elizabeth S; Kansal, Jyoti; Shah, Tushin; Katz, Ralph; Soriano, Theresa A

2015-01-01

To assess the oral health status, use of dental care, and dental needs of homebound elderly adults and to determine whether medical diagnoses or demographic factors influenced perceived oral health. Cross-sectional analysis. Participants' homes in New York City. Homebound elderly adults (N = 125). A trained dental research team conducted a comprehensive clinical examination in participants' homes and completed a dental use and needs survey and the Geriatric Oral Health Assessment Index. Participants who reported a high level of unmet oral health needs were more likely to be nonwhite, although this effect was not significant in multivariate analysis. Individual medical diagnoses and the presence of multiple comorbidities were not associated with unmet oral health needs. The oral health status of homebound elderly adults was poor regardless of their medical diagnoses. High unmet oral health needs combined with strong desire to receive dental care suggests there is a need to improve access to dental care for this growing population. In addition to improving awareness of geriatricians and primary care providers who care for homebound individuals, the medical community must partner with the dental community to develop home-based programs for older adults. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Progress Towards an Indirect Neutron Capture Capability at LANSCE

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

Koehler, Paul E.; Ullmann, John Leonard; Couture, Aaron Joseph

2017-09-20

There are many neutron-capture cross sections of importance to radiochemical diagnostics and nuclear forensics which are beyond the reach of direct measurements. Hence, we have been developing an apparatus on flight path (FP) 13 at target 1 at LANSCE for tightly constraining these cross sections via determination of the underlying physical quantities. FP-13 was initially a cold-neutron beam line for materials science and therefore required substantial modification for use for nuclear physics. In FY17, we made several improvements to FP-13, demonstrated improved performance due to these changes via measurements on a variety of samples, identified a few more needed improvements,more » and reconfigured the beam line to implement the most important of these. New measurements to assess the impact of the most recent improvement will commence when beam is restored to LANSCE. Although FP-13 has not yet reached the performance required for small radioactive samples, measurements on a gold sample have led to an important science result which we are preparing for publication.« less

77 FR 32084 - Notice of Proposed Information Collection Requests; Office of Planning, Evaluation and Policy...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-31

... educational agencies (SEAs) to request flexibility pursuant to the authority in section 9401 of ESEA, which... purpose of Title I of ESEA, including meeting the educational needs of low-achieving students, closing achievement gaps, and holding schools, local educational agencies, and SEAs accountable for improving the...

Report: EPA Needs to Comply with the Federal Insecticide, Fungicide, and Rodenticide Act and Improve Its Oversight of Exported Never-Registered Pesticides

EPA Pesticide Factsheets

Report #10-P-0026, November 10, 2009. EPA is not complying with FIFRA Section 17(a) which is, in part, intended to notify the government of an importing country that a potentially hazardous pesticide was imported into that country.

Serving New Populations. New Directions for Community Colleges, Number 27.

ERIC Educational Resources Information Center

Walsh, Patricia Ann, Ed.

1979-01-01

Improving the reponsiveness of community colleges to the needs of non-traditional students is the topic of 14 essays, grouped into sections focusing on older adults, the handicapped, and women. David Demko describes a program designed to integrate older adults into a community college's service population. Jared Sharon provides guidelines for…

Development of an Instrument to Measure Medical Students' Attitudes toward People with Disabilities

ERIC Educational Resources Information Center

Symons, Andrew B.; Fish, Reva; McGuigan, Denise; Fox, Jeffery; Akl, Elie A.

2012-01-01

As curricula to improve medical students' attitudes toward people with disabilities are developed, instruments are needed to guide the process and evaluate effectiveness. The authors developed an instrument to measure medical students' attitudes toward people with disabilities. A pilot instrument with 30 items in four sections was administered to…

English as a Second Language for Adults: A Curriculum Guide.

ERIC Educational Resources Information Center

Selman, Mary; And Others

To help improve English as a Second Language (ESL) programs for adult learners, this curriculum guide provides informative materials for the teacher and 30 sections of lessons suitable for adaptation by the teacher. Teacher information includes materials on language teaching and learning, use of the guide, needs assessment, adapting lesson plans,…

Thinking Like a 21st Century Nurse: Theories, Instruments and Methodologies to Improve Clinical Thinking

ERIC Educational Resources Information Center

Fountain, Lily

2011-01-01

This cross-sectional descriptive study of the Model of Domain Learning, which describes learners' progress from acclimation through competence to proficiency through the interplay of knowledge, interest and strategic processing/critical thinking (CT), examined its extension to maternity nursing. Based on the identified need for valid, reliable…

42 CFR 438.208 - Coordination and continuity of care.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Coordination and continuity of care. 438.208... Improvement Access Standards § 438.208 Coordination and continuity of care. (a) Basic requirement—(1) General... individual with special health care needs, as specified in paragraph (c) of this section. (3) Exception for...

42 CFR 438.208 - Coordination and continuity of care.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Coordination and continuity of care. 438.208... Improvement Access Standards § 438.208 Coordination and continuity of care. (a) Basic requirement—(1) General... individual with special health care needs, as specified in paragraph (c) of this section. (3) Exception for...

42 CFR 438.208 - Coordination and continuity of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Coordination and continuity of care. 438.208... Improvement Access Standards § 438.208 Coordination and continuity of care. (a) Basic requirement—(1) General... individual with special health care needs, as specified in paragraph (c) of this section. (3) Exception for...

Assessing Conscientious Personality in Primary Care: An Opportunity for Prevention and Health Promotion

ERIC Educational Resources Information Center

Israel, Salomon; Moffitt, Terrie E.

2014-01-01

The articles in this special section bolster the already strong evidence base that personality differences in the trait of conscientiousness predict health. What is now needed is a research agenda for translating documented risk associations between low conscientiousness and poor health into policies and interventions that improve health outcomes…

Sciencewise: Discovering Scientific Process through Problem Solving. Book 3.

ERIC Educational Resources Information Center

Holley, Dennis

This science activity book, for grades 8-12, can be used to teach students the thinking skills they will need to undertake scientific exploration on their own. The skills they develop will improve their science abilities and enhance their overall academic performance. This book is divided into two sections: (1) "Dynamo Demos", teacher-led…

Aircraft engine hot section technology: An overview of the HOST Project

NASA Technical Reports Server (NTRS)

Sokolowski, Daniel E.; Hirschberg, Marvin H.

1990-01-01

NASA sponsored the Turbine Engine Hot Section (HOST) project to address the need for improved durability in advanced aircraft engine combustors and turbines. Analytical and experimental activities aimed at more accurate prediction of the aerothermal environment, the thermomechanical loads, the material behavior and structural responses to loads, and life predictions for cyclic high temperature operation were conducted from 1980 to 1987. The project involved representatives from six engineering disciplines who are spread across three work disciplines - industry, academia, and NASA. The HOST project not only initiated and sponsored 70 major activities, but also was the keystone in joining the multiple disciplines and work sectors to focus on critical research needs. A broad overview of the project is given along with initial indications of the project's impact.

How to Apply Feedback to Improve Subjective Wellbeing of Government Servants Engaged in Environmental Protection in China?

PubMed Central

Wang, Xinmeng; Zhang, Na; Li, Miaomiao

2018-01-01

Background In order to improve subjective wellbeing of government servants engaged in environmental protection who work in high power distance in China, it is important to understand the impact mechanism of feedback. This study aims to analyze how feedback environment influences subjective wellbeing through basic psychological needs satisfaction and analyzing the moderating role of power distance. Method The study was designed as a cross-sectional study of 492 government servants engaged in environment protection in Shandong, China. Government servants who agreed to participate answered self-report questionnaires concerning demographic conditions, supervisor feedback environment, basic psychological need satisfaction, and power distance as well as subjective wellbeing. Results Employees in higher levels of supervisor feedback environment were more likely to experience subjective wellbeing. Full mediating effects were found for basic psychological needs satisfaction. Specifically, supervisor feedback environment firstly led to increased basic psychological needs satisfaction, which in turn resulted in increased subjective wellbeing. Additional analysis showed that the mediating effect of basic psychological needs satisfaction was stronger for employees who work in high power distance than in low power distance. Conclusion The results from the study indicate that supervisor feedback environment plays a vital role in improving subjective wellbeing of government servants engaged in environmental protection through basic psychological needs satisfaction, especially in high power distance. PMID:29662901

The infant microbiome development: mom matters

PubMed Central

Mueller, Noel T.; Bakacs, Elizabeth; Combellick, Joan; Grigoryan, Zoya; Dominguez-Bello, Maria G.

2015-01-01

The infant microbiome plays an essential role in human health and its assembly is determined by maternal– offspring exchanges of microbiota. This process is affected by several practices, including Cesarean section (C-section), perinatal antibiotics, and formula feeding, that have been linked to increased risks of metabolic and immune diseases. Here we review recent knowledge about the impacts on infant microbiome assembly, discuss preventive and restorative strategies to ameliorate the effects of these impacts, and highlight where research is needed to advance this field and improve the health of future generations. PMID:25578246

Regional variation in identified cancer care needs of early-career oncologists in China, India, and Pakistan.

PubMed

Lyerly, H Kim; Fawzy, Maria R; Aziz, Zeba; Nair, Reena; Pramesh, C S; Parmar, Vani; Parikh, Purvish M; Jamal, Rozmin; Irumnaz, Azizunissa; Ren, Jun; Stockler, Martin R; Abernethy, Amy P

2015-05-01

Cancer incidence and mortality is increasing in the developing world. Inequities between low-, middle-, and high-income countries affect disease burden and the infrastructure needs in response to cancer. We surveyed early-career oncologists attending workshops in clinical research in three countries with emerging economies about their perception of the evolving cancer burden. A cross-sectional survey questionnaire was distributed at clinical trial concept development workshops held in Beijing, Lahore, Karachi, and Mumbai at major hospitals to acquire information regarding home-country health conditions and needs. A total of 100 respondents participated in the workshops held at major hospitals in the region (India = 29, China = 25, Pakistan = 42, and other = 4). Expected consensus on many issues (e.g., emergence of cancer as a significant health issue) was balanced with significant variation in priorities, opportunities, and challenges. Chinese respondents prioritized improvements in cancer-specific care and palliative care, Indian respondents favored improved cancer detection and advancing research in cancer care, and Pakistani respondents prioritized awareness of cancer and improvements in disease detection and cancer care research. For all, the most frequently cited opportunity was help in improving professional cancer education and training. Predominantly early-career oncologists attending clinical research workshops (in China, India, and Pakistan) identified needs for increasing clinical cancer research, professional education, and public awareness of cancer. Decision makers supporting efforts to reduce the burden of cancer worldwide will need to factor the specific needs and aspirations of health care providers in their country in prioritizing health policies and budgets. ©AlphaMed Press.

Social and custodial needs of older adults in prison.

PubMed

Hayes, Adrian J; Burns, Alistair; Turnbull, Pauline; Shaw, Jenny J

2013-09-01

older prisoners are a fast-growing group but there is limited evidence for how well their needs are being met. to quantify the social and custodial needs of older prisoners and suggest improvements for service provision. cross-sectional study. twelve prisons holding adult males in North West England. two hundred and sixty-two prisoners; 97 aged between 50 and 59, 165 aged 60 and over. interview and case-note review for issues of social and custodial need and quality of life in prison, including Forensic Camberwell Assessment of Need and Lubben Scale for social networks. many had problems mixing with younger prisoners, accommodation and activities, and limited contact with friends and family. A small group had personal care needs which were not well managed in prison. older prisoners have distinct social and custodial needs which need to be addressed by a national strategy for their care and management.

The standardized functional support sectional for the Small Astronomy Satellite (SAS)

NASA Technical Reports Server (NTRS)

Townsend, M. R.

1974-01-01

The standardized functional support section for the improved Small Astronomy Satellite (SAS) spacecraft, which can be used virtually without change for a wide variety of experimental packages and missions, is described. This functional support section makes the spacecraft remarkably flexible for a small satellite. Able to point its thrust axis to any direction in space, it can also spin or slow its outer body rotation to zero for star- or earth-locked pointing of side-viewing experiments. It features a reprogrammable telemetry system, a delayed command system, and an improved control system. Experiments can be built independently and attached to the SAS spacecraft just prior to final acceptance testing and launch. The spacecraft subsystems are described in detail. Included are a summary of the spacecraft characteristics, special design considerations, project reliability requirements, and environmental test conditions. It is intended that this new functional support section afford virtual off-the-shelf availability of the SAS spacecraft to independently built experiments, thus providing quick response time and minimum cost in meeting a wide variety of experimenter needs.

Determinants of unmet need for contraception among Chinese migrants: a worksite-based survey.

PubMed

Decat, Peter; Zhang, Wei-Hong; Moyer, Eileen; Cheng, Yimin; Wang, Zhi-Jin; Lu, Ci-Yong; Wu, Shi-Zhong; Nadisauskiene, Ruta Jolanta; Luchters, Stanley; Deveugele, Myriam; Temmerman, Marleen

2011-02-01

Considerable sexual and reproductive health (SRH) challenges have been reported among rural-to-urban migrants in China. Predictors thereof are urgently needed to develop targeted interventions. A cross-sectional study assessed determinants of unmet need for contraception using semi-structured interviews in two cities in China: Guangzhou and Qingdao. Between July and September 2008, 4867 female rural-to-urban migrants aged 18-29 years participated in the study. Of these, 2264 were married or cohabiting. Among sexually-active women (n = 2513), unmet need for contraception was reported by 36.8% and 51.2% of respondents in Qingdao and Guangzhou, respectively; it was associated with being unmarried, having no children, less schooling, poor SRH knowledge, working in non-food industry, and not being covered by health insurance. A substantial proportion of unmarried migrants reported they had sexual intercourse (16.6 % in Qingdao and 21.4% in Guangzhou) contrary to current sexual standards in China. The study emphasises the importance of improving the response to the needs of rural-to-urban migrants and recommends strategies to address the unmet need for contraception. These should enhance open communication on sexuality, increase the availability of condoms, and improve health insurance coverage.

Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

ERIC Educational Resources Information Center

Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

2011-01-01

Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…

Learning Motivation and Adaptive Video Caption Filtering for EFL Learners Using Handheld Devices

ERIC Educational Resources Information Center

Hsu, Ching-Kun

2015-01-01

The aim of this study was to provide adaptive assistance to improve the listening comprehension of eleventh grade students. This study developed a video-based language learning system for handheld devices, using three levels of caption filtering adapted to student needs. Elementary level captioning excluded 220 English sight words (see Section 1…

Experimental and Theoretical Understanding of Neutron Capture on Uranium Isotopes

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

Ullmann, John Leonard

2017-09-21

Neutron capture cross sections on uranium isotopes are important quantities needed to model nuclear explosion performance, nuclear reactor design, nuclear test diagnostics, and nuclear forensics. It has been difficult to calculate capture accurately, and factors of 2 or more be- tween calculation and measurements are not uncommon, although normalization to measurements of the average capture width and nuclear level density can improve the result. The calculations of capture for 233,235,237,239U are further complicated by the need to accurately include the fission channel.

Integrating Stakeholders and Users into the Geography Discipline's Research Process

USGS Publications Warehouse

Hermans, Caroline M.; Taketa, Richard

2006-01-01

Future research priorities of Geography emphasize the discipline's leadership role in the U.S. Geological Survey (USGS) in multidisciplinary and integrated research on human and environmental systems and how these systems are interrelated and respond to change Geography's research priorities also emphasize providing science that is usable to society and creating decision support products applicable to given customer problems. To achieve these goals, we must understand the relationship between our research and our customer, and how to integrate the customer into the research process. This report details the elements of the research process that help achieve the degree of stakeholder involvement necessary to ensure a successful end-product. It offers suggestions that can help researchers better understand stakeholders and customers and involve them in the research process more effectively, while preserving the integrity of the science. Its aim is to help researchers understand the problems and challenges faced by our customers and communicate the ways in which Geography can help address their problems. Adopting these guidelines can improve the efficiency of the research process and lead to higher quality output. We will be able to conduct better research because we will have an improved understanding of the research problem and the stakeholders involved. This report covers a broad range of topics, from identifying and communicating with stakeholders and users, to the use of language, to how to effectively present scientific information to the user. It does not offer a 'one size fits all' method. Instead, perhaps only specific sections are suitable for a given project and customers, depending on project scope and needs. This report is based on the objectives of Geography's strategic plan, U. S. Geological Survey's strategic plan, and Department of Interior's strategic plan. Section 2 of these guidelines describes the purpose of the research process in Geography and the need for better user involvement in the process. Section 3 explains how to conduct a stakeholder analysis. Section 4 explains how to conduct a user-needs assessment.

Cross Section High Resolution Imaging of Polymer-Based Materials

NASA Astrophysics Data System (ADS)

Delaportas, D.; Aden, P.; Muckle, C.; Yeates, S.; Treutlein, R.; Haq, S.; Alexandrou, I.

This paper describes a methodology for preparing cross sections of organic layers suitable for transmission electron microscopy (TEM) at high resolution. Our principal aim is to prepare samples that are tough enough to allow the slicing into sub-150 nm sections. We also need strong contrast at the organic layer area to make it identifiable during TEM. Our approach is to deposit organic layers on flexible substrates and prepare thin cross sections using ultra-microtomy. We sandwich the organic layer between two metal thin films in order to isolate it and improve contrast. Our methodology is used to study the microstructure of polymer/nanotube composites, allowing us to accurately measure the organic layer thickness, determine nanotube dispersion and assess the effect of nanotube clustering on film structural stability.

Special report on transboundary air quality issues

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

NONE

1998-12-31

The International Air Quality Board was created in 1996 to provide advice to the International Joint Commission in fulfilling an air quality alerting function requested by governments in that year. The Board undertook a review of the many issues affecting transboundary air quality along the Canada-US border. This report reflects on issues previously addressed by the Board in its reporting to the Commission. Section 1 discusses the need for Canada and the US to adopt a seamless border approach to address pollution sources and receptors in a holistic manner. Section 2 discusses nitrogen oxides as a key contaminant because ofmore » its direct impact on the ecosystem and its effects on future levels of other secondary pollutants. Section 3 outlines the deficiencies of emission inventories regarding persistent toxic substances such as mercury, which must be addressed if source-to-receptor relationships are to be established. Section 4 covers the need to develop monitoring and modelling tools to further examine pollutant transport and concentration, and the resulting human and ecological exposure. Section 5 describes issues in individual regions along the border. Section 6 is directed at the harmonization of standards, which would assist in the effective control of transboundary pollutants such as ozone. Section 7 discusses collaboration with other organizations in addressing transboundary air pollution issues. Section 8 describes various feedback mechanisms for verifying that the elimination or management of air pollution is achieving improvement and benefits. Section 9 considers emissions and preventive strategies for major source sectors, including coal-fired utilities and mobile sources. The final section outlines future Board activities.« less

MDS 3.0 section M: Skin Conditions: what the medical director needs to know.

PubMed

Levine, Jeffrey M; Ayello, Elizabeth A

2011-03-01

The Centers for Medicare and Medicaid Services has released the new Resident Assessment Instrument version 3.0, which went into effect October 1, 2010. The intention of the revised Resident Assessment Instrument is to improve health-related quality of life and care planning, and incorporate evolving standards of terminology, assessment, and technology. To reach this goal, Section M: Skin Conditions has been greatly expanded and will alter the process of pressure ulcer assessment in all long-term care facilities across America. Details of this assessment instrument include upgraded criteria for risk factors, staging, identification, tracking, and evolution of pressure ulcers. The medical director can and should assume a leadership role in education and collaboration with primary care physicians and wound clinicians to accommodate changes in revised Section M. Integrating the medical director into the facility's wound care program will improve the quality of care for residents of long-term care facilities. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

Adoption of Clean Cookstoves after Improved Solid Fuel Stove Programme Exposure: A Cross-Sectional Study in Three Peruvian Andean Regions.

PubMed

Wolf, Jennyfer; Mäusezahl, Daniel; Verastegui, Hector; Hartinger, Stella M

2017-07-08

This study examined measures of clean cookstove adoption after improved solid fuel stove programmes in three geographically and culturally diverse rural Andean settings and explored factors associated with these measures. A questionnaire was administered to 1200 households on stove use and cooking behaviours including previously defined factors associated with clean cookstove adoption. Logistic multivariable regressions with 16 pre-specified explanatory variables were performed for three outcomes; (1) daily improved solid fuel stove use, (2) use of liquefied petroleum gas stove and (3) traditional stove displacement. Eighty-seven percent of households reported daily improved solid fuel stove use, 51% liquefied petroleum gas stove use and 66% no longer used the traditional cookstove. Variables associated with one or more of the three outcomes are: education, age and civil status of the reporting female, household wealth and size, region, encounters of problems with the improved solid fuel stove, knowledge of somebody able to build an improved solid fuel stove, whether stove parts are obtainable in the community, and subsidy schemes. We conclude that to be successful, improved solid fuel stove programmes need to consider (1) existing household characteristics, (2) the household's need for ready access to maintenance and repair, and (3) improved knowledge at the community level.

Adoption of Clean Cookstoves after Improved Solid Fuel Stove Programme Exposure: A Cross-Sectional Study in Three Peruvian Andean Regions

PubMed Central

Wolf, Jennyfer; Mäusezahl, Daniel; Verastegui, Hector; Hartinger, Stella M.

2017-01-01

This study examined measures of clean cookstove adoption after improved solid fuel stove programmes in three geographically and culturally diverse rural Andean settings and explored factors associated with these measures. A questionnaire was administered to 1200 households on stove use and cooking behaviours including previously defined factors associated with clean cookstove adoption. Logistic multivariable regressions with 16 pre-specified explanatory variables were performed for three outcomes; (1) daily improved solid fuel stove use, (2) use of liquefied petroleum gas stove and (3) traditional stove displacement. Eighty-seven percent of households reported daily improved solid fuel stove use, 51% liquefied petroleum gas stove use and 66% no longer used the traditional cookstove. Variables associated with one or more of the three outcomes are: education, age and civil status of the reporting female, household wealth and size, region, encounters of problems with the improved solid fuel stove, knowledge of somebody able to build an improved solid fuel stove, whether stove parts are obtainable in the community, and subsidy schemes. We conclude that to be successful, improved solid fuel stove programmes need to consider (1) existing household characteristics, (2) the household’s need for ready access to maintenance and repair, and (3) improved knowledge at the community level. PMID:28698468

Music during caesarean section under regional anaesthesia for improving maternal and infant outcomes.

PubMed

Laopaiboon, Malinee; Lumbiganon, Pisake; Martis, Ruth; Vatanasapt, Patravoot; Somjaivong, Busaba

2009-04-15

Evidence on the benefits of music during caesarean section under regional anaesthesia to improve clinical and psychological outcomes for mothers and infants has not been established. To evaluate the effectiveness of music during caesarean section under regional anaesthesia for improving clinical and psychological outcomes for mothers and infants. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2008). We included randomised controlled trials comparing music added to standard care during caesarean section under regional anaesthesia to standard care alone. Two review authors, Malinee Laopaiboon and Ruth Martis, independently assessed eligibility, risk of bias in included trials and extracted data. We analysed continuous outcomes using a mean difference (MD) with a 95% confidence interval (CI). One trial involving 76 women who planned to have their babies delivered by caesarean section met the inclusion criteria, but data were available for only 64 women. This trial was of low quality with unclear allocation concealment and only a few main clinical outcomes reported for the women. The trial did not report any infant outcomes. It appears that music added to standard care during caesarean section under regional anaesthesia had some impact on pulse rate at the end of maternal contact with the neonate in the intra-operative period (MD -7.50 fewer beats per minute, 95% CI -14.08 to -0.92) and after completion of skin suture for the caesarean section (MD -7.37 fewer beats per minute, 95% CI -13.37 to -1.37). There was also an improvement in the birth satisfaction score (maximum possible score of 35) (MD of 3.38, 95%CI 1.59 to 5.17). Effects on other outcomes were either not significant or not reported in the one included trial. The findings indicate that music during planned caesarean section under regional anaesthesia may improve pulse rate and birth satisfaction score. However, the magnitude of these benefits is small and the methodological quality of the one included trial is questionable. Therefore, the clinical significance of music is unclear. More research is needed to investigate the effects of music during caesarean section under regional anaesthesia on both maternal and infant outcomes, in various ethnic pregnant women, and with adequate sample sizes.

Coating Life Prediction

NASA Technical Reports Server (NTRS)

Nesbitt, J. A.; Gedwill, M. A.

1984-01-01

Hot-section gas-turbine components typically require some form of coating for oxidation and corrosion protection. Efficient use of coatings requires reliable and accurate predictions of the protective life of the coating. Currently engine inspections and component replacements are often made on a conservative basis. As a result, there is a constant need to improve and develop the life-prediction capability of metallic coatings for use in various service environments. The purpose of this present work is aimed at developing of an improved methodology for predicting metallic coating lives in an oxidizing environment and in a corrosive environment.

Access to Vocational Education. A Planning System for Local Secondary and Post-Secondary Program and Facility Accessibility. Step 1: Identifying Barriers.

ERIC Educational Resources Information Center

Rice, Eric; And Others

This guidebook focuses on the first of five steps included in a planning system for improving local secondary and postsecondary program and facilities accessibility: identifying barriers. The first five sections of the booklet are comprised of self-instructional descriptions of five needs-assessment procedures that can be used to identify…

How To Become a Teacher: A Complete Guide.

ERIC Educational Resources Information Center

Haselkorn, David; Calkins, Andrew

This guide to becoming a teacher includes six sections: (1) "A Snapshot of the Profession" (e.g, reasons to teach, the need to improve schools, working conditions for teachers, areas of high teacher demand, and how to find out more); (2) "Preparing to be a Teacher" (e.g., a primer on teacher education programs, three pathways to the classroom,…

El Conocimiento Ocupacional y del Yo para los Grupos Especiales. Monografias sobre el Conocimiento Ocupacional y del Yo.

ERIC Educational Resources Information Center

Hoyt, Kenneth B.

This Spanish translation of ED 132 428 includes the three papers representing Office of Education attempts to face the need for improving delivery of career education to special portions of the population. New additions are brief sections on basic definitions and additional considerations of the significance of work. The first paper, on career…

Raising Health Literacy and Promoting Empowerment to Meet the Challenges of Aging in Hong Kong

ERIC Educational Resources Information Center

Chau, Pui Hing; Mak, Benise; Choy, Shuk Yi; Chan, Kam Che; Cheung, Sai Hei; Woo, Jean

2010-01-01

This study aimed to determine the educational needs of members of the public and related professional disciplines in order to improve health literacy in elderly issues. A cross-sectional survey was conducted in 2007; 2,694 subjects were recruited from the noninstitutional Hong Kong population aged 16 years and over. Undergraduate students of…

How To Work with Small Businesses: Advice and Guidance for Providers of Training and Business Support.

ERIC Educational Resources Information Center

Allen, Anne Marie, Ed.

This publication provides guidance on good practice to help training providers in the United Kingdom improve the quality and relevance of services to small and medium-sized enterprises (SMEs). Section 1 focuses on key research findings regarding SMEs' needs and SME-college collaboration, including trading conditions for SMEs; services on offer by…

Vocational Training for Women Refugees in Africa: Guide-lines from Selected Field Projects. Training Discussion Paper No. 26.

ERIC Educational Resources Information Center

Hall, Eve

In addition to describing how training programs for African refugees fail to meet the needs of women (who along with children are the majority of refugees), this document offers guidelines for improving the programs and, thus, the productivity and incomes of women refugees. The first section, called "Women Refugees: The Overlooked…

Opening Doors to the Future: Preparing Low-Achieving Middle Grades Students To Succeed in High School. 2002 Outstanding Practices.

ERIC Educational Resources Information Center

Southern Regional Education Board, Atlanta, GA.

This publication describes the efforts of 15 schools to address systemic change needed to help low-achieving students move successfully from middle to high school. Section 1, "Getting Students Ready for High School," examines "Interdisciplinary Approach Helps Eighth-Graders Improve Their Scores on State Tests"; "Two-Year Interdisciplinary Program…

Delivering Integrated Services. Models for Facilitating Change in Small and Mid-Sized Firms. Business Assistance Tools.

ERIC Educational Resources Information Center

Mitchell, Stephen M.

This guide draws on case studies to identify lessons for small and midsized firms who wish to improve the quality of their services and facilitate change. Following an introduction, section 2 describes the context in which the research was undertaken after a needs analysis was conducted of small and midsized businesses and service providers, and…

Improved Neutronics Treatment of Burnable Poisons for the Prismatic HTR

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

Y. Wang; A. A. Bingham; J. Ortensi

2012-10-01

In prismatic block High Temperature Reactors (HTR), highly absorbing material such a burnable poison (BP) cause local flux depressions and large gradients in the flux across the blocks which can be a challenge to capture accurately with traditional homogenization methods. The purpose of this paper is to quantify the error associated with spatial homogenization, spectral condensation and discretization and to highlight what is needed for improved neutronics treatments of burnable poisons for the prismatic HTR. A new triangular based mesh is designed to separate the BP regions from the fuel assembly. A set of packages including Serpent (Monte Carlo), Xuthosmore » (1storder Sn), Pronghorn (diffusion), INSTANT (Pn) and RattleSnake (2ndorder Sn) is used for this study. The results from the deterministic calculations show that the cross sections generated directly in Serpent are not sufficient to accurately reproduce the reference Monte Carlo solution in all cases. The BP treatment produces good results, but this is mainly due to error cancellation. However, the Super Cell (SC) approach yields cross sections that are consistent with cross sections prepared on an “exact” full core calculation. In addition, very good agreement exists between the various deterministic transport and diffusion codes in both eigenvalue and power distributions. Future research will focus on improving the cross sections and quantifying the error cancellation.« less

Predicting equipment needs of children with cerebral palsy using the Gross Motor Function Classification System: a cross-sectional study.

PubMed

Novak, Iona; Smithers-Sheedy, Hayley; Morgan, Cathy

2012-01-01

Children with cerebral palsy (CP) routinely use assistive equipment to improve their independence. Specialist equipment is expensive and therefore not always available to the child when needed. The aim of this study was to determine whether the assistive equipment needs of children with CP and the associated costs could be predicted. A cross-sectional study using a chart audit was completed. Two hundred forty-two children met eligibility criteria and were included in the study. Data abstracted from files pertained to the child's CP, associated impairments and assistive equipment prescribed. The findings were generated using linear regression modelling. Gross Motor Function Classification System (GMFCS) level [B = 3.01 (95% CI, 2.36-3.57), p = 0.000] and the presence of epilepsy [B = 2.35 (95% CI, 0.64-4.06), p = 0.008] predicted the prescription of assistive equipment. The more severely affected the gross motor function impairment, the more equipment that was required and the more the equipment cost. The equipment needs of children with CP can be predicted for the duration of childhood. This information may be useful for families and for budget and service planning.

The validity of telepathological frozen section diagnosis with ISDN-mediated remote microscopy.

PubMed

Wellnitz, U; Fritz, P; Voudouri, V; Linder, A; Toomes, H; Schmid, J; Binder, B; Schwarzmann, P

2000-07-01

We investigated 109 randomly selected frozen section specimens from lung surgery patients in a retrospective blind mode using telepathology equipment. The telepathology system applied (HISTKOM) used one ISDN B-channel and telemicroscopy with a remotely operated robotic microscope. The performance of telepathological frozen section diagnosis was compared with that of conventional frozen section diagnosis. The false-positive rate achieved was identical for both methods. The sensitivity (P=0.03), but not the specificity, was significantly lower for the telepathological method. The time needed to establish a diagnosis with the remote microscope was too high; therefore, upgrading to multichannel technology is recommended. The quality of the images transmitted was judged to be sufficient by the pathologists involved in the study. In conclusion, with further technical improvements in telemicroscopy and additional experience in telepathology, remote diagnosis seems to be feasible.

Front-Line Physicians' Satisfaction with Information Systems in Hospitals.

PubMed

Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna

2018-01-01

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.

A Boon for the Architect Engineer

NASA Technical Reports Server (NTRS)

1992-01-01

Langley Research Center's need for an improved construction specification system led to an automated system called SPECSINTACT. A catalog of specifications, the system enables designers to retrieve relevant sections from computer storage and modify them as needed. SPECSINTACT has also been adopted by government agencies. The system is an integral part of the Construction Criteria Base (CCB), a single disc containing design and construction information for 10 government agencies including the American Institute of Architects' MASTERSPEC. CCB employs CD- ROM technologies and is available from the National Institute of Building Sciences. Users report substantial savings in time and productivity.

Making Child Care Work. Report to the 1987 Minnesota Legislature by the Child Care Task Force.

ERIC Educational Resources Information Center

Moriarty, Sheila; And Others

This report makes recommendations to the 1987 Minnesota Legislature on some actions that can be taken to improve Minnesota's child care system and make it work more effectively. The first section of the report documents the growing need for child care, emphasizing the number of children in Minnesota, the number of women in the labor force, changes…

Creating Energy Choices for the Future. A Summary of the National Plan for Energy Research, Development, and Demonstration.

ERIC Educational Resources Information Center

Energy Research and Development Administration, Washington, DC.

This booklet, which highlights and explains the 1975 National Energy Plan, is intended to improve the general public's understanding of U.S. energy policy. Sections in the publication include: (1) The Energy Problem and the Need for Planning; (2) Basic Principles of the Plan and How They Apply; (3) Overcoming the Oil and Gas Shortage; (4) The…

Addressing basic resource needs to improve primary care quality: a community collaboration programme.

PubMed

Berkowitz, Seth A; Hulberg, A Catherine; Hong, Clemens; Stowell, Brian J; Tirozzi, Karen J; Traore, Carine Y; Atlas, Steven J

2016-03-01

Unmet basic resource needs, such as difficulty affording healthcare, medications, food and housing, may contribute to worse healthcare quality indicators, but interventions are hampered by lack of specific knowledge regarding the distribution of unmet basic resource needs and their association with priority clinical conditions and health service use patterns. Cross-sectional study of primary care patients in two urban academic practices from 1 October 2013 to 30 April 2014. Patients were screened for unmet needs and enrolled in a programme to link them with community resources. Key measures included patient report of unmet basic resource needs, clinical conditions prioritised by quality improvement programmes (hypertension, diabetes and depression), and health service use patterns such as frequent emergency department (ED) visits (>2 in the preceding year) and frequent clinic 'no-shows' (>1 in the preceding year). 416 patients with unmet needs were included, and compared with 2750 patients who did not report needs. The most common types of needs reported were: difficulties affording healthcare (46.5%), food (40.1%) and utilities (36.3%). Patients who reported unmet needs were more likely to have depression (17.8% vs 9.5%, p<0.0001), diabetes (32.7% vs 20.4%, p<0.0001), hypertension (54.3% vs 46.3%, p=0.002), be frequent ED users (11.3% vs 5.4%, p<0.0001), and have frequent 'no-shows' to clinic (21.6% vs 11.9%, p<0.0001). Difficulty affording healthcare and food are particularly common needs among patients with priority conditions. Strategies to identify and address unmet needs as part of routine care may be an important way to improve healthcare quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Measuring Two Key Parameters of H3 Color Centers in Diamond

NASA Technical Reports Server (NTRS)

Roberts, W. Thomas

2005-01-01

A method of measuring two key parameters of H3 color centers in diamond has been created as part of a continuing effort to develop tunable, continuous-wave, visible lasers that would utilize diamond as the lasing medium. (An H3 color center in a diamond crystal lattice comprises two nitrogen atoms substituted for two carbon atoms bonded to a third carbon atom. H3 color centers can be induced artificially; they also occur naturally. If present in sufficient density, they impart a yellow hue.) The method may also be applicable to the corresponding parameters of other candidate lasing media. One of the parameters is the number density of color centers, which is needed for designing an efficient laser. The other parameter is an optical-absorption cross section, which, as explained below, is needed for determining the number density. The present method represents an improvement over prior methods in which optical-absorption measurements have been used to determine absorption cross sections or number densities. Heretofore, in order to determine a number density from such measurements, it has been necessary to know the applicable absorption cross section; alternatively, to determine the absorption cross section from such measurements, it has been necessary to know the number density. If, as in this case, both the number density and the absorption cross section are initially unknown, then it is impossible to determine either parameter in the absence of additional information.

Life prediction and constitutive behavior

NASA Technical Reports Server (NTRS)

Halford, G. R.

1983-01-01

One of the primary drivers that prompted the initiation of the hot section technology (HOST) program was the recognized need for improved cyclic durability of costly hot section components. All too frequently, fatigue in one form or another was directly responsible for the less than desired durability, and prospects for the future weren't going to improve unless a significant effort was mounted to increase our knowledge and understanding of the elements governing cyclic crack initiation and propagation lifetime. Certainly one of the important factors is the ability to perform accurate structural stress-strain analyses on a routine basis to determine the magnitudes of the localized stresses and strains since it is these localized conditions that govern the initiation and crack growth processes. Developing the ability to more accurately predict crack initiation lifetimes and cyclic crack growth rates for the complex loading conditions found in turbine engine hot sections is of course the ultimate goal of the life prediction research efforts. It has been found convenient to divide the research efforts into those dealing with nominally isotropic and anisotropic alloys; the latter for application to directionally solidified and single crystal turbine blades.

An exploration of needs and preferences for dietary support in colorectal cancer survivors: A mixed-methods study.

PubMed

Hoedjes, Meeke; de Kruif, Anja; Mols, Floortje; Bours, Martijn; Beijer, Sandra; Winkels, Renate; Westerman, Marjan J; Seidell, Jaap C; Kampman, Ellen

2017-01-01

To describe the proportion of colorectal cancer (CRC) survivors who perceive a need for dietary support; to examine which socio-demographic, cancer-related, and health-related characteristics are associated with this need; to explore reasons for (not) needing support; and to explore CRC survivors' specific needs and preferences with regard to lifestyle (i.e., dietary, exercise, and/or weight management) support. This mixed-methods study comprised a cross-sectional survey among 1774 Dutch CRC survivors and three focus groups (n = 16). To examine associations, logistic regression analyses were conducted. Focus groups were audio-taped, transcribed verbatim, and analyzed using a thematic approach. Of 1458 respondents (82%), 1198 (67.5%) were included for analyses. 17.5% reported a need for dietary support. Characteristics associated with this need were: being younger, living without a partner, having a stoma, having diabetes, and being overweight or obese. The main reason for needing support was being unable to initiate and maintain lifestyle changes without support. CRC survivors preferred receiving information soon after diagnosis to make an autonomous, informed decision on improving their lifestyle. They preferred to receive individually-tailored lifestyle support in an autonomy-supportive environment, preferably with involvement of their family and fellow-sufferers. This study has provided knowledge on appropriate support for CRC survivors in need for dietary support to improve health outcomes by promoting adherence to lifestyle and body weight recommendations. Findings can be used to better identify CRC survivors in need for dietary support, and to tailor lifestyle support to their needs and preferences in order to promote uptake, adherence, and effectiveness.

Evaluation of the Neutron Data Standards

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

Carlson, A. D.; Pronyaev, V. G.; Capote, R.

With the need for improving existing nuclear data evaluations, (e.g., ENDF/B-VIII.0 and JEFF-3.3 releases) the first step was to evaluate the standards for use in such a library. This new standards evaluation made use of improved experimental data and some developments in the methodology of analysis and evaluation. In addition to the work on the traditional standards, this work produced the extension of some energy ranges and includes new reactions that are called reference cross sections. Since the effort extends beyond the traditional standards, it is called the neutron data standards evaluation. This international effort has produced new evaluations ofmore » the following cross section standards: the H(n,n), 6Li(n,t), 10B(n,α), 10B(n,α 1γ), natC(n,n), Au(n,γ), 235U(n,f) and 238U(n,f). Also in the evaluation process the 238U(n,γ) and 239Pu(n,f) cross sections that are not standards were evaluated. Evaluations were also obtained for data that are not traditional standards: the Maxwellian spectrum averaged cross section for the Au(n,γ) cross section at 30 keV; reference cross sections for prompt γ-ray production in fast neutron-induced reactions; reference cross sections for very high energy fission cross sections; the 252Cf spontaneous fission neutron spectrum and the 235U prompt fission neutron spectrum induced by thermal incident neutrons; and the thermal neutron constants. The data and covariance matrices of the uncertainties were obtained directly from the evaluation procedure.« less

Evaluation of the Neutron Data Standards

DOE PAGES

Carlson, A. D.; Pronyaev, V. G.; Capote, R.; ...

2018-02-01

With the need for improving existing nuclear data evaluations, (e.g., ENDF/B-VIII.0 and JEFF-3.3 releases) the first step was to evaluate the standards for use in such a library. This new standards evaluation made use of improved experimental data and some developments in the methodology of analysis and evaluation. In addition to the work on the traditional standards, this work produced the extension of some energy ranges and includes new reactions that are called reference cross sections. Since the effort extends beyond the traditional standards, it is called the neutron data standards evaluation. This international effort has produced new evaluations ofmore » the following cross section standards: the H(n,n), 6Li(n,t), 10B(n,α), 10B(n,α 1γ), natC(n,n), Au(n,γ), 235U(n,f) and 238U(n,f). Also in the evaluation process the 238U(n,γ) and 239Pu(n,f) cross sections that are not standards were evaluated. Evaluations were also obtained for data that are not traditional standards: the Maxwellian spectrum averaged cross section for the Au(n,γ) cross section at 30 keV; reference cross sections for prompt γ-ray production in fast neutron-induced reactions; reference cross sections for very high energy fission cross sections; the 252Cf spontaneous fission neutron spectrum and the 235U prompt fission neutron spectrum induced by thermal incident neutrons; and the thermal neutron constants. The data and covariance matrices of the uncertainties were obtained directly from the evaluation procedure.« less

Lawrence Berkeley Laboratory, Institutional Plan FY 1994--1999

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

Not Available

1993-09-01

The Institutional Plan provides an overview of the Lawrence Berkeley Laboratory mission, strategic plan, scientific initiatives, research programs, environment and safety program plans, educational and technology transfer efforts, human resources, and facilities needs. For FY 1994-1999 the Institutional Plan reflects significant revisions based on the Laboratory`s strategic planning process. The Strategic Plan section identifies long-range conditions that will influence the Laboratory, as well as potential research trends and management implications. The Initiatives section identifies potential new research programs that represent major long-term opportunities for the Laboratory, and the resources required for their implementation. The Scientific and Technical Programs section summarizesmore » current programs and potential changes in research program activity. The Environment, Safety, and Health section describes the management systems and programs underway at the Laboratory to protect the environment, the public, and the employees. The Technology Transfer and Education programs section describes current and planned programs to enhance the nation`s scientific literacy and human infrastructure and to improve economic competitiveness. The Human Resources section identifies LBL staff diversity and development program. The section on Site and Facilities discusses resources required to sustain and improve the physical plant and its equipment. The new section on Information Resources reflects the importance of computing and communication resources to the Laboratory. The Resource Projections are estimates of required budgetary authority for the Laboratory`s ongoing research programs. The Institutional Plan is a management report for integration with the Department of Energy`s strategic planning activities, developed through an annual planning process.« less

Evaluation of the Neutron Data Standards

NASA Astrophysics Data System (ADS)

Carlson, A. D.; Pronyaev, V. G.; Capote, R.; Hale, G. M.; Chen, Z.-P.; Duran, I.; Hambsch, F.-J.; Kunieda, S.; Mannhart, W.; Marcinkevicius, B.; Nelson, R. O.; Neudecker, D.; Noguere, G.; Paris, M.; Simakov, S. P.; Schillebeeckx, P.; Smith, D. L.; Tao, X.; Trkov, A.; Wallner, A.; Wang, W.

2018-02-01

With the need for improving existing nuclear data evaluations, (e.g., ENDF/B-VIII.0 and JEFF-3.3 releases) the first step was to evaluate the standards for use in such a library. This new standards evaluation made use of improved experimental data and some developments in the methodology of analysis and evaluation. In addition to the work on the traditional standards, this work produced the extension of some energy ranges and includes new reactions that are called reference cross sections. Since the effort extends beyond the traditional standards, it is called the neutron data standards evaluation. This international effort has produced new evaluations of the following cross section standards: the H(n,n), 6Li(n,t), 10B(n,α), 10B(n,α1 γ), natC(n,n), Au(n,γ), 235U(n,f) and 238U(n,f). Also in the evaluation process the 238U(n,γ) and 239Pu(n,f) cross sections that are not standards were evaluated. Evaluations were also obtained for data that are not traditional standards: the Maxwellian spectrum averaged cross section for the Au(n,γ) cross section at 30 keV; reference cross sections for prompt γ-ray production in fast neutron-induced reactions; reference cross sections for very high energy fission cross sections; the 252Cf spontaneous fission neutron spectrum and the 235U prompt fission neutron spectrum induced by thermal incident neutrons; and the thermal neutron constants. The data and covariance matrices of the uncertainties were obtained directly from the evaluation procedure.

Unmet needs in health training among nurses in rural Chinese township health centers: a cross-sectional hospital-based study.

PubMed

Mo, Yan; Hu, Guijie; Yi, Yanhua; Ying, Yanping; Huang, Huiqiao; Huang, Zhongxian; Lin, Jiafeng

2017-01-01

Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.

Health-related quality of life in Asian patients with breast cancer: a systematic review

PubMed Central

Gernaat, Sofie A M; Hartman, Mikael

2018-01-01

Objective To summarise the evidence on determinants of health-related quality of life (HRQL) in Asian patients with breast cancer. Design Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO (CRD42015032468). Methods According to the PRISMA guidelines, databases of MEDLINE (PubMed), Embase and PsycINFO were systematically searched using the following terms and synonyms: breast cancer, quality of life and Asia. Articles reporting on HRQL using EORTC-QLQ-C30, EORTC-QLQ-BR23, FACT-G and FACT-B questionnaires in Asian patients with breast cancer were eligible for inclusion. The methodological quality of each article was assessed using the quality assessment scale for cross-sectional studies or the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Results Fifty-seven articles were selected for this qualitative synthesis, of which 43 (75%) were cross-sectional and 14 (25%) were longitudinal studies. Over 75 different determinants of HRQL were studied with either the EORTC or FACT questionnaires. Patients with comorbidities, treated with chemotherapy, with less social support and with more unmet needs have poorer HRQL. HRQL improves over time. Discordant results in studies were found in the association of age, marital status, household income, type of surgery, radiotherapy and hormone therapy and unmet sexuality needs with poor global health status or overall well-being. Conclusions In Asia, patients with breast cancer, in particular those with other comorbidities and those treated with chemotherapy, with less social support and with more unmet needs, have poorer HRQL. Appropriate social support and meeting the needs of patients may improve patients’ HRQL. PMID:29678980

New Opportunity for Improved Nuclear Forensics, Radiochemical Diagnostics, and Nuclear Astrophysics: Need for a Total-Cross-Section Apparatus at the LANSCE

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

Koehler, Paul E.; Hayes-Sterbenz, Anna C.; Bredeweg, Todd Allen

Total-cross-section measurements are feasible on a much wider range of radioactive samples than (n,γ) cross-section measurements, and information extracted from the former can be used to set tight constraints on the latter. There are many (n,γ) cross sections of great interest to radiochemical diagnostics, nuclear forensics, and nuclear astrophysics which are beyond the reach of current direct measurement, that could be obtained in this way. Our simulations indicate that measurements can be made at the Manuel Lujan Jr. Neutron Scattering Center at the Los Alamos Neutron Science Center for samples as small as 10μg. There are at least 40 high-interestmore » nuclides which should be measurable, including 88Y, 167,168,170,171Tm, 173,174Lu, and 189,190,192Ir.« less

Conservation challenges for the Austral and Neotropical America section.

PubMed

Ceballos, Gerardo; Vale, Mariana M; Bonacic, Cristian; Calvo-Alvarado, Julio; List, Rurik; Bynum, Nora; Medellín, Rodrigo A; Simonetti, Javier A; Rodríguez, Jon Paul

2009-08-01

The Austral and Neotropical America (ANA) section of the Society for Conservation Biology includes a vast territory with some of the largest relatively pristine ecosystems in the world. With more than 573 million people, the economic growth of the region still depends strongly on natural resource exploitation and still has high rates of environmental degradation and biodiversity loss. A survey among the ANA section membership, with more than 700 members, including most of the section's prominent ecologists and conservationists, indicates that lack of capacity building for conservation, corruption, and threats such as deforestation and illegal trade of species, are among the most urgent problems that need to be addressed to improve conservation in the region. There are, however, strong universities and ecology groups taking the lead in environmental research and conservation, a most important issue to enhance the ability of the region to solve conservation and development conflicts.

Theoretical and Experimental K+ + Nucleus Total and Reaction Cross Sections from the KDP-RIA Model

NASA Astrophysics Data System (ADS)

Kerr, L. K.; Clark, B. C.; Hama, S.; Ray, L.; Hoffmann, G. W.

2000-02-01

The 5-dimensional spin-0 form of the Kemmer-Duffin-Petiau (KDP) equation is used to calculate scattering observables [elastic differential cross sections (dσ / dΩ), total cross sections (σ Tot ), and total reaction cross sections (σ Reac )] and to deduce σ Tot and σReac from transmission data for K+ + 6Li, 12C, 28Si and 40Ca at several momenta in the range 488 - 714 MeV / c. Realistic uncertainties are generated for the theoretical predictions. These errors, mainly due to uncertainties associated with the elementary K+ + nucleon amplitudes, are large, which may account for some of the disagreement between experimental and theoretical σTot and σReac. The results suggest that the K+ + nucleon amplitudes need to be much better determined before further improvement in the understanding of these data can occur.

Concept for a large multi-mission amphibian aircraft

NASA Technical Reports Server (NTRS)

Vaughan, J. C., III; Earl, T. D.

1979-01-01

A very large aircraft has been proposed for meeting both civil cargo and military transport needs for 1995 and beyond. The concept includes a wide noncircular fuselage cross section with a low wing, thick inner wing section, fuselage-mounted engines, and an air cushion landing gear. The civil freighter operates independently of congested passenger airports, using sheltered water as a runway and a waterfront land site for parking and ground operations. The military transport can operate from a wide variety of surfaces and temporary bases. The air cushion landing gear weighs substantially less than conventional gear and permits the use of extended takeoff distance resulting in improved payload/gross weight ratio.

Need assessment of staffs' welfare services at tehran university of medical sciences: a cross-sectional study.

PubMed

Dehghan, Reza; Mafimoradi, Shiva; Hadi, Mohammad

2015-01-01

Reviewing the human resources management literature shows an absence of attention given to the employee's benefits. Taking a look at functions of the Tehran University of Medical Sciences' wellbeing services system, it uncovers a gap between employees' real needs and what is delivered to meet their needs. So it requires an improved comprehensive system for delivering wellbeing services (financial, insurance, health care services, educational and training services, etc). Wellbeing need assessment can helps planners to identify vital needs of employee and response to them effectively. Moreover it can be used to evaluate the effectiveness of the current services which are delivered. Thus, the aim of this study is to assess wellbeing services of staffs working in TUMS to (1) evaluate the satisfactory rate of services which are delivered, and (2) exploring those wellbeing needs which were not fulfilled by the organization. Being a cross-sectional and analytic-descriptive survey including 98 responding participants, it is conducted by a questionnaire collecting employees' demographic information, their satisfactory rate of the implemented services, and determines unfulfilled wellbeing needs which were not already covered. Results indicated that services related to financial, educational, non-financial, insurance, occupational health and tourism/recreational services were the most satisfactory services successively. 'Staff's unwillingness to receive services' and 'poor announcement' (unawareness on the wellbeing services),' were found to be the most frequent reasons for not receiving the existing wellbeing services. To increase the satisfaction rate and responsiveness to the real needs of the staff, the current delivery system of wellbeing services in the TUMS should be redesigned by defining new wellbeing packages.

Physical Health Care for People with Severe Mental Illness: the Attitudes, Practices, and Training Needs of Nurses in Three Asian Countries.

PubMed

Bressington, Daniel; Badnapurkar, Ashish; Inoue, Sachiko; Ma, Hin Yeung; Chien, Wai Tong; Nelson, Deborah; Gray, Richard

2018-02-15

People with severe mental illness (SMI) have considerable unmet physical health needs and an increased risk of early mortality. This cross-sectional survey utilized the Physical Health Attitude Scale (PHASe) to examine the attitudes, practices, and training needs of nurses towards physical health care of people with SMI in three Asian countries (Hong Kong, Japan, Qatar). Cross-country differences were explored and linear regression was used to investigate if nurses' attitudes and confidence were associated with their level of involvement in physical health care. A total of 481 questionnaires were returned. Hong Kong nurses were less involved in physical health care than those from Japan and Qatar. Nurses' attitudes and confidence were significant predictors of their participation in managing physical health. Compared with western countries, more nurses in this study felt that mental illness was a barrier to improving physical health. Three-quarters reported that they needed additional training in promoting cardiometabolic health. The perceived need for additional training in physical health care was held by Mental Health Nurses (MHN) irrespective of their type of nursing registration and nationality. Nurse educators and service providers should reconsider the physical health care training requirements of nurses working in mental health settings in order to improve the physical health of people with SMI.

Mount St. Helens Ecosystem Restoration General Reevaluation Study Reconnaissance Report

DTIC Science & Technology

2007-07-01

consist of several smaller channels ( braided ). 1 Hoffstadt Creek Currently maintaining stable connection to North Fork Toutle. Second confluence forms...during high runoff conditions, good holding pools at or just below several of the release sites are limited, and the release hoses need improvements to...Adult coho and steelhead release just above the SRS into the braided sections of the North Fork Toutle River passed upstream into tributaries, with

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

Orea, Adrian; Betancourt, Minerba

aThe objective for this project was to use MINERvA data to tune the simulation models in order to obtain the precision needed for current and future neutrino experiments. In order to do this, the current models need to be validated and then improved.more » $$\\#10146$$; Validation was done by recreating figures that have been used in previous publications $$\\#61553$$; This was done by comparing data from the detector and the simulation model (GENIE) $$\\#10146$$; Additionally, a newer version of GENIE was compared to the GENIE used for the publications to validate the new version as well as to note any improvements Another objective was to add new samples into the NUISANCE framework, which was used to compare data from the detector and simulation models. $$\\#10146$$; Specifically, the added sample was the two dimensional histogram of the double differential cross section as a function of the transversal and z-direction momentum for Numu and Numubar $$\\#61553$$; Was also used for validation« less

Factors influencing French medical students towards a career in psychiatry.

PubMed

Andlauer, Olivier; Guicherd, William; Haffen, Emmanuel; Sechter, Daniel; Bonin, Bernard; Seed, Kitty; Lydall, Gregory; Malik, Amit; Bhugra, Dinesh; Howard, Rob

2012-09-01

There is a need to increase the recruitment to psychiatry in France. Our aim in this study was to compare factors influencing career choice between French medical students considering and not considering psychiatry as a specialty. Quantitative cross-sectional online survey on 145 French students in their last year of medical school. 22.7% of our sample considered choosing a career in psychiatry. A preference for a career in psychiatry was associated with more frequent history of personal/familial mental illness, higher ratings of psychiatric teaching, more weeks of compulsory psychiatry teaching and placement, during which students had more often met patients in recovery and been asked their opinion on patients. Students considering psychiatry as a career also emphasized more the need for a good work-life balance, and presented better attitudes toward psychiatry. Improving opportunities of interactions between students and psychiatrists or psychiatric patients might help to improve recruitment in psychiatry.

Improving child and adolescent psychiatry education for medical students: an inter-organizational collaborative action plan.

PubMed

Fox, Geraldine S; Stock, Saundra; Briscoe, Gregory W; Beck, Gary L; Horton, Rita; Hunt, Jeffrey I; Liu, Howard Y; Partner Rutter, Ashley; Sexson, Sandra; Schlozman, Steven C; Stubbe, Dorothy E; Stuber, Margaret L

2012-11-01

A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students. The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP's CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies. The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

Reference Cross Sections for Charged-particle Monitor Reactions

NASA Astrophysics Data System (ADS)

Hermanne, A.; Ignatyuk, A. V.; Capote, R.; Carlson, B. V.; Engle, J. W.; Kellett, M. A.; Kibédi, T.; Kim, G.; Kondev, F. G.; Hussain, M.; Lebeda, O.; Luca, A.; Nagai, Y.; Naik, H.; Nichols, A. L.; Nortier, F. M.; Suryanarayana, S. V.; Takács, S.; Tárkányi, F. T.; Verpelli, M.

2018-02-01

Evaluated cross sections of beam-monitor reactions are expected to become the de-facto standard for cross-section measurements that are performed over a very broad energy range in accelerators in order to produce particular radionuclides for industrial and medical applications. The requirements for such data need to be addressed in a timely manner, and therefore an IAEA coordinated research project was launched in December 2012 to establish or improve the nuclear data required to characterise charged-particle monitor reactions. An international team was assembled to recommend more accurate cross-section data over a wide range of targets and projectiles, undertaken in conjunction with a limited number of measurements and more extensive evaluations of the decay data of specific radionuclides. Least-square evaluations of monitor-reaction cross sections including uncertainty quantification have been undertaken for charged-particle beams of protons, deuterons, 3He- and 4He-particles. Recommended beam monitor reaction data with their uncertainties are available at the IAEA-NDS medical portal http://www-nds.iaea.org/medical/monitor_reactions.html.

Balancing radiation benefits and risks: The needs of an informed public

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

Not Available

1994-04-01

The American public`s perceptions regarding ionizing radiation do not always conform to or correlate with scientific evidence. The ultimate purpose of this coordinated Federal effort and report is to increase the public`s knowledge of the benefits and risks associated with ionizing radiation. This report is divided into five sections. The first section, Introduction, discusses the public`s knowledge of radiation, their perceptions of benefits versus risks, and the Federal government`s role in public education. The section also outlines the charge to the Subpanel. Radiation Issues and Public Reactions discusses several radiation issues important to Federal agencies for which public education programsmore » need to be established or enhanced. Federal Programs describes Federal agencies with public education programs on radiation and the nature of the programs they support. Education Issues and Federal Strategies explores the elements identified by the Subpanel as critical to the development and implementation of an effective Federal program in the area of public education on radiation issues and nuclear technologies. An important issue repeatedly brought up during the public sector presentations to the Subpanel was the perceived lack of Federal credibility on radiation issues in the eyes of the public. To some degree, this concern was factored into all of the recommendations developed by the subpanel. The issues discussed in this section include the fragmented nature of Federal radiation programs and the need to improve credibility, promote agency responsiveness, and support the enhancement of scientific literacy. Finally, under Recommendations, the Subpanel discusses its overall findings and conclusions.« less

An analysis of the economic impact of the AN/APS-134 FLAR (Forward Looking Airborne Radar) retrofit on Coast Guard HC-130 aircraft

NASA Astrophysics Data System (ADS)

Dunn, R. E.

1984-12-01

Concern over the growing drug smuggling problem and improved national defense capability are manifest in the need for a new forward looking airborne radar (FLAR) for Coast Guard HC-130 aircraft, with a capability of detecting a target of 1 square meter radar cross section. This thesis reexamines the analysis that selected the AN/APS-134 FLAR over other contenders based on mission need, radar performance and life cycle cost criteria. This thesis presents a better understanding of the resulting HC-130 force structure based on the impact of FLAR technology.

Utility of the Care Dependency Scale in predicting care needs and health risks of elderly patients admitted to a geriatric unit: a cross-sectional study of 200 consecutive patients.

PubMed

Doroszkiewicz, Halina; Sierakowska, Matylda; Muszalik, Marta

2018-01-01

The aim of the study was to evaluate the usefulness of the Polish version of the Care Dependency Scale (CDS) in predicting care needs and health risks of elderly patients admitted to a geriatric unit. This was a cross-sectional study of 200 geriatric patients aged ≥60 years, chronologically admitted to a geriatrics unit in Poland. The study was carried out using the Polish version of the CDS questionnaire to evaluate biopsychosocial needs and the level of care dependency. The mean age of the participating geriatric patients was 81.8±6.6. The mean result of the sum of the CDS index for all the participants was 55.3±15.1. Detailed analysis of the results of evaluation of the respondents' functional condition showed statistically significant differences in the levels of care dependency. Evaluation of the patients' physical performance in terms of the ability to do basic activities of daily living (ADL) and instrumental ADL (I-ADL) showed statistically significant differences between the levels of care dependency. Patients with high dependency were more often prone to pressure ulcers - 13.1±3.3, falls (87.2%), poorer emotional state - 6.9±3.6, mental function - 5.1±2.8, and more often problems with locomotion, vision, and hearing. The results showed that locomotive disability, depression, advanced age, and problem with vision and hearing are connected with increasing care dependency. CDS evaluation of each admitted geriatric patient enables us to predict the care needs and health risks that need to be reduced and the disease states to be improved. CDS evaluation should be accompanied by the use of other instruments and assessments to evaluate pressure ulcer risk, fall risk, and actions toward the improvement of subjective well-being, as well as correction of vision and hearing problems where possible and assistive devices for locomotion.

Lawrence Berkeley Laboratory Institutional Plan, FY 1993--1998

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

Not Available

1992-10-01

The FY 1993--1998 Institutional Plan provides an overview of the Lawrence Berkeley Laboratory mission, strategic plan, scientific initiatives, research programs, environment and safety program plans, educational and technology transfer efforts, human resources, and facilities needs. The Strategic Plan section identifies long-range conditions that can influence the Laboratory, potential research trends, and several management implications. The Initiatives section identifies potential new research programs that represent major long-term opportunities for the Laboratory and the resources required for their implementation. The Scientific and Technical Programs section summarizes current programs and potential changes in research program activity. The Environment, Safety, and Health section describesmore » the management systems and programs underway at the Laboratory to protect the environment, the public, and the employees. The Technology Transfer and Education programs section describes current and planned programs to enhance the nation's scientific literacy and human infrastructure and to improve economic competitiveness. The Human Resources section identifies LBL staff composition and development programs. The section on Site and Facilities discusses resources required to sustain and improve the physical plant and its equipment. The Resource Projections are estimates of required budgetary authority for the Laboratory's ongoing research programs. The plan is an institutional management report for integration with the Department of Energy's strategic planning activities that is developed through an annual planning process. The plan identifies technical and administrative directions in the context of the National Energy Strategy and the Department of Energy's program planning initiatives. Preparation of the plan is coordinated by the Office for Planning and Development from information contributed by the Laboratory's scientific and support divisions.« less

Nursing Leaders' Satisfaction with Information Systems in the Day-to-Day Operations Management in Hospital Units.

PubMed

Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna

2018-01-01

Information usage in the day-to-day operations management of hospital units is complex due to numerous information systems in use. The aim of this study was to describe and compare nurse leaders' satisfaction with information systems used in the day-to-day operations management in hospital units. The design was a cross-sectional survey with five questions rated from one (disagree) to five (fully agree). The response rate was 65 % (n = 453). Respondents reported fair satisfaction with how information systems support decision-making (median 4, IQR 3-4) and improve ease of access to information (median 4, IQR 3-4). However, respondents were less satisfied with how systems improve speed of access to information (median 3, IQR 3-4). Nor did respondents think that systems were developed for them (median 3, IQR 2-4). Respondents further reported needing numerous systems daily to support decision-making (median 4, IQR 3-5). A clear need for one system, which would gather important information for display was stated (median 5, IQR 4-5). Work experience, gender and time when overseeing the unit were associated with some aspects related to satisfaction. In conclusion, information system improvements are needed to better support the day-to-day operations management in hospital units.

Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care.

PubMed

Haley, Danielle F; Linton, Sabriya; Luo, Ruiyan; Hunter-Jones, Josalin; Adimora, Adaora A; Wingood, Gina M; Bonney, Loida; Ross, Zev; Cooper, Hannah L

2017-01-01

Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and trans- portation access to unmet need for medical care. We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and admin- istrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51-0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02-1.31). These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.

Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care

PubMed Central

Haley, Danielle F.; Linton, Sabriya; Luo, Ruiyan; Hunter-Jones, Josalin; Adimora, Adaora A.; Wingood, Gina M.; Bonney, Loida; Ross, Zev; Cooper, Hannah L.F.

2017-01-01

Introduction Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and transportation access to unmet need for medical care. Methods We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and administrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. Results Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51–0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02–1.31). Conclusion These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population. PMID:28239005

Nuclear Data Needs for Generation IV Nuclear Energy Systems

NASA Astrophysics Data System (ADS)

Rullhusen, Peter

2006-04-01

Nuclear data needs for generation IV systems. Future of nuclear energy and the role of nuclear data / P. Finck. Nuclear data needs for generation IV nuclear energy systems-summary of U.S. workshop / T. A. Taiwo, H. S. Khalil. Nuclear data needs for the assessment of gen. IV systems / G. Rimpault. Nuclear data needs for generation IV-lessons from benchmarks / S. C. van der Marck, A. Hogenbirk, M. C. Duijvestijn. Core design issues of the supercritical water fast reactor / M. Mori ... [et al.]. GFR core neutronics studies at CEA / J. C. Bosq ... [et al]. Comparative study on different phonon frequency spectra of graphite in GCR / Young-Sik Cho ... [et al.]. Innovative fuel types for minor actinides transmutation / D. Haas, A. Fernandez, J. Somers. The importance of nuclear data in modeling and designing generation IV fast reactors / K. D. Weaver. The GIF and Mexico-"everything is possible" / C. Arrenondo Sánchez -- Benmarks, sensitivity calculations, uncertainties. Sensitivity of advanced reactor and fuel cycle performance parameters to nuclear data uncertainties / G. Aliberti ... [et al.]. Sensitivity and uncertainty study for thermal molten salt reactors / A. Biduad ... [et al.]. Integral reactor physics benchmarks- The International Criticality Safety Benchmark Evaluation Project (ICSBEP) and the International Reactor Physics Experiment Evaluation Project (IRPHEP) / J. B. Briggs, D. W. Nigg, E. Sartori. Computer model of an error propagation through micro-campaign of fast neutron gas cooled nuclear reactor / E. Ivanov. Combining differential and integral experiments on [symbol] for reducing uncertainties in nuclear data applications / T. Kawano ... [et al.]. Sensitivity of activation cross sections of the Hafnium, Tanatalum and Tungsten stable isotopes to nuclear reaction mechanisms / V. Avrigeanu ... [et al.]. Generating covariance data with nuclear models / A. J. Koning. Sensitivity of Candu-SCWR reactors physics calculations to nuclear data files / K. S. Kozier, G. R. Dyck. The lead cooled fast reactor benchmark BREST-300: analysis with sensitivity method / V. Smirnov ... [et al.]. Sensitivity analysis of neutron cross-sections considered for design and safety studies of LFR and SFR generation IV systems / K. Tucek, J. Carlsson, H. Wider -- Experiments. INL capabilities for nuclear data measurements using the Argonne intense pulsed neutron source facility / J. D. Cole ... [et al.]. Cross-section measurements in the fast neutron energy range / A. Plompen. Recent measurements of neutron capture cross sections for minor actinides by a JNC and Kyoto University Group / H. Harada ... [et al.]. Determination of minor actinides fission cross sections by means of transfer reactions / M. Aiche ... [et al.] -- Evaluated data libraries. Nuclear data services from the NEA / H. Henriksson, Y. Rugama. Nuclear databases for energy applications: an IAEA perspective / R. Capote Noy, A. L. Nichols, A. Trkov. Nuclear data evaluation for generation IV / G. Noguère ... [et al.]. Improved evaluations of neutron-induced reactions on americium isotopes / P. Talou ... [et al.]. Using improved ENDF-based nuclear data for candu reactor calculations / J. Prodea. A comparative study on the graphite-moderated reactors using different evaluated nuclear data / Do Heon Kim ... [et al.].

Maternal characteristics and treatment needs as predictors of dental health services utilisation among Mexican school children.

PubMed

Vallejos-Sánchez, A A; Medina-Solís, C E; Minaya-Sánchez, M; Villalobos-Rodelo, J J; Márquez-Corona, M L; Islas-Granillo, H; Maupomé, G

2012-12-01

To determine whether maternal characteristics and treatment needs are associated with dental health services utilization (DHSU) in school children. A cross-sectional study in 1373 school children aged 6- 12 years in elementary schools in Campeche, Mexico collected family and sociodemographic characteristics; an oral examination was conducted. The dependent variable was DHSU in the year preceding the study. DHSU prevalence was 65.5%. The variables associated (p<0.05) with DHSU in the final multivariate model were age (OR=1.27), maternal schooling (OR=1.07), mother's attitude toward oral health (OR=1.39), frequency of tooth brushing (OR=1.83), enamel defects (OR=1.55), and unmet oral health needs (moderate: OR=1.42 and high: OR=2.30). Specific sociodemographic and maternal variables were associated with DHSU. Strategies are needed to increase appropriate and timely use of services to improve health status.

Impacts of climate change on Oregon's coasts and estuaries: Chapter 6

USGS Publications Warehouse

Ruggiero,; Brown, Cheryl A.; Komar, Paul D.; Allan, Jonathan C.; Reusser, Deborah A.; Lee,

2010-01-01

In the following sections we attempt to summarize the most recent literature documenting historical changes as well as what may be expected to occur in response to climate change. Where little information is available we draw preliminary conclusions about the potential for specific impacts. When possible we highlight what research is needed to bridge knowledge gaps to improve our ability to identify climate change impacts more precisely, ultimately allowing for future projections.

Sharing psychological skills in the general practice setting.

PubMed

Weinman, J; Medlik, L

1985-09-01

Three broad areas of work are described in this paper. The first is concerned with the nature of psychological processes within the general practice consultation and the indications these provide for skill sharing. In the second section there is an account of courses designed to develop skills in the recognition of psychological aspects of illness and in the detection of psychological problems. The third section outlines various courses for developing and improving the consulting and counselling skills of general practitioners. In addition to describing a range of skills developed by ourselves and others, two general themes emerge from this paper. The first concerns the appropriateness of the general practice setting for the sharing of psychological skills and the extent to which the psychologist may be able to complement the skills of the general practitioner. The second theme concerns the importance of helping general practitioners to identify their own learning needs as an essential first step in deciding how to structure courses to meet these needs.

The evaluation of reflective learning from the nursing student's point of view: A mixed method approach.

PubMed

Fernández-Peña, Rosario; Fuentes-Pumarola, Concepció; Malagón-Aguilera, M Carme; Bonmatí-Tomàs, Anna; Bosch-Farré, Cristina; Ballester-Ferrando, David

2016-09-01

Adapting university programmes to European Higher Education Area criteria has required substantial changes in curricula and teaching methodologies. Reflective learning (RL) has attracted growing interest and occupies an important place in the scientific literature on theoretical and methodological aspects of university instruction. However, fewer studies have focused on evaluating the RL methodology from the point of view of nursing students. To assess nursing students' perceptions of the usefulness and challenges of RL methodology. Mixed method design, using a cross-sectional questionnaire and focus group discussion. The research was conducted via self-reported reflective learning questionnaire complemented by focus group discussion. Students provided a positive overall evaluation of RL, highlighting the method's capacity to help them better understand themselves, engage in self-reflection about the learning process, optimize their strengths and discover additional training needs, along with searching for continuous improvement. Nonetheless, RL does not help them as much to plan their learning or identify areas of weakness or needed improvement in knowledge, skills and attitudes. Among the difficulties or challenges, students reported low motivation and lack of familiarity with this type of learning, along with concerns about the privacy of their reflective journals and about the grading criteria. In general, students evaluated RL positively. The results suggest areas of needed improvement related to unfamiliarity with the methodology, ethical aspects of developing a reflective journal and the need for clear evaluation criteria. Copyright © 2016 Elsevier Ltd. All rights reserved.

Need Assessment of Staffs’ Welfare Services at Tehran University of Medical Sciences: A Cross-Sectional Study

PubMed Central

Dehghan, Reza; Mafimoradi, Shiva; Hadi, Mohammad

2015-01-01

Background: Reviewing the human resources management literature shows an absence of attention given to the employee's benefits. Taking a look at functions of the Tehran University of Medical Sciences’ wellbeing services system, it uncovers a gap between employees’ real needs and what is delivered to meet their needs. So it requires an improved comprehensive system for delivering wellbeing services (financial, insurance, health care services, educational and training services, etc). Wellbeing need assessment can helps planners to identify vital needs of employee and response to them effectively. Moreover it can be used to evaluate the effectiveness of the current services which are delivered. Thus, the aim of this study is to assess wellbeing services of staffs working in TUMS to (1) evaluate the satisfactory rate of services which are delivered, and (2) exploring those wellbeing needs which were not fulfilled by the organization. Material and Methods: Being a cross-sectional and analytic-descriptive survey including 98 responding participants, it is conducted by a questionnaire collecting employees’ demographic information, their satisfactory rate of the implemented services, and determines unfulfilled wellbeing needs which were not already covered. Result: Results indicated that services related to financial, educational, non-financial, insurance, occupational health and tourism/recreational services were the most satisfactory services successively. ‘Staff's unwillingness to receive services’ and ‘poor announcement’ (unawareness on the wellbeing services),’ were found to be the most frequent reasons for not receiving the existing wellbeing services. Conclusion: To increase the satisfaction rate and responsiveness to the real needs of the staff, the current delivery system of wellbeing services in the TUMS should be redesigned by defining new wellbeing packages. PMID:25767818

Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey

PubMed Central

Arvieu, Jean-Jacques; Aegerter, Philippe; Robine, Jean-Marie; Ankri, Joël

2014-01-01

Background: Unmet health care needs are associated with negative health outcomes, yet there is a paucity of data on this problem among older people. Objective: To identify unmet health care needs and associated factors among older people in France. Methods: This is a cross-sectional population study of people aged 70 years or older in which 2350 respondents were interviewed in 2008–10. During a standardized interview, a nurse examined health problems, functional abilities and use of health care resources. Unmet health care needs were defined as situations in which a participant needed health care and did not receive it. Results: The mean age was 83.2 ± 7.4 years. Almost all participants reporting a chronic disease (98.6%) had consulted a physician in the previous 6 months. Unmet health care needs were found in 23.0% of the sample and mainly consisted of lack of dental care (prevalence of 17.7%), followed by lack of management of visual or hearing impairments (prevalence of 4.4% and 3.1%, respectively). Age was the main factor associated with unmet health care needs [compared with people aged 70–79: odds ratio80–89 years = 2.26 (1.70–3.03), odds ratio90 years and over = 3.85 (2.71–5.45)]. Other associated factors were regular smoking, homebound status, poor socioeconomic conditions, depression, limitations in instrumental activities of daily living and low medical density. Conclusion: Unmet health care needs affect almost one-quarter of older people in France. Efforts should be made to improve oral health and develop home care, especially for the oldest-olds. PMID:24287029

The Space From Heart Disease Intervention for People With Cardiovascular Disease and Distress: A Mixed-Methods Study

PubMed Central

Clifton, Abigail; Lee, Geraldine; Norman, Ian J; O'Callaghan, David; Tierney, Karen; Richards, Derek

2015-01-01

Background Poor self-management of symptoms and psychological distress leads to worse outcomes and excess health service use in cardiovascular disease (CVD). Online-delivered therapy is effective, but generic interventions lack relevance for people with specific long-term conditions, such as cardiovascular disease. Objective To develop a comprehensive online CVD-specific intervention to improve both self-management and well-being, and to test acceptability and feasibility. Methods Informed by the Medical Research Council (MRC) guidance for the development of complex interventions, we adapted an existing evidence-based generic intervention for depression and anxiety for people with CVD. Content was informed by a literature review of existing resources and trial evidence, and the findings of a focus group study. Think-aloud usability testing was conducted to identify improvements to design and content. Acceptability and feasibility were tested in a cross-sectional study. Results Focus group participants (n=10) agreed that no existing resource met all their needs. Improvements such as "collapse and expand" features were added based on findings that participants’ information needs varied, and specific information, such as detecting heart attacks and when to seek help, was added. Think-aloud testing (n=2) led to changes in font size and design changes around navigation. All participants of the cross-sectional study (10/10, 100%) were able to access and use the intervention. Reported satisfaction was good, although the intervention was perceived to lack relevance for people without comorbid psychological distress. Conclusions We have developed an evidence-based, theory-informed, user-led online intervention for improving self-management and well-being in CVD. The use of multiple evaluation tests informed improvements to content and usability. Preliminary acceptability and feasibility has been demonstrated. The Space from Heart Disease intervention is now ready to be tested for effectiveness. This work has also identified that people with CVD symptoms and comorbid distress would be the most appropriate sample for a future randomized controlled trial to evaluate its effectiveness. PMID:26133739

Unmet Needs of Patients Feeling Severely Affected by Multiple Sclerosis in Germany: A Qualitative Study

PubMed Central

Golla, Heidrun; Strupp, Julia; Karbach, Ute; Kaiser, Claudia; Ernstmann, Nicole; Pfaff, Holger; Ostgathe, Christoph; Voltz, Raymond

2014-01-01

Abstract Background: The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general. Objective: The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS. Methods: The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients self-reporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis. Results: Unmet needs were identified in the main categories “support of family and friends,” “health care services,” “managing everyday life,” and “maintaining biographical continuity.” Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated. Conclusions: To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professional-patient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support. PMID:24527993

Contact with Nature and Children's Restorative Experiences: An Eye to the Future

PubMed Central

Collado, Silvia; Staats, Henk

2016-01-01

This article offers an overview of what has been done until now on restorative research with children and opens up new inquires for future research. Most of the work has studied children's exposure to nature and the restorative benefits this contact provides, focusing on the renewal of children's psychological resources. The paper begins with an introduction to children's current tendency toward an alienation from the natural world and sets out the objectives of the article. It is followed by four main sections. The first two sections report on what we already know in this research area, distinguishing between children with normal mental capabilities and those suffering from attention-deficit hyperactivity disorder (ADHD). The findings gathered in these sections suggest that children's contact with nature improves their mood and their cognitive functioning, increases their social interactions and reduces ADHD symptoms. The next section describes five suggestions for future research: (1) the need for considering the relational dynamics between the child and the environment in restoration research, and the concept of constrained restoration; (2) the possibility of restorative needs arising from understimulation; (3) the importance of considering children's social context for restoration; (4) the relationship between restoration and pro-social and pro-environmental behaviors; and (5) children's restorative environments other than nature. We close by making some final remarks about the importance of restoring daily depleted resources for children's healthy functioning. PMID:27965616

Physical Health Care for People with Severe Mental Illness: the Attitudes, Practices, and Training Needs of Nurses in Three Asian Countries

PubMed Central

Badnapurkar, Ashish; Ma, Hin Yeung; Nelson, Deborah

2018-01-01

People with severe mental illness (SMI) have considerable unmet physical health needs and an increased risk of early mortality. This cross-sectional survey utilized the Physical Health Attitude Scale (PHASe) to examine the attitudes, practices, and training needs of nurses towards physical health care of people with SMI in three Asian countries (Hong Kong, Japan, Qatar). Cross-country differences were explored and linear regression was used to investigate if nurses’ attitudes and confidence were associated with their level of involvement in physical health care. A total of 481 questionnaires were returned. Hong Kong nurses were less involved in physical health care than those from Japan and Qatar. Nurses’ attitudes and confidence were significant predictors of their participation in managing physical health. Compared with western countries, more nurses in this study felt that mental illness was a barrier to improving physical health. Three-quarters reported that they needed additional training in promoting cardiometabolic health. The perceived need for additional training in physical health care was held by Mental Health Nurses (MHN) irrespective of their type of nursing registration and nationality. Nurse educators and service providers should reconsider the physical health care training requirements of nurses working in mental health settings in order to improve the physical health of people with SMI. PMID:29462859

Spinal Cord Gray Matter Atrophy in Amyotrophic Lateral Sclerosis.

PubMed

Paquin, M-Ê; El Mendili, M M; Gros, C; Dupont, S M; Cohen-Adad, J; Pradat, P-F

2018-01-01

There is an emerging need for biomarkers to better categorize clinical phenotypes and predict progression in amyotrophic lateral sclerosis. This study aimed to quantify cervical spinal gray matter atrophy in amyotrophic lateral sclerosis and investigate its association with clinical disability at baseline and after 1 year. Twenty-nine patients with amyotrophic lateral sclerosis and 22 healthy controls were scanned with 3T MR imaging. Standard functional scale was recorded at the time of MR imaging and after 1 year. MR imaging data were processed automatically to measure the spinal cord, gray matter, and white matter cross-sectional areas. A statistical analysis assessed the difference in cross-sectional areas between patients with amyotrophic lateral sclerosis and controls, correlations between spinal cord and gray matter atrophy to clinical disability at baseline and at 1 year, and prediction of clinical disability at 1 year. Gray matter atrophy was more sensitive to discriminate patients with amyotrophic lateral sclerosis from controls ( P = .004) compared with spinal cord atrophy ( P = .02). Gray matter and spinal cord cross-sectional areas showed good correlations with clinical scores at baseline ( R = 0.56 for gray matter and R = 0.55 for spinal cord; P < .01). Prediction at 1 year with clinical scores ( R 2 = 0.54) was improved when including a combination of gray matter and white matter cross-sectional areas ( R 2 = 0.74). Although improvements over spinal cord cross-sectional areas were modest, this study suggests the potential use of gray matter cross-sectional areas as an MR imaging structural biomarker to monitor the evolution of amyotrophic lateral sclerosis. © 2018 by American Journal of Neuroradiology.

Queueing theoretic analysis of labor and delivery : Understanding management styles and C-section rates.

PubMed

Gombolay, Matthew; Golen, Toni; Shah, Neel; Shah, Julie

2017-09-04

Childbirth is a complex clinical service requiring the coordinated support of highly trained healthcare professionals as well as management of a finite set of critical resources (such as staff and beds) to provide safe care. The mode of delivery (vaginal delivery or cesarean section) has a significant effect on labor and delivery resource needs. Further, resource management decisions may impact the amount of time a physician or nurse is able to spend with any given patient. In this work, we employ queueing theory to model one year of transactional patient information at a tertiary care center in Boston, Massachusetts. First, we observe that the M/G/∞ model effectively predicts patient flow in an obstetrics department. This model captures the dynamics of labor and delivery where patients arrive randomly during the day, the duration of their stay is based on their individual acuity, and their labor progresses at some rate irrespective of whether they are given a bed. Second, using our queueing theoretic model, we show that reducing the rate of cesarean section - a current quality improvement goal in American obstetrics - may have important consequences with regard to the resource needs of a hospital. We also estimate the potential financial impact of these resource needs from the hospital perspective. Third, we report that application of our model to an analysis of potential patient coverage strategies supports the adoption of team-based care, in which attending physicians share responsibilities for patients.

Need States Based on Eating Occasions Experienced by Midlife Women Section of the Journal for which the manuscript is intended: Research Brief

PubMed Central

Degeneffe, Dennis; Reicks, Marla

2008-01-01

Objective To identify a comprehensive set of distinct “need states” based on the eating occasions experienced by midlife women. Design Series of 7 focus group interviews. Setting Meeting room on a university campus. Participants A convenience sample of 34 multi-ethnic women (mean age = 46 years). Phenomenon of Interest Descriptions of eating occasions by “need states” - specific patterns of needs for the occasion. Analysis Interviews were audio taped, transcribed verbatim and analyzed for common themes using qualitative data analysis procedures. Findings Eight need states suggested a hypothetical framework reflecting a wide range in emotional gratification. Need states with a low level of emotional gratification were dominated by sets of functional needs such as coping with stress, balancing intake across occasions, meeting external demands of time and effort and maintaining a routine. Food was a means for reinforcing family identity, social expression and celebration in need states with high levels of emotional gratification. Occurrence of need states varied by day and meal/snack occasion, with food type/amount dependent on need state. Conclusions and Implications Eating occasions are driven by specific sets of needs ranging from physical/functional to more emotional/social needs. Addressing need states may improve weight intervention programs for midlife women. PMID:18984495

Lawrence Berkeley Laboratory Institutional Plan, FY 1993--1998

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

Chew, Joseph T.; Stroh, Suzanne C.; Maio, Linda R.

1992-10-01

The FY 1993--1998 Institutional Plan provides an overview of the Lawrence Berkeley Laboratory mission, strategic plan, scientific initiatives, research programs, environment and safety program plans, educational and technology transfer efforts, human resources, and facilities needs. The Strategic Plan section identifies long-range conditions that can influence the Laboratory, potential research trends, and several management implications. The Initiatives section identifies potential new research programs that represent major long-term opportunities for the Laboratory and the resources required for their implementation. The Scientific and Technical Programs section summarizes current programs and potential changes in research program activity. The Environment, Safety, and Health section describesmore » the management systems and programs underway at the Laboratory to protect the environment, the public, and the employees. The Technology Transfer and Education programs section describes current and planned programs to enhance the nation`s scientific literacy and human infrastructure and to improve economic competitiveness. The Human Resources section identifies LBL staff composition and development programs. The section on Site and Facilities discusses resources required to sustain and improve the physical plant and its equipment. The Resource Projections are estimates of required budgetary authority for the Laboratory`s ongoing research programs. The plan is an institutional management report for integration with the Department of Energy`s strategic planning activities that is developed through an annual planning process. The plan identifies technical and administrative directions in the context of the National Energy Strategy and the Department of Energy`s program planning initiatives. Preparation of the plan is coordinated by the Office for Planning and Development from information contributed by the Laboratory`s scientific and support divisions.« less

Configuration-interaction relativistic-many-body-perturbation-theory calculations of photoionization cross sections from quasicontinuum oscillator strengths

DOE PAGES

Savukov, I. M.; Filin, D. V.

2014-12-29

Many applications are in need of accurate photoionization cross sections, especially in the case of complex atoms. Configuration-interaction relativistic-many-body-perturbation theory (CI-RMBPT) has been successful in predicting atomic energies, matrix elements between discrete states, and other properties, which is quite promising, but it has not been applied to photoionization problems owing to extra complications arising from continuum states. In this paper a method that will allow the conversion of discrete CI-(R)MPBT oscillator strengths (OS) to photoionization cross sections with minimal modifications of the codes is introduced and CI-RMBPT cross sections of Ne, Ar, Kr, and Xe are calculated. A consistent agreementmore » with experiment is found. RMBPT corrections are particularly significant for Ar, Kr, and Xe and improve agreement with experimental results compared to the particle-hole CI method. As a result, the demonstrated conversion method can be applied to CI-RMBPT photoionization calculations for a large number of multivalence atoms and ions.« less

Medical Writing Competency Model - Section 1: Functions, Tasks, and Activities.

PubMed

Clemow, David B; Wagner, Bertil; Marshallsay, Christopher; Benau, Dan; L'Heureux, Darryl; Brown, David H; Dasgupta, Devjani Ghosh; Girten, Eileen; Hubbard, Frank; Gawrylewski, Helle-Mai; Ebina, Hiroko; Stoltenborg, Janet; York, J P; Green, Kim; Wood, Linda Fossati; Toth, Lisa; Mihm, Michael; Katz, Nancy R; Vasconcelos, Nina-Maria; Sakiyama, Norihisa; Whitsell, Robin; Gopalakrishnan, Shobha; Bairnsfather, Susan; Wanderer, Tatyana; Schindler, Thomas M; Mikyas, Yeshi; Aoyama, Yumiko

2018-01-01

This article provides Section 1 of the 2017 Edition 2 Medical Writing Competency Model that describes the core work functions and associated tasks and activities related to professional medical writing within the life sciences industry. The functions in the Model are scientific communication strategy; document preparation, development, and finalization; document project management; document template, standard, format, and style development and maintenance; outsourcing, alliance partner, and client management; knowledge, skill, ability, and behavior development and sharing; and process improvement. The full Model also includes Section 2, which covers the knowledge, skills, abilities, and behaviors needed for medical writers to be effective in their roles; Section 2 is presented in a companion article. Regulatory, publication, and other scientific writing as well as management of writing activities are covered. The Model was developed to aid medical writers and managers within the life sciences industry regarding medical writing hiring, training, expectation and goal setting, performance evaluation, career development, retention, and role value sharing to cross-functional partners.

Temperature dependent O3 absorption cross sections for GOME, SCIAMACHY and GOME-2: II. New laboratory measurements

NASA Astrophysics Data System (ADS)

Serdyuchenko, Anna; Gorshelev, Victor; Chehade, Wissam; Weber, Mark; Burrows, John P.

We report on the work devoted to the up-to-date measurements of the ozone absorption cross-sections. The main goal of the project is to produce a consolidated and consistent set of high resolution cross-sections for satellite spectrometers series that allows a derivation of the harmonized long term data set. The generation of long-term datasets of atmospheric trace gases is a major need and prerequisite for climate and air quality related studies. At present there are three atmospheric chemistry instruments (GOME1, SCIAMACHY and GOME2) in operation and two more spectrometers (GOME2) to be launched five years apart in the next decade resulting in a time series covering two or more decades of ozone observations. Information from different sensors has to be com-bined for a consistent long-term data record, since the lifetime of individual satellite missions is limited. The harmonization of cross-sections is carried out by combination of new experimental work with re-evaluation of the existing cross-sections data. New laboratory measurements of ozone cross-section are underway that will improve a) absolute scaling of cross-sections, b) temper-ature dependence of cross-sections (using very low temperatures starting at 190 K and higher sampling of temperatures up to room temperature) and c) improved wavelength calibration. We take advantage of a Fourier transform spectrometer (visible, near IR) and Echelle spectropho-tometer (UV, visible) to extend the dynamic range of the system (covering several orders of magnitude in cross-sections from UV up to the near IR). We plan to cover the spectral range 220 -1000 nm at a spectral resolution of 0.02 nm in UV/VIS with absolute intensity accuracy of at least 2%, and wavelength accuracy better than 0.001 nm in the temperature range 193-293 K in 10 K steps. A lot of attention is paid to the accuracy of determining the temperature of the ozone flow and new methods for absolute calibration of relative spectra. This work is in progress. Based on the results of the work, it is expected that the ozone data quality and time series will improve significantly as required for climate, air quality, and strato-spheric ozone trend studies. Updated ozone cross-sections will be available for reprocessing with satellite spectrometers and to the scientific community as well.

Health Care Needs and Care Utilization Among Lesbian, Gay, Bisexual, and Transgender Populations in New Jersey.

PubMed

Qureshi, Rubab I; Zha, Peijia; Kim, Suzanne; Hindin, Patricia; Naqvi, Zoon; Holly, Cheryl; Dubbs, William; Ritch, Wendy

2018-01-01

The purpose of this study was to explore prevalent health issues, perceived barriers to seeking health care, and utilization of health care among lesbian, gay, bisexual, and transgender (LGBT) populations in New Jersey. A cross-sectional online survey was administered to 438 self-identified LGBT people. Results identified health needs, which included management of chronic diseases, preventive care for risky behaviors, mental health issues, and issues related to interpersonal violence. Barriers to seeking health care included scarceness of health professionals competent in LGBT health, inadequate health insurance coverage and lack of personal finances, and widely dispersed LGBT inclusive practices making transportation difficult. There is a need for better preparation of health care professionals who care for LGBT patients, to strengthen social services to improve access and for better integration of medical and social services.

Utility of additional tissue sections in dermatopathology: diagnostic, clinical and financial implications.

PubMed

Stuart, Lauren N; Rodriguez, Adrianna S; Gardner, Jerad M; Foster, Toby E; MacKelfresh, Jamie; Parker, Douglas C; Chen, Suephy C; Stoff, Benjamin K

2014-02-01

As histopathologic assessment is subject to sampling error, some institutions 'preorder' deeper sections on some or all cases (hereafter referred to as prospective deeper sections), while others order additional sections only when needed (hereafter referred to as retrospective deeper sections). We investigated how often additional sections changed a diagnosis and/or clinical management. Given the recent decrease in reimbursement for CPT-code 88305, we also considered the financial implications of ordering additional sections. Cases (n = 204) were assigned a preliminary diagnosis, based on review of the initial slide, and a final diagnosis, after reviewing additional sections. Cases with discordant diagnoses were assessed by two dermatologists, who indicated whether the change in diagnosis altered clinical management. Expenses were estimated for three scenarios: (a) no additional sections, (b) prospective deeper sections and (c) retrospective deeper sections. Diagnoses were modified in 9% of cases, which changed clinical management in 56% of these cases. Lesions obtained by punch-biopsy and inflammatory lesions were disproportionately overrepresented amongst cases with changed diagnoses (p < 0.001, p = 0.12, respectively). The cost of prospective deeper sections and retrospective deeper sections represented a 56% and 115% increase over base costs, respectively. Labor costs, particularly the cost of dermatopathologist evaluation, were the most significant cost-drivers. While additional sections improve diagnostic accuracy, they delay turn-around-time and increase expenditures. In our practice, prospective deeper sections are cost effective, however, this may vary by institution. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Walkability and cardiometabolic risk factors: Cross-sectional and longitudinal associations from the Multi-Ethnic Study of Atherosclerosis.

PubMed

Braun, Lindsay M; Rodríguez, Daniel A; Evenson, Kelly R; Hirsch, Jana A; Moore, Kari A; Diez Roux, Ana V

2016-05-01

We used data from 3227 older adults in the Multi-Ethnic Study of Atherosclerosis (2004-2012) to explore cross-sectional and longitudinal associations between walkability and cardiometabolic risk factors. In cross-sectional analyses, linear regression was used to estimate associations of Street Smart Walk Score® with glucose, triglycerides, HDL and LDL cholesterol, systolic and diastolic blood pressure, and waist circumference, while logistic regression was used to estimate associations with odds of metabolic syndrome. Econometric fixed effects models were used to estimate longitudinal associations of changes in walkability with changes in each risk factor among participants who moved residential locations between 2004 and 2012 (n=583). Most cross-sectional and longitudinal associations were small and statistically non-significant. We found limited evidence that higher walkability was cross-sectionally associated with lower blood pressure but that increases in walkability were associated with increases in triglycerides and blood pressure over time. Further research over longer time periods is needed to understand the potential for built environment interventions to improve cardiometabolic health. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Effect of New Ozone Cross Sections Applied to SBUV and TOMS Retrievals

NASA Technical Reports Server (NTRS)

McPeters, Richard D.; Labow, Gordon J.

2010-01-01

The ozone cross sections as measured by Bass and Paur have been used for processing of SBUV and TOMS data since 1986. While these cross sections were a big improvement over those previously available, there were known minor problems with accuracy for wavelengths longward of 330 nm and with the temperature dependance. Today's requirements to separate stratospheric ozone from tropospheric ozone and for the derivation of minor species such as BrO and N02 place stringent new requirements on the accuracy needed. The ozone cross section measurements of Brion, Daumont, and Malicet (BDM) are being considered for use in UV-based ozone retrievals. They have much better resolution, an extended wavelength range, and a more consistent temperature dependance. Tests show that BDM retrievals exhibit lower retrieval residuals in the satellite data; i.e., they explain our measured atmospheric radiances more accurately. Total column ozone retrieved by the TOMS instruments is about 1.5% higher than before. Ozone profiles retrieved from SBUV using the new cross sections are lower in the upper stratosphere and higher in the lower stratosphere and troposphere.

Optimization of Production Lines and Cross-sections of Fiberglass Rebar

NASA Astrophysics Data System (ADS)

Maksimov, S. P.; Dildin, A. N.; Maksimova, A. E.

2017-11-01

The article substantiates the need of the construction industry in new lightweight and durable materials that ensure reduction in the cost of work and increase in the operational characteristics of the constructed facilities. These materials include fiberglass reinforcement which is an auxiliary bar made of heavy-duty glass fibers impregnated with a polymer adhesive composition and additionally entwined to create a ribbed surface and tight fit with fiberglass threads. This fitting has undeniable advantages in comparison with steel fittings. The polymer composite is resistant to corroding medium, does not corrode, does not conduct electricity, has high elastic properties, low thermal conductivity, increased tensile strength, etc. It is shown that the issues related to the improvement of technology and the form of a fiberglass rebar section are relevant for the construction industry. So, in particular, the presented developments will significantly reduce the consumption of adhesive composition for impregnating roving threads, reduce production costs by eliminating the loss of adhesive composition in impregnating vessels and pull-guide rollers, increasing the environmental friendliness of production and increasing the line productivity. In addition, it is possible to improve the strength characteristics by optimizing the cross-section and longitudinal cross-sections of the resulting fiberglass reinforcement. The presented changes in the design and technology of fiberglass reinforcement production can be realized as a separate independent module. It is easy to integrate into existing lines during repair work or routine maintenance of equipment.

Preface [to special section on recent Loch Vale Watershed research

USGS Publications Warehouse

Baron, Jill S.; Williams, Mark W.

2000-01-01

Catchment-scale intensive and extensive research conducted over the last decade shows that our understanding of the biogeochemical and hydrologic processes in subalpine and alpine basins is not yet sufficiently mature to model and predict how biogeochemical transformations and surface water quality will change in response to climatic or human-driven changes in energy, water, and chemicals. A better understanding of these processes is needed for input to decision-making regulatory agencies and federal land managers. In recognition of this problem the National Research Council [1998] has identified as a critical research need an improved understanding of how global change will affect biogeochemical interactions with the hydrologic cycle and biogeochemical controls over the transport of water, nutrients, and materials from land to freshwater ecosystems. Improved knowledge of alpine and subalpine ecosystems is particularly important since high-elevation catchments are very sensitive to small changes in the flux of energy, chemicals, and water. Furthermore, alpine ecosystems may act as early warning indicators for ecosystem changes at lower elevations.

76 FR 75603 - Family Educational Rights and Privacy

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-02

...The Secretary of Education (Secretary) amends the regulations implementing section 444 of the General Education Provisions Act (GEPA), which is commonly referred to as the Family Educational Rights and Privacy Act (FERPA). These amendments are needed to ensure that the U.S. Department of Education (Department or we) continues to implement FERPA in a way that protects the privacy of education records while allowing for the effective use of data. Improved access to data will facilitate States' ability to evaluate education programs, to ensure limited resources are invested effectively, to build upon what works and discard what does not, to increase accountability and transparency, and to contribute to a culture of innovation and continuous improvement in education. The use of data is vital to ensuring the best education for our children. However, the benefits of using student data must always be balanced with the need to protect student privacy. Protecting student privacy helps achieve a number of important goals, including avoiding discrimination, identity theft, as well as other malicious and damaging criminal acts.

Improving Large-Scale Testing Capability by Modifying the 40- by 80-ft Wind Tunnel

NASA Technical Reports Server (NTRS)

Mort, Kenneth W.; Soderman, Paul T.; Eckert, William T.

1979-01-01

Interagency studies conducted during the last several years have indicated the need to Improve full-scale testing capabilities. The studies showed that the most effective trade between test capability and facility cost was provided by re-powering the existing Ames Research Center 40- by 80-ft Wind Tunnel to Increase the maximum speed from about 100 m/s (200 knots) lo about 150 m/s (300 knots) and by adding a new 24- by 37-m (80- by 120-ft) test section powered for about a 50-m/s (100-knot) maximum speed. This paper reviews the design of the facility, a few or its capabilities, and some of its unique features.

Interventional Cultural and Language Assistance Program: Associations between Cultural and Linguistic Factors and Satisfaction with Cancer Care

PubMed Central

Costas-Muniz, R; Amir, J; Paris, M; Spratt, D; Arevalo-Perez, J; Fareedy, S; González, CJ; Gany, F; Camacho-Rivera, M; Osborne, JR

2017-01-01

Addressing language and cultural nuance is required to improve the quality of care among all patients. The tenth version of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) recommends implementing ongoing assessments to integrate specific actions into measurement and continuous quality improvement activities. To this end, we have created the Interventional Cultural and Language Assistance Program (ICLAP). As part of ICLAP, we conducted a cross-sectional needs assessment survey with 564 consecutive patients receiving outpatient Positron emission tomography-computed tomography (PET/CT) imaging at a comprehensive cancer center in the five most prevalent languages of New York City: English, Spanish, Russian, Chinese, and Arabic. The purpose of this study is to describe the language assistance characteristics and needs of a sample of patients receiving care in the cancer center. We examined the relationship between race, ethnicity, birthplace, communication and language assistance characteristics and the satisfaction with the care received. Our results show that race and ethnicity, birthplace, cultural beliefs, language assistance, and communication characteristics were all factors associated with patients’ satisfaction with care, illustrating that there is an unmet need among cancer patients to have cultural and linguistic sensitive services. PMID:29423339

Impact of Dental Rehabilitation on Oral Health-related Quality-of-life in Healthy Children and Those with Special Health Care Needs.

PubMed

Farsi, Deema J; Farsi, Nada J; El-Housseiny, Azza A; Turkistani, Jihan M; Farsi, Najat M

2018-04-01

Aim: The aim of this study is to compare the effect of dental rehabilitation on oral health-related quality-of-life (OHRQoL) in children with special health care needs (CSHCN) and healthy children. Materials and methods: The prospective study's sample consisted of 213 parents of caries-affected children, who were aged 6 years or younger and were scheduled for dental rehabilitation under general anesthesia (DRGA). The parent-child dyads were recruited from three public hospitals in Jeddah between October 2014 and May 2016. They comprised healthy children (n = 133) and CSHCN (n = 80). Parents self-completed the early childhood oral health impact scale (ECOHIS) before and 1 month after DRGA. The parents also rated the overall oral health status of their children by answering a global question before and after DRGA. Results: At baseline, the CSHCN had significantly worse OHRQoL in most of the scale domains at 25.9 [standard deviation (SD) 11.3] and 19.9 (SD 10.3) respectively. The OHRQoL significantly improved in both groups postoperatively (p = 0.005, Wilcoxon rank-sum test). The effect size of the improvement in the CSHCN group (+1.8) was greater than that in the healthy group (+1.5) in all domains, except for the family impact and parental distress sections. Conclusion: The DRGA markedly improves OHRQoL in children aged 6 years or younger, and the improvement is even greater in CSHCN. Clinical significance: The substantial improvement in OHRQoL after DRGA highlights the importance of oral health care in young children, which should receive higher priority than it has been done to date. Keywords: Children with special health care needs, Dental caries, Early childhood oral health impact scale, General anesthesia, Oral health-related quality-of-life.

PubMed

Di Mare, Valerio; Garramone, Gaetano; Rubbiani, Maristella; Moretto, Angelo

2017-02-15

Hazard classification of chemicals can be defined as a logic-mathematical operation aimed at identifying the type and severity of the inherent hazards of a substance or a mixture. The purpose of this study was to evaluate, in 134 safety data sheets (SDSs): i) the hazard classification and ii) its coherence with sections 9 (physical-chemical properties), 11 (toxicological properties) and 12 (ecological properties) of the SDSs. Hazard classification and the information provided in sections 9, 11 and 12 of the SDSs have been evaluated against the criteria provided in annexes VI of the Dangerous Substance Directive, II and III of the Dangerous Preparations Directive, I and VI of the Regulation (EC) n. 1272/2008. Most of the analyzed SDSs of substances (62%) was associated to non-classified chemicals (61.4%), although 19.6% of them should have been classified. By contrast, 59.4% of classified substances (representing 38.6% of analyzed ones) were wrongly classified. Fifty-four %, 54% and 67% of suggested substances hazard classification were in line with sections 9 (physical-chemical properties), 11 (toxicological properties) and 12 (ecological properties). The proportion of hazard classification mistakes in SDS was significant, suggesting the need of more qualified experts to derive classification. The introduction of an ad hoc evaluation team, managed by a single, qualified specialist, could represent a solution to ensure the needed improvement of SDSs quality.

Work environment and health promotion needs among personnel in the faculty of medicine, Thammasat university.

PubMed

Buranatrevedh, Surasak

2013-04-01

Work environment and health promotion needs are important factors for quality of life of workers. Study occupational health and safety hazards and control measures as well as health status and health promotion needs among personnel in Faculty of Medicine, Thammasat University. This was a cross sectional study. Questionnaires were designed to collect demographic data, health status, health promotion needs, occupational health and safety hazards, and job demand/control data. Questionnaires were sent out to 181 personnel and 145 were returned filled-out (80.1%). Among them, 42.8% had physical illness or stress, 68.3% had debt problem, 20% had some problems with coworker or work environment, 65.5% had a high workload, and 64.1% felt they did not get enough work benefits. Job demand and control factors included attention from leaders, fast-pace work, relationship among coworkers, repetitive work, hard work, high stress work, and high workload The occupational safety and health system included training to use new equipment, supervisor training, work skill training, work in sitting position for long period of time, appropriate periodic health exam, appropriate medical service, proper canteen, proper salary raise, and facilities for health promotion. In the occupational health hazards, employees were working in low temperature, bright light, and had a lack of health promotion programs. Requested programs to improve quality of life were Thai traditional massage, workplace improvement, health promotion, one-day travel, and Friday's happy and healthy program. Results from the present study can be used to improve workplace environment and health of personnel in the Faculty of Medicine, Thammasat University.

The association of sociodemographic factors and needs of hemodialysis patients according to Maslow's hierarchy of needs.

PubMed

Shih, Chiung-Yu; Huang, Chiu-Ya; Huang, Mei-Lun; Chen, Chyong-Mei; Tang, Fu-In

2018-05-18

To explore the association between the sociodemographic factors and the needs of patients undergoing hemodialysis in Taiwan. Concomitant discomfort, including physical and mental aspects, affects the patients' quality of life and their willingness to undergo hemodialysis. Maslow's hierarchy of needs is a well-known tool to assess different levels of human needs. We conducted a small-scale cross-sectional observational study using a structured needs assessment questionnaire on 159 patients from the Taipei Veterans General Hospital hemodialysis unit. The overall mean scores of physical, mental, spiritual, other needs, and needs in relation to medical staff care were 4.0±0.8, 3.2±0.8, 2.7±1.0, 3.1±0.9, and 4.1±0.7, respectively. The results showed that the patients' highest need was in relation to medical staff care, followed by physical needs. Further analysis showed that patients who are still employed during the treatment process have higher mental, spiritual, and other needs. Patient who are financially supported by their family have higher physical needs. Patients taken cared of by paid caregivers have lower spiritual needs and other needs. This is also the same with patients who are religious as opposed to those who are non-religious. Patients who have attained tertiary education have higher other needs compared to patients who have only achieved up to primary or secondary education. The study is the first in Taiwan to identify and quantify the needs of patients undergoing hemodialysis. When the needs of the patients are identified in relation to their sociodemographic factors, the medical staff can give the appropriate treatment in order to meet the needs and improve the patients' well-being. Healthcare providers should not only focus on the patients' physiological needs, but should determine and address their other needs in various aspects in order to improve the quality and efficacy of the dialysis care process. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Consensus on the clinical management, screening-to-treat, and surveillance of Helicobacter pylori infection to improve gastric cancer control on a nationwide scale.

PubMed

Sheu, Bor-Shyang; Wu, Ming-Shiang; Chiu, Cheng-Tang; Lo, Jing-Chuan; Wu, Deng-Chyang; Liou, Jyh-Ming; Wu, Chun-Ying; Cheng, Hsiu-Chi; Lee, Yi-Chia; Hsu, Ping-I; Chang, Chun-Chao; Chang, Wei-Lun; Lin, Jaw-Town

2017-06-01

Previous international consensus statements provided general policies for the management of Helicobacter pylori infection. However, there are geographic differences in the prevalence and antimicrobial resistance of H. pylori, and in the availability of medications and endoscopy. Thus, nationwide or regional consensus statements are needed to improve control of H. pylori infection and gastric cancer. This consensus statement for management of H. pylori in Taiwan has three major sections: (1) optimal diagnosis and indications; (2) current treatment strategies; and (3) screening-to-treat and surveillance for control of gastric cancer. The literature review emphasized recent data for development of draft statements and determination of levels of evidence. Twenty-five Taiwan experts conducted a consensus conference, by a modified Delphi process, to modify the draft statements. Consensus, defined as an agreement of least 80% of the experts, and recommendation grade were determined by anonymous voting. There were 24 consensus statements. Section 1 has seven statements on recommendations for the diagnosis and indications for treatment of H. pylori infection. Section 2 has 10 statements that provide an updated treatment algorithm for first-line, second-line, and third-line regimens. Section 3 has seven statements regarding H. pylori eradication for reducing the risk of gastric cancer, with a cost-benefit analysis. After H. pylori eradication, the consensus highlights the use of endoscopic surveillance and/or chemoprevention to further reduce the burden of gastric cancer. This consensus statement has updated recommendations for improving the clinical management of H. pylori infection in areas such as Taiwan, which have high prevalence of H. pylori infection and gastric cancer. © 2017 The Authors. Helicobacter Published by John Wiley & Sons Ltd.

Knowledge-based system for detailed blade design of turbines

NASA Astrophysics Data System (ADS)

Goel, Sanjay; Lamson, Scott

1994-03-01

A design optimization methodology that couples optimization techniques to CFD analysis for design of airfoils is presented. This technique optimizes 2D airfoil sections of a blade by minimizing the deviation of the actual Mach number distribution on the blade surface from a smooth fit of the distribution. The airfoil is not reverse engineered by specification of a precise distribution of the desired Mach number plot, only general desired characteristics of the distribution are specified for the design. Since the Mach number distribution is very complex, and cannot be conveniently represented by a single polynomial, it is partitioned into segments, each of which is characterized by a different order polynomial. The sum of the deviation of all the segments is minimized during optimization. To make intelligent changes to the airfoil geometry, it needs to be associated with features observed in the Mach number distribution. Associating the geometry parameters with independent features of the distribution is a fairly complex task. Also, for different optimization techniques to work efficiently the airfoil geometry needs to be parameterized into independent parameters, with enough degrees of freedom for adequate geometry manipulation. A high-pressure, low reaction steam turbine blade section was optimized using this methodology. The Mach number distribution was partitioned into pressure and suction surfaces and the suction surface distribution was further subdivided into leading edge, mid section and trailing edge sections. Two different airfoil representation schemes were used for defining the design variables of the optimization problem. The optimization was performed by using a combination of heuristic search and numerical optimization. The optimization results for the two schemes are discussed in the paper. The results are also compared to a manual design improvement study conducted independently by an experienced airfoil designer. The turbine blade optimization system (TBOS) is developed using the described methodology of coupling knowledge engineering with multiple search techniques for blade shape optimization. TBOS removes a major bottleneck in the design cycle by performing multiple design optimizations in parallel, and improves design quality at the same time. TBOS not only improves the design but also the designers' quality of work by taking the mundane repetitive task of design iterations away and leaving them more time for innovative design.

Design and Evaluation of Modifications to the NASA Langley Flow Impedance Tube

NASA Technical Reports Server (NTRS)

Jones, Michael G.; Watson, Willie R.; Parrott, Tony L.; Smith, Charles D.

2004-01-01

The need to minimize fan noise radiation from commercial aircraft engine nacelles continues to provide an impetus for developing new acoustic liner concepts. If the full value of such concepts is to be attained, an understanding of grazing flow effects is crucial. Because of this need for improved understanding of grazing flow effects, the NASA Langley Research Center Liner Physics Group has invested a large effort over the past decade into the development of a 2-D finite element method that characterizes wave propagation through a lined duct. The original test section in the Langley Grazing IncidenceTube was used to acquire data needed for implementation of this finite element method. This test section employed a stepper motor-driven axial-traversing bar, embedded in the wall opposite the test liner, to position a flush-mounted microphone at pre-selected locations. Complex acoustic pressure data acquired with this traversing microphone were used to educe the acoustic impedance of test liners using this 2-D finite element method and a local optimization technique. Results acquired in this facility have been extensively reported, and were compared with corresponding results from various U.S. aeroacoustics laboratories in the late 1990 s. Impedance data comparisons acquired from this multi-laboratory study suggested that it would be valuable to incorporate more realistic 3-D aeroacoustic effects into the impedance eduction methodology. This paper provides a description of modifications that have been implemented to facilitate studies of 3-D effects. The two key features of the modified test section are (1) the replacement of the traversing bar and its flush-mounted microphone with an array of 95 fixed-location microphones that are flush-mounted in all four walls of the duct, and (2) the inclusion of a suction device to modify the boundary layer upstream of the lined portion of the duct. The initial results achieved with the modified test section are provided in this report, and a comparison of these results with those achieved using the original test section is used to demonstrate that the data acquisition and analysis with the new test section can be confidently used for impedance eduction.

Pion Production Data Needed for Space Radiation

NASA Technical Reports Server (NTRS)

Norbury, John W.

2010-01-01

A recent discovery concerning the importance of hadron production in space radiation is that pions can contribute up to twenty percent of the dose from galactic cosmic ray interactions (S. Aghara, S. Blattnig, J. Norbury, R. Singleterry, Nuclear Instruments and Methods, Vol. 267, 2009, p. 1115). Although the contribution for dose equivalent will be smaller, the dose contribution could be important for fluence based radiation models. Pion production cross sections will be an essential ingredient to such models, and it is of interest to investigate the adequacy of the pion production experimental data base for energies relevant to space radiation. The pion production threshold in nucleon - nucleon reactions is at 280 MeV and, in an interesting accident of nature, this lies near the peak of the galactic cosmic ray proton spectrum. Therefore, pion production data are needed from threshold up to energies around 50 GeV/nucleon, where the galactic cosmic ray fluence is of decreasing importance. Total and differential cross section data for pion production in this energy range will be reviewed. The availability and accuracy of theoretical models will also be discussed. It will be shown that there are a significant lack of data in this important energy range and that theoretical models still need improvement.

Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates.

PubMed

Lundgren, Ingela; van Limbeek, Evelien; Vehvilainen-Julkunen, Katri; Nilsson, Christina

2015-08-28

The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of 'OptiBIRTH', an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates. Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012-2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women's trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open. This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians' perspectives is needed from countries with low, as well as high, VBAC rates.

Partial Left Ventriculectomy: Have Well-Succeeded Cases and Innovations in the Procedure Been Observed in the Last 12 Years?

PubMed Central

Domingues, José Sérgio; Vale, Marcos de Paula; Barbosa, Marcos Pinotti

2015-01-01

OBJECTIVE In 1996, the Brazilian cardiovascular surgeon, Dr. Randas Batista, introduced a surgical technique called partial left ventriculectomy, where he admitted the possibility of reducing the diameter of the left ventricle through the sectioning of one section of its wall. After the publication of this study, thousands of case reports and procedure analysis have been published, and due to several disappointing results, many doctors and institutions failed to execute it. As the main objective of this study, stands out the search for success cases of ventriculectomy in the last 12 years and if during this period it was achieved some significant development in this procedure that allows obtaining lower mortality rate postoperatively. METHODS Systematic review of indexed scientific literature over the past 12 years and the term "Partial Left Ventriculectomy". RESULTS There has been a considerable number of reported successful cases and highly significant findings in regard to determining the most suitable region for the section, proper selection of the patients indicated to the procedure, including the influence of the coronary artery anatomy in the nomination procedure and the need for preservation of ventricular geometry to ensure better quality of ventricular contractions after the sectioning. CONCLUSION This surgical procedure has been successfully performed, mainly in Japan, improvements in its efficiency were found and the need for a mathematical modeling of the slice to be severed is a prominent factor in many studies. PMID:26735606

Identifying state resources and support programs on e-government websites for persons with intellectual and developmental disabilities.

PubMed

Fisher, Kathleen M; Peterson, Justin D; Albert, Jon D

2015-01-01

This descriptive cross-sectional study identified resources and programs that are available nationwide on the Internet to support individuals and families with intellectual and developmental disabilities (I/DD), with a focus on intellectual disability. This evaluation included easily identifiable information on specific resources and highlighted unique programs found in individual states that were linked from e-government websites. Researchers documented the ease of access and available information for all 50 states and the District of Columbia. A number of disparities and areas for improvement were recorded for states and I/DD websites. The researchers conclude that a number of additional health and support services will be needed to address the growing needs of this vulnerable population.

RIAD visual imaging branch assessment

NASA Technical Reports Server (NTRS)

Beam, Sherilee F.

1993-01-01

Every year the demand to visualize research efforts increases. The visualization provides the means to effectively analyze data and present the results. The technology support for visualization is constantly changing, improving, and being made available to users everywhere. As such, many researchers are entering into the practice of doing their own visualization in house - sometimes successfully, sometimes not. In an effort to keep pace with the visualization needs of researchers, the Visual Imaging Branch of the Research, Information, and Applications Division at NASA Langley Research Center has conducted an investigation into the current status of imaging technology and imaging production throughout the various research branches at the center. This investigation will allow the branch to evaluate its current resources and personnel in an effort to identify future directions for meeting the needs of the researchers at the center. The investigation team, which consisted of the ASEE fellow, the head of the video section, and the head of the photo section, developed an interview format that could be accomplished during a short interview period with researchers, and yet still provide adequate statistics about items such as in-house equipment and usage.

The AGU Hydrology Student Subcommittee (H3S) - fostering the Fall Meeting experience for young hydrologists

NASA Astrophysics Data System (ADS)

Claes, N.; Beria, H.; Brown, M. R. M.; Kumar, A.; Goodwell, A. E.; Preziosi-Ribero, A.; Morris, C. K.; Cheng, F. Y.; Gootman, K. S.; Welsh, M.; Khatami, S.; Knoben, W.

2017-12-01

The AGU Hydrology Section Student Subcommittee (H3S), the student body of the AGU hydrology section, caters to the needs of students and early career scientists whose research interests contain a hydrological component. The past two years, H3S organized a Student and Early Career Scientist conference addressing both the technical and research needs of young hydrologists. Over the past several years, H3S organized pop-up sessions in Water Sciences and Social Dimensions of Geosciences which allowed young hydrologists to share and learn from their collective experiences. Social events like the early career social mixer, co-organized with CUAHSI, led to increased networking opportunities among peers. Continuous social media engagement led to a general dialogue within the community over varied issues including research productivity, gender equality, etc. Ice-breaker events between junior and senior academics encouraged young hydrologists to talk with their academic crushes and continuously seek out mentorship opportunities. Collating our past experiences, we ponder over our accomplishments, failures, and opportunities to improve representation of early career hydrologists within the community.

Evaluation of observational research reports published in Turkish nursing journals.

PubMed

Karaçam, Z; Şen, E; Yildirim, B

2015-09-01

The aim of this literature-based descriptive study was to examine the reporting of the observational research studies published in peer-reviewed nursing journals in Turkey. Eleven peer-reviewed nursing journals printed on a regular basis in Turkey between 2007 and 2012 were selected. These journals were searched for observational research studies, and 502 studies were selected and examined by using the Strengthening the Reporting of Observational Studies in Epidemiology Statement. Of the 502 studies, 495 were cross-sectional, 3 were cohort, and 4 were case controlled. Summary and introduction and aim sections were sufficient in most of the studies. The methods sections of the reports were mostly not reported: 64.3% of the reports did not indicate eligibility/inclusion criteria; sampling method, 67.0%; possible sources of bias, 99.2%; ways to reach sample size, 92.6%. In the results section, the number of individuals participating in each stage of the studies (44.0%) and in other analyses made (39.2%) was not reported. In the discussion section, a main comment about research findings was partly made (97.4%), and limitations of the studies and possible sources of bias were not written in 99.0% of the studies. This study clearly revealed that the observational research studies published in nursing journals in Turkey did not fulfil the important criteria and needed to be improved. Information obtained from this study can contribute to improvement of the quality of reporting observational studies in nursing and thus using obtained findings in practice. © 2015 International Council of Nurses.

[Open repair of gluteus medius and minimus tendons tears with double-row technique : Clinical and radiological results].

PubMed

Schröder, J H; Geßlein, M; Schütz, M; Perka, C; Krüger, D

2018-03-01

Operative refixation is a new therapeutic option in cases of failed conservative treatment for trochanteric pain syndrome (TPS) and lesions of the hip abductors in magnetic resonance imaging (MRI). Evaluation of the clinical and radiological results after open gluteus medius and minimus tendon reconstruction with a double-row technique was carried out. Patients with failed conservative treatment for TPS and confirmed lesions of the hip abductors in MRI were treated by open hip abductor tendon reconstruction with a double-row technique. The patients were evaluated preoperatively and postoperatively (minimum follow-up 12 months) using the modified Harris hip score (mHHS) and a subjective score (subjective hip value, SHV). Preoperative and postoperative MRI evaluation included measurement of hip abductor muscle diameter and cross-sectional area as well as fatty degeneration. In this study 12 consecutive cases of open reconstruction of the hip abductor tendons were included. There was a significant improvement in the mHHS. In one case the patient showed an atraumatic rupture in the proximal anchor row. The MRI showed a significant improvement in muscle diameter and cross-sectional area for the gluteus medius muscle of the affected and the contralateral side, while the degree of fatty degeneration did not improve. The fatty degeneration showed a significant correlation with the postoperative results in the mHHS and the SHV. Operative reconstruction of lesions in the hip abductor tendons is a therapy option with significant improvement of patient satisfaction and functional scores as well as muscle diameter and cross-sectional area for the gluteus medius. The degree of fatty degeneration and possible differential diagnoses need to be taken into consideration.

Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: a cross-sectional study

PubMed Central

Banerjee, Sushanta K; Andersen, Kathryn; Pearson, Erin; Warvadekar, Janardan; Khan, Danish U; Batra, Sangeeta

2017-01-01

Background This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women's knowledge and usage of safe abortion services, as well as the dose effect of intervention exposure. Methods We conducted two cross-sectional household surveys among married women aged 15–49 years in intervention and comparison districts. Difference-in-difference models were used to assess the efficacy of the intervention, adjusting for sociodemographic characteristics. Results Although both intervention types improved abortion knowledge, the HIM intervention was more effective in improving comprehensive knowledge about abortion. In particular, there were improvements in knowledge on legality of abortion (AOR=2.2; 95% CI 1.6 to 2.9) and nearby sources of safe abortion care (AOR=1.7; 95% CI 1.2 to 1.3). Conclusions Higher level of exposure to abortion-related messages was related to more accurate knowledge about abortion within both intervention groups. Evidence was mixed on changes in abortion care-seeking behaviour. More work is needed to ensure that women seek safe abortion services in lieu of informal services that may be more likely to lead to postabortion complications. PMID:28237953

Use of Section 18 Emergency Exemption and Section 24(c) Special Local Need Products in Indian Country

EPA Pesticide Factsheets

This finding provides for use of registered section 18 and section 24(c) products in areas of Indian country that are within the geographic boundaries of the state(s) or county(ies) where the emergency exemption or special local need registration applies.

Unmet refractive need and its determinants in Shahroud, Iran.

PubMed

Emamian, Mohammad Hassan; Zeraati, Hojjat; Majdzadeh, Reza; Shariati, Mohammad; Hashemi, Hassan; Fotouhi, Akbar

2012-08-01

Uncorrected refractive error plays a significant role in poor vision and blindness, and its correction is the most cost-effective intervention in eye care. In this study, we report the status of the unmet refractive need and the role of economic inequality in determining the level of this need in Shahroud, Iran. This cross-sectional nested case-control study was performed on 5,190 individuals aged 40-64 years. Cases and controls were individuals with uncorrected visual acuity worse than 0.3 LogMAR in the better eye who showed at least 0.2 LogMAR improvement after correction. Cases were individuals whose presenting vision was worse than 0.3 in the better eye but improved by at least 0.2 LogMAR after correction. Controls were individuals in whom the difference between the presenting and corrected vision was less than 0.2 LogMAR. The prevalence of the unmet need was 5.7 % and it was more prevalent in women (6.5 %) than in men (4.6 %) (p = 0.003). There was a gap of 19.6 % between the two groups of high and low economic status. The Oaxaca-Blinder decomposition method revealed that differences in the education level of the two groups accounted for half of this gap. Spectacle usage is better in Iran than in some other developing countries; however, in this study, about 40 % of those who required spectacles did not have them.

Use of the preparticipation physical examination form to screen for the female athlete triad in Canadian interuniversity sport universities.

PubMed

Rumball, Jane S; Lebrun, Constance M

2005-09-01

The purpose of this study was to survey universities affiliated with Canadian Interuniversity Sport on existing screening protocols for the female athlete triad, and to identify any potential areas for improvement of this system. Surveys were faxed or e-mailed to Canadian Interuniversity Sport-affiliated universities in Canada, and preparticipation physical examination (PPE)/medical history forms from each institution were analyzed. The Fowler Kennedy Sports Medicine Clinic at the University of Western Ontario. In 2000, of the 48 universities, 35 responded (73.0% response rate). In 2002, 39 of 49 universities responded (79.6%). Although the majority of institutions surveyed implement a PPE form (80.0% in 2000, 87.2% in 2002), only 70.6% to 75.0% of these institutions actually conduct a follow-up when deemed necessary. However, the number of forms including a specific female section increased from 46.4% in 2000 to 61.8% in 2002. Also encouraging is the percentage of universities attempting to increase awareness of the triad disorders (33.3% in 2002 vs. 14.3% in 2000). It is interesting to note that in over half of the institutions surveyed both years, the athletic therapist or trainer is responsible for analyzing the completed PPE forms. This study has shown substantial improvement from 2000 to 2002 in the development of the PPE across Canada, even in a relatively short period of 2 years. However, this study also demonstrates the lack of uniformity within Canada of the PPE forms. There remains a need to improve the PPE form to target a section of the form specifically to female athletes, or else cases may be missed. The triad is also not found solely in sports where leanness is associated with better performance. Better efforts need to made to increase awareness of the triad and its risks among female athletes, as well as provide educational opportunities for athletic therapists, who are the first line of intervention in many cases. The key to successful prevention and intervention is education. This study demonstrates the need for education for all people directly involved with the athlete, and the need to work together to promote a healthy and realistic body image and increase awareness of the female athlete triad among athletes.

Breastfeeding Practices and Barriers to Implementing the Ten Steps to Successful Breastfeeding in Mississippi Hospitals.

PubMed

Alakaam, Amir; Lemacks, Jennifer; Yadrick, Kathleen; Connell, Carol; Choi, Hwanseok Winston; Newman, Ray G

2018-05-01

Mississippi has the lowest rates of breastfeeding in the United States at 6 and 12 months. There is growing evidence that the rates and duration of infant breastfeeding improve after hospitals implement the Ten Steps to Successful Breastfeeding; moreover, the Ten Steps approach is considered the standard model for evaluation of breastfeeding practices in birthplaces. Research aim: This study aimed to examine the implementation level of the Ten Steps and identify barriers to implementing the Ten Steps in Mississippi hospitals. A cross-sectional self-report survey was used to answer the research aim. Nurse managers of the birthing and maternity units of all 43 Mississippi hospitals that provided birthing and maternity care were recruited. A response rate of 72% ( N = 31) was obtained. Implementation of the Ten Steps in these hospitals was categorized as low, partial, moderate, or high. The researcher classified implementation in 29% of hospitals as moderate and in 71% as partial. The hospital level of implementation was significantly positively associated with the hospital delivery rate along with the hospital cesarean section rate per year. The main barriers for the implementation process of the Ten Steps reported were resistance to new policies, limited financial and human resources, and lack of support from national and state governments. Breastfeeding practices in Mississippi hospitals need to be improved. New policies need to be established in Mississippi to encourage hospitals to adopt the Ten Steps policies and practice in the maternity and birthing units.

Radiation Hard Active Media R&D for CMS Hadron Endcap Calorimetry

NASA Astrophysics Data System (ADS)

Tiras, Emrah; CMS-HCAL Collaboration

2015-04-01

The High Luminosity LHC era imposes unprecedented radiation conditions on the CMS detectors targeting a factor of 5-10 higher than the LHC design luminosity. The CMS detectors will need to be upgraded in order to withstand these conditions yet maintain/improve the physics measurement capabilities. One of the upgrade options is reconstructing the CMS Endcap Calorimeters with a shashlik design electromagnetic section and replacing active media of the hadronic section with radiation-hard scintillation materials. In this context, we have studied various radiation-hard materials such as Polyethylene Naphthalate (PEN), Polyethylene Terephthalate (PET), HEM and quartz plates coated with various organic materials such as p-Terphenyl (pTp), Gallium doped Zinc Oxide (ZnO:Ga) and Anthracene. Here we discuss the related test beam activities, laboratory measurements and recent developments.

Benchmarking aerodynamic prediction of unsteady rotor aerodynamics of active flaps on wind turbine blades using ranging fidelity tools

NASA Astrophysics Data System (ADS)

Barlas, Thanasis; Jost, Eva; Pirrung, Georg; Tsiantas, Theofanis; Riziotis, Vasilis; Navalkar, Sachin T.; Lutz, Thorsten; van Wingerden, Jan-Willem

2016-09-01

Simulations of a stiff rotor configuration of the DTU 10MW Reference Wind Turbine are performed in order to assess the impact of prescribed flap motion on the aerodynamic loads on a blade sectional and rotor integral level. Results of the engineering models used by DTU (HAWC2), TUDelft (Bladed) and NTUA (hGAST) are compared to the CFD predictions of USTUTT-IAG (FLOWer). Results show fairly good comparison in terms of axial loading, while alignment of tangential and drag-related forces across the numerical codes needs to be improved, together with unsteady corrections associated with rotor wake dynamics. The use of a new wake model in HAWC2 shows considerable accuracy improvements.

Educational needs for improving self-care in heart failure patients with diabetes.

PubMed

Cha, EunSeok; Clark, Patricia C; Reilly, Carolyn Miller; Higgins, Melinda; Lobb, Maureen; Smith, Andrew L; Dunbar, Sandra B

2012-01-01

To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF- DM patients) by describing cognitive and affective factors to provide guidance in developing effective self-management education. A cross-sectional correlation design was employed using baseline patient data from a study testing a 12-week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and comorbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t tests, or Mann-Whitney tests were performed to compare HF patients with and without DM. HF-DM patients were older and heavier, had more comorbidities, and took more daily medications than HF patients. High self-efficacy on medication and low-sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication-taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients but clinically higher levels of sodium. Diabetes educators need to be aware of potential conflicts of treatment regimens to manage 2 chronic diseases. Special and integrated diabetes self-management education programs that incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients.

Wood Composite Adhesives

NASA Astrophysics Data System (ADS)

Gomez-Bueso, Jose; Haupt, Robert

The global environment, in which phenolic resins are being used for wood composite manufacture, has changed significantly during the last decade. This chapter reviews trends that are driving the use and consumption of phenolic resins around the world. The review begins with recent data on volume usage and regional trends, followed by an analysis of factors affecting global markets. In a section on environmental factors, the impact of recent formaldehyde emission regulations is discussed. The section on economics introduces wood composite production as it relates to the available adhesive systems, with special emphasis on the technical requirement to improve phenolic reactivity. Advances in composite process technology are introduced, especially in regard to the increased demands the improvements place upon adhesive system performance. The specific requirements for the various wood composite families are considered in the context of adhesive performance needs. The results of research into current chemistries are discussed, with a review of recent findings regarding the mechanisms of phenolic condensation and acceleration. Also, the work regarding alternate natural materials, such as carbohydrates, lignins, tannins, and proteinaceous materials, is presented. Finally, new developments in alternative adhesive technologies are reported.

Identification of nuclear effects in neutrino-carbon interactions at low three-momentum transfer

DOE PAGES

Rodrigues, P. A.

2016-02-17

Two different nuclear-medium effects are isolated using a low three-momentum transfer subsample of neutrino-carbon scattering data from the MINERvA neutrino experiment. The observed hadronic energy in charged-current νμ interactions is combined with muon kinematics to permit separation of the quasielastic and Δ(1232) resonance processes. First, we observe a small cross section at very low energy transfer that matches the expected screening effect of long-range nucleon correlations. Second, additions to the event rate in the kinematic region between the quasielastic and Δ resonance processes are needed to describe the data. The data in this kinematic region also have an enhanced populationmore » of multiproton final states. Contributions predicted for scattering from a nucleon pair have both properties; the model tested in this analysis is a significant improvement but does not fully describe the data. We present the results as a double-differential cross section to enable further investigation of nuclear models. Furthermore, improved description of the effects of the nuclear environment are required by current and future neutrino oscillation experiments.« less

Radiology employees' quality of work life.

PubMed

Dargahi, Hussein; Changizi, Vahid; Jazayeri Gharabagh, Elaheh

2012-01-01

Quality of work Life (QWL) originates from interactions between employees' needs and relative organizational resources. QWL is aimed to improve and retain employees' satisfaction, productivity and effectiveness of all organizations. A cross-sectional descriptive study was conducted among 15 Tehran University of Medical Sciences. A Cross-Sectional, descriptive study was conducted among 15 Tehran University of Medical Sciences' Hospitals' Radiology Departments' Employees by QWL questionnaire. Respondents were asked to express their attitudes about a range of key factors as the most important issues impacting their QWL. The data was collected and analyzed by SPSS version 15 software. Most of the respondents indicated that they were unsatisfied and very unsatisfied with key factors of their QWL. Comparison of QWL key factors of TUMS radiology employees with the other countries indicated that most of the employees are unsatisfied with their poor QWL factors. We hope, the implications of these findings deliberate to improve QWL within each of TUMS hospitals radiology departments and also be relevant and value to policymakers of healthcare organizations in Iran. © 2012 Tehran University of Medical Sciences. All rights reserved.

Precise Nuclear Data Measurements Possible with the NIFFTE fissionTPC for Advanced Reactor Designs

NASA Astrophysics Data System (ADS)

Towell, Rusty; Niffte Collaboration

2015-10-01

The Neutron Induced Fission Fragment Tracking Experiment (NIFFTE) Collaboration has applied the proven technology of Time Projection Chambers (TPC) to the task of precisely measuring fission cross sections. With the NIFFTE fission TPC, precise measurements have been made during the last year at the Los Alamos Neutron Science Center from both U-235 and Pu-239 targets. The exquisite tracking capabilities of this device allow the full reconstruction of charged particles produced by neutron beam induced fissions from a thin central target. The wealth of information gained from this approach will allow systematics to be controlled at the level of 1%. The fissionTPC performance will be presented. These results are critical to the development of advanced uranium-fueled reactors. However, there are clear advantages to developing thorium-fueled reactors such as Liquid Fluoride Thorium Reactors over uranium-fueled reactors. These advantages include improved reactor safety, minimizing radioactive waste, improved reactor efficiency, and enhanced proliferation resistance. The potential for using the fissionTPC to measure needed cross sections important to the development of thorium-fueled reactors will also be discussed.

Realistic 3D computer model of the gerbil middle ear, featuring accurate morphology of bone and soft tissue structures.

PubMed

Buytaert, Jan A N; Salih, Wasil H M; Dierick, Manual; Jacobs, Patric; Dirckx, Joris J J

2011-12-01

In order to improve realism in middle ear (ME) finite-element modeling (FEM), comprehensive and precise morphological data are needed. To date, micro-scale X-ray computed tomography (μCT) recordings have been used as geometric input data for FEM models of the ME ossicles. Previously, attempts were made to obtain these data on ME soft tissue structures as well. However, due to low X-ray absorption of soft tissue, quality of these images is limited. Another popular approach is using histological sections as data for 3D models, delivering high in-plane resolution for the sections, but the technique is destructive in nature and registration of the sections is difficult. We combine data from high-resolution μCT recordings with data from high-resolution orthogonal-plane fluorescence optical-sectioning microscopy (OPFOS), both obtained on the same gerbil specimen. State-of-the-art μCT delivers high-resolution data on the 3D shape of ossicles and other ME bony structures, while the OPFOS setup generates data of unprecedented quality both on bone and soft tissue ME structures. Each of these techniques is tomographic and non-destructive and delivers sets of automatically aligned virtual sections. The datasets coming from different techniques need to be registered with respect to each other. By combining both datasets, we obtain a complete high-resolution morphological model of all functional components in the gerbil ME. The resulting 3D model can be readily imported in FEM software and is made freely available to the research community. In this paper, we discuss the methods used, present the resulting merged model, and discuss the morphological properties of the soft tissue structures, such as muscles and ligaments.

Needs of relatives of critically ill patients in an academic hospital in Chile.

PubMed

Padilla-Fortunatti, C; Rojas-Silva, N; Amthauer-Rojas, M; Molina-Muñoz, Y

To identify the importance of the needs of family members of patients in an intensive care unit (ICU). Descriptive, comparative and cross-sectional study based on a secondary data analysis of 251 relatives of ICU patients at a university hospital in Santiago, Chile. Using non-random sampling, the 'Critical Care Family Needs Inventory' was used to establish the family needs, as well as a sociodemographic questionnaire that included: age, gender, educational level, patient relationship and previous ICU experience. A descriptive statistical analysis, Student's T test and ANOVA were performed. The most important family needs related to the dimensions of 'security' (mean=3.90) and 'information' (mean=3.76), while those of minor importance with 'support' (mean=3.09). In the latter, differences were observed at an older age (P<.05), an educational level (P<.001) and relationship with the patient (P<.05). The most relevant needs for family members in the ICU are related to safety and information. Less important needs are influenced by certain sociodemographic variables. Identifying the degree of importance of family needs will allow the health team to improve its relationship with families in ICUs. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Diets and Feeding Practices during the First 1000 Days Window in the Phnom Penh and North Eastern Districts of Cambodia.

PubMed

Som, Somphos Vicheth; Prak, Sophonneary; Laillou, Arnaud; Gauthier, Ludovic; Berger, Jacques; Poirot, Etienne; Wieringa, Frank T

2018-04-18

Although several health and development indicators have improved significantly in Cambodia, inadequate breastfeeding and inappropriate complementary feeding practices leave many children at high risk of malnutrition during the early stages of life. In 2014, the prevalence of wasting and stunting among Cambodian children under 5 were 10% and 32%, respectively. Thus, a strong focus on improving feeding practices within the first 1000 days window to reduce child malnutrition prevalence in Cambodia is needed. This cross-sectional study assessed the current feeding practices among of women of reproductive age, pregnant women, lactating women and children less than 24 months living in six districts from Phnom Penh and two rural provinces in the North East of Cambodia. The nutritional status of pregnant women was poor, with 21.4% having a Middle Upper arm circumference below 23 cm. While breastfeeding was predominant within the first 6 months of age in every district, feeding practices of pregnant women and children were a concern, as >70% of the children were not meeting the minimum acceptable diet, and most of the women did not improve their diet during pregnancy. Inadequate nutrition during the first 1000 days is highly prevalent in Cambodia. A comprehensive national Mother, Infant and Young Child Nutrition strategy needs to be developed and operationalized to improve feeding practices of Cambodian women and children.

Diets and Feeding Practices during the First 1000 Days Window in the Phnom Penh and North Eastern Districts of Cambodia

PubMed Central

Som, Somphos Vicheth; Prak, Sophonneary; Laillou, Arnaud; Gauthier, Ludovic; Berger, Jacques; Poirot, Etienne; Wieringa, Frank T.

2018-01-01

Although several health and development indicators have improved significantly in Cambodia, inadequate breastfeeding and inappropriate complementary feeding practices leave many children at high risk of malnutrition during the early stages of life. In 2014, the prevalence of wasting and stunting among Cambodian children under 5 were 10% and 32%, respectively. Thus, a strong focus on improving feeding practices within the first 1000 days window to reduce child malnutrition prevalence in Cambodia is needed. This cross-sectional study assessed the current feeding practices among of women of reproductive age, pregnant women, lactating women and children less than 24 months living in six districts from Phnom Penh and two rural provinces in the North East of Cambodia. The nutritional status of pregnant women was poor, with 21.4% having a Middle Upper arm circumference below 23 cm. While breastfeeding was predominant within the first 6 months of age in every district, feeding practices of pregnant women and children were a concern, as >70% of the children were not meeting the minimum acceptable diet, and most of the women did not improve their diet during pregnancy. Inadequate nutrition during the first 1000 days is highly prevalent in Cambodia. A comprehensive national Mother, Infant and Young Child Nutrition strategy needs to be developed and operationalized to improve feeding practices of Cambodian women and children. PMID:29670006

Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan Demographic and Health Surveys, 1990-2013.

PubMed

Mumtaz, Sarwat; Bahk, Jinwook; Khang, Young-Ho

2017-01-01

Despite global efforts to improve maternal health, many developing countries including Pakistan have failed to achieve the target of a 75% reduction in maternal deaths by 2015. Addressing socioeconomic inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality rate. This study was done to examine the time trends and socioeconomic inequalities in the utilization of cesarean section (C-section) in Pakistan during 1990-2013. We used data from the Pakistan Demographic and Health Surveys (PDHS) conducted during 1990 to 2013. All these surveys are nationally representative surveys of ever-married women aged 15-49 years with a sample size of 6611, 10,023, and 13,558 women in 1990-1991, 2006-2007, and 2012-2013, respectively, with an overall response rate of over 90%. The unit of analysis for this study was women with their most recent live birth in the five years preceding the surveys. Bivariate analyses and multivariable logistic regression models were employed to investigate the prevalence of cesarean sections according to selected sociodemographic characteristics of women. C-section rates were found to have increased during this period, with an especially significant rise from 2.7% in 1990-1991 to 15.8% in 2012-2013 with lower utilization among the non-educated women (7.5%), compared with the women with higher education (40.3%). C-section rates ranged from 5.5% in the poorest women to 35.3% in the richest women. Only 11.5% of the rural women had a C-section compared to 25.6% of the urban women. A greater likelihood of having a cesarean section was observed in the richest, highly educated, and urban-living women while there was no significant difference observed in cesarean section rates between the private and public sectors in all three surveys. To improve maternal health, routine monitoring and evaluation of the provision of emergency obstetric services are needed to address the underuse of C-section in poor and rural areas and overuse in rich and urban areas.

Mapping hospice patients' perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry

PubMed Central

2011-01-01

Background Comprehensive "Total Pain" assessments of patients' end-of-life needs are critical for providing improved patient-clinician communication, assessing needs, and offering high quality palliative care. However, patients' needs-based research methodologies and findings remain highly diverse with their lack of consensus preventing optimum needs assessments and care planning. Mixed-methods is an underused yet robust "patient-based" approach for reported lived experiences to map both the incidence and prevalence of what patients perceive as important end of life needs. Methods Findings often include methodological artifacts and their own selection bias. Moving beyond diverse findings therefore requires revisiting methodological choices. A mixed methods research cross-sectional design is therefore used to reduce limitations inherent in both qualitative and quantitative methodologies. Audio-taped phenomenological "thinking aloud" interviews of a purposive sample of 30 hospice patients are used to identify their vocabulary for communicating perceptions of end-of-life needs. Grounded theory procedures assisted by QSR-NVivo software is then used for discovering domains of needs embedded in the interview narratives. Summary findings are translated into quantified format for presentation and analytical purposes. Results Findings from this mixed-methods feasibility study indicate patients' narratives represent 7 core domains of end-of-life needs. These are (1) time, (2) social, (3) physiological, (4) death and dying, (5) safety, (6) spirituality, (7) change & adaptation. The prevalence, rather than just the occurrence, of patients' reported needs provides further insight into their relative importance. Conclusion Patients' perceptions of end-of-life needs are multidimensional, often ambiguous and uncertain. Mixed methodology appears to hold considerable promise for unpacking both the occurrence and prevalence of cognitive structures represented by verbal encoding that constitute patients' narratives. Communication is a key currency for delivering optimal palliative care. Therefore understanding the domains of needs that emerge from patient-based vocabularies indicate potential for: (1) developing more comprehensive clinical-patient needs assessment tools; (2) improved patient-clinician communication; and (3) moving toward a theoretical model of human needs that can emerge at the end of life. PMID:21272318

How to compete for NASA contracts

NASA Technical Reports Server (NTRS)

1989-01-01

Various studies and NASA experience have found that business concerns can provide a vital and significant impetus to technological innovation, not only in the fields of space and aeronautics, but also in national technological growth. NASA personnel are determined to foster the development of small business capabilities in technical areas that will support future projects and establish a small business base for the development and production of flight hardware for future missions. The solicitation process for Federal contracts has grown quite complex over the years. Where possible, we continue to try to simplify and streamline procedures for obtaining and performing these contracts. This booklet is designed to help understand NASA solicitations, find the information needed in deciding whether to respond, and improve chances for success. The first section of this booklet will answer general questions concerning the various types of NASA solicitations. Your specific questions on how to prepare bids will be answered in the second section, which is followed by a third section on the unique features of construction contracting. A fourth section describes how to submit technical and cost proposals for the negotiated procurement process. Some tips or suggestions, called DO's and DONT's, are placed at the end of the second, third, and fourth sections. Then, in the fifth section, ways to seek business as a subcontractor are identified.

Accurate Rapid Lifetime Determination on Time-Gated FLIM Microscopy with Optical Sectioning

PubMed Central

Silva, Susana F.; Domingues, José Paulo

2018-01-01

Time-gated fluorescence lifetime imaging microscopy (FLIM) is a powerful technique to assess the biochemistry of cells and tissues. When applied to living thick samples, it is hampered by the lack of optical sectioning and the need of acquiring many images for an accurate measurement of fluorescence lifetimes. Here, we report on the use of processing techniques to overcome these limitations, minimizing the acquisition time, while providing optical sectioning. We evaluated the application of the HiLo and the rapid lifetime determination (RLD) techniques for accurate measurement of fluorescence lifetimes with optical sectioning. HiLo provides optical sectioning by combining the high-frequency content from a standard image, obtained with uniform illumination, with the low-frequency content of a second image, acquired using structured illumination. Our results show that HiLo produces optical sectioning on thick samples without degrading the accuracy of the measured lifetimes. We also show that instrument response function (IRF) deconvolution can be applied with the RLD technique on HiLo images, improving greatly the accuracy of the measured lifetimes. These results open the possibility of using the RLD technique with pulsed diode laser sources to determine accurately fluorescence lifetimes in the subnanosecond range on thick multilayer samples, providing that offline processing is allowed. PMID:29599938

Accurate Rapid Lifetime Determination on Time-Gated FLIM Microscopy with Optical Sectioning.

PubMed

Silva, Susana F; Domingues, José Paulo; Morgado, António Miguel

2018-01-01

Time-gated fluorescence lifetime imaging microscopy (FLIM) is a powerful technique to assess the biochemistry of cells and tissues. When applied to living thick samples, it is hampered by the lack of optical sectioning and the need of acquiring many images for an accurate measurement of fluorescence lifetimes. Here, we report on the use of processing techniques to overcome these limitations, minimizing the acquisition time, while providing optical sectioning. We evaluated the application of the HiLo and the rapid lifetime determination (RLD) techniques for accurate measurement of fluorescence lifetimes with optical sectioning. HiLo provides optical sectioning by combining the high-frequency content from a standard image, obtained with uniform illumination, with the low-frequency content of a second image, acquired using structured illumination. Our results show that HiLo produces optical sectioning on thick samples without degrading the accuracy of the measured lifetimes. We also show that instrument response function (IRF) deconvolution can be applied with the RLD technique on HiLo images, improving greatly the accuracy of the measured lifetimes. These results open the possibility of using the RLD technique with pulsed diode laser sources to determine accurately fluorescence lifetimes in the subnanosecond range on thick multilayer samples, providing that offline processing is allowed.

IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS

PubMed Central

Rai, Arti K.

2014-01-01

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office (“PTO”) could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software. PMID:25221346

Education Intervention "Caregivers Like Me" for Latino Family Caregivers Improved Attitudes Toward Professional Assistance at End-of-life Care.

PubMed

Cruz-Oliver, Dulce M; Malmstrom, Theodore K; Fernández, Natalia; Parikh, Manas; García, Jessica; Sanchez-Reilly, Sandra

2016-07-01

This study explores the ability of a culturally sensitive and case-based education intervention, Caregivers Like Me, to improve knowledge and attitudes regarding end-of-life (EOL) resources among Latino caregivers. A multicentered, cross-sectional study of Latino communities from different geographical regions and cultural backgrounds. An educational intervention was administered to family caregivers of Latino elders using a case-based video "telenovela" and pretest-posttest questionnaires. Participants (N = 145) were mostly females (79%) with mean age of 56 ± 15 years. They reported active learning from intervention (91%) and high satisfaction (92%) with educational experience. Both caregiver stress self-awareness and willingness to accept professional help improved significantly from pretest to posttest. A culturally sensitive educational intervention increased Latino caregivers' self-awareness about caregiver stress and the need to consider professional assistance for EOL care. © The Author(s) 2015.

Information and communications technology for future health systems in developing countries.

PubMed

Lucas, Henry

2008-05-01

There has been much discussion of the role that recent advances in information and communication technologies (ICTs) could play in improving health systems in developing countries, but limited independent analysis of existing applications. Combining a case study approach with a general discussion of the issues, this paper attempts to assess the potential benefits of a diverse range of ICT innovations and some of the constraints they will need to overcome. Four broad areas are considered: improvements in traditional health information systems; computer-aided diagnosis and treatment monitoring; a range of applications generically labelled 'telemedicine'; and the use of ICT to inform general populations on health and healthcare. The final section speculates on the possible medium-term impacts of ICT in terms of improving the performance of existing systems, allowing scope for radical innovations, or even changing basic assumptions about the provider-patient relationship.

IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS.

PubMed

Rai, Arti K

2013-11-24

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office ("PTO") could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software.

Extracting Characteristics of the Study Subjects from Full-Text Articles

PubMed Central

Demner-Fushman, Dina; Mork, James G

2015-01-01

Characteristics of the subjects of biomedical research are important in determining if a publication describing the research is relevant to a search. To facilitate finding relevant publications, MEDLINE citations provide Medical Subject Headings that describe the subjects’ characteristics, such as their species, gender, and age. We seek to improve the recommendation of these headings by the Medical Text Indexer (MTI) that supports manual indexing of MEDLINE. To that end, we explore the potential of the full text of the publications. Using simple recall-oriented rule-based methods we determined that adding sentences extracted from the methods sections and captions to the abstracts prior to MTI processing significantly improved recall and F1 score with only a slight drop in precision. Improvements were also achieved in directly assigning several headings extracted from the full text. These results indicate the need for further development of automated methods capable of leveraging the full text for indexing. PMID:26958181

Radiation Transport and Shielding for Space Exploration and High Speed Flight Transportation

NASA Technical Reports Server (NTRS)

Maung, Khin Maung; Trapathi, R. K.

1997-01-01

Transportation of ions and neutrons in matter is of direct interest in several technologically important and scientific areas, including space radiation, cosmic ray propagation studies in galactic medium, nuclear power plants and radiological effects that impact industrial and public health. For the proper assessment of radiation exposure, both reliable transport codes and accurate data are needed. Nuclear cross section data is one of the essential inputs into the transport codes. In order to obtain an accurate parametrization of cross section data, theoretical input is indispensable especially for processes where there is little or no experimental data available. In this grant period work has been done on the studies of the use of relativistic equations and their one-body limits. The results will be useful in choosing appropriate effective one-body equation for reaction calculations. Work has also been done to improve upon the data base needed for the transport codes used in the studies of radiation transport and shielding for space exploration and high speed flight transportation. A phenomenological model was developed for the total absorption cross sections valid for any system of charged and/or uncharged collision pairs for the entire energy range. The success of the model is gratifying. It is being used by other federal agencies, national labs and universities. A list of publications based on the work during the grant period is given below and copies are enclosed with this report.

Damage accumulation in closed cross-section, laminated, composite structures

NASA Technical Reports Server (NTRS)

Bucinell, Ronald B.

1996-01-01

The need for safe, lightweight, less expensive, and more reliable launch vehicle components is being driven by the competitiveness of the commercial launch market. The United States has lost 2/3 of the commercial lunch market to Europe. As low cost Russian and Chinese vehicles become available, the US market share could be reduced even further. This international climate is driving the Single Stage To Orbit (SSTO) program at NASA. The goal of the SSTO program is to radically reduce the cost of safe, routine transportation to and from space with a totally reusable launch vehicle designed for low-cost aircraft-like operations. Achieving this goal will require more efficient uses of materials. Composite materials can provide this program with the material and structural efficiencies needed to stay competitive in the international launch market place. In satellite systems the high specific properties, design flexibility, improved corrosion and wear resistance, increased fatigue life, and low coefficient of thermal expansion that are characteristic of composite materials can all be used to improve the overall satellite performance. Some of the satellites that may be able to take advantage of these performance characteristics are the Tethered Satellite Systems (TOSCIFER, AIRSEDS, TSS2, SEDS1, and SEDS2), AXAF, GRO, and the next generation Hubble Space Telescope. These materials can also be utilized in projects at the NASAIMSFC Space Optics Technology and System Center of Excellence. The successful implementation of composite materials requires accurate performance characterization. Materials characterization data for composite materials is typically generated using flat coupons of finite width. At the free edge of these coupons the stress state is exacerbated by the presence of stiffness and geometric discontinuities. The exacerbated stress state has been shown to dominate the damage accumulation in these materials and to have a profound affect on the material constants. Space structures typically have closed cross-sections, absent of free edges. As a result, composite material characterization data generated using finite width flat specimens does not accurately reflect the performance of the composite materials used in a closed cross-section structural configuration. Several investigators have recognized the need to develop characterization techniques for composite materials in closed cross-sectioned structures. In these investigations test methods were developed and cylindrical specimens were evaluated. The behavior of the cylindrical specimens were observed to depart from behavior typical of flat coupons. However, no attempts were made to identify and monitor the progression of damage in these cylindrical specimens during loading. The identification and monitoring of damage is fundamental to the characterization of composite materials in closed cross-section configurations. In the study reported here, a closed cross-sectioned test method was developed to monitor damage progression in 2 in. diameter cylindrical specimens and 1.5 in. finite width flat coupons subjected to quasi-static, tensile loading conditions. Damage in these specimen configurations was monitored using pulse echo ultrasonic, acoustic emission, and X-ray techniques.

The Los Alamos universe: Using multimedia to promote laboratory capabilities

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

Kindel, J.

2000-03-01

This project consists of a multimedia presentation that explains the technological capabilities of Los Alamos National Laboratory. It takes the form of a human-computer interface built around the metaphor of the universe. The project is intended promote Laboratory capabilities to a wide audience. Multimedia is simply a means of communicating information through a diverse set of tools--be they text, sound, animation, video, etc. Likewise, Los Alamos National Laboratory is a collection of diverse technologies, projects, and people. Given the ample material available at the Laboratory, there are tangible benefits to be gained by communicating across media. This paper consists ofmore » three parts. The first section provides some basic information about the Laboratory, its mission, and its needs. The second section introduces this multimedia presentation and the metaphor it is based on along with some basic concepts of color and user interaction used in the building of this project. The final section covers construction of the project, pitfalls, and future improvements.« less

Nuclear Data Needs for the Neutronic Design of MYRRHA Fast Spectrum Research Reactor

NASA Astrophysics Data System (ADS)

Stankovskiy, A.; Malambu, E.; Van den Eynde, G.; Díez, C. J.

2014-04-01

A global sensitivity analysis of effective neutron multiplication factor to the change of nuclear data library has been performed. It revealed that the test version of JEFF-3.2 neutron-induced evaluated data library produces closer results to ENDF/B-VII.1 than JEFF-3.1.2 does. The analysis of contributions of individual evaluations into keff sensitivity resulted in the priority list of nuclides, uncertainties on cross sections and fission neutron multiplicities of which have to be improved by setting up dedicated differential and integral experiments.

Synthetic Environments for HSI Application, Assessment, and Improvement (Environnements synthetiques pour l’application, l’evaluation et l’amelioration de l’integration homme-systeme)

DTIC Science & Technology

2015-06-01

very coarse architectural model proposed in Section 2.4 into something that might be implemented . Figure 11 shows the model we have created based ...interoperability through common data models . So many of the pieces are either in place or are being developed currently. However, SEA still needs: • A core...of knowledge derived through the scientific method. In NATO, S&T is addressed using different business models , namely a collaborative business model

Depression partially mediated the relationship between basic psychological needs and quality of life among people living with HIV.

PubMed

Majeed, Zahraa; van Wijngaarden, Edwin; Dolan, James G; Shah, Krupa N

2017-11-01

Few studies have examined the relationship between basic psychological needs (BPN), depression and quality of life (QOL) in people living with HIV (PLWH). This cross-sectional study (N = 65; 37% females, 37% Caucasian, mean age = 55 ± 6 years, mean CD4 count = 668 ± 368 cells/mm 3 , average duration of HIV = 18 ± 4 years) found that BPN frustration was related with lower QOL. The strength of this relationship was reduced after controlling for depression. This suggests that depression partially mediated the relationship between BPN and QOL. BPN and depression may be specific targets for psychosocial interventions aimed at improving QOL in PLWH to promote successful aging.

HPV literacy and its link to initiation and completion of HPV vaccine among young adults in Minnesota.

PubMed

Lee, H Y; Lee, J; Henning-Smith, C; Choi, J

2017-11-01

This study identifies whether, and how, human papillomavirus (HPV) literacy and predisposing, enabling, and need factors are associated with HPV vaccine initiation and completion among young adults in Minnesota. Cross-sectional survey design. Using a sample of 170 young adults (aged 18-26 years), we used logistic regression models to identify factors associated with HPV vaccination initiation and completion, including HPV literacy, adjusting for relevant predisposing, enabling, and need factors. Consistent with national estimates, we found relatively low rates of HPV vaccination initiation (46%) and completion (36%). Better HPV literacy was significantly associated with higher rates of both initiation and completion, as was being female and having an annual check-up. Being married/partnered was significantly associated with lower odds of HPV vaccination. Public health programs, policy-makers, and healthcare providers can use these results to increase HPV vaccination rates by making concerted efforts to improve HPV vaccination literacy through individual and public education campaigns and by improving access to annual check-ups. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Improved cutback method measuring beat-length for high-birefringence optical fiber by fitting data of photoelectric signal

NASA Astrophysics Data System (ADS)

Shi, Zhi-Dong; Lin, Jian-Qiang; Bao, Huan-Huan; Liu, Shu; Xiang, Xue-Nong

2008-03-01

A photoelectric measurement system for measuring the beat length of birefringence fiber is set up including a set of rotating-wave-plate polarimeter using single photodiode. And two improved cutback methods suitable for measuring beat-length within millimeter range of high birefringence fiber are proposed through data processing technique. The cut length needs not to be restricted shorter than one centimeter so that the auto-cleaving machine is freely used, and no need to carefully operate the manually cleaving blade with low efficiency and poor success. The first method adopts the parameter-fitting to a saw-tooth function of tried beat length by the criterion of minimum square deviations, without special limitation on the cut length. The second method adopts linear-fitting in the divided length ranges, only restrict condition is the increment between different cut lengths less than one beat-length. For a section of holey high-birefringence fiber, we do experiments respectively by the two methods. The detecting error of beat-length is discussed and the advantage is compared.

TOOLKIT, Version 2. 0

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

Schroeder, E.; Bagot, B.; McNeill, R.L.

1990-05-09

The purpose of this User's Guide is to show by example many of the features of Toolkit II. Some examples will be copies of screens as they appear while running the Toolkit. Other examples will show what the user should enter in various situations; in these instances, what the computer asserts will be in boldface and what the user responds will be in regular type. The User's Guide is divided into four sections. The first section, FOCUS Databases'', will give a broad overview of the Focus administrative databases that are available on the VAX; easy-to-use reports are available for mostmore » of them in the Toolkit. The second section, Getting Started'', will cover the steps necessary to log onto the Computer Center VAX cluster and how to start Focus and the Toolkit. The third section, Using the Toolkit'', will discuss some of the features in the Toolkit -- the available reports and how to access them, as well as some utilities. The fourth section, Helpful Hints'', will cover some useful facts about the VAX and Focus as well as some of the more common problems that can occur. The Toolkit is not set in concrete but is continually being revised and improved. If you have any opinions as to changes that you would like to see made to the Toolkit or new features that you would like included, please let us know. Since we do try to respond to the needs of the user and make periodic improvement to the Toolkit, this User's Guide may not correspond exactly to what is available in the computer. In general, changes are made to provide new options or features; rarely is an existing feature deleted.« less

Meeting the Needs of Homeless Youth. A Report of the Homeless Youth Steering Committee.

ERIC Educational Resources Information Center

Frawley, Robert; Zafonte, Suzanne M.

This report examines the unique aspects of homelessness among youth ages 16 to 21. Section I reviews existing literature and data on the size, characteristics, and needs of homeless youth. Section II summarizes New York State's current efforts on their behalf. Section III analyzes obstacles to serving this population. Section IV outlines an action…

Sick-listed employees with severe medically unexplained physical symptoms: burden or routine for the occupational health physician? A cross sectional study

PubMed Central

2010-01-01

Background The two primary objectives of this study were to the assess consultation load of occupational health physicians (OHPs), and their difficulties and needs with regard to their sickness certification tasks in sick-listed employees with severe medical unexplained physical symptoms (MUPS). Third objective was to determine which disease-, patient-, doctor- and practice-related factors are associated with the difficulties and needs of the OHPs. Methods In this cross-sectional study, 43 participating OHPs from 5 group practices assessed 489 sick-listed employees with and without severe MUPS. The OHPs filled in a questionnaire about difficulties concerning sickness certification tasks, consultation time, their needs with regard to consultation with or referral to a psychiatrist or psychologist, and communication with GPs. The OHPs also completed a questionnaire about their personal characteristics. Results OHPs only experienced task difficulties in employees with severe MUPS in relation to their communication with the treating physician. This only occured in cases in which the OHP attributed the physical symptoms to somatoform causes. If they attributed the physical symptoms to mental causes, the OHPs reported a need to consultate a psychiatrist about the diagnosis and treatment. Conclusions OHPs experience few difficulties with their sickness certification tasks and consultation load concerning employees with severe MUPS. However, they encounter problems if the diagnostic uncertainties of the treating physician interfere with the return to work process. OHPs have a need for psychiatric expertise whenever they are uncertain about the psychiatric causes of a delayed return to work process. We recommend further training programs for OHPs. They should also have more opportunity for consultation and referral to a psychiatrist, and their communication with treating physicians should be improved. PMID:21059232

Are school children ready to donate blood?

PubMed

Thaver, Danyal Hasan; Masud, Nazish; Ashraf, Mariam

2014-01-01

Voluntary non-remunerated blood donors are considered the best among all different types of blood donors for improving the supply of safe blood. Though safe blood transfusion services have improved in Pakistan, but efforts are still required to optimize blood banks and improve recruitment of voluntary donors, such as senior school/college going students as a source of safe blood. This study looks into the awareness of senior school children concerning blood related issues including blood donation. This cross-sectional descriptive study enrolled 106 senior school students of private schools. Data were collected through self-administered questionnaire. Although 90% of the students considered blood as an important entity for saving lives still 56.8% had never thought of donating blood. Respondents had good knowledge regarding the possible spread of HIV/AIDS, and Hepatitis B and C through unsafe transfusions. Possible hindrances to donating blood included fear of needles, fear of acquiring disease, lack of knowledge regarding where to donate blood and lack of trust on blood banks. More than half of the students believed that blood should be bought from professional blood donors. Senior school going children are not ready to donate blood. Lack of knowledge and prevailing misconceptions regarding blood transfusions need to be addressed and mechanisms to motivate and mobilize youth for becoming voluntary blood donors need to be established.

Assessing the Performance of Medical Personnel Involved in the Diagnostic Imaging Processes in Mulago Hospital, Kampala, Uganda

PubMed Central

Kawooya, Michael G.; Pariyo, George; Malwadde, Elsie Kiguli; Byanyima, Rosemary; Kisembo, Harrient

2012-01-01

Objectives: Uganda, has limited health resources and improving performance of personnel involved in imaging is necessary for efficiency. The objectives of the study were to develop and pilot imaging user performance indices, document non-tangible aspects of performance, and propose ways of improving performance. Materials and Methods: This was a cross-sectional survey employing triangulation methodology, conducted in Mulago National Referral Hospital over a period of 3 years from 2005 to 2008. The qualitative study used in-depth interviews, focus group discussions, and self-administered questionnaires, to explore clinicians’ and radiologists’ performancerelated views. Results: The study came up with following indices: appropriate service utilization (ASU), appropriateness of clinician's nonimaging decisions (ANID), and clinical utilization of imaging results (CUI). The ASU, ANID, and CUI were: 94%, 80%, and 97%, respectively. The clinician's requisitioning validity was high (positive likelihood ratio of 10.6) contrasting with a poor validity for detecting those patients not needing imaging (negative likelihood ratio of 0.16). Some requisitions were inappropriate and some requisition and reports lacked detail, clarity, and precision. Conclusion: Clinicians perform well at imaging requisition-decisions but there are issues in imaging requisitioning and reporting that need to be addressed to improve performance. PMID:23230543

Children within the juvenile justice system in Nigeria: psychopathology and psychosocial needs.

PubMed

Bella, T T; Atilola, O; Omigbodun, O O

2010-06-01

Many children in Nigeria face a life of poverty, family instability, inadequate educational opportunities and poor physical and mental health which hinder their ability to develop into healthy adults, live an improved quality of life or fulfil their life aspirations. These factors have also been associated with juvenile delinquency and need for institutional care. As a step toward providing comprehensive services for incarcerated children in Nigeria, this study aimed to identify the psychosocial needs as well as types of psychopathology among a group of incarcerated children at the Ibadan remand home. A cross-sectional survey of children and adolescents at the Ibadan remand home was carried out using a semi-structured questionnaire. A total of 59 children were assessed over a one year period. Majority (90%) were in need of care and protection. All (100%) had significant psychosocial needs presenting as difficulty with their primary support, economic, social environment, or educational systems. Majority (97%) also demonstrated significant psychopathology and anxiety, suicidal and depressive symptoms were the most commonly elicited. Incarcerated children in this study showed significant mental health needs which need to be addressed as a matter of urgency. This should be carried out through the collaborative efforts of mental health professionals with various stakeholders in child care.

Improvements in Cesarean Section Techniques: Arad's Obstetrics Department Experience on Adapting the Vejnovic Cesarean Section Technique

PubMed Central

FURAU, Cristian; FURAU, Gheorghe; DASCAU, Voicu; CIOBANU, Gheorghe; ONEL, Cristina; STANESCU, Casiana

2013-01-01

ABSTRACT Objectives: Cesarean section has become recently the first choice for delivery in many clinics in Romania and worldwide. The purpose of our study is to assess the benefits of introducing the adapted Vejnovic uterine suture technique into daily practice. Material and Methods: A total of 1703 out of the 1776 cesarean section performed in the period January, 2012 - March, 2013 in the Obstetric Department of the Emergency Clinical County Hospital of Arad were retrospectively analyzed based on the cesarean section registries, birth registries and patient's personal medical records. We compared results between the group of patients undergoing adapted Vejnovic cesarean section technique and the group of patients operated in a classic manner. Outcomes: The cesarean section rate in the studied period was 56.48%. Adapted Vejnovic cesarean section technique was performed in 548 cases (30.86% of the cases), furthermore in the last 3 months studied it reached 57.27%. Mean APGAR score was better in the adapted Vejnovic cesarean section group (8.43) compared with the reference group (8.34). No significant differences were seen between the two groups regarding maternal age, gestation, weeks of gestation, newborn weight, anesthesia and indications for cesarean section. Exteriorizing the uterus helped the incidental diagnosis of 35 uterine myoma, 22 adnexal masses and 13 uterine malformations. Conclusion: In a society with a constant growth of cesarean rate, the adapted Vejnovic cesarean section technique is becoming popular amongst clinicians for its advantages, but further studies need to be developed for its standardization. PMID:24371494

Changes in caesarean section rates and milk feeding patterns of infants between 1986 and 2013 in the Dominican Republic.

PubMed

McLennan, John D

2016-10-01

The relationship between caesarean sections (C-sections) and infant feeding varies between different samples and indicators of feeding. The current study aimed to determine the relationship between C-sections and five indicators of infant milk feeding (breast-feeding within 1 h after delivery, at the time of the survey (current) and ever; milk-based prelacteal feeds; and current non-breast milk use) over time in a country with a rapidly rising C-section rate. Secondary data analysis on cross-sectional data from Demographic and Health Surveys from six different time points between 1986 and 2013. Dominican Republic. Infants under 6 months of age. Over 90 % of infants were ever breast-fed in each survey sample. However, non-breast milk use has expanded over time with a concomitant drop in predominant breast-feeding. C-section prevalence has increased over time reaching 63 % of sampled infants in the most recent survey. C-sections remained significantly related to three infant feeding practices - the child not put to the breast within 1 h after delivery, milk-based prelacteal feeds and current non-breast milk use - in multivariate models that included sociodemographic control variables. However, current non-breast milk use was no longer related to C-sections when milk-based prelacteal feeds were factored into the model. Reducing or avoiding milk-based prelacteal feeds, particularly among those having C-sections, may improve subsequent breast-feeding patterns. Simultaneously, efforts are needed to understand and help reduce the exceptionally high C-section rate in the Dominican Republic.

A systematic review of the effectiveness of warming interventions for women undergoing cesarean section.

PubMed

Munday, Judy; Hines, Sonia; Wallace, Karen; Chang, Anne M; Gibbons, Kristen; Yates, Patsy

2014-12-01

Women undergoing cesarean section are vulnerable to adverse effects associated with inadvertent perioperative hypothermia, but there has been a lack of synthesized evidence for temperature management in this population. This systematic review aimed to synthesize the best available evidence in relation to preventing hypothermia in mothers undergoing cesarean section surgery. Randomized controlled trials meeting the inclusion criteria (adult patients of any ethnic background, with or without comorbidities, undergoing any mode of anesthesia for any type of cesarean section) were eligible for consideration. Active or passive warming interventions versus usual care or placebo, aiming to limit or manage core heat loss in women undergoing cesarean section were considered. The primary outcome was maternal core temperature. A comprehensive search with no language restrictions was undertaken of multiple databases from their inception until May 2012. Two independent reviewers using the standardized critical appraisal instrument for randomized controlled trials from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MASTARI) assessed retrieved papers for methodological quality and conducted data collection. Where possible, results were combined in a fixed effects meta-analysis using the Cochrane Collaboration Review Manager software. Due to heterogeneity for one outcome, random effects meta-analysis was also used. A combined total of 719 participants from 12 studies were included. Intravenous fluid warming was found to be effective at maintaining maternal temperature and preventing shivering. Warming devices, including forced air warming and under-body carbon polymer mattresses, were effective at preventing hypothermia. However, effectiveness increased if the devices were applied preoperatively. Preoperative warming devices reduced shivering and improved neonatal temperatures at birth. Intravenous fluid warming did not improve neonatal temperature, and the effectiveness of warming interventions on umbilical pH remains unclear. Intravenous fluid warming by any method improves maternal temperature and reduces shivering during and after cesarean section, as does preoperative body warming. Preoperative warming strategies should be utilized where possible. Preoperative or intraoperative warmed IV fluids should be standard practice. Warming strategies are less effective when intrathecal opioids are administered. Further research is needed to investigate interventions in emergency cesarean section surgery. Larger scale studies using standardized, clinically meaningful temperature measurement time points are required. © 2014 Sigma Theta Tau International.

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross‐sectional survey

PubMed Central

Phung, Viet‐Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne

2015-01-01

Abstract Rationale, aims and objectives Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). Methods We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. Results There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Conclusions Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. PMID:26303398

The needs of people with dementia living at home from user, caregiver and professional perspectives: a cross-sectional survey

PubMed Central

2013-01-01

Background Few reports have been published about differences in perspectives on perceived needs among community-residing people with dementia, their family caregivers, and professionals. The aim of this study was to compare these perspectives. Method During 2006 and 2007, one-hundred and fifty two interviews of people with dementia and their caregivers about the needs of the person with dementia were performed by four professionals using The Camberwell Assessment of Need for the Elderly (CANE). Professionals’ views on met and unmet needs of people with dementia were obtained for the total sample, family caregivers’ perspectives were gained for 125 people with dementia, and people with dementia’s views on their own needs were obtained for 125 persons with dementia. Results People with dementia reported fewer needs compared with the reports of their caregivers and the professionals. The most frequent unmet needs reported by people with dementia, caregivers and professionals were in the areas of daytime activities, company, and psychological distress; however, people with dementia rated psychological distress as the commonest unmet need. Conclusions Since the priorities of people with dementia can be different from those of caregivers and professionals, it is important to consider all perspectives when making care plans. Thus, compliance with treatment of people with dementia and also their quality of life could be potentially improved by a more collaborative partnership with them. PMID:23379786

The needs of people with dementia living at home from user, caregiver and professional perspectives: a cross-sectional survey.

PubMed

Miranda-Castillo, Claudia; Woods, Bob; Orrell, Martin

2013-02-04

Few reports have been published about differences in perspectives on perceived needs among community-residing people with dementia, their family caregivers, and professionals. The aim of this study was to compare these perspectives. During 2006 and 2007, one-hundred and fifty two interviews of people with dementia and their caregivers about the needs of the person with dementia were performed by four professionals using The Camberwell Assessment of Need for the Elderly (CANE). Professionals' views on met and unmet needs of people with dementia were obtained for the total sample, family caregivers' perspectives were gained for 125 people with dementia, and people with dementia's views on their own needs were obtained for 125 persons with dementia. People with dementia reported fewer needs compared with the reports of their caregivers and the professionals. The most frequent unmet needs reported by people with dementia, caregivers and professionals were in the areas of daytime activities, company, and psychological distress; however, people with dementia rated psychological distress as the commonest unmet need. Since the priorities of people with dementia can be different from those of caregivers and professionals, it is important to consider all perspectives when making care plans. Thus, compliance with treatment of people with dementia and also their quality of life could be potentially improved by a more collaborative partnership with them.

Impact of emotional competence on supportive care needs, anxiety and depression symptoms of cancer patients: a multiple mediation model.

PubMed

Baudry, A-S; Lelorain, S; Mahieuxe, M; Christophe, V

2018-01-01

The aim of this study was to test the effect of intrapersonal and interpersonal emotional competence on cancer patients' supportive care needs, as mediated by anxiety and depression symptoms. Cross-sectional design: 137 cancer patients (42% breast or ovarian cancer, 58% gastrointestinal cancer) in 4 French hospitals completed the Profile of Emotional Competence (PEC), the Hospital Anxiety and Depression Scale (HADS), and the Supportive Care Needs Survey Short Form (SCNS-SF). Bootstrap methods with PROCESS Macro were used to test multiple mediation models. Emotional competence presented a direct or indirect beneficial effect on the satisfaction of supportive care needs, anxiety and depression symptoms. As expected, anxiety and depression symptoms had also strong positive correlations with unmet needs. All multiple mediation models were significant, except for physical needs: intrapersonal and interpersonal emotional competence impacted anxiety and depression symptoms, which in turn impacted psychological, sexual, care/support, and information needs. These innovative results show the important effect of patients' emotional competence on their supportive care need satisfaction, as mediated by anxiety and depression. Consequently, patients with high emotional competence may require less psychosocial input from medical clinicians. Thus, emotional competence may be integrated into health models and psychosocial interventions to improve patient adjustment. Further investigation is, however, needed to know which are the most beneficial specific emotional competences and at what point of the cancer pathway.

Energy transport corridors: the potential role of Federal lands in states identified by the Energy Policy Act of 2005, section 368(b).

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

Krummel, J.; Hlohowskyj, I.; Kuiper, J.

2011-09-01

On August 8, 2005, the President signed the Energy Policy Act of 2005 (EPAct) into law. In Subtitle F of EPAct, Congress set forth various provisions that would change the way certain federal agencies (Agencies) coordinate to authorize the use of land for a variety of energy-related purposes. As part of Subtitle F of EPAct, Section 368 addresses the issue of energy transportation corridors on federal land for oil, gas, and hydrogen pipelines, as well as electricity transmission and distribution facilities. Because of the critical importance of improving the nation's electrical transmission grid, Congress recognized that electricity transmission issues shouldmore » receive added attention when the Agencies address corridor location and analysis issues. In Section 368, Congress specifically directed the Agencies to consider the need for upgraded and new facilities to deliver electricity: In carrying out [Section 368], the Secretaries shall take into account the need for upgraded and new electricity transmission and distribution facilities to (1) improve reliability; (2) relieve congestion; and (3) enhance capability of the national grid to deliver electricity. Section 368 does not require the Agencies to consider or approve specific projects, applications for rights-of-way (ROWs), or other permits within designated energy corridors. Importantly, Section 368 does not direct, license, or otherwise permit any on-the-ground activity of any sort. If an applicant is interested in obtaining an authorization to develop a project within any corridor designated under Section 368, the applicant would have to apply for a ROW authorization and applicable permits. The Agencies would consider each application by applying appropriate project-specific reviews under requirements of laws and related regulations, including, but not limited to, the National Environmental Policy Act (NEPA), the Clean Water Act, the Clean Air Act, Section 7 of the Endangered Species Act (ESA), and Section 106 of the National Historic Preservation Act (NHPA). Under Section 368, Congress divided the United States into two groups of states: the 11 contiguous western states and the remaining states. Direction for energy transportation corridor analysis and selection in the 11 western states was addressed in Section 368(a) of EPAct, while direction for energy transportation corridor analysis and selection in all other states was addressed under Section 368(b) of EPAct. It was clearly the priority of Congress to conduct corridor location studies and designation first on federal lands in the western states. Under Section 368(a), the Agencies produced a programmatic environmental impact statement (EIS), Designation of Energy Corridors on Federal Land in the 11 Western States (DOE and DOI 2008), that was used in part as the basis for designating more than 6,000 mi (9,656 km) of energy transportation corridors on federal land in 11 western states. Under Section 368(a) of EPAct, Congress clearly stated the Agencies needed to (1) designate energy transportation corridors on federal land, (2) conduct the necessary environmental review of the designated corridors, and (3) incorporate the designated corridors into the appropriate land use plans. Congressional direction under Section 368(b) of EPAct differs from that provided under Section 368(a). Specifically, Section 368(b) requires the secretaries of the Agencies, in consultation with the Federal Energy Regulatory Commission (FERC), affected utility industries, and other interested persons, to jointly: (1) Identify corridors for oil, gas, and hydrogen pipelines and electricity transmission and distribution facilities on federal land in states other than the 11 western states identified under Section 368(a) of EPAct, and (2) Schedule prompt action to identify, designate, and incorporate the corridors into the applicable land use plans. While Section 368(a) clearly directs designation as a necessary first step for energy transportation corridors in the 11 western states, Section 368(b) directs the Agencies to first identify corridors and then schedule prompt action to identify, designate, and incorporate the corridors into applicable land use plans. To comply with the congressional direction provided in Section 368(b), the Agencies investigated corridor identification issues in the Section 368(b) states; this report to Congress provides information that could be relevant to possible future designation of energy corridors. Future designations, if appropriate and necessary, would occur when the Agencies undertake revisions and/or updates to land use plans that guide management decisions on lands located within individual administrative units, such as specific National Forests, National Parks, or Wildlife Refuges. At this time, the Agencies are not proposing any actions or decisions related directly or indirectly to designating energy corridors on federal land under Section 368(b) of EPAct.« less

3D prostate histology image reconstruction: Quantifying the impact of tissue deformation and histology section location

PubMed Central

Gibson, Eli; Gaed, Mena; Gómez, José A.; Moussa, Madeleine; Pautler, Stephen; Chin, Joseph L.; Crukley, Cathie; Bauman, Glenn S.; Fenster, Aaron; Ward, Aaron D.

2013-01-01

Background: Guidelines for localizing prostate cancer on imaging are ideally informed by registered post-prostatectomy histology. 3D histology reconstruction methods can support this by reintroducing 3D spatial information lost during histology processing. The need to register small, high-grade foci drives a need for high accuracy. Accurate 3D reconstruction method design is impacted by the answers to the following central questions of this work. (1) How does prostate tissue deform during histology processing? (2) What spatial misalignment of the tissue sections is induced by microtome cutting? (3) How does the choice of reconstruction model affect histology reconstruction accuracy? Materials and Methods: Histology, paraffin block face and magnetic resonance images were acquired for 18 whole mid-gland tissue slices from six prostates. 7-15 homologous landmarks were identified on each image. Tissue deformation due to histology processing was characterized using the target registration error (TRE) after landmark-based registration under four deformation models (rigid, similarity, affine and thin-plate-spline [TPS]). The misalignment of histology sections from the front faces of tissue slices was quantified using manually identified landmarks. The impact of reconstruction models on the TRE after landmark-based reconstruction was measured under eight reconstruction models comprising one of four deformation models with and without constraining histology images to the tissue slice front faces. Results: Isotropic scaling improved the mean TRE by 0.8-1.0 mm (all results reported as 95% confidence intervals), while skew or TPS deformation improved the mean TRE by <0.1 mm. The mean misalignment was 1.1-1.9° (angle) and 0.9-1.3 mm (depth). Using isotropic scaling, the front face constraint raised the mean TRE by 0.6-0.8 mm. Conclusions: For sub-millimeter accuracy, 3D reconstruction models should not constrain histology images to the tissue slice front faces and should be flexible enough to model isotropic scaling. PMID:24392245

Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: a cross-sectional study.

PubMed

Banerjee, Sushanta K; Andersen, Kathryn; Pearson, Erin; Warvadekar, Janardan; Khan, Danish U; Batra, Sangeeta

2017-02-24

This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women's knowledge and usage of safe abortion services, as well as the dose effect of intervention exposure. We conducted two cross-sectional household surveys among married women aged 15-49 years in intervention and comparison districts. Difference-in-difference models were used to assess the efficacy of the intervention, adjusting for sociodemographic characteristics. Although both intervention types improved abortion knowledge, the HIM intervention was more effective in improving comprehensive knowledge about abortion. In particular, there were improvements in knowledge on legality of abortion (AOR=2.2; 95% CI 1.6 to 2.9) and nearby sources of safe abortion care (AOR=1.7; 95% CI 1.2 to 1.3). Higher level of exposure to abortion-related messages was related to more accurate knowledge about abortion within both intervention groups. Evidence was mixed on changes in abortion care-seeking behaviour. More work is needed to ensure that women seek safe abortion services in lieu of informal services that may be more likely to lead to postabortion complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Relationship between needs driving eating occasions and eating behavior in midlife women.

PubMed

Sudo, Noriko; Degeneffe, Dennis; Vue, Houa; Ghosh, Koel; Reicks, Marla

2009-02-01

The purpose of this cross-sectional study was to determine the relationship between type of eating occasion based on need state segments experienced by 200 midlife women (46+/-6 years) and food group, nutrient, and energy intake. Women completed an Eating Occasion Questionnaire for 3 eating occasions over a 3-day period for which they maintained diet records. Cluster analysis segmented 559 eating occasions into six need states. Energy, total fat, and cholesterol consumption per occasion were highest in "routine family meal" occasions of which more than 60% were dinner and eaten at home with their children. The percentage of eating occasions in which fruits/vegetables were eaten was also highest in "routine family meal," followed by "healthy regimen." More than half of "indulgent escape" eating occasions occurred away from home and about one-third were experienced as a snack. Saturated fat and sweets intakes were the highest in the "indulgent escapes" occasions. Eating occasions experienced by women according to needs surrounding the occasion should be considered when developing tailored interventions to improve intake.

Relationship between needs driving eating occasions and eating behavior in midlife women

PubMed Central

Sudo, Noriko; Degeneffe, Dennis; Vue, Houa; Ghosh, Koel; Reicks, Marla

2009-01-01

The purpose of this cross-sectional study was to determine the relationship between type of eating occasion based on need state segments experienced by 200 midlife women (46 ± 6 years) and food group, nutrient, and energy intake. Women completed an Eating Occasion Questionnaire for 3 eating occasions over a 3-day period for which they maintained diet records. Cluster analysis segmented 559 eating occasions into six need states. Energy, total fat, and cholesterol consumption per occasion were highest in “routine family meal” occasions of which more than 60% were dinner and eaten at home with their children. The percentage of eating occasions in which fruits/vegetables were eaten was also highest in “routine family meal,” followed by “healthy regimen.” More than half of “indulgent escape” eating occasions occurred away from home and about one-third were experienced as a snack. Saturated fat and sweets intakes were the highest in the “indulgent escapes” occasions. Eating occasions experienced by women according to needs surrounding the occasion should be considered when developing tailored interventions to improve intake. PMID:18835412

16 CFR 1500.88 - Exemptions from lead limits under section 101 of the Consumer Product Safety Improvement Act for...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 101 of the Consumer Product Safety Improvement Act for certain electronic devices. 1500.88 Section... from lead limits under section 101 of the Consumer Product Safety Improvement Act for certain electronic devices. (a) The Consumer Product Safety Improvement Act (CPSIA) provides for specific lead limits...

Self-perceived care needs in older adults with joint pain and comorbidity.

PubMed

Hermsen, Lotte A H; Hoogendijk, Emiel O; van der Wouden, Johannes C; Smalbrugge, Martin; Leone, Stephanie S; van der Horst, Henriëtte E; Dekker, Joost

2018-05-01

The aim of this study was to explore self-perceived care needs and determinants of identified needs in older adults with joint pain and comorbidity. This is a cross-sectional study using baseline data from a cohort study of older adults in the Netherlands (≥65 years) with joint pain and comorbidity (n = 407). We used the Camberwell Assessment of Need for the Elderly (CANE) to assess self-perceived care needs. Regression analyses were conducted to examine the associations between needs and sociodemographic factors (age, gender, partner status and educational level), physical factors (pain intensity, comorbidity, frailty and physical functioning) and psychosocial factors (anxiety, depression and social support). Older adults with joint pain and comorbidity reported on average 4.0 care needs out of 13 CANE items, of which 0.3 were unmet. High levels of environmental and physical needs were reported, such as needs with regard to physical illness (91%), household (61%) and mobility/falls (53%). However, most of these needs were met. Only few people reported psychosocial needs, but a large proportion of these needs was unmet, especially regarding company (66.7%) and daytime activities (37%). Psychosocial needs were more often present in frail participants (OR 2.40, 95% CI 1.25-4.61), and those with less perceived social support (OR 1.05, 95% CI 1.01-1.08) and more depressive symptoms (OR 1.17, 95% CI 1.07-1.26). Unmet needs are mainly present in the psychosocial domain. Specific attention targeted at these unmet needs may improve psychosocial well-being of older adults with joint pain and comorbidity.

Influence of strut cross-section of stents on local hemodynamics in stented arteries

NASA Astrophysics Data System (ADS)

Jiang, Yongfei; Zhang, Jun; Zhao, Wanhua

2016-05-01

Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression of restenosis, especially in the near wall in stented arterial regions. So stent designs have become one of the indispensable factors needed to be considered for reducing the flow disturbances. In this paper, the structural designs of strut cross-section are considered as an aspect of stent designs to be studied in details. Six virtual stents with different strut cross-section are designed for deployments in the same ideal arterial model. Computational fluid dynamics (CFD) methods are performed to study how the shape and the aspect ratio (AR) of strut cross-section modified the local hemodynamics in the stented segments. The results indicate that stents with different strut cross-sections have different influence on the hemodynamics. Stents with streamlined cross-sectional struts for circular arc or elliptical arc can significantly enhance wall shear stress (WSS) in the stented segments, and reduce the flow disturbances around stent struts. The performances of stents with streamlined cross-sectional struts are better than that of stents with non-streamlined cross-sectional struts for rectangle. The results also show that stents with a larger AR cross-section are more conductive to improve the blood flow. The present study provides an understanding of the flow physics in the vicinity of stent struts and indicates that the shape and AR of strut cross-section ought to be considered as important factors to minimize flow disturbance in stent designs.

The European Hematology Association Roadmap for European Hematology Research: a consensus document.

PubMed

Engert, Andreas; Balduini, Carlo; Brand, Anneke; Coiffier, Bertrand; Cordonnier, Catherine; Döhner, Hartmut; de Wit, Thom Duyvené; Eichinger, Sabine; Fibbe, Willem; Green, Tony; de Haas, Fleur; Iolascon, Achille; Jaffredo, Thierry; Rodeghiero, Francesco; Salles, Gilles; Schuringa, Jan Jacob

2016-02-01

The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap.The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders.The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients. Copyright© Ferrata Storti Foundation.

The moderating role of team resources in translating nursing teams' accountability into learning and performance: a cross-sectional study.

PubMed

Rashkovits, Sarit; Drach-Zahavy, Anat

2017-05-01

The aim of this study was to test the moderated-mediation model suggesting that nursing teams' accountability affects team effectiveness by enhancing team learning when relevant resources are available to the team. Disappointing evidence regarding improvement in nurses' safe and quality care elevate the need in broadening our knowledge regarding the factors that enhance constant learning in nursing teams. Accountability is considered as crucial for team learning and quality of care but empirical findings have shown mixed evidence. A cross-sectional design. Forty-four nursing teams participated in the study. Data were collected in 2013-2014: Head nurses completed validated questionnaires, regarding team resources for learning (time availability, team autonomy and team performance feedback), and nursing teams' effectiveness; and nurses answered questionnaires regarding teams' accountability and learning (answers were aggregated to the team level). The model was tested using a moderated-mediation analysis with resources as moderating variables, and team learning as the mediator in the team accountability-team effectiveness link. The results of a mixed linear regression show that, as expected, nursing teams' accountability was positively linked to nursing teams' learning, when time availability, and team autonomy were high rather than low, and team performance feedback was low rather than high. Nurturing team accountability is not enough for achieving team learning and subsequent team effectiveness. Rather there is a need to provide nursing teams with adequate time, autonomy, and be cautious with performance feedback, as the latter may motivate nurses to repeat routine work strategies rather than explore improved ones. © 2016 John Wiley & Sons Ltd.

Self-Reported Physical Tasks and Exercise Training in Special Weapons and Tactics (SWAT) Teams.

PubMed

Davis, Matthew R; Easter, Richard L; Carlock, Jonathan M; Weiss, Lawrence W; Longo, Elizabeth A; Smith, Lisa M; Dawes, J Jay; Schilling, Brian K

2016-11-01

Davis, MR, Easter, RL, Carlock, JM, Weiss, LW, Longo, EA, Smith, LM, Dawes, JJ, and Schilling, BK. Self-reported physical tasks and exercise training in Special Weapons and Tactics (SWAT) teams. J Strength Cond Res 30(11): 3242-3248, 2016-Little research has been done examining the most physically demanding tasks a SWAT officer may perform in the line of duty. Our objective was to analyze the rankings of tasks by SWAT officers based on frequency, difficulty, and importance and assess if training is addressing traits needed for successful task completion. A survey was designed using Qualtrics (Qualtrics Labs Inc). The survey had a demographics section, performance section, and training section. Officers were contacted by phone or e-mail and asked about interest in participating. Officers who agreed were sent the survey. Our results found a strong correlation between frequency of task and importance (r = 0.69, p = 0.001), and a moderate correlation was found between task difficulty and importance (r = 0.37, p = 0.005). Task rankings were averaged across the 3 domains to assess "overall" importance, and the top 3 tasks were assessed for necessary traits for successful performance. Power and strength were determined to be the most important traits for successful performance. Officers ranked the top 2 focuses of their training program in the training section as stamina/muscular endurance and cardiovascular/respiratory endurance. Training programs for SWAT officers should be developed to improve performance of the tasks with the highest "overall" importance. Therefore, a training program should emphasize strength and power improvements while not neglecting other measures of fitness.

The Early Needs of Children with Cerebral Palsy: A Comprehensive View.

ERIC Educational Resources Information Center

Blackman, James A.; Healy, Alfred

Intended for professionals and parents, this monograph focuses on the service needs of young children with cerebral palsy. Section I presents an overview of cerebral palsy, including etiology, incidence, and history of management. Section II describes service needs in the following areas: prevention; early identification; treatment; the…

Cross-sectional study of factors associated with community health centre use in a recently urbanised community in Chengdu, China.

PubMed

Liu, Danping; Meng, Hongdao; Dobbs, Debra; Conner, Kyaien O; Hyer, Kathryn; Li, Ningxiu; Ren, Xiaohui; Gao, Bo

2017-06-08

Public investment in community health centres (CHCs) has been increasing as a response to rapid urbanisation in China. The objectives of this study were: (1) to examine factors associated with CHC use among residents from a recently urbanised community in western China and (2) to describe satisfaction with CHC among users. Cross-sectional design. A community recently converted to urban status with a newly constructed CHC in Southwest China. A random sample of 2259 adults in the Hezuo community in Chengdu, China, completed the survey in 2013. Trained staff interviewed study participants in their homes using structured questionnaires. The survey included questions regarding sociodemographics, health status, access to and usage of healthcare, health behaviours and CHC use. The Andersen's behavioural model of health service use was used to guide multivariable logistic regression modelling in identifying predisposing, enabling and need factors associated with the likelihood of using CHC. Descriptive statistics were used to describe residents' satisfaction with the CHC. A total of 71.8% of the respondents reported using the CHC during the past year. Factors influencing adults' CHC use included: gender, marital status, education level and knowledge of one's blood pressure (predisposing factors); annual household per capita income and walking time to the CHC (enabling factors) and self-rated health as well as physical activities (need factors). CHC users reported modest satisfaction across various aspects of the CHC. Neighbourhood CHC in urban areas provides important services to these residents living in a recently urbanised community. All three categories of factors in the Andersen model help explain the likelihood of CHC use. There is much room for improvement in CHC to enhance customer satisfaction. Future research is needed to improve access to CHCs and promote their use in urbanised populations with low to modest education. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Educational Needs for Improving Self-care in Heart Failure Patients with Diabetes

PubMed Central

Cha, Eun Seok; Clark, Patricia C.; Reilly, Carolyn Miller; Higgins, Melinda; Lobb, Maureen; Smith, Andrew L.; Dunbar, Sandra B.

2013-01-01

Purpose To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF-DM patients) by describing cognitive and affective factors to provide guidance in developing effective self- management education. Method A cross-sectional correlation design was employed using baseline patient data from a study testing a 12 week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and co-morbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t-tests or Mann Whitney tests were performed to compare HF patients with and without DM. Results HF-DM patients were older, heavier, had more co- morbidities, and took more daily medications than HF patients. High self-efficacy on medication and low sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients, but clinically higher levels of sodium. Conclusions Diabetes educators need to be aware of potential conflicts of treatment regimens to manage two chronic diseases. Special and integrated diabetes self-management education programs which incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients. PMID:22722611

Health technology assessment: the process in Brazil.

PubMed

Lessa, Fernanda; Ferraz, Marcos Bosi

2017-06-08

To describe, analyze, and compare the opinions of decisionmakers involved in the health technology assessment (HTA) process in Brazil in 2011. A cross-sectional study was conducted using a structured questionnaire to evaluate the opinions of a convenience sample of health care professionals from both the public and private health care systems (HCS). The survey collected demographic data for each respondent along with their input on national regulations. Data analysis included descriptive statistics, including chi-square tests to compare groups. Of the 200 completed questionnaires, 65% of the respondents were 31-50 years of age; 36% were HCS managers, 49.3% from the public and 50.7% from the private system. The majority of respondents (85%) considered the time permitted for submission of new technology to be inadequate; 88% also stated that the composition of the evaluation committee needed improvement. Respondents from the private health system more frequently stated that submission times were inappropriate (P = 0.019) and that the deadline for a decision by the committee should be defined (P = 0.021), with a maximum of no more than 180 days / 6 months (P < 0.001). Respondents indicated that the HTA process should be improved to meet their expectations. Given that new legislation has been enacted to continuously accept submissions, to make decisions within 180 days, and to expand the committee to represent more stakeholders, most of the respondents concerns have been addressed. This study is valuable as an historical analysis of HTA process improvement. Further surveys are needed to track the new HTA process, its application, and its contribution to health care needs in Brazil.

Antibiotic prescribing in women during and after delivery in a non-teaching, tertiary care hospital in Ujjain, India: a prospective cross-sectional study.

PubMed

Sharma, Megha; Sanneving, Linda; Mahadik, Kalpana; Santacatterina, Michele; Dhaneria, Suryaprakash; Stålsby Lundborg, Cecilia

2013-01-01

Antibacterial drugs (hereafter referred to as antibiotics) are crucial to treat infections during delivery and postpartum period to reduce maternal mortality. Institutional deliveries have the potential to save lives of many women but extensive use of antibiotics, add to the development and spread of antibiotic resistance. The aim of this study was to present antibiotic prescribing among inpatients during and after delivery in a non-teaching, tertiary care hospital in the city of Ujjain, Madhya Pradesh, India. A prospective cross-sectional study was conducted including women having had either a vaginal delivery or a cesarean section in the hospital. Trained nursing staff collected the data on daily bases, using a specific form attached to each patient file. Statistical analysis, including bivariate and multivariable logistic regression was conducted. Of the total 1077 women, 566 (53%) had a vaginal delivery and 511 (47%) had a cesarean section. Eighty-seven percent of the women that had a vaginal delivery and 98% of the women having a cesarean section were prescribed antibiotics. The mean number of days on antibiotics in hospital for the women with a vaginal delivery was 3.1 (±1.7) and for the women with cesarean section was 6.0 (±2.5). Twenty-eight percent of both the women with vaginal deliveries and the women with cesarean sections were prescribed antibiotics at discharge. The most commonly prescribed antibiotic group in the hospital for both the women that had a vaginal delivery and the women that had a cesarean section were third-generation cephalosporins (J01DD). The total number of defined daily doses (DDD) per100 bed days for women that had a vaginal delivery was 101, and 127 for women that had a cesarean section. The high percentage of women having had a vaginal delivery that received antibiotics and the deviation from recommendation for cesarean section in the hospital is a cause of concern. Improved maternal health and rational use of antibiotics are intertwined. Specific policy and guidelines on how to prescribe antibiotics during delivery at health care facilities are needed. Additionally, monitoring system of antibiotic prescribing and resistance needs to be developed and implemented.

Association between unmet needs and quality of life in hospitalised cancer patients no longer receiving anti-cancer treatment.

PubMed

Bužgová, R; Hajnová, E; Sikorová, L; Jarošová, D

2014-09-01

Assessing the quality of life and unmet needs of cancer patients is an integral part of palliative care. This cross-sectional study sought to determine whether there is an association between quality of life and unmet needs, anxiety and depression in cancer patients who are no longer receiving anti-cancer treatment. The sample consisted of 93 patients from the oncology department at the University Hospital in Ostrava for whom further cancer treatment had been terminated as ineffective in halting the progression of their cancer. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Patient Needs Assessment in Palliative Care (PNAP) questionnaire, and the Hospital Anxiety and Depression Scale (HADS) were used to collect data. The overall quality of life score was quite low at 46. Most unmet needs were defined in terms of physical, psychological or spiritual needs. Correlations were found between impaired quality of life and lower Karnofsky scores (r = 0.50); increased physical (r = 0.52), psychological (r = 0.44) and spiritual (r = 0.36) needs; and higher levels of anxiety (r = -0.30) and depression (r = -0.68). Effective management of patients' physical (pain, fatigue and depression), psychological and spiritual needs may improve their quality of life. © 2014 John Wiley & Sons Ltd.

[ISMP-Spain questionnaire and strategy for improving good medication practices in the Andalusian health system].

PubMed

Padilla-Marín, V; Corral-Baena, S; Domínguez-Guerrero, F; Santos-Rubio, M D; Santana-López, V; Moreno-Campoy, E

2012-01-01

To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.

National plan to enhance aviation safety through human factors improvements

NASA Technical Reports Server (NTRS)

Foushee, Clay

1990-01-01

The purpose of this section of the plan is to establish a development and implementation strategy plan for improving safety and efficiency in the Air Traffic Control (ATC) system. These improvements will be achieved through the proper applications of human factors considerations to the present and future systems. The program will have four basic goals: (1) prepare for the future system through proper hiring and training; (2) develop a controller work station team concept (managing human errors); (3) understand and address the human factors implications of negative system results; and (4) define the proper division of responsibilities and interactions between the human and the machine in ATC systems. This plan addresses six program elements which together address the overall purpose. The six program elements are: (1) determine principles of human-centered automation that will enhance aviation safety and the efficiency of the air traffic controller; (2) provide new and/or enhanced methods and techniques to measure, assess, and improve human performance in the ATC environment; (3) determine system needs and methods for information transfer between and within controller teams and between controller teams and the cockpit; (4) determine how new controller work station technology can optimally be applied and integrated to enhance safety and efficiency; (5) assess training needs and develop improved techniques and strategies for selection, training, and evaluation of controllers; and (6) develop standards, methods, and procedures for the certification and validation of human engineering in the design, testing, and implementation of any hardware or software system element which affects information flow to or from the human.

Employee factors associated with interest in improving sun protection in an Australian mining workforce.

PubMed

Street, Tamara D; Thomas, Drew Leighton

2015-04-01

As Australia experiences moderate to extreme levels of ultraviolet radiation from the sun, high participation in sun protection behaviour is required to minimise the risk of developing skin cancer. Understanding factors associated with interest in improving sun protection will enable employers to increase enrolment in sun protection programs. A cross-sectional survey was conducted at mining sites in rural Australia. The survey assessed employee demographics, stages of change and health-belief model variables, sun protection behaviour, and preferences for improving sun protection. Overall, 897 employees participated: 73% were male and 47% were classed as being at high risk of ultraviolet-related illnesses. Although 24% of high-risk participants wanted to increase their sun protection practices, only 6% wanted employer-provided sun protection assistance. Marital status and recent experience of sunburn were associated with desire to improve sun protection. Over 50% of the high-risk participants who did not want to increase their sun protection and did not want assistance were in the pre-contemplative stage of change. Self-efficacy was associated with desire to improve sun protection while susceptibility was associated with desire for assistance. The use of sun protection behaviours among this sample was low. Many employees at high risk of ultraviolet radiation exposure do not believe their approach to sun protection needs changing. SO WHAT?: Workplace health promotion programs need to educate employees about susceptibility to ultraviolet radiation exposure and develop employees' self-efficacy for sun protection behaviours. These findings can inform the content development of sun protection communication strategies targeting employees.

Variability in CKD stage in outpatients followed in two large renal clinics.

PubMed

Sikaneta, Tabo; Abdolell, Mohamed; Taskapan, Hulya; Roscoe, Janet; Fung, Jason; Nagai, Gordon; Ting, Robert H; Ng, Paul; Wu, George; Oreopoulos, Dimitrios; Tam, Paul Y

2012-10-01

Chronic kidney disease (CKD) is staged by glomerular filtration rate (GFR). CKD stages sometimes vary between routine office visits, and it is unknown if this impacts renal and patient survival separately from a cross-sectional CKD stage value. We quantified and categorized CKD stage variability in a large group of outpatients and correlated this with clinical and demographic features and with renal and patient survival. All estimated GFRs were staged in the first observation period. CKD stages were then categorized as static, improving, worsening, or fluctuating. Logistic regression analysis was performed to identify clinical variables associated with CKD stage variability. Death and dialysis progression rates were then collected and analyzed using Cox proportional regression. During a 1.1-year observation period, 1,262 patients (mean age 71.25 years) had a mean 5 eGFR's. CKD stages were static in 60.4%, worsened in 14.4%, improved in 7.4%, and fluctuated in 17.2% of patients. Secondary analysis revealed heavy proteinuria and East Asian ethnicity to be negatively, and diabetes mellitus and previous acute kidney injury to be positively associated with improving CKD stages. Cox proportional regression of 902 patients analyzed 2.3 years later revealed a negative association with improving CKD stage and subsequent need for dialysis. CKD stage changed in 40% of 1,262 elderly patients when determined 5 times in just over 1 year. Improving CKD stage was the only variability pattern significantly associated with any of the clinical outcomes when assessed 2.3 years later, being unlikely to be linked with subsequent need for dialysis.

Efficacy of caesarean scar defect repair in improving postmenstrual bleeding and factors associated with poor effect.

PubMed

Xu, He-Yang; Yang, Meng-Yi; Zhang, Xuyin; Wang, Qing; Yi, Xiao-Fang; Ding, Jing-Xin; Hua, Ke-Qin

2017-11-01

Caesarean scar defect (CSD) can cause postmenstrual bleeding. Defect repair is an effective technique to improve this symptom, but there are still a few patients getting little improvement. This retrospective study evaluates the efficacy of scar repair and explores the factors associated with poor effect. In total, 123 patients were involved in the final analysis. All of them complained about menstruation period >7 days due to postmenstrual bleeding. Before surgery, 87.8% of patients had a menstruation period more than 10 days and 20.3% had a period more than 15 days. After surgery, a normal menstruation period (< =7 days) was achieved in 46.3% (95%CI 37.3%-55.6%) of patients and a menstruation period lasting no more than 10 days was achieved in 74.8% (95%CI 66.2%-82.2%). Through multivariate logistic analysis, four factors were found dependently associated with poor effect (defined as menstruation period >10 days after surgery): repeated caesarean section (OR 9.75, 95%CI 2.30-41.36, 0.002) was a risk factor, while defect volume >600 mm 3 (OR 0.14, 95%CI 0.03-0.56, 0.006), interval from caesarean section to symptom emerging >3 months (OR 0.25, 95%CI 0.07-0.94, 0.041) and straight or retroflexed uterus (OR 0.19, 95%CI 0.05-0.79, 0.022) were protective factors. Impact statement What is already known on this subject? Caesarean scar defect can cause postmenstrual bleeding. Defect repair can improve this symptom, but there are still a few patients getting little improvement after surgery. What do the results of this study add? Defect volume >600 mm 3 , interval from caesarean section to symptom emerging >3 months and straight or retroflexed uterus are protective factors of poor effect (defined as menstruation period >10 days after surgery), and repeated caesarean section is a risk factor. What are the implications of these findings for clinical practice and/or further research? These findings may help in counselling the patients and in medical decision. Further researches are needed to explore other factors associated with surgical effect and build prediction models.

Study of the Integration of the CNU-TS-1 Mobile Tunnel Monitoring System.

PubMed

Du, Liming; Zhong, Ruofei; Sun, Haili; Zhu, Qiang; Zhang, Zhen

2018-02-01

A rapid, precise and automated means for the regular inspection and maintenance of a large number of tunnels is needed. Based on the depth study of the tunnel monitoring method, the CNU-TS-1 mobile tunnel monitoring system (TS1) is developed and presented. It can efficiently obtain the cross-sections that are orthogonal to the tunnel in a dynamic way, and the control measurements that depend on design data are eliminated. By using odometers to locate the cross-sections and correcting the data based on longitudinal joints of tunnel segment lining, the cost of the system has been significantly reduced, and the interval between adjacent cross-sections can reach 1-2 cm when pushed to collect data at a normal walking speed. Meanwhile, the relative deformation of tunnel can be analyzed by selecting cross-sections from original data. Through the measurement of the actual tunnel, the applicability of the system for tunnel deformation detection is verified, and the system is shown to be 15 times more efficient than that of the total station. The simulation experiment of the tunnel deformation indicates that the measurement accuracy of TS1 for cross-sections is 1.1 mm. Compared with the traditional method, TS1 improves the efficiency as well as increases the density of the obtained points.

Clinical nutrition knowledge of gastroenterology fellows: is there anything omitted?

PubMed

Eslamian, Ghazaleh; Jacobson, Kevan; Hekmatdoost, Azita

2013-01-01

Despite the increased emphasis on chronic non-communicable diseases, there are notable deficits about nutrition education in many medicine training programs particularly gastroenterology fellowship programs. In the present cross-sectional study, we examined the nutritional knowledge related to clinical nutrition among Iranian gastroenterology fellows. Thirty-six gastroenterology fellows currently enrolled in a gastroenterology fellowship program completed a questionnaire, including two sections. The first of which assessed the gastroenterology fellows experience about nutrition training, nutrition management of patients with gastrointestinal (GI) disorders and evaluating perceived nutrition education needs. The second section consisted of multiple choice questions that assessed nutritional knowledge. A total of 32 gastroenterology fellows completed the first section. The majority of gastroenterology fellows failed to partake in any nutrition education during their fellowship training particularly for inpatients despite the availability to participate in the nutrition training especially for the purpose of nutrition support. Mean correct response rates for the second section was 38%. The highest mean score was seen in nutrition assessment (48.1%), followed by scores of 40.5% in nutrition support, 37.0% nutrition in GI disease, and 25.0% in micro and macronutrients. Iranian gastroenterology fellows have serious deficits in their nutrition knowledge. This study paves the way for the development of an education program to improve nutritional knowledge of gastroenterology fellows.

Sexual Quality of Life and Needs for Sexology Care of Cancer Patients Admitted for Radiotherapy: A 3-Month Cross-Sectional Study in a Regional Comprehensive Reference Cancer Center.

PubMed

Almont, Thierry; Delannes, Martine; Ducassou, Anne; Corman, André; Bondil, Pierre; Moyal, Elizabeth; Schover, Leslie; Huyghe, Eric

2017-04-01

Providing early and better care in onco-sexuality and a better understanding of the sexual health care needs of patients before they start treatment is required. To assess sexual quality of life and need for sexology care of patients when they are starting radiotherapy. We performed a cross-sectional study of adult patients with cancer admitted for radiotherapy treatment in a regional comprehensive cancer center. We selected all consecutive adult patients scheduled to start radiotherapy within a 3-month period and excluded patients who could not complete the questionnaires. Patients were asked to complete the Sexual Quality of Life Questionnaire (SQoL) and a needs-assessment questionnaire. Total score on the SQoL and willingness (yes or no) to get help for a sexual problem. The study sample was composed of 77 men and 123 women. The average SQoL scores were 68.4 ± 20.9 and 47.1 ± 13.0 for men and women, respectively (P < .001). Of sexually active patients, 58% had decreased frequency of intercourse or had completely stopped sexual activity after their cancer diagnosis. Half the participants wanted care for their sexual concerns. The proportion desiring specific types of care varied from 28.5% (couple counseling) to 54.5% (sexual physician) with variation by sex or type of cancer. Furthermore, 11.5% of participants declared their willingness to join support groups. Early interventions before radiotherapy could improve sexual quality of life, particularly in women. Strengths are the SQoL validated in men and women, the original window for assessment, and the study location. Limitations are the monocentric design, the potential recall bias for data before cancer diagnosis, and the fact that some patients had treatments before radiotherapy. Our data suggest the need to examine the sexual health trajectory in a prospective fashion from diagnosis to survivorship. Almont T, Delannes M, Ducasson A, et al. Sexual Quality of Life and Needs for Sexology Care of Cancer Patients Admitted for Radiotherapy: A 3-Month Cross-Sectional Study in a Regional Comprehensive Reference Cancer Center. J Sex Med 2017;14:566-576. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Genetic Modification of Short Rotation Poplar Biomass Feedstock for Efficient Conversion to Ethanol

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

Dinus, R.J.

2000-08-30

The Bioenergy Feedstock Development Program, Environmental Sciences Division, Oak Ridge National Laboratory is developing poplars (Populus species and hybrids) as sources of renewable energy, i.e., ethanol. Notable increases in adaptability, volume productivity, and pest/stress resistance have been achieved via classical selection and breeding and intensified cultural practices. Significant advances have also been made in the efficiencies of harvesting and handling systems. Given these and anticipated accomplishments, program leaders are considering shifting some attention to genetically modifying feedstock physical and chemical properties, so as to improve the efficiency with which feedstocks can be converted to ethanol. This report provides an in-depthmore » review and synthesis of opportunities for and feasibilities of genetically modifying feedstock qualities via classical selection and breeding, marker-aided selection and breeding, and genetic transformation. Information was collected by analysis of the literature, with emphasis on that published since 1995, and interviews with prominent scientists, breeders, and growers. Poplar research is well advanced, and literature is abundant. The report therefore primarily reflects advances in poplars, but data from other species, particularly other shortrotation hardwoods, are incorporated to fill gaps. An executive summary and recommendations for research, development, and technology transfer are provided immediately after the table of contents. The first major section of the report describes processes most likely to be used for conversion of poplar biomass to ethanol, the various physical and chemical properties of poplar feedstocks, and how such properties are expected to affect process efficiency. The need is stressed for improved understanding of the impact of change on both overall process and individual process step efficiencies. The second part documents advances in trait measurement instrumentation and methodology. The importance of these and future developments is emphasized, since trait measurement constitutes the largest cost associated with adding additional traits to improvement efforts, regardless of genetic approach. In subsequent sections, recent and projected advances in classical selection and breeding, marker-aided selection, and genetic transformation are documented and used to evaluate the feasibility of individual approaches. Interviews with specialists engaged in research and development on each approach were given particular emphasis in gauging feasibilities and defining future needs and directions. Summaries of important findings and major conclusions are presented at the end of individual sections. Closing portions describe the targeted workshop, conducted in December 1999 and list interviewees and literature cited in the text. Information obtained at the workshop was used to improve accuracy, refine conclusions, and recommend priorities for future research, development, and technology transfer.« less

The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

PubMed

Dhaliwal, Rupinder; Cahill, Naomi; Lemieux, Margot; Heyland, Daren K

2014-02-01

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.

Gap analysis: assessing the value perception of consultant pharmacist services and the performance of consultant pharmacists.

PubMed

Clark, Thomas R

2008-09-01

To understand the importance of services provided by consultant pharmacists and to assess perception of their performance of services. Cross-sectional; nursing facility team. Random e-mail survey of consultant pharmacists; phone survey of team members. 233 consultant pharmacists (practicing in a nursing facility); 540 team members (practicing in a nursing facility, interacting with > or = 1 consultant pharmacist): 120 medical directors, 210 directors of nursing, 210 administrators. Consultant pharmacists, directors of nursing, medical directors, and administrators rating importance/performance of 21 services. Gap between teams' ratings of importance and consultant pharmacists' performance is assessed to categorize services. Importance/performance ranked on five-point scale. Mean scores used for gap analysis to cluster services into four categories. Per combined group, six services categorized as "Keep It Up" (important, good performance), consensus with individual groups, except discrepancy with medical directors, for one service. Six services each categorized as "Improve" (important, large gap) and "Improve Second" (lower importance, large gap), with varied responses by individual groups. Three different services were categorized into "Don't Worry," with consensus within individual groups. Consensus from all groups found 5 of 21 services are important and performed well by consultant pharmacists, indicating to maintain performance of services. For three services, consultant pharmacists do not need to worry about their performance. Thirteen services require improvement in consultant pharmacists' performance; various groups differ on extent of improvement needed. Results can serve as benchmark comparisons with results obtained by consultant pharmacists in their own facilities.

Assessment of eye bank-prepared posterior lamellar corneal tissue for endothelial keratoplasty.

PubMed

Rose, Linda; Briceño, César A; Stark, Walter J; Gloria, Dante G; Jun, Albert S

2008-02-01

To evaluate eye bank-prepared tissue for Descemet's stripping automated endothelial keratoplasty (DSAEK). Experimental study and retrospective case series. Seventeen human donor corneas and 4 recipient patients undergoing DSAEK surgery. Corneal-scleral discs were obtained. Specular microscopy and pachymetry were performed. A designated Tissue Banks International technician used a microkeratome to prepare a flap. Posterior bed thickness was measured. The sectioned tissue was stored, and at 24 and 48 hours, pachymetry was repeated. At 48 hours, specular microscopy was repeated, and endothelial cell viability was assessed with trypan blue. Descemet's stripping automated endothelial keratoplasty was performed in 4 patients using eye bank-prepared posterior lamellar tissue. Corneal tissue was assessed with the following parameters: corneal thickness measured with ultrasonic pachymetry, cell density counts measured with a keratoanalyzer, and cell viability as observed with trypan blue exclusion. Patient outcomes were measured by changes in visual acuity (VA) and the presence of a clear graft. Donor corneal pachymetry before sectioning averaged 599+/-52 microm. Immediately after sectioning with a microkeratome set at a depth of 300 microm, mean posterior bed thickness was 328+/-95 microm. Thus, the mean cutting depth achieved by the microkeratome when set at 300 micrometers averaged 271+/-83 microm. After storage for 24 hours, the posterior beds measured 352 microm, an average swelling of 24 (7%) microm (P = 0.14). After 48 hours, the posterior beds measured 382 microm, an average swelling of 54 (16%) microm (P = 0.02). Cell counts 48 hours after sectioning decreased by an average of 11% (P = 0.10). Endothelial cell staining confirmed improvement in postsectioning morphology and survival with increased technician experience. All 4 patients receiving eye bank-prepared DSAEK tissue showed uncomplicated postoperative results, with improvement in VA. The microkeratome cutting depth was moderately accurate. Pachymetry, cell density, and cell viability of sectioned tissue after 48 hours in storage were encouraging overall. Initial clinical results of eye bank-prepared DSAEK tissue showed uncomplicated postoperative courses and improved VA. Additional studies are needed to follow the long-term outcomes in the recipients of these tissues.

Converting point-wise nuclear cross sections to pole representation using regularized vector fitting

NASA Astrophysics Data System (ADS)

Peng, Xingjie; Ducru, Pablo; Liu, Shichang; Forget, Benoit; Liang, Jingang; Smith, Kord

2018-03-01

Direct Doppler broadening of nuclear cross sections in Monte Carlo codes has been widely sought for coupled reactor simulations. One recent approach proposed analytical broadening using a pole representation of the commonly used resonance models and the introduction of a local windowing scheme to improve performance (Hwang, 1987; Forget et al., 2014; Josey et al., 2015, 2016). This pole representation has been achieved in the past by converting resonance parameters in the evaluation nuclear data library into poles and residues. However, cross sections of some isotopes are only provided as point-wise data in ENDF/B-VII.1 library. To convert these isotopes to pole representation, a recent approach has been proposed using the relaxed vector fitting (RVF) algorithm (Gustavsen and Semlyen, 1999; Gustavsen, 2006; Liu et al., 2018). This approach however needs to specify ahead of time the number of poles. This article addresses this issue by adding a poles and residues filtering step to the RVF procedure. This regularized VF (ReV-Fit) algorithm is shown to efficiently converge the poles close to the physical ones, eliminating most of the superfluous poles, and thus enabling the conversion of point-wise nuclear cross sections.

The Impact of Entrepreneurial Leadership on Nurses' Innovation Behavior.

PubMed

Bagheri, Afsaneh; Akbari, Morteza

2018-01-01

The purpose of this study was to examine the influence of entrepreneurial leadership on nurses' innovation work behavior and its dimensions. This cross-sectional study employed the 10-item Innovation Work Behavior Questionnaire and the 8-item Entrepreneurial Leadership Questionnaire to explore the impact of entrepreneurial leadership on the innovation work behavior of 273 nurses from public and private hospitals in Iran. Entrepreneurial leadership had a significant positive impact on nurses' innovation work behavior and most strongly improved idea exploration, followed by idea generation, idea implementation, and idea championing. Entrepreneurial leadership was effective in enhancing nurses' innovation work behavior. More attention needs to be focused on developing entrepreneurial leadership competencies and on developing nurse leaders. Healthcare policies and strategies are needed to facilitate the implementation of entrepreneurial leadership by providing healthcare leaders with the appropriate environment. © 2017 Sigma Theta Tau International.

Assessment of primary health care: health professionals' perspective.

PubMed

Silva, Simone Albino da; Nogueira, Denismar Alves; Paraizo, Camila Maria da Silva; Fracolli, Lislaine Aparecida

2014-08-01

Objective To assess primary health care attributes of access to a first contact, comprehensiveness, coordination, continuity, family guidance and community orientation. Method An evaluative, quantitative and cross-sectional study with 35 professional teams in the Family Health Program of the Alfenas region, Minas Gerais, Brazil. Data collection was done with the Primary Care Assessment Tool - Brazil, professional version. Results Results revealed a low percentage of medical experts among the participants who evaluated the attributes with high scores, with the exception of access to a first contact. Data analysis revealed needs for improvement: hours of service; forms of communication between clients and healthcare services and between clients and professionals; the mechanism of counter-referral. Conclusion It was concluded that there is a mismatch between the provision of services and the needs of the population, which compromises the quality of primary health care.

Nonprescription medication use and literacy among New Hampshire eighth graders.

PubMed

Abel, Cheryl; Johnson, Kerri; Waller, Dustin; Abdalla, Maha; Goldsmith, Carroll-Ann W

2012-01-01

To assess whether New Hampshire (NH) eighth graders were self-medicating with over-the-counter (OTC) medications, had literacy skills necessary to safely and accurately interpret OTC medication labels, and showed improvement in OTC medication safe use and literacy skills after student pharmacist-led education. Cross-sectional repeated-measures study. NH, five separate sessions, in 2010 and 2011. 101 NH eighth grade students. Participants answered questions derived from OTC drug facts labels that assessed OTC medication safe use and literacy before and after a student pharmacist-led presentation describing each section of the labels. Participant use of OTC medications, whether participants interpreted OTC drug facts labels correctly, and whether participants were able to identify safe use of OTC medications before and after instruction about OTC drug facts labels. 57% of participants reported taking OTC medications in the previous month, 22% reported taking OTC medications autonomously, and 43% reported checking with a trusted adult before self-administration. After student pharmacist-led education, significant improvements were seen in identifying product indications, calculating adult doses, interpreting adverse effects, knowing when to call a medical provider, understanding proper medication storage, identifying expiration dates, and identifying duplicate medications in products. NH eighth graders were self-medicating with OTC medications. Significant improvements in OTC medication label literacy were seen after student pharmacist-led education. These results provide evidence of the need for, and positive effects of, OTC medication education among U.S. adolescents.

Bulimia: Issues a University Counseling Center Needs To Address.

ERIC Educational Resources Information Center

Whitner, Phillip A.; Shetterly, Arminta

The eating disorder known as bulimia is a relatively new and baffling phenomenon. This paper raises questions that college and university counseling center professionals need to address regarding this phenomenon. The first section focuses on defining the term "bulimia" and its evolution. The second section identifies numerous symptoms that need to…

Assessment of the Higher Education Needs of Snohomish, Island, and Skagit Counties (SIS)

ERIC Educational Resources Information Center

Washington Higher Education Coordinating Board, 2006

2006-01-01

This report contains the Higher Education Coordinating Board's (HECB) assessment of the higher education needs in Snohomish, Skagit, and Island (SIS) Counties, and its recommendations to the legislature regarding those needs. The report contains two sections. Section I provides: (1) Primary conclusions and related considerations derived from the…

78 FR 49681 - Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... failure to meet the community health needs assessment (CHNA) requirements for any taxable year. The... organizations to satisfy the community health needs assessment requirements of section 501(r)(3). A hospital... three years and adopt an implementation strategy to meet the community health needs identified through...

Executive summary of the CAEP 2014 Academic Symposium: How to make research succeed in your department.

PubMed

Stiell, Ian G; Artz, Jennifer D; Perry, Jeffrey; Vaillancourt, Christian; Calder, Lisa

2015-05-01

The vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic Section is to promote high-quality emergency patient care by conducting world-leading education and research in emergency medicine. The Academic Section plans to achieve this goal by enhancing academic emergency medicine primarily at Canadian medical schools and teaching hospitals. It seeks to foster and develop education, research, and academic leadership amongst Canadian emergency physicians, residents, and students. In this light, the Academic Section began in 2013 to hold the annual Academic Symposia to highlight best practices and recommendations for the three core domains of governance and leadership, education scholarship, and research. Each year, members of three panels are asked to review the literature, survey and interview experts, achieve consensus, and present their recommendations at the Symposium (2013, Education Scholarship; 2014, Research; and 2015, Governance and Funding). Research is essential to medical advancement. As a relatively young specialty, emergency medicine is rapidly evolving to adapt to new diagnostic tools, the challenges of crowding in emergency departments, and the growing needs of emergency patients. There is significant variability in the infrastructure, support, and productivity of emergency medicine research programs across Canada. All Canadians benefit from an investigation of the means to improve research infrastructure, training programs, and funding opportunities. Such an analysis is essential to identify areas for improvement, which will support the expansion of emergency medicine research. To this end, physician-scientist leaders were gathered from across Canada to develop pragmatic recommendations on the improvement of emergency medicine research through a comprehensive analysis of current best practices, systematic literature reviews, stakeholder surveys, and expert interviews.

Postgraduate nurses' self-assessment of clinical competence and need for further training. A European cross-sectional survey.

PubMed

Wangensteen, Sigrid; Finnbakk, Elisabeth; Adolfsson, Annsofie; Kristjansdottir, Gudrun; Roodbol, Petrie; Ward, Helen; Fagerström, Lisbeth

2018-03-01

Nursing practice requires application of knowledge, skills and values in various combinations and has undergone substantial changes the last decades. An increased focus on inter-professional collaboration and possible new and more independent roles for nurses are described. A variety of programs have been developed in order to educate registered nurses (RN) to meet the changes and demands in health and nursing care throughout the world. The aims were to 1) describe nurses' self-assessment of clinical competence and need for further training, and 2) explore possible differences between nurses in specialist vs master's programs. A cross-sectional survey design was applied. 97 nurses in postgraduate programs from five countries responded (response rate 45%). A revised version of the Professional Nurse Self-Assessment Scale of clinical core competencies (PROFFNurseSASII) was used for data collection. Independent student t-test and regression analyses were carried out. The respondents rated their competence highest in taking full responsibility, cooperation with other health professionals and in acting ethically. Items where they considered themselves needing further training most were competence on medications, interaction and side effects and differential diagnoses. For all items, nurses in master's programs rated their competence higher than nurses in the specialist programs. Nurses in specialist programs rated their need for more training for all items higher than nurses in master's degree programs, and for 47 out of the 50 items these differences were statistically significant. Even though the nurses rated their competence high for important competence aspects such as taking responsibility and cooperation with other health professionals, it is worrying that their need for further training was highest for effects and interaction of various types of medications. Further studies are needed to conclude if and how master's education improves patient outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

Mental health status and its predictors among call center employees: A cross-sectional study.

PubMed

Oh, Hyunjin; Park, Heyeon; Boo, Sunjoo

2017-06-01

In this study, we assessed the mental health of Korean call center employees and investigated the potential predictors of their mental health status. A cross-sectional study using self-completing questionnaire was conducted for employees working for a credit card call center. A total of 306 call center employees completed the Depression Anxiety Stress Scale, the Emotion Labor Scale, and the Korean Occupational Stress Scale. The results showed that more than half of the participants reported high levels of depression, anxiety, and stress. A multiple regression analysis indicated that the total scores on the Depression Anxiety Stress Scale were predicted by perceived health, job satisfaction, job demands, organizational injustice, and emotional dissonance suggesting that, in the interest of improving the mental health of call center employees, their job demands and emotional dissonance should be reduced and the work environment be improved. Consideration should be given to providing routine assessments of mental health, including depression, anxiety, and stress, and the corresponding need for the development of an intervention program and other work-related policies that would protect employees from the risk of poor mental health outcomes. © 2017 John Wiley & Sons Australia, Ltd.

Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland.

PubMed

O'Donoghue, G; Cunningham, C; Murphy, F; Woods, C; Aagaard-Hansen, J

2014-06-01

To provide a snapshot of current activities, barriers and perceived training needs for the assessment and management of behavioural risk factors in physiotherapy practice in primary care settings in the Republic of Ireland. Cross-sectional survey of primary care physiotherapists. Two hundred and twenty primary care physiotherapists were invited to participate. Each received a questionnaire, consisting of 23 questions, within five key sections. Its main focus was the risk factor management practices of physiotherapists. Descriptive statistics and frequencies were used to analyse the data. A response rate of 74% (163/220) was achieved. Level of physical activity was the most common risk factor assessed at initial and follow-up visits (78%, 127/163), followed by dietary status (55%, 90/163). Few respondents included smoking status and alcohol consumption in their assessment; however, the majority considered them as risk factors that should be addressed. The main reasons why smoking status and alcohol consumption were not assessed were lack of time, limited knowledge and expertise, not traditionally viewed as the physiotherapist's role, and patient's lack of interest in changing their unhealthy behaviour. The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors. A number of strategies are required to improve the systematic assessment and management of these risk factors. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Reducing nonpoint source pollution through collaboration: policies and programs across the U.S. States.

PubMed

Hardy, Scott D; Koontz, Tomas M

2008-03-01

Nonpoint source (NPS) pollution has emerged as the largest threat to water quality in the United States, influencing policy makers and resource managers to direct more attention toward NPS prevention and remediation. In response, the United States Environmental Protection Agency (USEPA) spent more than $204 million in fiscal year (FY) 2006 on the Clean Water Act's Section 319 program to combat NPS pollution, much of it on the development and implementation of watershed-based plans. State governments have also increasingly allocated financial and technical resources to collaborative watershed efforts within their own borders to fight NPS pollution. With increased collaboration among the federal government, states, and citizens to combat NPS pollution, more information is needed to understand how public resources are being used, by whom, and for what, and what policy changes might improve effectiveness. Analysis from a 50-state study suggests that, in addition to the average 35% of all Section 319 funds per state that are passed on to collaborative watershed groups, 35 states have provided financial assistance beyond Section 319 funding to support collaborative watershed initiatives. State programs frequently provide technical assistance and training, in addition to financial resources, to encourage collaborative partnerships. Such assistance is typically granted in exchange for requirements to generate a watershed action plan and/or follow a mutually agreed upon work plan to address NPS pollution. Program managers indicated a need for greater fiscal resources and flexibility to achieve water quality goals.

The "New" Section 504: Student Issues in the Wake of the ADAAA

ERIC Educational Resources Information Center

Hardcastle, Lisa A.; Zirkel, Perry A.

2012-01-01

School leaders are familiar with the Individuals With Disabilities Education Act, but they also need to be legally literate about Section 504 of the Rehabilitation Act. This need is particularly pressing in the wake of significant recent changes in Section 504 as a result of the Americans With Disabilities Amendments Act. This case illustrates the…

78 FR 49700 - Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... health needs assessment requirements for any taxable year to file Form 4720, ``Return of Certain Excise... imposed by section 4959 for failure to meet the community health needs assessment requirements of section... Executive Order 12866, as supplemented by Executive Order 13563. Therefore, a regulatory assessment is not...

Numerical and Experimental Investigation of the Turbulent Flow in a Ribbed Serpentine Passage

NASA Technical Reports Server (NTRS)

Iaccarino, Gianluca; Kalitzin, Georgi; Elkins, Christopher J.

2003-01-01

In this paper, the turbulent flow in a serpentine with oblique ribs is investigated experimentally and by numerical simulations. The measurements are carried out by using Magnetic Resonance Velocimetry (MRV) and the simulations using the Immersed Boundary (IB) technique. A brief description of these two approaches is reported in following sections. The results are reported in terms of velocity distributions in various planes in the serpentine; differences between measurements and simulations are presented qualitatively and quantitatively. The study of the discrepancy allows us to identify areas of needed improvements in the turbulence modeling.

The Relationship Between Experiences of Lateral Violence and Career Choice Satisfaction Among Nursing Students.

PubMed

Furst, Cari

This article explores associate degree nursing students' experiences with lateral violence and its impact on career choice satisfaction. Lateral violence has been linked to decreased professional identity, increased errors, and poor self-esteem, leading to a negative culture and attrition. A nonexperimental, quantitative, cross-sectional, correlational design was used; 13.4 percent of respondents (n = 32) met the criteria for intermittent bullying. Analysis confirmed a significant negative correlation between experiences of lateral/vertical violence and career choice satisfaction (r = - .140, p < .05) even after controlling for affect and support. Improved efforts are needed to prevent lateral violence.

The satisfaction of families in the care of their loved ones in CCUs in Lebanon.

PubMed

Hajj, Madeleine; Gulgulian, Taline; Haydar, Lili; Saab, Amali; Dirany, Fatima; Badr, Lina Kurdahi

2017-07-01

The needs of family members vary among cultures and hospitals. Often, these needs remain unmet increasing their stress and anxiety and decreasing their satisfaction with care, which may negatively impact the quality of patient care. To assess the satisfaction of families with the care of their loved ones in critical care units (CCUs) in a large university medical centre in Lebanon and to assess the predictors of satisfaction. A cross-sectional descriptive design was conducted using the Critical Care Family Satisfaction Survey (CCFSS). The participants were 123 adult relatives or significant others of patients cared for in both adult and paediatric intensive care units for at least 3 days. The CCFSS showed acceptable internal reliability and construct validity in a Lebanese population. In general, families were satisfied with the care their loved ones received in the CCUs, and the least satisfaction was in the area of 'comfort' and the highest was in 'assurance'. Younger family members with more education were less satisfied with care and Christian families expressed less satisfaction with informational needs compared with Muslim families. Families of children in the paediatric CCU expressed least satisfaction with care. Gender, residency, relationship to patient, unit, prior experience in a CCU and diagnosis had no effect on satisfaction scores. Assessment of family satisfaction in different cultures is important as each culture has specific needs that are essential to decipher. Patient satisfaction leads to improved quality of care; thus, it behoves nurses to meet the needs of families from different cultures to help them cope and increase their satisfaction, which leads to improve patient outcomes. © 2015 British Association of Critical Care Nurses.

Antiretroviral drug diversion links social vulnerability to poor medication adherence in substance abusing populations.

PubMed

Tsuyuki, Kiyomi; Surratt, Hilary L

2015-05-01

Antiretroviral (ARV) medication diversion to the illicit market has been documented in South Florida, and linked to sub-optimal adherence in people living with HIV. ARV diversion reflects an unmet need for care in vulnerable populations that have difficulty engaging in consistent HIV care due to competing needs and co-morbidities. This study applies the Gelberg-Andersen behavioral model of health care utilization for vulnerable populations to understand how social vulnerability is linked to ARV diversion and adherence. Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in South Florida between 2010 and 2012 (n = 503). Structured interviews collected quantitative data on ARV diversion, access and utilization of care, and ARV adherence. Logistic regression was used to estimate the goodness-of-fit of additive models that test domain fit. Linear regression was used to estimate the effects of social vulnerability and ARV diversion on ARV adherence. The best fitting model to predict ARV diversion identifies having a low monthly income and unstable HIV care as salient enabling factors that promote ARV diversion. Importantly, health care need factors did not protect against ARV diversion, evidence that immediate competing needs are prioritized even in the face of poor health for this sample. We also find that ARV diversion provides a link between social vulnerability and sub-optimal ARV adherence, with ARV diversion and domains from the Behavioral Model explaining 25 % of the variation in ARV adherence. Our analyses reveal great need to improve engagement in HIV care for vulnerable populations by strengthening enabling factors (e.g. patient-provider relationship) to improve retention in HIV care and ARV adherence for vulnerable populations.

Improving referrals and integrating family planning and HIV services through organizational network strengthening.

PubMed

Thomas, James C; Reynolds, Heidi W; Alterescu, Xavier; Bevc, Christine; Tsegaye, Ademe

2016-04-01

The service needs of people with human immunodeficiency virus (HIV) in low-income settings are wide-ranging. Service provision in a community is often disjointed among a variety of providers. We sought to reduce unmet patient needs by increasing referral coordination for HIV and family planning, measured as network density, with an organizational network approach. We conducted organizational network analysis on two networks in sub-cities of Addis Ababa, Ethiopia. There were 25 organizations in one sub-city network and 26 in the other. In one of them we sought to increase referrals through three network strengthening meetings. We then conducted the network analysis again in both sub-cities to measure any changes since baseline. We also quantitatively measured reported client service needs in both sub-cities before and after the intervention with two cross-sectional samples of face-to-face interviews with clients (459 at baseline and 587 at follow-up). In the sub-city with the intervention, the number of referral connections between organizations, measured as network density, increased 55%. In the control community, the density decreased over the same period. Reported unmet client service needs declined more consistently across services in the intervention community. This quasi experiment demonstrated that (1) an organizational network analysis can inform an intervention, (2) a modest network strengthening intervention can enhance client referrals in the network, (3) improvement in client referrals was accompanied by a decrease in atient-reported unmet needs and (4) a series of network analyses can be a useful evaluation tool. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Elastic and inelastic neutron scattering cross sections for 12C at En = 5.9, 6.1, and 7.0 MeV

NASA Astrophysics Data System (ADS)

Lyons, Elizabeth; Hicks, Sally; Morin, Theodore; Derdeyn, Elizabeth; Peters, Erin

2017-09-01

Measurements of neutron elastic and inelastic scattering differential cross sections from 12C have been performed at incident neutron energies of 5.9, 6.1, and 7.0 MeV. Comparisons of existing experimental cross sections (NNDC) at these incident neutron energies reveal large discrepancies. Accurate measurements of 12C cross sections are vital to facilitate precise calculations regarding criticality conditions for nuclear reactors, advances in security screening methods, and better understanding astrophysical and nuclear phenomenon. During preliminary measurements of 12C cross sections at the University of Kentucky Accelerator Laboratory (UKAL), we realized the relative efficiency of the deuterated benzene (main) detector was needed over an unusually large range of neutron energies due to the high Q value of the first excited state of 12C. Those experiments were repeated during the summer of 2017 to measure in situ the relative detector efficiency with better beam conditions and a better understanding of background observed from the 2H(d, n)3He source reaction. The resulting improved detector efficiency was used in determining the neutron elastic and inelastic scattering cross sections. While the former were found to be in excellent agreement with evaluated cross sections from ENDF, the latter show some discrepancies, especially at 6.1 MeV. Our results will be presented. Research is supported by USDOE-NNSA-SSAP: NA0002931, NSF: PHY-1606890, and the Donald A. Cowan Physics Institute at the University of Dallas.

16 CFR 1500.91 - Determinations regarding lead content for certain materials or products under section 101 of the...

Code of Federal Regulations, 2010 CFR

2010-01-01

... certain materials or products under section 101 of the Consumer Product Safety Improvement Act. 1500.91 Section 1500.91 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL HAZARDOUS SUBSTANCES ACT... Safety Improvement Act. (a) The Consumer Product Safety Improvement Act provides for specific lead limits...

16 CFR 1500.89 - Procedures and requirements for determinations regarding lead content of materials or products...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Safety Improvement Act. 1500.89 Section 1500.89 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... materials or products under section 101(a) of the Consumer Product Safety Improvement Act. (a) The Consumer Product Safety Improvement Act provides for specific lead limits in children's products. Section 101(a) of...

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross-sectional survey.

PubMed

Phung, Viet-Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne; Siriwardena, Aloysius N

2016-02-01

Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). We used a self-administered online questionnaire survey sent to front-line clinicians in all 12 English ambulance services. We conducted a cross-sectional analysis of quantitative data and qualitative analysis of free-text responses. There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre-hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large-scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

78 FR 59228 - Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-26

... the community health needs assessment (CHNA) requirements for any taxable year. DATES: This correction... the reporting of the excise tax under section 4959 of the Internal Revenue Code. Need for Correction... misleading and are in need of clarification. Correction of Publication Accordingly, the final and temporary...

The MPI-Mainz UV/VIS Spectral Atlas of Gaseous Molecules of Atmospheric Interest

NASA Astrophysics Data System (ADS)

Sander, Rolf; Keller-Rudek, Hannelore; Moortgat, Geert; Sörensen, Rüdiger

2014-05-01

Measurements from satellites can be used to obtain global concentration maps of atmospheric trace constituents. Critical parameters needed in the analysis of the satellite data are the absorption cross sections of the observed molecules. Here, we present the MPI-Mainz UV/VIS Spectral Atlas, which is a large collection of more than 5000 absorption cross section and quantum yield data files in the ultraviolet and visible (UV/VIS) wavelength region for gaseous molecules and radicals primarily of atmospheric interest. The data files contain results of individual measurements, covering research of almost a whole century. To compare and visualize the data sets, multicoloured graphical representations have been created. The Spectral Atlas is available on the internet at http://www.uv-vis-spectral-atlas-mainz.org. It has been completely overhauled and now appears with improved browse and search options, based on PostgreSQL, Django and Python database software. The web pages are continuously updated.

Nutritional attitudes of homosexual people living with human immunodeficiency virus (HIV) in Chongqing, Southwest China: a cross-sectional study.

PubMed

Zhou, Wenjie; Ma, Rui; Sharma, Manoj; Zhao, Yong

This article aimed at understanding nutritional knowledge, attitudes, and behaviors of homosexual persons living with HIV/AIDS in Chongqing, China. A cross sectional design using a valid and reliable survey was used. The survey was completed in Chongqing, Southwest China (n = 172). Knowledge of nutrition was deficient regarding sources of nutrients such as calcium and iron, relationships between diet/nutrients and disease, and only 36.1% of participants knew about the Balanced Diet Pagoda for Chinese. Eating habits did not meet the nutritional requirements, and a majority (59.3%) did not eat breakfast every day. The average score on the knowledge quiz was 51.8%. This study showed that homosexual persons with HIV/AIDS in China longed for nutrition knowledge, and this was supported by objective data. Efforts and targeted education programs aiming to improve their nutrition knowledge, attitudes, and behaviors need to be emphasized.

The importance of social media for patients and families affected by congenital anomalies: A Facebook cross-sectional analysis and user survey.

PubMed

Jacobs, Robyn; Boyd, Leanne; Brennan, Kirsty; Sinha, C K; Giuliani, Stefano

2016-11-01

We aimed to define characteristics and needs of Facebook users in relation to congenital anomalies. Cross-sectional analysis of Facebook related to four congenital anomalies: anorectal malformation (ARM), congenital diaphragmatic hernia (CDH), congenital heart disease (CHD) and hypospadias/epispadias (HS/ES). A keyword search was performed to identify relevant Groups/Pages. An anonymous survey was posted to obtain quantitative/qualitative data on users and their healthcare needs. 54 Groups and 24 Pages were identified (ARM: 10 Groups; CDH: 9 Groups, 7 Pages; CHD: 32 Groups, 17 Pages; HS/ES: 3 Groups), with 16,191 Group members and 48,766 Page likes. 868/1103 (79%) of respondents were parents. Male:female ratio was 1:10.9. 65% of the users were 26-40years old. Common reasons for joining these Groups/Pages included: seeking support, education, making friends, and providing support to others. 932/1103 (84%) would like healthcare professionals (HCPs) to actively participate in their Group. 31% of the respondents felt that they did not receive enough support from their healthcare system. 97% of the respondents would like to join a Group linked to their primary hospital. Facebook Groups/Pages related to congenital anomalies are highly populated and active. There is a need for HCPs and policy makers to better understand and participate in social media to support families and improve patient care. Copyright © 2016 Elsevier Inc. All rights reserved.

Would a new definition and classification of nocturia and nocturnal polyuria improve our management of patients? ICI-RS 2014.

PubMed

Bosch, J L H Ruud; Everaert, Karel; Weiss, Jeffrey P; Hashim, Hashim; Rahnama'i, M Sajjad; Goessaert, An-Sofie; Aizen, Joshua

2016-02-01

The following is a report of the proceedings of the Nocturia Think Tank sessions of the annual International Consultation on Incontinence-Research Society, which took place September 22-24, 2014 in Bristol, UK. The report is organized into sections pertaining to the main topic of discussion focussing on the question as to whether a new definition and classification of nocturia and nocturnal polyuria would improve the outcome of management in our patients. First, discussions identified theoretical and practical shortcomings of current definitions. Secondly, the utility of several nocturnal polyuria definitions was tested in a real life population in relation to the symptom nocturia, in order to display weaknesses of these definitions. Thirdly, we explored in a clinical population the utility of bladder diary based parameters by asking the question: when nocturia improves, which of these parameters improve most? Based on the above explorations the Think Tank summarized elements of the current definitions that need reconsideration and suggests proposals for further research to reach more practical and more clinically meaningful definitions. © 2015 Wiley Periodicals, Inc.

Review and assessment of the database and numerical modeling for turbine heat transfer

NASA Technical Reports Server (NTRS)

Gladden, H. J.; Simoneau, R. J.

1989-01-01

The objectives of the NASA Hot Section Technology (HOST) Turbine Heat Transfer subproject were to obtain a better understanding of the physics of the aerothermodynamic phenomena and to assess and improve the analytical methods used to predict the flow and heat transfer in high-temperature gas turbines. At the time the HOST project was initiated, an across-the-board improvement in turbine design technology was needed. A building-block approach was utilized and the research ranged from the study of fundamental phenomena and modeling to experiments in simulated real engine environments. Experimental research accounted for approximately 75 percent of the funding while the analytical efforts were approximately 25 percent. A healthy government/industry/university partnership, with industry providing almost half of the research, was created to advance the turbine heat transfer design technology base.

Hospital nurses' working conditions in relation to motivation and patient safety.

PubMed

Toode, Kristi; Routasalo, Pirkko; Helminen, Mika; Suominen, Tarja

2015-03-01

There is a lack of empirical knowledge about nurses' perceptions of their workplace characteristics and conditions, such as level of autonomy and decision authority, work climate, teamwork, skill exploitation and learning opportunities, and their work motivation in relation to practice outputs such as patient safety. Such knowledge is needed particularly in countries, such as Estonia, where hospital systems for preventing errors and improving patient safety are in the early stages of development. This article reports the findings from a cross-sectional survey of hospital nurses in Estonia that was aimed at determining their perceptions of workplace characteristics, working conditions, work motivation and patient safety, and at exploring the relationship between these. Results suggest that perceptions of personal control over their work can affect nurses' motivation, and that perceptions of work satisfaction might be relevant to patient safety improvement work.

A methodological analysis of chaplaincy research: 2000-2009.

PubMed

Galek, Kathleen; Flannelly, Kevin J; Jankowski, Katherine R B; Handzo, George F

2011-01-01

The present article presents a comprehensive review and analysis of quantitative research conducted in the United States on chaplaincy and closely related topics published between 2000 and 2009. A combined search strategy identified 49 quantitative studies in 13 journals. The analysis focuses on the methodological sophistication of the studies, compared to earlier research on chaplaincy and pastoral care. Cross-sectional surveys of convenience samples still dominate the field, but sample sizes have increased somewhat over the past three decades. Reporting of the validity and reliability of measures continues to be low, although reporting of response rates has improved. Improvements in the use of inferential statistics and statistical controls were also observed, compared to previous research. The authors conclude that more experimental research is needed on chaplaincy, along with an increased use of hypothesis testing, regardless of the research designs that are used.

Factors associated to acceptable treatment adherence among children with chronic kidney disease in Guatemala

PubMed Central

Cerón, Alejandro; Méndez-Alburez, Luis Pablo; Lou-Meda, Randall

2017-01-01

Pediatric patients with Chronic Kidney Disease face several barriers to medication adherence that, if addressed, may improve clinical care outcomes. A cross sectional questionnaire was administered in the Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City) from September of 2015 to April of 2016 to identify the predisposing factors, enabling factors and need factors related to medication adherence. Sample size was calculated using simple random sampling with a confidence level of 95%, confidence interval of 0.05 and a proportion of 87%. A total of 103 participants responded to the questionnaire (calculated sample size was 96). Independent variables were defined and described, and the bivariate relationship to dependent variables was determined using Odds Ratio. Multivariate analysis was carried out using logistic regression. The mean adherence of study population was 78% (SD 0.08, max = 96%, min = 55%). The mean adherence in transplant patients was 82% (SD 7.8, max 96%, min 63%), and the mean adherence in dialysis patients was 76% (SD 7.8 max 90%, min 55%). Adherence was positively associated to the mother’s educational level and to higher monthly household income. Together predisposing, enabling and need factors illustrate the complexities surrounding adherence in this pediatric CKD population. Public policy strategies aimed at improving access to comprehensive treatment regimens may facilitate treatment access, alleviating economic strain on caregivers and may improve adherence outcomes. PMID:29036228

Factors associated to acceptable treatment adherence among children with chronic kidney disease in Guatemala.

PubMed

Ramay, Brooke M; Cerón, Alejandro; Méndez-Alburez, Luis Pablo; Lou-Meda, Randall

2017-01-01

Pediatric patients with Chronic Kidney Disease face several barriers to medication adherence that, if addressed, may improve clinical care outcomes. A cross sectional questionnaire was administered in the Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City) from September of 2015 to April of 2016 to identify the predisposing factors, enabling factors and need factors related to medication adherence. Sample size was calculated using simple random sampling with a confidence level of 95%, confidence interval of 0.05 and a proportion of 87%. A total of 103 participants responded to the questionnaire (calculated sample size was 96). Independent variables were defined and described, and the bivariate relationship to dependent variables was determined using Odds Ratio. Multivariate analysis was carried out using logistic regression. The mean adherence of study population was 78% (SD 0.08, max = 96%, min = 55%). The mean adherence in transplant patients was 82% (SD 7.8, max 96%, min 63%), and the mean adherence in dialysis patients was 76% (SD 7.8 max 90%, min 55%). Adherence was positively associated to the mother's educational level and to higher monthly household income. Together predisposing, enabling and need factors illustrate the complexities surrounding adherence in this pediatric CKD population. Public policy strategies aimed at improving access to comprehensive treatment regimens may facilitate treatment access, alleviating economic strain on caregivers and may improve adherence outcomes.

Life, lifestyle and location: examining the complexities of psychological distress in young adult Indigenous and non-Indigenous Australians.

PubMed

Davison, B; Nagel, T; Singh, G R

2017-10-01

Mental health is fundamental to an individual's health and well-being. Mental health disorders affect a substantial portion of the Australian population, with the most vulnerable time in adolescence and young adulthood. Indigenous Australians fare worse than other Australians on almost every measure of physical and mental health. Cross-sectional data from young adults (21-27 years) participating in the Life Course Program, Northern Territory, Australia, is presented. Rates of psychological distress were high in remote and urban residing Indigenous and urban non-Indigenous young adults. This rate was more pronounced in young women, particularly in Indigenous remote and urban residing women. Young adults with high psychological distress also had lower levels of positive well-being, higher perceived stress levels, experienced a higher number of major life events and were at an increased risk of suicidal ideation and/or self-harm. This study supports the need for a continued focus on early screening and treatment at this vulnerable age. The significant association seen between psychological distress and other markers of emotional well-being, particularly risk of suicidal ideation and/or self-harm, highlights the need for a holistic approach to mental health assessment and treatment. A concerted focus on improving the environs of young adults by lowering levels of stress, improving access to adequate housing, educational and employment opportunity, will assist in improving the emotional health of young adults.

The research of new type stratified water injection process intelligent measurement technology

NASA Astrophysics Data System (ADS)

Zhao, Xin

2017-10-01

To meet the needs of injection and development of Daqing Oilfield, the injection of oil from the early stage of general water injection to the subdivision of water is the purpose of improving the utilization degree and the qualified rate of water injection, improving the performance of water injection column and the matching process. Sets of suitable for high water content of the effective water injection technology supporting technology. New layered water injection technology intelligent measurement technology will be more information testing and flow control combined into a unified whole, long-term automatic monitoring of the work of the various sections, in the custom The process has the characteristics of "multi-layer synchronous measurement, continuous monitoring of process parameters, centralized admission data", which can meet the requirement of subdivision water injection, but also realize the automatic synchronization measurement of each interval, greatly improve the efficiency of tiered injection wells to provide a new means for the remaining oil potential.

Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options—a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference

PubMed Central

Kirchhof, Paulus; Lip, Gregory Y.H.; Van Gelder, Isabelle C.; Bax, Jeroen; Hylek, Elaine; Kaab, Stefan; Schotten, Ulrich; Wegscheider, Karl; Boriani, Giuseppe; Brandes, Axel; Ezekowitz, Michael; Diener, Hans; Haegeli, Laurent; Heidbuchel, Hein; Lane, Deirdre; Mont, Luis; Willems, Stephan; Dorian, Paul; Aunes-Jansson, Maria; Blomstrom-Lundqvist, Carina; Borentain, Maria; Breitenstein, Stefanie; Brueckmann, Martina; Cater, Nilo; Clemens, Andreas; Dobrev, Dobromir; Dubner, Sergio; Edvardsson, Nils G.; Friberg, Leif; Goette, Andreas; Gulizia, Michele; Hatala, Robert; Horwood, Jenny; Szumowski, Lukas; Kappenberger, Lukas; Kautzner, Josef; Leute, Angelika; Lobban, Trudie; Meyer, Ralf; Millerhagen, Jay; Morgan, John; Muenzel, Felix; Nabauer, Michael; Baertels, Christoph; Oeff, Michael; Paar, Dieter; Polifka, Juergen; Ravens, Ursula; Rosin, Ludger; Stegink, W.; Steinbeck, Gerhard; Vardas, Panos; Vincent, Alphons; Walter, Maureen; Breithardt, Günter; Camm, A. John

2012-01-01

While management of atrial fibrillation (AF) patients is improved by guideline-conform application of anticoagulant therapy, rate control, rhythm control, and therapy of accompanying heart disease, the morbidity and mortality associated with AF remain unacceptably high. This paper describes the proceedings of the 3rd Atrial Fibrillation NETwork (AFNET)/European Heart Rhythm Association (EHRA) consensus conference that convened over 60 scientists and representatives from industry to jointly discuss emerging therapeutic and diagnostic improvements to achieve better management of AF patients. The paper covers four chapters: (i) risk factors and risk markers for AF; (ii) pathophysiological classification of AF; (iii) relevance of monitored AF duration for AF-related outcomes; and (iv) perspectives and needs for implementing better antithrombotic therapy. Relevant published literature for each section is covered, and suggestions for the improvement of management in each area are put forward. Combined, the propositions formulate a perspective to implement comprehensive management in AF. PMID:21791573

Pyroshock: Bibliography

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

Zimmerman, R.M.

1993-01-01

This paper represents a review copy for text that is to be included in the Shock and Vibration Recommended Practice Document. This section on pyroshock is written an a general introduction to and description of the topic loading to presentation of an extensive bibliography on the subject. Pyroshock is an evolving science that needs continued focus on both achieving improvements in testing and measurement techniques and advancing instrumentation capabilities. When desired in the near future, recommended practices can be presented. Pyroshock phenomena are associated with separation systems of missiles. spacecraft, and in some cases airplanes. During launch, a rocket drivenmore » vehicle may be exposed to 19 to 30 g's of acceleration with predominant frequencies less than 200 Hz. After launch or takeoffs sections or parts of vehicles may be separated rapidly using explosive driven release mechanisms. Separations can involve stage disconnections for spacecraft sections or payload ejections from missiles and airplanes. At separation, localized pyrotechnic induced accelerations may range from 1000 to over 100,000 g's at frequencies much higher than 1000 Hz. These pyroshocks are characterized by high intensity, high frequency transients that decay rapidly. Pyroshock impulses have insignificant velocity changes.« less

Three Software Tools for Viewing Sectional Planes, Volume Models, and Surface Models of a Cadaver Hand.

PubMed

Chung, Beom Sun; Chung, Min Suk; Shin, Byeong Seok; Kwon, Koojoo

2018-02-19

The hand anatomy, including the complicated hand muscles, can be grasped by using computer-assisted learning tools with high quality two-dimensional images and three-dimensional models. The purpose of this study was to present up-to-date software tools that promote learning of stereoscopic morphology of the hand. On the basis of horizontal sectioned images and outlined images of a male cadaver, vertical planes, volume models, and surface models were elaborated. Software to browse pairs of the sectioned and outlined images in orthogonal planes and software to peel and rotate the volume models, as well as a portable document format (PDF) file to select and rotate the surface models, were produced. All of the software tools were downloadable free of charge and usable off-line. The three types of tools for viewing multiple aspects of the hand could be adequately employed according to individual needs. These new tools involving the realistic images of a cadaver and the diverse functions are expected to improve comprehensive knowledge of the hand shape. © 2018 The Korean Academy of Medical Sciences.

Three Software Tools for Viewing Sectional Planes, Volume Models, and Surface Models of a Cadaver Hand

PubMed Central

2018-01-01

Background The hand anatomy, including the complicated hand muscles, can be grasped by using computer-assisted learning tools with high quality two-dimensional images and three-dimensional models. The purpose of this study was to present up-to-date software tools that promote learning of stereoscopic morphology of the hand. Methods On the basis of horizontal sectioned images and outlined images of a male cadaver, vertical planes, volume models, and surface models were elaborated. Software to browse pairs of the sectioned and outlined images in orthogonal planes and software to peel and rotate the volume models, as well as a portable document format (PDF) file to select and rotate the surface models, were produced. Results All of the software tools were downloadable free of charge and usable off-line. The three types of tools for viewing multiple aspects of the hand could be adequately employed according to individual needs. Conclusion These new tools involving the realistic images of a cadaver and the diverse functions are expected to improve comprehensive knowledge of the hand shape. PMID:29441756

Elderly health beliefs, attitudes, and maintenance.

PubMed

Jensen, J; Counte, M A; Glandon, G L

1992-07-01

Why older persons engage in varying amounts of health maintenance activity is becoming both an increasingly important policy issue and a topic of interest to health services researchers. Such activity may help the elderly to delay the onset of the health-related problems associated with aging, maintain if not improve their functional abilities, and perhaps improve their quality of life. Using a conceptual model largely based upon the health belief model, this study sought to examine predictors of variability of health maintenance activity among older persons. The project included cross-sectional data drawn from the first phase of a multiyear panel study of elderly community residents. Results of ordinary least-squares and logistic regression analyses of seven types of health maintenance activity suggest that health beliefs are an important consideration but that other variables, namely, type of insurance plan and select sociodemographic factors, also had significant impacts. Another consistent finding was that each of the types of health maintenance activity was associated with different types of predictor variables. These findings suggest that in order for levels of health maintenance activity to be increased, intervention programs need to be targeted toward specific types of health beliefs and need to take into account the importance of social differences.

A comparison of parent satisfaction in an open-bay and single-family room neonatal intensive care unit.

PubMed

Stevens, Dennis C; Helseth, Carol C; Khan, M Akram; Munson, David P; Reid, E J

2011-01-01

The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU). This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities. Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility. Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.

Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display

PubMed Central

Clarke, M.A.; Steege, L.M.; Moore, J.L.; Koopman, R.J.; Belden, J.L.; Kim, M.S.

2014-01-01

Summary Background With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display. Method Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller’s and Cochran Q. Results Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians’ highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes. Conclusion A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly “not needed,” but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load. PMID:24734131

Educational treasures in radiology: a free online program for Radiology Boards preparation.

PubMed

Talanow, Roland

2011-01-01

An objective tool is desired, which optimally prepares for Radiology boards examination. Such program should prepare examinees with pertinent radiological contents and simulations as expected in the real examination. Many countries require written boards examinations for Radiology certification eligibility. No objective measure exists to tell if the examinee is ready to pass the exam or not. Time pressure and computer environment might be unfamiliar to examinees. Traditional preparation lectures don't simulate the "real" Radiology exam because they don't provide the special environment with multiple choice questions and timing. This online program consists of 4 parts. The entry section allows to create questions with additional fields for comprehensive information. Sections include Pediatrics/Mammography/GI/IR/Nucs/Thoracic/Musculoskeletal/GU/Neuro/Ultrasound/Cardiac/OB/GYN and Miscellaneous. Experienced radiologists and educators evaluate and release/delete these entries in the administrator section. In the exam section users can create (un)timed customized exams for individual needs and learning pace. Exams can either include all sections or only specific sections to gear learning towards areas with weaker performance. Comprehensive statistics unveil the user's strengths and weaknesses to help focussing on "weak" areas. In the search section a comprehensive search and review can be performed by searching the entire database for keywords/topics or only searching within specific sections. www.RadiologyBoards.org is a new working concept of Radiology boards preparation to detect and improve the examinee's weaknesses and finally to increase the examinee's confidence level for the final exam. It is beneficial for Radiology residents and also board certified radiologists to refresh/maintain radiological knowledge.

A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities

PubMed Central

2013-01-01

Background Homeless persons experience a high burden of health problems; yet, they face significant barriers in accessing health care. Less is known about unmet needs for care among vulnerably housed persons who live in poor-quality or temporary housing and are at high risk of becoming homeless. The objectives of this study were to examine the prevalence of and factors associated with unmet needs for health care in a population-based sample of homeless and vulnerably housed adults in three major cities within a universal health insurance system. Methods Participants were recruited at shelters, meal programs, community health centers, drop-in centers, rooming houses, and single room occupancy hotels in Vancouver, Toronto, and Ottawa, Canada, throughout 2009. Baseline interviews elicited demographic characteristics, health status, and barriers to health care. Logistic regression was used to identify factors associated with self-reported unmet needs for health care in the past 12 months. Results Of the 1,181 participants included in the analysis, 445 (37%) reported unmet needs. In adjusted analyses, factors associated with a greater odds of reporting unmet needs were having employment in the past 12 months (AOR = 1.40, 95% CI = 1.03–1.91) and having ≥3 chronic health conditions (AOR = 2.17, 95% CI = 1.24–3.79). Having higher health-related quality of life (AOR = 0.21, 95% CI = 0.09–0.53), improved mental (AOR = 0.97, 95% CI = 0.96–0.98) or physical health (AOR = 0.98, 95% CI = 0.96–0.99), and having a primary care provider (AOR = 0.63, 95% CI = 0.46–0.85) decreased the odds of reporting unmet needs. Conclusions Homeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed. PMID:23764199

Cross-sectional survey of patients' need for information and support with medicines after discharge from hospital.

PubMed

Mackridge, Adam J; Rodgers, Ruth; Lee, Dan; Morecroft, Charles W; Krska, Janet

2017-11-20

Most patients experience changes to prescribed medicines during a hospital stay. Ensuring they understand such changes is important for preventing adverse events post-discharge and optimising patient understanding. However, little work has explored the information that patients receive about medicines or their perceived needs for information and support after discharge. To determine information that hospital inpatients who experience medicine changes receive about their medicines during admission and their needs and preferences for, and use of, post-discharge support. Cross-sectional survey with adult medical inpatients experiencing medicine changes in six English hospitals, with telephone follow-up 2-3 weeks post-discharge. A total of 444 inpatients completed surveys, and 99 of these were followed up post-discharge. Of the 444, 44 (10%) were unaware of changes to medicines and 65 (16%) did not recall discussing them with a health professional, but 305 (77%) reported understanding the changes. Type of information provided and patients' perceived need for post-discharge support differed between hospitals. Information about changes was most frequently provided by consultant medical staff (157; 39%) with pharmacists providing information least often (71; 17%). One third of patients surveyed considered community pharmacists as potential sources of information about medicines and associated support post-discharge. Post-discharge, just 5% had spoken to a pharmacist, although 35% reported medicine-related problems. In north-west England, patient inclusion in treatment decisions could be improved, but provision of information prior to discharge is reasonable. There is scope to develop hospital and community pharmacists' role in medicine optimisation to maximise safety and effectiveness of care. © 2017 Royal Pharmaceutical Society.

Cross-sectional associations between psychological traits, and HPV vaccine uptake and intentions in young adults from the United States.

PubMed

Scherer, Aaron M; Schacht Reisinger, Heather; Schweizer, Marin L; Askelson, Natoshia M; Fagerlin, Angela; Lynch, Charles F

2018-01-01

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and can lead to the development of genital warts, and cancers throughout the body. Despite the availability of HPV vaccines for over a decade, uptake in the United States among adolescents and young adults remains well below national targets. While most efforts to improve HPV vaccine uptake have rightly focused on adolescents, there is still a tremendous opportunity to improve vaccination among young adults who have not been vaccinated against HPV. To that end, we report an exploratory examination of associations between HPV vaccination status and intentions with psychological traits that may impact HPV vaccine uptake with a national, demographically diverse sample of young adults (N = 1358) who completed an online survey. These psychological traits conceptually mapped onto motivations to: 1) understand health-related information, 2) deliberate, 3) manage uncertainty, and 4) manage threats. We found notable gender differences for the association of these motivations and vaccination status. For women, higher interest in and ability to understand health-related information seemed to distinguish those who reported receiving the HPV vaccine from those who did not. For men, less need to deliberate and greater needs to manage threat and uncertainty seemed to be the distinguishing motives for those who reported receiving the HPV vaccine compared to those who did not. Results for vaccination intentions were less consistent, but there was some evidence to indicate that, regardless of gender, greater health-related information interest and understanding and need to manage uncertainty and threats were associated with increased intention to receive the HPV vaccine, while greater need to deliberate was associated with decreased vaccination intentions. These results suggest that there are psychological differences that are associated with HPV vaccination decisions and that these motivations should be considered in efforts to improve HPV vaccine uptake.

Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage.

PubMed

Mugali, Raveesha R; Mansoor, Farooq; Parwiz, Sardar; Ahmad, Fazil; Safi, Najibullah; Higgins-Steele, Ariel; Varkey, Sherin

2017-04-04

Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births. The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12-23 months. Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%). The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Depression, anxiety, and suicidal ideation among Vietnamese secondary school students and proposed solutions: a cross-sectional study.

PubMed

Nguyen, Dat Tan; Dedding, Christine; Pham, Tam Thi; Wright, Pamela; Bunders, Joske

2013-12-17

There is a rapidly growing public awareness of mental health problems among Vietnamese secondary school students. This study aims to determine the prevalence of anxiety, depression, and suicidal ideation, to identify related risk factors, and to explore students' own proposals for improving their mental health. A cross-sectional study was conducted among 1161 secondary students in Can Tho City, Vietnam during September through December, 2011. A structured questionnaire was used to assess anxiety, depression, suicidal ideation and proposed solutions. Depression was measured using the Center for Epidemiology Studies Depression Scale. The prevalence estimates of symptoms reaching a threshold comparable to a diagnosis of anxiety and depression were 22.8% and 41.1%, respectively. Suicide had been seriously considered by 26.3% of the students, while 12.9% had made a suicide plan and 3.8% had attempted suicide. Major risk factors related to anxiety and depression were physical or emotional abuse by the family, and high educational stress. As proposed solutions, nearly 80% of students suggested that the academic workload should be reduced and that confidential counselors should be appointed at schools. About half the students stated that the attitudes of their parents and teachers needed to change. A significant majority said that they would visit a website that provided mental health support for students. Anxiety, depression, and suicidal ideation are common among Vietnamese secondary school students. There are strong associations with physical and emotional abuse in the family and high educational stress. Academic curricula and attitudes of parents and teachers need to be changed from a punitive to a more supportive approach to reduce the risk of poor mental health. An internet-based mental health intervention could be a feasible and effective first step to improve students' mental health.

Implementation issues relevant to outpatient neurology palliative care.

PubMed

Kluger, Benzi M; Persenaire, Michael J; Holden, Samantha K; Palmer, Laura T; Redwine, Hannah; Berk, Julie; Anderson, C Alan; Filley, Christopher M; Kutner, Jean; Miyasaki, Janis; Carter, Julie

2017-11-29

There is growing interest in the application of palliative care principles to improve care for patients and families affected by neurologic diseases. We developed an interdisciplinary outpatient clinic for patients and families affected by neurologic disorders to better address the problems faced by our highest need patients. We have developed and improved this program over the past three years and share several of our most important lessons as well as ongoing challenges and areas where we see our clinic evolving in the future. We provide a description of our clinic logistics, including key steps in the initiation of the clinic, and provide descriptions from similar clinics at other institutions to demonstrate some of the variability in this growing field. We also provide results from a formal one-year quality improvement project and a one-year retrospective study of patients attending this clinic. Our clinic has grown steadily since its inception and maintains high satisfaction ratings from patients, caregivers, and referring providers. To maintain standardized and efficient care we have developed materials for patients and referring physicians as well as checklists and other processes used by our interdisciplinary team. Feedback from our quality improvement project helped define optimal visit duration and refine communication among team members and with patients and families. Results from our chart review suggest our clinic influences advance care planning and place of death. Common referral reasons include psychosocial support, complex symptom management, and advance care planning. Current challenges for our clinic include developing a strategy for continued growth, creating a sustainable financial model for interdisciplinary care, integrating our services with disease-specific sections, improving primary palliative care knowledge and skills within our referral base, and building effective alliances with community neurologists, geriatrics, primary care, nursing homes, and hospices. Specialized outpatient palliative care for neurologic disorders fills several important gaps in care for this patient population, provides important educational opportunities for trainees, and creates opportunities for patient and caregiver-centered research. Educational initiatives are needed to train general neurologists in primary palliative care, to train neurologists in specialist palliative care, and to train palliative medicine specialists in neurology. Research is needed to build an evidence base to identify patient and caregiver needs, support specific interventions, and to build more efficient models of care in both academic and community settings.

Intelligent Memory Module Overcomes Harsh Environments

NASA Technical Reports Server (NTRS)

2008-01-01

Solar cells, integrated circuits, and sensors are essential to manned and unmanned space flight and exploration, but such systems are highly susceptible to damage from radiation. Especially problematic, the Van Allen radiation belts encircle Earth in concentric radioactive tori at distances from about 6,300 to 38,000 km, though the inner radiation belt can dip as low as 700 km, posing a severe hazard to craft and humans leaving Earth s atmosphere. To avoid this radiation, the International Space Station and space shuttles orbit at altitudes between 275 and 460 km, below the belts range, and Apollo astronauts skirted the edge of the belts to minimize exposure, passing swiftly through thinner sections of the belts and thereby avoiding significant side effects. This radiation can, however, prove detrimental to improperly protected electronics on satellites that spend the majority of their service life in the harsh environment of the belts. Compact, high-performance electronics that can withstand extreme environmental and radiation stress are thus critical to future space missions. Increasing miniaturization of electronics addresses the need for lighter weight in launch payloads, as launch costs put weight at a premium. Likewise, improved memory technologies have reduced size, cost, mass, power demand, and system complexity, and improved high-bandwidth communication to meet the data volume needs of the next-generation high-resolution sensors. This very miniaturization, however, has exacerbated system susceptibility to radiation, as the charge of ions may meet or exceed that of circuitry, overwhelming the circuit and disrupting operation of a satellite. The Hubble Space Telescope, for example, must turn off its sensors when passing through intense radiation to maintain reliable operation. To address the need for improved data quality, additional capacity for raw and processed data, ever-increasing resolution, and radiation tolerance, NASA spurred the development of the Radiation Tolerant Intelligent Memory Stack (RTIMS).

Differences in psychosocial determinants of hand hygiene between health care professional groups: Insights from a mixed-methods analysis.

PubMed

Ibrahim, Muhamad Alif Bin; Chow, Chengzi; Poh, Bee Fong; Ang, Brenda; Chow, Angela

2018-03-01

Good hand hygiene (HH) prevents health care-associated infections. We compared psychosocial and organizational factors associated with HH compliance and perceived need for improvement among physicians, nurses, and allied health professionals (AHPs). We conducted a mixed-methods study in a 1,600-bed adult tertiary-care hospital in Singapore. Seven focus group discussions were conducted and data were analyzed using thematic analysis. The subsequent cross-sectional survey involved 1,064 staff members. Principal components analysis was performed to derive the latent factor structure that was applied in multivariable analyses. All staff members acknowledged that HH was an integral part of their work, but were noncompliant due to competing priorities. Physicians were forgetful but appreciated reminders. Nurses were intrinsically motivated for HH. After adjusting for gender, staff category, seniority, and dermatitis history, having positive knowledge-attitudes-behaviors (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.23-1.69), personal motivators-enablers (OR, 1.60; 95% CI, 1.38-1.86), and emotional motivators (OR, 1.62; 95% CI 1.40-1.88) were positively associated with good HH compliance. Women (OR, 3.91; 95% CI, 1.37-11.11), seniors (OR, 2.88; 95% CI, 1.08-7.68), nurses (OR, 4.05; 95% CI, 1.51-10.87), and staff with personal motivators-enablers for HH (OR, 1.60; 95% CI, 1.08-2.37) were more likely to perceive a need for improvement. Factors influencing self-reported HH differed between health care professional groups. Group-specific interventions are needed to improve compliance. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

MOSTELLER, RUSSELL D.

Previous studies have indicated that ENDF/B-VII preliminary releases {beta}-2 and {beta}-3, predecessors to the recent initial release of ENDF/B-VII.0, produce significantly better overall agreement with criticality benchmarks than does ENDF/B-VI. However, one of those studies also suggests that improvements still may be needed for thermal plutonium cross sections. The current study substantiates that concern by examining criticality benchmarks for unreflected spheres of plutonium-nitrate solutions and for slightly and heavily borated mixed-oxide (MOX) lattices. Results are presented for the JEFF-3.1 and JENDL-3.3 nuclear data libraries as well as ENDF/B-VII.0 and ENDF/B-VI. It is shown that ENDF/B-VII.0 tends to overpredict reactivity formore » thermal plutonium benchmarks over at least a portion of the thermal range. In addition, it is found that additional benchmark data are needed for the deep thermal range.« less

Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients.

PubMed

Boyle, Joseph; Speroff, Theodore; Worley, Katherine; Cao, Aize; Goggins, Kathryn; Dittus, Robert S; Kripalani, Sunil

2017-11-01

To examine the association of health literacy with the number and type of transitional care needs (TCN) among patients being discharged to home. A cross-sectional analysis of patients admitted to an academic medical center. Nurses administered the Brief Health Literacy Screen and documented TCNs along 10 domains: caregiver support, transportation, healthcare utilization, high-risk medical comorbidities, medication management, medical devices, functional status, mental health comorbidities, communication, and financial resources. Among the 384 patients analyzed, 113 (29%) had inadequate health literacy. Patients with inadequate health literacy had needs in more TCN domains (mean = 5.29 vs 4.36; P < 0 .001). In unadjusted analysis, patients with inadequate health literacy were significantly more likely to have TCNs in 7 out of the 10 domains. In multivariate analyses, inadequate health literacy remained significantly associated with inadequate caregiver support (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.37-4.99) and transportation barriers (OR, 1.69; 95% CI, 1.04-2.76). Among hospitalized patients, inadequate health literacy is prevalent and independently associated with other needs that place patients at a higher risk of adverse outcomes, such as hospital readmission. Screening for inadequate health literacy and associated needs may enable hospitals to address these barriers and improve postdischarge outcomes. © 2017 Society of Hospital Medicine

Moving to a Soft Path for Water: Integrated Research and Management Needs

NASA Astrophysics Data System (ADS)

Gleick, P. H.

2011-12-01

Water on Earth in its three fundamental phases is integral to the functioning, dynamics, and variability of the global climatological and biological support systems. From a purely scientific point of view, understanding the complexity of the hydrological cycle is of paramount interest and central to our understanding of other planetary geological, atmospheric, chemical, and physical processes. But water is more than that: water is key to economic, social, and political issues as well, including some of the core challenges of our time such central to issues of poverty, health, environmental sustainability, conflict, and economic prosperity. The more society seeks to solve these challenges, the more obvious it becomes that we must improve more than just our understanding of the fundamental science of the hydrological cycle and its links with related global processes; we must also improve our understanding of the complex social, economic, and structural challenges facing water managers and users. We must move to a different paradigm where water is managed in a far more integrated way - what I call the "soft path for water." Central to our basic science needs are (1) an expansion of the frequency and nature of the data we collect, (2) the development of systems for managing, sharing, and analyzing those data, and (3) improvements in our ability to model and forecast the hydrological cycle together with other climatological, geophysical, and biochemical systems. These improvements would lead to a far better understanding of the local, regional, and global details of the water balance on timescales from minutes to millennia. These needs are increasingly well understood in the research community and extensive efforts in these areas are underway under the auspices of national research centers, universities, and international scientific collaborations. But it is also becoming increasingly apparent that many of the current water challenges facing society are not going to be resolved solely through improvements in scientific understanding. Many water challenges lie at the intersection between pure science and applied science, or between the sciences and economics and policy. Any effort to summarize future needs must therefore also acknowledge the urgent need to improve our understanding of how humans are increasingly influencing and changing the hydrologic cycle and the ultimate consequences of those changes for societal well-being. Such efforts would be greatly enhanced by interdisciplinary research and policy efforts involving the scientific community and a broader range of engineers, economists, utility managers, irrigators, and local communities. For example, as one measure of the recognition of these challenges, the Hydrology Section of the American Geophysical Union has just constituted a new Technical Committee on Water and Society to broaden the issues addressed by AGU members and to develop alternative paths - including "soft paths" to addressing a wide range of water-related challenges.

Supportive care needs in Hong Kong Chinese women confronting advanced breast cancer.

PubMed

Au, Angel; Lam, Wendy; Tsang, Janice; Yau, Tsz-kok; Soong, Inda; Yeo, Winnie; Suen, Joyce; Ho, Wing M; Wong, Ka-yan; Kwong, Ava; Suen, Dacita; Sze, Wing-Kin; Ng, Alice; Girgis, Afaf; Fielding, Richard

2013-05-01

Women with advanced breast cancer (ABC) are living longer, so understanding their needs becomes important. This cross-sectional study investigated the type and extent of unmet supportive care needs in Hong Kong Chinese women with advanced breast cancer. Face-to-face interviews were conducted among women with stage III or stage IV disease mostly awaiting chemotherapy (76%) to identify unmet needs using the Supportive Care Needs Survey Short Form, psychological morbidity using the Hospital Anxiety and Depression Scale, symptom distress using the Memorial Symptom Assessment Scale, and satisfaction with care using the Patient satisfaction questionnaire (PSQ-9). About 27-72% of 198/220 (90%) women (mean age = 53.4 ± 9.74 (standard deviation) years) identified needs from the health system, information, and patient support (HSIPS) domain as the top 15 most prevalent unmet needs. 'having one member of hospital staff with whom you can talk to about all aspect of your condition, treatment, and follow-up' was most cited by 72% of the patients, with remaining unmet needs addressing mostly desire for information. Unmet need strength did not differ between women with stage III and stage IV disease, whereas women with first time diagnosis reported greater health system and information unmet needs compared with women with recurrent disease. Stepwise multiple regression analyses revealed that symptom distress was consistently positively associated with all but sexuality need domains, whereas low satisfaction with care was associated with HSIPS (β = 3.270, p < 0.001) and physical and daily living (β = 2.810, p < 0.01) domains. Chinese women with ABC expressed need for continuity of care and improved information provision. High symptom distress was associated with lower levels of satisfaction with care. These unmet needs appear to reflect current care services shortcomings. Copyright © 2012 John Wiley & Sons, Ltd.

Analysis of the equity of emergency medical services: a cross-sectional survey in Chongqing city.

PubMed

Liu, Yalan; Jiang, Yi; Tang, Shenglan; Qiu, Jingfu; Zhong, Xiaoni; Wang, Yang

2015-12-21

Due to reform of the economic system and the even distribution of available wealth, emergency medical services (EMS) experienced greater risks in equity. This study aimed to assess the equity of EMS needs, utilisation, and distribution of related resources, and to provide evidence for policy-makers to improve such services in Chongqing city, China. Five emergency needs variables (mortality rate of maternal, neonatal, cerebrovascular, cardiovascular, injury and poisoning) from the death surveillance, and two utilisation variables (emergency room visits and rate of utilisation) were collected from Chongqing Health Statistical Year Book 2008 to 2012. We used a concentration index (CI) to assess equality in the distribution of needs and utilisation among three areas with different per-head gross domestic product (GDP). In each area, we randomly chose two districts as sample areas and selected all the medical institutions with emergency services as subjects. We used the Gini coefficient (G) to measure equity in population and geographic distribution of facilities and human resources related EMS. Maternal-caused (CI: range -0.213 to -0.096) and neonatal-caused (CI: range -0.161 to -0.046)deaths declined in 2008-12, which focusing mainly on the less developed area. The maternal deaths were less equitably distributed than neonatal, and the gaps between areas gradually become more noticeable. For cerebrovascular (CI: range 0.106 to 0.455), cardiovascular (CI: range 0.101 to 0.329), injury and poisoning (CI: range 0.001 to 0.301) deaths, we documented a steady improvement of mortality; the overall equity of these mortalities was lower than those of maternal and neonatal mortalities, but distinct decreases were seen over time. The patients in developed area were more likely to use EMS (CI: range 0.296 to 0.423) than those in less developed area, and the CI increased over the 5-year period, suggesting that gaps in equity were increasing. The population distribution of facilities, physicians and nurses (G: range 0.2 to 0.3) was relatively equitable; the geographic distribution (G: range 0.4 to 0.5) showed a big gap between areas. In Chongqing city, equity of needs, utilization, and resources allocation of EMS is low, and the provision of such services has not met the needs of patients. To narrow the gap of equity, improvement in the capability of EMS to decrease cerebrovascular, cardiovascular, injury and poisoning cases, should be regarded as a top priority. In poor areas, allocation of facilities and human resources needs to be improved, and the economy should also be enhanced.

Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses.

PubMed

Stumbo, Scott P; Yarborough, Bobbi Jo H; Yarborough, Micah T; Green, Carla A

2018-01-01

Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Cross-sectional; mixed methods. An integrated health system and a network of federally qualified health centers and safety net clinics. Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Semi-structured interviews and surveys. Thematic analysis for qualitative data; frequencies for quantitative data. More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients' chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician-patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.

A Systematic Review of Unmet Information and Psychosocial Support Needs of Adults Diagnosed with Thyroid Cancer.

PubMed

Hyun, Yong Gyu; Alhashemi, Ahmad; Fazelzad, Rouhi; Goldberg, Alyse S; Goldstein, David P; Sawka, Anna M

2016-09-01

Patient education and psychosocial support to patients are important elements of comprehensive cancer care, but the needs of thyroid cancer survivors are not well understood. The published English-language quantitative literature on (i) unmet medical information and (ii) psychosocial support needs of thyroid cancer survivors was systematically reviewed. A librarian information specialist searched seven electronic databases and a hand search was conducted. Two reviewers independently screened citations from the electronic search and reviewed relevant full-text papers. There was consensus between reviewers on the included papers, and duplicate independent abstraction was performed. The results were summarized descriptively. A total of 1984 unique electronic citations were screened, and 51 full-text studies were reviewed (three from the hand search). Seven cross-sectional, single-arm, survey studies were included, containing data from 6215 thyroid cancer survivor respondents. The respective study sizes ranged from 57 to 2398 subjects. All of the studies had some methodological limitations. Unmet information needs were variable relating to the disease, diagnostic tests, treatments, and co-ordination of medical care. There were relatively high unmet information needs related to aftercare (especially long-term effects of the disease or its treatment and its management) and psychosocial concerns (including practical and financial matters). Psychosocial support needs were incompletely met. Patient information on complementary and alternative medicine was very limited. In conclusion, thyroid cancer survivors perceive many unmet information needs, and these needs extend to aftercare. Psychosocial information and supportive care needs may be insufficiently met in this population. More work is needed to improve knowledge translation and psychosocial support for thyroid cancer survivors.

Positron follow-up in liquid water: I. A new Monte Carlo track-structure code.

PubMed

Champion, C; Le Loirec, C

2006-04-07

When biological matter is irradiated by charged particles, a wide variety of interactions occur, which lead to a deep modification of the cellular environment. To understand the fine structure of the microscopic distribution of energy deposits, Monte Carlo event-by-event simulations are particularly suitable. However, the development of these track-structure codes needs accurate interaction cross sections for all the electronic processes: ionization, excitation, positronium formation and even elastic scattering. Under these conditions, we have recently developed a Monte Carlo code for positrons in water, the latter being commonly used to simulate the biological medium. All the processes are studied in detail via theoretical differential and total cross-section calculations performed by using partial wave methods. Comparisons with existing theoretical and experimental data in terms of stopping powers, mean energy transfers and ranges show very good agreements. Moreover, thanks to the theoretical description of positronium formation, we have access, for the first time, to the complete kinematics of the electron capture process. Then, the present Monte Carlo code is able to describe the detailed positronium history, which will provide useful information for medical imaging (like positron emission tomography) where improvements are needed to define with the best accuracy the tumoural volumes.

Oral health status of San Francisco public school kindergarteners 2000-2005.

PubMed

Chung, Lisa H; Shain, Sara G; Stephen, Samantha M; Weintraub, Jane A

2006-01-01

To determine the prevalence of dental caries and oral health disparities in San Francisco kindergarten public school children from 2000-2005. The San Francisco Department of Public Health in partnership with the San Francisco Dental Society and assistance from the National Dental Association, has been conducting annual dental screenings of kindergarten children enrolled in the San Francisco Unified School District since 2000. Outcomes assessed from this series of cross-sectional screenings included prevalence of caries experience, untreated caries, treatment needs, and caries severity by child's sex, race/ethnicity, residential zip code, and a proxy for socioeconomic status. Of 76 eligible schools, 62-72 participated, and 86-92% of enrolled children (n=3,354-3,527) were screened yearly. Although there was a small, significant decrease over the time period, in 2005, 50.1% of children had caries experience; 28.8% had untreated caries and 7.6% had urgent treatment needs. Each year caries prevalence was greatest for Asian children, those attending schools with > 50% children eligible for the free or reduced-price meal program, and children living in zip codes in and around Chinatown and San Francisco's southern border. Despite signs of improvement, caries remains a public health problem especially in Asian and Hispanic children, and children living in certain sections of San Francisco.

Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal.

PubMed

Freidoony, Leila; Ranabhat, Chhabi Lal; Kim, Chun-Bae; Kim, Chang-Soo; Ahn, Dong-Won; Doh, Young Ah

2018-01-01

Use of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen's behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother's education, encouraging them to attend ANC visits and addressing disparities between different regions.

An improvement project within urological care.

PubMed

Khatami, Annelie; Rosengren, Kristina

2015-01-01

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. This study includes one team (six members, different health professionals) within the same urology department. Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

Applying Lean Six Sigma methodology to reduce cesarean section rate.

PubMed

Chai, Ze-Ying; Hu, Hua-Min; Ren, Xiu-Ling; Zeng, Bao-Jin; Zheng, Ling-Zhi; Qi, Feng

2017-06-01

This study aims to reduce cesarean section rate and increase rate of vaginal delivery. By using Lean Six Sigma (LSS) methodology, the cesarean section rate was investigated and analyzed through a 5-phase roadmap consisting of Define, Measure, Analyze, Improve, and Control. The principal causes of cesarean section were identified, improvement measures were implemented, and the rate of cesarean section before and after intervention was compared. After patients with a valid medical reason for cesarean were excluded, the main causes of cesarean section were maternal request, labor pain, parturient women assessment, and labor observation. A series of measures was implemented, including an improved parturient women assessment system, strengthened pregnancy nutrition guidance, implementation of painless labor techniques, enhanced midwifery team building, and promotion of childbirth-assist skills. Ten months after introduction of the improvement measures, the cesarean section rate decreased from 41.83% to 32.00%, and the Six Sigma score (ie, Z value) increased from 1.706 to 1.967 (P < .001). LSS is an effective way to reduce the rate of cesarean section. © 2016 John Wiley & Sons, Ltd.

The hospital incident command system: modified model for hospitals in iran.

PubMed

Djalali, Ahmadreza; Hosseinijenab, Vahid; Peyravi, Mahmoudreza; Nekoei-Moghadam, Mahmood; Hosseini, Bashir; Schoenthal, Lisa; Koenig, Kristi L

2015-03-27

Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran. In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS. The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section. An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.

Design of a compliant wheel for a miniature rover to be used on Mars

NASA Astrophysics Data System (ADS)

Carroll, Mark; Johnson, Jess; Yong, Jimmy

1991-12-01

The Jet Propulsion Laboratory has identified the need for a compliant wheel for a miniature martian rover vehicle. This wheel must meet requirements of minimum mass, linear radial deflection, and reliability in cryogenic conditions over a five year lifespan. Additionally, axial and tangential deflections must be no more than 10 percent of the radial value. The team designed a wheel by use of finite element and dimensionless parameter analysis. Due to the complex geometry of the wheel, a finite element model describing its behavior was constructed to investigate different wheel configurations. Axial and tangential deflections were greatly reduced but did not meet design criteria. A composite material was selected for its high strength, toughness, fatigue resistance, and damping characteristics. The team chose a Kevlar fiber filled thermoplastic composite. This report is divided into four primary sections. First, the introduction section gives background information, defines the task, and discusses the scope and limitations of the project. Second, the alternative designs section introduces alternative design solutions, addresses advantages and disadvantages of each, and identifies the parameters used to determine the best design. Third, the design solution section introduces the methods used to evaluate the alternates, and gives a description of the design process used. Finally, the conclusion and recommendations section evaluates the wheel design, and offers recommendations pertaining to improvement of the design solution.

Novel Methods of Determining Urinary Calculi Composition: Petrographic Thin Sectioning of Calculi and Nanoscale Flow Cytometry Urinalysis

PubMed Central

Gavin, Carson T; Ali, Sohrab N; Tailly, Thomas; Olvera-Posada, Daniel; Alenezi, Husain; Power, Nicholas E; Hou, Jinqiang; St. Amant, Andre H; Luyt, Leonard G; Wood, Stephen; Wu, Charles; Razvi, Hassan; Leong, Hon S

2016-01-01

Accurate determination of urinary stone composition has significant bearing on understanding pathophysiology, choosing treatment modalities and preventing recurrence. A need exists for improved methods to determine stone composition. Urine of 31 patients with known renal calculi was examined with nanoscale flow cytometry and the calculi collected during surgery subsequently underwent petrographic thin sectioning with polarized and fluorescent microscopy. Fluorescently labeled bisphosphonate probes (Alendronate-fluorescein/Alendronate-Cy5) were developed for nanoscale flow cytometry to enumerate nanocrystals that bound the fluorescent probes. Petrographic sections of stones were also imaged by fluorescent and polarized light microscopy with composition analysis correlated to alendronate +ve nanocrystal counts in corresponding urine samples. Urine samples from patients with Ca2+ and Mg2+ based calculi exhibited the highest alendronate +ve nanocrystal counts, ranging from 100–1000 nm in diameter. This novel urine based assay was in agreement with composition determined by petrographic thin sections with Alendronate probes. In some cases, high alendronate +ve nanocrystal counts indicated a Ca2+ or Mg2+ composition, as confirmed by petrographic analysis, overturning initial spectrophotometric diagnosis of stone composition. The combination of nanoscale flow cytometry and petrographic thin sections offer an alternative means for determining stone composition. Nanoscale flow cytometry of alendronate +ve nanocrystals alone may provide a high-throughput means of evaluating stone burden. PMID:26771074

Design of a compliant wheel for a miniature rover to be used on Mars

NASA Technical Reports Server (NTRS)

Carroll, Mark; Johnson, Jess; Yong, Jimmy

1991-01-01

The Jet Propulsion Laboratory has identified the need for a compliant wheel for a miniature martian rover vehicle. This wheel must meet requirements of minimum mass, linear radial deflection, and reliability in cryogenic conditions over a five year lifespan. Additionally, axial and tangential deflections must be no more than 10 percent of the radial value. The team designed a wheel by use of finite element and dimensionless parameter analysis. Due to the complex geometry of the wheel, a finite element model describing its behavior was constructed to investigate different wheel configurations. Axial and tangential deflections were greatly reduced but did not meet design criteria. A composite material was selected for its high strength, toughness, fatigue resistance, and damping characteristics. The team chose a Kevlar fiber filled thermoplastic composite. This report is divided into four primary sections. First, the introduction section gives background information, defines the task, and discusses the scope and limitations of the project. Second, the alternative designs section introduces alternative design solutions, addresses advantages and disadvantages of each, and identifies the parameters used to determine the best design. Third, the design solution section introduces the methods used to evaluate the alternates, and gives a description of the design process used. Finally, the conclusion and recommendations section evaluates the wheel design, and offers recommendations pertaining to improvement of the design solution.

The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon

PubMed Central

2014-01-01

Background In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. Methods The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. Results The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. Conclusions To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well. PMID:24568632

Long-term outcomes in patients with ulnar neuropathy at the elbow treated according to the presumed aetiology.

PubMed

Omejec, Gregor; Podnar, Simon

2018-06-01

Ulnar neuropathy at the elbow (UNE) consists mainly of two conditions: entrapment under the humeroulnar aponeurosis (HUA) and extrinsic compression in the retrocondylar (RTC) groove. These in our opinion need different treatment: surgical HUA release and avoidance of inappropriate arm positioning, respectively. We treated our UNE patients accordingly, and studied their long-term outcomes. We invited our cohort of UNE patients to a follow-up examination consisting of history, neurological, electrodiagnostic (EDx) and ultrasonographic (US) examinations performed by four blinded investigators. At a mean follow-up time of 881 days, we performed a complete evaluation in 117 of 165 (65%) patients, with 96 (90%; 35 HUA and 61 RTC) treated according to our recommendations. An improvement was reported by 83% of HUA and 84% of RTC patients. In both groups the ulnar nerve mean compound muscle action potential (CMAP) amplitude, and the minimal motor nerve conduction velocity increased, while the maximal ulnar nerve cross-sectional area (CSA) decreased. After 2.5 years similar proportions of HUA and RTC patients reported clinical improvement that was supported by improvement in EDx and US findings. These results suggest that patients with UNE improve following both surgical decompression and non-operative treatment. A clinical trial comparing treatment approaches in neuropathy localised to the HUA and RTC will be needed to possibly confirm our opinion that the therapeutic approach should be tailored according to the presumed aetiology of UNE. Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Differences in perception of dysentery and enteric fever and willingness to receive vaccines among rural residents in China.

PubMed

Chen, Xinguang; Stanton, Bonita; Wang, Xuanyi; Nyamette, Andrew; Pach, Alfred; Kaljee, Linda; Pack, Robert; von Seidlein, Lorenz; Clemens, John; Gong, Youlong; Mao, Rong

2006-01-30

Enteric diseases including dysentery and enteric fever remain significant public health problems in China. While vaccines offer great potential in controlling these diseases, greater understanding of factors influencing acceptance of vaccines is needed to create effective enteric disease control programs in rural China. Cross-sectional quantitative study with randomly sampled households from two sites in China, one experiencing high rates of shigellosis (Zengding) and the other of typhoid/paratyphoid (Lingchuan). Sociobehavioral survey data were collected through face-to-face interviews from 501 respondents (56% female) in Zhengding regarding dysentery and 624 in Lingchuan (51% female) regarding enteric fever. Vaccine acceptability was measured by expressed need for vaccination and willingness to pay. Comparative and associative analyses were conducted to assess disease perception, vaccination service satisfaction, likelihood of improvements in water and sanitation, and vaccine acceptability. Nearly all respondents in Lingchuan considered enteric fever to be prevalent in the community, while only one half of the respondents in Zhengding considered dysentery to be problematic (p < 0.01). Nevertheless, more respondents in Zhengding were fearful that a household member would acquire dysentery than were Lingchuan respondents worried that a household member would acquire enteric fever (p < 0.01). Perceived vulnerability of specific subgroups (odds ratios ranging from 1.6 to 8.1), knowing someone who died of the disease (odds ratio reached infinity) and satisfaction with past vaccination services (odds ratios reached infinity) were consistently associated with perceived need for vaccines of target populations of all age groups while the association between perception of sanitary improvement and vaccine need was limited. Perceived need for a vaccine was associated with willingness to pay for the vaccine. Perceptions of enhanced vulnerability of specific subgroups to a disease and satisfactory experiences with vaccination services may increase the perceived need for a vaccine, leading to increased willingness to pay for vaccine. Vaccines are not perceived as important for the elderly.

Healthcare-associated infections are associated with insufficient dietary intake: an observational cross-sectional study.

PubMed

Thibault, Ronan; Makhlouf, Anne-Marie; Kossovsky, Michel P; Iavindrasana, Jimison; Chikhi, Marinette; Meyer, Rodolphe; Pittet, Didier; Zingg, Walter; Pichard, Claude

2015-01-01

Indicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population. Dietary intake was assessed by dedicated dieticians on one day for all hospitalized patients receiving three meals per day. Nutritional risk was assessed using Nutritional Risk Screening (NRS)-2002, and defined as a NRS score ≥ 3. Energy needs were calculated using 110% of Harris-Benedict formula. HCAIs were diagnosed based on the Center for Disease Control criteria and their association with nutritional risk and measured energy intake was done using a multivariate logistic regression analysis. From 1689 hospitalised patients, 1024 and 1091 were eligible for the measurement of energy intake and nutritional risk, respectively. The prevalence of HCAI was 6.8%, and 30.1% of patients were at nutritional risk. Patients with HCAI were more likely identified with decreased energy intake (i.e. ≤ 70% of predicted energy needs) (30.3% vs. 14.5%, P = 0.002). The proportion of patients at nutritional risk was not significantly different between patients with and without HCAI (35.6% vs.29.7%, P = 0.28), respectively. Measured energy intake ≤ 70% of predicted energy needs (odds ratio: 2.26; 95% CI: 1.24 to 4.11, P = 0.008) and moderate severity of the disease (odds ratio: 3.38; 95% CI: 1.49 to 7.68, P = 0.004) were associated with HCAI in the multivariate analysis. Measured energy intake ≤ 70% of predicted energy needs is associated with HCAI in hospitalised patients. This suggests that insufficient dietary intake could be a risk factor of HCAI, without excluding reverse causality. Randomized trials are needed to assess whether improving energy intake in patients identified with decreased dietary intake could be a novel strategy for HCAI prevention.

Open rivers: barrier removal planning and the restoration of free-flowing rivers.

PubMed

O'Hanley, Jesse R

2011-12-01

Restoration of unobstructed, free-flowing sections of river can provide considerable environmental and ecological benefits. It removes impediments to aquatic species dispersal and improves flow, sediment and nutrient transport. This, in turn, can serve to improve environmental quality and abundance of native species, not only within the river channel itself, but also within adjacent riparian, floodplain and coastal areas. In support of this effort, a generic optimization model is presented in this paper for prioritizing the removal of problematic structures, which adversely affect aquatic species dispersal and river hydrology. Its purpose is to maximize, subject to a budget, the size of the single largest section of connected river unimpeded by artificial flow and dispersal barriers. The model is designed to improve, in a holistic way, the connectivity and environmental status of a river network. Furthermore, unlike most previous prioritization methods, it is particularly well suited to meet the needs of potamodromous fish species and other resident aquatic organisms, which regularly disperse among different parts of a river network. After presenting an initial mixed integer linear programming formulation of the model, more scalable reformulation and solution techniques are investigated for solving large, realistic-sized instances. Results from a case-study of the Pike River Watershed, located in northeast Wisconsin, USA, demonstrate the computational efficiency of the proposed model as well as highlight some general insights about systematic barrier removal planning. Copyright © 2011 Elsevier Ltd. All rights reserved.

Constraining the Sea Quark Distributions Through W+/- Cross Section Ratio Measurements at STAR

NASA Astrophysics Data System (ADS)

Posik, Matthew; STAR Collaboration

2017-09-01

Over the years, extractions of parton distribution functions (PDFs) have become more precise, however there are still regions where more data are needed to improve constraints. One such distribution is the sea quark distribution near the valence region, in particular the d / u distribution. Currently, measurements in the high-x region still have large uncertainties and suggest different trends for this distribution. The charged W cross section ratio is sensitive to the unpolarized sea quark distributions and could be used to help constrain the d / u distribution. Through pp collisions, the STAR experiment at RHIC, is well equipped to measure the e+/- leptonic decays of W+/- bosons in the mid-rapidity range | η | <= 1 at √{ s} = 500/510 GeV. At these kinematics STAR is sensitive to quark distributions near Bjorken-x of 0.16. STAR can also extend the sea quark sensitivity to higher x by measuring the leptonic decays in the forward rapidity range 1.1 < η < 2.0. STAR runs from 2011 through 2013 have collected about 350 pb-1 of data. Presented here are preliminary results for the 2011-2012 W cross section ratios ( 100 pb-1), and an update on the 2013 W cross section analysis ( 250 pb-1).

Effects of instructional strategies using cross sections on the recognition of anatomical structures in correlated CT and MR images.

PubMed

Khalil, Mohammed K; Paas, Fred; Johnson, Tristan E; Su, Yung K; Payer, Andrew F

2008-01-01

This research is an effort to best utilize the interactive anatomical images for instructional purposes based on cognitive load theory. Three studies explored the differential effects of three computer-based instructional strategies that use anatomical cross-sections to enhance the interpretation of radiological images. These strategies include: (1) cross-sectional images of the head that can be superimposed on radiological images, (2) transparent highlighting of anatomical structures in radiological images, and (3) cross-sectional images of the head with radiological images presented side-by-side. Data collected included: (1) time spent on instruction and on solving test questions, (2) mental effort during instruction and test, and (3) students' performance to identify anatomical structures in radiological images. Participants were 28 freshmen medical students (15 males and 13 females) and 208 biology students (190 females and 18 males). All studies used posttest-only control group design, and the collected data were analyzed by either t test or ANOVA. In self-directed computer-based environments, the strategies that used cross sections to improve students' ability to recognize anatomic structures in radiological images showed no significant positive effects. However, when increasing the complexity of the instructional materials, cross-sectional images imposed a higher cognitive load, as indicated by higher investment of mental effort. There is not enough evidence to claim that the simultaneous combination of cross sections and radiological images has no effect on the identification of anatomical structures in radiological images for novices. Further research that control for students' learning and cognitive style is needed to reach an informative conclusion.

Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh.

PubMed

Begum, Tahmina; Rahman, Aminur; Nababan, Herfina; Hoque, Dewan Md Emdadul; Khan, Al Fazal; Ali, Taslim; Anwar, Iqbal

2017-01-01

Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. C-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure.

Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh

PubMed Central

Begum, Tahmina; Nababan, Herfina; Hoque, Dewan Md. Emdadul; Khan, Al Fazal; Ali, Taslim; Anwar, Iqbal

2017-01-01

Background and methods Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. Findings During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. Conclusions C-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure. PMID:29155840

The New Maia Detector System: Methods For High Definition Trace Element Imaging Of Natural Material

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

Ryan, C. G.; School of Physics, University of Melbourne, Parkville VIC; CODES Centre of Excellence, University of Tasmania, Hobart TAS

2010-04-06

Motivated by the need for megapixel high definition trace element imaging to capture intricate detail in natural material, together with faster acquisition and improved counting statistics in elemental imaging, a large energy-dispersive detector array called Maia has been developed by CSIRO and BNL for SXRF imaging on the XFM beamline at the Australian Synchrotron. A 96 detector prototype demonstrated the capacity of the system for real-time deconvolution of complex spectral data using an embedded implementation of the Dynamic Analysis method and acquiring highly detailed images up to 77 M pixels spanning large areas of complex mineral sample sections.

The New Maia Detector System: Methods For High Definition Trace Element Imaging Of Natural Material

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

Ryan, C.G.; Siddons, D.P.; Kirkham, R.

2010-05-25

Motivated by the need for megapixel high definition trace element imaging to capture intricate detail in natural material, together with faster acquisition and improved counting statistics in elemental imaging, a large energy-dispersive detector array called Maia has been developed by CSIRO and BNL for SXRF imaging on the XFM beamline at the Australian Synchrotron. A 96 detector prototype demonstrated the capacity of the system for real-time deconvolution of complex spectral data using an embedded implementation of the Dynamic Analysis method and acquiring highly detailed images up to 77 M pixels spanning large areas of complex mineral sample sections.

Education and social inclusion of people with disabilities in five countries in West Africa: a literature review.

PubMed

Jolley, Emma; Lynch, Paul; Virendrakumar, Bhavisha; Rowe, Stacy; Schmidt, Elena

2017-07-14

An estimated 1 billion people worldwide live with some form of disability. With the adoption of the Sustainable Development Goals and the "Leave no one behind" agenda, there is a global momentum to ensure that disadvantaged groups, not least people with disabilities, are included and accounted for, in mainstream development efforts. However, in many low-income settings little is known about disability and the policies and programs in place to improve the lives of those affected. This literature review describes the extent and quality of published and unpublished literature on education and social inclusion of people with disabilities in five West African countries: Cameroon, Liberia, Mali, Sierra Leone and Senegal. Fifty-four unique documents met inclusion criteria of the review and described related policy and legislation; national and international stakeholders; intervention programs and primary research related to disability and inclusion. The majority of documents were from Sierra Leone (19); and four described more than one country. Primary research included mainly qualitative studies and cross-sectional surveys; 33 sources were critically appraised with the majority being attributed unclear risk of bias (20). The findings call for (i) standardized tools for monitoring the implementation of programs and policies at national level; (ii) improved stakeholder coordination mechanisms; (iii) development and adoption of coordinated approaches to measuring disability and social exclusion; (iv) rigorous evaluations of the effectiveness of disability programs and (v) disaggregation of routine data by disability. Implication for Rehabilitation There is a need for standardized tools for monitoring the implementation of programs and policies at national level. Countries that have not yet ratified the UNCRPD or the protocol should be supported to do so. Stakeholder coordination mechanisms need to be improved. Improved coordination between stakeholders involved in disability at the country level could help improve the quality of services delivered. Development and adoption of coordinated approaches is key to measuring disability and social exclusion. There are few, if any, rigorous evaluation of the effectiveness of disability-specific evaluations in the five countries. There is a need for disaggregation of routine data from development programs by disability to inform implementation.

Current training provision and training needs in oral health for UK general practice trainees: survey of General Practitioner Training Programme Directors.

PubMed

Ahluwalia, Aneeta; Crossman, Tim; Smith, Helen

2016-05-11

In the UK the incidence of oral cancers has risen by a third in the last decade, and there have been minimal improvements in survival rates. Moreover, a significant proportion of the population no longer access dental health services regularly, instead presenting their oral health concerns to their General Medical Practitioner. Therefore, General Practitioners (GP) have an important role in the diagnosis of oral health pathologies and the earlier detection of oral cancers. This study aims to understand the current provision of training in oral health and cancer for GP trainees and to identify how unmet training needs could be met. A cross-sectional survey of GP Training Programme Directors using an online questionnaire asking about current oral health education training (hospital placements and structured teaching), the competencies covered with trainees and ways to improve oral health training. Quantitative data were analysed using descriptive statistics and content analysis was undertaken of free text responses. We obtained responses from 132 GP Training Programme Directors (GPTPDs), from 13 of the 16 UK medical deaneries surveyed. The majority of respondents (71.2%) indicated that their programmes did not provide any structured oral health training to GP trainees and that ≤ 10% of their trainees were undertaking hospital posts relevant to oral health. GPTPDs were of the view that the quality of oral health training was poor, relative to the specified competencies, and that teaching on clinical presentations of 'normal' oral anatomy was particularly poor. It was envisaged that oral health training could be improved by access to specialist tutors, e-learning programmes and problem-based-learning sessions. Respondents highlighted the need for training sessions to be relevant to GPs. Barriers to improving training in oral health were time constraints, competing priorities and reluctance to taking on the workload of dentists. This UK-wide survey has identified important gaps in the training of GP trainees in relation to oral health care and cancer detection. Addressing these knowledge and skill gaps, particularly in the identification of oral cancers, will help to improve oral health and, more importantly, the timely diagnosis of oral cancer.

Concussion management in United States college sports: compliance with National Collegiate Athletic Association concussion policy and areas for improvement.

PubMed

Baugh, Christine M; Kroshus, Emily; Daneshvar, Daniel H; Filali, Naji A; Hiscox, Michael J; Glantz, Leonard H

2015-01-01

In 2010, the National Collegiate Athletic Association (NCAA) adopted its Concussion Policy and Legislation, which applies to more than 450,000 collegiate athletes annually. To date, there has been no examination of school-level compliance with the NCAA Concussion Policy. To examine whether stakeholders at NCAA schools report that their school has a concussion management plan and whether existing plans are consistent with the NCAA policy. Also examined were stakeholders' perceptions regarding concussion management at their institution and possible areas for improvement. Cross-sectional study; Level of evidence, 3. Surveys were sent by e-mail to coaches, sports medicine clinicians, and compliance administrators at all 1066 NCAA member institutions. Surveys asked population-specific questions about institutional concussion management. Individuals (N=2880) from 907 unique schools participated in this survey. Most respondents (n=2607; 92.7%) indicated their school had a concussion management plan. Most schools had all (82.1%) or some (15.2%) respondents indicate a concussion management plan was present. When asked to indicate all individuals who could have final responsibility for returning athletes to play after a concussion, 83.4% selected team doctor, 72.8% athletic trainer, 31.0% specialist physician, 6.8% coach, and 6.6% athlete. Most respondents (76.1%) indicated that their institution had a process for annual athlete concussion education; 91.2% required athletes to acknowledge their responsibility to report concussion symptoms. Nearly all respondents (98.8%) thought their school's concussion management plan protected athletes "well" or "very well." Top categories suggested for improvement included better coach education (39.7%), increasing sports medicine staffing (37.2%), and better athlete education (35.2%). Although a large majority of respondents indicated that their school has a concussion management plan, improvement is needed. Compliance with specified components (eg, annual athlete education) lags behind the presence of the plan itself, and stakeholders had suggestions for areas in which improvements are needed. Increasing scientific evidence supporting the seriousness of concussion underscores the need for the NCAA to use its regulatory capabilities to ensure that athletes' brains are safe. © 2014 The Author(s).

Toward improved durability in advanced aircraft engine hot sections

NASA Technical Reports Server (NTRS)

Sokolowski, Daniel E. (Editor)

1989-01-01

The conference on durability improvement methods for advanced aircraft gas turbine hot-section components discussed NASA's Hot Section Technology (HOST) project, advanced high-temperature instrumentation for hot-section research, the development and application of combustor aerothermal models, and the evaluation of a data base and numerical model for turbine heat transfer. Also discussed are structural analysis methods for gas turbine hot section components, fatigue life-prediction modeling for turbine hot section materials, and the service life modeling of thermal barrier coatings for aircraft gas turbine engines.

Health Professionals' Use of Online Information Retrieval Systems and Online Evidence.

PubMed

Lialiou, Paschalina; Pavlopoulou, Ioanna; Mantas, John

2016-01-01

Across-sectional survey was designed to determine health professionals' awareness and usage of online evidence retrieval systems in clinical practice. A questionnaire was used to measure professionals' behavior and utilization of online evidences, as well as, reasons and barriers on information retrieval. 439 nurses and physicians from public and private hospitals in Greece formulate the study's sample. The two most common reasons that individuals are using online information systems were for writing scientific manuscripts or filling a knowledge gap. A positive correlation was found between participants with postgraduate studies and information system usage. The majority of them (90,6%) believe that online information systems improves patient care and 67,6% of them had their own experiences on this. More support is needed to nurses and physicians in order to use the online evidence and as a result to improve the provided care and practices.

Water, Sanitation and Hygiene Situation in Kenya's Urban Slums.

PubMed

Kamau, Njoroge; Njiru, Haron

2018-01-01

Kenya has undergone rapid urbanization as people migrate to the cities in search of economic opportunities. This has given rise to informal settlements characterized by overcrowding, poor infrastructure, and inadequate social amenities. A cross-sectional study on water, sanitation, and hygiene (WASH) status was carried out in Mathare, an informal settlement in Nairobi. A random sample of 380 households was used. The average household size was five people, and 26% of the household heads had completed secondary or higher level of education. The main source of income (70%) was self-employment with 41% of the households living on less than 1.5 USD per day. The WASH situation in the urban slums is below the minimum standard recommended by the World Health Organization (WHO). There is need to improve the situation by improving and installing basic infrastructure including water, sanitation, and solid waste collection.

Socioeconomic Determinants of the Utilization of Antenatal Care and Child Vaccination in India.

PubMed

Zuhair, Mohd; Roy, Ram Babu

2017-11-01

Antenatal care and child vaccination services are adopted worldwide to reduce the risk of child mortality, maternal mortality, and burden of infectious diseases. This article examines the effect of socioeconomic factors on the utilization of antenatal care and child vaccination services in India. The generalized linear model has been used along with the Indian National Family Health Survey data for the period 2005-2006. The analysis shows that the health insurance plan has a significant effect on the use of antenatal care but not in the child vaccination. Furthermore, there is inequality in the utilization of antenatal care as well as child vaccination services and it is positively related to the wealth. The study suggests that there is a need to improve the socioeconomic status of the financially weaker section of the society for improving the use of child and maternal care services.

Performance Improvement of Friction Stir Welds by Better Surface Finish

NASA Technical Reports Server (NTRS)

Russell, Sam; Nettles, Mindy

2015-01-01

The as-welded friction stir weld has a cross section that may act as a stress concentrator. The geometry associated with the stress concentration may reduce the weld strength and it makes the weld challenging to inspect with ultrasound. In some cases, the geometry leads to false positive nondestructive evaluation (NDE) indications and, in many cases, it requires manual blending to facilitate the inspection. This study will measure the stress concentration effect and develop an improved phased array ultrasound testing (PAUT) technique for friction stir welding. Post-welding, the friction stir weld (FSW) tool would be fitted with an end mill that would machine the weld smooth, trimmed shaved. This would eliminate the need for manual weld preparation for ultrasonic inspections. Manual surface preparation is a hand operation that varies widely depending on the person preparing the welds. Shaving is a process that can be automated and tightly controlled.

[Tools to enhance the quality and transparency of health research reports: reporting guidelines].

PubMed

Galvão, Taís Freire; Silva, Marcus Tolentino; Garcia, Leila Posenato

2016-01-01

Scientific writing is the cornestone for publishing the results of research. Reporting guidelines are important tools for all those involved in the process of research production and report writing. These guidelines detail what is expected to be found in each section of a report for a given study design. The EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research) is an international initiative that seeks to improve the reliability and the value of health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines. The use of reporting guidelines has contributed to improved reports as well as increased quality of research methods. Reporting guidelines need to be publicized in order to increase knowledge about these essential tools among health researchers. Encouraging their use by journals is key to enhancing the quality of scientific publications.

Cannabis use in HIV for pain and other medical symptoms.

PubMed

Woolridge, Emily; Barton, Simon; Samuel, Jonathon; Osorio, Jess; Dougherty, Andrew; Holdcroft, Anita

2005-04-01

Despite the major benefits of antiretroviral therapy on survival during HIV infection, there is an increasing need to manage symptoms and side effects during long-term drug therapy. Cannabis has been reported anecdotally as being beneficial for a number of common symptoms and complications in HIV infections, for example, poor appetite and neuropathy. This study aimed to investigate symptom management with cannabis. Following Ethics Committee approval, HIV-positive individuals attending a large clinic were recruited into an anonymous cross-sectional questionnaire study. Up to one-third (27%, 143/523) reported using cannabis for treating symptoms. Patients reported improved appetite (97%), muscle pain (94%), nausea (93%), anxiety (93%), nerve pain (90%), depression (86%), and paresthesia (85%). Many cannabis users (47%) reported associated memory deterioration. Symptom control using cannabis is widespread in HIV outpatients. A large number of patients reported that cannabis improved symptom control.

Readability of Online Health Information: A Meta-Narrative Systematic Review.

PubMed

Daraz, Lubna; Morrow, Allison S; Ponce, Oscar J; Farah, Wigdan; Katabi, Abdulrahman; Majzoub, Abdul; Seisa, Mohamed O; Benkhadra, Raed; Alsawas, Mouaz; Larry, Prokop; Murad, M Hassan

2018-01-01

Online health information should meet the reading level for the general public (set at sixth-grade level). Readability is a key requirement for information to be helpful and improve quality of care. The authors conducted a systematic review to evaluate the readability of online health information in the United States and Canada. Out of 3743 references, the authors included 157 cross-sectional studies evaluating 7891 websites using 13 readability scales. The mean readability grade level across websites ranged from grade 10 to 15 based on the different scales. Stratification by specialty, health condition, and type of organization producing information revealed the same findings. In conclusion, online health information in the United States and Canada has a readability level that is inappropriate for general public use. Poor readability can lead to misinformation and may have a detrimental effect on health. Efforts are needed to improve readability and the content of online health information.

Dyadic differences in friendships of adolescents with chronic pain compared with pain-free peers.

PubMed

Forgeron, Paula A; Chambers, Christine T; Cohen, Janice; Dick, Bruce D; Finley, G Allen; Lamontagne, Christine

2018-06-01

A multisite cross-sectional study was conducted to examine dyadic friendship features between adolescents with chronic pain (ACP) and their friends compared with non-pain adolescent friendship dyads and the association of these friendship features with loneliness and depressive symptoms. Participants completed a battery of standardized measures to capture friendship features (friendship quality, closeness, and perceived social support from friends) and indices of social-emotional well-being. Sixty-one same sex friendship dyads (122 adolescents) participated; 30 friendship dyads included an adolescent with chronic pain and 52 dyads were female. Adolescents with chronic pain scored significantly higher on measures of loneliness and depressive symptoms compared with all other participants. Hierarchical Multiple Regression analysis revealed that friendship features predicted loneliness and depressive symptoms. Chronic pain predicted loneliness and depressive symptoms above and beyond friendship features. Actor Partner Interdependence Modeling found perceived social support from friends had differing associations on loneliness and depressive symptoms for dyads with a chronic pain member compared with pain-free control dyads. Friendship features were associated with loneliness and depressive symptoms for adolescents, but friendship features alone did not explain loneliness and depressive symptoms for ACP. Further research is needed to understand whether pain-related social support improves loneliness and depressive symptoms for ACP. Furthermore, a more nuanced understanding of loneliness in this population is warranted. Strategies to help ACP garner needed social support from friends are needed to decrease rates of loneliness to improve long-term outcomes.

Improving human welfare through appropriate technology: government responsibility, citizen duty or customer choice.

PubMed

Bell, M; Franceys, R

1995-05-01

This paper explores recent attempts to improve the effectiveness of environmental health programmes and projects by reference to the International Drinking Water Supply and Sanitation Decade (1980-1990) and beyond. Reference is made to how water and sanitation as technical interventions have drawn upon the natural sciences, notably concepts of race and sex, and the social sciences including culture and gender, for their authority and legitimacy. A new and apparently progressive movement, the Water Decade sought to challenge the powerful and enduring high tech image of development on which much western environmental and social transformations have been based. Beginning as a critique of modernism with a commitment to basic needs as human rights, it was driven by a recognition that sophisticated technology could not satisfy human health needs. Alternative technologies would, by contrast, cater for a more extensive and varied market and would promote participatory approaches to service delivery. The paper demonstrates how, during the course of the Decade, sections of the aid community began to redefine basic needs as commodities involving the efficient marketing and delivery of a product with minimal state intervention. Within a shifting international political and economic context, it examines the changing role of the expert and the links being forged between large donors, non-governmental organisations and the private sector. The significance of this reformulated progressivism for the development debate is then considered, notably in relation to concepts of citizenship, consumer choice and the role of the state.

Information needs and requirements in patients with brain tumours and their relatives.

PubMed

Reinert, Christiane; Rathberger, Katharina; Klinkhammer-Schalke, Monika; Kölbl, Oliver; Proescholdt, Martin; Riemenschneider, Markus J; Schuierer, Gerhard; Hutterer, Markus; Gerken, Michael; Hau, Peter

2018-06-01

Patients with brain tumours face a number of medical and social challenges. Previous studies have shown that these patients and their relatives need a high level of patient-oriented information and counselling. However, these needs are often underestimated. In this single-centre cross-sectional study, we evaluated, for the first time, the information needs of patients with brain tumours and their relatives depending on diagnosis, age and level of education. The participants were interviewed using pre-specified questionnaires. Answers were evaluated descriptively using standard statistical methods. A total of 888 questionnaires were sent out. The return rate was 50.7%. The majority of patients (nP = 103; 59.9%) and a higher proportion of relatives (nR = 103; 72.5%; p = 0.019) wished to receive a maximum of information. The majority (79.7% of patients; 83.1% of relatives) also stated that they preferred a personal, face-to-face meeting as primary source of information. The need for information increased with education (p = 0.015), and decreased with tumour grade (p = 0.025) and age (p = 0.118). Our data indicate that patients with brain tumours and their relatives have high information needs throughout their disease and continuously require information and counselling. Optimal provision of information is based on personal preferences, which needs to be evaluated appropriately. Patient-oriented information and counselling are parts of a successful communication strategy that can improve cancer care significantly.

Is social media the way to empower patients to share their experiences of dental care?

PubMed

Barber, Sophy K; Lam, Yung; Hodge, Trevor M; Pavitt, Susan

2018-06-01

Social media present opportunities to understand patient experience and information needs. In this study, the authors use hypodontia as an example to explore social media use by dental patients and how this provides for understanding patient experience. The cross-sectional survey design involved systematic search of 6 social media online environments with hypodontia-related terms. The authors categorized records by using a coding system for user, type and theme of post, and target audience. The authors used a thematic framework approach to analyze qualitatively the word content of posts from people affected by hypodontia (nondentists). The authors searched and identified 571 records and included 467 of them in their study. The authors analyzed the content of records from people affected by hypodontia (n = 176). Themes emerged about the experience of untreated hypodontia, treatment experience and outcomes, and decision making. Content analysis provided evidence about peer-to-peer communication, areas of information need, and desire for peer support. Social media communities have responded to the need for information exchange and peer support by the public. Analysis of communications helped identify a need for dissemination of understandable information to patients and improved dentist awareness of patient needs. Clinicians should reassess understanding and information needs actively throughout treatment and identify support needs. Clinicians should refer patients to quality information sources and peer support groups. Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.

Customer quality and type 2 diabetes from the patients' perspective: a cross-sectional study.

PubMed

Tabrizi, Jafar S; Wilson, Andrew J; O'Rourke, Peter K

2010-12-18

Quality in health care can be seen as having three principal dimensions: service, technical and customer quality. This study aimed to measure Customer Quality in relation to self-management of Type 2 diabetes. A cross-sectional survey of 577 Type 2 diabetes people was carried out in Australia. The 13-item Patient Activation Measure was used to evaluate Customer Quality based on self-reported knowledge, skills and confidence in four stages of self-management. All statistical analyses were conducted using SPSS 13.0. All participants achieved scores at the level of stage 1, but ten percent did not achieve score levels consistent with stage 2 and a further 16% did not reach the actual action stage. Seventy-four percent reported capacity for taking action for self-management and 38% reported the highest Customer Quality score and ability to change the action by changing health and environment. Participants with a higher education attainment, better diabetes control status and those who maintain continuity of care reported a higher Customer Quality score, reflecting higher capacity for self-management. Specific capacity building programs for health care providers and people with Type 2 diabetes are needed to increase their knowledge and skills; and improve their confidence to self-management, to achieve improved quality of delivered care and better health outcomes.

Employee engagement within the NHS: a cross-sectional study.

PubMed

Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-02-01

Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both). The score for absorption was significantly higher than comparison group (P< 0.0001). However, total score is not significantly different. The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one's effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

Oral Health Knowledge and Dental Visits in Community Living Older Adults in Rural Appalachia-West Virginia: A Cross-Sectional Analysis

PubMed Central

Wiener, R. Constance; Shockey, Alcinda Trickett

2014-01-01

Introduction The purpose of this study was to investigate the relationship between oral health knowledge and dental visits of older adults in an Appalachian county. Methods A cross-sectional study design was used. Surveys were returned from 205 older adults (50 years and above) from an Appalachian county. Questions were asked about oral health, last dental visit and sociodemographics. Results The variable of interest, oral health knowledge, was associated with dental visit. Having low oral health knowledge increased odds of having delayed a dental visit beyond a year (unadjusted odds ratio: 2.99; 95% Confidence interval: 1.70, 5.28). Even after considering the number of existing teeth, and controlling for age, sex, education and smoking, the association remained positive and independently significant (adjusted odds ratio: 2.25; 95% Confidence interval: 1.05, 4.82). Education was the only sociodemographic variable associated with last dental visit Conclusion The surveyed older adults have a need for increasing dental visits within the previous year. Increasing dental knowledge was associated with odds of increased dental visits. Improving dental knowledge may be a strategy to improve the number of older adults having a dental visit within the year. PMID:25530938

77 FR 38147 - Additional Requirements for Charitable Hospitals

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... which the requirements of section 501(r) are not separately met. Community Health Needs Assessments Section 501(r)(3) requires a hospital organization to conduct a community health needs assessment (CHNA) at least once every three years and adopt an implementation strategy to meet the community health...

Driver Education Curriculum Guide.

ERIC Educational Resources Information Center

Brum, Herbert D.; And Others

Intended for driver education instructors in Ohio, the guide is designed to acquaint teachers with special characteristics, capacities, and needs of the handicapped student population and to provide resources, information, and ideas for meeting those special needs. An introductory section discusses the purpose and use of the curriculum. Section 2…

12 CFR Appendix A to Part 228 - Ratings

Code of Federal Regulations, 2011 CFR

2011-01-01

... loans. (iv) Needs to improve. The Board rates a bank's lending performance “needs to improve” if, in... to improve. The Board rates a bank's investment performance “needs to improve” if, in general, it... to improve. The Board rates a bank's service performance “needs to improve” if, in general, the bank...

Distribution of Funds and Mentoring of Finance Officers for the Afghanistan National Army Payroll Need Improvement

DTIC Science & Technology

2012-02-29

National Army Payroll Need Improvement Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of...Funds and Mentoring of Finance Officers for the Afghanistan National Army Payroll Need Improvement 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...SUBJECT: Distribution of Funds and Mentoring of Finance Officers for the Afghanistan National Army Payroll Need Improvement (Report No. DODIG-2012-058

Centrifugal casting of ZA8 zinc alloy and composite A356/silicon carbide: Study and modeling of phases' and particles' segregation

NASA Astrophysics Data System (ADS)

Balout, Bahaa

Centrifugation is a casting technology that allows the production of cylindrical and graduated parts with different mechanical properties through the section. The need for materials with good quality and specific mechanical properties has been driven this technology in order to produce different types of materials such as zinc alloys and graduated metal matrix composites reinforced by hard and wear resistant particles. The goal of this research project is to study and model the eutectic macrosegregation, the solidification speed, and the speeds of solidification fronts during centrifugal casting of ZA8 zinc-aluminum alloy in order to improve the part quality and increase its strength and field reliability. Moreover, the segregation of the particles during centrifugal casting of an aluminum matrix composite reinforced by silicon carbide particles (A356/SiC) is also studied to improve and control the graduation of the parts. The cooling rate, the speed, acceleration/deceleration, displacement, and segregation of the particles across the section will be modeled by discretization of Stokes' law in time in order to take into consideration the change in the centrifugal radius and melt viscosity during cooling process. This study will allow the control of the graduation degree of particles across the section in order to improve the properties and wear resistance of the composite. This composite can be used in systems where friction is critical and load is high (reinforcements of parts for the cylinders of pneumatic systems). The results show that the maximum macrosegregation zone of the eutectic across the casting section corresponds to the last point of solidification. The eutectic macrosegregation produced during centrifugal casting of thin walled part is a normal segregation which varies depending on the solidification speed and the ratio between the speeds of solidification fronts. On the other hand, it was found that the position and volume fraction of the particles on the outer/inner casting surface and across the section varies whether the viscosity of the liquid metal used and the centrifugal radius are considered constant or variable during the modeling. Modeling the particles' segregation while discretizing, in time, the particles' velocities gives more consistent results compared to those obtained experimentally. Key-words: centrifugal casting, composite, macrosegregation, solidification.

Contemporary analysis of practicing otolaryngologists.

PubMed

Harrill, Willard C; Melon, David E; Seshul, Merritt J; Katz, Marc S; Zanation, Adam M

2018-05-04

To investigate contemporary issues facing practicing otolaryngologists including workforce dynamics, ancillary service modeling, otolaryngic allergy integration, ambulatory surgery center utilization, and relevant certificate of need legislation. A cross-sectional survey analysis of academic and private practicing otolaryngologists in North and South Carolina in 2016. A cross-sectional survey was e-mailed to 510 practicing otolaryngologists in North and South Carolina. A 21.3% survey response rate was achieved. Otolaryngology workforce was defined by horizontal aggregation of otolaryngologists into larger group models, with fewer solo practitioners being replaced by younger otolaryngologists or employing otolaryngology extenders. Excluding academic practice, few otolaryngologists have chosen direct hospital employment as a career option, although otolaryngologists with fewer years of practice are pursuing that option with greater frequency. Ancillary services showed audiology and hearing aid services being the most common, followed by otolaryngic allergy, point-of-service computed tomography, and ultrasound. Although otolaryngologists tend to avoid vertical integration, ambulatory surgery center (ASC) ownership trends favor a joint venture model with a hospital system partner. Most otolaryngologists favor changes to certificate of need legislation to improve patient access to these lower-cost facilities, regardless of whether they currently utilize or have access to an ASC. Otolaryngology is uniquely positioned to adapt and respond to current paradigm shifts within ambulatory medicine. Further analysis is needed to prepare current and future otolaryngologists for the demands and opportunities these challenges pose as patient-centered care models and consumer dynamics shape future patient expectations and utilization of healthcare. 5. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Evaluating hospital information systems from the point of view of the medical records section users in Medical-Educational Hospitals of Kermanshah 2014.

PubMed

Rostami, S; Sarmad, A; Mohammadi, M; Cheleie, M; Amiri, S; Zardoei Golanbary, S H

2015-01-01

Evaluating hospital information systems leads to the improvement and devotion based on the users' needs, especially the medical records section users in hospitals, which are in contact with this system from the moment the patient enters the hospital until his/ her release and after that. The present research aimed to evaluate the hospital information systems from the point of view of the medical record section employees. Materials and method : The current research was applicative-descriptive analytical and the research society included 70 users of the medical history section in the educational-medical centers of Kermanshah city. The data-gathering tool was the 10th part of 9241/ 10 Isometric standard questionnaire of evaluating hospital information systems, with 75 specific questions in 7 bases, with the five spectra Likertt scale, its conceptual admissibility being confirmed in previous researches. 22 SPSS statistical software analyzed its permanency in the present study, which was also confirmed by Cronbach's's alpha test, which equaled to 0.89, and the data. Findings : The highest level of the employees' satisfaction, based on gained scores median, was respectively the incompatibility with the users' expectations, measuring 3.55, self-description measuring 3.54 and controllability - 3.51, which in total presented the average scores of 3.39, the lowest level of satisfaction being related to useful learning , whose value was 3.19. Discussion and conclusion : Hospital information systems' users believe that it is more desirable that the existing systems are based on the measures and consider them proper for making them non-governmental and useful for undesired learning. Considering the long distance of the existing information systems with the desired performance, it is essential that "these systems pay more attention to a more complete and deeper recognition and awareness of users' opinions and requirements in their road. The movement and development is to increase their chance in succeeding and achieving their goals, where the goal is to improve the patients' care and improve the health of the society members with the help of information technology.

Three Dimensional Optical Coherence Tomography Imaging: Advantages and Advances

PubMed Central

Gabriele, Michelle L; Wollstein, Gadi; Ishikawa, Hiroshi; Xu, Juan; Kim, Jongsick; Kagemann, Larry; Folio, Lindsey S; Schuman, Joel S.

2010-01-01

Three dimensional (3D) ophthalmic imaging using optical coherence tomography (OCT) has revolutionized assessment of the eye, the retina in particular. Recent technological improvements have made the acquisition of 3D-OCT datasets feasible. However, while volumetric data can improve disease diagnosis and follow-up, novel image analysis techniques are now necessary in order to process the dense 3D-OCT dataset. Fundamental software improvements include methods for correcting subject eye motion, segmenting structures or volumes of interest, extracting relevant data post hoc and signal averaging to improve delineation of retinal layers. In addition, innovative methods for image display, such as C-mode sectioning, provide a unique viewing perspective and may improve interpretation of OCT images of pathologic structures. While all of these methods are being developed, most remain in an immature state. This review describes the current status of 3D-OCT scanning and interpretation, and discusses the need for standardization of clinical protocols as well as the potential benefits of 3D-OCT scanning that could come when software methods for fully exploiting these rich data sets are available clinically. The implications of new image analysis approaches include improved reproducibility of measurements garnered from 3D-OCT, which may then help improve disease discrimination and progression detection. In addition, 3D-OCT offers the potential for preoperative surgical planning and intraoperative surgical guidance. PMID:20542136

PRGdb 3.0: a comprehensive platform for prediction and analysis of plant disease resistance genes.

PubMed

Osuna-Cruz, Cristina M; Paytuvi-Gallart, Andreu; Di Donato, Antimo; Sundesha, Vicky; Andolfo, Giuseppe; Aiese Cigliano, Riccardo; Sanseverino, Walter; Ercolano, Maria R

2018-01-04

The Plant Resistance Genes database (PRGdb; http://prgdb.org) has been redesigned with a new user interface, new sections, new tools and new data for genetic improvement, allowing easy access not only to the plant science research community but also to breeders who want to improve plant disease resistance. The home page offers an overview of easy-to-read search boxes that streamline data queries and directly show plant species for which data from candidate or cloned genes have been collected. Bulk data files and curated resistance gene annotations are made available for each plant species hosted. The new Gene Model view offers detailed information on each cloned resistance gene structure to highlight shared attributes with other genes. PRGdb 3.0 offers 153 reference resistance genes and 177 072 annotated candidate Pathogen Receptor Genes (PRGs). Compared to the previous release, the number of putative genes has been increased from 106 to 177 K from 76 sequenced Viridiplantae and algae genomes. The DRAGO 2 tool, which automatically annotates and predicts (PRGs) from DNA and amino acid with high accuracy and sensitivity, has been added. BLAST search has been implemented to offer users the opportunity to annotate and compare their own sequences. The improved section on plant diseases displays useful information linked to genes and genomes to connect complementary data and better address specific needs. Through, a revised and enlarged collection of data, the development of new tools and a renewed portal, PRGdb 3.0 engages the plant science community in developing a consensus plan to improve knowledge and strategies to fight diseases that afflict main crops and other plants. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

Accounting for recent trends in the prevalence of diarrhoea in the Democratic Republic of Congo (DRC): results from consecutive cross-sectional surveys.

PubMed

Emina, Jacques B O; Kandala, Ngianga-Bakwin

2012-01-01

To analyse trends in diarrhoea prevalence by maternal education, access to clean water and improved sanitation, household wealth index; to identify the sources of variation and assess contribution of changes in socioeconomic characteristics in the Democratic Republic of Congo (DRC). Consecutive cross-sectional surveys. DRC. The databases contain information on 9748 children from the 2001 Multiple Indicators Cluster Survey and 7987 children from the 2007 Demographic and Health Survey. N/A. Whether the child had diarrhoea 14 days preceding the survey. The overall prevalence of diarrhoea decreased by 26 percent (from 22.1% in 2001 to 16.4% in 2007). Findings from the three complementary statistical methods are consistent and confirm a significant decrease in diarrhoea regardless of socioeconomic characteristics. Changes in behaviour and/or in public health policy seem to be the likely main source of the change. There were no significant changes in diarrhoea prevalence associated with variation of the population structure. It is worth mentioning that the decrease in diarrhoea prevalence is in contrast to the generalised poor living conditions of the population. Therefore, it is difficult to ascertain whether the decline in diarrhoea prevalence was due to real improvement in public-health policy or to data quality issues. The decline of diarrhoea prevalence in our study need to be further investigated by conducting district-based or provincial-based studies to validate findings from household surveys such as Demographic and Health Surveys and Multiple Indicators Cluster Survey taking into account the current context of the country: ongoing conflict, poor socioeconomic and poor health infrastructure. However, improvement in living conditions such as access to clean water and improved sanitation will contribute to accelerate the reduction of diarrhoea prevalence as well as reduction of child mortality.

24 CFR 700.120 - Eligible supportive services.

Code of Federal Regulations, 2014 CFR

2014-04-01

... section 802(k)(16) and in section 700.105. (c) Meal services shall meet the following guidelines: (1) Type... shall provide special menus as necessary for meeting the dietary needs arising from the health requirements of conditions such as diabetes and hypertension. Grantees should attempt to meet the dietary needs...

24 CFR 700.120 - Eligible supportive services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... section 802(k)(16) and in section 700.105. (c) Meal services shall meet the following guidelines: (1) Type... shall provide special menus as necessary for meeting the dietary needs arising from the health requirements of conditions such as diabetes and hypertension. Grantees should attempt to meet the dietary needs...

24 CFR 700.120 - Eligible supportive services.

Code of Federal Regulations, 2013 CFR

2013-04-01

... section 802(k)(16) and in section 700.105. (c) Meal services shall meet the following guidelines: (1) Type... shall provide special menus as necessary for meeting the dietary needs arising from the health requirements of conditions such as diabetes and hypertension. Grantees should attempt to meet the dietary needs...

Model Children's Code.

ERIC Educational Resources Information Center

New Mexico Univ., Albuquerque. American Indian Law Center.

The Model Children's Code was developed to provide a legally correct model code that American Indian tribes can use to enact children's codes that fulfill their legal, cultural and economic needs. Code sections cover the court system, jurisdiction, juvenile offender procedures, minor-in-need-of-care, and termination. Almost every Code section is…

Assessment of the dietary pattern of dormitory students in Kerman, Iran.

PubMed

Doostan, Farideh; Mohseni-Takalloo, Sahar; Nosrati, Mohammad

2016-09-01

Nowadays it is known that dietary imbalances are associated with non-communicable diseases which would be a major cause of worldwide deaths in 2020. This study was conducted to assess the dietary pattern of students who live in a dormitory in Kerman, Iran, based on Healthy Eating Index-2005 (HEI-2005). This cross-sectional study was conducted on 229 students who lived in the dormitory of Kerman University of Medical Science. The participants were recruited by multistage sampling. Their usual dietary intake was collected by using a valid food frequency questionnaire. The diet quality was calculated via HEI-2005. The HEI-2005 score was categorized into three groups: less than 50 (poor diet), between 50-70 (needs improvement) and more than 70 (good diet). The mean score of HEI-2005 in the present study was 64.22±8.98. 8.1% of the participants had poor diet, 63.4% had to improve their diet, and 28.5% enjoyed a good diet. The percent of energy intake from total fat, saturated fatty acid, solid fat and added sugar, and also sodium were significantly lower in the highest category of HEI-2005 than the lowest category. There was no significant difference in the intake of cholesterol, total vegetable and dairy products between the highest and lowest quartile categories. Majority of the participants need to improve their diet.Policy revisions and dietary interventions would require to promote diet quality and prevent non-communicable diseases in the future.

Evaluation of water, sanitation and hygiene program outcomes shows knowledge-behavior gaps in Coast Province, Kenya.

PubMed

Schlegelmilch, Michael Paul; Lakhani, Amyn; Saunders, Leslie Duncan; Jhangri, Gian Singh

2016-01-01

Water related diseases constitute a significant proportion of the burden of disease in Kenya. Water, sanitation and hygiene (WASH) programs are in operation nation-wide to address these challenges. This study evaluated the impact of the Sombeza Water and Sanitation Improvement Program (SWASIP) in Coast Province, Kenya. This study is a cluster randomized, follow-up evaluation that compared baseline (2007) to follow-up (2013) indicators from 250 households. Twenty-five villages were selected with probability proportional to size sampling, and ten households were selected randomly from each village. Follow-up data were collected by in-person interviews using pre-tested questionnaires, and analyzed to compare indicators collected at baseline. Cross-sectional results from the follow-up data were also reported. Statistically significant improvements from baseline were observed in the proportions of respondents with latrine access at home, who washed their hands after defecation, who treated their household drinking water and the average time to collect water in the dry season. However, this study also observed significant decreases in the proportion of respondents who washed their hands before preparing their food, or feeding their children, and after attending to a child who has defecated. The analysis also revealed a knowledge-behavior gap in WASH behaviors. SWASIP contributed to improvements from baseline, but further progress still needs to be seen. The findings challenge the assumption that providing infrastructure and knowledge will result in behavior change. Further understanding of specific, non-knowledge predictors of WASH related behavior is needed.

Quality of nursing doctoral education in Korea: towards policy development.

PubMed

Ja Kim, Mi; Gi Park, Chang; Kim, Minju; Lee, Hyeonkyeong; Ahn, Yang-Heui; Kim, Euisook; Yun, Soon-Nyoung; Lee, Kwang-Ja

2012-07-01

This article is a report on an international study of the quality of nursing doctoral education; herein, we report findings for Korea. Specific aims were to: examine the validity and reliability of the quality of nursing doctoral education questionnaire; and identify contributing factors and domain(s) for improvement. The quality of nursing doctoral education has been a worldwide concern with the recent rapid increase in number of nursing doctoral programmes around the world, and comprehensive evaluation is needed for policy recommendations. A cross-sectional descriptive study, conducted from October 2006 to January 2007, used an online questionnaire evaluating four domains: programme, faculty, resources and evaluation. Seven deans, 48 faculty, 52 graduates and 87 students from 14 nursing schools participated. Content and construct validity, and construct reliability of the questionnaire were established. Overall, participants reported that the perceived quality of private universities/schools was significantly higher than that of public/national universities. A higher ratio of doctoral to non-doctoral students was significantly associated with higher quality. The domains of programme, faculty and resources were highly correlated. The programme was the most important domain; availability of sufficient materials and information for students most needed improvement. Overall, faculty perceived the quality of the programme, faculty and resources as more positively than did the graduates and students. This study provides useful policy guidance for nurse educators worldwide for improving doctoral programmes and faculty's role in educating students. Further study is recommended that examines contributing factors to quality doctoral education. © 2011 Blackwell Publishing Ltd.

A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.

PubMed

Flores, Glenn; Lin, Hua; Walker, Candy; Lee, Michael; Portillo, Alberto; Henry, Monica; Fierro, Marco; Massey, Kenneth

2016-03-22

Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden. For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden. The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden. Half of parents of uninsured minority children are unaware that their children are Medicaid/CHIP-eligible. These uninsured children have suboptimal health, impaired access to care, and major unmet needs. The child's health causes considerable family financial burden, and one in 10 parents ceased work. The study findings indicate urgent needs for better parental education about Medicaid/CHIP, and for improved Medicaid/CHIP outreach and enrollment.

Preconception-related needs of reproductive-aged women.

PubMed

Goossens, Joline; Delbaere, Ilse; Dhaenens, Celine; Willems, Lies; Van Hecke, Ann; Verhaeghe, Sofie; Beeckman, Dimitri

2016-02-01

to assess women׳s interest in preconception care, their organisational preferences, and their preconception-related information and support needs. cross-sectional study design. participants were recruited online through social media and discussion forums for issues relating to (in)fertility, pregnancy and parenting, and at the Women׳s Clinic of Ghent University Hospital. 242 reproductive-aged women with a desire to have (more) children. the majority of women (75%) wanted to receive preconception care in the future. Gynaecologists (93%) were the preferred source of preconception care, followed by midwives (73%) and general practitioners (63%). Most women wanted information about lifestyle, environmental exposures, working conditions and medical issues. Information needs were higher among women with (history of) mental illness [odds ratio (OR) 3.50, 95% confidence interval (CI) 1.08-11.36], (history of) eye and otolaryngological problems (OR 2.22, 95% CI 0.95-5.21) and overweight (OR 2.22, 95% CI 1.01-4.93). A few women indicated that they needed preconception-related support. Overweight women reported greater need for lifestyle-related support compared with women of healthy weight (p=0.001). reproductive-aged women are interested in preconception care, and would prefer to receive this care directly from a professional caregiver. Most women had high preconception-related information needs and lower support needs. although women reported that they would prefer to receive preconception care from gynaecologists, the results indicate that midwives can also play an important role in the provision of preconception care. They would need further training to improve their knowledge, skills and awareness regarding preconception care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Environmental restoration and waste management: Robotics technology development program: Robotics 5-year program plan

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

Not Available

In FY 1990 Robotics Technology Development Program (RTDP) planning teams visited five DOE sites. These sites were selected by the Office of Technology Development to provide a needs basis for developing a 5-Year Plan. Visits to five DOE sites provided identification of needs for robotics technology development to support Environmental Restoration and Waste Management (ER WM) projects at those sites. Additional site visits will be conducted in the future to expand the planning basis. This volume summarizes both the results of the site visits and the needs and requirements of the priority ER WM activities at the sites, including potentialmore » needs for robotics and remote systems technology. It also discusses hazards associated with the site activities and any problems or technical uncertainties associated with dealing with the hazards in the performance of the ER WM work. Robotic or remote systems currently under development for remediation projects or waste operations are also discussed. The information in this document is organized principally by site, activity, and priority. Section 2.0, Site Needs, is based on information from the site visit reports and provides a summary which focuses on the site needs and requirements for each priority activity. Section 2.0 also records evaluations and discussions by the RTDP team following the site visit. Section 3.0, Commonality Assessment, documents similar site needs where common, or cross-cutting, robotics technology might be applied to several activities. Section 4.0 contains a summary of the site needs and requirements in tabular form. 1 tab.« less

Continuous quality improvement and medical informatics: the convergent synergy.

PubMed

Werth, G R; Connelly, D P

1992-01-01

Continuous quality improvement (CQI) and medical informatics specialists need to converge their efforts to create synergy for improving health care. Health care CQI needs medical informatics' expertise and technology to build the information systems needed to manage health care organizations according to quality improvement principles. Medical informatics needs CQI's philosophy and methods to build health care information systems that can evolve to meet the changing needs of clinicians and other stakeholders. This paper explores the philosophical basis for convergence of CQI and medical informatics efforts, and then examines a clinical computer workstation development project that is applying a combined approach.

The impact of shift work on nurses' job stress, sleep quality and self-perceived health status.

PubMed

Lin, Shu-Hui; Liao, Wen-Chun; Chen, Mei-Yen; Fan, Jun-Yu

2014-07-01

The aim of this study was to describe the current state of nurses' shift work in Taiwan and how it affects nurses' stress, sleep quality and self-perceived health status. To enable the provision of 24-hour patient care, nurses need to work various shifts. Long-term shift work significantly affects nurses' overall physical and mental health. Nurses from four Chiayi County district hospitals in Taiwan (n = 266) participated in this cross-sectional study from August to September 2010. Demographics, work schedule forms, a stress checklist, a sleep-quality measure and a health-status measure were used to collect data. Independent t-test, one-way anova, Pearson's r, and hierarchical regression were applied for analysis. The results showed that regardless of the amount of shift work they performed, nurses reported moderate job stress, poor sleep quality and moderate self-perceived health. The following significant relationships were observed: job stress was inversely related to sleep quality, which was directly related to self-perceived health status. Hospital managers need to ensure more healthy shift work scheduling in order to improve nurses' clinical performance and personal health status, thereby also improving the quality of patient care. © 2012 John Wiley & Sons Ltd.

Pyroshock: Bibliography

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

Zimmerman, R.M.

1993-02-01

This paper represents a review copy for text that is to be included in the Shock and Vibration Recommended Practice Document. This section on pyroshock is written an a general introduction to and description of the topic loading to presentation of an extensive bibliography on the subject. Pyroshock is an evolving science that needs continued focus on both achieving improvements in testing and measurement techniques and advancing instrumentation capabilities. When desired in the near future, recommended practices can be presented. Pyroshock phenomena are associated with separation systems of missiles. spacecraft, and in some cases airplanes. During launch, a rocket drivenmore » vehicle may be exposed to 19 to 30 g`s of acceleration with predominant frequencies less than 200 Hz. After launch or takeoffs sections or parts of vehicles may be separated rapidly using explosive driven release mechanisms. Separations can involve stage disconnections for spacecraft sections or payload ejections from missiles and airplanes. At separation, localized pyrotechnic induced accelerations may range from 1000 to over 100,000 g`s at frequencies much higher than 1000 Hz. These pyroshocks are characterized by high intensity, high frequency transients that decay rapidly. Pyroshock impulses have insignificant velocity changes.« less

Performance of motor imitation in children with and without dyspraxia.

PubMed

Ruttanathantong, Korrawan; Siritaratiwat, Wantana; Sriphetcharawut, Sarinya; Emasithi, Alongkot; Saengsuwan, Jiamjit; Saengsuwan, Jittima

2013-07-01

Motor imitation is truly essential for young children to learn new motor skills, social behavior and skilled acts or praxis. The present study aimed to investigate motor imitation ability between typically-developing children and dyspraxic children and to examine the development trends in both children groups. The comparison ofmotor imitation was studied in 55 typically-developing children and 59 dyspraxic children aged 5 to 8 years. The Motor Imitation subtest consisted of two sections, imitation of postures and imitation of verbal instructions. Typically-developing children and dyspraxic children were examined for developmental trends. The independent samples t-test was used to analyze the differences between both groups. Two-way analysis of variance (ANOVA) was used to analyze inter-age differences for each age group. The results revealed significant differences between dyspraxic and typically-developing children. Both typically-developing and dyspraxic children demonstrated age trends. The older children scored higher than younger children. Imitation is a primary learning strategy of young children. It is essential that children with dyspraxia receive early detection and need effective intervention. Typically-developing children and dyspraxic children showed higher mean score on the Imitation of Posture section than the Verbal Instructions section. Motor imitation competency, therefore, changes and improves with age.

Development of Raman microspectroscopy for automated detection and imaging of basal cell carcinoma

NASA Astrophysics Data System (ADS)

Larraona-Puy, Marta; Ghita, Adrian; Zoladek, Alina; Perkins, William; Varma, Sandeep; Leach, Iain H.; Koloydenko, Alexey A.; Williams, Hywel; Notingher, Ioan

2009-09-01

We investigate the potential of Raman microspectroscopy (RMS) for automated evaluation of excised skin tissue during Mohs micrographic surgery (MMS). The main aim is to develop an automated method for imaging and diagnosis of basal cell carcinoma (BCC) regions. Selected Raman bands responsible for the largest spectral differences between BCC and normal skin regions and linear discriminant analysis (LDA) are used to build a multivariate supervised classification model. The model is based on 329 Raman spectra measured on skin tissue obtained from 20 patients. BCC is discriminated from healthy tissue with 90+/-9% sensitivity and 85+/-9% specificity in a 70% to 30% split cross-validation algorithm. This multivariate model is then applied on tissue sections from new patients to image tumor regions. The RMS images show excellent correlation with the gold standard of histopathology sections, BCC being detected in all positive sections. We demonstrate the potential of RMS as an automated objective method for tumor evaluation during MMS. The replacement of current histopathology during MMS by a ``generalization'' of the proposed technique may improve the feasibility and efficacy of MMS, leading to a wider use according to clinical need.

Introduction to Preharvest Food Safety.

PubMed

Torrence, Mary E

2016-10-01

This introductory article provides an overview of preharvest food safety activities and initiatives for the past 15 years. The section on traditional areas of preharvest food safety focuses on significant scientific advancements that are a culmination of collaborative efforts (both public health and agriculture) and significant research results. The highlighted advancements provide the foundation for exploring future preharvest areas and for improving and focusing on more specific intervention/control/prevention strategies. Examples include Escherichia coli and cattle, Salmonella and Campylobacter in poultry, and interventions and prevention and control programs. The section on "nontraditional" preharvest food safety areas brings attention to potential emerging food safety issues and to future food safety research directions. These include organic production, the FDA's Produce Rule (water and manure), genomic sequencing, antimicrobial resistance, and performance metrics. The concluding section emphasizes important themes such as strategic planning, coordination, epidemiology, and the need for understanding food safety production as a continuum. Food safety research, whether at the pre- or postharvest level, will continue to be a fascinating complex web of foodborne pathogens, risk factors, and scientific and policy interactions. Food safety priorities and research must continue to evolve with emerging global issues, emerging technologies, and methods but remain grounded in a multidisciplinary, collaborative, and systematic approach.

How much choice is there in housing choice vouchers? Neighborhood risk and free market rental housing accessibility for active drug users in Hartford, Connecticut.

PubMed

Dickson-Gomez, Julia B; Cromley, Ellen; Convey, Mark; Hilario, Helena

2009-04-15

Since the mid-1970s, the dominant model for U.S. federal housing policy has shifted from unit-based programs to tenant based vouchers and certificates, intended to allow recipients a choice in their housing and neighborhoods. Surprisingly little research has examined the question of where those with Section 8 housing vouchers are able to live, but some research suggests that voucher holders are more likely to reside in distressed neighborhoods than unsubsidized renter households. Further, federal housing policy has limited drug users' access to housing subsidies. In turn, neighborhood disorder has been associated with higher levels of injection drug risk behaviors, and higher drug-related mortality. This paper explores rental accessibility and neighborhood characteristics of advertised rental housing in Hartford CT. Brief telephone interviews were conducted with landlords or management companies with units to rent in Hartford to explore housing accessibility measured as initial move in costs, credit and criminal background checks, and whether rental subsidies were accepted. These data were supplemented with in-depth interviews with landlords, shelter staff and active users of heroin, crack or cocaine. Apartments for rent were geocoded and mapped using ArcGIS. We used location quotients to identify areas where low-income rental housing is concentrated. Finally, we mapped apartments in relation to drug and violent arrest rates in each neighborhood. High security deposits, criminal background and credit checks limit housing accessibility even for drug users receiving vouchers. While most landlords or management companies accepted housing subsidies, several did not. Voucher units are concentrated in neighborhoods with high poverty neighborhoods. Landlords reported little incentive to accept rental subsidies in neighborhoods with low crime rates, but appreciated the guarantee provided by Section 8 in high crime neighborhoods that were less likely to attract applicants with good jobs and credit. Housing vouchers in themselves do not greatly improve recipients' choice of neighborhood and voucher units are concentrated in the most distressed neighborhoods. Policy changes are needed to increase landlords' incentives to accept housing subsidies. Interventions to improve neighborhood conditions are needed to improve the probability of success for those recovering from drug addictions.

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease.

PubMed

Liu, Yi; Li, Weina; Tan, Changhong; Liu, Xi; Wang, Xin; Gui, Yuejiang; Qin, Lu; Deng, Fen; Hu, Changlin; Chen, Lifen

2014-09-01

Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). The globus pallidus internus (GPi) and the subthalamic nucleus (STN) are commonly targeted by this procedure. The purpose of this meta-analysis was to compare the efficacy of DBS in each region. MEDLINE/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library were searched for English-language studies published before April 2013. of studies investigating the efficacy and clinical outcomes of DBS of the GPi and STN for PD were analyzed. Six eligible trials containing a total of 563 patients were included in the analysis. Deep brain stimulation of the GPi or STN equally improved motor function, measured by the Unified Parkinson's Disease Rating Scale Section III (UPDRSIII) (motor section, for patients in on- and off-medication phases), within 1 year postsurgery. The change score for the on-medication phase was 0.68 (95% CI - 2.12 to 3.47, p > 0.05; 5 studies, 518 patients) and for the off-medication phase was 1.83 (95% CI - 3.12 to 6.77, p > 0.05; 5 studies, 518 patients). The UPDRS Section II (activities of daily living) scores for patients on medication improved equally in both DBS groups (p = 0.97). STN DBS allowed medication dosages to be reduced more than GPi DBS (95% CI 129.27-316.64, p < 0.00001; 5 studies, 540 patients). Psychiatric symptoms, measured by Beck Depression Inventory, 2nd edition scores, showed greater improvement from baseline after GPi DBS than after STN DBS (standardized mean difference -2.28, 95% CI -3.73 to -0.84, p = 0.002; 3 studies, 382 patients). GPi and STN DBS improve motor function and activities of daily living for PD patients. Differences in therapeutic efficacy for PD were not observed between the 2 procedures. STN DBS allowed greater reduction in medication for patients, whereas GPi DBS provided greater relief from psychiatric symptoms. An understanding of other symptomatic aspects of targeting each region and long-term observations on therapeutic effects are needed.

Novel High-Voltage, High-Power Piezoelectric Transformer Developed and Demonstrated for Space Communications Applications

NASA Technical Reports Server (NTRS)

Carazo, Alfredo V.; Wintucky, Edwin G.

2004-01-01

Improvements in individual piezoelectric transformer (PT) performance and the combination of these PTs in a unique modular topology under a Phase I contract with the NASA Glenn Research Center have enabled for the first time the simultaneous achievement of both high voltage and high power at much higher levels than previously obtained with any PT. Feasibility was demonstrated by a prototype transformer (called a Tap-Soner), which is shown in the preceding photograph as part of a direct-current to direct-current (dc-dc) converter having two outputs rated at 1.5 kV/5 W and 4.5 kV/20 W. The power density of 3.5 W/cm3 is significantly lower than for magnetic transformers with the same voltage and power output. This development, which is being done under a Small Business Innovation Research (SBIR) contract by Face Electronics, LC (Norfolk, VA), is based on improvements in the materials and design of Face's basic patented Transoner-T3 PT, shown in the left in the following figure. The T3 PT is most simply described as a resonant multilayer transducer where electrical energy at the input section is efficiently mechanically coupled to the output section, which then vibrates in a fundamental longitudinal mode to generate a high gain in voltage. The piezoelectric material used is a modified lead-zirconium-titanate-based ceramic. One of the significant improvements in PT design was the incorporation of a symmetrical double input layer, shown on the right in the following figure, which eliminated the lossy bending vibration modes characteristic of a single input layer. The performance of the improved PT was optimized to 1.5 kV/5 W. The next step was devising a way to combine the individual PTs in a modular circuit topology needed to achieve the desired high voltage and power output. Since the optimum performance of the individual PT occurs at resonance, the most efficient operation of the modular transformer was achieved by using a separate drive circuit for each PT. The output section consists of a separate output rectifier for each PT connected in series.

Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey.

PubMed

Poortinga, Wouter; Jones, Nikki; Lannon, Simon; Jenkins, Huw

2017-12-02

While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as those of their specific constituent measures. This study evaluates the impacts of a managed housing upgrade programme through a repeated cross-sectional survey design. A five-wave repeated cross-sectional survey was conducted over a seven-year period from 2009 to 2016 (n = 2075; n = 2219; n = 2015; n = 1991; and n = 1709, respectively). The study followed a managed upgrade programme designed to meet a national social housing standard over an extended period. The data were analysed from a multilevel perspective to take account of the time-dependent nature of the observations and differences in socio-demographic composition. The installation of the majority of individual housing measures (new windows and doors; boilers; kitchens; bathrooms; electrics; loft insulation; and cavity/external wall insulation) were associated with improvements in several social (housing suitability, satisfaction, and quality; thermal comfort and household finances) and health (mental, respiratory and general health) outcomes; and analyses showed relationships between the number of measures installed and the total amount invested on the one hand and the social and health outcomes on the other. There were however a few exceptions. Most notably, the installation of cavity wall insulation was associated with poorer health outcomes, and did not lead to better social outcomes. Also, no association was found between the number of measures installed and respiratory health. The study suggests that substantial housing investments through a managed upgrade programme may result in better social and health outcomes, and that the size of the improvements are proportionate to the number of measures installed and amount invested. However, there may be risks associated with specific measures; and more attention is needed for mechanical ventilation when upgrading energy efficiency of houses through fabric work. In addition to providing new evidence regarding the wider social and health outcomes, the study provides an analytical approach to evaluate upgrade programmes that are delivered over multiple years.

Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

PubMed

Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

2018-03-01

To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p < .0001). Healthcare providers perceived the interprofessional care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

Activities of the DOE Nuclear Criticality Safety Program (NCSP) at the Oak Ridge Electron Linear Accelerator (ORELA)

NASA Astrophysics Data System (ADS)

Valentine, Timothy E.; Leal, Luiz C.; Guber, Klaus H.

2002-12-01

The Department of Energy established the Nuclear Criticality Safety Program (NCSP) in response to the Recommendation 97-2 by the Defense Nuclear Facilities Safety Board. The NCSP consists of seven elements of which nuclear data measurements and evaluations is a key component. The intent of the nuclear data activities is to provide high resolution nuclear data measurements that are evaluated, validated, and formatted for use by the nuclear criticality safety community to provide improved and reliable calculations for nuclear criticality safety evaluations. High resolution capture, fission, and transmission measurements are performed at the Oak Ridge Electron Linear Accelerator (ORELA) to address the needs of the criticality safety community and to address known deficiencies in nuclear data evaluations. The activities at ORELA include measurements on both light and heavy nuclei and have been used to identify improvements in measurement techniques that greatly improve the measurement of small capture cross sections. The measurement activities at ORELA provide precise and reliable high-resolution nuclear data for the nuclear criticality safety community.

Influence of workplace culture on nursing-sensitive nurse outcomes in municipal primary health care.

PubMed

Hahtela, Nina; Paavilainen, Eija; McCormack, Brendan; Slater, Paul; Helminen, Mika; Suominen, Tarja

2015-10-01

To explore the influence of workplace culture on sickness absences, overtime work and occupational injuries in municipal primary health care. The need to improve nursing sensitive outcomes has been highlighted. Therefore, an adequate understanding of the influence of workplace culture on nursing-sensitive nurse outcomes is essential for nurse managers to meet the requirements of improving nursing outcomes. A cross-sectional survey design was used to incorporating the data from 21 inpatient acute care units of nine organisations at the Finnish municipal primary health care system from 2011 to 2012. Findings emphasise in particular the importance of the practice environment as being an interpretative factor for nurses' absences owing to sickness, overtime work and occupational injuries. To ensure favourable nursing sensitive outcomes it is essential that there is a shared interest in the unit to invest in the creation of a supportive practice environment. Outcome improvements require a special focus on issues related to nursing management, adequate staffing and resources and intention to leave. © 2014 John Wiley & Sons Ltd.

Web-based provision of information on infectious diseases: a systems study.

PubMed

Roy, Anjana; Kostkova, Patty; Catchpole, Michael; Carson, Ewart

2006-12-01

The National electronic Library for Health (NeLH) is an Internet medical information resources portal, principally for healthcare professionals, within which the National electronic Library of Infection (NeLI) is one of NeLH Specialist Libraries providing evidence on infectious diseases. In this article, we describe a systems-based evaluation of NeLI based on a soft systems methodology. User feedback and other data for the analysis were obtained using online questionnaires. This evaluation, which is a pilot study aimed at demonstrating proof of concept, provided evidence for improving three systems that are crucial to effective NeLI provision. These are navigation of the site, quality and tagging of information provided by NeLI, and information regarding users and their usage of the system. On the basis of a soft systems analysis, an action plan was formulated identifying areas where improvement is needed. Actions for consideration included simplifying terminologies to improve the navigation, enhancing the provision of research assessments, quality tagging NeLI documents, provided by experts in the field, and attracting a broader cross-section of healthcare professional user.

Terahertz Imaging of Three-Dimensional Dehydrated Breast Cancer Tumors

NASA Astrophysics Data System (ADS)

Bowman, Tyler; Wu, Yuhao; Gauch, John; Campbell, Lucas K.; El-Shenawee, Magda

2017-06-01

This work presents the application of terahertz imaging to three-dimensional formalin-fixed, paraffin-embedded human breast cancer tumors. The results demonstrate the capability of terahertz for in-depth scanning to produce cross section images without the need to slice the tumor. Samples of tumors excised from women diagnosed with infiltrating ductal carcinoma and lobular carcinoma are investigated using a pulsed terahertz time domain imaging system. A time of flight estimation is used to obtain vertical and horizontal cross section images of tumor tissues embedded in paraffin block. Strong agreement is shown comparing the terahertz images obtained by electronically scanning the tumor in-depth in comparison with histopathology images. The detection of cancer tissue inside the block is found to be accurate to depths over 1 mm. Image processing techniques are applied to provide improved contrast and automation of the obtained terahertz images. In particular, unsharp masking and edge detection methods are found to be most effective for three-dimensional block imaging.

Hospital board effectiveness: relationships between governing board composition and hospital financial viability.

PubMed Central

Molinari, C; Morlock, L; Alexander, J; Lyles, C A

1993-01-01

OBJECTIVE. Two theories--agency and managerialism--are compared with respect to their usefulness in explaining the role of insiders on the hospital board: whether their participation enhances or impairs board financial decision making. DATA SOURCES/STUDY SETTING. The study used 1985 hospital financial and governing board data for a representative sample of acute care California hospitals. STUDY DESIGN. Relationships were examined cross-sectionally between the presence or absence of insiders on the board and measures of hospital financial viability while controlling for the organizational factors of system affiliation, ownership, size, region, and corporate restructuring. PRINCIPAL FINDINGS. Multiple regression analysis found significant relationships between insider (CEO, medical staff) participation and hospital viability. CONCLUSIONS. These results support the managerial theory of governance by suggesting that the CEO and medical staff provide informational advantages to the hospital governing board. However, the cross-sectional design points to the need for future longitudinal studies in order to sequence these relationships between insider participation and improved hospital viability. PMID:8344824

Active Management of Integrated Geothermal-CO2 Storage Reservoirs in Sedimentary Formations

DOE Data Explorer

Buscheck, Thomas A.

2012-01-01

Active Management of Integrated Geothermal–CO2 Storage Reservoirs in Sedimentary Formations: An Approach to Improve Energy Recovery and Mitigate Risk : FY1 Final Report The purpose of phase 1 is to determine the feasibility of integrating geologic CO2 storage (GCS) with geothermal energy production. Phase 1 includes reservoir analyses to determine injector/producer well schemes that balance the generation of economically useful flow rates at the producers with the need to manage reservoir overpressure to reduce the risks associated with overpressure, such as induced seismicity and CO2 leakage to overlying aquifers. This submittal contains input and output files of the reservoir model analyses. A reservoir-model "index-html" file was sent in a previous submittal to organize the reservoir-model input and output files according to sections of the FY1 Final Report to which they pertain. The recipient should save the file: Reservoir-models-inputs-outputs-index.html in the same directory that the files: Section2.1.*.tar.gz files are saved in.

Active Management of Integrated Geothermal-CO2 Storage Reservoirs in Sedimentary Formations

DOE Data Explorer

Buscheck, Thomas A.

2000-01-01

Active Management of Integrated Geothermal–CO2 Storage Reservoirs in Sedimentary Formations: An Approach to Improve Energy Recovery and Mitigate Risk: FY1 Final Report The purpose of phase 1 is to determine the feasibility of integrating geologic CO2 storage (GCS) with geothermal energy production. Phase 1 includes reservoir analyses to determine injector/producer well schemes that balance the generation of economically useful flow rates at the producers with the need to manage reservoir overpressure to reduce the risks associated with overpressure, such as induced seismicity and CO2 leakage to overlying aquifers. This submittal contains input and output files of the reservoir model analyses. A reservoir-model "index-html" file was sent in a previous submittal to organize the reservoir-model input and output files according to sections of the FY1 Final Report to which they pertain. The recipient should save the file: Reservoir-models-inputs-outputs-index.html in the same directory that the files: Section2.1.*.tar.gz files are saved in.

2014 section on pediatrics knowledge translation lecture: clinicians and researchers on the same path toward facilitating family goals for mobility and participation.

PubMed

Damiano, Diane L; Leonard, Rebecca

2015-01-01

The knowledge translation (KT) lecture at the Combined Sections Meeting 2014 was a personal perspective from a researcher who had been a therapist and a longtime clinician, now a PhD candidate. To better integrate research and clinical care, KT is a seamless rather than separate process. Knowledge translation can be enhanced by improved receptivity to evidence, and increasing use of research designs that encourage and even require clinician involvement, from single-subject designs to large-scale pragmatic trials. Clinical practice databases and hiring therapists to provide intervention in research efforts also serve to integrate research and clinical care. Limitations of applying mean group research results to an individual patient were also discussed and suggest an important unanswered topic for future research. We all need to assume responsibility for the researcher-clinician partnership, making our jobs more joyful and fulfilling, and hopefully the biggest beneficiaries will be our current and future patients.

Trainer Guide: Serving Campers With Special Needs. Camp Administration Series.

ERIC Educational Resources Information Center

Brookhiser, Judy

Part of the materials developed for Project STRETCH (Strategies to Try out Resources to Enhance the Training of Camp directors serving the Handicapped), this guide consists of three sections: an introduction, the managerial trainer guide, and appendices. Section I addresses the rise of organized camping as big business, the need to provide camping…

Service, Resource and Training Needs of American Indian Vocational Rehabilitation Projects.

ERIC Educational Resources Information Center

Lonetree, Georgia L.

This study sought to identify resources available and training/technical assistance needs of personnel employed by projects serving American Indians and Alaska Natives under the provisions of Section 130 of the Rehabilitation Act. Section 130 authorizes funding of vocational rehabilitation service grants to the governing bodies of Indian tribes on…

Client Assessment in an Industrial Setting: A Cross-Sectional Method.

ERIC Educational Resources Information Center

Yamatani, Hide

1988-01-01

Used cross-sectional method for evaluating social service programs in industrial setting to estimate numbers of workers needing social services, levels of program use, and penetration and to examine program outcome. Workers served by social service or employee assistance programs can be examined to determine additional services needed, adequacy of…

44 CFR 9.5 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... and 306; (2) Emergency Support Teams (section 304); (3) Unemployment Assistance (section 407); (4...) actions: (i) Housing needs or expenses, except for restoring, repairing or building private bridges...) Replacement of building contents, materials and equipment. (sections 402 and 419). (4) Repairs under section...

44 CFR 9.5 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and 306; (2) Emergency Support Teams (section 304); (3) Unemployment Assistance (section 407); (4...) actions: (i) Housing needs or expenses, except for restoring, repairing or building private bridges...) Replacement of building contents, materials and equipment. (sections 402 and 419). (4) Repairs under section...

44 CFR 9.5 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... and 306; (2) Emergency Support Teams (section 304); (3) Unemployment Assistance (section 407); (4...) actions: (i) Housing needs or expenses, except for restoring, repairing or building private bridges...) Replacement of building contents, materials and equipment. (sections 402 and 419). (4) Repairs under section...

Soil in the City: Sustainably Improving Urban Soils.

PubMed

Kumar, Kuldip; Hundal, Lakhwinder S

2016-01-01

Large tracts of abandoned urban land, resulting from the deindustrialization of metropolitan areas, are generating a renewed interest among city planners and community organizations envisioning the productive use of this land not only to produce fresh food but to effectively manage stormwater and mitigate the impact of urban heat islands. Healthy and productive soils are paramount to meet these objectives. However, these urban lands are often severely degraded due to anthropogenic activities and are generally contaminated with priority pollutants, especially heavy metals and polycyclic aromatic hydrocarbons. Characterizing these degraded and contaminated soils and making them productive again to restore the required ecosystem services was the theme of the "Soil in the City- 2014" conference organized by W-2170 Committee (USDA's Sponsored Multi-State Research Project: Soil-Based Use of Residuals, Wastewater, & Reclaimed Water). This special section of comprises 12 targeted papers authored by conference participants to make available much needed information about the characteristics of urban soils. Innovative ways to mitigate the risks from pollutants and to improve the soil quality using local resources are discussed. Such practices include the use of composts and biosolids to grow healthy foods, reclaim brownfields, manage stormwater, and improve the overall ecosystem functioning of urban soils. These papers provide a needed resource for educating policymakers, practitioners, and the general public about using locally available resources to restore fertility, productivity, and ecosystem functioning of degraded urban land to revitalize metropolitan areas for improving the overall quality of life for a large segment of a rapidly growing urban population. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Working Party on International Nuclear Data Evaluation Cooperation (WPEC)

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

Dupont, E., E-mail: wpec@oecd-nea.org; Chadwick, M.B.; Danon, Y.

The OECD Nuclear Energy Agency (NEA) organizes cooperation between the major nuclear data evaluation projects in the world. The NEA Working Party on International Nuclear Data Evaluation Cooperation (WPEC) was established to promote the exchange of information on nuclear data evaluation, measurement, nuclear model calculation, validation, and related topics, and to provide a framework for cooperative activities between the participating projects. The working party assesses nuclear data improvement needs and addresses these needs by initiating joint activities in the framework of dedicated WPEC subgroups. Studies recently completed comprise a number of works related to nuclear data covariance and associated processingmore » issues, as well as more specific studies related to the resonance parameter representation in the unresolved resonance region, the gamma production from fission product capture reactions, the {sup 235}U capture cross section, the EXFOR database, and the improvement of nuclear data for advanced reactor systems. Ongoing activities focus on the evaluation of {sup 239}Pu in the resonance region, scattering angular distribution in the fast energy range, and reporting/usage of experimental data for evaluation in the resolved resonance region. New activities include two subgroups on improved fission product yield evaluation methodologies and on modern nuclear database structures. Future activities under discussion include a pilot project for a Collaborative International Evaluated Library Organization (CIELO) and methods to provide feedback from nuclear and covariance data adjustment for improvement of nuclear data. In addition to the above mentioned short-term task-oriented subgroups, WPEC also hosts a longer-term subgroup charged with reviewing and compiling the most important nuclear data requirements in a high priority request list (HPRL)« less

Working Party on International Nuclear Data Evaluation Cooperation (WPEC)

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

Giuseppe Palmiotti

The OECD Nuclear Energy Agency (NEA) is organizing the cooperation between the major nuclear data evaluation projects in the world. The NEA Working Party on International Nuclear Data Evaluation Cooperation (WPEC) was established to promote the exchange of information on nuclear data evaluation, measurement, nuclear model calculation, validation, and related topics, and to provide a framework for cooperative activities between the participating projects. The working party assesses nuclear data improvement needs and addresses these needs by initiating joint activities in the framework of dedicated WPEC subgroups. Studies recently completed comprise a number of works related to nuclear data covariance andmore » associated processing issues, as well as more specific studies related to the resonance parameter representation in the unresolved resonance region, the gamma production from fission-product capture reactions, the U-235 capture cross-section, the EXFOR database, and the improvement of nuclear data for advanced reactor systems. Ongoing activities focus on the evaluation of Pu-239 in the resonance region, scattering angular distribution in the fast energy range, and reporting/usage of experimental data for evaluation in the resolved resonance region. New activities include two new subgroups on improved fission product yield evaluation methodologies and on modern nuclear database structures. Future activities under discussion include a pilot project of a Collaborative International Evaluated Library (CIELO) and methods to provide feedback from nuclear and covariance data adjustment for improvement of nuclear data. In addition to the above mentioned short-term, task-oriented subgroups, the WPEC also hosts a longer-term subgroup charged with reviewing and compiling the most important nuclear data requirements in a high priority request list (HPRL).« less

Working Party on International Nuclear Data Evaluation Cooperation (WPEC)

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

Dupont, E.; Herman, M.; Dupont, E.

The OECD Nuclear Energy Agency (NEA) organizes cooperation between the major nuclear data evaluation projects in the world. Moreover, the NEA Working Party on International Nuclear Data Evaluation Cooperation (WPEC) was established to promote the exchange of information on nuclear data evaluation, measurement, nuclear model calculation, validation, and related topics, and to provide a framework for cooperative activities between the participating projects. The working party assesses nuclear data improvement needs and addresses these needs by initiating joint activities in the framework of dedicated WPEC subgroups. Studies recently completed comprise a number of works related to nuclear data covariance and associatedmore » processing issues, as well as more specific studies related to the resonance parameter representation in the unresolved resonance region, the gamma production from fission product capture reactions, the 235U capture cross section, the EXFOR database, and the improvement of nuclear data for advanced reactor systems. Ongoing activities focus on the evaluation of 239Pu in the resonance region, scattering angular distribution in the fast energy range, and reporting/usage of experimental data for evaluation in the resolved resonance region. New activities include two subgroups on improved fission product yield evaluation methodologies and on modern nuclear database structures. Some future activities under discussion include a pilot project for a Collaborative International Evaluated Library Organization (CIELO) and methods to provide feedback from nuclear and covariance data adjustment for improvement of nuclear data. In addition to the above mentioned short-term task-oriented subgroups, WPEC also hosts a longer-term subgroup charged with reviewing and compiling the most important nuclear data requirements in a high priority request list (HPRL).« less

The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices.

PubMed

Salgado, Teresa M; Mackler, Emily; Severson, Jane A; Lindsay, Jamie; Batra, Peter; Petersen, Laura; Farris, Karen B

2017-06-01

The Michigan Oncology Quality Consortium (MOQC) is a continuous quality improvement collaborative seeking to improve oncology care in Michigan, including for patients taking oral chemotherapy. The aim of this study was to assess the relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics to inform future oncology care. A multicenter cross-sectional observational study was conducted using an online survey to examine patient activation (patient activation measure, PAM), health literacy, symptom burden (Edmonton Symptom Assessment System, ESAS), confidence to self-manage side effects (fatigue, nausea, and diarrhea), and adherence to oral oncolytics. Inclusion criteria were patients taking an oral oncolytic for at least 1 month. Bivariate analyses and logistic regression were performed to evaluate relationships between the variables. A total of 125 respondents, mean (SD) age 66.2 (13.6), 57.7% female, and 95.1% Caucasian completed the survey. The mean (SD) PAM score was 65.0 (18.0). Confidence to manage fatigue, nausea, and diarrhea was associated with higher activation, and confidence to self-manage fatigue and diarrhea were associated with higher health literacy. About 30% of participants reported some level of non-adherence to oral oncolytics, and those who experienced side effects (Fisher's exact test p = 0.033) and with shorter length of therapy (t test p = 0.027) were significantly more likely to be non-adherent. These findings show that there is room for improvement across practices involved with MOQC with regard to supporting patients taking oral oncolytics. Patients will need to improve their activation levels, and oncology clinics will need to create new workflows in order to enhance self-care management ability for patients taking oral oncolytics.

Hearings Before the Select Committee on Nutrition and Human Needs of the United States Senate, Ninety-First Congress, Second Session on Nutrition and Human Needs. Nutrition and Human Needs--1970. Part 2--National School Lunch Program; the Urban Crisis. Hearings Held Modesto, Calif., March 23, 1970, and Chicago, Ill., April 20, 1970.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Select Committee on Nutrition and Human Needs.

The contents of this part of the hearings before the Senate Select Committee on Nutrition and Human Needs are organized in six sections. Section one comprises the testimony and/or prepared statements of 10 witnesses submitted on March 23, 1970 before the Select Committee at Modesto, California, including: Daniel Lowenstein and Philip Neumark,…

Tooth loss, prosthetic status and treatment needs among industrial workers in Belgaum, Karnataka, India.

PubMed

Patil, Vishal V; Shigli, Kamal; Hebbal, Mamata; Agrawal, Neha

2012-01-01

The health of industrial workers often goes uncared for due to their stressful working conditions, busy schedules and poor economic conditions. A cross-sectional survey was conducted to determine the prevalence of tooth loss, prosthetic status and treatment needs among industrial workers in Belgaum, Karnataka, India according to the criteria described in the World Health Organization (WHO) Oral Health Assessment form (1997). A total of 614 workers participated in the study. Information was obtained regarding their oral hygiene practice. The presence or absence of habits, and the frequency and duration since the last visit to a dentist were recorded followed by clinical examination. Chi-square test was used to determine the association between the variables and tooth loss. There was a statistically significant difference between the number of missing teeth in different age groups, methods of cleaning, smoking habits and visits to the dentist. Regarding prosthetic status, only one worker had a fixed prosthesis in the mandibular arch. The study revealed that tooth loss was associated with oral hygiene practices, habits and visits to the dentist. Poor prosthetic status and high treatment needs were observed. This study emphasized the need for improved dental health awareness and availability of dental facilities to industrial workers.

An evaluation of the health and wellbeing needs of employees: An organizational case study

PubMed Central

Chetty, Laran

2016-01-01

Introduction: Workplace health and wellbeing is a major public health issue for employers. Wellbeing health initiatives are known to be cost-effective, especially when the programs are targeted and matched to the health problems of the specific population. The aim of this paper is to gather information about the health and wellbeing needs and resources of employees at one British organization. Subjects and Methods: A cross-sectional survey was carried out to explore the health and wellbeing needs and resources of employees at one British organization. All employees were invited to participate in the survey, and, therefore, sampling was not necessary. Results: 838 questionnaires were viable and included in the analysis. Employees reported "feeling happier at work" was the most important factor promoting their health and wellbeing. Physical tasks, such as "moving and handling" were reported to affect employee health and wellbeing the most. The "provision of physiotherapy" was the most useful resource at work. In all, 75% felt that maintaining a healthy lifestyle in the workplace is achievable. Conclusions: More needs to be done by organizations and occupational health to improve the working conditions and organizational culture so that employees feel that they can function at their optimal and not perceive the workplace as a contributor to ill-health. PMID:27853056

An evaluation of the health and wellbeing needs of employees: An organizational case study.

PubMed

Chetty, Laran

2017-01-24

Workplace health and wellbeing is a major public health issue for employers. Wellbeing health initiatives are known to be cost-effective, especially when the programs are targeted and matched to the health problems of the specific population. The aim of this paper is to gather information about the health and wellbeing needs and resources of employees at one British organization. A cross-sectional survey was carried out to explore the health and wellbeing needs and resources of employees at one British organization. All employees were invited to participate in the survey, and, therefore, sampling was not necessary. 838 questionnaires were viable and included in the analysis. Employees reported "feeling happier at work" was the most important factor promoting their health and wellbeing. Physical tasks, such as "moving and handling" were reported to affect employee health and wellbeing the most. The "provision of physiotherapy" was the most useful resource at work. In all, 75% felt that maintaining a healthy lifestyle in the workplace is achievable. More needs to be done by organizations and occupational health to improve the working conditions and organizational culture so that employees feel that they can function at their optimal and not perceive the workplace as a contributor to ill-health.

Randomized Multilevel Intervention to Improve Outcomes of Residents in Nursing Homes in Need of Improvement

PubMed Central

Rantz, Marilyn J.; Nahm, Helen E.; Zwygart-Stauffacher, Mary; Hicks, Lanis; Mehr, David; Flesner, Marcia; Petroski, Gregory F.; Madsen, Richard W.; Scott-Cawiezell, Jill

2012-01-01

Purpose A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. Design and Methods Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs. Results The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. Implications Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. PMID:21816681

Integrating palliative care into disease management guidelines.

PubMed

Emanuel, Linda; Alexander, Carla; Arnold, Robert M; Bernstein, Richard; Dart, Richard; Dellasantina, Christopher; Dykstra, Lee; Tulsky, James

2004-12-01

Palliative care should not be reserved for those who are close to dying; as a comprehensive approach to minimizing illness-related suffering, it is appropriate for patients with significant illness from the time of diagnosis on. The American Hospice Foundation Guidelines Committee's initiative aims to provide a practical approach for guideline writers and others to integrate palliative care into disease management and care services whenever it is relevant. A consensus approach was used to design recommendations for upgrading existing disease management and service guidelines to include palliative care. A template is described for identifying stages in disease management guidelines when integration of palliative care is appropriate: (1) Introductory sections to disease management guidelines should include prognosis and other disease consequences; (2) Diagnostic sections should include recommendations for conducting a whole patient assessment; (3) Treatment sections should include discernment of patient goals for care, continuous goal reassessment, palliative care interventions to reduce suffering as needed, and treatment decisions should include discussion of the type of expected improvement. Service guidelines should note the role of interdisciplinary team care as well as palliative care consultative or care services; (4) Sections that conclude the care provided to incurable patients should not end without recommendations on grief and bereavement care, and care during the last hours of living. The American Hospice Foundation Guidelines Committee recommends integration of relevant aspects of palliative care in introductory, diagnostic, treatment, and closing sections of management guidelines for all significant illnesses.

Coverage and equity in reproductive and maternal health interventions in Brazil: impressive progress following the implementation of the Unified Health System.

PubMed

França, Giovanny V A; Restrepo-Méndez, María Clara; Maia, Maria Fátima S; Victora, Cesar G; Barros, Aluísio J D

2016-11-17

The Brazilian SUS (Unified Health System) was created in 1988 within the new constitution, based on the premises of being universal, comprehensive, and equitable. The SUS offers free health care, independent of contribution or affiliation. Since then, great efforts and increasing investments have been made for the system to achieve its goals. We assessed how coverage and equity in selected reproductive and maternal interventions progressed in Brazil from 1986 to 2013. We reanalysed data from four national health surveys carried out in Brazil in 1986, 1996, 2006 and 2013. We estimated coverage for six interventions [use of modern contraceptives; antenatal care (ANC) 1+ visits by any provider; ANC 4+ visits by any provider; first ANC visit during the first trimester of pregnancy; institutional delivery; and Caesarean sections] using standard international definitions, and stratified results by wealth quintile, urban or rural residence and country regions. We also calculated two inequality indicators: the slope index of inequality (SII) and the concentration index (CIX). All indicators showed steady increases in coverage over time. ANC 1+ and 4+ and institutional delivery reached coverage above 90 % in 2013. Prevalence of use of modern contraceptives was 83 % in 2013, indicating nearly universal satisfaction of need for contraception. On a less positive note, the proportion of C-sections has also grown continuously, reaching 55 % in 2013. There were marked reductions in wealth inequalities for all preventive interventions. Inequalities were significantly reduced for all indicators except for the C-section rate (p = 0.06), particularly in absolute terms (SII). Despite the difficulties faced in the implementation of SUS, coverage of essential interventions increased and equity has improved dramatically, due in most cases to marked increase in coverage among the poorest 40 %. An increase in unnecessary Caesarean sections was also observed during the period. Further evaluation on the quality of healthcare provided is needed.

Summary of Booster Development and Qualification Report

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

Francois, Elizabeth G.; Harry, Herbert H.; Hartline, Ernest L.

2012-06-21

This report outlines booster development work done at Los Alamos National Laboratory from 2007 to present. The booster is a critical link in the initiation train of explosive assemblies, from complex devices like nuclear weapons to conventional munitions. The booster bridges the gap from a small, relatively sensitive detonator to an insensitive, but massive, main charge. The movement throughout the explosives development community is to use more and more insensitive explosive components. With that, more energy is needed out of the booster. It has to initiate reliably, promptly, powerfully and safely. This report is divided into four sections. The firstmore » provides a summary of a collaborative effort between LANL, LLNL, and AWE to identify candidate materials and uniformly develop a testing plan for new boosters. Important parameters and the tests required to measure them were defined. The nature of the collaboration and the specific goals of the participating partners has changed over time, but the booster development plan stands on its own merit as a complete description of the test protocol necessary to compare and qualify booster materials, and is discussed in its entirety in this report. The second section describes a project, which began in 2009 with the Department of Defense to develop replacement booster formulations for PBXN-7. Replacement of PBXN-7 was necessary because it contained Triaminotrinitrobenzene (TATB), which was becoming unavailable to the DoD and because it contained Cyclotrimethylenetrinitramine (RDX), which was sensitive and toxic. A LANL-developed explosive, Diaminoazoxyfurazan (DAAF), was an important candidate. This project required any replacement formulation be a drop-in replacement in existing munitions. This project was timely, in that it made use of the collaborative booster development project, and had the additional constraint of matching shock sensitivity. Additionally it needed to be a safety improvement, and a performance improvement, especially at cold temperatures. The requirements of this project necessitated novel test development and a different approach to ranking booster qualities. Results of this project have been documented to the DoD and the relevant portions are included within. The third section of this booster report outlines testing related to main charge initiation merit. Initiability can be evaluated by looking at critical diameter, run distance, and shock sensitivity. Once a booster is initiated, it needs to be powerful enough to initiate the main charge symmetrically and evenly. Main charge initiability is evaluated directly by observing detonation wave symmetry, curvature, and first break out over the surface of a charge. Furthermore it must be insensitive to accidents and insults, and safe and reliable across a range of temperatures. These effects, tests, and results will be discussed individually in the context of DAAF and other explosives similarly tested. The last section provides a conclusion and summary of our experimental work and recommendations for the path forward. References and additional supporting documentation and results are provided in the appendices at the end of this report.« less

Central nervous system lesions: correlation of intraoperative and final diagnoses, six year experience at a referral centre in a developing country, Pakistan.

PubMed

Ud Din, Nasir; Memon, Aisha; Idress, Romana; Ahmad, Zubair; Hasan, Sheema

2011-01-01

Intraoperative consultation of CNS lesions provides accurate diagnosis to neurosurgeons. Some lesions, however, may cause diagnostic difficulty. In this study accuracy of intraoperative consultations of CNS lesions and discrepancies in diagnosis and deferrals were analysed. All CNS cases from May 1, 2004 to September 20, 2010 in which intraoperative frozen section had been performed, and which were reported in the Section of Histopathology, Aga Khan University Hospital, Karachi Pakistan were retrieved. The diagnoses given on FS were compared with the final diagnosis given on permanent sections (and additional material if received), as indicated in the frozen section and final pathology report. During the study period, 171 CNS cases were received for intraoperative consultation. In all cases, cryostat sections (FS) plus cytology smears were prepared. The ages of the patients ranged from 03 to 77 years. 106 were males and 65 were females. Out of these 171 cases, 160 cases (94.1 %) were concordant, 10 cases (5.8 %) were discrepant, and one case was deferred until permanent sections. The diagnostic accuracy of frozen section was 88.9%. The sensitivity and specificity were 94.8% and 87.5% respectively. The positive predictive value was 98.6% and negative predictive value was 63.6%. All our cases in which intraoperative consultation was requested were sent for primary diagnosis. Adequacy per se was not a criterion for sending cases for intraoperative consultation. Our results show a reasonably high percentage of accuracy in the intraoperative diagnosis of CNS lesions. However, there are limitations and some lesions pose a diagnostic challenge. There is a need to improve our own diagnostic skills and establish better communication with neurosurgeons.

Morphological and molecular characterization of three Agaricus species from tropical Asia (Pakistan, Thailand) reveals a new group in section Xanthodermatei.

PubMed

Thongklang, Naritsada; Nawaz, Rizwana; Khalid, Abdul N; Chen, Jie; Hyde, Kevin D; Zhao, Ruilin; Parra, Luis A; Hanif, Muhammad; Moinard, Magalie; Callac, Philippe

2014-01-01

The genus Agaricus is known for its medicinal and edible species but also includes toxic species that belong to section Xanthodermatei. Previous phylogenetic reconstruction for temperate species, based on sequence data of nuc rRNA gene (rDNA) internal transcribed spacers (ITS), has revealed two major groups in this section and a possible third lineage for A. pseudopratensis. Recent research in Agaricus has shown that classifications need improving with the addition of tropical taxa. In this study we add new tropical collections to section Xanthodermatei. We describe three species from collections made in Pakistan and Thailand and include them in a larger analysis using all available ITS data for section Xanthodermatei. Agaricus bisporiticus sp. nov. and A. fuscopunctatus sp. nov. are introduced based on molecular and morphological studies, whereas A. microvolvatulus is recorded for the first time in Asia. Specimens from Thailand however have a much larger pileus than the type specimens from Congo. In maximum likelihood (ML) and maximum parsimony (MP) phylogenetic analyses these three species cluster with A. pseudopratensis from the Mediterranean area and A. murinocephalus recently described from Thailand. In Agaricus section Xanthodermatei this new group is monophyletic and receives low bootstrap support whereas the two previously known groups receive strong support. Within the new group, the most closely related species share some traits, but we did not find any unifying morphological character; however the five species of the group share a unique short nucleotide sequence. Two putatively toxic species of section Xanthodermatei are now recognized in Pakistan and six in Thailand. © 2014 by The Mycological Society of America.

Road and Roadside Feature Extraction Using Imagery and LIDAR Data for Transportation Operation

NASA Astrophysics Data System (ADS)

Ural, S.; Shan, J.; Romero, M. A.; Tarko, A.

2015-03-01

Transportation agencies require up-to-date, reliable, and feasibly acquired information on road geometry and features within proximity to the roads as input for evaluating and prioritizing new or improvement road projects. The information needed for a robust evaluation of road projects includes road centerline, width, and extent together with the average grade, cross-sections, and obstructions near the travelled way. Remote sensing is equipped with a large collection of data and well-established tools for acquiring the information and extracting aforementioned various road features at various levels and scopes. Even with many remote sensing data and methods available for road extraction, transportation operation requires more than the centerlines. Acquiring information that is spatially coherent at the operational level for the entire road system is challenging and needs multiple data sources to be integrated. In the presented study, we established a framework that used data from multiple sources, including one-foot resolution color infrared orthophotos, airborne LiDAR point clouds, and existing spatially non-accurate ancillary road networks. We were able to extract 90.25% of a total of 23.6 miles of road networks together with estimated road width, average grade along the road, and cross sections at specified intervals. Also, we have extracted buildings and vegetation within a predetermined proximity to the extracted road extent. 90.6% of 107 existing buildings were correctly identified with 31% false detection rate.

Changes in the job situation due to telemedicine.

PubMed

Aas, I H Monrad

2002-01-01

Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.

Computerized design of controllers using data models

NASA Technical Reports Server (NTRS)

Irwin, Dennis; Mitchell, Jerrel; Medina, Enrique; Allwine, Dan; Frazier, Garth; Duncan, Mark

1995-01-01

The major contributions of the grant effort have been the enhancement of the Compensator Improvement Program (CIP), which resulted in the Ohio University CIP (OUCIP) package, and the development of the Model and Data-Oriented Computer Aided Design System (MADCADS). Incorporation of direct z-domain designs into CIP was tested and determined to be numerically ill-conditioned for the type of lightly damped problems for which the development was intended. Therefore, it was decided to pursue the development of z-plane designs in the w-plane, and to make this conversion transparent to the user. The analytical development needed for this feature, as well as that needed for including compensator damping ratios and DC gain specifications, closed loop stability requirements, and closed loop disturbance rejection specifications into OUCIP are all contained in Section 3. OUCIP was successfully tested with several example systems to verify proper operation of existing and new features. The extension of the CIP philosophy and algorithmic approach to handle modern multivariable controller design criteria was implemented and tested. Several new algorithms for implementing the search approach to modern multivariable control system design were developed and tested. This analytical development, most of which was incorporated into the MADCADS software package, is described in Section 4, which also includes results of the application of MADCADS to the MSFC ACES facility and the Hubble Space Telescope.

Dyadic interdependence of psychosocial outcomes among haematological cancer survivors and their support persons.

PubMed

Paul, Christine; Hall, Alix; Oldmeadow, Christopher; Lynagh, Marita; Campbell, Sharon; Bradstock, Ken; Williamson, Anna; Carey, Mariko; Sanson-Fisher, Rob

2017-11-01

This study aimed to explore the dyadic relationships between unmet need, depression, and anxiety in people diagnosed with haematological cancer and their support persons. Adult survivors (18 years+) who had been diagnosed with a haematological cancer were recruited to a cross-sectional mailed survey via five state cancer registries in Australia. Participating survivors invited a support person to also complete a survey. Structural equation modelling was used to explore the relationships among survivor and support person self-reported depression, anxiety, and unmet needs. Of the 4299 eligible haematological cancer survivors contacted by the registries, 1511 (35%) returned a completed survey as did 1004 support persons. There were 787 dyads with complete data. After adjusting for age, gender, rurality, cancer type, and whether the support person was a relative, positive correlations were found between survivor and support person scores for depression (p = 0.0029) and unmet needs (p < 0.001), but not anxiety scores (p = 0.075). Survivor unmet needs were significantly related to support person depression (p = 0.0036). Support person unmet needs were significantly related to a higher depression score for survivors (p = 0.0067). Greater support person unmet needs were significantly related to a higher anxiety score for survivors (p = 0.0083). Survivor unmet needs did not have a significant relationship to support person anxiety (p = 0.78). Unmet needs may mediate the interdependence of psychosocial experiences for survivors and support persons, although a longitudinal study is required to confirm causality. Addressing unmet needs may be a potential target for improving outcomes for both groups.

A solvent-free coating-procedure for the improved preparation of cryostat sections in light microscope histochemistry.

PubMed

Fink, S

1992-01-01

A new technique is presented for the external stabilization of cryostat sections by spraying the specimen surfaces with an aqueous solution of poly(vinyl alcohol) before each sectioning stroke. The spray freezes upon the surface and forms a tough coating which facilitates subsequent sectioning and handling especially of difficult material. The sections are affixed upon cold glass slides covered with an improved formulation of pressure-sensitive adhesive. During further processing of the affixed sections, the PVA-coating and any surrounding supporting medium dissolve without traces in the first aqueous incubation or staining solution.

Pediatric hospital medicine core competencies: development and methodology.

PubMed

Stucky, Erin R; Ottolini, Mary C; Maniscalco, Jennifer

2010-01-01

Pediatric hospital medicine is the most rapidly growing site-based pediatric specialty. There are over 2500 unique members in the three core societies in which pediatric hospitalists are members: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA) and the Society of Hospital Medicine (SHM). Pediatric hospitalists are fulfilling both clinical and system improvement roles within varied hospital systems. Defined expectations and competencies for pediatric hospitalists are needed. In 2005, SHM's Pediatric Core Curriculum Task Force initiated the project and formed the editorial board. Over the subsequent four years, multiple pediatric hospitalists belonging to the AAP, APA, or SHM contributed to the content of and guided the development of the project. Editors and collaborators created a framework for identifying appropriate competency content areas. Content experts from both within and outside of pediatric hospital medicine participated as contributors. A number of selected national organizations and societies provided valuable feedback on chapters. The final product was validated by formal review from the AAP, APA, and SHM. The Pediatric Hospital Medicine Core Competencies were created. They include 54 chapters divided into four sections: Common Clinical Diagnoses and Conditions, Core Skills, Specialized Clinical Services, and Healthcare Systems: Supporting and Advancing Child Health. Each chapter can be used independently of the others. Chapters follow the knowledge, skills, and attitudes educational curriculum format, and have an additional section on systems organization and improvement to reflect the pediatric hospitalist's responsibility to advance systems of care. These competencies provide a foundation for the creation of pediatric hospital medicine curricula and serve to standardize and improve inpatient training practices. (c) 2010 Society of Hospital Medicine.

Supplemental nutrition assistance program participation and child food security.

PubMed

Mabli, James; Worthington, Julie

2014-04-01

This article investigates the association between Supplemental Nutrition Assistance Program (SNAP) participation and child food security by using data from the largest national survey of the food security of SNAP participants to date. The analysis used a survey of nearly 3000 households with children and a quasi-experimental research design that consisted of 2 sets of comparisons. Using a cross-sectional sample, we compared information collected from SNAP households within days of program entry with information collected from a contemporaneous sample of SNAP households that had participated for ∼6 months. Next, by using a longitudinal sample, we compared baseline information collected from new-entrant SNAP households with information from those same households 6 months later. Multivariate logistic regression analysis was used to estimate associations between SNAP and child food security. SNAP participation was associated with an approximately one-third decrease in the odds of children being food insecure in both samples. In the cross-sectional analysis only, SNAP was also associated with a decrease in the odds of children experiencing severe food insecurity (designated very low food security). Findings were qualitatively robust to different empirical specifications. After controlling for other possible confounders, we found children in households that had participated in SNAP for 6 months experienced improvements in food security. On the basis of these findings, we conclude SNAP serves a vital role in improving the health and well-being of low-income children by increasing food security. Future research is needed to determine whether specific groups of children experience differential improvements in food security.

What is the use? Application of the short form (SF) questionnaires for the evaluation of treatment effects.

PubMed

Pelle, Aline J; Kupper, Nina; Mols, Floortje; de Jonge, Peter

2013-08-01

Health status has evolved as a clinical outcome measure that is of great interest in medical care. However, there is still debate about the appropriateness of scoring algorithms for the often used short form questionnaires. Therefore, our aim was to evaluate the consequences of the traditional scoring procedure based on orthogonal factor rotation for clinical applications by (a) re-evaluating the results of randomized controlled trials (RCTs) on the effectiveness of antidepressants in improving health status in cardiac patients and (b) comparing empirical evidence on depression and health status using orthogonal and oblique factor rotation (alternative scoring method) in a community sample and a heart failure (HF) sample. This is a systematic literature review and cross-sectional analysis among 1,598 community sample participants and 282 HF patients. Orthogonal rotation artificially forces the mental component summary (MCS) and physical component summary (PCS) to be unrelated, which is illustrated in two of the three included RCTs. Two RCTs showed improvements in MCS, but no improvement in PCS over time. Cross-sectional analysis in the two datasets showed that employing the alternative scoring algorithm resulted in higher negative correlations of MCS and PCS with depression, and a gradual decline in MCS with each decile of decline in PCS. Our data showed that appropriate carefulness is needed when calculating and interpreting summary scores. The traditional scoring algorithm seems inappropriate to objectively evaluate the effects of interventions on both the MCS and the PCS. Awareness in the design and evaluation of interventions using these outcomes is warranted.

Contact and perspective taking improve humanness standards and perceptions of humanness of older adults and people with dementia: a cross-sectional survey study.

PubMed

Miron, Anca M; McFadden, Susan H; Hermus, Nathan J; Buelow, Jennifer; Nazario, Amanda S; Seelman, Katarena

2017-10-01

No empirical work has systematically explored perceptions of humanness of people with dementia and of older adults and the variables that could improve these perceptions. We thus investigated the role of contact and perspective taking in improving perceptions of humanness of these social groups. To do so, we developed a new concept, humanness standards, defined as the amount of evidence of ability impairment needed to conclude that elderly people and those with dementia have lost personhood. We used a cross-sectional survey design (n = 619) to assess participants' humanness standards and perceptions of uniquely human characteristics and human nature characteristics of two social groups (people with dementia and older adults). Half the participants (n = 311) completed a survey about people with dementia and half (n = 308) assessed older adults. People with dementia were perceived as possessing humanness characteristics to a lesser extent than were older adults. For both groups, contact predicted enhanced perceptions of humanness characteristics. Participants' degree of contact with individuals with dementia also predicted humanness standards, but only under low perspective-taking conditions. As predicted, for older adults, participants set the highest humanness impairment thresholds in the high contact/high perspective-taking condition. We conclude that while social programs that bring persons with dementia and other individuals in contact could change humanness standards and perceptions of humanness characteristics of people with dementia, in the case of elderly adults, the contact must be supplemented by variables that facilitate taking the perspective of the person.

Improved harvesting systems for wet sites

Treesearch

Bryce J. Stokes; Alvin Schilling

1997-01-01

Environmentally acceptable and economical forest operations are needed for sustainable management of forest resources. Improved methods for harvesting and transporting timber are especially needed for wet sites. As the demand for hardwood lumber continues to increase, improved and alternative methods are needed to ensure acceptance of timber harvesting for the wet site...

Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti

DTIC Science & Technology

2016-09-30

Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti S E P T E M B E R 3 0 , 2 0 1 6 Report...Improvements Needed in Managing Scope Changes and Oversight of Construction Projects at Camp Lemonnier, Djibouti Visit us at www.dodig.mil Objective We...Findings (cont’d) ii │ DODIG-2016-141 (Project No. D2014-D000RE-0157.000) Results in Brief Improvements Needed in Managing Scope Changes and Oversight

Guidelines for psychosocial interventions in addictive disorders in India: An introduction and overview.

PubMed

Murthy, Pratima

2018-02-01

While guidelines for psychosocial interventions in addictive disorders in India were earlier rooted in clinical experience and global empirical evidence, recently there have been efforts to develop guidelines for intervention based on the local needs assessments of specific populations and more appreciably, a testing of the effectiveness of the interventions. This supplement on psychosocial interventions for addictive disorders covers some of the important aspects of psychosocial interventions in five sections. Section I covers the general principles of management and specific assessment approaches, screening for cognitive dysfunction and assessment of co-morbidities. Section II focuses on specific psychosocial interventions including brief interventions, relapse prevention, cognitive behavioural interventions, psychoanalytical interventions, cognitive rehabilitation, interventions in dual disorders, marital and family therapy, psychosocial interventions for sexual dysfunction and sexual addictions. Section III describes innovative approaches including third wave therapies, video-based relapse prevention, digital technology as a tool for psychosocial interventions as well as psychosocial interventions in technological addictions. The latter part of this section also deals with psychosocial interventions in special populations including children and adolescents, women, sexual minorities and the elderly. Section IV pans into community based psychosocial interventions including community camps and workplace prevention. The need to develop task sharing through the involvement of trained health workers to deliver community and home-based interventions is highlighted. Section V underscores the ethical issues in different aspects of psychosocial intervention and the need for research in this area. Although there is a tendency to formulate addiction in either biomedical or psychosocial terms and to view interventions either as pharmacological or psychosocial, these dichotomies neither exist in the affected individual's mind, nor should be present in the treating clinician. A comprehensive understanding of addiction requires an understanding of the person in his/her environment and needs a personalised holistic approach that addresses the diverse physical/mental health, occupational, legal, social and aftercare needs.

Correlation of embryonic skeletal muscle myotube physical characteristics with contractile force generation on an atomic force microscope-based bio-microelectromechanical systems device

NASA Astrophysics Data System (ADS)

Pirozzi, K. L.; Long, C. J.; McAleer, C. W.; Smith, A. S. T.; Hickman, J. J.

2013-08-01

Rigorous analysis of muscle function in in vitro systems is needed for both acute and chronic biomedical applications. Forces generated by skeletal myotubes on bio-microelectromechanical cantilevers were calculated using a modified version of Stoney's thin-film equation and finite element analysis (FEA), then analyzed for regression to physical parameters. The Stoney's equation results closely matched the more intensive FEA and the force correlated to cross-sectional area (CSA). Normalizing force to measured CSA significantly improved the statistical sensitivity and now allows for close comparison of in vitro data to in vivo measurements for applications in exercise physiology, robotics, and modeling neuromuscular diseases.

Financing the future of independent community hospitals.

PubMed

Richman, Alan P

2011-11-01

Effingham Hospital, a critical access hospital, undertook a modernization initiative to expand the limited scope of its inpatient services to improve financial performance and ability to build liquidity reserves. FHA Section 242 mortgage insurance was the only means for Effingham to credit enhance its debt and obtain a low-interest rate loan. Effingham needed to convince residents and county commissioners to pledge 27 years of additional tax support to offset its annual uncompensated care. The hospital won support from the community and the commissioners, in part because of the educational outreach of the CEO, CFO, and board in articulating the imperative for maintaining local hospital care and the present and future economic benefits for Effingham County.

Low bit rate coding of Earth science images

NASA Technical Reports Server (NTRS)

Kossentini, Faouzi; Chung, Wilson C.; Smith, Mark J. T.

1993-01-01

In this paper, the authors discuss compression based on some new ideas in vector quantization and their incorporation in a sub-band coding framework. Several variations are considered, which collectively address many of the individual compression needs within the earth science community. The approach taken in this work is based on some recent advances in the area of variable rate residual vector quantization (RVQ). This new RVQ method is considered separately and in conjunction with sub-band image decomposition. Very good results are achieved in coding a variety of earth science images. The last section of the paper provides some comparisons that illustrate the improvement in performance attributable to this approach relative the the JPEG coding standard.

Intrapartum care could be improved according to Swedish fathers: mode of birth matters for satisfaction.

PubMed

Johansson, Margareta; Hildingsson, Ingegerd

2013-09-01

Intrapartum care is expected to be shaped by parents' need and preferences. The aim was to explore Swedish fathers' intrapartum care quality experiences, with a specific focus on care deficiencies in relation to birth mode. A secondary aim was to explore which issues of quality that contributed most to dissatisfaction with the overall assessment of the care. Cross-sectional design, part of a prospective longitudinal survey in Sweden. A quality of care index was developed, based on perceived reality and subjective importance of given intrapartum care. Two months after birth 827 fathers answered nine questions related to quality of care. Descriptive statistics and logistic regression analysis were used. Dissatisfaction with overall intrapartum care was related to deficiencies in partner's medical care (OR 5.6; 2.7-11.2), involvement in decision-making during childbirth (OR 2.6; 1.3-4.9), midwives presence in the labour room (OR 2.4; 1.2-4.7), and ability to discuss the birth afterwards (OR 2.0; 1.1-3.8). After emergency caesarean section 46% judged the partner's medical intrapartum care as most deficient (OR 1.73; 1.05-2.86), and after elective caesarean section 40% of the fathers judged involvement in decision-making as deficient (OR 4.07; 1.95-8.50). When the fathers had participated in a spontaneous vaginal birth they were dissatisfied with the presence of the midwife in the labour room (OR 1.72; 1.03-2.87). Deficiencies existed in the intrapartum care and were judged differently depending on mode of birth. The fathers needed to feel secure about the women's medical care, and wanted to be involved and supported. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Nursing and midwifery students' perception of learning enablers and gains in the first semester of their BSc programmes: A cross sectional study.

PubMed

Redmond, Catherine; Davies, Carmel; Halligan, Phil; Joye, Regina; Carroll, Lorraine; Frawley, Timothy

2018-06-01

The student experience in the first year of university is fundamental to successful adaption to the higher education environment and shapes student engagement with their chosen degree. Students' feedback on this experience is essential when designing or reviewing curricula. The aim of this study was to explore students' perceptions of their learning gains to identify factors that support student learning and identify elements that need improvement if specific learning needs are to be met. A cross sectional descriptive study. A large urban university in Ireland that provides undergraduate nursing and midwifery degree programmes. The study was conducted using the Student Assessment of Learning Gains (SALG) questionnaire. This instrument consists of a series of closed questions which explore perceived student gains in skills, cognitions and attitudes. The questionnaire was adapted for a semester rather than a module evaluation. The tool also includes a series of open questions inviting students to comment in each section. Students (n = 206) positively evaluated teaching and learning approaches used. The greatest enablers of learning were clinical skills laboratory small group teaching and support followed by online learning materials and multiple choice formative assessment questions. They reported gains in knowledge, generic skills development and an increase in confidence and enthusiasm for their chosen career. The feedback gained in this study provides valuable knowledge about the elements that support nursing and midwifery students learning and highlights areas that require attention. This is particularly useful for faculty who are involved in curriculum review and enhancement and in student engagement and retention. Copyright © 2018 Elsevier Ltd. All rights reserved.

Going home after a C-section

MedlinePlus

... ency/patientinstructions/000624.htm Going home after a C-section To use the sharing features on this ... enable JavaScript. You are going home after a C-section. You should expect to need help caring ...

Survivorship Care for Older Adults with Cancer: U13 Conference Report

PubMed Central

Guerard, Emily J.; Nightingale, Ginah; Bellizzi, Keith; Burhenn, Peggy; Rosko, Ashley; Artz, Andrew S.; Korc-Grodzicki, Beatriz; Canin, Beverly; Dale, William; Ferrell, Betty

2016-01-01

Older adult cancer survivors currently account for almost 60% of all cancer survivors. The number of older cancer survivors will continue to increase as the population ages and as patients’ live longer after a cancer diagnosis. As part of cancer center accreditation, the American College of Surgeons Commission on Cancer® (CoC) has placed great importance on survivorship care planning. While the CoC has set standards for general survivorship care, there is sparse evidence on how to best care for older adult cancer survivors. Concern exists among the medical community that survivorship care plans could increase paperwork without improving outcomes. Given the diverse and unique needs of older adult cancer survivors, the inter-professional team provides a structure and process for survivorship care built around the particular needs of older adults. The Cancer and Aging Research Group (CARG), in partnership with the NIA/NCI, held a U13 conference in May 2015 in part to discuss survivorship care for older adults with cancer. This report discusses four themes that emerged from one section of the conference: (1) survivorship care is a process that continually evolves to meet the needs of older adults; (2) older adult cancer survivors have unique needs and care plans should be tailored to meet these needs; (3) the inter-professional team is ideally suited to structure survivorship care of older adults; (4) patient advocacy must be encouraged throughout the cancer care continuum. As evidence based survivorship practices develop, the unique needs of older adults need to be given substantial attention. PMID:27424802

Dental needs of intellectualy disabled children attending six special educational facilities in Cape Town.

PubMed

Roberts, T; Chetty, M; Kimmie-Dhansay, F; Fieggen, K; Stephen, L X G

2016-05-25

To assess the dental needs of a group of children with intellectual disability (ID) attending six special educational facilities in Cape Town, South Africa. Methods. This was a cross-sectional study based on a convenience sampling method. One hundred and fifty-seven children with ID attending six special educational facilities in Cape Town were included in the survey. Five schools were exclusively funded by the State and one school received additional private financial support. The oral examinations complied with guidelines drafted by Special Olympics Special Smiles programme and the Centers for Disease Control, USA. The most common dental disorders requiring management were gingival disease (69%) and untreated dental caries (68%). Almost 50% of the children had missing teeth. Twenty-nine percent needed orthodontic correction of malocclusion and 7% had structural abnormalities of their teeth that required either aesthetic or functional intervention. Fillings were evident in only 8% of the children. Females required more dental treatment than males. The dental needs of children with ID increased with age. There were no significant differences in the dental needs of children attending State-funded schools and those attending the single school that received additional financial assistance. The frequency of unmet dental needs of children with ID attending special educational facilities in Cape Town was high and the dental care available to them was minimal. The study highlights the need for improved dental services to ensure that optimal oral health is accessible to children with ID attending special educational facilities in Cape Town.

Care needs of persons with long-term spinal cord injury living at home in the Netherlands.

PubMed

van Loo, M A; Post, M W M; Bloemen, J H A; van Asbeck, F W A

2010-05-01

Cross-sectional survey. To describe the care received, care needs and preventability of secondary conditions according to persons with long-term spinal cord injury (SCI) living at home. The Netherlands. A questionnaire was sent to all members of the Dutch SCI Patient Organisation. From a list of 26 SCI secondary conditions, participants chose the five conditions they perceived as most important. For each of these conditions, they described the type of care they received, their need for (extra) care and its preventability. Response rate was 45% (n=453) and mean time after injury was 13.3 years. In case of secondary conditions, participants were more likely to visit their general practitioner (58%) than another medical specialist (29%) or rehabilitation specialist (25%). For all most-important secondary conditions, care was received in 47% and care, or extra care, was needed in 41.3%. Treatment was the type of care most often received (29.5%) and needed (17.2%). However, for information and psychosocial care, the care needed (12.2 and 9.9%, respectively) was higher than the care received (7.6 and 5.9%, respectively). Thirty-four percent of all most-important secondary conditions were perceived as preventable, the rate increasing to 52.8% for pressure sores, of which 29.9% were considered to be preventable by the participants themselves. This study showed substantial unmet care needs in persons with long-term SCI living at home and underlines the further improvement of long-term care for this group. Information, psychosocial care and self-efficacy seem to be the areas to be enhanced.

UNICEF and New Initiatives in Child Health and Development.

ERIC Educational Resources Information Center

Nyi, Nyi

The four sections of this paper outline changes in UNICEF programs from their inception in 1946 to recent initiatives circa 1983. The first section delineates shifts in program emphasis, showing how the organization's focus has moved from meeting the emergency needs of post-World War II European children toward addressing the long-term needs of…

Caring for Children with Special Needs. BNA Special Report Series on Work & Family. Special Report #43.

ERIC Educational Resources Information Center

Ott-Worrow, Karen; Baldassano, Victoria A.

This report examines day care needs and services for families with handicapped children. A section providing background information identifies barriers to finding day care for these children and discusses the relevance of federal legislation, especially the Americans with Disabilities Act of 1990. The next section presents information on standards…

Step by Step: Eating To Lower Your High Blood Cholesterol. Revised.

ERIC Educational Resources Information Center

National Heart, Lung, and Blood Inst. (DHHS/NIH), Bethesda, MD.

This booklet offers advice for adults who want to lower their blood cholesterol level. The first section, "What You Need To Know about High Blood Cholesterol," discusses blood cholesterol and why it matters, what cholesterol numbers mean, and what affects blood cholesterol levels. Section 2, "What You Need To Do To Lower Blood…

New Roles for Early Adolescents in Schools and Communities.

ERIC Educational Resources Information Center

Schine, Joan; And Others

This booklet is intended to stimulate new interest in the need of young adolescents to take on meaningful roles and to help planners and practitioneers to translate that interest into youth participation programs. There are three major sections. Section I examines the special needs and characteristics of youth in the 10 to 14 age group. Discussed…

Knowledge, attitudes, and practices among mothers of children with epilepsy: A study in a teaching hospital.

PubMed

Kolahi, Ali-Asghar; Abbasi-Kangevari, Mohsen; Bakhshaei, Pouya; Mahvelati-Shamsabadi, Farhad; Tonekaboni, Seyed-Hassan; Farsar, Ahmad-Reza

2017-04-01

Knowledge about epilepsy and attitudes towards patients with epilepsy can affect measures taken to manage epilepsy and seizures. Support and understanding of mothers is invaluable in enabling children with epilepsy to develop normal life skills in living with epilepsy. In order to identify the educational needs of mothers of children with epilepsy, their knowledge, attitudes, and practices should be assessed. Therefore, we interviewed a group of mothers of children with epilepsy who were referred to a pediatric neurology clinic in a teaching hospital. The objective of this study was to assess knowledge, attitudes, and practices among mothers of children with epilepsy in order to identify their educational needs. In the period of August 2014 to January 2015, mothers whose children were diagnosed with epilepsy for at least six months participated in this cross sectional study, while returning to the neurology clinic of a pediatric hospital for usual follow-up. Data were collected through face-to-face interviews, held by trained female general practitioners. The interviewer used questions from a questionnaire. The knowledge section of the questionnaire included questions regarding prevalence and general knowledge about epilepsy, its etiology, symptoms, and seizure provoking factors. The attitudes section included statements regarding the mother's attitudes towards epilepsy and patients with the disease. The practice section included questions about first-aid measures taken by mothers who had witnessed generalized seizures by the time of interview. Responses of 206 participants were analyzed. At least 83% of mothers knew that epilepsy is a noncontagious neurological disorder which can be treated by regular drug therapy. In spite of demonstrating good knowledge scores, the majority of mothers felt the need for further training in epilepsy. More than 98% of mothers were against the idea that patients with epilepsy should hide their disease. Though having been referred to physicians, 84% of mothers had provided their children with at least one ineffective treatment, mostly based on superstitions. Mothers' level of knowledge of epilepsy was good, and their attitudes towards epilepsy were mainly positive. Regarding the right first-aid measures at time of the last seizure, mothers' practices were acceptable. However, there is still room for improvement regarding avoiding the wrong measures. It is suggested that both practice-related issues and other aspects of epilepsy be taken into account in epilepsy-related education programs. Copyright © 2016 Elsevier Inc. All rights reserved.

Weaknesses in the reporting of cross-sectional studies according to the STROBE statement

PubMed Central

Malaga, German; Miranda, Jaime

2015-01-01

Introduction: The inadequate reporting of cross-sectional studies, as in the case of the prevalence of metabolic syndrome, could cause problems in the synthesis of new evidence and lead to errors in the formulation of public policies. Objective: To evaluate the reporting quality of the articles regarding metabolic syndrome prevalence in Peruvian adults using the STROBE recommendations. Methods: We conducted a thorough literature search with the terms "Metabolic Syndrome", "Sindrome Metabolico" and "Peru" in MEDLINE/PubMed, LILACS, SciELO, LIPECS and BVS-Peru until December 2014. We selected those who were population-based observational studies with randomized sampling that reported prevalence of metabolic syndrome in adults aged 18 or more of both sexes. Information was analysed through the STROBE score per item and recommendation. Results: Seventeen articles were included in this study. All articles met the recommendations related to the report of the study's rationale, design, and provision of summary measures. The recommendations with the lowest scores were those related to the sensitivity analysis (8%, n= 1/17), participant flowchart (18%, n= 3/17), missing data analysis (24%, n= 4/17), and number of participants in each study phase (24%, n= 4/17). Conclusion: Cross-sectional studies regarding the prevalence of metabolic syndrome in peruvian adults have an inadequate reporting on the methods and results sections. We identified a clear need to improve the quality of such studies. PMID:26848197

Weaknesses in the reporting of cross-sectional studies according to the STROBE statement: the case of metabolic syndrome in adults from Peru.

PubMed

Tapia, Jose Carlos; Ruiz, Eloy F; Ponce, Oscar J; Malaga, German; Miranda, Jaime

2015-12-30

The inadequate reporting of cross-sectional studies, as in the case of the prevalence of metabolic syndrome, could cause problems in the synthesis of new evidence and lead to errors in the formulation of public policies. To evaluate the reporting quality of the articles regarding metabolic syndrome prevalence in Peruvian adults using the STROBE recommendations. We conducted a thorough literature search with the terms "Metabolic Syndrome", "Sindrome Metabolico" and "Peru" in MEDLINE/PubMed, LILACS, SciELO, LIPECS and BVS-Peru until December 2014. We selected those who were population-based observational studies with randomized sampling that reported prevalence of metabolic syndrome in adults aged 18 or more of both sexes. Information was analysed through the STROBE score per item and recommendation. Seventeen articles were included in this study. All articles met the recommendations related to the report of the study's rationale, design, and provision of summary measures. The recommendations with the lowest scores were those related to the sensitivity analysis (8%, n= 1/17), participant flowchart (18%, n= 3/17), missing data analysis (24%, n= 4/17), and number of participants in each study phase (24%, n= 4/17). Cross-sectional studies regarding the prevalence of metabolic syndrome in peruvian adults have an inadequate reporting on the methods and results sections. We identified a clear need to improve the quality of such studies.

Investigation of the reaction 74Ge(p,γ)75As using the in-beam method to improve reaction network predictions for p nuclei

NASA Astrophysics Data System (ADS)

Sauerwein, A.; Endres, J.; Netterdon, L.; Zilges, A.; Foteinou, V.; Provatas, G.; Konstantinopoulos, T.; Axiotis, M.; Ashley, S. F.; Harissopulos, S.; Rauscher, T.

2012-09-01

Background: Astrophysical models studying the origin of the neutron-deficient p nuclides require knowledge of proton capture cross sections at low energy. The production site of the p nuclei is still under discussion but a firm basis of nuclear reaction rates is required to address the astrophysical uncertainties. Data at astrophysically relevant interaction energies are scarce. Problems with the prediction of charged particle capture cross sections at low energy were found in the comparisons between previous data and calculations in the Hauser-Feshbach statistical model of compound reactions.Purpose: A measurement of 74Ge(p,γ)75As at low proton energies, inside the astrophysically relevant energy region, is important in several respects. The reaction is directly important because it is a bottleneck in the reaction flow which produces the lightest p nucleus 74Se. It is also an important addition to the data set required to test reaction-rate predictions and to allow an improvement in the global p+nucleus optical potential required in such calculations.Method: An in-beam experiment was performed, making it possible to measure in the range 2.1≤Ep≤3.7MeV, which is for the most part inside the astrophysically relevant energy window. Angular distributions of the γ-ray transitions were measured with high-purity germanium detectors at eight angles relative to the beam axis. In addition to the total cross sections, partial cross sections for the direct population of 12 levels were determined.Results: The resulting cross sections were compared to Hauser-Feshbach calculations using the code smaragd. Only a constant renormalization factor of the calculated proton widths allowed a good reproduction of both total and partial cross sections. The accuracy of the calculation made it possible to check the spin assignment of some states in 75As. In the case of the 1075-keV state, a double state with spins and parities of 3/2- and 5/2- is needed to explain the experimental partial cross sections. A change in parity from 5/2+ to 5/2- is required for the state at 401 keV. Furthermore, in the case of 74Ge, studying the combination of total and partial cross sections made it possible to test the γ width, which is essential in the calculation of the astrophysical 74As(n,γ)75As rate.Conclusions: Between data and statistical model prediction a factor of about two was found. Nevertheless, the improved astrophysical reaction rate of 74Ge(p,γ) (and its reverse reaction) is only 28% larger than the previous standard rate. The prediction of the 74As(n,γ)75As rate (and its reverse) was confirmed, the newly calculated rate differs only by a few percent from the previous prediction. The in-beam method with high-efficiency detectors proved to be a powerful tool for studies in nuclear astrophysics and nuclear structure.

Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre cross-sectional study.

PubMed

Prazeres, Filipe; Santiago, Luiz

2016-11-11

Multimorbidity has a high prevalence in the primary care context and it is frequently associated with worse health-related quality of life (HRQoL). Few studies evaluated the variables that could have a potential effect on HRQoL of primary care patients with multimorbidity. The purpose of this study, the first of its kind ever undertaken in Portugal, is to analyse the relationship between multimorbidity, health-related quality of life, perceived family support and unmet health needs in adult patients attending primary care. Multicentre, cross-sectional survey conducted among primary care patients with multimorbidity. It included 521 participants (64.1 % females) who met the inclusion criteria. HRQoL was evaluated using the Portuguese Short Form-12 Health Status Questionnaire. The Portuguese Family APGAR was used to measure the perceived family support. A patients' unmet health needs questionnaire was used. The unmet needs for medical, surgical and dental care; prescription medications; mental healthcare or counselling; and eyeglasses or other technical aid was assessed. Descriptive and multivariate analyses were performed. The sample had an overall average of 4.5 chronic health problems. Increased multimorbidity levels were linked to worse health-related quality of life, particularly the physical health. Some variables were confirmed as playing a role on health-related quality of life. Male patients with high monthly incomes and highly functional families had better physical and mental health. High levels of education and the presence of asthma were also associated with better physical health. Contrariwise, elderly patients with high levels of multimorbidity and with osteoarthritis had lower physical health. The majority of the patients did not have unmet health needs. When health needs were stated they were mostly for generalist medical care, dental care, and eyeglasses/other technical aid. Financial insufficiency was the primary reason for not fulfilling their health needs. To improve the quality of life of multimorbid patients, within primary care practices and health delivery systems, one should take into special account the sex of the patient, the perceived family support and the self-perceived economic status because of their relationship with both physical and mental health. Limitations and recommendations are discussed.

Wavelengths, f-Values, and Cross Sections in the UV Spectra of Astrophysical Atoms, Ions, and Molecules

NASA Technical Reports Server (NTRS)

Crane, Phil (Technical Monitor); Raymond, John C.; Parkinson, W. H.

2004-01-01

Contents include the following: Improved UV wavelengths, energy levels, and f-values for iron group ions. Update of Kurucz database of wavelengths and f-values. Publication of improved UV photodissociation cross sections for H2O. UV photoabsorption cross sections for CO bands. Service Activities and Data Outreach.

Study on the availability of physical infrastructure and manpower facilities in sub-centers of Chittoor district of Andhra Pradesh.

PubMed

Reddy, N Bayapa; Prabhu, G Ravi; Sai, T S R

2012-01-01

The sub-centers (SCs) are under constant criticism for their inability to deliver quality services due to the nonavailability of adequate infrastructure, manpower and supply of drugs.A cross-sectional study was conducted in Chittoor District of Andhra Pradesh to assess the availability of physical infrastructure and manpower in the SCs. A total of 34 SCs were selected by multistage and stratified random sampling technique. The data was statistically analyzed by using Microsoft Excel. The deficiency in the availability of health workers male and female were found to be 67.7% and 27.5%, respectively. The residential facility for health workers was available only in 26.4% SCs. Only 20.6% of SCs had stethoscope and B.P apparatus. The physical infrastructure and manpower availability at the SCs needs considerable improvement as per the Indian Public Health Standard (IPHS). Facilities to conduct the normal delivery and 24-hours emergency referral services need to be addressed at the earliest.

Concrete Nanoscience and Nanotechnology: Definitions and Applications

NASA Astrophysics Data System (ADS)

Garboczi, E. J.

There are many improvements needed in concrete, especially for use in renewal and expansion of the world’s infrastructure. Nanomodification can help solve many of these problems. However, concrete has been slow to catch on to the nanotechnology revolution. There are several reasons for this lag in the nanoscience and nanotechnology of concrete (NNC). First is the lack of a complete basic understanding of chemical and physical mechanisms and structure at the nanometer length scale. Another reason is the lack of a broad understanding of what nanomodification means to concrete, which is a liquid-solid composite. NNC ideas need to profit from, but not be bound by, experience with other materials. As an illustration of these ideas, a specific application will be given of using nano-size molecules in solution to affect the viscosity of the concrete pore solution so that ionic diffusion is slowed. A molecular-based understanding would help move this project towards true nanotechnology. A final section of this paper lists some possibly fruitful focus areas for the nanoscience and nanotechnology of concrete.

Associations between state minimum wage policy and health care access: a multi-level analysis of the 2004 Behavioral Risk Factor survey.

PubMed

McCarrier, Kelly P; Martin, Diane P; Ralston, James D; Zimmerman, Frederick J

2010-05-01

Minimum wage policies have been advanced as mechanisms to improve the economic conditions of the working poor. Both positive and negative effects of such policies on health care access have been hypothesized, but associations have yet to be thoroughly tested. To examine whether the presence of minimum wage policies in excess of the federal standard of $5.15 per hour was associated with health care access indicators among low-skilled adults of working age, a cross-sectional analysis of 2004 Behavioral Risk Factor Surveillance System data was conducted. Self-reported health insurance status and experience with cost-related barriers to needed medical care were adjusted in multi-level logistic regression models to control for potential confounding at the state, county, and individual levels. State-level wage policy was not found to be associated with insurance status or unmet medical need in the models, providing early evidence that increased minimum wage rates may neither strengthen nor weaken access to care as previously predicted.

Using local authority data for action on health inequalities: the Caerphilly Health and Social Needs Study.

PubMed Central

Fone, David; Jones, Andrew; Watkins, John; Lester, Nathan; Cole, Jane; Thomas, Gary; Webber, Margaret; Coyle, Edward

2002-01-01

BACKGROUND: Primary care organisations in the United Kingdom have been given new and challenging population health responsibilities to improve health and address health inequality in local communities through partnership working with local authorities. This requires robust health and social needs assessment data for effective local planning. AIM: To assess the use and value of local authority data shared through partnership working between Caerphilly Local Health Group and Caerphilly County Borough Council. DESIGN OF STUDY: Cross-sectional analysis of aggregate electoral division data. SETTING: Caephilly County Borough, south-east Wales. METHOD: Local authority datasets identified were categorised into one of six domains: income, unemployment, housing, health, education, and social services. Data were presented at electoral division level as rates in thematic maps and correlations between the variables within and between each domain were explored using Spearman's rank correlation coefficient, with particular focus on children in families. Local planning documents were scrutinised to ascertain the use and value of the data. RESULTS: A broad range of data described a comprehensive picture of health and social inequalities within the borough. Multiple deprivation tended to cluster in electoral divisions, particularly for data relating to children, painting an overwhelming picture of inequality in life chances. The data were used in a wide range of local partnership planning initiatives, including the Health Improvement Programme, Children's Services Plan, and a successful Healthy Living Centre bid. CONCLUSION: Local authority data can help primary care organisations in a population approach to needs assessment for use in local partnership planning targeted at reducing health inequalities. PMID:12392118

43 CFR 10010.29 - Purpose and need.

Code of Federal Regulations, 2012 CFR

2012-10-01

... POLICY ACT Environmental Impact Statements § 10010.29 Purpose and need. The purpose and need section may introduce a number of factors, including economic and technical considerations and Commission statutory...

43 CFR 10010.29 - Purpose and need.

Code of Federal Regulations, 2013 CFR

2013-10-01

... POLICY ACT Environmental Impact Statements § 10010.29 Purpose and need. The purpose and need section may introduce a number of factors, including economic and technical considerations and Commission statutory...

43 CFR 10010.29 - Purpose and need.

Code of Federal Regulations, 2011 CFR

2011-10-01

... POLICY ACT Environmental Impact Statements § 10010.29 Purpose and need. The purpose and need section may introduce a number of factors, including economic and technical considerations and Commission statutory...

43 CFR 10010.29 - Purpose and need.

Code of Federal Regulations, 2014 CFR

2014-10-01

... POLICY ACT Environmental Impact Statements § 10010.29 Purpose and need. The purpose and need section may introduce a number of factors, including economic and technical considerations and Commission statutory...

Are public health professionals prepared for public health genomics? A cross-sectional survey in Italy

PubMed Central

2014-01-01

Background Public health genomics is an emerging multidisciplinary approach, which aims to integrate genome-based knowledge in a responsible and effective way into public health. Despite several surveys performed to evaluate knowledge, attitudes and professional behaviors of physicians towards predictive genetic testing, similar surveys have not been carried out for public health practitioners. This study is the first to assess knowledge, attitudes and training needs of public health professionals in the field of predictive genetic testing for chronic diseases. Methods A self-administered questionnaire was used to carry out a cross-sectional survey of a random sample of Italian public health professionals. Results A response rate of 67.4% (797 questionnaires) was achieved. Italian public health professionals have the necessary attitudinal background to contribute to the proper use of predictive genetic testing for chronic diseases, but they need additional training to increase their methodological knowledge. Knowledge significantly increases with exposure to predictive genetic testing during postgraduate training (odds ratio (OR) = 1.74, 95% confidence interval (CI) = 1.05–2.88), time dedicated to continuing medical education (OR = 1.53, 95% CI = 1.14–2.04) and level of English language knowledge (OR = 1.36, 95% CI = 1.07–1.72). Adequate knowledge is the strongest predictor of positive attitudes from a public health perspective (OR = 3.98, 95% CI = 2.44–6.50). Physicians show a lower level of knowledge and more public health attitudes than other public health professionals do. About 80% of public health professionals considered their knowledge inadequate and 86.0% believed that it should be improved through specific postgraduate training courses. Conclusions Specific and targeted training initiatives are needed to develop a skilled public health workforce competent in identifying genomic technology that is ready for use in population health and in modeling public health genomic programs and primary care services that need to be developed, implemented and evaluated. PMID:24885316

Early detection monitoring for aquatic non-indigenous species: Optimizing surveillance, incorporating advanced technologies, and identifying research needs.

PubMed

Trebitz, Anett S; Hoffman, Joel C; Darling, John A; Pilgrim, Erik M; Kelly, John R; Brown, Emily A; Chadderton, W Lindsay; Egan, Scott P; Grey, Erin K; Hashsham, Syed A; Klymus, Katy E; Mahon, Andrew R; Ram, Jeffrey L; Schultz, Martin T; Stepien, Carol A; Schardt, James C

2017-11-01

Following decades of ecologic and economic impacts from a growing list of nonindigenous and invasive species, government and management entities are committing to systematic early- detection monitoring (EDM). This has reinvigorated investment in the science underpinning such monitoring, as well as the need to convey that science in practical terms to those tasked with EDM implementation. Using the context of nonindigenous species in the North American Great Lakes, this article summarizes the current scientific tools and knowledge - including limitations, research needs, and likely future developments - relevant to various aspects of planning and conducting comprehensive EDM. We begin with the scope of the effort, contrasting target-species with broad-spectrum monitoring, reviewing information to support prioritization based on species and locations, and exploring the challenge of moving beyond individual surveys towards a coordinated monitoring network. Next, we discuss survey design, including effort to expend and its allocation over space and time. A section on sample collection and analysis overviews the merits of collecting actual organisms versus shed DNA, reviews the capabilities and limitations of identification by morphology, DNA target markers, or DNA barcoding, and examines best practices for sample handling and data verification. We end with a section addressing the analysis of monitoring data, including methods to evaluate survey performance and characterize and communicate uncertainty. Although the body of science supporting EDM implementation is already substantial, research and information needs (many already actively being addressed) include: better data to support risk assessments that guide choice of taxa and locations to monitor; improved understanding of spatiotemporal scales for sample collection; further development of DNA target markers, reference barcodes, genomic workflows, and synergies between DNA-based and morphology-based taxonomy; and tools and information management systems for better evaluating and communicating survey outcomes and uncertainty. Published by Elsevier Ltd.

STRESS, MOTIVATION, AND PROFESSIONAL SATISFACTION AMONG HEALTH CARE WORKERS IN HIV CARE AND TREATMENT CENTERS IN URBAN TANZANIA: A CROSS-SECTIONAL STUDY

PubMed Central

Siril, Hellen; Hirschhorn, Lisa R; Hawkins, Claudia; Garcia, Maria E; Li, Michelle S; Ismail, Shabbir; Mdingi, Sarah Geoffrey; Chalamilla, Guerino; Fawzi, Wafaie; Kaaya, Sylvia

2013-01-01

Background Shortages of health care workers (HCWs) represents a serious challenge to ensuring effective HIV care in resource-limited settings (RLS). Stress, motivation, and job satisfaction have been linked with HCW retention and are important in addressing HCW shortages. In this cross-sectional study HCW stress, motivation, and perceived ability to meet patient needs were assessed in PEPFAR-supported urban HIV care and treatment clinics (CTCs) in Tanzania. Methods A self-administered questionnaire measuring motivation, stress, and perceived ability to meet patient needs was given to HCWs at 16 CTCs. Scales measuring HCW satisfaction, motivation, and stress were developed using principle components analysis. Hierarchical linear models were used to explore the association of HCW and site characteristics with reported satisfaction, stress, motivation, and ability to meet patient needs. Results Seventy-three percent (279) of HCWs completed the questionnaire. Most (73%) HCWs reported minimal/no work-related stress, with 48% reporting good/excellent motivation, but 41% also reporting feeling emotionally drained. Almost all (98%) reported feeling able to help their patients, with 68% reporting work as rewarding. Most reported receipt of training and supervision, with good availability of resources. In the multivariate model, direct clinical providers reported lower motivation than management (p<0.05) and HCWs at medium-sized sites reported higher motivation than HCWs at larger sites (p<0.05). HCWs at small and medium sites were more likely to feel able to help patients than those from larger sites (p<0.05 and p<0.001 respectively). Conclusion Despite significant patient loads, HCWs in these PEPFAR-supported CTCs reported high levels of motivation, job satisfaction, ability to meet patient needs, low levels of stress but significant emotional toll. Understanding the relationship between support systems such as strong supervision and training and these outcomes is critical in designing interventions to improve motivation, reduce stress and increase retention of HCWs. PMID:22066277

Paediatric advance care planning survey: a cross-sectional examination of congruence and discordance between adolescents with HIV/AIDS and their families.

PubMed

Lyon, Maureen E; Dallas, Ronald H; Garvie, Patricia A; Wilkins, Megan L; Garcia, Ana; Cheng, Yao Iris; Wang, Jichuan

2017-09-21

To identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family's perception of their needs. A cross-sectional survey among six paediatric hospital-based outpatient HIV specialty clinics. Participants included 48 adolescent/family dyads (n=96 participants) within a larger study facilitating pACP. The main outcome measure was the Lyon Advance Care Planning Survey - Adolescent and Surrogate Versions-Revised. Adolescents' mean age was 18 years (range ≥14-<21); 54% male; 92% African-American; 27% with prior AIDS diagnosis. If dying, 92% believed in completing an advance directive ; 85% preferred to die at home ; 88% knowing how to say good bye ; 71% being off machines that extend life and 77% dying a natural death . Best timing for end-of-life (EOL) decisions was while healthy (38%), when first diagnosed (17%), when first sick from a life-threatening illness (4%), when first hospitalised (8%), if dying (4%) and all of the above (19%). Prevalence-adjusted bias-adjusted Kappa (PABAK) measured congruence in pACP needs within adolescent/family dyads. There was substantial congruence in that being free from pain (PABAK=0.83), and understanding your treatment choices (PABAK=0.92) were very important or important. There was discordance about being off machines that extend life (PABAK=0.08) and when is the best time to bring up EOL decisions (PABAK=0.32). Areas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth's EOL wishes. NCT01289444; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Health-Related Quality of Life and Its Correlates among Chinese Migrants in Small- and Medium-Sized Enterprises in Two Cities of Guangdong

PubMed Central

Lu, Liming; Zou, Guanyang; Zeng, Zhi; Han, Lu; Guo, Yan; Ling, Li

2014-01-01

Objectives To explore the relationship between health-related quality of life (HRQOL) status and associated factors among rural-to-urban migrants in China. Methods A cross-sectional survey was conducted with 856 rural-to-urban migrants working at small- and medium-size enterprises (SMEs) in Shenzhen and Zhongshan City in 2012. Andersen's behavioral model was used as a theoretical framework to exam the relationships among factors affecting HRQOL. Analysis was performed using structural equation modeling (SEM). Results Workers with statutory working hours, higher wages and less migrant experience had higher HRQOL scores. Need (contracting a disease in the past two weeks and perception of needing health service) had the greatest total effect on HRQOL (β = −0.78), followed by enabling (labor contract, insurance purchase, income, physical examination during work and training) (β = 0.40), predisposing (age, family separation, education) (β = 0.22) and health practices and use of health service (physical exercise weekly, health check-up and use of protective equipments) (β = −0.20). Conclusions Priority should be given to satisfy the needs of migrant workers, and improve the enabling resources. PMID:24392084

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use.

PubMed

Duff, Putu; Muzaaya, Godfrey; Muldoon, Katherine; Dobrer, Sabina; Akello, Monika; Birungi, Josephine; Shannon, Kate

2017-06-01

This study aimed to examine the correlates of unintended pregnancies among young women sex workers in conflict-affected northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young women engaged in sex work. Bivariable and multivariable logistic regression was used to examine the correlates of ever having an unintended pregnancy. Among 400 sex workers (median age=20 years; IQR 19-25), 175 (43.8%) reported at least one unintended pregnancy. In multivariable analysis, primarily servicing clients in lodges/brothels [Adjusted Odds Ratio (AOR= 2.24; 95% Confidence Interval: 1.03-4.84)], hormonal contraceptive usage [AOR=1.68; 95%CI 1.11-2.59] and drug/alcohol use while working [AOR= 1.64; 95%CI 1.04-2.60] were positively correlated with previous unintended pregnancy. Given that unintended pregnancy is an indicator of unmet reproductive health need, these findings highlight a need for improved access to integrated reproductive health and HIV services, catered to sex workers' needs. Sex work-led strategies (e.g., peer outreach) should be considered, alongside structural strategies and education targeting brothel/lodge owners and managers.

The Needs and Resources of Drug Information at Community Pharmacies in Gondar Town, Northwest Ethiopia.

PubMed

Asmelashe Gelayee, Dessalegn; Binega Mekonnen, Gashaw; Birarra, Mequanent Kassa

2017-01-01

Community pharmacists are in a key position to provide information on drugs and thus promote the rational use of drugs. The present study was designed to determine the needs and resources of drug information in community pharmacies. A prospective institution based cross-sectional study was carried out and data were collected on 48 community pharmacists in Gondar, Northwest Ethiopia, using interviewer administered structured questionnaire. Almost all pharmacists ( N = 47, 97.9%) often receive drug related queries and these were mainly from consumers ( N = 41, 85.4%). While most questions relate to drug price ( N = 29, 60.4%) and dosage ( N = 21, 43.8%), the information resources mainly referred to were drug package inserts and national standard treatment guidelines. However, limited availability of information resources as well as limited ability to retrieve relevant information influenced the practice of pharmacists. Female pharmacists claimed better use of different information resources than males ( P < 0.05). Community pharmacists in Gondar, Northwest Ethiopia, are often accessed for drug related information. But there are limitations in using up to date and most reliable resources. Therefore, intervention aimed at improving pharmacists' access to and evaluation of drug information is urgently needed.

Procedural justice, supervisor autonomy support, work satisfaction, organizational identification and job performance: the mediating role of need satisfaction and perceived organizational support.

PubMed

Gillet, Nicolas; Colombat, Philippe; Michinov, Estelle; Pronost, Anne-Marie; Fouquereau, Evelyne

2013-11-01

To test a model linking procedural justice, supervisor autonomy support, need satisfaction, organizational support, work satisfaction, organizational identification and job performance. Research in industrial and organizational psychology has shown that procedural justice and supervisor autonomy support lead to positive outcomes. However, very little research related to this subject has been conducted in healthcare settings. Moreover, few studies have examined mechanisms that could account for these positive relationships. A cross-sectional correlational design was used. Convenience sampling was used and a sample of 500 nurses working in haematology, oncology and haematology/oncology units in France was surveyed in 2011. The final sample consisted of 323 nurses (64.6% response rate). The hypothesized model was tested using structural equation modelling. Procedural justice and supervisor autonomy support significantly and positively influenced need satisfaction and perceived organizational support, which in turn positively predicted work satisfaction, organizational identification and job performance. Organizations could deliver training programmes for their managers aimed at enhancing the use of fair procedures in allocating outcomes and developing their autonomy-supportive behaviours to improve nurses' work satisfaction, organizational identification and job performance. © 2013 Blackwell Publishing Ltd.

Nurses' knowledge of foot care in the context of home care: a cross-sectional correlational survey study.

PubMed

Stolt, Minna; Suhonen, Riitta; Puukka, Pauli; Viitanen, Matti; Voutilainen, Päivi; Leino-Kilpi, Helena

2015-10-01

This study aimed to explore nurses' knowledge of foot care and related factors in home care nursing. Nurses caring for older people are increasingly confronted with clients who have multiple foot problems and need support with their foot health. The role of nurses in promoting foot health, caring for existing foot problems and supporting older people in foot self-care is especially important in the home care context. However, this entails up-to-date foot care knowledge and practices. A cross-sectional correlational survey study design. Nurses' knowledge of foot care was evaluated using the Nurses' Foot Care Knowledge Test developed for this study. The data were analysed with descriptive and inferential statistics. Nurses (registered nurses, public health nurses and licensed practical nurses) from public home care (n = 322, response rate 50%) participated the study. Nurses' knowledge in foot care varied. The knowledge scores were highest for skin and nail care and lowest for the identification and care of foot structural deformities. Longer working experience in the current work place and participation in continuing education explained higher Nurses' Foot Care Knowledge Test scores. Nurses need more knowledge, and hence continuing education, in the foot care of older people to effectively prevent, recognise and care for foot problems and promote independent living in the community. Nurses' have clinically relevant knowledge gaps. Therefore, foot care knowledge of nurses needs to be improved by continuing education in clinical settings. Adequate foot care knowledge among nurses is important to identify, prevent and care foot problems especially in older people. © 2015 John Wiley & Sons Ltd.

Collaboration and research as key elements for strengthening blood donation in developing nations: the case of Grenada, West Indies.

PubMed

Gomez, A; Messam, L L McV; Toner, L

2013-01-01

The purpose of the study was to identify ways to strengthen the collaboration between the Grenadian Blood Bank, the St George's University (SGU) chapter of the American Medical Students Association, and St George's University Health Clinic in order to improve the promotion of blood drives and increase the number of volunteer donors. The study had two phases. Phase 1: an assessment of the strengths and needs of the collaborators and of the blood drives. Phase 2 consisted of three student assessments: a cross-sectional survey of second year medical students, a cross-sectional survey of students in the School of Arts and Sciences and a case-control study of factors affecting student donation on the day of blood drives. Embedded within both phases were service-learning opportunities for students. Both phases received approval from SGU's Institutional Review Board. Preliminary achievements included a transient increase in blood donation of twenty per cent during five months though advertising of blood drives remains inadequate. Assessments reveal that most students lack knowledge about the drives, and time (medical students) and fear of needles and infection (Arts and Science students) are potential hindrances to blood donation. The Blood Bank needs to increase its profile on the university campus and develop a more effective promotion of the blood drives addressing the concerns of students. St George's University needs to continue supporting student involvement in health promotion activities and identify ways to ensure the sustainability and continuity of these activities. Collaboration and research are useful and effective means to promote blood donation. College students are potentially an excellent source of collaborators and donors if provided with the promotion skills and participation is made convenient.

Factors associated with quality of life in elderly hospitalised patients undergoing post-acute rehabilitation: a cross-sectional analytical study in Switzerland

PubMed Central

Rubli Truchard, Eve; Rochat, Etienne; Pasquier, Jérôme; Monod, Stéfanie

2017-01-01

Objectives We investigated whether biopsychosocial and spiritual factors and satisfaction with care were associated with patients’ perceived quality of life. Design This was a cross-sectional analytical study. Setting Data were collected from inpatients at a postacute geriatric rehabilitation centre in a university hospital in Switzerland. Participants Participants aged 65 years and over were consecutively recruited from October 2014 to January 2016. Exclusion criteria included significant cognitive disorder and terminal illness. Of 227 eligible participants, complete data were collected from 167. Main outcome measures Perceived quality of life was measured using WHO Quality of Life Questionnaire—version for older people. Predictive factors were age, sex, functional status at admission, comorbidities, cognitive status, depressive symptoms, living conditions and satisfaction with care. A secondary focus was the association between spiritual needs and quality of life. Results Patients undergoing geriatric rehabilitation experienced a good quality of life. Greater quality of life was significantly associated with higher functional status (rs=0.204, p=0.011), better cognitive status (rs=0.175, p=0.029) and greater satisfaction with care (rs=0.264, p=0.003). Poorer quality of life was significantly associated with comorbidities (rs=−.226, p=0.033), greater depressive symptoms (rs=−.379, p<0.001) and unmet spiritual needs (rs=−.211, p=0.049). Multivariate linear regression indicated that depressive symptoms (β=−0.961; 95% CIs −1.449 to 0.472; p<0.001) significantly predicted quality of life. Conclusions Patient perceptions of quality of life were significantly associated with depression. More research is needed to assess whether considering quality of life could improve care plan creation. PMID:29061633

Translabyrinthine vestibular neurectomy and simultaneous cochlear implant for Ménière's disease.

PubMed

Canzi, Pietro; Manfrin, Marco; Perotti, Marco; Aprile, Federico; Quaglieri, Silvia; Rebecchi, Elisabetta; Locatelli, Giulia; Benazzo, Marco

2017-01-01

Surgical management of Ménière's disease (MD) is recommended in case of medical and intratympanic treatment failures. Translabyrinthine vestibular nerve section has been considered the gold standard for denervation procedures in order to control vertigo attacks, although at the cost of sacrificing residual hearing. To the best of our knowledge, no work has been published with regard to a group of patients submitted to translabyrinthine vestibular neurectomy and simultaneous cochlear implant for MD. The aim of the present study was to assess the effectiveness of translabyrinthine vestibular nerve section and simultaneous cochlear implant in a prospective study. All adult patients (over 18 years of age) with a diagnosis of intractable unilateral definite MD and useless residual hearing function were enrolled after medical and intratympanic treatment failures. Pre- and postoperative otoneurological evaluation concerned: frequency of vertigo attacks, head impulse test and caloric testing, pure tone average and speech perception audiometry in quiet conditions, tinnitus handicap inventory test, functional level scale and rate of vertigo control, dizziness handicap inventory test, and MD patient-oriented severity index. At least 6 months of follow-up were needed to be enrolled in the study. Four patients were included in the study. Translabyrinthine vestibular nerve section and simultaneous cochlear implant seemed to considerably improve the disabling effects of MD, achieving a good control of vestibular symptoms (mean pre/postoperative vertigo attacks per month: 16.5/0), resolving hearing loss (mean pre/postoperative pure tone average in the affected ear: 86.2/32.5 dB), improving the tinnitus (mean pre/postoperative tinnitus handicap inventory test: 77.2/6), and finally increasing the overall quality-of-life parameters. In our preliminary report, translabyrinthine vestibular nerve section and simultaneous cochlear implant showed encouraging results in order to definitively control both vestibular and cochlear symptoms during the same therapeutic procedure.

Effects of the Pulmonary Hypertension Manual (PulHMan) on Awareness of Exercise in Patients with Pulmonary Hypertension.

PubMed

Babu, Abraham Samuel; Ramachandran, Padmakumar; Maiya, Arun G

2016-01-01

Patient education is an important part of holistic care for patients with chronic diseases. With the success of the Heart Manual, it was felt there is a strong need to develop such a manual for those with pulmonary hypertension (PH) - the Pulmonary Hypertension Manual (PulHMan). This was developed through a qualitative methodology in order to ensure the needs of the patients were being met. The impact of the PulHMan on awareness about exercise-related benefits and PH are not known. Therefore the aim of this study was to assess the effects of the PulHMan on improving awareness among individuals with PH. A repeat cross sectional study was carried out on 30 patients with PH to assess the effects of using the PulHMan on awareness of exercise-related benefits in PH. Awareness was assessed from a self-developed and validated questionnaire that included components of PH and exercise related components. Thirty patients with PH (mean right ventricular systolic pressure and six minute walk distance of 89.2±4.1mm Hg and 322.8±102m respectively) were included in the study. At baseline, it was seen that there was a low awareness regarding the benefits of exercise for PH. However, they were aware of the general health benefits of walking. After three months, it was seen that the PulHMan improved awareness on the benefits of exercising. Despite a low number willing to exercise (2/30) and participate in a home-based program (2/30), after using the PulHMan for three months, there was an improvement in those willing to exercise and participate in a home-based program (22/30 and 25/30 respectively). The PulHMan was seen to improve awareness regarding the exercise-related benefits among patients with PH. More studies are needed to determine if this change in awareness translates into a behavioural change for those with PH. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Does appraisal enhance learning, improve practice and encourage continuing professional development? A survey of general practitioners' experiences of appraisal.

PubMed

Finlay, Karen; McLaren, Susan

2009-01-01

Revalidation of the medical profession is under review and a system has been proposed to ensure doctors meet standards of practice and professionalism. The current appraisal system allows clinicians to chart their progress and identify developmental needs in order to improve performance. Appraisal is now an annual compulsory requirement for all doctors. The aim of the study was to investigate the experiences of general practitioners (GPs) of the current appraisal process. The specific objectives were to consider the impact the appraisal process had exerted on their learning, practice and individual continuing professional development (CPD). We employed a cross-sectional design using a postal questionnaire sent to all doctors who work as GPs (n = 385) in West Kent. Questionnaires were returned from 71.7% of doctors (n = 276). The key findings obtained were that 47.5% (n = 131) of doctors stated that taking part in the appraisal process had enhanced their learning, 40.2% (n = 111) felt that the appraisal process had improved their practice and 55.8% (n = 154) stated that the appraisal process had encouraged their CPD. Qualitative findings derived from thematic analysis of open questions revealed that participants viewed the role of the appraiser as respected peer to be vital and there was a need for independence in the appraiser's appointment. The time-consuming nature of the appraisal process was emphasised, with little protected time for preparation of documentation and engagement in CPD. Concerns were expressed about links between appraisal and revalidation. Many doctors considered that the appraisal process had enhanced their learning, improved their practice and encouraged their CPD. A vital, independent role for the appraiser was emphasised as was a need to review the time-consuming nature of the current appraisal process, together with identifying protected time to complete this and CPD engagement. As the role of appraisal within the revalidation process changes it is recognised that ensuring the quality, consistency and nature of appraisal will be essential to maintain the confidence of patients and doctors.

24 CFR 220.350 - Cross-reference.

Code of Federal Regulations, 2010 CFR

2010-04-01

... section 203(k) of the Act shall apply to home improvement loans on one-to-four family dwellings under... not be applicable to home improvement loans on one-to-four family dwellings under section 220(h) of...

Perspectives of nursing professionals and older adults differ on aspects of care for older people after a nationwide improvement program.

PubMed

Verweij, Lisanne Marlieke; Wehrens, Rik; Oldenhof, Lieke; Bal, Roland; Francke, Anneke L

2018-05-02

The perspectives of nursing professionals might differ from those of older adults when it comes to care for older people. This cross-sectional study compares the views of older adults with the views of nursing professionals on the quality of care after a nationwide improvement program for care for older people was implemented (2008-2016) in the Netherlands. Questionnaire data were used from 385 nursing professionals (response rate 51%) that were part of the Nursing Staff Panel, a nationwide representative group of nursing staff, and working in home care, hospitals or general practices. Additionally, questionnaire data were used from 73 older adults (response rate 81%) who were involved in regional networks to discuss project proposals and to represent the voice of older adults in the nationwide improvement program. Participants were asked to evaluate care for older people with regard to collaboration between healthcare organizations and with regard to the tailored service, accessibility, and quality of care within their organizations and in the region in which they lived. A majority of older adults (54%) and nursing professionals (61%) felt that collaboration with others had improved over the last few years. Approximately one third of the older adults stated that care for older people was tailored to fit individual needs and was accessible most of the time or always, as opposed to approximately two thirds of the professionals. Moreover, 17% older adults thought that the quality of care was good, compared with 54% of the nursing professionals. 77% of the nursing professionals and 94% of the older adults thought that improvements were still needed in care for older people, for example better integration of the different aspects of care and a more patient-centered approach. Older adults who were involved in networks of the improvement program generally gave a less positive evaluation of aspects of care for older people and its development than nursing professionals. Considering differences in the perspectives of key stakeholders is relevant for the development and evaluation of nationwide improvement programs, for a correct interpretation of findings, and for making appropriate recommendations.

The resident-as-teacher educational challenge: a needs assessment survey at the National Autonomous University of Mexico Faculty of Medicine.

PubMed

Sánchez-Mendiola, Melchor; Graue-Wiechers, Enrique L; Ruiz-Pérez, Leobardo C; García-Durán, Rocío; Durante-Montiel, Irene

2010-02-16

The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution. A cross-sectional descriptive survey was developed based on a review of the available literature and discussion by an expert multidisciplinary committee. The goal was to identify the residents' attitudes, academic needs and preferred educational strategies regarding resident-as-teacher activities throughout the residency. The survey was piloted and modified accordingly. The paper anonymous survey was sent to 7,685 residents, the total population of medical residents in UNAM programs in the country. There was a 65.7% return rate (5,186 questionnaires), a broad and representative sample of the student population. The residents felt they had knowledge and were competent in medical education, but the majority felt a need to improve their knowledge and skills in this discipline. Most residents (92.5%) felt that their role as educators of medical students, interns and other residents was important/very important. They estimated that 45.5% of their learning came from other residents. Ninety percent stated that it was necessary to be trained in teaching skills. The themes identified to include in the educational intervention were mostly clinically oriented. The educational strategies in order of preference were interactive lectures with a professor, small groups with a moderator, material available in a website for self-learning, printed material for self-study and homework, and small group web-based learning. There is a large unmet need to implement educational interventions to improve residents' educational skills in postgraduate educational programs in developing countries. Most perceived needs of residents are practical and clinically oriented, and they prefer traditional educational strategies. Resident as teachers educational interventions need to be designed taking into account local needs and resources.

The resident-as-teacher educational challenge: a needs assessment survey at the National Autonomous University of Mexico Faculty of Medicine

PubMed Central

2010-01-01

Background The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution. Methods A cross-sectional descriptive survey was developed based on a review of the available literature and discussion by an expert multidisciplinary committee. The goal was to identify the residents' attitudes, academic needs and preferred educational strategies regarding resident-as-teacher activities throughout the residency. The survey was piloted and modified accordingly. The paper anonymous survey was sent to 7,685 residents, the total population of medical residents in UNAM programs in the country. Results There was a 65.7% return rate (5,186 questionnaires), a broad and representative sample of the student population. The residents felt they had knowledge and were competent in medical education, but the majority felt a need to improve their knowledge and skills in this discipline. Most residents (92.5%) felt that their role as educators of medical students, interns and other residents was important/very important. They estimated that 45.5% of their learning came from other residents. Ninety percent stated that it was necessary to be trained in teaching skills. The themes identified to include in the educational intervention were mostly clinically oriented. The educational strategies in order of preference were interactive lectures with a professor, small groups with a moderator, material available in a website for self-learning, printed material for self-study and homework, and small group web-based learning. Conclusions There is a large unmet need to implement educational interventions to improve residents' educational skills in postgraduate educational programs in developing countries. Most perceived needs of residents are practical and clinically oriented, and they prefer traditional educational strategies. Resident as teachers educational interventions need to be designed taking into account local needs and resources. PMID:20156365

Local food-based complementary feeding recommendations developed by the linear programming approach to improve the intake of problem nutrients among 12-23-month-old Myanmar children.

PubMed

Hlaing, Lwin Mar; Fahmida, Umi; Htet, Min Kyaw; Utomo, Budi; Firmansyah, Agus; Ferguson, Elaine L

2016-07-01

Poor feeding practices result in inadequate nutrient intakes in young children in developing countries. To improve practices, local food-based complementary feeding recommendations (CFR) are needed. This cross-sectional survey aimed to describe current food consumption patterns of 12-23-month-old Myanmar children (n 106) from Ayeyarwady region in order to identify nutrient requirements that are difficult to achieve using local foods and to formulate affordable and realistic CFR to improve dietary adequacy. Weekly food consumption patterns were assessed using a 12-h weighed dietary record, single 24-h recall and a 5-d food record. Food costs were estimated by market surveys. CFR were formulated by linear programming analysis using WHO Optifood software and evaluated among mothers (n 20) using trial of improved practices (TIP). Findings showed that Ca, Zn, niacin, folate and Fe were 'problem nutrients': nutrients that did not achieve 100 % recommended nutrient intake even when the diet was optimised. Chicken liver, anchovy and roselle leaves were locally available nutrient-dense foods that would fill these nutrient gaps. The final set of six CFR would ensure dietary adequacy for five of twelve nutrients at a minimal cost of 271 kyats/d (based on the exchange rate of 900 kyats/USD at the time of data collection: 3rd quarter of 2012), but inadequacies remained for niacin, folate, thiamin, Fe, Zn, Ca and vitamin B6. TIP showed that mothers believed liver and vegetables would cause worms and diarrhoea, but these beliefs could be overcome to successfully promote liver consumption. Therefore, an acceptable set of CFR were developed to improve the dietary practices of 12-23-month-old Myanmar children using locally available foods. Alternative interventions such as fortification, however, are still needed to ensure dietary adequacy of all nutrients.

Job satisfaction in mainland China: comparing critical care nurses and general ward nurses.

PubMed

Zhang, Aihua; Tao, Hong; Ellenbecker, Carol Hall; Liu, Xiaohong

2013-08-01

To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China. Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown. A cross-sectional design was selected for this descriptive correlation study. Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010. Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job. Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse. © 2012 Blackwell Publishing Ltd.

Individual differences and their impact on the safety and the efficiency of human-wheelchair systems.

PubMed

Jipp, Meike

2012-12-01

The extent to which individual differences in fine motor abilities affect indoor safety and efficiency of human-wheelchair systems was examined. To reduce the currently large number of indoor wheelchair accidents, assistance systems with a high level of automation were developed. It was proposed to adapt the wheelchair's level of automation to the user's ability to steer the device to avoid drawbacks of highly automated wheelchairs. The state of the art, however, lacks an empirical identification of those abilities. A study with 23 participants is described. The participants drove through various sections of a course with a powered wheelchair. Repeatedly measured criteria were safety (numbers of collisions) and efficiency (times required for reaching goals). As covariates, the participants' fine motor abilities were assessed. A random coefficient modeling approach was conducted to analyze the data,which were available on two levels as course sections were nested within participants.The participants' aiming, precision, and armhand speed contributed significantly to both criteria: Participants with lower fine motor abilities had more collisions and required more time for reaching goals. Adapting the wheelchair's level of automation to these fine motor abilities can improve indoor safety and efficiency. In addition, the results highlight the need to further examine the impact of individual differences on the design of automation features for powered wheelchairs as well as other applications of automation. The results facilitate the improvement of current wheelchair technology.

Quality and accuracy of publicly accessible cancer-related physical activity information on the Internet: a cross-sectional assessment.

PubMed

Buote, R D; Malone, S D; Bélanger, L J; McGowan, E L

2016-09-01

In this study, we assessed the quality of publicly available cancer-related physical activity (PA) information appearing on reputable sites from Canada and other English-speaking countries. A cross-sectional Internet search was conducted on select countries (Canada, USA, Australia, New Zealand, UK) using Google to generate top 50 results per country for the keywords "'physical activity' AND 'cancer'". Top results were assessed for quality of PA information based on a coding frame. Additional searches were performed for Canadian-based sites to produce an exhaustive list. Results found that many sites offered cancer-related PA information (94.5%), but rarely defined PA (25.2%). Top 50 results from each country did not differ on any indicator examined. The exhaustive list of Canadian sites found that many sites gave information about PA for survivorship (78.3%) and prevention (70.0%), but rarely defined (6.7%) or referenced PA guidelines (28.3%). Cancer-related PA information is plentiful on the Internet but the quality needs improvement. Sites should do more than mention PA; they should provide definitions, examples and guidelines. With improvements, these websites would enable healthcare providers to effectively educate their patients about PA, and serve as a valuable resource to the general public who may be seeking cancer-related PA information. © 2016 John Wiley & Sons Ltd.

Employee engagement within the NHS: a cross-sectional study

PubMed Central

Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-01-01

Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both). The score for absorption was significantly higher than comparison group (P< 0.0001). However, total score is not significantly different. Conclusion: The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

Knowledge, attitudes and practices of voluntary HIV counselling and testing among rural migrants in central China: a cross-sectional study.

PubMed

Zhang, Tiejun; Zhang, Jinling; Gao, Meiyang; He, Na; Detels, Roger

2012-04-01

To document knowledge, attitudes and practices of voluntary HIV counselling and testing (VCT) among rural migrants in central China. A cross-sectional study with face-to-face anonymous questionnaire interviews was conducted using a structured questionnaire. Among 1280 participants, 87.9% reported having had sexual intercourse during their lifetime, with 69% of singles reporting having had sexual intercourse and 49.1% having had sex in the past month. Only 21% always used condoms, 84.4% knew HIV infection was diagnosed through blood testing, 56.6% had heard of VCT, but only 3.8% perceived their own risk for HIV infection. Only 43 (2.3%) had ever been tested for HIV, and none had ever been tested at a VCT site. About two-thirds (64.5%) would be willing to use VCT services upon awareness of HIV risk. A logistic regression model showed that females, those having little knowledge of HIV/AIDS, those unwilling to work with HIV-infected individuals, never having been tested for HIV and having low awareness regarding HIV risk were less willing to use VCT. The results of this study indicated that much greater efforts are needed to improve HIV/AIDS and VCT knowledge, to promote safer sex and to improve VCT acceptance among rural migrants in central China, particularly those engaging in risky behaviours.

Longitudinal association between cognitive performance and obsessive-compulsive symptoms in patients with psychosis and unaffected siblings.

PubMed

Schirmbeck, F; Swets, M; Meijer, C J; Zink, M; de Haan, L

2016-05-01

Obsessive-compulsive symptoms (OCS) frequently occur in psychotic disorders. Cross-sectional associations between OCS and cognitive impairment have led to different causal explanations. Whereas one assumes that higher cognitive impairment reflects a risk factor for psychotic patients to develop OCS, another suggests that deficits reflect a consequence of OCS. This study investigated the longitudinal interrelation between OCS and cognitive functioning. Baseline and follow-up data from 622 patients and 670 un-affected siblings from the 'Genetic Risk and Outcome in Psychosis' study were analyzed. Participants were allocated to groups according to the presence or absence of OCS at assessments and compared on several cognitive domains. Cross-sectional comparisons revealed no group differences in cognitive performance. Longitudinal analyses comparing the groups with changes in OCS revealed one significant group effect with more problems in set-shifting abilities in patient who reported OCS development at follow-up. Significant time and interaction effects were mainly due to improvement in immediate verbal recall and digit-symbol coding in patients and siblings who reported remission of OCS. Although insight into causality needs further exploration, our results do not confirm the hypothesis of pre-existing cognitive risk constellations. Findings suggest that remission of comorbid OCS results in improved immediate verbal recall and processing speed. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Perceived human rights violation in persons with mental illness: role of education.

PubMed

Vijayalakshmi, Poreddi; Ramachandra; Reddemma, Konduru; Math, Suresh Bada

2013-06-01

People with mental illness are vulnerable to human rights violations and people with illiteracy and mental illness are at a double disadvantage. To determine the role of education in ascertaining human rights needs of people with mental illness. This was a descriptive study carried out among randomly selected (N = 100) recovered psychiatric patients with mental illness in the past based on the Clinical Global Impression-Improvement scale at a tertiary care centre. Data were collected through face-to-face interview using structured needs assessment questionnaire comprising two sections related to family and community domains. Data were analysed and interpreted using descriptive and inferential statistics. Our findings revealed that human rights needs in the physical needs dimension--i.e., access to electricity (χ2 = 5.523, p < .019) and safe drinking water facilities (χ2 = 9.665, p < .022)--were rated higher in illiterates than in literates. The human rights needs in emotional dimension - i.e. feeling separated from their families because of their illness (χ2 = 13.118, p < .004), afraid of family members (χ2 = 13.388, p < .004) and called filthy nicknames (χ2 = 17.759, p < .000) - were rated higher in literates than in illiterates. The human rights needs in the religious needs dimension - i.e. allowed to go to temple, church, mosque etc. (χ2 = 12.000, p < .007) - and in the social needs dimension - i.e. friendliness with family members -were rated higher in illiterates than in literates (χ2 = 9.661, p < .022). Empowering people with mental illness by providing adequate opportunity to pursue education will play an important role in fulfilling the obligation of the United Nations Convention on the Rights of Persons with Disabilities.

Socio-Economic Determinants of the Need for Dental Care in Adults.

PubMed

Trohel, Gilda; Bertaud-Gounot, Valérie; Soler, Marion; Chauvin, Pierre; Grimaud, Olivier

2016-01-01

Oral health has improved in France. However, there are still inequalities related to the socio-economic status. The aim of this study was to measure the prevalence of dental care needs in an adult population and to identify the demographic, socio-economic and behavioral variables that may explain variations in this parameter. A cross-sectional analysis of the French SIRS cohort (n = 2,997 adults from the Paris region; 2010 data) was carried out to determine the prevalence of self-reported dental care needs relative to demographic, socio-economic and behavioral variables. A logistic regression model was used to identify the variables that were most strongly associated with the level of need. In 2010, the prevalence of the need for dental care in the SIRS cohort was 35.0% (95% CI [32.3-37.8]). It was lower in people with higher education levels (31.3% [27.9-34.6]), without immigrant background (31.3% [28.0-34.6]) and with comprehensive health insurance (social security + complementary health cover; 32.8% [30.2-35.4]). It decreased as the socio-economic status increased, but without following a strict linear change. It was also lower among individuals who had a dental check-up visit in the previous two years. In multivariate analyses, the socioeconomic variables most strongly associated with the need for dental care were: educational attainment (OR = 1.21 [1.02-1.44]), income level (OR = 1.66 [1.92-2.12]) and national origin (OR = 1.53 [1.26-1.86]). These results confirm that the prevalence of dental care needs is higher among adults with low socio-economic status. Education level, income level and also national origin were more strongly associated with the need for dental care than insurance cover level.

Determining unmet, adequately met, and overly met needs for health care and services for persons living with HIV/AIDS in Mississippi.

PubMed

Krause, Denise D; May, Warren L; Butler, Kenneth R

2013-08-01

A statewide needs assessment of persons living with HIV/AIDS (PLWHA) was conducted to determine what is known about access to care, utilization of services, and perceived barriers to receiving care and services. Our objective was to determine which needs were being met or unmet among PLWHA in Mississippi to provide a better understanding of how effectively to allocate funding to provide for the needs of that group. In this cross-sectional study, a true random sample of PLWHA in Mississippi was interviewed in 2005-2006. Questions were asked to identify opinions about respondents' experiences with 23 health care services and 30 public or private assistance services. The kappa statistic was used to measure agreement between level of services needed and level of services provided. Services with the lowest kappa scores revealed which services were being either mostly unmet, or even overly met. Greatest service needs were HIV viral load test, Pap smear, CD4/T-cell count test, and medication for HIV/AIDS, which were reasonably well met. The most significantly unmet needs were dental care and dental exams, eye care and eye exams, help paying for housing, subsidized housing assistance, mental health therapy or counseling, access to emotional support groups, and job placement or employment. Overly met services included medical care at a physician's office or clinic and free condoms. This study identified needs perceived to be significantly unmet by PLWHA, as well as areas that were perceived to be adequately or overly met. This information may be used to target areas with the greatest impact for improvement and provide insight into how to effectively allocate health care resources and public/private assistance.

Hablamos Juntos (Together We Speak): Interpreters, Provider Communication, and Satisfaction with Care

PubMed Central

Morales, Leo S.

2010-01-01

BACKGROUND The Hablamos Juntos—Together We Speak (HJ)—national demonstration project targeted the improvement of language access for Spanish-speaking Latinos in areas with rapidly growing Latino populations. The objective of HJ was to improve doctor-patient communication by increasing access to and quality of interpreter services for Spanish-speaking patients. OBJECTIVE To investigate how access to interpreters for adult Spanish-speaking Latinos is associated with ratings of doctor/office staff communication and satisfaction with care. DESIGN Cross-sectional cohort study. PATIENTS A total of 1,590 Spanish-speaking Latino adults from eight sites across the United States who participated in the outpatient HJ evaluation. MEASUREMENTS We analyzed two multi-item measures of doctor communication (4 items) and office staff helpfulness (2 items), and one global item of satisfaction with care by interpreter use. We performed regression analyses to control for patient sociodemographic characteristics, survey year, and clustering at the site of care. RESULTS Ninety-five percent of participants were born outside the US, 81% were females, and survey response rates ranged from 45% to 85% across sites. In this cohort of Spanish-speaking patients, those who needed and always used interpreters reported better experiences with care than their counterparts who needed but had interpreters unavailable. Patients who always used an interpreter had better adjusted ratings of doctor communication [effect size (ES = 0.51)], office staff helpfulness (ES = 0.37), and satisfaction with care (ES = 0.37) than patients who needed but did not always use an interpreter. Patients who needed and always used interpreters also reported better experiences with care in all three domains measured [doctor communication (ES = 0.30), office staff helpfulness (ES = 0.21), and satisfaction with care (ES = 0.23)] than patients who did not need interpreters. CONCLUSIONS Among adult Spanish-speaking Latinos, interpreter use is independently associated with higher satisfaction with doctor communication, office staff helpfulness, and ambulatory care. Increased attention to the need for effective interpreter services is warranted in areas with rapidly growing Spanish-speaking populations. PMID:20703951

Nutritional Status among Rural Community Elderly in the Risk Area of Liver Fluke, Surin Province, Thailand.

PubMed

Kaewpitoon, Soraya J; Namwichaisirikul, Niwatchai; Loyd, Ryan A; Churproong, Seekaow; Ueng-Arporn, Naporn; Matrakool, Likit; Tongtawee, Taweesak; Rujirakul, Ratana; Nimkhuntod, Porntip; Wakhuwathapong, Parichart; Kaewpitoon, Natthawut

2015-01-01

Thailand is becoming an aging society, this presenting as a serious problem situation especially regarding health. Chronic diseases found frequently in the elderly may be related to dietary intake and life style. Surin province has been reported as a risk area for liver fluke with a high incidence of cholangiocarcinma especially in the elderly. Therefore, this study aimed to determine the nutritional status and associated factors among elderly in Surin province, northeast of Thailand. A community-based cross-sectional study was conducted among 405 people aged 60 years and above, between September 2012 and July 2014. The participants were selected through a randomized systematic sampling method and completed a pre-designed questionnaire with general information, food recorded, weight, height, waist circumference, and behavior regarding to food consume related to liver fluke infection. The data were analyzed using descriptive statistics and Spearman's rank correlation coefficients. The majority of participants was female (63.5%), age between 60-70 years old (75.6%), with elementary school education (96.6%), living with their (78.9%), and having underlying diseases (38.3%). Carbohydrate (95.3%) was need to improve the consumption. The participants demonstrated under-nutrition (24.4%), over-nutrition (16.4%), and obesity (15.4%). Elderly had a waist circumference as the higher than normal level (34.0%). Gender, female, age 71-80 years old, elementary school and underlying diseases were significantly associated with poor nutritional status. The majority of them had a high knowledge (43.0%), moderate attitude (44.4%), and moderate practice (46.2%) regarding food consumption related to liver fluke infection. In conclusion, these findings data indicated that elderly age group often have an under- or over-nutritional status. Carbohydrate consumption needs to be improved. Some elderly show behavior regarding food consumption that is related to liver fluke infection hat needs to be improved, so that health education pertaining good nutrition is required.

Evaluation of water, sanitation and hygiene program outcomes shows knowledge-behavior gaps in Coast Province, Kenya

PubMed Central

Schlegelmilch, Michael Paul; Lakhani, Amyn; Saunders, Leslie Duncan; Jhangri, Gian Singh

2016-01-01

Introduction Water related diseases constitute a significant proportion of the burden of disease in Kenya. Water, sanitation and hygiene (WASH) programs are in operation nation-wide to address these challenges. This study evaluated the impact of the Sombeza Water and Sanitation Improvement Program (SWASIP) in Coast Province, Kenya. Methods This study is a cluster randomized, follow-up evaluation that compared baseline (2007) to follow-up (2013) indicators from 250 households. Twenty-five villages were selected with probability proportional to size sampling, and ten households were selected randomly from each village. Follow-up data were collected by in-person interviews using pre-tested questionnaires, and analyzed to compare indicators collected at baseline. Cross-sectional results from the follow-up data were also reported. Results Statistically significant improvements from baseline were observed in the proportions of respondents with latrine access at home, who washed their hands after defecation, who treated their household drinking water and the average time to collect water in the dry season. However, this study also observed significant decreases in the proportion of respondents who washed their hands before preparing their food, or feeding their children, and after attending to a child who has defecated. The analysis also revealed a knowledge-behavior gap in WASH behaviors. Conclusion SWASIP contributed to improvements from baseline, but further progress still needs to be seen. The findings challenge the assumption that providing infrastructure and knowledge will result in behavior change. Further understanding of specific, non-knowledge predictors of WASH related behavior is needed. PMID:27279970

Barriers and perceived needs for understanding and using research among emergency nurses.

PubMed

Chan, Garrett K; Barnason, Susan; Dakin, Cynthia L; Gillespie, Gordon; Kamienski, Mary C; Stapleton, Stephen; Williams, Jennifer; Juarez, Altair; Li, Suling

2011-01-01

Nurses are involved in conducting research and incorporating evidence into their practice. However, barriers exist at the individual, unit, and organizational level related to understanding, conducting, and evaluating the evidence. The Emergency Nurses Association (ENA) conducted a study to understand levels of education in research, the extent of experience, and needs and barriers to research at the individual and organizational levels in emergency nursing. A cross-sectional survey design was used to poll members of the ENA. A 62-item survey instrument was designed to assess five areas: 1) nurses' research values, skills, experience, and awareness; 2) organizational settings' opportunities, barriers, and limitations to research; 3) nurses' understanding and comprehension of research and evidence; 4) presentation and accessibility of research; and 5) continuing educational topics to improve knowledge of the research process. Respondents (n = 948) identified barriers at the individual level that included lack of knowledge about critiquing research studies and familiarity with the research process. Barriers at the unit level included obtaining help from administrators and other staff in starting a project or having the authority to change practice. Barriers at the institution level included lack of support systems such as protected time to conduct research or implement changes in practice. Emergency nurses are highly motivated and interested in learning more about conducting and utilizing research to improve practice. Perceived personal, unit-based, and organizational barriers were identified through this research in an effort to highlight areas for improvement at the local and national levels. Copyright © 2011 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Testing the Birth Unit Design Spatial Evaluation Tool (BUDSET) in Australia: a pilot study.

PubMed

Foureur, Maralyn J; Leap, Nicky; Davis, Deborah L; Forbes, Ian F; Homer, Caroline E S

2011-01-01

To pilot test the Birth Unit Design Spatial Evaluation Tool (BUDSET) in an Australian maternity care setting to determine whether such an instrument can measure the optimality of different birth settings. Optimally designed spaces to give birth are likely to influence a woman's ability to experience physiologically normal labor and birth. This is important in the current industrialized environment, where increased caesarean section rates are causing concerns. The measurement of an optimal birth space is currently impossible, because there are limited tools available. A quantitative study was undertaken to pilot test the discriminant ability of the BUDSET in eight maternity units in New South Wales, Australia. Five auditors trained in the use of the BUDSET assessed the birth units using the BUDSET, which is based on 18 design principles and is divided into four domains (Fear Cascade, Facility, Aesthetics, and Support) with three to eight assessable items in each. Data were independently collected in eight birth units. Values for each of the domains were aggregated to provide an overall Optimality Score for each birth unit. A range of Optimality Scores was derived for each of the birth units (from 51 to 77 out of a possible 100 points). The BUDSET identified units with low-scoring domains. Essentially these were older units and conventional labor ward settings. The BUDSET provides a way to assess the optimality of birth units and determine which domain areas may need improvement. There is potential for improvements to existing birth spaces, and considerable improvement can be made with simple low-cost modifications. Further research is needed to validate the tool.

43 CFR 3802.1-5 - Plan approval.

Code of Federal Regulations, 2011 CFR

2011-10-01

... National Historic Preservation Act (NHPA) or section 7 of the Endangered Species Act is needed. Periods... or compliance with section 106 of NHPA or section 7 of the Endangered Species Act, operations under... NHPA or section 7 of the Endangered Species Act, the plan of operations shall not be approved until the...

43 CFR 3802.1-5 - Plan approval.

Code of Federal Regulations, 2013 CFR

2013-10-01

... National Historic Preservation Act (NHPA) or section 7 of the Endangered Species Act is needed. Periods... or compliance with section 106 of NHPA or section 7 of the Endangered Species Act, operations under... NHPA or section 7 of the Endangered Species Act, the plan of operations shall not be approved until the...

43 CFR 3802.1-5 - Plan approval.

Code of Federal Regulations, 2012 CFR

2012-10-01

... National Historic Preservation Act (NHPA) or section 7 of the Endangered Species Act is needed. Periods... or compliance with section 106 of NHPA or section 7 of the Endangered Species Act, operations under... NHPA or section 7 of the Endangered Species Act, the plan of operations shall not be approved until the...

43 CFR 3802.1-5 - Plan approval.

Code of Federal Regulations, 2014 CFR

2014-10-01

... National Historic Preservation Act (NHPA) or section 7 of the Endangered Species Act is needed. Periods... or compliance with section 106 of NHPA or section 7 of the Endangered Species Act, operations under... NHPA or section 7 of the Endangered Species Act, the plan of operations shall not be approved until the...

The level of leisure time physical activity is associated with work ability-a cross sectional and prospective study of health care workers.

PubMed

Arvidson, Elin; Börjesson, Mats; Ahlborg, Gunnar; Lindegård, Agneta; Jonsdottir, Ingibjörg H

2013-09-17

With increasing age, physical capacity decreases, while the need and time for recovery increases. At the same time, the demands of work usually do not change with age. In the near future, an aging and physically changing workforce risks reduced work ability. Therefore, the impact of different factors, such as physical activity, on work ability is of interest. Thus, the aim of this study was to evaluate the association between physical activity and work ability using both cross sectional and prospective analyses. This study was based on an extensive questionnaire survey. The number of participants included in the analysis at baseline in 2004 was 2.783, of whom 2.597 were also included in the follow-up in 2006. The primary outcome measure was the Work Ability Index (WAI), and the level of physical activity was measured using a single-item question. In the cross-sectional analysis we calculated the level of physical activity and the prevalence of poor or moderate work ability as reported by the participants. In the prospective analysis we calculated different levels of physical activity and the prevalence of positive changes in WAI-category from baseline to follow-up. In both the cross sectional and the prospective analyses the prevalence ratio was calculated using Generalized Linear Models. The cross-sectional analysis showed that with an increased level of physical activity, the reporting of poor or moderate work ability decreased. In the prospective analysis, participants reporting a higher level of physical activity were more likely to have made an improvement in WAI from 2004 to 2006. The level of physical activity seems to be related to work ability. Assessment of physical activity may also be useful as a predictive tool, potentially making it possible to prevent poor work ability and improve future work ability. For employers, the main implications of this study are the importance of promoting and facilitating the employees' engagement in physical activity, and the importance of the employees' maintaining a physically active lifestyle.

26 CFR 16A.126-1 - Certain cost-sharing payments-in general.

Code of Federal Regulations, 2011 CFR

2011-04-01

... improvement. An increase in annual income is substantial if it exceeds the greater of 10 percent of the average annual income derived from the affected property prior to receipt of the improvement or an amount... upon the receipt of a section 126 payment is the value of the section 126 improvement, reduced by the...

14 CFR 16.1 - Applicability and description of part.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) The assurances contained in grant-in-aid agreements issued under the Airport and Airway Improvement...(a) and (b). (6) Section 505(d) of the Airport and Airway Improvement Act of 1982, as amended, 49 U.S... (49 U.S.C. 1723), or section 516 of the Airport and Airway Improvement Act (49 U.S.C. 47125). (8...

Subretinal Implantation of Retinal Pigment Epithelial Cells Derived From Human Embryonic Stem Cells: Improved Survival When Implanted as a Monolayer

PubMed Central

Diniz, Bruno; Thomas, Padmaja; Thomas, Biju; Ribeiro, Ramiro; Hu, Yuntao; Brant, Rodrigo; Ahuja, Ashish; Zhu, Danhong; Liu, Laura; Koss, Michael; Maia, Mauricio; Chader, Gerald; Hinton, David R.; Humayun, Mark S.

2013-01-01

Purpose. To evaluate cell survival and tumorigenicity of human embryonic stem cell–derived retinal pigment epithelium (hESC-RPE) transplantation in immunocompromised nude rats. Cells were transplanted as a cell suspension (CS) or as a polarized monolayer plated on a parylene membrane (PM). Methods. Sixty-nine rats (38 male, 31 female) were surgically implanted with CS (n = 33) or PM (n = 36). Cohort subsets were killed at 1, 6, and 12 months after surgery. Both ocular tissues and systemic organs (brain, liver, kidneys, spleen, heart, and lungs) were fixed in 4% paraformaldehyde, embedded in paraffin, and sectioned. Every fifth section was stained with hematoxylin and eosin and analyzed histologically. Adjacent sections were processed for immunohistochemical analysis (as needed) using the following antibodies: anti-RPE65 (RPE-specific marker), anti-TRA-1-85 (human cell marker), anti-Ki67 (proliferation marker), anti-CD68 (macrophage), and anti-cytokeratin (epithelial marker). Results. The implanted cells were immunopositive for the RPE65 and TRA-1-85. Cell survival (P = 0.006) and the presence of a monolayer (P < 0.001) of hESC-RPE were significantly higher in eyes that received the PM. Gross morphological and histological analysis of the eye and the systemic organs after the surgery revealed no evidence of tumor or ectopic tissue formation in either group. Conclusions. hESC-RPE can survive for at least 12 months in an immunocompromised animal model. Polarized monolayers of hESC-RPE show improved survival compared to cell suspensions. The lack of teratoma or any ectopic tissue formation in the implanted rats bodes well for similar results with respect to safety in human subjects. PMID:23833067

Soccer-based promotion of voluntary medical male circumcision: A mixed-methods feasibility study with secondary students in Uganda.

PubMed

Miiro, George; DeCelles, Jeff; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Muzira, Philip; Ssembajjwe, Wilber; Musoke, Saidat; Gibson, Lorna J; Hershow, Rebecca B; Francis, Suzanna; Torondel, Belen; Ross, David A; Weiss, Helen A

2017-01-01

The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention ("Make The Cut") among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised "coaches" who facilitated a 60-minute session delivered in schools, including an interactive penalty shoot-out game using metaphors for HIV prevention, sharing of the coaches' circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale.

Depression, anxiety, and suicidal ideation among Vietnamese secondary school students and proposed solutions: a cross-sectional study

PubMed Central

2013-01-01

Background There is a rapidly growing public awareness of mental health problems among Vietnamese secondary school students. This study aims to determine the prevalence of anxiety, depression, and suicidal ideation, to identify related risk factors, and to explore students’ own proposals for improving their mental health. Methods A cross-sectional study was conducted among 1161 secondary students in Can Tho City, Vietnam during September through December, 2011. A structured questionnaire was used to assess anxiety, depression, suicidal ideation and proposed solutions. Depression was measured using the Center for Epidemiology Studies Depression Scale. Results The prevalence estimates of symptoms reaching a threshold comparable to a diagnosis of anxiety and depression were 22.8% and 41.1%, respectively. Suicide had been seriously considered by 26.3% of the students, while 12.9% had made a suicide plan and 3.8% had attempted suicide. Major risk factors related to anxiety and depression were physical or emotional abuse by the family, and high educational stress. As proposed solutions, nearly 80% of students suggested that the academic workload should be reduced and that confidential counselors should be appointed at schools. About half the students stated that the attitudes of their parents and teachers needed to change. A significant majority said that they would visit a website that provided mental health support for students. Conclusions Anxiety, depression, and suicidal ideation are common among Vietnamese secondary school students. There are strong associations with physical and emotional abuse in the family and high educational stress. Academic curricula and attitudes of parents and teachers need to be changed from a punitive to a more supportive approach to reduce the risk of poor mental health. An internet-based mental health intervention could be a feasible and effective first step to improve students’ mental health. PMID:24341792

Children, care, career - a cross-sectional study on the risk of burnout among German hospital physicians at different career stages.

PubMed

Richter, Astrid; Kostova, Petya; Harth, Volker; Wegner, Ralf

2014-01-01

With the increasing number of female medical students physicians' need for work-life balanced hospital jobs rises at all career stages. The Working Time Act (Arbeitszeitgesetz, ArbZG), an implementation of the European Working Time Directive into German law in 2004, should have improved the general conditions for creating flexible work. Nevertheless, the vast majority of female physicians still report an incompatibility of work and family. So far, little is known about mothers working on leading positions in the medical field. The presented study focuses on gender differences in the level of emotional exhaustion between child-rearing junior and senior physicians and different predictors of burnout. Three years after the ArbZT-enactment, 994 physicians from the listed hospital physicians in the Medical Register of the city of Hamburg participated in the cross-sectional study and completed a 60-item questionnaire (return rate of 46,5%). The questionnaire included a 22-item version of the German translation of the Maslach Burnout Inventory whereat emotional exhaustion was interpreted as the crucial predictor of burnout. Results of an univariate covariance analysis and regression analyses are reported. In the level of emotional exhaustion no gender differences were found between junior and senior physicians with children in the overall analysis. Support by the superior was the only overall predictor of burnout. Female senior physicians having children presented the highest risk of burnout. Only in this group parenting contributed significantly to the risk of burnout. Support by the superior and the relationship to colleagues are generally important predictors of burnout among hospital physicians. Parenthood only gets a crucial influence on psychomental health for female senior physicians. Still conservative role models are common in this group, thus dealing with the triple burden of work, leadership responsibility and child rearing seems to be a special female challenge. Innovative approaches of human resource policy need to be implemented to improve the reconciliation of family and working life.

Soccer-based promotion of voluntary medical male circumcision: A mixed-methods feasibility study with secondary students in Uganda

PubMed Central

DeCelles, Jeff; Rutakumwa, Rwamahe; Nakiyingi-Miiro, Jessica; Muzira, Philip; Ssembajjwe, Wilber; Musoke, Saidat; Gibson, Lorna J.; Hershow, Rebecca B.; Francis, Suzanna; Torondel, Belen; Ross, David A.

2017-01-01

The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention (“Make The Cut”) among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised “coaches” who facilitated a 60-minute session delivered in schools, including an interactive penalty shoot-out game using metaphors for HIV prevention, sharing of the coaches’ circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale. PMID:29016651

Nurses' perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey.

PubMed

Emsley, Robin; Alptekin, Koksal; Azorin, Jean-Michel; Cañas, Fernando; Dubois, Vincent; Gorwood, Philip; Haddad, Peter M; Naber, Dieter; Olivares, José Manuel; Papageorgiou, Georgios; Roca, Miguel; Thomas, Pierre; Hargarter, Ludger; Schreiner, Andreas

2015-12-01

Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses' survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication. A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses. Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%). Nurses are highly aware of adherence issues faced by their patients; further patient education on treatment options is needed.

Nurses’ perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey

PubMed Central

Emsley, Robin; Alptekin, Koksal; Azorin, Jean-Michel; Cañas, Fernando; Dubois, Vincent; Gorwood, Philip; Haddad, Peter M.; Naber, Dieter; Olivares, José Manuel; Papageorgiou, Georgios; Roca, Miguel; Thomas, Pierre; Hargarter, Ludger; Schreiner, Andreas

2015-01-01

Objectives: Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses’ survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication. Methods: A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses. Results: Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%). Conclusion: Nurses are highly aware of adherence issues faced by their patients; further patient education on treatment options is needed. PMID:26834967

CUSTOMS SERVICE MODERNIZATION: Management Improvements Needed on High-Risk Automated Commercial Environment Project

DTIC Science & Technology

2002-05-01

GAO United States General Accounting OfficeReport to Congressional CommitteesMay 2002 CUSTOMS SERVICE MODERNIZATION Management Improvements Needed...from... to) - Title and Subtitle CUSTOMS SERVICE MODERNIZATION: Management Improvements Needed on High-Risk Automated Commercial Environment... Customs management of ACE. Subject Terms Report Classification unclassified Classification of this page unclassified Classification of Abstract

Defense Information Systems Agency and Defense Logistics Agency Information Technology Contracts Awarded Without Competition Were Generally Justified

DTIC Science & Technology

2015-07-29

9 DISA Contracting Personnel Need to Improve When Synopsizing Noncompetitive IT...Conducted__________________________________________________ 30 Appendix F. Synopses Needed Improvements _____________________________________________ 36 iv │ DODIG-2015-152 Contents...exception under FAR 5.202 applies. We discuss this in the “DISA Contracting Personnel Need to Improve When Synopsizing Noncompetitive IT Contracts

Healthcare-Associated Infections Are Associated with Insufficient Dietary Intake: An Observational Cross-Sectional Study

PubMed Central

Kossovsky, Michel P.; Iavindrasana, Jimison; Chikhi, Marinette; Meyer, Rodolphe; Pittet, Didier; Zingg, Walter; Pichard, Claude

2015-01-01

Background Indicators to predict healthcare-associated infections (HCAI) are scarce. Malnutrition is known to be associated with adverse outcomes in healthcare but its identification is time-consuming and rarely done in daily practice. This cross-sectional study assessed the association between dietary intake, nutritional risk, and the prevalence of HCAI, in a general hospital population. Methods and findings Dietary intake was assessed by dedicated dieticians on one day for all hospitalized patients receiving three meals per day. Nutritional risk was assessed using Nutritional Risk Screening (NRS)-2002, and defined as a NRS score ≥ 3. Energy needs were calculated using 110% of Harris-Benedict formula. HCAIs were diagnosed based on the Center for Disease Control criteria and their association with nutritional risk and measured energy intake was done using a multivariate logistic regression analysis. From 1689 hospitalised patients, 1024 and 1091 were eligible for the measurement of energy intake and nutritional risk, respectively. The prevalence of HCAI was 6.8%, and 30.1% of patients were at nutritional risk. Patients with HCAI were more likely identified with decreased energy intake (i.e. ≤ 70% of predicted energy needs) (30.3% vs. 14.5%, P = 0.002). The proportion of patients at nutritional risk was not significantly different between patients with and without HCAI (35.6% vs.29.7%, P = 0.28), respectively. Measured energy intake ≤ 70% of predicted energy needs (odds ratio: 2.26; 95% CI: 1.24 to 4.11, P = 0.008) and moderate severity of the disease (odds ratio: 3.38; 95% CI: 1.49 to 7.68, P = 0.004) were associated with HCAI in the multivariate analysis. Conclusion Measured energy intake ≤ 70% of predicted energy needs is associated with HCAI in hospitalised patients. This suggests that insufficient dietary intake could be a risk factor of HCAI, without excluding reverse causality. Randomized trials are needed to assess whether improving energy intake in patients identified with decreased dietary intake could be a novel strategy for HCAI prevention. PMID:25923783

Association between health service utilisation of internal migrant children and parents’ acculturation in Guangdong, China: a cross-sectional study

PubMed Central

Peng, Bo-li; Zou, Guan-yang; Chen, Wen; Lin, Yan-wei; Ling, Li

2018-01-01

Objectives To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children’s health service utilisation and their parents’ acculturation. Design Cross-sectional survey between April and May 2016. Setting Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. Participants We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. Main outcome measures The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children’s unmet needs for outpatient or inpatient service and their parents’ acculturation (categorised into high, middle and low groups). Results In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. Conclusions Our study suggested that the association between migrant children’s health service utilisation and their parents’ acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants. PMID:29331968

Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study.

PubMed

Peng, Bo-Li; Zou, Guan-Yang; Chen, Wen; Lin, Yan-Wei; Ling, Li

2018-01-13

To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation. Cross-sectional survey between April and May 2016. Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence ( hukou ) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups). In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Do specialist self-referral insurance policies improve access to HIV-experienced physicians as a regular source of care?

PubMed

Heslin, Kevin C; Andersen, Ronald M; Ettner, Susan L; Kominski, Gerald F; Belin, Thomas R; Morgenstern, Hal; Cunningham, William E

2005-10-01

Health insurance policies that require prior authorization for specialty care may be detrimental to persons with HIV, according to evidence that having a regular physician with HIV expertise leads to improved patient outcomes. The objective of this study is to determine whether HIV patients who can self-refer to specialists are more likely to have physicians who mainly treat HIV. The authors analyze cross-sectional survey data from the HIV Costs and Services Utilization Study. At baseline, 67 percent of patients had insurance that permitted self-referral. In multivariate analyses, being able to self-refer was associated with an 8-12 percent increased likelihood of having a physician at a regular source of care that mainly treats patients with HIV. Patients who can self-refer are more likely to have HIV-experienced physicians than are patients who need prior authorization. Insurance policies allowing self-referral to specialists may result in HIV patients seeing physicians with clinical expertise relevant to HIV care.

Turbine Engine Clearance Control Systems: Current Practices and Future Directions

NASA Astrophysics Data System (ADS)

Lattime, Scott B.; Steinetz, Bruce M.

2002-09-01

Improved blade tip sealing in the high pressure compressor (HPC) and high pressure turbine (HPT) can provide dramatic reductions in specific fuel consumption (SFC), time-on-wing, compressor stall margin, and engine efficiency as well as increased payload and mission range capabilities. Maintenance costs to overhaul large commercial gas turbine engines can easily exceed 1M. Engine removal from service is primarily due to spent exhaust gas temperature (EGT) margin caused mainly by the deterioration of HPT components. Increased blade tip clearance is a major factor in hot section component degradation. As engine designs continue to push the performance envelope with fewer parts and the market drives manufacturers to increase service life, the need for advanced sealing continues to grow. A review of aero gas turbine engine HPT performance degradation and the mechanisms that promote these losses are discussed. Benefits to the HPT due to improved clearance management are identified. Past and present sealing technologies are presented along with specifications for next generation engine clearance control systems.

Overview of the NASA Subsonic Rotary Wing Aeronautics Research Program in Rotorcraft Crashworthiness

NASA Technical Reports Server (NTRS)

Jackson, Karen E.; Kellas, Sotiris; Fuchs, Yvonne T.

2009-01-01

This paper provides an overview of rotorcraft crashworthiness research being conducted at NASA Langley Research Center under sponsorship of the Subsonic Rotary Wing (SRW) Aeronautics Program. The research is focused in two areas: development of an externally deployable energy attenuating concept and improved prediction of rotorcraft crashworthiness. The deployable energy absorber (DEA) is a composite honeycomb structure, with a unique flexible hinge design that allows the honeycomb to be packaged and remain flat until needed for deployment. The capabilities of the DEA have been demonstrated through component crush tests and vertical drop tests of a retrofitted fuselage section onto different surfaces or terrain. The research on improved prediction of rotorcraft crashworthiness is focused in several areas including simulating occupant responses and injury risk assessment, predicting multi-terrain impact, and utilizing probabilistic analysis methods. A final task is to perform a system-integrated simulation of a full-scale helicopter crash test onto a rigid surface. A brief description of each research task is provided along with a summary of recent accomplishments.

Overview of the NASA Subsonic Rotary Wing Aeronautics Research Program in Rotorcraft Crashworthiness

NASA Technical Reports Server (NTRS)

Jackson, Karen E.; Fuchs, Yvonne T.; Kellas, Sotiris

2008-01-01

This paper provides an overview of rotorcraft crashworthiness research being conducted at NASA Langley Research Center under sponsorship of the Subsonic Rotary Wing (SRW) Aeronautics Program. The research is focused in two areas: development of an externally deployable energy attenuating concept and improved prediction of rotorcraft crashworthiness. The deployable energy absorber (DEA) is a composite honeycomb structure, with a unique flexible hinge design that allows the honeycomb to be packaged and remain flat until needed for deployment. The capabilities of the DEA have been demonstrated through component crush tests and vertical drop tests of a retrofitted fuselage section onto different surfaces or terrain. The research on improved prediction of rotorcraft crashworthiness is focused in several areas including simulating occupant responses and injury risk assessment, predicting multi-terrain impact, and utilizing probabilistic analysis methods. A final task is to perform a system-integrated simulation of a full-scale helicopter crash test onto a rigid surface. A brief description of each research task is provided along with a summary of recent accomplishments.

Turbine Engine Clearance Control Systems: Current Practices and Future Directions

NASA Technical Reports Server (NTRS)

Lattime, Scott B.; Steinetz, Bruce M.

2002-01-01

Improved blade tip sealing in the high pressure compressor (HPC) and high pressure turbine (HPT) can provide dramatic reductions in specific fuel consumption (SFC), time-on-wing, compressor stall margin, and engine efficiency as well as increased payload and mission range capabilities. Maintenance costs to overhaul large commercial gas turbine engines can easily exceed $1M. Engine removal from service is primarily due to spent exhaust gas temperature (EGT) margin caused mainly by the deterioration of HPT components. Increased blade tip clearance is a major factor in hot section component degradation. As engine designs continue to push the performance envelope with fewer parts and the market drives manufacturers to increase service life, the need for advanced sealing continues to grow. A review of aero gas turbine engine HPT performance degradation and the mechanisms that promote these losses are discussed. Benefits to the HPT due to improved clearance management are identified. Past and present sealing technologies are presented along with specifications for next generation engine clearance control systems.

Cystic precursors to invasive pancreatic cancer

PubMed Central

Matthaei, Hanno; Schulick, Richard D.; Hruban, Ralph H.; Maitra, Anirban

2011-01-01

Improvements in the sensitivity and quality of cross-sectional imaging have led to increasing numbers of patients being diagnosed with cystic lesions of the pancreas. In parallel, clinical, radiological, pathological and molecular studies have improved the systems for classifying these cysts. Patients with asymptomatic serous cystic neoplasms can be managed conservatively with regular monitoring; however, the clinical management of patients with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms is far more challenging, as it is difficult to determine whether these lesions will progress to malignancy. Fortunately, prospective studies have helped to establish that proposed clinical and radiological criteria (the Sendai guidelines) can be used to guide the care of patients with cystic lesions of the pancreas. Despite this progress in imaging and clinical guidelines, sensitive and specific tests have not yet been developed that can reliably predict the histology and biological properties of a cystic lesion. Such biomarkers are urgently needed, as noninvasive precursors of pancreatic cancer are curable, while the vast majority of invasive pancreatic adenocarcinomas are not. PMID:21383670

Direct and indirect constraints on CP-violating Higgs-quark and Higgs-gluon interactions

DOE PAGES

Chien, Y. T.; Cirigliano, V.; Dekens, W.; ...

2016-02-01

Here we investigate direct and indirect constraints on the complete set of anomalous CP-violating Higgs couplings to quarks and gluons originating from dimension-6 operators, by studying their signatures at the LHC and in electric dipole moments (EDMs). We also show that existing uncertainties in hadronic and nuclear matrix elements have a significant impact on the interpretation of EDM experiments, and we quantify the improvements needed to fully exploit the power of EDM searches. Currently, the best bounds on the anomalous CP-violating Higgs interactions come from a combination of EDM measurements and the data from LHC Run 1. We argue thatmore » Higgs production cross section and branching ratios measurements at the LHC Run 2 will not improve the constraints significantly. But, the bounds on the couplings scale roughly linearly with EDM limits, so that future theoretical and experimental EDM developments can have a major impact in pinning down interactions of the Higgs.« less

The role of media literacy in body dissatisfaction and disordered eating: A systematic review.

PubMed

McLean, Siân A; Paxton, Susan J; Wertheim, Eleanor H

2016-12-01

This study comprised a systematic review of literature examining empirical relationships between levels of media literacy and body dissatisfaction and disordered eating. The review aimed to integrate research on this topic. Electronic databases were searched for key concepts: media literacy, body dissatisfaction, and disordered eating. Media literacy measures were coded for consistency with media literacy constructs. Sixteen eligible studies were identified. Cross-sectional outcomes depended upon the media literacy construct assessed. Some relationships between high scores on measures consistent with media literacy constructs and low scores on body dissatisfaction and related attitudes were found. Media literacy-based interventions revealed improvements in media literacy constructs realism scepticism, influence of media, and awareness of media motives for profit, and improvements in body-related variables, but not disordered eating. Further research examining relationships between theoretically driven media literacy constructs and body and eating concerns is needed. Recommendations are made for evaluating media literacy-based eating disorder prevention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Nutrition education practices of primary school teachers in a resource-constrained community in Gauteng, South Africa.

PubMed

Kupolati, Mojisola D; Gericke, Gerda J; MacIntyre, Una E; Ferreira, Ronel; Fraser, William; Du Toit, Peet

2016-01-01

We investigated the nutrition education (NE) practices of teachers of grade 4‒7 learners in 11 primary schools (85% of total number) of the Bronkhorstspruit district (Gauteng Province) to identify opportunities for improving NE in these schools. A descriptive cross-sectional survey was carried out among a convenient sample of the teachers (N = 73) using a structured nutrition education practice questionnaire. Descriptive data analysis was done. Results showed that the majority of the teachers taught nutrition in about 10% to 20% of their teaching time. Thirty percent had no training to teach nutrition, and most teachers (86%) would like to receive training in nutrition. Teachers mostly taught nutrition as part of the curriculum (67%) and very few (18%) integrated nutrition into other subjects. Needing improvement were adequate classroom time for nutrition education delivery, continuing training in nutrition for teachers, and provision of up-to-date instructional materials for teaching nutrition.

Improved reservoir characterization of the Rose Run sandstone on the East Randolph Field, Portage County, Ohio

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

Safley, I.E.; Thomas, J.B.

1996-09-01

The East Randolph Field, located in Randolph Township, Portage County, Ohio, produces oil and gas from the Cambrian Rose Run sandstone unit, a member of the Knox Supergroup. Field development and infill drilling opportunities illustrate the need for improved reservoir characterization of the hydrocarbon productive intervals. This reservoir study is conducted under the Department of Energy`s Reservoir Management Program with professionals from BDM-Oklahoma and Belden & Blake Corporation. Well log and core analyses were conducted to determine the reservoir distribution, the heterogeneity of the hydrocarbon producing intervals, and the effects of faulting and fracturing on well productivity. The Rose Runmore » sandstones and interbedded dolomites were subdivided into three productive intervals. Cross sections were constructed for correlation of individual layers and identification of localized faulting. The geologic data was input into GeoGraphix software for construction of structure, net pay, production, and gas- and water-oil ratio maps.« less

A relational leadership perspective on unit-level safety climate.

PubMed

Thompson, Debra N; Hoffman, Leslie A; Sereika, Susan M; Lorenz, Holly L; Wolf, Gail A; Burns, Helen K; Minnier, Tamra E; Ramanujam, Rangaraj

2011-11-01

This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences. Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions. Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted. Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors. The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hypothesis: proposals for the management of a neonate at risk of hyperammonaemia due to a urea cycle disorder.

PubMed

Leonard, James Vivian; Ward Platt, Martin Peter; Morris, Andrew Alan Myles

2008-03-01

It is difficult to prevent hyperammonaemia in patients with urea cycle disorders that present in the newborn period. This is true, even if treatment is started prospectively because of an affected relative. We propose several additional measures that could be used in conjunction with conventional therapy to improve the metabolic control. Catabolism could be reduced by delivering the babies by elective caesarean section, by starting intravenous glucose immediately after delivery and, possibly, by using beta-blockers or octreotide and insulin. The effectiveness of sodium benzoate and sodium phenylbutyrate might be increased by giving phenobarbital to the mother before delivery and subsequently to the baby to induce the enzymes for conjugation. We would expect the proposed measures to reduce the risk of hyperammonaemia and to improve the outcome for these patients. They have not, however, previously been used in this context, so families would need to be counselled carefully and controlled studies should be undertaken.

Direct and indirect constraints on CP-violating Higgs-quark and Higgs-gluon interactions

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

Chien, Y. T.; Cirigliano, V.; Dekens, W.

Here we investigate direct and indirect constraints on the complete set of anomalous CP-violating Higgs couplings to quarks and gluons originating from dimension-6 operators, by studying their signatures at the LHC and in electric dipole moments (EDMs). We also show that existing uncertainties in hadronic and nuclear matrix elements have a significant impact on the interpretation of EDM experiments, and we quantify the improvements needed to fully exploit the power of EDM searches. Currently, the best bounds on the anomalous CP-violating Higgs interactions come from a combination of EDM measurements and the data from LHC Run 1. We argue thatmore » Higgs production cross section and branching ratios measurements at the LHC Run 2 will not improve the constraints significantly. But, the bounds on the couplings scale roughly linearly with EDM limits, so that future theoretical and experimental EDM developments can have a major impact in pinning down interactions of the Higgs.« less