Sustainability Factors for E-Learning Initiatives

ERIC Educational Resources Information Center

Gunn, Cathy

2010-01-01

This paper examines the challenges that "grass roots" e-learning initiatives face in trying to become sustainable. A cross-institutional study focused on local, rather than centrally driven, initiatives. A number of successful e-learning innovations were identified that had been driven by capable teachers seeking solutions to real…

Research at the Crossroads: How Intellectual Initiatives across Disciplines Evolve

ERIC Educational Resources Information Center

Frost, Susan H.; Jean, Paul M.; Teodorescu, Daniel; Brown, Amy B.

2004-01-01

How do intellectual initiatives across disciplines evolve? This qualitative case study of 11 interdisciplinary research initiatives at Emory University identifies key factors in their development: the passionate commitments of scholarly leaders, the presence of strong collegial networks, access to timely and multiple resources, flexible practices,…

I Got 99 Problems, and eHealth Is One.

PubMed

Wass, Sofie; Vimarlund, Vivian

2017-01-01

Many eHealth initiatives are never implemented or merely end as pilot projects. Previous studies report that organisational, technical and human issues need to be properly taken into consideration if such initiatives are to be successful. The aim of this paper is to explore whether previously identified challenges within the area have remained in the Swedish eHealth setting or whether they have changed. After interviewing experts in eHealth, we present a classification of areas of concern. Recurrence of previously identified challenges was found, but also new issues were identified. The results of the study indicate that there is a need to consider organisational and semantic issues on both national and international levels. Legal and technical challenges still exist but it seems even more important to support eHealth initiatives financially, increase practitioners' knowledge in health informatics and manage new expectations from patients.

The U.S. Army Wounded Warrior Program (AW2): a case study in designing a nonmedical case management program for severely wounded, injured, and ill service members and their families.

PubMed

Hudak, Ronald P; Morrison, Christine; Carstensen, Mary; Rice, James S; Jurgersen, Brent R

2009-06-01

This case study describes the innovative and unique U.S. Army Wounded Warrior Program (AW2), which provides nonmedical case management to the most severely wounded, injured, and ill soldiers and their families. The study describes the program and identifies the features for a successful nonmedical case management program of an identified population who has complex medical needs. Although the article focuses primarily on the role of the AW2 advocate, key components of the program are discussed, including successful initiatives as well as areas that required adjustment. The lessons learned are identified as well as recommendations for future nonmedical case management initiatives.

Identifying Nursing Interventions in a Cancer Screening Program Using Nursing Interventions Classification Taxonomy.

PubMed

Benito, Llucia; Lluch, María Teresa; Falcó, Anna Marta; García, Montse; Puig, Montse

2017-04-01

This study aimed to investigate which Nursing Interventions Classification (NIC) labels correspond to specific nursing interventions provided during cancer screening to establish a nursing documentation system. This descriptive study was conducted to identify and classify the interventions that cancer screening nurses perform based on an initial list. The initial list was grouped into 15 interventions that corresponded to four domains and eight classes. The study found expert consensus regarding the duties of cancer screening nurses and identified 15 interventions that should be implemented in clinical practice for cancer screening care, according to the NIC taxonomy. This study is the first step in developing indicators to assess nursing performance in cancer screening, and it helps to establish the core competency requirements for cancer screening nurses. © 2015 NANDA International, Inc.

Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review.

PubMed

Eminaga, Fatma; La-Crette, Jonathan; Jones, Adrian; Abhishek, A

2016-12-01

The aim of this study was to systematically review the literature on effect of initiating urate-lowering treatment (ULT) during an acute attack of gout on duration of index attack and persistence on ULT. OVID (Medline), EMBASE and AMED were searched to identify randomized controlled trials (RCTs) of ULT initiation during acute gout attack published in English language. Two reviewers appraised the study quality and extracted data independently. Standardized mean difference (SMD) and relative risk (RR) were used to pool continuous and categorical data. Meta-analysis was carried out using STATA version 14. A total of 537 studies were selected. A total of 487 titles and abstracts were reviewed after removing duplicates. Three RCTs were identified. There was evidence from two high-quality studies that early initiation of allopurinol did not increase pain severity at days 10-15 [SMD pooled (95 % CI) 0.18 (-0.58, 0.93)]. Data from three studies suggested that initiation of ULT during an acute attack of gout did not associate with dropouts [RR pooled (95 % CI) 1.16 (0.58, 2.31)]. There is moderate-quality evidence that the initiation of ULT during an acute attack of gout does not increase pain severity and risk of ULT discontinuation. Larger studies are required to confirm these findings so that patients with acute gout can be initiated on ULT with confidence.

Second Chances: Investigating Athletes’ Experiences of Talent Transfer

PubMed Central

2015-01-01

Talent transfer initiatives seek to transfer talented, mature individuals from one sport to another. Unfortunately talent transfer initiatives seem to lack an evidence-based direction and a rigorous exploration of the mechanisms underpinning the approach. The purpose of this exploratory study was to identify the factors which successfully transferring athletes cite as facilitative of talent transfer. In contrast to the anthropometric and performance variables that underpin current talent transfer initiatives, participants identified a range of psycho-behavioral and environmental factors as key to successful transfer. We argue that further research into the mechanisms of talent transfer is needed in order to provide a strong evidence base for the methodologies employed in these initiatives. PMID:26600303

Second Chances: Investigating Athletes' Experiences of Talent Transfer.

PubMed

MacNamara, Áine; Collins, Dave

2015-01-01

Talent transfer initiatives seek to transfer talented, mature individuals from one sport to another. Unfortunately talent transfer initiatives seem to lack an evidence-based direction and a rigorous exploration of the mechanisms underpinning the approach. The purpose of this exploratory study was to identify the factors which successfully transferring athletes cite as facilitative of talent transfer. In contrast to the anthropometric and performance variables that underpin current talent transfer initiatives, participants identified a range of psycho-behavioral and environmental factors as key to successful transfer. We argue that further research into the mechanisms of talent transfer is needed in order to provide a strong evidence base for the methodologies employed in these initiatives.

Design criteria for median turn lanes.

DOT National Transportation Integrated Search

1978-03-01

This study was initiated with an extensive literature review and survey of : left-turn median lane practices in Texas cities. The initial phase identified : characteristics of urban arterial accidents, basic design elements, current use of : left-tur...

Testing the Feasibility of Fidelity Evaluation in a Multisite, Multiprogram Initiative

ERIC Educational Resources Information Center

Cornish, Disa Lubker; Losch, Mary E.; Avery, Mitchell

2016-01-01

Monitoring fidelity of implementation is a critical task when initiating evidence-based programs. This pilot study sought to identify best practices in a fidelity monitoring process and determine the feasibility of continuing a fidelity monitoring process with a multisite, multiprogram initiative. A fidelity log was created for each of 11…

Stability of Initial Autism Spectrum Disorder Diagnoses in Community Settings

ERIC Educational Resources Information Center

Daniels, Amy M.; Rosenberg, Rebecca E.; Law, J. Kiely; Lord, Catherine; Kaufmann, Walter E.; Law, Paul A.

2011-01-01

The study's objectives were to assess diagnostic stability of initial autism spectrum disorder (ASD) diagnoses in community settings and identify factors associated with diagnostic instability using data from a national Web-based autism registry. A Cox proportional hazards model was used to assess the relative risk of change in initial ASD…

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis.

PubMed

Guise, Andy; Horyniak, Danielle; Melo, Jason; McNeil, Ryan; Werb, Dan

2017-12-01

Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change. © 2017 Society for the Study of Addiction.

Initial 12-h operative fluid volume is an independent risk factor for pleural effusion after hepatectomy.

PubMed

Cheng, Xiang; Wu, Jia-Wei; Sun, Ping; Song, Zi-Fang; Zheng, Qi-Chang

2016-12-01

Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays. Several studies have addressed the risk factors for postoperative pleural effusion. However, there are no researches concerning the role of the initial 12-h operative fluid volume. The aim of this study was to evaluate whether the initial 12-h operative fluid volume during liver resection is an independent risk factor for pleural effusion after hepatectomy. In this study, we retrospectively analyzed clinical data of 470 patients consecutively undergoing elective hepatectomy between January 2011 and December 2012. We prospectively collected and retrospectively analyzed baseline and clinical data, including preoperative, intraoperative, and postoperative variables. Univariate and multivariate analyses were carried out to identify whether the initial 12-h operative fluid volume was an independent risk factor for pleural effusion after hepatectomy. The multivariate analysis identified 2 independent risk factors for pleural effusion: operative time [odds ratio (OR)=10.2] and initial 12-h operative fluid volume (OR=1.0003). Threshold effect analyses revealed that the initial 12 h operative fluid volume was positively correlated with the incidence of pleural effusion when the initial 12-h operative fluid volume exceeded 4636 mL. We conclude that the initial 12-h operative fluid volume during liver resection and operative time are independent risk factors for pleural effusion after hepatectomy. Perioperative intravenous fluids should be restricted properly.

Communication technologies to improve HPV vaccination initiation and completion: A systematic review.

PubMed

Francis, Diane B; Cates, Joan R; Wagner, Kyla P Garrett; Zola, Tracey; Fitter, Jenny E; Coyne-Beasley, Tamera

2017-07-01

This systematic review examines the effectiveness of communication technology interventions on HPV vaccination initiation and completion. A comprehensive search strategy was used to identify existing randomized controlled trials testing the impact of computer-, mobile- or internet-based interventions on receipt of any dose of the HPV vaccine. Twelve relevant studies were identified with a total of 38,945 participants. The interventions were delivered using several different methods, including electronic health record (i.e. recall/reminder) prompts, text messaging, automated phone calls, interactive computer videos, and email. Vaccine initiation and completion was greater for technology-based studies relative to their control conditions. There is evidence that interventions utilizing communication technologies as their sole or primary mode for HPV vaccination intervention delivery may increase vaccination coverage. Communication technologies hold much promise for the future of HPV vaccination efforts, especially initiatives in practice-based settings. Copyright © 2017 Elsevier B.V. All rights reserved.

Sifting, sorting and saturating data in a grounded theory study of information use by practice nurses: a worked example.

PubMed

Hoare, Karen J; Mills, Jane; Francis, Karen

2012-12-01

The terminology used to analyse data in a grounded theory study can be confusing. Different grounded theorists use a variety of terms which all have similar meanings. In the following study, we use terms adopted by Charmaz including: initial, focused and axial coding. Initial codes are used to analyse data with an emphasis on identifying gerunds, a verb acting as a noun. If initial codes are relevant to the developing theory, they are grouped with similar codes into categories. Categories become saturated when there are no new codes identified in the data. Axial codes are used to link categories together into a grounded theory process. Memo writing accompanies this data sifting and sorting. The following article explains how one initial code became a category providing a worked example of the grounded theory method of constant comparative analysis. The interplay between coding and categorization is facilitated by the constant comparative method. © 2012 Wiley Publishing Asia Pty Ltd.

Study of the Special Education Initial Referral and Placement Process in MCPS Elementary Schools.

ERIC Educational Resources Information Center

Bowman, Jan E.; Frechtling, Joy A.

The study examined procedures utilized in 28 elementary schools in Montgomery County (Maryland) when a student is found to have academic or behavioral problems that make functioning in the regular classroom difficult. The study examined one part of special education--how the school system initially identifies students for special services. The…

Characteristics of Clinical Studies Conducted Over the Total Product Life Cycle of High-Risk Therapeutic Medical Devices Receiving FDA Premarket Approval in 2010 and 2011.

PubMed

Rathi, Vinay K; Krumholz, Harlan M; Masoudi, Frederick A; Ross, Joseph S

2015-08-11

The US Food and Drug Administration (FDA) approves high-risk medical devices, those that support or sustain human life or present potential unreasonable risk to patients, via the Premarket Approval (PMA) pathway. The generation of clinical evidence to understand device safety and effectiveness is shifting from predominantly premarket to continual study throughout the total product life cycle. To characterize the clinical evidence generated for high-risk therapeutic devices over the total product life cycle. All clinical studies of high-risk therapeutic devices receiving initial market approval via the PMA pathway in 2010 and 2011 identified through ClinicalTrials.gov and publicly available FDA documents as of October 2014. Studies were characterized by type (pivotal, studies that served as the basis of FDA approval; FDA-required postapproval studies [PAS]; or manufacturer/investigator-initiated); premarket or postmarket; status (completed, ongoing, or terminated/unknown); and design features, including enrollment, comparator, and longest duration of primary effectiveness end point follow-up. In 2010 and 2011, 28 high-risk therapeutic devices received initial marketing approval via the PMA pathway. We identified 286 clinical studies of these devices: 82 (28.7%) premarket and 204 (71.3%) postmarket, among which there were 52 (18.2%) nonpivotal premarket studies, 30 (10.5%) pivotal premarket studies, 33 (11.5%) FDA-required PAS, and 171 (59.8%) manufacturer/investigator-initiated postmarket studies. Six of 33 (18.2%) PAS and 20 of 171 (11.7%) manufacturer/investigator-initiated postmarket studies were reported as completed. No postmarket studies were identified for 5 (17.9%) devices; 3 or fewer were identified for 13 (46.4%) devices overall. Median enrollment was 65 patients (interquartile range [IQR], 25-111), 241 patients (IQR, 147-415), 222 patients (IQR, 119-640), and 250 patients (IQR, 60-800) for nonpivotal premarket, pivotal, FDA-required PAS, and manufacturer/investigator-initiated postmarket studies, respectively. Approximately half of all studies used no comparator (pivotal: 13/30 [43.3%]; completed postmarket: 16/26 [61.5%]; ongoing postmarket: 70/153 [45.8%]). Median duration of primary effectiveness end point follow-up was 3.0 months (IQR, 3.0-12.0), 9.0 months (IQR, 0.3-12.0), and 12.0 months (IQR, 7.0-24.0) for pivotal, completed postmarket, and ongoing postmarket studies, respectively. Among high-risk therapeutic devices approved via the FDA PMA pathway, total product life cycle evidence generation varied in both the number and quality of premarket and postmarket studies, with approximately 13% of initiated postmarket studies completed between 3 and 5 years after FDA approval.

Master Logic Diagram: An Approach to Identify Initiating Events of HTGRs

NASA Astrophysics Data System (ADS)

Purba, J. H.

2018-02-01

Initiating events of a nuclear power plant being evaluated need to be firstly identified prior to applying probabilistic safety assessment on that plant. Various types of master logic diagrams (MLDs) have been proposedforsearching initiating events of the next generation of nuclear power plants, which have limited data and operating experiences. Those MLDs are different in the number of steps or levels and different in the basis for developing them. This study proposed another type of MLD approach to find high temperature gas cooled reactor (HTGR) initiating events. It consists of five functional steps starting from the top event representing the final objective of the safety functions to the basic event representing the goal of the MLD development, which is an initiating event. The application of the proposed approach to search for two HTGR initiating events, i.e. power turbine generator trip and loss of offsite power, is provided. The results confirmed that the proposed MLD is feasiblefor finding HTGR initiating events.

Initial Development and Validation of the Youth Internalizing Problems Screener

ERIC Educational Resources Information Center

Renshaw, Tyler L.; Cook, Clayton R.

2018-01-01

The present studies report on the initial development and validation of the Youth Internalizing Problems Screener (YIPS), which is a 10-item self-report rating scale for assessing general internalizing problems and identifying depression and anxiety caseness within the context of school mental health screening. Results from Study 1 (N = 177)…

The current state of funded NIH grants in implementation science in genomic medicine: a portfolio analysis.

PubMed

Roberts, Megan C; Clyne, Mindy; Kennedy, Amy E; Chambers, David A; Khoury, Muin J

2017-10-26

PurposeImplementation science offers methods to evaluate the translation of genomic medicine research into practice. The extent to which the National Institutes of Health (NIH) human genomics grant portfolio includes implementation science is unknown. This brief report's objective is to describe recently funded implementation science studies in genomic medicine in the NIH grant portfolio, and identify remaining gaps.MethodsWe identified investigator-initiated NIH research grants on implementation science in genomic medicine (funding initiated 2012-2016). A codebook was adapted from the literature, three authors coded grants, and descriptive statistics were calculated for each code.ResultsForty-two grants fit the inclusion criteria (~1.75% of investigator-initiated genomics grants). The majority of included grants proposed qualitative and/or quantitative methods with cross-sectional study designs, and described clinical settings and primarily white, non-Hispanic study populations. Most grants were in oncology and examined genetic testing for risk assessment. Finally, grants lacked the use of implementation science frameworks, and most examined uptake of genomic medicine and/or assessed patient-centeredness.ConclusionWe identified large gaps in implementation science studies in genomic medicine in the funded NIH portfolio over the past 5 years. To move the genomics field forward, investigator-initiated research grants should employ rigorous implementation science methods within diverse settings and populations.Genetics in Medicine advance online publication, 26 October 2017; doi:10.1038/gim.2017.180.

Bilateral Wilms' tumor with anaplasia: lessons from the National Wilms' Tumor Study.

PubMed

Hamilton, Thomas E; Green, Daniel M; Perlman, Elizabeth J; Argani, Pedram; Grundy, Paul; Ritchey, Michael L; Shamberger, Robert C

2006-10-01

The purpose of this study was to evaluate whether initial diagnostic technique influenced the ability to identify anaplastic histology, to determine the time interval to diagnosis of anaplasia, and to delineate the incidence of discordant pathology in bilateral Wilms' tumor. We hypothesized that delay in diagnosis of anaplasia could affect time to appropriate surgery and intensive multimodality therapy. One hundred eight-nine children were enrolled in the fourth National Wilms' Tumor Study with synchronous bilateral tumors, 27 of whom were eventually shown to have anaplastic histology. Initial diagnostic technique, time interval to diagnosis of anaplasia, and the incidence of discordant pathology were determined. Anaplasia was identified in 0 of 7 tumors by core needle biopsy, 3 of 9 tumors by open wedge biopsy, and in 7 of 9 cases by partial or complete nephrectomy. The mean duration of first chemotherapy regimen (DD or EE) was 20, 39, and 36 weeks, respectively, before anaplasia was identified at second surgery. Discordant pathology between bilateral tumors was identified on final tissue diagnosis in 20 patients. Only 4 patients had anaplastic tumors in both kidneys. Core needle biopsy did not identify anaplasia in 7 of 7 children. Open biopsy or partial/complete nephrectomy identified anaplasia at initial diagnostic procedure in 10 of 18 children. Twenty of 24 patients at final tissue diagnosis had discordant pathology between the 2 kidneys. Earlier interval incisional biopsy or resection may identify anaplastic histology and limit the duration of chemotherapy targeted to favorable histology for children with bilateral Wilms' tumor and anaplasia.

Culturally Safe Health Initiatives for Indigenous Peoples in Canada: A Scoping Review.

PubMed

Brooks-Cleator, Lauren; Phillipps, Breanna; Giles, Audrey

2018-01-01

Background Cultural safety has the potential to improve the health disparities between Indigenous and non-Indigenous Canadians, yet practical applications of the concept are lacking in the literature. Purpose This study aims to identify the key components of culturally safe health initiatives for the Indigenous population of Canada to refine its application in health-care settings. Methods We conducted a scoping review of the literature pertaining to culturally safe health promotion programs, initiatives, services, or care for the Indigenous population in Canada. Our initial search yielded 501 publications, but after full review of 44 publications, 30 were included in the review. After charting the data, we used thematic analysis to identify themes in the data. Results We identified six themes: collaboration/partnerships, power sharing, address the broader context of the patient's life, safe environment, organizational and individual level self-reflection, and training for health-care providers. Conclusion While it is important to recognize that the provision of culturally safe initiatives depend on the specific interaction between the health-care provider and the patient, having a common understanding of the components of cultural safety, such as those that we identified through this research, will help in the transition of cultural safety from theory into practice.

Factors associated with the initiation of disease-modifying antirheumatic drugs in newly diagnosed rheumatoid arthritis: a retrospective claims database study.

PubMed

Bonafede, Machaon M K; Fox, Kathleen M; Johnson, Barbara H; Watson, Crystal; Gandra, Shravanthi R

2012-02-01

The objectives of this study were to quantify the proportion of US patients with newly diagnosed rheumatoid arthritis (RA) in whom disease-modifying antirheumatic drug (DMARD) therapy was initiated within 12 months following diagnosis, to determine mean time to initiation, to compare the characteristics of initiators versus noninitiators, and to identify factors associated with noninitiation. A retrospective study was conducted using claims from the databases of commercial managed care and Medicare supplemental managed care to identify patients with claims containing codes for RA dated January 1, 2004, through September 30, 2008. The percentage of patients with RA and a prescription for a DMARD within 12 months after the index date (initiators) was evaluated. The characteristics of DMARD initiators and noninitiators during the preindex period were compared, including demographic and clinical characteristics, health care resource utilization, and cost variables. The probability of DMARD initiation was determined using survival analysis. Multivariate analysis was performed to estimate mean time from diagnosis to DMARD initiation based on demographic and clinical variables. Of 26,911 patients with newly diagnosed RA identified in the database searches, 63% had been prescribed a DMARD within 12 months after diagnosis. DMARD initiators were significantly more likely to have had a rheumatologist visit and rheumatoid factor testing and were more likely to have received a corticosteroid and/or an NSAID (all, P < 0.001). DMARD initiators had significantly lower total costs ($10,534 vs $12,725, respectively) and pharmacy drug costs ($2438 vs $2822) over the preindex period compared with noninitiators (both, P < 0.001). Independent factors associated with a greater likelihood of DMARD initiation included a rheumatologist visit, rheumatoid factor testing, NSAID use, and corticosteroid use. Age ≥85 years and the presence of comorbidities were associated with a significantly lower likelihood of DMARD initiation. Among managed care enrollees in the present analysis, 37% of patients newly diagnosed with RA were not being treated with DMARDs in the first 12 months after diagnosis. Time to DMARD initiation plateaued after 90 days, suggesting that if a patient was not prescribed a DMARD soon after RA diagnosis, he or she was not likely to receive one. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Risk and Protective Factors for Early Substance Use Initiation: A Longitudinal Study of Mexican-Origin Youth

PubMed Central

Atherton, Olivia E.; Conger, Rand D.; Ferrer, Emilio; Robins, Richard W.

2015-01-01

Substance use initiation in adolescence is a critical issue, given its association with substance dependency and associated problems in adulthood. However, due to the dearth of fine-grained, longitudinal studies, the factors associated with early initiation are poorly understood, especially in minority youth. The present study examined substance use initiation in a sample of Mexican-origin youth (N=674) assessed annually from age 10 to 16. Using discrete-time survival analyses, we found that initiation escalated rapidly from late childhood to adolescence, and we identified a wide range of factors, from the individual to the cultural level of analysis, that significantly increased or decreased risk for early initiation. These findings have important implications for programs aimed at preventing early substance use by Mexican-origin youth. PMID:27990071

Co-Optimization of Fuels & Engines (Co-Optima) Initiative: Recent Progress on Light-Duty Boosted Spark-Ignition Fuels/Engines

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

Farrell, John

This presentation reports recent progress on light-duty boosted spark-ignition fuels/engines being developed under the Co-Optimization of Fuels and Engines initiative (Co-Optima). Co-Optima is focused on identifying fuel properties that optimize engine performance, independent of composition, allowing the market to define the best means to blend and provide these fuels. However, in support of this, we are pursuing a systematic study of blendstocks to identify a broad range of feasible options, with the objective of identifying blendstocks that can provide target ranges of key fuel properties, identifying trade-offs on consistent and comprehensive basis, and sharing information with stakeholders.

Antecedents and outcomes of marijuana use initiation during adolescence.

PubMed

Ellickson, Phyllis L; Tucker, Joan S; Klein, David J; Saner, Hilary

2004-11-01

This study identified similarities and differences in risk factors for marijuana use initiation from grades 7 to 8, grades 8 to 9, and grades 9 to 10, and examined differences between earlier initiates, later initiates, and nonusers on various problem behaviors at grade 10. Longitudinal data were used to examine predictors and outcomes associated with marijuana initiation from grade 7 (N = 1,955) to grade 10 (N = 909). Participants completed yearly surveys to assess problem behaviors, social influences, and marijuana-related attitudes and behavior. Earlier initiates were more likely than later initiates to exhibit problem-related marijuana use, hard drug use, polydrug use, poor grades, and low academic intentions at grade 10. Across ages, initiation was predicted by smoking, frequency of marijuana offers, and poor grades. Results provided some evidence for a shift from familial to peer influence on marijuana initiation with increasing age. Marijuana-related beliefs were relatively weak predictors of initiation at all ages after controlling for pro-marijuana social influences and engagement in other types of substance use and delinquent behavior. Results emphasize the importance of early intervention and identify a wide range of potentially modifiable risk factors that may be targeted.

Retrospective qualitative analysis of ecological networks under environmental perturbation: a copper-polluted intertidal community as a case study.

PubMed

Ramos-Jiliberto, Rodrigo; Garay-Narváez, Leslie; Medina, Matías H

2012-01-01

The coast of Chañaral Bay in northern Chile has been affected by copper mine wastes for decades. This sustained perturbation has disrupted the intertidal community in several ways, but the mechanisms behind the observed shifts in local biodiversity remain poorly understood. Our main goal was to identify the species (lumped into trophic groups) belonging to the Chañaral intertidal community that, being directly affected by copper pollution, contributed primarily to the generation of the observed changes in community structure. These groups of species were called initiators. We applied a qualitative modelling approach based only on the sign and direction of effects among species, and present a formula for predicting changes in equilibrium abundances considering stress on multiple variables simultaneously. We then applied this technique retrospectively to identify the most likely set of initiators. Our analyses allowed identification of a unique set of four initiators in the studied intertidal system (a group of algae, sessile invertebrates, a group of herbivores and starfish), which were hypothesized to be the primary drivers of the observed changes in community structure. In addition, a hypothesis was derived about how the perturbation affected these initiators. The hypothesis is that pollution affected negatively the population growth rate of both algae and sessile invertebrates and suppressed the interaction between herbivores and starfish. Our analytic approach, focused on identifying initiators, constitutes an advance towards understanding the mechanisms underlying human-driven ecosystem disruption and permits identifying species that may serve as a focal point for community management and restoration.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

PubMed Central

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

Lessons Learned from a Community Engagement Initiative within Irish Higher Education

ERIC Educational Resources Information Center

Quillinan, Bernie; McEvoy, Eileen; MacPhail, Ann; Dempsey, Ciara

2018-01-01

This paper focuses on a community-university partnership built around a programme of study co-created by residents of a disadvantaged community and situated, for the most part, within that community. The aim of this paper is to share lessons learned from this community engagement initiative, as identified through a research study which ran…

Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 1-review of major initiatives and implementation strategies.

PubMed

Menear, Matthew; Briand, Catherine

2014-04-01

Providing comprehensive care to people with severe mental illness (SMI) involves moving beyond pharmacological treatment and ensuring access to a wide range of evidence-based psychosocial services. Numerous initiatives carried out in North America and internationally have promoted the widespread adoption of such services. Objectives of this rapid review were 3-fold: to identify these implementation initiatives, to describe the implementation strategies used to promote the uptake of psychosocial services, and to identify key issues related to the implementation of a broad range of services. Part 1 presents findings for objectives 1 and 2 of the review. Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, psychosocial practices, and implementation. Contacts with experts and reference list and reverse citation searches were also conducted. Fifty-five articles were retained that identified more than a dozen major North American and international implementation initiatives. Initiative leaders employed diverse strategies at the planning, execution, and evaluation stages of the implementation process. Stakeholder meetings, training, ongoing consultation, and quality or fidelity monitoring were strategies consistently adopted across most initiatives, whereas theory-based approaches and organizational- and system-level strategies were less frequently described. Insights from the initiatives identified in this review can help guide future efforts to implement a broad range of psychosocial services for people with SMI. However, such efforts will also need to be informed by more rigorous, theory-based studies of implementation processes and outcomes.

Predicting Intentional Communication in Preverbal Preschoolers with Autism Spectrum Disorder.

PubMed

Sandbank, Micheal; Woynaroski, Tiffany; Watson, Linda R; Gardner, Elizabeth; Keçeli Kaysili, Bahar; Yoder, Paul

2017-06-01

Intentional communication has previously been identified as a value-added predictor of expressive language in preverbal preschoolers with autism spectrum disorder. In the present study, we sought to identify value-added predictors of intentional communication. Of five theoretically-motivated putative predictors of intentional communication measured early in the study (at study entry and 4 months after), three had significant zero-order correlations with later intentional communication (12 months after study entry) and were thus added to a linear model that predicted later intentional communication scores controlling for initial intentional communication scores at study entry. After controlling for initial intentional communication, early motor imitation was the only predictor that accounted for a significant amount of variance in children's later intentional communication.

Study of the regulatory issues affecting truck freight movement in the Midwest : [tech transfer summary].

DOT National Transportation Integrated Search

2014-12-01

This initial study identified the need for and interest in a peer-to-peer event focused on identifying regulatory trends and issues, as : well as the potential for Iowa and other states to find and prioritize : possible regulatory changes to improve ...

Socio-Cultural Factors Associated with the Initiation of Opium Use in Darab, Iran

ERIC Educational Resources Information Center

Jafari, Siavash; Movaghar, Afarin Rahimi; Craib, Kevin; Baharlou, Souzan; Mathias, Richard

2009-01-01

This study aimed to identify socio-cultural factors facilitating initiation of opium use among drug users in Darab, Iran. A qualitative study using in-depth interviews was conducted. The study began in June 2006 and included 76 drug users, aged 20-43, of whom 95% (72) were male, and 5% (4) were female. The five most common factors facilitating…

Mobile Health Initiatives in Vietnam: Scoping Study.

PubMed

Lam, Jeffrey A; Dang, Linh Thuy; Phan, Ngoc Tran; Trinh, Hue Thi; Vu, Nguyen Cong; Nguyen, Cuong Kieu

2018-04-24

Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. ©Jeffrey A Lam, Linh Thuy Dang, Ngoc Tran Phan, Hue Thi Trinh, Nguyen Cong Vu, Cuong Kieu Nguyen. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.04.2018.

Mobile Health Initiatives in Vietnam: Scoping Study

PubMed Central

Lam, Jeffrey A; Dang, Linh Thuy; Phan, Ngoc Tran; Trinh, Hue Thi; Vu, Nguyen Cong

2018-01-01

Background Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. Objective The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. Methods This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. Results We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). Conclusions The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. PMID:29691214

Practical Challenges of Systems Thinking and Modeling in Public Health

PubMed Central

Trochim, William M.; Cabrera, Derek A.; Milstein, Bobby; Gallagher, Richard S.; Leischow, Scott J.

2006-01-01

Objectives. Awareness of and support for systems thinking and modeling in the public health field are growing, yet there are many practical challenges to implementation. We sought to identify and describe these challenges from the perspectives of practicing public health professionals. Methods. A systems-based methodology, concept mapping, was used in a study of 133 participants from 2 systems-based public health initiatives (the Initiative for the Study and Implementation of Systems and the Syndemics Prevention Network). This method identified 100 key challenges to implementation of systems thinking and modeling in public health work. Results. The project resulted in a map identifying 8 categories of challenges and the dynamic interactions among them. Conclusions. Implementation by public health professionals of the 8 simple rules we derived from the clusters in the map identified here will help to address challenges and improve the organization of systems that protect the public’s health. PMID:16449581

Influence of initial stress, irregularity and heterogeneity on Love-type wave propagation in double pre-stressed irregular layers lying over a pre-stressed half-space

NASA Astrophysics Data System (ADS)

Singh, Abhishek Kumar; Das, Amrita; Parween, Zeenat; Chattopadhyay, Amares

2015-10-01

The present paper deals with the propagation of Love-type wave in an initially stressed irregular vertically heterogeneous layer lying over an initially stressed isotropic layer and an initially stressed isotropic half-space. Two different types of irregularities, viz., rectangular and parabolic, are considered at the interface of uppermost initially stressed heterogeneous layer and intermediate initially stressed isotropic layer. Dispersion equations are obtained in closed form for both cases of irregularities, distinctly. The effect of size and shape of irregularity, horizontal compressive initial stress, horizontal tensile initial stress, heterogeneity of the uppermost layer and width ratio of the layers on phase velocity of Love-type wave are the major highlights of the study. Comparative study has been made to identify the effects of different shapes of irregularity, presence of heterogeneity and initial stresses. Numerical computations have been carried out and depicted by means of graphs for the present study.

Barriers and enablers to a physician-delivered educational initiative to reduce low-acuity visits to the pediatric emergency department.

PubMed

Huyer, Gregory; Chreim, Samia; Michalowski, Wojtek; Farion, Ken J

2018-01-01

Use of the pediatric emergency department (PED) for low-acuity health issues is a growing problem, contributing to overcrowding, longer waits and higher health system costs. This study examines an educational initiative aimed at reducing low-acuity PED visits. The initiative, implemented at an academic pediatric hospital, saw PED physicians share a pamphlet with caregivers to educate them about appropriate PED use and alternatives. Despite early impacts, the initiative was not sustained. This study analyzes the barriers and enablers to physician participation in the initiative, and offers strategies to improve implementation and sustainability of similar future initiatives. Forty-two PED physicians were invited to participate in a semi-structured individual interview assessing their views about low-acuity visits, their pamphlet use, barriers and enablers to pamphlet use, and the initiative's potential for reducing low-acuity visits. Suggestions were solicited for improving the initiative and reducing low-acuity visits. Constant comparative method was used during analysis. Codes were developed inductively and iteratively, then grouped according to the Theoretical Domains Framework (TDF). Efforts to ensure study credibility included seeking participant feedback on the findings. Twenty-three PED physicians were interviewed (55%). Barriers and enablers for pamphlet use were identified and grouped according to five of the 14 TDF domains: social/professional role and identity; beliefs about consequences; environmental context and resources; social influences; and emotions. The TDF provided an effective approach to identify the key elements influencing physician participation in the educational initiative. This information will help inform behavior change interventions to improve the implementation of similar future initiatives that involve physicians as the primary educators of caregivers.

Commentary on the Federal Government's Role in Influencing E-prescribing Use and Research

PubMed Central

Odukoya, Olufunmilola K; Chui, Michelle A

2012-01-01

Electronic prescribing (e-prescribing) is one of the most studied areas of health information technology due to advocacy for its use by influential organizations such as the Institute of Medicine (IOM). In the United States, the federal government has played a significant role in encouraging use of e-prescribing technology and in stimulating associated research nationwide. The federal government has increased e-prescribing research initiatives through agencies such as the Agency for Healthcare Research and Quality (AHRQ) and the Health Resources and Services Administration (HRSA). Initial initiatives focused on the development of standards for e-prescribing systems and implementation. In recent times, e-prescribing research initiatives have become more focused on identifying unintended consequences of using this technology and identifying new possibilities of use that were previously not envisioned. Continuous studies of how healthcare professionals are interfacing with this new technology, how systems have been implemented, and the impact of this technology on healthcare processes and outcomes are crucial. PMID:22737095

Role of Individual, Family, and Peers in Sexual Initiation Among Late Adolescents Attending Institutions of Higher Learning in Malaysia.

PubMed

Abdul Samad, Shazimah; Hairi, Noran Naqiah; Ismail, Maslinor

2016-05-01

This cross-sectional study aimed to determine the prevalence and the factors associated with sexual initiation among the late adolescents in 6 institutions of higher learning in Malaysia. A total of 1572 students completed self-administered questionnaires between April and September 2013. Hierarchical multivariate logistic regression analyses stratified by gender were employed to identify the correlates of sexual initiation. The analyses were further adjusted by sampling weights. The overall prevalence of sexual initiation was 9.8% (95% confidence interval [CI] = 8.3-11.6), 18.1% (95% CI = 15.1-21.5) among males, and 4.1% (95% CI = 2.9-5.9) among females. The risk factors identified in this study supported the influence of the individual, family, and peer factors in the social-ecological model on adolescents' behaviors. The findings suggest the need for risk-reduction strategies aimed at the individual, family, and peer levels as well as the importance of gender-specific focus in assuring better outcomes. © 2016 APJPH.

Interventions to improve or facilitate linkage to or retention in pre-ART (HIV) care and initiation of ART in low- and middle-income settings – a systematic review

PubMed Central

Govindasamy, Darshini; Meghij, Jamilah; Negussi, Eyerusalem Kebede; Baggaley, Rachel Clare; Ford, Nathan; Kranzer, Katharina

2014-01-01

Introduction Several approaches have been taken to reduce pre-antiretroviral therapy (ART) losses between HIV testing and ART initiation in low- and middle-income countries, but a systematic assessment of the evidence has not yet been undertaken. The aim of this systematic review is to assess the potential for interventions to improve or facilitate linkage to or retention in pre-ART care and initiation of ART in low- and middle-income settings. Methods An electronic search was conducted on Medline, Embase, Global Health, Web of Science and conference databases to identify studies describing interventions aimed at improving linkage to or retention in pre-ART care or initiation of ART. Additional searches were conducted to identify on-going trials on this topic, and experts in the field were contacted. An assessment of the risk of bias was conducted. Interventions were categorized according to key domains in the existing literature. Results A total of 11,129 potentially relevant citations were identified, of which 24 were eligible for inclusion, with the majority (n=21) from sub-Saharan Africa. In addition, 15 on-going trials were identified. The most common interventions described under key domains included: health system interventions (i.e. integration in the setting of antenatal care); patient convenience and accessibility (i.e. point-of-care CD4 count (POC) testing with immediate results, home-based ART initiation); behaviour interventions and peer support (i.e. improved communication, patient referral and education) and incentives (i.e. food support). Several interventions showed favourable outcomes: integration of care and peer supporters increased enrolment into HIV care, medical incentives increased pre-ART retention, POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation. Most studies focused on the general adult patient population or pregnant women. The majority of published studies were observational cohort studies, subject to an unclear risk of bias. Conclusions Findings suggest that streamlining services to minimize patient visits, providing adequate medical and peer support, and providing incentives may decrease attrition, but the quality of the current evidence base is low. Few studies have investigated combined interventions, or assessed the impact of interventions across the HIV cascade. Results from on-going trials investigating POC CD4 count testing, patient navigation, rapid ART initiation and mobile phone technology may fill the quality of evidence gap. Further high-quality studies on key population groups are required, with interventions informed by previously reported barriers to care. PMID:25095831

Comparative effectiveness of generic versus brand-name antiepileptic medications.

PubMed

Gagne, Joshua J; Kesselheim, Aaron S; Choudhry, Niteesh K; Polinski, Jennifer M; Hutchins, David; Matlin, Olga S; Brennan, Troyen A; Avorn, Jerry; Shrank, William H

2015-11-01

The objective of this study was to compare treatment persistence and rates of seizure-related events in patients who initiate antiepileptic drug (AED) therapy with a generic versus a brand-name product. We used linked electronic medical and pharmacy claims data to identify Medicare beneficiaries who initiated one of five AEDs (clonazepam, gabapentin, oxcarbazepine, phenytoin, zonisamide). We matched initiators of generic versus brand-name versions of these drugs using a propensity score that accounted for demographic, clinical, and health service utilization variables. We used a Cox proportional hazards model to compare rates of seizure-related emergency room (ER) visit or hospitalization (primary outcome) and ER visit for bone fracture or head injury (secondary outcome) between the matched generic and brand-name initiators. We also compared treatment persistence, measured as time to first 14-day treatment gap, between generic and brand-name initiators. We identified 19,760 AED initiators who met study eligibility criteria; 18,306 (93%) initiated a generic AED. In the matched cohort, we observed 47 seizure-related hospitalizations and ER visits among brand-name initiators and 31 events among generic initiators, corresponding to a hazard ratio of 0.53 (95% confidence interval, 0.30 to 0.96). Similar results were observed for the secondary clinical endpoint and across sensitivity analyses. Mean time to first treatment gap was 124.2 days (standard deviation [sd], 125.8) for brand-name initiators and 137.9 (sd, 148.6) for generic initiators. Patients who initiated generic AEDs had fewer adverse seizure-related clinical outcomes and longer continuous treatment periods before experiencing a gap than those who initiated brand-name versions. Copyright © 2015 Elsevier Inc. All rights reserved.

Demographic and health attributes of the Nahua, initial contact population of the Peruvian Amazon.

PubMed

Culqui, Dante R; Ayuso-Alvarez, Ana; Munayco, Cesar V; Quispe-Huaman, Carlos; Mayta-Tristán, Percy; Campos, Juan de Mata Donado

2016-01-01

We present the case of the Nahua population of Santa Rosa de Serjali, Peruvian Amazon's population, considered of initial contact. This population consists of human groups that for a long time decided to live in isolation, but lately have begun living a more sedentary lifestyle and in contact with Western populations. There are two fully identified initial contact groups in Peru: the Nahua and the Nanti. The health statistics of the Nahua are scarce. This study offers an interpretation of demographic and epidemiological indicators of the Nahua people, trying to identify if a certain degree of health vulnerability exists. We performed a cross sectional study, and after analyzing their health indicators, as well as the supplemental qualitative analysis of the population, brought us to conclude that in 2006, the Nahua, remained in a state of health vulnerability.

Treating Hepatitis C in a Ryan White-Funded HIV Clinic: Has the Treatment Uptake Improved in the Interferon-Free Directly Active Antiviral Era?

PubMed

Cope, Rebecca; Glowa, Thomas; Faulds, Samantha; McMahon, Deborah; Prasad, Ramakrishna

2016-02-01

Now that highly efficacious, interferon-free (IFN-free), direct acting antivirals (DAA) for the treatment of hepatitis C (HCV) have closed the gap between treatment and cure, identifying barriers that prevent initiation of treatment is more crucial than ever. This is a retrospective study utilizing Electronic Medical Records and Prior Authorization Records to identify HCV treatment gaps, including predictors for intention-to-treat and treatment initiation in the first 15 months of a Ryan White funded human immunodeficiency virus (HIV)/HCV co-infection clinic. This study included 128 adults ≥ 18 years old with HIV and chronic HCV infection who had visited the treatment center at least once since January 2013. Provider intent-to-treat was used to differentiate patients actively considered for treatment based on documentation kept by a multidisciplinary HCV team. Members of this group who had gone on to initiate treatment were identified. Baseline characteristics were compared. Rates of active treatment consideration and treatment initiation were 30% and 14%, respectively. HCV treatment-naïve individuals were less likely to be considered for treatment [risk ratio (RR) 1.58, 95% confidence interval (CI) 1.07-2.32] and initiate therapy (RR 2.33, 95% CI 0.97-5.60). Advanced liver disease had no significant association. Black race (RR 1.96, 95% CI 0.90-4.25) and Medicaid insurance holders (RR 1.90, 95% CI 0.95-3.82) tended to be less likely to initiate therapy. The availability of IFN-free DAA regimens has yet to increase HCV treatment uptake in our HIV/HCV co-infected population. Barriers to HCV treatment initiation have shifted from medical contraindications to socioeconomic variables.

A National Cohort Study of U.S. Medical School Students Who Initially Failed Step 1 of the United States Medical Licensing Examination

PubMed Central

Andriole, Dorothy A.; Jeffe, Donna B.

2012-01-01

Purpose To describe educational outcomes for a national cohort of U.S. medical students who initially failed Step 1 of the United States Medical Licensing Examination Method The authors analyzed de-identified, individualized records for the 1993–2000 cohort of U.S. medical school matriculants who both initially failed Step l and were no longer in medical school as of March 2, 2009, using multivariable logistic regression to identify factors associated with attempting, and initially passing, Step 2 Clinical Knowledge (CK). Results Of 6,594 students who failed Step l, 5,985 (90.8%) took Step 2CK. Women and Asian/Pacific Islander students were more likely to attempt Step 2CK; more recent matriculants and students with lower failing Step 1 scores were less likely. Of the 5,985 students who attempted Step 2CK, 4,168 (69.6%) initially passed. Women, students with higher Medical College Admission Test scores, and more recent matriculants were more likely to pass Step 2CK; Asian/Pacific Islander students, underrepresented minority students, older students, and students with lower failing Step 1 scores were less likely. Ninety percent of students in the study sample (5,952/6,594) ultimately graduated from medical school, including 99.5% (4,148/4,168) of those who initially passed, 96.7% (1,757/1,817) of those who initially failed, and 7.7% (47/609) of those who never attempted Step 2CK. Conclusions The authors identified variables associated with educational outcomes among students who failed Step l. These findings can inform medical schools’ efforts to develop tailored interventions to maximize the likelihood that students will take Step 2CK and pass it on the first attempt. PMID:22361789

Nuclear power systems for lunar and Mars exploration

NASA Technical Reports Server (NTRS)

Sovie, R. J.; Bozek, J. M.

1990-01-01

Initial studies of a variety of mission scenarios for the new Space Exploration Initiative, and the technologies necessary to enable or significantly enhance them, have identified the development of advanced space power systems whether solar, chemical or nuclear to be of prime importance. Lightweight, compact, reliable power systems for planetary rovers and a variety of surface vehicles, utility surface power, and power for advanced propulsion systems have been identified as critical needs for these missions. These mission scenarios, the concomitant power system requirements, and power system options considered are discussed. The significant potential benefits of nuclear power are identified for meeting the power needs of the above applications.

Improving the Standards-Based Management-Recognition initiative to provide high-quality, equitable maternal health services in Malawi: an implementation research protocol.

PubMed

Mumtaz, Zubia; Salway, Sarah; Nyagero, Josephat; Osur, Joachim; Chirwa, Ellen; Kachale, Fannie; Saunders, Duncan

2016-01-01

The Government of Malawi is seeking evidence to improve implementation of its flagship quality of care improvement initiative-the Standards Based Management-Recognition for Reproductive Health (SBM-R(RH)). This implementation study will assess the quality of maternal healthcare in facilities where the SBM-R(RH) initiative has been employed, identify factors that support or undermine effectiveness of the initiative and develop strategies to further enhance its operation. Data will be collected in 4 interlinked modules using quantitative and qualitative research methods. Module 1 will develop the programme theory underlying the SBM-R(RH) initiative, using document review and in-depth interviews with policymakers and programme managers. Module 2 will quantitatively assess the quality and equity of maternal healthcare provided in facilities where the SBM-R(RH) initiative has been implemented, using the Malawi Integrated Performance Standards for Reproductive Health. Module 3 will conduct an organisational ethnography to explore the structures and processes through which SBM-R(RH) is currently operationalised. Barriers and facilitators will be identified. Module 4 will involve coordinated co-production of knowledge by researchers, policymakers and the public, to identify and test strategies to improve implementation of the initiative. The research outcomes will provide empirical evidence of strategies that will enhance the facilitators and address the barriers to effective implementation of the initiative. It will also contribute to the theoretical advances in the emerging science of implementation research.

Judgemental and Developmental Mentoring in Further Education Initial Teacher Education in England: Mentor and Mentee Perspectives

ERIC Educational Resources Information Center

Manning, Catherine; Hobson, Andrew J.

2017-01-01

This article presents findings from a study which sought to identify the extent to which trainee teachers and their mentors considered their mentoring experiences and approaches to be judgemental or developmental. The article draws on a case study of trainee teachers and mentors on an Initial Teacher Education programme at a further education…

What Impact Does a Change-Agent Have on Faculty Use of Technology?

ERIC Educational Resources Information Center

Stanley, Iain

2015-01-01

This study was undertaken to examine the influence that a set of Professional Development (PD) initiatives had on faculty use of Moodle, a well-known Course Management System. The context of the study was a private university in Japan that specializes in languages. Specifically, it aimed to identify the way in which the PD initiatives adhered to…

Public Health Needs Assessments of Tutuila Island, American Samoa, After the 2009 Tsunami

PubMed Central

Choudhary, Ekta; Chen, Tai-Ho; Martin, Colleen; Vagi, Sara; Roth, Joseph; Keim, Mark; Noe, Rebecca; Ponausuia, Seiuli Elisapeta; Lemusu, Siitia; Bayleyegn, Tesfaye; Wolkin, Amy

2015-01-01

Objective An 8.3 magnitude earthquake followed by tsunami waves devastated American Samoa on September 29, 2009, resulting in widespread loss of property and public services. An initial and a follow-up Community Needs Assessment for Public Health Emergency Response (CASPER) objectively quantified disaster-affected population needs. Methods Using a 2-stage cluster sampling method of CASPER, a household questionnaire eliciting information about medical and basic needs, illnesses, and injuries was administered. To assess response efforts, percent changes in basic and medical needs, illnesses, and injuries between the initial and follow-up CASPER were calculated. Results During the initial CASPER (N=212 households), 47.6% and 51.6% of households reported needing a tarpaulin and having no electricity, respectively. The self-reported greatest needs were water (27.8%) and financial help with cleanup (25.5%). The follow-up CASPER (N=207 households) identified increased vector problems compared to pre-tsunami, and food (26%) was identified as the self-reported greatest need. As compared to the initial CASPER, the follow-up CASPER observed decreases in electricity (−78.3%), drinking water (−44.4%), and clothing (−26.6%). Conclusion This study highlights the use of CASPER during the response and recovery phases following a disaster. The initial CASPER identified basic needs immediately after the earthquake, whereas the follow-up CASPER assessed effectiveness of relief efforts and identified ongoing community needs. PMID:23077263

Predictors of Sexual Intercourse among Korean Adolescents

ERIC Educational Resources Information Center

Ryu, Eunjung; Kim, Kyunghee; Kwon, Hyejin

2007-01-01

Background: The proportion of adolescents experiencing unwanted pregnancy and abortion caused by the premature initiation of sexual intercourse is increasing at an alarming rate in Korea. This study aimed at developing a theoretical model for identifying individual and environmental risk factors affecting the initiation of sexual intercourse by…

Sibling response to initial antiepileptic medication predicts treatment success.

PubMed

Ueda, Keisuke; Serajee, Fatema; Rajlich, Jan; Taraman, Sharief; Steckling, Lindsey; Huq, Ahm M

2017-10-01

A recent study focusing on a response to antiepileptic drugs (AED) among siblings for epilepsy showed a similar response among epileptic siblings to specific AEDs or AED combinations. Currently, however, family history of treatment response to AEDs is not readily employed in deciding which initial medication to use when treating patients with epilepsy. We tested the hypothesis that sibling response to initial AED predicts treatment success. Presumed siblings were identified from a single-center database of patients diagnosed with epilepsy by matching last name, address, and name of parent(s). We identified 28 sibling pairs and two sibling trios with epilepsy. Seventeen of these sibling pairs were started on the same initial AED, with 15 sibling pairs having the same type of epilepsy. The remaining 11 pairs were started on a different initial AED, with 8 of these sibling pairs having the same type of epilepsy. Subjects with seizure freedom for a period of ≥1year were classified as a "responder". When at least one of the sibling pair responded to an initial AED, the proportion of the other siblings also responding to the initial AED was significantly higher if the siblings were treated with the same AED (8/11) compared to siblings who were treated with different AED (1/10) (Fisher's exact test, p-value=0.0075). These findings suggest that sibling response to initial AED is predictive of the success of AED therapy. This study is limited by a small cohort and retrospective design. Future, larger prospective studies are needed to reproduce and further validate these findings. Copyright © 2017. Published by Elsevier B.V.

Recognising and Validating Outcomes of Non-Accredited Learning: A Practical Approach.

ERIC Educational Resources Information Center

Greenwood, Maggie, Ed.; Hayes, Amanda, Ed.; Turner, Cheryl, Ed.; Vorhaus, John, Ed.

A group of adult educators in England conducted seven case studies to identify strategies for recognizing adult students' learning progress in nonaccredited programs. The case studies identified the following elements of good practice in the process of recording and validating achievement: (1) initial identification of learning objectives; (2)…

Group Therapy Goals: A Comparison of Group Therapy Providers and Male Inmates

ERIC Educational Resources Information Center

Morgan, Robert D.; Garland, J. Travis; Rozycki, Alicia T.; Reich, Darcy A.; Wilson, Scott

2005-01-01

This study was designed to identify important process and content goals from the perspective of inmates and compare these goals to the goals identified by group therapists in a previous study conducted by Winterowd, Morgan, and Ferrell (2001). Utilizing survey data from 156 incarcerated adult males, an initial confirmatory factor analysis…

Bridging Technometric Method and Innovation Process: An Initial Study

NASA Astrophysics Data System (ADS)

Rumanti, A. A.; Reynaldo, R.; Samadhi, T. M. A. A.; Wiratmadja, I. I.; Dwita, A. C.

2018-03-01

The process of innovation is one of ways utilized to increase the capability of a technology component that reflects the need of SME. Technometric method can be used to identify to what extent the level of technology advancement in a SME is, and also which technology component that needs to be maximized in order to significantly deliver an innovation. This paper serves as an early study, which lays out a conceptual framework that identifies and elaborates the principles of innovation process from a well-established innovation model by Martin with the technometric method, based on the initial background research conducted at SME Ira Silver in Jogjakarta, Indonesia.

Initiation into prescription opioid injection and associated trends in heroin use among people who use illicit drugs.

PubMed

Lake, Stephanie; Milloy, M-J; Dong, Huiru; Hayashi, Kanna; Wood, Evan; Kerr, Thomas; DeBeck, Kora

2016-12-01

Prescription opioid (PO) injection among people who use illicit drugs (PWUD) is an ongoing concern, yet little is known about drug use trajectories associated with initiating PO injection, including potential associations with heroin use. This study aimed to identify predictors of PO injection initiation among PWUD, and examine trends in heroin use before and after initiating PO injection. Data were merged from three cohorts of PWUD recruited between September 2005 and November 2015. Predictors of PO injection initiation were identified using extended Cox regression models. Trends in heroin use pre- and post-initiation were examined with McNemar's test and compared to matched controls with linear growth curve models. Among 1580 participants, 247 initiated PO injection yielding an incidence density of 3.9 (95% Confidence Interval [CI]: 3.4-4.4) per 100 person-years. In a multivariable analysis, independent predictors of PO injection initiation included heroin injection (Adjusted Hazard Ratio [AHR]=4.39, 95% CI: 3.24-5.95) and non-injection PO use (AHR=1.99, 95% CI: 1.25-3.17). In a sub-analysis, compared to matched controls, PO injection corresponded with elevated heroin use post-initiation (p≤0.05). In this study, heroin use and non-injection PO use strongly predicted PO injection initiation. Those who initiated PO injecting had elevated heroin use patterns post-initiation compared to controls. These findings suggest that transitioning to PO injection does not appear to be a substitute for heroin use among PWUD. These findings highlight the importance of addressing PO injection in harm reduction and treatment settings. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: a qualitative study.

PubMed

Kash, Bita A; Spaulding, Aaron; Gamm, Larry; Johnson, Christopher E

2013-01-01

The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives. The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems. Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators. Data analysis was performed following deductive qualitative analysis guidelines. Interview transcripts were coded based on the four dimensions of ACAP: acquiring, assimilating, internalizing/transforming, and exploiting knowledge. Furthermore, we link results related to utilization of management resources, including number of key personnel involved and time consumption, to dimensions of ACAP. Participants' description of multiple strategic change initiatives confirmed the importance of the four ACAP dimensions. ACAP can be a useful framework to assess organizational capacity with respect to the organization's ability to concurrently implement multiple strategic initiatives. This capacity specifically revolves around human capital requirements from upper management based on the initiatives' location or stage within the ACAP framework. Strategic change initiatives in health care can be usefully viewed from an ACAP perspective. There is a tendency for those strategic initiatives ranking higher in priority and time consumption to reflect more advanced dimensions of ACAP (assimilate and transform), whereas few initiatives were identified in the ACAP "exploit" dimension. This may suggest that health care leaders tend to no longer identify as strategic initiatives those innovations that have moved to the exploitation stage or that less attention is given to the exploitation elements of a strategic initiative than to the earlier stages.

A Review of the Factors Associated With the Timely Initiation of Breastfeeding and Exclusive Breastfeeding in the Middle East

PubMed Central

Alzaheb, Riyadh A

2017-01-01

Background: Breastfeeding supplies all the nutrients that infants need for their healthy development. Breastfeeding practice is multifactorial, and numerous variables influence mothers’ decisions and ability to breastfeed. This review identifies the factors potentially affecting the timely initiation of breastfeeding within an hour after birth and exclusive breastfeeding in the first 6 months in Middle Eastern countries. Methods: The Medline, ScienceDirect, and Web of Science databases were keyword-searched for primary studies meeting the following inclusion criteria: (1) publication in the English language between January 2001 and May 2017, (2) original research articles reporting primary data on the factors influencing the timely initiation of breastfeeding and/or exclusive breastfeeding, (3) the use of World Health Organization definitions, and (4) Middle Eastern research contexts. A random effect model was used to establish the average prevalence of the timely initiation of breastfeeding and exclusive breastfeeding in the Middle East. Results: The review identified 19 studies conducted in Saudi Arabia (7), Iran (3), Egypt (2), Turkey (2), Kuwait (1), the United Arab Emirates (1), Qatar (1), Lebanon (1), and Syria (1). The meta-analysis established that 34.3% (confidence interval [CI]: 20.2%-51.9%) of Middle Eastern newborns received breastfeeding initiated within an hour of birth, and only 20.5% (CI: 14.5%-28.2%) were fed only breast milk for the first 6 months. The 8 studies exploring breastfeeding initiation most commonly associated it with the following: delivery mode, maternal employment, rooming-in, and prelacteal feeding. The 17 studies investigating exclusive breastfeeding most frequently linked it to the following: maternal age, maternal education, maternal employment, and delivery mode. Conclusions: Middle Eastern health care organizations should fully understand all the determinants of breastfeeding identified by this review to provide suitable practical guidance and advice to help new mothers to overcome barriers where possible and to contribute to improving infant and maternal health in the region. PMID:29317851

National Aeronautics and Space Administration (NASA) education 1993--2009

NASA Astrophysics Data System (ADS)

Ivie, Christine M.

The National Aeronautics and Space Administration was established in 1958 and began operating a formal education program in 1993. The purpose of this study was to analyze the education program from 1993 -- 2009 by examining strategic plan documents produced by the NASA education office and interviewing NASA education officials who served during that time period. Constant changes in education leadership at NASA resulted in changes in direction in the education program and the documents produced by each administration reflected both small and some significant changes in program direction. The result of the analysis of documents and interview data was the identification of several trends in the NASA education program. This study identified three significant trends in NASA education. First, the approach that NASA took in both its EPO efforts and in the efforts directed by the Office of Education is disjointed and seems to reflect individual preferences in education approaches designed to reach populations that are of interest to the individuals in decision-making positions rather than reflect a systematic approach designed to meet identified goals and outcomes. Second, this disjointed and person-driven approach led to a lack of consistent evaluation data available for review and planning purposes. Third, there was an ongoing assumption made by the education community that NASA education efforts were tied to larger education reports, concerns, needs, initiatives and evidence collected and presented in Science Technology Engineering and Math (STEM) education-related studies over the past twenty years. In fact, there is no evidence that the programs and projects initiated were a response to these identified needs or initiatives. That does not mean that NASA's efforts did not contribute to STEM education initiatives in the United States. This study, however, indicates that contributions to those initiatives occurred as a byproduct of the effort and not because of specific goals aligned to those initiatives.

[Panorama of self-management initiatives in Spain].

PubMed

Nuño-Solinis, Roberto; Rodríguez-Pereira, Carolina; Piñera-Elorriaga, Koldo; Zaballa-González, Irune; Bikandi-Irazabal, Javier

2013-01-01

To describe the current situation of self-management initiatives in Spain. We performed a descriptive study of self-management support initiatives in Spain from the perspective of the patient as expert. Three databases were searched in October 2010 (Pubmed, Scientific Electronic Library Online [SCIELO] and Indice Médico Español [IME]), using the following Keywords «paciente experto» (expert patient), «paciente activo» (active patient) and «apoyo al autocuidado» (self-management support). Web sites were also consulted, using the same key words. Of the initiatives found, we selected those with the most advanced development and continuity, using the perspective of the expert patient (in which patients have an active role) and with a systematic format and methodology. A questionnaire was designed and was sent to the heads of the selected initiatives in the last quarter of 2010. To update the information, the questionnaire was sent again between August and September, 2012. Subsequently, the web sites were visited to review their contents and presence in social networks. Seven initiatives were identified in the autonomous regions of Murcia, Andalusia, Galicia, Castile-La Mancha, Basque Country, and Catalonia. These initiatives used distinct methodologies, formats and assessment systems. In Spain, there is increasing interest in the development of self-management support programs, although their scope is limited and their impact is mostly unknown, except for patient satisfaction. There is a need for studies on results assessment to identify the impact of these initiatives in our setting, as well as for studies on their implementation to encourage the introduction of patient activation initiatives in routine clinical practice. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

Changes in breastfeeding initiation at hospital discharge between first and second births in Nova Scotia: a population-based cohort study

PubMed Central

Nix, Kimberley; Dodds, Linda

2017-01-01

Background: Breastfeeding has well-recognized health benefits for infants and mothers. However, little research has been conducted to investigate changes in breastfeeding from one pregnancy to another. This study was conducted to describe rates of breastfeeding initiation at hospital discharge for women's first and second births and to identify factors associated with changes in initiation at the second birth. Methods: We conducted a longitudinal, population-based cohort study involving women residing in Nova Scotia who delivered a first and second live-born singleton between 2007 and 2013. Separate analyses were conducted among women who breastfed their first infant and among women who did not breastfeed their first infant. Results: Of the 9643 (82.6%) mothers who initiated breastfeeding in the first birth, 973 (10.3%) did not initiate breastfeeding in the second birth. Of first-birth noninitiators, 526 (26.3%) initiated breastfeeding in the second birth. With the exception of smoking and cesarean births, factors that were associated with breastfeeding initiation in the second birth depended on breastfeeding initiation status in the first birth. These factors were associated with increased odds of not breastfeeding in the second birth among the subset of mothers who breastfed in the first birth, and decreased odds of breastfeeding in the second birth among the subset of mothers who did not breastfeed in the first birth. Interpretation: Most women continue the same method of infant feeding after their first and second births. Identifying factors associated with change in breastfeeding status between the first and second births may help to inform interventions for optimal breastfeeding initiation in the second birth. PMID:28401137

A Method for Defining Competency in Pediatrics

ERIC Educational Resources Information Center

Burg, Fredric D.; And Others

1976-01-01

In 1972 the American Board of Pediatrics (ABP) initiated studies leading to a report that identifies the important components of competency needed in pediatrics. Three dimensions of competence were identified: subject matter, abilities, and tasks. Each of these is discussed. (LBH)

Making the Grade: Describing Inherent Requirements for the Initial Teacher Education Practicum

ERIC Educational Resources Information Center

Sharplin, Elaine; Peden, Sanna; Marais, Ida

2016-01-01

This study explores the development, description, and illustration of inherent requirement (IR) statements to make explicit the requirements for performance on an initial teacher education (ITE) practicum. Through consultative group processes with stakeholders involved in ITE, seven IR domains were identified. From interviews with academics,…

Relationship between Teacher Views on Levels of Organizational Support--Organizational Identification and Climate of Initiative

ERIC Educational Resources Information Center

Nartgün, Senay Sezgin; Taskin, Sevgi

2017-01-01

This study aimed to identify secondary school teachers' views on levels of organizational support, organizational identification and climate of initiative and to determine whether there were any significant differences between these views based on teachers' demographic characteristics and whether there were significant differences between…

Further Education Colleges and Inner-City Regeneration. Strategies for Action.

ERIC Educational Resources Information Center

Further Education Unit, London (England).

A study explored the roles of three British further education colleges in different inner-city geographical settings in initiating and supporting inner-city regeneration. Selected colleges initiated and contributed toward local regeneration during 1989-90. The project identified an increasing recognition that there were social and economic…

77 FR 71211 - Request for Information: Establish a Public-Private Collaboration, “Drug Development Initiative...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-29

... clinical trials with the support of the VA Cooperative Studies Program. To identify and test new drug..., ``Drug Development Initiative'' (DDI), for New Pharmacological Treatments for Post-Traumatic Stress... will delineate the collaboration for PTSD treatment intended to test new drugs to benefit Veterans...

Smoking Onset among Teens: An Empirical Analysis of Initial Situations.

ERIC Educational Resources Information Center

Friedman, Larry S.; And Others

This study attempted to identify factors associated with smoking onset among teens. It was hypothesized that initial cigarette smoking is largely prompted by peers, and that these prompts and subsequent social reinforcement may account for smoking participation. An in-depth structured interview investigating the first three smoking or smoking…

Space-Time Analysis of the Air Quality Model Evaluation International Initiative (AQMEII) Phase 1 Air Quality Simulations

EPA Science Inventory

This study presents an evaluation of summertime daily maximum ozone concentrations over North America (NA) and Europe (EU) using the database generated during Phase 1 of the Air Quality Model Evaluation International Initiative (AQMEII). The analysis focuses on identifying tempor...

Gender Differences in Alcohol Prevention Programming

ERIC Educational Resources Information Center

Ogenchuk, Marcella J.; Hellsten, Laurie-Ann M.; Prytula, Michelle

2012-01-01

The purpose of this article is to describe a study of the outcomes of a school-based alcohol abuse prevention initiative. The initiative was focused on identifying, developing, disseminating, and evaluating information for high school students based on the school community needs. Student learning outcomes were measured using pre- and post-tests…

The role of alternative and natural agents, cryotherapy, and/or laser for management of alimentary mucositis.

PubMed

Migliorati, Cesar A; Oberle-Edwards, Loree; Schubert, Mark

2006-06-01

To review the literature and update the current guidelines of alternative/natural agents, cryotherapy, and/or laser therapy in the management of alimentary mucositis (AM). The original guidelines developed by the Multinational Association for Supportive Care in Cancer (MASCC)/International Society for Oral Oncology (ISOO) mucositis study group were the basis for this study. A medical librarian conducted an initial Medline search to identify research articles published between 2002 and 2005 in English language. A search term combination that included stomatitis, mucositis, mucous membrane, neoplasm, lasers, complimentary therapies, amino acids, antioxidants, vitamins, minerals, plant extracts, and cryotherapy was conducted. This initial search identified articles with a strong scientific methodology that included both preclinical and clinical research. Using standardized scoring forms, authors reviewed and scored individual articles. A consensus result of the review was achieved in a meeting of reviewers in June of 2005. The initial search identified a total of 167 new articles. Of these, 14 were selected and reviewed: alternative/natural therapy (one preclinical study); cryotherapy (four clinical studies); lasers (two clinical studies); and alternative/natural agents (seven clinical studies). A new guideline could be established for the use of cryotherapy in the management of AM in hematopoietic stem cell transplant (HSCT) patients receiving melphalan in the conditioning phase. The rapid progress in the understanding of AM created a need for new prevention and management protocols. Frequent literature review is now necessary to identify agents and protocols being developed in this important area of supportive care in cancer.

Data visualization methods, data visualization devices, data visualization apparatuses, and articles of manufacture

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

Turner, Alan E.; Crow, Vernon L.; Payne, Deborah A.

Data visualization methods, data visualization devices, data visualization apparatuses, and articles of manufacture are described according to some aspects. In one aspect, a data visualization method includes accessing a plurality of initial documents at a first moment in time, first processing the initial documents providing processed initial documents, first identifying a plurality of first associations of the initial documents using the processed initial documents, generating a first visualization depicting the first associations, accessing a plurality of additional documents at a second moment in time after the first moment in time, second processing the additional documents providing processed additional documents, secondmore » identifying a plurality of second associations of the additional documents and at least some of the initial documents, wherein the second identifying comprises identifying using the processed initial documents and the processed additional documents, and generating a second visualization depicting the second associations.« less

Permethrin Exposure Dosimetry: Biomarkers and Modifiable Factors

DTIC Science & Technology

2015-08-01

ongoing communication with the US Army Center for Initial Military Training (CIMT) has taken place, initiating in August 2014. The PI briefed the DCG ...2016, ongoing communication with National Guard Bureau has taken place, initiating in April 2015. o With DCG -IMT approval (see Task 3 below...September 2015. TASK 3 Study 1 site approval [COMPLETE] o DCG -IMT Approval Memorandum, 1 June 2015. Approval process identified Ft. Sill as the location

The impact of the Baby Friendly Health Initiative in the Australian health care system: a critical narrative review of the evidence.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2013-07-01

Studies have identified that the practices of maternity facilities and health professionals are crucial to women's experience of support and breastfeeding 'success'. The Baby Friendly Hospital Initiative (BFHI) was launched globally in 1991 to protect, promote and support breastfeeding. While a direct causal effect has not been established and critics suggest the rhetoric conflicts with women's lived experiences as new mothers, a positive association between the Initiative and breastfeeding prevalence is apparent. Internationally, impact studies have demonstrated that where the Initiative is well integrated, there is an increase in rates of breastfeeding initiation and, to a lesser extent, duration. In consideration of the known health risks associated with the use of artificial baby milks this would suggest that BFHI implementation and accreditation should be a desirable strategy for committed health facilities. However, a variation in both BFHI uptake and breastfeeding prevalence between nations has been reported. This narrative review critically discusses a variety of issues relevant to the uptake and support of breastfeeding and the BFHI, utilising Australia as a case study. Whilst it enjoys 'in principle' policy support, Australia also suffers from a lack of uniformity in uptake and perception of the benefits of BFHI at all levels of the health system. Australian and international studies have identified similar enablers and barriers to implementation.

Constructing Departmental Culture to Support Student Development: Evidence from a Case Study in Rwanda

ERIC Educational Resources Information Center

Schendel, Rebecca

2016-01-01

In recent years, there have been numerous attempts to improve the quality of higher education in Africa, but there is limited knowledge about the impact of these initiatives on student learning. The results of a study published in 2015 offered some initial data in this regard by identifying a lack of improvement in the critical thinking ability of…

Using probabilistic record linkage methods to identify Australian Indigenous women on the Queensland Pap Smear Register: the National Indigenous Cervical Screening Project

PubMed Central

Diaz, Abbey; Baade, Peter; Garvey, Gail; Cunningham, Joan; Brotherton, Julia M L; Canfell, Karen; Valery, Patricia C; O'Connell, Dianne L; Taylor, Catherine; Moore, Suzanne P; Condon, John R

2016-01-01

Objective To evaluate the feasibility and reliability of record linkage of existing population-based data sets to determine Indigenous status among women receiving Pap smears. This method may allow for the first ever population measure of Australian Indigenous women's cervical screening participation rates. Setting/participants A linked data set of women aged 20–69 in the Queensland Pap Smear Register (PSR; 1999–2011) and Queensland Cancer Registry (QCR; 1997–2010) formed the Initial Study Cohort. Two extracts (1995–2011) were taken from Queensland public hospitals data (Queensland Hospital Admitted Patient Data Collection, QHAPDC) for women, aged 20–69, who had ever been identified as Indigenous (extract 1) and had a diagnosis or procedure code relating to cervical cancer (extract 2). The Initial Study Cohort was linked to extract 1, and women with cervical cancer in the initial cohort were linked to extract 2. Outcome measures The proportion of women in the Initial Cohort who linked with the extracts (true -pairs) is reported, as well as the proportion of potential pairs that required clerical review. After assigning Indigenous status from QHAPDC to the PSR, the proportion of women identified as Indigenous was calculated using 4 algorithms, and compared. Results There were 28 872 women (2.1%) from the Initial Study Cohort who matched to an ever Indigenous record in extract 1 (n=76 831). Women with cervical cancer in the Initial Study Cohort linked to 1385 (71%) records in extract 2. The proportion of Indigenous women ranged from 2.00% to 2.08% when using different algorithms to define Indigenous status. The Final Study Cohort included 1 372 823 women (PSR n=1 374 401; QCR n=1955), and 5 062 118 records. Conclusions Indigenous status in Queensland cervical screening data was successfully ascertained through record linkage, allowing for the crucial assessment of the current cervical screening programme for Indigenous women. Our study highlights the need to include Indigenous status on Pap smear request and report forms in any renewed and redesigned cervical screening programme in Australia. PMID:26873047

Application of “Systems Vaccinology” to Evaluate Inflammation and Reactogenicity of Adjuvanted Preventative Vaccines

PubMed Central

Lewis, David J. M.; Lythgoe, Mark P.

2015-01-01

Advances in “omics” technology (transcriptomics, proteomics, metabolomics, genomics/epigenomics, etc.) allied with statistical and bioinformatics tools are providing insights into basic mechanisms of vaccine and adjuvant efficacy or inflammation/reactogenicity. Predictive biomarkers of relatively frequent inflammatory reactogenicity may be identified in systems vaccinology studies involving tens or hundreds of participants and used to screen new vaccines and adjuvants in in vitro, ex vivo, animal, or human models. The identification of rare events (such as those observed with initial rotavirus vaccine or suspected autoimmune complications) will require interrogation of large data sets and population-based research before application of systems vaccinology. The Innovative Medicine Initiative funded public-private project BIOVACSAFE is an initial attempt to systematically identify biomarkers of relatively common inflammatory events after adjuvanted immunization using human, animal, and population-based models. Discriminatory profiles or biomarkers are being identified, which require validation in large trials involving thousands of participants before they can be generalized. Ultimately, it is to be hoped that the knowledge gained from such initiatives will provide tools to the industry, academia, and regulators to select optimal noninflammatory but immunogenic and effective vaccine adjuvant combinations, thereby shortening product development cycles and identifying unsuitable vaccine candidates that would fail in expensive late stage development or postmarketing. PMID:26380327

Age of smoking initiation among adolescents in Africa.

PubMed

Veeranki, Sreenivas P; John, Rijo M; Ibrahim, Abdallah; Pillendla, Divya; Thrasher, James F; Owusu, Daniel; Ouma, Ahmed E O; Mamudu, Hadii M

2017-01-01

To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents' age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents' age of smoking initiation. Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d'Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.

Screening for Homelessness in the Veterans Health Administration: Monitoring Housing Stability through Repeat Screening.

PubMed

Byrne, Thomas; Fargo, Jamison D; Montgomery, Ann Elizabeth; Roberts, Christopher B; Culhane, Dennis P; Kane, Vincent

2015-01-01

This study examined veterans' responses to the Veterans Health Administration's (VHA's) universal screen for homelessness and risk of homelessness during the first 12 months of implementation. We calculated the baseline annual frequency of homelessness and risk of homelessness among all veterans who completed an initial screen during the study period. We measured changes in housing status among veterans who initially screened positive and then completed a follow-up screen, assessed factors associated with such changes, and identified distinct risk profiles of veterans who completed a follow-up screen. More than 4 million veterans completed an initial screen; 1.8% (n=77,621) screened positive for homelessness or risk of homelessness. Of those who initially screened positive for either homelessness or risk of homelessness and who completed a second screen during the study period, 85.0% (n=15,060) resolved their housing instability prior to their second screen. Age, sex, race, VHA eligibility, and screening location were all associated with changes in housing stability. We identified four distinct risk profiles for veterans with ongoing housing instability. To address homelessness among veterans, efforts should include increased and targeted engagement of veterans experiencing persistent housing instability.

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

PubMed

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Shining lights: studies that have most influenced the understanding of health promotion's financial impact.

PubMed

Golaszewski, T

2001-01-01

To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion. A panel of experts was used to identify the top studies supporting the purpose of this article. Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion. Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article. A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.

Physical examination prior to initiating hormonal contraception: a systematic review.

PubMed

Tepper, Naomi K; Curtis, Kathryn M; Steenland, Maria W; Marchbanks, Polly A

2013-05-01

Provision of contraception is often linked with physical examination, including clinical breast examination (CBE) and pelvic examination. This review was conducted to evaluate the evidence regarding outcomes among women with and without physical examination prior to initiating hormonal contraceptives. The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning CBE and pelvic examination prior to initiating hormonal contraceptives. The quality of each study was assessed using the United States Preventive Services Task Force grading system. The search did not identify any evidence regarding outcomes among women screened versus not screened with CBE prior to initiation of hormonal contraceptives. The search identified two case-control studies of fair quality which compared women who did or did not undergo pelvic examination prior to initiating oral contraceptives (OCs) or depot medroxyprogesterone acetate (DMPA). No differences in risk factors for cervical neoplasia, incidence of sexually transmitted infections, incidence of abnormal Pap smears or incidence of abnormal wet mount findings were observed. Although women with breast cancer should not use hormonal contraceptives, there is little utility in screening prior to initiation, due to the low incidence of breast cancer and uncertain value of CBE among women of reproductive age. Two fair quality studies demonstrated no differences between women who did or did not undergo pelvic examination prior to initiating OCs or DMPA with respect to risk factors or clinical outcomes. In addition, pelvic examination is not likely to detect any conditions for which hormonal contraceptives would be unsafe. Published by Elsevier Inc.

Ghost Authorship in Industry-Initiated Randomised Trials

PubMed Central

Gøtzsche, Peter C; Hróbjartsson, Asbjørn; Johansen, Helle Krogh; Haahr, Mette T; Altman, Douglas G; Chan, An-Wen

2007-01-01

Background Ghost authorship, the failure to name, as an author, an individual who has made substantial contributions to an article, may result in lack of accountability. The prevalence and nature of ghost authorship in industry-initiated randomised trials is not known. Methods and Findings We conducted a cohort study comparing protocols and corresponding publications for industry-initiated trials approved by the Scientific-Ethical Committees for Copenhagen and Frederiksberg in 1994–1995. We defined ghost authorship as present if individuals who wrote the trial protocol, performed the statistical analyses, or wrote the manuscript, were not listed as authors of the publication, or as members of a study group or writing committee, or in an acknowledgment. We identified 44 industry-initiated trials. We did not find any trial protocol or publication that stated explicitly that the clinical study report or the manuscript was to be written or was written by the clinical investigators, and none of the protocols stated that clinical investigators were to be involved with data analysis. We found evidence of ghost authorship for 33 trials (75%; 95% confidence interval 60%–87%). The prevalence of ghost authorship was increased to 91% (40 of 44 articles; 95% confidence interval 78%–98%) when we included cases where a person qualifying for authorship was acknowledged rather than appearing as an author. In 31 trials, the ghost authors we identified were statisticians. It is likely that we have overlooked some ghost authors, as we had very limited information to identify the possible omission of other individuals who would have qualified as authors. Conclusions Ghost authorship in industry-initiated trials is very common. Its prevalence could be considerably reduced, and transparency improved, if existing guidelines were followed, and if protocols were publicly available. PMID:17227134

Ghost authorship in industry-initiated randomised trials.

PubMed

Gøtzsche, Peter C; Hróbjartsson, Asbjørn; Johansen, Helle Krogh; Haahr, Mette T; Altman, Douglas G; Chan, An-Wen

2007-01-01

Ghost authorship, the failure to name, as an author, an individual who has made substantial contributions to an article, may result in lack of accountability. The prevalence and nature of ghost authorship in industry-initiated randomised trials is not known. We conducted a cohort study comparing protocols and corresponding publications for industry-initiated trials approved by the Scientific-Ethical Committees for Copenhagen and Frederiksberg in 1994-1995. We defined ghost authorship as present if individuals who wrote the trial protocol, performed the statistical analyses, or wrote the manuscript, were not listed as authors of the publication, or as members of a study group or writing committee, or in an acknowledgment. We identified 44 industry-initiated trials. We did not find any trial protocol or publication that stated explicitly that the clinical study report or the manuscript was to be written or was written by the clinical investigators, and none of the protocols stated that clinical investigators were to be involved with data analysis. We found evidence of ghost authorship for 33 trials (75%; 95% confidence interval 60%-87%). The prevalence of ghost authorship was increased to 91% (40 of 44 articles; 95% confidence interval 78%-98%) when we included cases where a person qualifying for authorship was acknowledged rather than appearing as an author. In 31 trials, the ghost authors we identified were statisticians. It is likely that we have overlooked some ghost authors, as we had very limited information to identify the possible omission of other individuals who would have qualified as authors. Ghost authorship in industry-initiated trials is very common. Its prevalence could be considerably reduced, and transparency improved, if existing guidelines were followed, and if protocols were publicly available.

Determinants of saxagliptin use among patients with type 2 diabetes mellitus treated with oral anti-diabetic drugs.

PubMed

Saine, M Elle; Carbonari, Dena M; Newcomb, Craig W; Nezamzadeh, Melissa S; Haynes, Kevin; Roy, Jason A; Cardillo, Serena; Hennessy, Sean; Holick, Crystal N; Esposito, Daina B; Gallagher, Arlene M; Bhullar, Harshvinder; Strom, Brian L; Lo Re, Vincent

2015-04-02

The patterns and determinants of saxagliptin use among patients with type 2 diabetes mellitus (T2DM) are unknown in real-world settings. We compared the characteristics of T2DM patients who were new initiators of saxagliptin to those who were new initiators of non-dipeptidyl peptidase-4 (DPP-4) inhibitor oral anti-diabetic drugs (OADs) and identified factors associated with saxagliptin use. We conducted a cross-sectional study within the Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), US Medicare, and the HealthCore Integrated Research Database (HIRD(SM)) across the first 36 months of saxagliptin availability (29 months for US Medicare). Patients were included if they were: 1) ≥18 years old, 2) newly prescribed saxagliptin or a non-DPP-4 inhibitor OAD, and 3) enrolled in their respective database for 180 days. For each saxagliptin initiator, we randomly selected up to ten non-DPP-4 inhibitor OAD initiators matched on age, sex, and geographic region. Conditional logistic regression was used to identify determinants of saxagliptin use. We identified 64,079 saxagliptin initiators (CPRD: 1,962; THIN: 2,084; US Medicare: 51,976; HIRD(SM): 8,057) and 610,660 non-DPP-4 inhibitor OAD initiators (CPRD: 19,484; THIN: 19,936; US Medicare: 493,432; HIRD(SM): 77,808). Across all four data sources, prior OAD use, hypertension, and hyperlipidemia were associated with saxagliptin use. Saxagliptin initiation was also associated with hemoglobin A1c results >8% within the UK data sources, and a greater number of hemoglobin A1c measurements in the US data sources. In these UK and US data sources, initiation of saxagliptin was associated with prior poor glycemic control, prior OAD use, and diagnoses of hypertension and hyperlipidemia. ClinicalTrials.gov identifiers NCT01086280 , NCT01086293 , NCT01086319 , NCT01086306 , and NCT01377935.

Effect of Statin Use on Acute Kidney Injury Risk Following Coronary Artery Bypass Grafting

PubMed Central

Layton, J. Bradley; Kshirsagar, Abhijit V.; Simpson, Ross J.; Pate, Virginia; Funk, Michele Jonsson; Sturmer, Til; Brookhart, M. Alan

2013-01-01

Acute kidney injury (AKI) is a serious complication of cardiovascular surgery. While some non-experimental studies suggest statin use may reduce post-surgical AKI, methodological differences in study designs leave uncertainty regarding the reality or magnitude of the effect. We estimated the effect of pre-operative statin initiation on post-coronary artery bypass graft (CABG) AKI using an epidemiologic approach more closely simulating a randomized controlled trial in a large CABG patient population. We utilized healthcare claims from large, employer-based and Medicare insurance databases for the years 2000 – 2010. To minimize healthy user bias, we identified patients undergoing non-emergency CABG who either newly initiated a statin within 20 days prior to surgery or were unexposed for 200+ days prior to CABG. AKI was identified within 15 days following CABG. We calculated multivariable adjusted risk ratios (RR) and 95% confidence intervals (CI) with Poisson regression. Analyses were repeated using propensity score methods adjusted for clinical and healthcare utilization variables. We identified 17,077 CABG patients. Post-CABG AKI developed in 3.4% of statin initiators and 6.2% of non-initiators. After adjustment, we observed a protective effect of statin initiation on AKI (RR = 0.78, 95% CI 0.63, 0.96). This effect differed by age: ≥65 years, RR=0.91 (95% CI: 0.68, 1.20); <65 years, RR=0.62 (95% CI: 0.45, 0.86), although AKI was more common in the older age group (7.7 vs. 4.0%). In conclusion, statin initiation immediately prior to CABG may modestly reduce the risk of post-operative AKI, particularly in younger CABG patients. PMID:23273532

A Pilot Study Using a Web Survey to Identify Characteristics That Influence Hypogonadal Men to Initiate Testosterone Replacement Therapy.

PubMed

Rosen, Raymond C; Seftel, Allen D; Ruff, Dustin D; Muram, David

2018-05-01

Men with hypogonadism (HG) who choose testosterone replacement therapy (TRT) may have distinct characteristics that provide insight as to why they may/may not initiate therapy. The aim of the current study was to identify trends in patient characteristics and attitudes in men diagnosed with HG who initiated TRT (TRT+) compared with men who were diagnosed with HG but did not initiate TRT (TRT-). The market research-based online survey conducted between 2012 and 2013 included patients from a Federated Sample, a commercially available panel of patients with diverse medical conditions. The current analysis was composed of two groups: TRT+ ( n = 155) and TRT- ( n = 157). Patient demographics, clinical characteristics, and attitudes toward HG and TRT were examined as potential predictors of primary adherence in men with HG; cohorts were compared by using Fisher's exact test. Significant associations among sexual orientation, relationship status, educational level, presence of comorbid erectile dysfunction, area of residence, and TRT initiation were present ( p ≤ .05). College-educated, heterosexual, married men with comorbid erectile dysfunction living in suburban and urban areas were more likely to initiate treatment. The most bothersome symptoms reported were lack of energy (90% vs. 81%, p = .075), decreased strength and endurance (86% vs. 76%, p = .077), and deterioration in work performance (52% vs. 31%, p = .004); lack of energy prompted men to seek help. Patients (48%) in the TRT+ group were more knowledgeable regarding HG as compared with TRT- respondents (14%, p < .001), and most men obtained their information from a health care professional (89% vs. 82%, p = .074). The current analysis identified distinct demographic and clinical characteristics and attitudes among TRT users compared with men who were diagnosed with HG yet remained untreated.

Validation and refinement of mixture volumetric material properties identified in superpave monitoring project II : phase II.

DOT National Transportation Integrated Search

2015-02-01

This study was initiated to validate and refine mixture volumetric material properties identified in the : Superpave Monitoring Project II. It has been found that differences in performance are primarily controlled : by differences in gradation and r...

Student Achievement in Identified Workforce Clusters: Understanding Factors that Influence Student Success

ERIC Educational Resources Information Center

D'Amico, Mark M.; Morgan, Grant B.; Robertson, Thashundray C.

2011-01-01

This study blends elements from two South Carolina Technical College System initiatives--Achieving the Dream and a workforce cluster strategy. Achieving the Dream is a national non-profit organization created to help technical and community college students succeed, particularly low-income students and students of color. This initiative, combined…

Connecting the Dots--From Planning to Implementation: Translating Commitments into Action in a Strategic Planning Process

ERIC Educational Resources Information Center

Mieso, Rob Roba

2010-01-01

This study examines the implementation of the Commitments to Action (CTAs) that were developed for the Outreach Institutional Initiative (OII) as part of the 2006 strategic planning process at De Anza College. Although the strategic planning process identified four Institutional Initiatives (IIs) [Outreach, Individualized Attention to Student…

"It Is Not Easy": Challenges for Provider-Initiated HIV Testing and Counseling in Flanders, Belgium

ERIC Educational Resources Information Center

Manirankunda, Lazare; Loos, Jasna; Debackaere, Pieterjan; Nostlinger, Christiana

2012-01-01

This study identified physicians' HIV testing practices and their barriers toward implementing provider-initiated HIV testing and counseling (PITC) for Sub-Saharan African migrants (SAM) in Flanders, Belgium. In-depth interviews were conducted on a purposive sample of 20 physicians (ten GPs and ten internists). GPs performed mainly…

Development and Initial Validation of the Intimate Violence Responsibility Scale (IVRS)

ERIC Educational Resources Information Center

Yun, Sung Hyun; Vonk, M. Elizabeth

2011-01-01

The present study demonstrates the development and initial examination of psychometric properties of the Intimate Violence Responsibility Scale (IVRS) in a community-based sample (N = 527). The underlying factor structure of the IVRS was tested by the exploratory factor analysis (Principal Axis Factoring), which identifies the four factors:…

Identifying and Articulating Library Connections to Student Success

ERIC Educational Resources Information Center

Massengale, Lisa; Piotrowski, Pattie; Savage, Devin

2016-01-01

Engaging in ongoing assessment is key to libraries demonstrating their value to their institutions. This study is an initial step in a STEM library's long-term goal of measuring the library's connection to, and impact on, student academic success markers such as retention and persistence. Initial results showed that any library usage was always…

Mature Student Teachers in Initial Teacher Education in Greece: Personal and Academic Identities

ERIC Educational Resources Information Center

Kaldi, Stavroula

2009-01-01

This qualitative study examined mature student teachers in initial teacher preparation for primary schools in Greece. More specifically it sought to identify the profile of mature student teachers, their intentions to become primary school teachers, their academic needs, concerns and expectations as well as their coping strategies across private…

Improving Beta Test Evaluation Response Rates: A Meta-Evaluation

ERIC Educational Resources Information Center

Russ-Eft, Darlene; Preskill, Hallie

2005-01-01

This study presents a meta-evaluation of a beta-test of a customer service training program. The initial evaluation showed a low response rate. Therefore, the meta-evaluation focused on issues related to the conduct of the initial evaluation and reasons for nonresponse. The meta-evaluation identified solutions to the nonresponse problem as related…

Degradation of oxcarbazepine by UV-activated persulfate oxidation: kinetics, mechanisms, and pathways.

PubMed

Bu, Lingjun; Zhou, Shiqing; Shi, Zhou; Deng, Lin; Li, Guangchao; Yi, Qihang; Gao, Naiyun

2016-02-01

The degradation kinetics and mechanism of the antiepileptic drug oxcarbazepine (OXC) by UV-activated persulfate oxidation were investigated in this study. Results showed that UV/persulfate (UV/PS) process appeared to be more effective in degrading OXC than UV or PS alone. The OXC degradation exhibited a pseudo-first order kinetics pattern and the degradation rate constants (k obs) were affected by initial OXC concentration, PS dosage, initial pH, and humic acid concentration to different degrees. It was found that low initial OXC concentration, high persulfate dosage, and initial pH enhanced the OXC degradation. Additionally, the presence of humic acid in the solution could greatly inhibit the degradation of OXC. Moreover, hydroxyl radical (OH•) and sulfate radical (SO4 (-)••) were identified to be responsible for OXC degradation and SO4 (-)• made the predominant contribution in this study. Finally, major intermediate products were identified and a preliminary degradation pathway was proposed. Results demonstrated that UV/PS system is a potential technology to control the water pollution caused by emerging contaminants such as OXC.

Change Strategies and Associated Implementation Challenges: An Analysis of Online Counselling Sessions.

PubMed

Rodda, Simone N; Hing, Nerilee; Hodgins, David C; Cheetham, Alison; Dickins, Marissa; Lubman, Dan I

2017-09-01

Self-change is the most frequent way people limit or reduce gambling involvement and often the first choice of people experiencing gambling-related problems. Less well known is the range of change strategies gamblers use and how these are selected, initiated or maintained. This study examined change strategies discussed in counselling transcripts from 149 clients who accessed a national online gambling help service in Australia. Using thematic analysis, we identified the presence of six change strategies; cash control and financial management, social support, avoiding or limiting gambling, alternative activities, changing thoughts and beliefs, and self-assessment and monitoring. Four implementation issues were also identified; a mismatch between need and strategy selection or maintenance; importance and readiness versus the cost of implementation; poor or unplanned transitions between strategies; and failure to review the helpfulness of strategies resulting in premature abandonment or unhelpful prolonged application. This study is the first to identify change strategies discussed in online counselling sessions. This study suggests change strategies are frequently discussed in online counselling sessions and we identified multiple new actions associated with change strategies that had not previously been identified. However, multiple implementation issues were identified and further work is required to determine the helpfulness of change strategies in terms of their selection, initiation and maintenance.

Barriers to and Reasons for Treatment Initiation Among Gambling Help-line Callers.

PubMed

Khayyat-Abuaita, Ula; Ostojic, Dragana; Wiedemann, Ashley; Arfken, Cynthia L; Ledgerwood, David M

2015-08-01

Identifying barriers to seeking treatment is essential for increasing problem gambler treatment initiation in the community, given that as few as 1 in 10 problem gamblers ever seek treatment. Further, many problem gamblers who take the initial step of contacting problem gambling help-lines do not subsequently go on to attend face-to-face treatment. There is limited research examining reasons for attending treatment among this population. This study addressed these gaps in the literature by examining barriers and attractions to treatment among callers to the State of Michigan Problem Gambling Help-line. In total, 143 callers (n = 86 women) completed the Barriers to Treatment for Problem Gambling (BTPG) questionnaire and responded to open-ended questions regarding barriers to and reasons for treatment initiation, as part of a telephone interview. Greater endorsement of barriers to treatment was associated with a lower likelihood of initiating treatment, especially perceived absence of problem and treatment unavailability. Correspondingly, problem gamblers who identified more reasons to attend treatment were more likely to attend, with positive treatment perceptions being the most influential. These findings can help get people into treatment by addressing barriers and fostering reasons for attending treatment, as well as reminding clinicians of the importance of identifying and addressing individual treatment barriers among patients with problem gambling.

Barriers to Student Mobilization and Service at Institutions of Higher Education: A Greenbuilding Initiative Case Study on a Historic, Urban Campus in Charleston, South Carolina, USA

ERIC Educational Resources Information Center

Zimmerman, Katherine S.; Halfacre-Hitchcock, Angela

2006-01-01

Purpose: To identify some of the barriers to mobilizing students of higher education in sustainable initiatives, in order to enhance project success on campuses. Design/methodology/approach: Uses a case study of a model green building retrofit on the College of Charleston campus in Charleston, South Carolina, USA. Several constraints already…

Inhaled corticosteroids and the occurrence of oral candidiasis: a prescription sequence symmetry analysis.

PubMed

van Boven, Job F M; de Jong-van den Berg, Lolkje T W; Vegter, Stefan

2013-04-01

The primary aim of the study was to gain insight into the relative risk of clinically relevant oral candidiasis following inhaled corticosteroid (ICS) initiation over time. A secondary aim was to analyse the influence of patient characteristics and co-medication on the occurrence of this adverse effect. Drug prescription data from 1994 to 2011 were retrieved from the IADB.nl database. To study the influence of ICS use on occurrence of oral candidiasis, a prescription symmetry analysis was used, including patients using medication for oral candidiasis up to 1 year before or after ICS initiation. The relative risk was calculated by dividing the number of patients receiving medication for oral candidiasis after ICS initiation by the number of patients receiving the same medication before ICS initiation. Sub-analyses were conducted to compare the relative risks at several time points after ICS initiation and to account for therapy persistence by only including chronic users of ICS. A multivariate logistic regression model was used to identify predictive factors. A total of 52,279 incident users of ICS therapy were identified, of which 1,081 received medication for oral candidiasis up to 1 year before or after ICS initiation. A total of 701 patients received medication for oral candidiasis after ICS initiation, while 361 received these medications in the reversed sequence, resulting in a sequence ratio (SR) of 1.94 (95 % CI 1.71-2.21). In the first 3 months after ICS initiation, the SR was 2.72 (95 % CI 2.19-3.38) and then decreased to 1.47 (95 % CI 1.11-1.95) 9-12 months after ICS initiation. Predictive factors were higher daily dose of ICS and concomitant use of oral corticosteroids. This study found a significant and clinically relevant increased number of patients receiving medication for oral candidiasis in the first year after therapy initiation with ICS. Relative risk is highest in the first 3 months, but remains increased up to at least 1 year after ICS initiation. This study stresses the need for patient education and inhalation instruction.

How healthcare systems evaluate their advance care planning initiatives: Results from a systematic review.

PubMed

Biondo, Patricia D; Lee, Lydia D; Davison, Sara N; Simon, Jessica E

2016-09-01

Advance care planning initiatives are being implemented across healthcare systems around the world, but how best to evaluate their implementation is unknown. To identify gaps and/or redundancies in current evaluative strategies to help healthcare systems develop future evaluative frameworks for ACP. Systematic review. Peer-reviewed and gray literature searches were conducted till February 2015 to answer: "What methods have healthcare systems used to evaluate implementation of advance care planning initiatives?" A PICOS framework was developed to identify articles describing the implementation and evaluation of a health system-level advance care planning initiative. Outcome measures were mapped onto a conceptual quality indicator framework based on the Institute of Medicine and Donabedian models of healthcare quality. A total of 46 studies met inclusion criteria for analysis. Most articles reported on single parts of a healthcare system (e.g. continuing care). The most common outcome measures pertained to document completion, followed by healthcare resource use. Patient-, family-, or healthcare provider-reported outcomes were less commonly measured. Concordance measures (e.g. dying in place of choice) were reported by only 26% of studies. The conceptual quality indicator framework identified gaps and redundancies in measurement and is presented as a potential foundation from which to develop a comprehensive advance care planning evaluation framework. Document completion is frequently used to evaluate advance care planning program implementation; capturing the quality of care appears to be more difficult. This systematic review provides health system administrators with a comprehensive summary of measures used to evaluate advance care planning and may identify gaps in evaluation within their local context. © The Author(s) 2016.

HPV vaccination: Population approaches for improving rates.

PubMed

Oliver, Kristin; Frawley, Alean; Garland, Elizabeth

2016-06-02

To review the literature on interventions to increase HPV vaccinations and assess whether The Community Preventive Services Task Force recommendations are supported by current evidence. We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs. Of the 13 studies identified, 8 included client reminder and recall interventions, 4 included provider assessment and feedback and/or provider reminders and 2 included clinic based education. 11 of the 13 studies demonstrated a positive effect on HPV vaccine initiation or completion. Provider assessment and feedback studies were more likely to report a positive effect on HPV vaccine initiation than on series completion, while client reminder recall interventions more frequently produced an effect on series completion than on initiation. There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.

Reading, Mathematics, and Science Instructional Strategies for English Language Learners with Disabilities: Insights from Educators Nationwide. ELLs with Disabilities Report 19

ERIC Educational Resources Information Center

Barrera, Manuel; Shyyan, Vitaliy; Liu, Kristi K.; Thurlow, Martha L.

2008-01-01

This study, conducted in 2005-06, identified teacher-initiated instructional strategies currently preferred by practitioners who daily work with English language learners (ELLs) with disabilities. The findings generated in this study could potentially confirm strategies identified in the authors' earlier work (Thurlow et al., 2004) through the…

A Pilot Study on the Ability of Young Children and Adults to Identify and Reproduce Novel Speech Sounds.

ERIC Educational Resources Information Center

Yeni-Komshian, Grace; And Others

This study was designed to compare children and adults on their initial ability to identify and reproduce novel speech sounds and to evaluate their performance after receiving several training sessions in producing these sounds. The novel speech sounds used were two voiceless fricatives which are consonant phonemes in Arabic but which are…

Learning How to Identify Species in a Situated Learning Scenario: Using Dynamic-Static Visualizations to Prepare Students for Their Visit to the Aquarium

ERIC Educational Resources Information Center

Pfeiffer, Vanessa D. I.; Scheiter, Katharina; Kuhl, Tim; Gemballa, Sven

2011-01-01

This study investigated whether studying dynamic-static visualizations prepared first-year Biology students better for an out-of-classroom experience in an aquarium than learning how to identify species with more traditional instructional materials. During an initial classroom phase, learners either watched underwater videos of 15 freshwater fish…

[Local food production for school feeding programmes in Spain].

PubMed

Soares, Panmela; Martínez-Mián, Maria Asunción; Caballero, Pablo; Vives-Cases, Carmen; Davó-Blanes, Mari Carmen

To identify and characterize initiatives that promote the purchase of locally-sourced foods to supply schools and the school centres carrying out the initiatives. Exploratory, descriptive study based on secondary data and key informant reports. A search of governmental and non-governmental initiatives was carried out at the autonomous community level. Government initiatives were located through school feeding programmes in the different autonomous communities, their nutritional guides and representatives of the councils for education and agriculture. Non-governmental initiatives were found through their own websites and the snowball technique. Initiatives were analysed by their geographic distribution, organizational area (government vs. non-government), number of school centres carrying out the initiatives, management style and organic food purchase. A descriptive analysis of the data was carried out. 12 initiatives carried out by 318 schools (2.16% of all the schools with food service in Spain) were identified. Among these, 6 are governmental initiatives with a scope of 274 schools (1.86%), and 6 are non-governmental initiatives with a scope of 44 schools (0.30%). Most of these schools have a public management system in place (n=284). All the initiatives provide for the purchase of organic food. Local food purchase initiatives in Spain have a limited reach. However, the existence of a state directive could support and strengthen the development of such initiatives, given that school commitment is greater when initiatives are driven by the public sector. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Macroinvertebrate Response to Drought in Undisturbed Headwater Streams of Southwest Georgia.

NASA Astrophysics Data System (ADS)

Winn, R. T.; Griswold, M. W.; Golladay, S. W.; Crisman, T. L.

2005-05-01

Macroinvertebrates were sampled in four headwater streams for two years (2001-2003) to establish baseline conditions for a study evaluating forestry best management practices. The Palmer Drought Severity Index indicated that the study site experienced a prolonged moderate to severe drought prior to study initiation, with year one of the study characterized as a moderate drought, while year two encompassed drought and initial rainfall recovery. Benthic macroinvertebrates were collected in streams during year one (December 2001/February 2002) and year two (December 2002/February 2003) using a multi-habitat sampling procedure. Individuals were identified to the lowest practical taxonomic level (mostly genus), and metrics including abundance, total number of taxa, and Ephemeroptera, Plecoptera, and Trichoptera (EPT) taxa were calculated. Repeated measures ANOVA identified differences in macroinvertebrate assemblages due to sampling period, with lower values for December 2001 relative to February 2003. Abundance and EPT taxa showed an increasing relationship with average daily flow in successive samples of the study. Initiation of drought conditions prior to the study adversely affected species composition (low numbers of EPT taxa and long lived taxa) and trophic structure (co-dominance of shredders, collectors, and predators).

[Initial antiretroviral treatment in human immunodeficiency virus-infected patients in Spain: Decisions made in relation to particular immunovirological characteristics (PERFIL-es study)].

PubMed

Viciana, Pompeyo; Ocampo, Antonio; Hevia, Henar; Palazuelos, Marta; Ledesma, Francisco

2014-02-01

The purpose of Perfil-es study was to identify the proportion of patients starting ARV treatment based on NNRTIs or PI/r, and to identify the variables involved in the therapeutic decision-making in standard clinical practice. An observational retrospective study performed in 65 Spanish hospitals. Was a total of 1,687 starts: 53% with NNRTI-based regimen and 42% with PI/r, and of the 642 patients analyzed, 72% had a CD4 count<350 cells/μl. The initiation of ARV treatment is still late in Spain. NNRTIs are the more frequent choice, although PI/r plays an important role. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Studying the potential impact of automated document classification on scheduling a systematic review update.

PubMed

Cohen, Aaron M; Ambert, Kyle; McDonagh, Marian

2012-04-19

Systematic Reviews (SRs) are an essential part of evidence-based medicine, providing support for clinical practice and policy on a wide range of medical topics. However, producing SRs is resource-intensive, and progress in the research they review leads to SRs becoming outdated, requiring updates. Although the question of how and when to update SRs has been studied, the best method for determining when to update is still unclear, necessitating further research. In this work we study the potential impact of a machine learning-based automated system for providing alerts when new publications become available within an SR topic. Some of these new publications are especially important, as they report findings that are more likely to initiate a review update. To this end, we have designed a classification algorithm to identify articles that are likely to be included in an SR update, along with an annotation scheme designed to identify the most important publications in a topic area. Using an SR database containing over 70,000 articles, we annotated articles from 9 topics that had received an update during the study period. The algorithm was then evaluated in terms of the overall correct and incorrect alert rate for publications meeting the topic inclusion criteria, as well as in terms of its ability to identify important, update-motivating publications in a topic area. Our initial approach, based on our previous work in topic-specific SR publication classification, identifies over 70% of the most important new publications, while maintaining a low overall alert rate. We performed an initial analysis of the opportunities and challenges in aiding the SR update planning process with an informatics-based machine learning approach. Alerts could be a useful tool in the planning, scheduling, and allocation of resources for SR updates, providing an improvement in timeliness and coverage for the large number of medical topics needing SRs. While the performance of this initial method is not perfect, it could be a useful supplement to current approaches to scheduling an SR update. Approaches specifically targeting the types of important publications identified by this work are likely to improve results.

Studying the potential impact of automated document classification on scheduling a systematic review update

PubMed Central

2012-01-01

Background Systematic Reviews (SRs) are an essential part of evidence-based medicine, providing support for clinical practice and policy on a wide range of medical topics. However, producing SRs is resource-intensive, and progress in the research they review leads to SRs becoming outdated, requiring updates. Although the question of how and when to update SRs has been studied, the best method for determining when to update is still unclear, necessitating further research. Methods In this work we study the potential impact of a machine learning-based automated system for providing alerts when new publications become available within an SR topic. Some of these new publications are especially important, as they report findings that are more likely to initiate a review update. To this end, we have designed a classification algorithm to identify articles that are likely to be included in an SR update, along with an annotation scheme designed to identify the most important publications in a topic area. Using an SR database containing over 70,000 articles, we annotated articles from 9 topics that had received an update during the study period. The algorithm was then evaluated in terms of the overall correct and incorrect alert rate for publications meeting the topic inclusion criteria, as well as in terms of its ability to identify important, update-motivating publications in a topic area. Results Our initial approach, based on our previous work in topic-specific SR publication classification, identifies over 70% of the most important new publications, while maintaining a low overall alert rate. Conclusions We performed an initial analysis of the opportunities and challenges in aiding the SR update planning process with an informatics-based machine learning approach. Alerts could be a useful tool in the planning, scheduling, and allocation of resources for SR updates, providing an improvement in timeliness and coverage for the large number of medical topics needing SRs. While the performance of this initial method is not perfect, it could be a useful supplement to current approaches to scheduling an SR update. Approaches specifically targeting the types of important publications identified by this work are likely to improve results. PMID:22515596

Avionic architecture requirements for Space Exploration Initiative systems

NASA Technical Reports Server (NTRS)

Herbella, C. G.; Brown, D. C.

1991-01-01

The authors discuss NASA's Strategic Avionics Technology Working Group (SATWG) and the results of the first study commissioned by the SATWG, the Space Avionics Requirements Study (SARS). The goal of the SARS task was to show that an open avionics architecture, using modular, standardized components, could be applied across the wide range of systems that comprise the Space Exploration Initiative. The study addressed systems ranging from expendable launch vehicles and the space station to surface systems such as Mars or lunar rovers and habitats. Top-level avionics requirements were derived from characterizations of each of the systems considered. Then a set of avionics subsystems were identified, along with estimates of the numbers and types of modules needed to meet the requirements. Applicability of these results across the infrastructure was then illustrated. In addition to these tasks, critical technologies were identified, characterized, and assessed in terms of their criticality and impact on the program. Design, development, test, and evaluation methods were addressed to identify potential areas of improvement.

Study the Problem.

ERIC Educational Resources Information Center

Choate, Joyce S.

1990-01-01

The initial step of a strategic process for solving mathematical problems, "studying the question," is discussed. A lesson plan for teaching students to identify and revise arithmetic problems is presented, involving directed instruction and supervised practice. (JDD)

An analysis of population-based prenatal screening for overt hypothyroidism.

PubMed

Bryant, Stefanie N; Nelson, David B; McIntire, Donald D; Casey, Brian M; Cunningham, F Gary

2015-10-01

The purpose of the study was to evaluate pregnancy outcomes of hypothyroidism that were identified in a population-based prenatal screening program. This is a secondary analysis of a prospective prenatal population-based study in which serum thyroid analytes were obtained from November 2000 to April 2003. Initial screening thresholds were intentionally inclusive (thyroid-stimulating hormone [TSH], >3.0 mU/L; free thyroxine, <0.9 ng/dL); those who screened positive were referred for confirmatory testing in a hospital-based laboratory. Hypothyroidism was identified and treated if TSH level was >4.5 mU/L and if fT4 level was <0.76 ng/dL. Perinatal outcomes in these women and those who screened positive but unconfirmed to have hypothyroidism were compared with women with euthyroidism. Outcomes were then analyzed according to initial TSH levels. A total of 26,518 women completed initial screening: 24,584 women (93%) were euthyroid, and 284 women (1%) had abnormal initial values that suggested hypothyroidism. Of those referred, 232 women (82%) underwent repeat testing, and 47 women (0.2% initially screened) were confirmed to have hypothyroidism. Perinatal outcomes of women with treated overt hypothyroidism were similar to women with euthyroidism. Higher rates of pregnancy-related hypertension were identified in the 182 women with unconfirmed hypothyroidism when compared with women with euthyroidism (P < .001); however, this association was seen only in women with initial TSH >4.5 mU/L (adjusted odds ratio, 2.53; 95% confidence interval, 1.4-4.5). The identification and treatment of overt hypothyroidism results in pregnancy outcomes similar to women with euthyroidism. Unconfirmed screening results suggestive of hypothyroidism portend pregnancy risks similar to women with subclinical hypothyroidism, specifically preeclampsia; however, this increased risk was seen only in women with initial TSH levels of >4.5 mU/L and suggests that this is a more clinically relevant threshold than 3.0 mU/L. Copyright © 2015 Elsevier Inc. All rights reserved.

The Role of Substance Use Initiation in Adolescent Development of Subsequent Substance-Related Problems

ERIC Educational Resources Information Center

Magid, Viktoriya; Moreland, Angela D.

2014-01-01

A systematic review was conducted on the role of substance use initiation in subsequent use and substance-related problems among adolescents. Specifically, we examine previous studies to identify whether age of onset predicts subsequent levels of misuse; we also posit reasons for this association that have been suggested within the literature. In…

Enhancing Expectations of Cooperative Learning Use through Initial Teacher Training

ERIC Educational Resources Information Center

Duran Gisbert, David; Corcelles Seuba, Mariona; Flores Coll, Marta

2017-01-01

Despite its relevance and evidence support, Cooperative Learning (CL) is a challenge for all educational systems due to the difficulties in its implementation. The objective of this study is to identify the effect of Primary Education initial teacher training in the prediction of future CL use. Two groups of 44 and 45 students were conceptually…

Using Metaphors to Know the Conceptions about the Teaching Profession in Initial Teacher Education

ERIC Educational Resources Information Center

Martínez-de-la-Hidalga, Zoe; Villardón-Gallego, Lourdes

2017-01-01

The Conceptions about the teaching profession affect professional performance, and metaphors are a tool to identify them. In this qualitative study metaphors are used to gain insight into conceptions held by pre-service teachers, and their development during Initial Teacher Training in the Bachelor's Degree in Primary Education. A total of 247…

Undertaking an Institutional "Stock-Take" of SoTL: New Zealand University Case Studies

ERIC Educational Resources Information Center

Haigh, Neil; Gossman, Peter; Jiao, Xiaomin

2011-01-01

A working group was established at AUT University in 2005 with a brief to identify initiatives that might be taken to promote and support staff engagement in the Scholarship of Teaching and Learning (SoTL). The working group recognized that a "stock-taking" exercise would need to be undertaken before appropriate initiatives could be…

Initial Training for VET Teachers: A Portrait within a Larger Canvas

ERIC Educational Resources Information Center

Guthrie, Hugh; McNaughton, Alicen; Gamlin, Tracy

2011-01-01

This study focuses on a critical aspect of the vocational education and training (VET) workforce: initial VET teacher training. It has identified the generic teacher education courses offered both by the VET and higher education sectors, ranging from the Certificate IV in Training and Assessment (now the Certificate IV in Training and Education)…

Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2014-06-01

The Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as 'baby friendly'. This variance has persisted regardless of BFHI implementation in Australia gaining 'in principle' support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices. Identify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia. Knowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia. Australian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Categorizing accident sequences in the external radiotherapy for risk analysis

PubMed Central

2013-01-01

Purpose This study identifies accident sequences from the past accidents in order to help the risk analysis application to the external radiotherapy. Materials and Methods This study reviews 59 accidental cases in two retrospective safety analyses that have collected the incidents in the external radiotherapy extensively. Two accident analysis reports that accumulated past incidents are investigated to identify accident sequences including initiating events, failure of safety measures, and consequences. This study classifies the accidents by the treatments stages and sources of errors for initiating events, types of failures in the safety measures, and types of undesirable consequences and the number of affected patients. Then, the accident sequences are grouped into several categories on the basis of similarity of progression. As a result, these cases can be categorized into 14 groups of accident sequence. Results The result indicates that risk analysis needs to pay attention to not only the planning stage, but also the calibration stage that is committed prior to the main treatment process. It also shows that human error is the largest contributor to initiating events as well as to the failure of safety measures. This study also illustrates an event tree analysis for an accident sequence initiated in the calibration. Conclusion This study is expected to provide sights into the accident sequences for the prospective risk analysis through the review of experiences. PMID:23865005

[Usefulness of stratigraphy and computerized tomography in the initial staging of osteosarcoma of the extremities. Retrospective study of 217 cases].

PubMed

Pelotti, P; Ciminari, R; Bacci, G; Avella, M; Briccoli, A

1988-01-01

The value of stratigraphy and pulmonary CT in the initial work-up of osteosarcoma of the extremities is assessed with reference to 217 patients encountered in the Bone Tumour Centre of Rizzoli Orthopaedic Institute in May 1983-May 1986. Stratigraphy revealed lung metastases not identified by standard radiography in 4 patients (1.8%), while CT revealed metastases not identified by either standard X-rays or stratigraphy in a further 6 cases (2.7%). It is concluded that the increase in the percentage of cures (about 30%) reported in the last 10 years in osteosarcoma cases given adjuvant chemotherapy cannot be explained by any difference in initial selection due to the use of these techniques that were not adopted in the historical series.

Sustainbility and Undergraduate Management Curricula: Changes over a 5-Year Period

ERIC Educational Resources Information Center

Fisher, Josie; Bonn, Ingrid

2017-01-01

Global initiatives and a rapidly expanding academic literature identify the responsibility that universities have to incorporate sustainability education into their curricula. This study had two aims: first, to investigate the extent to which Australian undergraduate management curricula explicitly identified a focus on sustainability and, second,…

Improving Human Papillomavirus Vaccination Uptake in College Students: A Socioecological Perspective

ERIC Educational Resources Information Center

Lanning, Beth; Golman, Mandy; Crosslin, Katie

2017-01-01

Background: Human papillomavirus (HPV) vaccination rates remain relatively low, despite new recommendations found in "Healthy People 2020." Purpose: The purpose of this study was to determine vaccination rates, identify factors that influenced initiation/continuance of HPV vaccine series, and identify levels of influence for HPV health…

Residential Mobility, Transience, Depression, and Marijuana Use Initiation Among Adolescents and Young Adults

PubMed Central

Glasheen, Cristie; Forman-Hoffman, Valerie L; Williams, Jason

2017-01-01

Marijuana use initiation is associated with numerous health and behavioral consequences, particularly among young adolescents. Finding easily identifiable risk markers for marijuana initiation is an important step for targeting primary and secondary prevention efforts. This study used data from the 2010–2014 National Survey on Drug Use and Health to evaluate the association between residential mobility (no mobility, low mobility, high mobility [ie, transience]), and major depressive episode(s) (MDE) on marijuana initiation among adolescents (12–17) and young adults (18–20). Age-stratified logistic regression models indicated that among 12- to 13-year-old adolescents, mobility in the past 5 years and past year MDE have a multiplicative effect on the odds of past year marijuana initiation. Among adolescents aged 14 to 15 years, both mobility and MDE were independently associated with marijuana initiation, but there was no interaction. Among older adolescents (aged 16–17 years), only transience (⩾3 moves in the past 5 years) was associated with marijuana use initiation, and although MDE was significantly associated with marijuana initiation, there was no interaction with mobility. Among young adults, mobility was not associated with marijuana initiation. Residential mobility among young adolescents is an easily identifiable risk marker that may serve as an indicator for physical and mental health professionals, school personnel, and parents to use in targeting both depression and marijuana prevention efforts. PMID:28607541

The role of initial affective impressions in responses to educational communications: the case of carbon capture and sequestration (CCS).

PubMed

Bruine de Bruin, Wändi; Wong-Parodi, Gabrielle

2014-06-01

Emerging technologies promise potential benefits at a potential cost. Developers of educational communications aim to improve people's understanding and to facilitate public debate. However, even relatively uninformed recipients may have initial feelings that are difficult to change. We report that people's initial affective impressions about carbon capture and sequestration (CCS), a low-carbon coal-based electricity-generation technology with which most people are unfamiliar, influences how they interpret previously validated education materials. As a result, even individuals who had originally self-identified as uninformed persisted in their initial feelings after reading the educational communication-though perseverance of feelings about CCS was stronger among recipients who had originally self-identified as relatively informed (Study 1). Moreover, uninformed recipients whose initial feelings were experimentally manipulated by relatively uninformative pro-CCS or anti-CCS arguments persisted in their manipulated feelings after reading the educational communication, due to evaluating the educational communication in line with their manipulated impressions (Study 2). Hence, our results suggest that educational communications will have more impact if they are disseminated before people form strong feelings about the topic under consideration, especially if these are based on little to no factual understanding. PsycINFO Database Record (c) 2014 APA, all rights reserved.

A Systematic Review of Interventions to Improve Initiation of Mental Health Care Among Racial-Ethnic Minority Groups.

PubMed

Lee-Tauler, Su Yeon; Eun, John; Corbett, Dawn; Collins, Pamela Y

2018-06-01

The objective of this systematic review was to identify interventions to improve the initiation of mental health care among racial-ethnic minority groups. The authors searched three electronic databases in February 2016 and independently assessed eligibility of 2,065 titles and abstracts on the basis of three criteria: the study design included an intervention, the participants were members of racial-ethnic minority groups and lived in the United States, and the outcome measures included initial access to or attitudes toward mental health care. The qualitative synthesis involved 29 studies. Interventions identified included collaborative care (N=10), psychoeducation (N=7), case management (N=5), colocation of mental health services within existing services (N=4), screening and referral (N=2), and a change in Medicare medication reimbursement policy that served as a natural experiment (N=1). Reduction of disparities in the initiation of antidepressants or psychotherapy was noted in seven interventions (four involving collaborative care, two involving colocation of mental health services, and one involving screening and referral). Five of these disparities-reducing interventions were tested among older adults only. Most (N=23) interventions incorporated adaptations designed to address social or cultural barriers to care. Interventions that used a model of integrated care reduced racial-ethnic disparities in the initiation of mental health care.

HFR1 Sequesters PIF1 to Govern the Transcriptional Network Underlying Light-Initiated Seed Germination in Arabidopsis[C][W][OPEN

PubMed Central

Shi, Hui; Zhong, Shangwei; Mo, Xiaorong; Liu, Na; Nezames, Cynthia D.; Deng, Xing Wang

2013-01-01

Seed germination is the first step for seed plants to initiate a new life cycle. Light plays a predominant role in promoting seed germination, where the initial phase is mediated by photoreceptor phytochrome B (phyB). Previous studies showed that PHYTOCHROME-INTERACTING FACTOR1 (PIF1) represses seed germination downstream of phyB. Here, we identify a positive regulator of phyB-dependent seed germination, LONG HYPOCOTYL IN FAR-RED1 (HFR1). HFR1 blocks PIF1 transcriptional activity by forming a heterodimer with PIF1 that prevents PIF1 from binding to DNA. Our whole-genomic analysis shows that HFR1 and PIF1 oppositely mediate the light-regulated transcriptome in imbibed seeds. Through the HFR1–PIF1 module, light regulates expression of numerous genes involved in cell wall loosening, cell division, and hormone pathways to initiate seed germination. The functionally antagonistic HFR1–PIF1 pair constructs a fail-safe mechanism for fine-tuning seed germination during low-level illumination, ensuring a rapid response to favorable environmental changes. This study identifies the HFR1–PIF1 pair as a central module directing the whole genomic transcriptional network to rapidly initiate light-induced seed germination. PMID:24179122

System cost performance analysis (study 2.3). Volume 1: Executive summary. [unmanned automated payload programs and program planning

NASA Technical Reports Server (NTRS)

Campbell, B. H.

1974-01-01

A study is described which was initiated to identify and quantify the interrelationships between and within the performance, safety, cost, and schedule parameters for unmanned, automated payload programs. The result of the investigation was a systems cost/performance model which was implemented as a digital computer program and could be used to perform initial program planning, cost/performance tradeoffs, and sensitivity analyses for mission model and advanced payload studies. Program objectives and results are described briefly.

Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors’ Responses During Oncology Interviews*

PubMed Central

Beach, Wayne A.; Dozier, David M.

2015-01-01

New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A sub-sampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre-post self-report measures about fears, uncertainties, and hopes as well as post-evaluations of interview satisfaction. Conversation Analysis (CA) was employed to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre-post results it was determined that the higher patients’ reported fears, the higher their post-visit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties following encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: Oncology interviews significantly decreased patients’ fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care. PMID:26134261

Incidence of Depression and Associated Factors in Patients With Type 2 Diabetes in Quebec, Canada: A Population-Based Cohort Study.

PubMed

Lunghi, Carlotta; Moisan, Jocelyne; Grégoire, Jean-Pierre; Guénette, Line

2016-05-01

It has been reported that the risk of depression is higher among people with type 2 diabetes compared with a nondiabetic population. Among diabetic patients, depression has been associated with worse self-care behaviors, poor glycemic control, and an increased risk of diabetes complications. Identifying factors associated with the occurrence of depression may help physicians identify earlier diabetic patients at a high risk of developing depression, improve prevention, and accelerate proper treatment. To our knowledge, very few population-based studies have reported on the incidence of clinically diagnosed depression as a consequence of type 2 diabetes over a long follow-up period. The objective of this study was to estimate the incidence of clinically diagnosed depression among type 2 diabetic patients newly treated with oral antidiabetic drugs (ADs) and to identify factors associated with the occurrence of depression.Administrative claims data from the public health insurance plan were used to identify a cohort of new oral AD users aged ≥18 years between 2000 and 2006. Patients were followed from oral AD treatment initiation until the diagnosis of depression, ineligibility for the public drug plan, death, or the end of the study, whichever came first. Incidence rates were determined using person-time analysis. Factors associated with depression were identified using multivariable Cox regression analysis.We identified 114,366 new oral AD users, of which 4808 had a diagnosis of depression. The overall incidence rate of depression was 9.47/1000 person-years (PYs) (10.72/1000 PYs for women and 8.27/1000 PYs for men). The incidence of depression was higher during the year after oral AD treatment initiation. Independent factors associated with depression included having had mental disorders other than depression, hospitalization, a higher number of different drugs taken and of physicians visited during the year before oral AD initiation. Moreover, we observed a statistically significant age-by-socioeconomic status interaction.The incidence of diagnosed depression is higher during the first year after oral AD treatment initiation. Clinicians could pay particular attention to women, patients starting an AD at a young age, those with a low socioeconomic status, and especially those with a history of anxiety or dementia.

Federal Highway Administration 100-year coating study.

DOT National Transportation Integrated Search

2012-11-01

The Federal Highway Administration 100-Year Coating Study was initiated in August 2009 to search for durable : coating systems at a reasonable cost. The objective of the study was to identify and evaluate coating materials that can : provide 100 year...

Downstream Imaging Utilization After Emergency Department Ultrasound Interpreted by Radiologists Versus Nonradiologists: A Medicare Claims-Based Study.

PubMed

Allen, Bibb; Carrol, L Van; Hughes, Danny R; Hemingway, Jennifer; Duszak, Richard; Rosenkrantz, Andrew B

2017-04-01

To study differences in imaging utilization downstream to initial emergency department (ED) ultrasound examinations interpreted by radiologists versus nonradiologists. Using 5% Medicare Research Identifiable Files from 2009 to 2014, we identified episodes where the place of service was "emergency room hospital" and the patient also underwent an ultrasound examination. We determined whether the initial ultrasound was interpreted by a radiologist or nonradiologist and then summed all additional imaging events occurring within 7, 14, and 30 days of each initial ED ultrasound. For each year and each study window, we calculated the mean number of downstream imaging procedures by specialty group. Of 200,357 ED ultrasound events, 163,569 (81.6%) were interpreted by radiologists and 36,788 (18.4%) by nonradiologists. Across all study years, ED patients undergoing ultrasound examinations interpreted by nonradiologists underwent 1.08, 1.22, and 1.34 additional diagnostic imaging studies at 7, 14, and 30 days, respectively (P < .01) compared with when the initial ultrasound examination was interpreted by a radiologist. From 2010 to 2014, the volume of downstream imaging for both radiologists and nonradiologists significantly decreased, with each year resulting in 0.08 fewer imaging examinations (P < .001) 14 days after the ED ultrasound event. Despite that decline, differences in downstream imaging between radiologists and nonradiologists persisted over time. Downstream imaging after an initial ED ultrasound is significantly reduced when the ultrasound examination is interpreted by a radiologist rather than a nonradiologist. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Using Incoming Student Information to Identify Students At-Risk of Not Returning to Their Initial Institution in Year Two. ACT Working Paper 2016 (04)

ERIC Educational Resources Information Center

Radunzel, Justine

2016-01-01

As pushes for increased accountability in higher education continue, postsecondary institutions are interested in identifying early on students who are at risk of leaving their institution. With this in mind, this study sought to identify incoming first-year student information (such as that available on the ACT student record) that postsecondary…

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003-2007).

PubMed

Green, Tiffany I; Tonozzi, Caroline C; Kirby, Rebecca; Rudloff, Elke

2011-02-01

To test whether an initial plasma lactate ≥ 6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation-volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival. Retrospective study over a 5-year period (2003-2007). Urban private referral small animal teaching hospital. Eighty-four client-owned dogs with a diagnosis of GDV and plasma lactate measurements. None. There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate ≥ 6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by ≥ 50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by ≥ 50% from the initial blood lactate. The results of this study indicate that an initial presenting plasma lactate concentration ≥ 6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations ≥ 50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome. © Veterinary Emergency and Critical Care Society 2011.

The Value of Serum CA125 in the Diagnosis of Borderline Tumors of the Ovary: A Subanalysis of the Prospective Multicenter ROBOT Study.

PubMed

Fotopoulou, Christina; Sehouli, Jalid; Ewald-Riegler, Nina; de Gregorio, Nikolaus; Reuss, Alexander; Richter, Rolf; Mahner, Sven; Kommoss, Friedrich; Schmalfeldt, Barbara; Fehm, Tanja; Hanker, Lars; Wimberger, Pauline; Canzler, Ulrich; Pfisterer, Jacobus; Kommoss, Stefan; Hauptmann, Steffen; du Bois, Andreas

2015-09-01

The value of the serum tumor marker CA125 in borderline tumors of the ovary (BOTs) is not well defined, with unclear benefit in both diagnosis and follow-up. The aim of the present project was to identify the predictive value of CA125 for stage and relapse. CA125 data were extracted from the ROBOT multicenter study of patients with BOT treated between 1998 and 2008 in 24 German centers. While patients' data were retrieved retrospectively from hospital records and clinical tumor registries, follow-up and independent central pathology review were performed prospectively. We identified 127 patients from the ROBOT database fulfilling the eligibility criterion of available CA125 at initial diagnosis. Eighty-three (65.3%) patients had increased CA125 levels (>35 U/L). Of the patients, 85.0% presented with serous and 13.4% with mucinous BOT histology, whereas 29.9% had stage I disease. Fifteen (11.8%) patients experienced a relapse. Multivariate analysis identified raised CA125, young age, and serous histology as independent predictors of peritoneal implants of any type at initial presentation. Raised CA125 at initial diagnosis was, however, not an independent predictor of future relapse. Elevated CA125 seems to be associated with the presence of peritoneal implants of any type at initial diagnosis of serous BOT, but failed to have any independent predictive value on future relapse. Prospective multicenter studies are warranted to evaluate CA125 measurements in the follow-up management of BOT.

5' diversity of human hepatic PXR (NR1I2) transcripts and identification of the major transcription initiation site.

PubMed

Kurose, Kouichi; Koyano, Satoru; Ikeda, Shinobu; Tohkin, Masahiro; Hasegawa, Ryuichi; Sawada, Jun-Ichi

2005-05-01

The human pregnane X receptor (PXR) is a crucial regulator of the genes encoding several major cytochrome P450 enzymes and transporters, such as CYP3A4 and MDR1, but its own transcriptional regulation remains unclear. To elucidate the transcriptional mechanisms of human PXR gene, we first endeavored to identify the transcription initiation site of human PXR using 5'-RACE. Five types of 5'-variable transcripts (a, b, c, d, and e) with common exon 2 sequence were found, and comparison of these sequences with the genomic sequence suggested that their 5' diversity is derived from initiation by alternative promoters and alternative splicing. None of the exons found in our study contain any new in-frame coding regions. Newly identified introns IVS-a and IVS-b were found to have CT-AC splice sites that do not follow the GT-AG rule of conventional donor and acceptor splice sites. Of the five types of 5' variable transcripts identified, RT-PCR showed that type-a was the major transcript type. Four transcription initiation sites (A-D) for type-a transcript were identified by 5'-RACE using GeneRacer RACE Ready cDNA (human liver) constructed by the oligo-capping method. Putative TATA boxes were located approximately 30 bp upstream from the transcriptional start sites of the major transcript (C) and the longest minor transcript (A) expressed in the human liver. These results indicate that the initiation of transcription of human PXR is more complex than previously reported.

A Comprehensive Evaluation of the Community Action Program in Austin and Travis County, Texas. Final Report.

ERIC Educational Resources Information Center

Tracor, Inc., Austin, TX.

Produced in four parts, this report covers a study of poor people in Austin, Texas, begun in 1967. Initial research efforts defined the problem and identified the population to be studied. An interim report was then made on the first year's findings. This involved evaluating some of the community action programs (CAP) and identifying and analyzing…

Sorption of VX to Clay Minerals and Soils: Thermodynamic and Kinetic Studies

DTIC Science & Technology

2012-12-01

Suspengel 200, humus , and soil substrates for use in this study. In addition, the authors gratefully acknowledge the support of the ECBC Technical...sorption profiles for VX with clay substrates ..................................55 30. Initial kinetic sorption profiles for VX with humus ...naturally derived garden soil amendment, identified as humus , was purchased from Frey Brothers (Quarryville, PA). Two natural soils, identified as MCL lot

Early appendectomy reduces costs in children with perforated appendicitis.

PubMed

Church, Joseph T; Klein, Edwin J; Carr, Benjamin D; Bruch, Steven W

2017-12-01

Perforated appendicitis can be managed with early appendectomy, or nonoperative management followed by interval appendectomy. We aimed to identify the strategy with the lowest health care utilization and cost. We retrospectively reviewed the medical records of all children ≤18 years old with perforated appendicitis admitted to a single institution between January 2009 and March 2016. After excluding immunosuppressed patients and transfers from outside hospitals, we grouped the remaining patients by early or interval appendectomy. Cost accounting data were obtained from our institutional database. The primary outcome was total hospital cost over 2 y from initial admission for appendicitis. Other outcomes analyzed included initial admission costs, number of admissions, emergency room and clinic visits, percutaneous procedures, cross-sectional and overall imaging studies, and length of stay. A total of 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and outside hospital transfers, 94 patients were included in the study. Thirty-nine underwent early appendectomy and 55 initial nonoperative management; of these, 54 underwent elective interval appendectomy. Five of 55 patients (9%) failed initial nonoperative management and required earlier-than-planned appendectomy. Total cost over 2 y was significantly lower with early appendectomy than initial nonoperative management ($19,300 ± 14,300 versus $26,000 ± 17,500; P = 0.05). Early appendectomy resulted in fewer hospital admissions, clinic visits, invasive procedures, and imaging studies. Early appendectomy results in lower hospital costs and less health care utilization compared with initial nonoperative management with elective interval appendectomy. A prospective study will shed more light on this question and can assess the role of nonoperative management without interval appendectomy in children with perforated appendicitis. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Multiple and substitute addictions involving prescription drugs misuse among 12th graders: gateway theory revisited with Market Basket Analysis.

PubMed

Jayawardene, Wasantha Parakrama; YoussefAgha, Ahmed Hassan

2014-01-01

This study aimed to identify the sequential patterns of drug use initiation, which included prescription drugs misuse (PDM), among 12th-grade students in Indiana. The study also tested the suitability of the data mining method Market Basket Analysis (MBA) to detect common drug use initiation sequences in large-scale surveys. Data from 2007 to 2009 Annual Surveys of Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents were used for this study. A close-ended, self-administered questionnaire was used to ask adolescents about the use of 21 substance categories and the age of first use. "Support%" and "confidence%" statistics of Market Basket Analysis detected multiple and substitute addictions, respectively. The lifetime prevalence of using any addictive substance was 73.3%, and it has been decreasing during past few years. Although the lifetime prevalence of PDM was 19.2%, it has been increasing. Males and whites were more likely to use drugs and engage in multiple addictions. Market Basket Analysis identified common drug use initiation sequences that involved 11 drugs. High levels of support existed for associations among alcohol, cigarettes, and marijuana, whereas associations that included prescription drugs had medium levels of support. Market Basket Analysis is useful for the detection of common substance use initiation sequences in large-scale surveys. Before initiation of prescription drugs, physicians should consider the adolescents' risk of addiction. Prevention programs should address multiple addictions, substitute addictions, common sequences in drug use initiation, sex and racial differences in PDM, and normative beliefs of parents and adolescents in relation to PDM.

Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report.

PubMed

Soghaier, Mohammed A; Hagar, Ahmed; Abbas, Mohammed A; Elmangory, Mutasim M; Eltahir, Khalid M; Sall, Amadou A

2013-10-01

Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. The field investigation confirmed the outbreak and identified its cause to be YF. National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Using technology to enhance the quality of home health care: three case studies of health information technology initiatives at the visiting nurse service of New York.

PubMed

Russell, David; Rosenfeld, Peri; Ames, Sylvia; Rosati, Robert J

2010-01-01

There is a growing recognition among health services researchers and policy makers that Health Information Technology (HIT) has the potential to address challenging issues that face patients and providers of healthcare. The Visiting Nurse Service of New York (VNSNY), a large not-for-profit home healthcare agency, has integrated technology applications into the service delivery model of several programs. Case studies, including the development and implementation, of three informatics initiatives at VNSNY are presented on: (1) Quality Scorecards that utilize process, outcomes, cost, and satisfaction measures to assess performance among clinical staff and programs; (2) a tool to identify patients at risk of being hospitalized, and (3) a predictive model that identifies patients who are eligible for physical rehabilitation services. Following a description of these initiatives, we discuss their impact on quality and process indicators, as well as the opportunities and challenges to implementation. © 2010 National Association for Healthcare Quality.

Key principles of community-based natural resource management: a synthesis and interpretation of identified effective approaches for managing the commons.

PubMed

Gruber, James S

2010-01-01

This article examines recent research on approaches to community-based environmental and natural resource management and reviews the commonalities and differences between these interdisciplinary and multistakeholder initiatives. To identify the most effective characteristics of Community-based natural resource management (CBNRM), I collected a multiplicity of perspectives from research teams and then grouped findings into a matrix of organizational principles and key characteristics. The matrix was initially vetted (or "field tested") by applying numerous case studies that were previously submitted to the World Bank International Workshop on CBNRM. These practitioner case studies were then compared and contrasted with the findings of the research teams. It is hoped that the developed matrix may be useful to researchers in further focusing research, understanding core characteristics of effective and sustainable CBNRM, providing practitioners with a framework for developing new CBNRM initiatives for managing the commons, and providing a potential resource for academic institutions during their evaluation of their practitioner-focused environmental management and leadership curriculum.

Predictors of patient entry into alcohol treatment after initial diagnosis.

PubMed

Kirchner, J E; Booth, B M; Owen, R R; Lancaster, A E; Smith, G R

2000-08-01

To improve the quality of care for alcohol-related disorders, key transitions in the continuum of care, including treatment entry, must be fully understood. The purpose of this study was to investigate identifiable predictors of patient entry into a substance-use treatment program following the initial diagnosis of an alcohol-related disorder on a medical or surgical inpatient unit. An administrative computerized database was used to identify the sample for this study. Inpatient and outpatient records were obtained from the Little Rock VAMC/DHCP. Predictors of patient entry into treatment within six months of the initial diagnosis of an alcohol related disorder included age younger than than 60 (odds ratio [OR] = 4.6), not married (OR = 1.7), primary diagnosis of an alcohol-related disorder (OR = 7.7), diagnosis of a comorbid drug (OR = 4.3) or psychiatric disorder (OR = 3.6), diagnosis by a medical as opposed to a surgical specialty (OR = 6.0), and African American (OR = 1.7).

Brain-Derived Neurotrophic Factor Levels in Autism: A Systematic Review and Meta-Analysis.

PubMed

Saghazadeh, Amene; Rezaei, Nima

2017-04-01

Brain-derived neurotrophic factor (BDNF) plays an important role in activity-dependent synaptic plasticity. Altered blood BDNF levels have been frequently identified in people with autism spectrum disorders (ASD). There are however wide discrepancies in the evidence. Therefore, we performed the present systematic review and meta-analysis aimed at qualitative and quantitative synthesis of studies that measured blood BDNF levels in ASD and control subjects. Observational studies were identified through electronic database searching and also hand-searching of reference lists of relevant articles. A total of 183 papers were initially identified for review and eventually twenty studies were included in the meta-analysis. A meta-analysis of blood BDNF in 887 patients with ASD and 901 control subjects demonstrated significantly higher BDNF levels in ASD compared to controls with the SMD of 0.47 (95% CI 0.07-0.86, p = 0.02). In addition subgroup meta-analyses were performed based on the BDNF specimen. The present meta-analysis study led to conclusion that BDNF might play role in autism initiation/ propagation and therefore it can be considered as a possible biomarker of ASD.

Using probabilistic record linkage methods to identify Australian Indigenous women on the Queensland Pap Smear Register: the National Indigenous Cervical Screening Project.

PubMed

Whop, Lisa J; Diaz, Abbey; Baade, Peter; Garvey, Gail; Cunningham, Joan; Brotherton, Julia M L; Canfell, Karen; Valery, Patricia C; O'Connell, Dianne L; Taylor, Catherine; Moore, Suzanne P; Condon, John R

2016-02-12

To evaluate the feasibility and reliability of record linkage of existing population-based data sets to determine Indigenous status among women receiving Pap smears. This method may allow for the first ever population measure of Australian Indigenous women's cervical screening participation rates. A linked data set of women aged 20-69 in the Queensland Pap Smear Register (PSR; 1999-2011) and Queensland Cancer Registry (QCR; 1997-2010) formed the Initial Study Cohort. Two extracts (1995-2011) were taken from Queensland public hospitals data (Queensland Hospital Admitted Patient Data Collection, QHAPDC) for women, aged 20-69, who had ever been identified as Indigenous (extract 1) and had a diagnosis or procedure code relating to cervical cancer (extract 2). The Initial Study Cohort was linked to extract 1, and women with cervical cancer in the initial cohort were linked to extract 2. The proportion of women in the Initial Cohort who linked with the extracts (true -pairs) is reported, as well as the proportion of potential pairs that required clerical review. After assigning Indigenous status from QHAPDC to the PSR, the proportion of women identified as Indigenous was calculated using 4 algorithms, and compared. There were 28,872 women (2.1%) from the Initial Study Cohort who matched to an ever Indigenous record in extract 1 (n=76,831). Women with cervical cancer in the Initial Study Cohort linked to 1385 (71%) records in extract 2. The proportion of Indigenous women ranged from 2.00% to 2.08% when using different algorithms to define Indigenous status. The Final Study Cohort included 1,372,823 women (PSR n=1,374,401; QCR n=1955), and 5,062,118 records. Indigenous status in Queensland cervical screening data was successfully ascertained through record linkage, allowing for the crucial assessment of the current cervical screening programme for Indigenous women. Our study highlights the need to include Indigenous status on Pap smear request and report forms in any renewed and redesigned cervical screening programme in Australia. 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/

Factors influencing adolescent girls' decision in initiation for human papillomavirus vaccination: a cross-sectional study in Hong Kong.

PubMed

Lee, Albert; Ho, Mandy; Cheung, Calvin Ka Man; Keung, Vera Mei Wen

2014-09-08

Cervical cancer is one of the common cancers among women worldwide. Despite HPV vaccination being one of the effective preventive measures, it is not included in government vaccination programme in Hong Kong. This study aimed to assess the knowledge of and attitude towards cervical cancer prevention among Chinese adolescent girls in Hong Kong, and to identify factors influencing the initiation of HPV vaccination. This was a cross-sectional study conducted in Hong Kong during the period of October 2010 to November 2010. A self-administered questionnaire was used, with 1,416 girls from 8 secondary schools completing the questionnaire. Knowledge scores were composited and initiation of HPV vaccination was staged based on stage of change. Analyses were conducted to identify the association of initiation of HPV vaccination with participant's personal and family factors as well as their knowledge and attitude towards cervical cancer prevention. The uptake rate of HPV vaccination was low (7%) with 58% respondents in pre-contemplation and contemplation stage. The survey identified a significant gap in knowledge on cervical cancer prevention. The main channels of information were from media and very few from schools or parents. However, 70% expressed their wishes to have more information on cancer prevention, and 78% stated that they were willing to change their lifestyles if they knew the ways of prevention. Multivariate analysis identified three independent significant factors for initiation of vaccination (action and intention): perceived cancer as terrifying disease, school should provide more information on cancer prevention, and comments from relatives and friends having received the vaccine. The cost of vaccination and socio-economic background were not found to be significant. Public education on cervical cancer needs to be well penetrated into the community for more sharing among friends and relatives. School as setting to provide source of information would facilitate uptake rate of HPV vaccine as students have expressed their wishes that school should provide more information on prevention of cancer. School and community education on cancer prevention would help adolescents to have better understanding of the seriousness of cancer.

What is an adequate sample size? Operationalising data saturation for theory-based interview studies.

PubMed

Francis, Jill J; Johnston, Marie; Robertson, Clare; Glidewell, Liz; Entwistle, Vikki; Eccles, Martin P; Grimshaw, Jeremy M

2010-12-01

In interview studies, sample size is often justified by interviewing participants until reaching 'data saturation'. However, there is no agreed method of establishing this. We propose principles for deciding saturation in theory-based interview studies (where conceptual categories are pre-established by existing theory). First, specify a minimum sample size for initial analysis (initial analysis sample). Second, specify how many more interviews will be conducted without new ideas emerging (stopping criterion). We demonstrate these principles in two studies, based on the theory of planned behaviour, designed to identify three belief categories (Behavioural, Normative and Control), using an initial analysis sample of 10 and stopping criterion of 3. Study 1 (retrospective analysis of existing data) identified 84 shared beliefs of 14 general medical practitioners about managing patients with sore throat without prescribing antibiotics. The criterion for saturation was achieved for Normative beliefs but not for other beliefs or studywise saturation. In Study 2 (prospective analysis), 17 relatives of people with Paget's disease of the bone reported 44 shared beliefs about taking genetic testing. Studywise data saturation was achieved at interview 17. We propose specification of these principles for reporting data saturation in theory-based interview studies. The principles may be adaptable for other types of studies.

Functional Analysis of Problem Behavior: A Systematic Approach for Identifying Idiosyncratic Variables

PubMed Central

Roscoe, Eileen M.; Schlichenmeyer, Kevin J.; Dube, William V.

2015-01-01

When inconclusive functional analysis (FA) outcomes occur, a number of modifications have been made to enhance the putative establishing operation or consequence associated with behavioral maintenance. However, a systematic method for identifying relevant events to test during modified FAs has not been evaluated. The purpose of this study was to develop and evaluate a technology for systematically identifying events to test in a modified FA after an initial FA led to inconclusive outcomes. Six individuals whose initial FA showed little or no responding or high levels only in the control condition participated. An indirect assessment (IA) questionnaire developed for identifying idiosyncratic variables was administered, and a descriptive analysis (DA) was conducted. Results from the IA only or a combination of the IA and DA were used to inform modified FA test and control conditions. Conclusive FA outcomes were obtained with five of the six participants during the modified FA phase. PMID:25930176

Practical recommendations for the evaluation of improvement initiatives

PubMed Central

Parry, Gareth; Coly, Astou; Goldmann, Don; Rowe, Alexander K; Chattu, Vijay; Logiudice, Deneil; Rabrenovic, Mihajlo; Nambiar, Bejoy

2018-01-01

Abstract A lack of clear guidance for funders, evaluators and improvers on what to include in evaluation proposals can lead to evaluation designs that do not answer the questions stakeholders want to know. These evaluation designs may not match the iterative nature of improvement and may be imposed onto an initiative in a way that is impractical from the perspective of improvers and the communities with whom they work. Consequently, the results of evaluations are often controversial, and attribution remains poorly understood. Improvement initiatives are iterative, adaptive and context-specific. Evaluation approaches and designs must align with these features, specifically in their ability to consider complexity, to evolve as the initiative adapts over time and to understand the interaction with local context. Improvement initiatives often identify broadly defined change concepts and provide tools for care teams to tailor these in more detail to local conditions. Correspondingly, recommendations for evaluation are best provided as broad guidance, to be tailored to the specifics of the initiative. In this paper, we provide practical guidance and recommendations that funders and evaluators can use when developing an evaluation plan for improvement initiatives that seeks to: identify the questions stakeholders want to address; develop the initial program theory of the initiative; identify high-priority areas to measure progress over time; describe the context the initiative will be applied within; and identify experimental or observational designs that will address attribution. PMID:29447410

Strengthening the role of the ward manager: a review of the literature.

PubMed

Pegram, Anne M; Grainger, Michelle; Sigsworth, Janice; While, Alison E

2014-09-01

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. To identify initiatives that have strengthened the ward manager role. A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems. © 2013 John Wiley & Sons Ltd.

Initial antihyperglycemic drug therapy among 241 327 adults with newly identified diabetes from 2005 through 2010: a surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) study.

PubMed

Raebel, Marsha A; Xu, Stanley; Goodrich, Glenn K; Schroeder, Emily B; Schmittdiel, Julie A; Segal, Jodi B; O'Connor, Patrick J; Nichols, Gregory A; Lawrence, Jean M; Kirchner, H Lester; Elston Lafata, Jennifer; Butler, Melissa; Newton, Katherine M; Steiner, John F

2013-10-01

Among adults with incident diabetes, data are lacking about first antihyperglycemic initiation and whether medication choice aligns with recommendations. To identify predictors of initiating any antihyperglycemic, and specifically sulfonylurea versus metformin. This retrospective cohort study included 241 327 patients from 11 US health systems, 2005 through 2010. Assessments included antihyperglycemic initiation within 6 months of diabetes identification, first medication initiated, and initiation predictors. Only 40.3% (n = 97 350) started any antihyperglycemic; 75.2% (n = 73 221) started metformin. Glycosylated hemoglobin (HbA1c) predicted initiating any antihyperglycemic (HbA1c >9%, relative risk [RR] = 3.94, 95% CI = 3.82, 4.07, vs HbA1c >6.5%-7%). Age modified the HbA1c effect: at higher HbA1c, likelihood of starting antihyperglycemics differed little across ages; at lower HbA1c, older patients were less likely to start antihyperglycemics (P < .001). Individuals with elevated serum creatinine (SCr) were more likely to started on sulfonylurea (SCr = 1.4-2, RR = 2.21 [2.05, 2.39]; SCr >2, RR = 2.75 [2.30, 3.29] vs normal SCr), particularly as HbA1c increased: patients with HbA1c 8%-9% and SCr >2 were 5.59 times (2.94, 10.65) more likely to start sulfonylurea versus those with HbA1c >6.5%-7% and normal SCr. Age predicted sulfonylurea initiation (20-39 years, RR = 0.87 [0.79, 0.95]; ≥ 80 years, RR = 2.41 [2.20, 2.65] vs 50-59 years). Among adults with incident diabetes, metformin was generally the first antihyperglycemic initiated. However, 59.7% did not start any antihyperglycemic at diabetes identification. HbA1c and age predict antihyperglycemic initiation; SCr and age predict sulfonylurea initiation.

Factors associated with early outcomes following standardised therapy in children with ulcerative colitis (PROTECT): a multicentre inception cohort study.

PubMed

Hyams, Jeffrey S; Davis, Sonia; Mack, David R; Boyle, Brendan; Griffiths, Anne M; LeLeiko, Neal S; Sauer, Cary G; Keljo, David J; Markowitz, James; Baker, Susan S; Rosh, Joel; Baldassano, Robert N; Patel, Ashish; Pfefferkorn, Marian; Otley, Anthony; Heyman, Melvin; Noe, Joshua; Oliva-Hemker, Maria; Rufo, Paul; Strople, Jennifer; Ziring, David; Guthery, Stephen L; Sudel, Boris; Benkov, Keith; Wali, Prateek; Moulton, Dedrick; Evans, Jonathan; Kappelman, Michael D; Marquis, Alison; Sylvester, Francisco A; Collins, Margaret H; Venkateswaran, Suresh; Dubinsky, Marla; Tangpricha, Vin; Spada, Krista L; Britt, Ashley; Saul, Bradley; Gotman, Nathan; Wang, Jessie; Serrano, Jose; Kugathasan, Subra; Walters, Thomas; Denson, Lee A

2017-12-01

Previous retrospective studies of paediatric ulcerative colitis have had limited ability to describe disease progression and identify predictors of treatment response. In this study, we aimed to identify characteristics associated with outcomes following standardised therapy after initial diagnosis. The PROTECT multicentre inception cohort study was based at 29 centres in the USA and Canada and included paediatric patients aged 4-17 years who were newly diagnosed with ulcerative colitis. Guided by the Pediatric Ulcerative Colitis Activity Index (PUCAI), patients received initial standardised treatment with mesalazine (PUCAI 10-30) oral corticosteroids (PUCAI 35-60), or intravenous corticosteroids (PUCAI ≥65). The key outcomes for this analysis were week 12 corticosteroid-free remission, defined as PUCAI less than 10 and taking only mesalazine, and treatment escalation during the 12 study weeks to anti-tumour necrosis factor α (TNFα) agents, immunomodulators, or colectomy among those initially treated with intravenous corticosteroids. We identified independent predictors of outcome through multivariable logistic regression using a per-protocol approach. This study is registered with ClinicalTrials.gov, number NCT01536535. Patients were recruited between July 10, 2012, and April 21, 2015. 428 children initiated mesalazine (n=136), oral corticosteroids (n=144), or intravenous corticosteroids (n=148). Initial mean PUCAI was 31·1 (SD 13·3) in children initiating with mesalazine, 50·4 (13·8) in those initiating oral corticosteroids, and 66·9 (13·7) in those initiating intravenous corticosteroids (p<0·0001 for between-group comparison). Week 12 outcome data were available for 132 patients who initiated with mesalazine, 141 with oral corticosteroids, and 143 with intravenous corticosteroids. Corticosteroid-free remission with the patient receiving mesalazine treatment only at 12 weeks was achieved by 64 (48%) patients in the mesalazine group, 47 (33%) in the oral corticosteroid group, and 30 (21%) in the intravenous corticosteroid group (p<0·0001). Treatment escalation was required by nine (7%) patients in the mesalazine group, 21 (15%) in the oral corticosteroid group, and 52 (36%) in the intravenous corticosteroid group (p<0·0001). Eight patients, all of whom were initially treated with intravenous corticosteroids, underwent colectomy. Predictors of week 12 corticosteroid-free remission were baseline PUCAI less than 35 (odds ratio 2·44, 95% CI 1·41-4·22; p=0·0015), higher baseline albumin by 1 g/dL increments among children younger than 12 years (4·05, 1·90-8·64; p=0·00030), and week 4 remission (6·26, 3·79-10·35; p<0·0001). Predictors of treatment escalation by week 12 in patients initially treated with intravenous corticosteroids included baseline total Mayo score of 11 or higher (2·59, 0·93-7·21; p=0·068 [retained in model due to clinical relevance]), rectal biopsy eosinophil count less than or equal to 32 cells per high power field (4·55, 1·62-12·78; p=0·0040), rectal biopsy surface villiform changes (3·05, 1·09-8·56; p=0·034), and not achieving week 4 remission (30·28, 6·36-144·20; p<0·0001). Our findings provide guidelines to assess the response of children newly diagnosed with ulcerative colitis to standardised initial therapy and identify predictors of treatment response and failure. These data suggest that additional therapeutic interventions might be warranted to improve early outcomes, especially in patients presenting with severe disease and requiring intravenous corticosteroids. National Institutes of Health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Students with Special Needs and 1:1 Computing: A Teacher's Perspective

ERIC Educational Resources Information Center

Corn, Jenifer; Tagsold, Jennifer T.; Argueta, Rodolfo

2012-01-01

To better understand the growing trend of 1:1 learning, researchers conducted an evaluation of a laptop initiative in 18 North Carolina high schools. The goal of the study was to provide information about the value of the initiative to enhance student learning, as well as to identify challenges to the successful implementation of 1:1 programs,…

Learning from Experience: A Cross-Case Comparison of School-to-Work Transition Reform Initiatives.

ERIC Educational Resources Information Center

Rogers, Anne M.; And Others

A cross-case study approach was used to determine how school-to-work reform affects clients and participants and to identify elements critical to the success of school-to-work systems. Fourteen school-to-work reform initiatives in communities across the United States were examined by using a research protocol that included individual interviews,…

Independence and Interdependence: An Analysis of Pre-Service Candidates' Use of Focused Assignments on an Electronic Discussion Forum during the Initial Field Experience

ERIC Educational Resources Information Center

Fisch, Audrey A.; Bennett, Deborah J.

2011-01-01

This article describes a case study using an electronic learning platform for creating an interactive learning community through asynchronous discussion to enhance the initial field experience of secondary math and English teacher candidates enrolled in Field Experience. We identified three problems with the field experience course--lack of…

The Use of Classroom Walk-Through Observations as a Strategy to Improve Teaching and Learning: An Administrative Perspective

ERIC Educational Resources Information Center

Weller, Mark J.

2010-01-01

The purpose of this study was to identify the possible use of structured classroom walk-through observations as a strategy to improve teaching and learning. A wide variety of programs and initiatives have recently been implemented across the country to improve student achievement. One such initiative is classroom walk-through observations.…

Final definition and preliminary design study for the initial atmospheric cloud physics laboratory, a spacelab mission payload

NASA Technical Reports Server (NTRS)

1976-01-01

The Atmospheric Cloud Physics Laboratory (ACPL) task flow is shown. Current progress is identified. The requirements generated in task 1 have been used to formulate an initial ACPL baseline design concept. ACPL design/functional features are illustrated. A timetable is presented of the routines for ACPL integration with the spacelab system.

Trajectories of Social Withdrawal from Grades 1 to 6: Prediction from Early Parenting, Attachment, and Temperament

ERIC Educational Resources Information Center

Booth-LaForce, Cathryn; Oxford, Monica L.

2008-01-01

From 1,092 children in the NICHD Study of Early Child Care and Youth Development, the authors identified 3 trajectory patterns of social withdrawal from teacher reports in Grades 1-6: a normative consistently low group (86%), a decreasing group (5%) with initially high withdrawal that decreased, and an increasing group (9%) with initially low…

Polygenic risk accelerates the developmental progression to heavy, persistent smoking and nicotine dependence: Evidence from a 4-Decade Longitudinal Study

PubMed Central

Moffitt, Terrie E; Baker, Timothy B; Biddle, Andrea K; Evans, James P; Harrington, HonaLee; Houts, Renate; Meier, Madeline; Sugden, Karen; Williams, Benjamin; Poulton, Richie; Caspi, Avshalom

2013-01-01

OBJECTIVE To test how genomic loci identified in genome-wide association studies (GWAS) influence the developmental progression of smoking behavior. DESIGN A 38-year prospective longitudinal study of a representative birth-cohort. SETTING The Dunedin Multidisciplinary Health and Development Study, New Zealand. PARTICIPANTS N=1037 male and female study members. MAIN EXPOSURES We assessed genetic risk with a multi-locus genetic risk score (GRS). The GRS was composed of single-nucleotide polymorphisms identified in three meta-analyses of GWAS of smoking quantity phenotypes. OUTCOME MEASURES Smoking initiation, conversion to daily smoking, progression to heavy smoking, nicotine dependence (Fagerstrom Test of Nicotine Dependence), and cessation difficulties were evaluated at eight assessments spanning ages 11-38 years. RESULTS Genetic risk score was unrelated to smoking initiation. However, individuals at higher genetic risk were more likely to convert to daily smoking as teenagers, progressed more rapidly from smoking initiation to heavy smoking, persisted longer in smoking heavily, developed nicotine dependence more frequently, were more reliant on smoking to cope with stress, and were more likely to fail in their cessation attempts. Further analysis revealed that two adolescent developmental phenotypes—early conversion to daily smoking and rapid progression to heavy smoking--mediated associations between the genetic risk score and mature phenotypes of persistent heavy smoking, nicotine dependence, and cessation failure. The genetic risk score predicted smoking risk over and above family history. CONCLUSIONS Initiatives that disrupt the developmental progression of smoking behavior among adolescents may mitigate genetic risks for developing adult smoking problems. Future genetic research may maximize discovery potential by focusing on smoking behavior soon after smoking initiation and by studying young smokers. PMID:23536134

Perinatal depressive symptoms, sociodemographic correlates, and breast-feeding among Chinese women.

PubMed

Lau, Ying; Chan, Kin Sun

2009-01-01

The objectives of the study were to (1) investigate the relationship between breast-feeding initiation and duration and patterns of perinatal depressive symptoms and (2) identify the sociodemographic correlates of such initiation and duration. A sample of 2365 women in their second and third trimesters and 6 weeks postdelivery was recruited via systematic sampling from 6 regional public hospitals in Hong Kong. The women were identified as having perinatal depressive symptoms, using the Edinburgh Postnatal Depression Scale. Their sociodemographic variables were investigated using the empirical evidence. A total of 285 (47.66%) of the participants were found to have initiated breast-feeding, of whom 222 had breast-fed for more than 3 weeks. Logistic regression analysis revealed a monthly family income less than HK$5000 to be significantly associated with breast-feeding initiation and that housewives or part-time workers with antenatal depressive symptoms at 32 weeks of gestation were significantly more likely to breast-feed for longer duration. These findings help explicate breast-feeding practices among Chinese women and indicate that effective breast-feeding promotion should consider sociodemographic correlates and perinatal depressive symptoms. The study's limitations and implications are discussed.

NEP processing, operations, and disposal

NASA Technical Reports Server (NTRS)

Stancati, Mike

1993-01-01

Several recent studies by ASAO/NPO staff members at LeRC and by other organizations have highlighted the potential benefits of using Nuclear Electric Propulsion (NEP) as the primary transportation means for some of the proposed missions of the Space Exploration Initiative. These include the potential to reduce initial mass in orbit and Mars transit time. Modular NEP configurations also introduce fully redundant main propulsion to Mars flight systems adding several abort or fall back options not otherwise available. Recent studies have also identified mission operations, such as on orbital assembly, refurbishment, and reactor disposal, as important discriminators for propulsion system evaluation. This study is intended to identify and assess 'end-to-end' operational issues associated with using NEP for transporting crews and cargo between Earth and Mars. We also include some consideration of lunar cargo transfer as well.

Two-part random effects growth modeling to identify risks associated with alcohol and cannabis initiation, initial average use and changes in drug consumption in a sample of adult, male twins

PubMed Central

Gillespie, Nathan A.; Lubke, Gitta H.; Gardner, Charles O.; Neale, Michael C.; Kendler, Kenneth S.

2012-01-01

Aims Our aim was to profile alcohol and cannabis initiation and to characterize the effects of developmental and environmental risk factors on changes in average drug use over time. Design We fitted a two-part random effects growth model to identify developmental and environmental risks associated with alcohol and cannabis initiation, initial average use and changes in average use. Participants 1796 males aged 24–63 from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Measurements Data from three interview waves included self-report measures of average alcohol and cannabis use between ages 15 and 24, genetic risk of problem drug use, childhood environmental risks, personality, psychiatric symptoms, as well as personal, family and social risk factors. Findings Average alcohol and cannabis use were correlated at all ages. Genetic risk of drug use based on family history, higher sensation seeking, and peer group deviance predicted both alcohol and cannabis initiation. Higher drug availability predicted cannabis initiation while less parental monitoring and drug availability were the best predictors of how much cannabis individuals consumed over time. Conclusion The liability to initiate alcohol and cannabis, average drug use as well as changes in drug use during teenage years and young adulthood is associated with known risk factors. PMID:22177896

Identifying Threshold Concepts: Case Study of an Open Catchment Hydraulics Course

ERIC Educational Resources Information Center

Knight, D. B.; Callaghan, D. P.; Baldock, T. E.; Meyer, J. H. F.

2014-01-01

The Threshold Concept Framework is used to initiate a dialogue on an empirically supported pedagogy that focuses on students' conceptual understanding required for solving application-based problems. The present paper uses a triangulation approach to identify the threshold concept in a third-year undergraduate civil engineering course on open…

The relationship among learning, health beliefs, alcohol consumption, and tobacco use of primigravidas.

PubMed

Strychar, I M; Griffith, W S; Conry, R F

1990-01-01

The purposes of this study were to identify how pregnant women learned about alcohol consumption and tobacco use, and to identify the relationship between learning, health beliefs and behaviours. Determining how pregnant women learned was based upon Tough's and Knowles' view of learning and consisted of identifying knowledge levels, resources utilized, advice given, time in learning, and initiators of learning episodes. The ex post facto research design involved one-hour interviews with 128 primigravidas at 8 hospitals in British Columbia, 75% of the sample consumed alcoholic beverages before becoming pregnant and these women reduced their intake by an average of 82%; 39% smoked cigarettes before becoming pregnant and these women reduced their cigarette smoking by an average of 52%. Drinkers were advised not to consume alcoholic beverages during pregnancy, whereas smokers were told by friends and family members that it was okay to smoke during pregnancy. Engagement in other-initiated learning episodes was found to be correlated with reduced alcohol intake (p less than or equal to .05); whereas, health beliefs were not correlated with reduced alcohol intake. Neither self-initiated nor other-initiated learning was associated with reduced cigarette smoking; however, perceived risk was associated with reduced cigarette smoking. Knowledge about smoking was associated with health beliefs, suggesting that learning may be indirectly related to smoking behaviours. This study should be replicated with a larger sample to determine the directionality of the association between learning, beliefs and behaviours.

What factors have influence on persistence of neck pain after a whiplash?

PubMed

Cobo, Eulogio Pleguezuelos; Mesquida, M Engracia Pérez; Fanegas, Elisabet Palomera; Atanasio, Eva Moreno; Pastor, M Beatriz Samitier; Pont, Cristina Perucho; Prieto, Carlos Matarrubia; Gómez, Genoveva Reverón; Cano, Lluis Guirao

2010-04-20

Prospective longitudinal study. To identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury. The prognosis factors for poor recovery in acute whiplash are not conclusive. We included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment. The variables were collected following a protocol designed for the study, and all patients were assessed through the Visual Analogue Scale (VAS) for the intensity of neck pain, the Goldberg Depression and Anxiety Scale and the Northwick Park Neck Pain Questionnaire (NPH) for cervical column functionality at initial evaluation and 6 months later. Factors related with VAS 6 months after the whiplash injury were women, age, number of days of cervical column immobilization, previous neck pain, self-employed workers, housewives, pensioners, students, presence of headache or dizziness, and VAS, Goldberg Depression and Anxiety scale, and NPH scores at initial evaluation. In multivaried analysis, it had been found that the variables that had influence on VAS 6 months after the whiplash injury were statistically significant for age, presence of dizziness, self-employed workers, and VAS and NPH scores at initial evaluation. Our findings indicate that factors that allow us to identify patients at risk for poor recovery are age, dizziness, and initial evaluation of neck pain with VAS and cervical column functionality with NPH.

'Crisis' and 'everyday' initiators: A qualitative study of coercion and agency in the context of methadone maintenance treatment initiation.

PubMed

Damon, Will; Small, Will; Anderson, Solanna; Maher, Lisa; Wood, Evan; Kerr, Thomas; McNeil, Ryan

2017-03-01

Patient attrition is common among people enrolled in methadone maintenance treatment (MMT) programs and most pronounced during the first year of treatment. However, the experiences of patients initiating MMT have been overlooked in the literature. This study explores experiences of MMT initiation among MMT patients, focusing on contextual influences on MMT initiation and perceptions of MMT and their subsequent influence on treatment retention. Semi-structured qualitative interviews were conducted with 39 MMT patients in Vancouver, Canada. Individuals reporting enrolment in MMT were recruited from within two ongoing cohort studies comprised of people who use drugs. Interview transcripts were analysed using an inductive and iterative approach. Two groups of MMT initiators were identified: (i) 'crisis initiators' prescribed methadone following critical transition events, such as incarceration or pregnancy; and (ii) 'everyday initiators' enrolled in MMT as part of routine healthcare utilisation. While most 'crisis initiators' and some 'everyday initiators' described experiencing coercion during MMT initiation, 'crisis initiators' were further subjected to the coercive leveraging of their vulnerability to motivate 'consent' for MMT. 'Crisis initiators' developed negative views towards MMT and were more likely to discontinue treatment. Long-standing patient-provider relationships and open dialogue were associated with more positive views regarding MMT, regardless of the circumstances of initiation. Findings underscore the need for clear and effective communication regarding treatment regimens and expectations during MMT initiation. Furthermore, training in trauma-informed care may help reduce perceptions of coercion and rates of early treatment termination. [Damon W, Small W, Anderson S, Maher L, Wood E, Kerr T, McNeil R. Crisis' and 'everyday' initiators: A qualitative study of coercion and agency in the context of methadone maintenance treatment initiation. Drug Alcohol Rev 2017;36:253-260]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

A methodology to condition distorted acoustic emission signals to identify fracture timing from human cadaver spine impact tests.

PubMed

Arun, Mike W J; Yoganandan, Narayan; Stemper, Brian D; Pintar, Frank A

2014-12-01

While studies have used acoustic sensors to determine fracture initiation time in biomechanical studies, a systematic procedure is not established to process acoustic signals. The objective of the study was to develop a methodology to condition distorted acoustic emission data using signal processing techniques to identify fracture initiation time. The methodology was developed from testing a human cadaver lumbar spine column. Acoustic sensors were glued to all vertebrae, high-rate impact loading was applied, load-time histories were recorded (load cell), and fracture was documented using CT. Compression fracture occurred to L1 while other vertebrae were intact. FFT of raw voltage-time traces were used to determine an optimum frequency range associated with high decibel levels. Signals were bandpass filtered in this range. Bursting pattern was found in the fractured vertebra while signals from other vertebrae were silent. Bursting time was associated with time of fracture initiation. Force at fracture was determined using this time and force-time data. The methodology is independent of selecting parameters a priori such as fixing a voltage level(s), bandpass frequency and/or using force-time signal, and allows determination of force based on time identified during signal processing. The methodology can be used for different body regions in cadaver experiments. Copyright © 2014 Elsevier Ltd. All rights reserved.

The influence of country of origin on engagement in self-care behaviours following heart surgery: a descriptive correlational study.

PubMed

Fredericks, Suzanne

2012-08-01

The aim of this study was to determine whether an individual's country of origin influenced performance of self-care behaviours after heart surgery. Patients are required to perform self-care behaviours following cardiovascular surgery. Usual care encompasses a patient education initiative that addresses self-care behaviour performance. Within Canada, current heart surgery patient education efforts have been designed and evaluated using homogenous samples that self-identify their country of origin as England, Ireland or Scotland. However, approximately 42·6% of Canadian cardiovascular surgical patients self-identify their country of origin as India or China. Thus, current cardiovascular surgery patient education initiatives may not be applicable to all patients undergoing heart surgery, which may result in decreased patient outcomes such as performance of self-care behaviours. This descriptive study. A convenience sample of 90 patients who underwent heart surgery at one of two university-affiliated teaching hospitals, representing individuals of diverse backgrounds. Point-biserial correlational analysis was conducted to determine the relationship between country of origin and performance of self-care behaviours. Findings indicate individuals who self-identified their country of origin as England or Ireland were associated with a higher score on the number of self-care behaviours performed (p < 0·05) than individuals who self-identified other countries of origin. Self-care behaviours were taught using patient education materials that were designed based on feedback obtained from individuals whose country of origin was England or Ireland. This study provides preliminary evidence to suggest country of origin influences the amount of self-care behaviours individuals will perform. Patient education initiatives should incorporate the values, beliefs, attitudes and customs reflective of an individual's country of origin to enhance the likelihood of producing desired outcomes. © 2012 Blackwell Publishing Ltd.

The Existence of Trust in the Relationship of Parents and District Administration in the Placement Process of 3- to 8-Year-Old Students with Autism

ERIC Educational Resources Information Center

Wellner, Laurie L.

2009-01-01

Purpose: The purpose of this study was to identify the degree to which trust-building variables exist between public school districts and parents of 3- to 8-year-old children with autism during the initial placement process in the perception of special education administration. Additional purposes of the study were to identify barriers and…

Defence Reporter. Summer/Autumn 2011

DTIC Science & Technology

2011-01-01

of protection afforded by this material was determined against a liquid challenge. R000259AA Cermet Materials for Armour Applications Dstl Porton...initial research, however areas of focus have been identified and a comprehensive plan of study has been developed. R000261FE Force Multipliers in... study was not intended to be a rigorous quantitative analysis of COIN. It has identified six factors that have had an overall positive effect upon the

A case study of polypharmacy management in nine European countries: Implications for change management and implementation

PubMed Central

MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F.; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Background Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Methods Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Results Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Conclusion Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives. PMID:29668763

Predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers.

PubMed

Lok, Kris Yuet Wan; Bai, Dorothy Li; Tarrant, Marie

2015-11-03

In recent years there has been a steady influx of immigrants into Hong Kong from Mainland China, where breastfeeding patterns differ. Studies in other regions have found substantial differences in breastfeeding rates between native-born and immigrant mothers. The purpose of this study was to examine factors associated with breastfeeding initiation in Hong Kong born and Mainland China born mothers living in Hong Kong. We used a multi-center cross-sectional study design and recruited 2761 new mothers from the postnatal wards of all eight public hospitals in Hong Kong that offer obstetric services. We assessed breastfeeding status as well as various socio-demographic, maternal and birth characteristics. Chi-square tests and multivariable logistic regression were used to identify the predictors of breastfeeding initiation in Hong Kong born and Mainland China born participants. 80.3 % of Hong Kong and 81.1 % of Mainland Chinese born women initiated breastfeeding. In the fully adjusted models, multiparity (Odds Ratio [OR] 0.53, 95 % CI 0.43-0.66) and maternal smoking (OR 0.29, 95 % CI 0.18-0.45) were strongly associated with failure to initiate breastfeeding in both Hong Kong and Mainland China born participants. In Hong Kong born mothers, participants with lower maternal education and those who had a cesarean section were significantly less likely to breastfeed. For Mainland China born mothers, paternal smoking (OR 0.70, 95 % CI 0.49-0.99) and having a pregnancy-related health problem (OR 0.60, 95 % CI 0.38-0.94) were both additional risk factors for not breastfeeding. This study has identified predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers. Given the current high breastfeeding initiation rates among both groups, antenatal breastfeeding education and promotion programmes need to specifically intervene with sub-groups of pregnant women at risk for not breastfeeding so that their efforts are more strategic and cost-effective.

Finite Element Analysis of Composite Joint Configurations with Gaps and Overlaps

NASA Technical Reports Server (NTRS)

Krueger, Ronald

2014-01-01

The goal of the current study is to identify scenarios for which thermal and moisture effects become significant in the loading of a composite structure. In the current work, a simple configuration was defined, and material properties were selected. A Fortran routine was created to automate the mesh generation process. The routine was used to create the models for the initial mesh refinement study. A combination of element length and width suitable for further studies was identified. Also, the effect of the overlap length and gap length on computed shear and through-thickness stresses along the bondline of the joints was studied for the mechanical load case. Further, the influence of neighboring gaps and overlaps on these joint stresses was studied and was found to be negligible. The results suggest that for an initial study it is sufficient to focus on one configuration with fixed overlap and gap lengths to study the effects of mechanical, thermal and moisture loading and combinations thereof on computed joint stresses

Benchmarking: applications to transfusion medicine.

PubMed

Apelseth, Torunn Oveland; Molnar, Laura; Arnold, Emmy; Heddle, Nancy M

2012-10-01

Benchmarking is as a structured continuous collaborative process in which comparisons for selected indicators are used to identify factors that, when implemented, will improve transfusion practices. This study aimed to identify transfusion medicine studies reporting on benchmarking, summarize the benchmarking approaches used, and identify important considerations to move the concept of benchmarking forward in the field of transfusion medicine. A systematic review of published literature was performed to identify transfusion medicine-related studies that compared at least 2 separate institutions or regions with the intention of benchmarking focusing on 4 areas: blood utilization, safety, operational aspects, and blood donation. Forty-five studies were included: blood utilization (n = 35), safety (n = 5), operational aspects of transfusion medicine (n = 5), and blood donation (n = 0). Based on predefined criteria, 7 publications were classified as benchmarking, 2 as trending, and 36 as single-event studies. Three models of benchmarking are described: (1) a regional benchmarking program that collects and links relevant data from existing electronic sources, (2) a sentinel site model where data from a limited number of sites are collected, and (3) an institutional-initiated model where a site identifies indicators of interest and approaches other institutions. Benchmarking approaches are needed in the field of transfusion medicine. Major challenges include defining best practices and developing cost-effective methods of data collection. For those interested in initiating a benchmarking program, the sentinel site model may be most effective and sustainable as a starting point, although the regional model would be the ideal goal. Copyright © 2012 Elsevier Inc. All rights reserved.

Application of Viscoelastic Fracture Model and Non-uniform Crack Initiation at Clinically Relevant Notches in Crosslinked UHMWPE

PubMed Central

Sirimamilla, P. Abhiram; Furmanski, Jevan; Rimnac, Clare M.

2012-01-01

The mechanism of crack initiation from a clinically relevant notch is not well-understood for crosslinked ultra high molecular weight polyethylene (UHMWPE) used in total joint replacement components. Static mode driving forces, rather than the cyclic mode conditions typically associated with fatigue processes, have been shown to drive crack propagation in this material. Thus, in this study, crack initiation in a notched specimen under a static load was investigated. A video microscope was used to monitor the notch surface of the specimen and crack initiation time was measured from the video by identifying the onset of crack initiation at the notch. Crack initiation was considered using a viscoelastic fracture theory. It was found that the mechanism of crack initiation involved both single layer and a distributed multi-layer phenomenon and that multi-layer crack initiation delayed the crack initiation time for all loading conditions examined. The findings of this study support that the viscoelastic fracture theory governs fracture mechanics in crosslinked UHMWPE. The findings also support that crack initiation from a notch in UHMWPE is a more complex phenomenon than treated by traditional fracture theories for polymers. PMID:23127638

U.S. Transit Track Assessment and Research Needs

DOT National Transportation Integrated Search

1979-12-01

The overall objective of the study is to help expand and systematize the current search for improvements in transit track. The study was initiated to identify new technology and research tasks that may help increase the performance, reliability, and ...

Advanced Active Thermal Control Systems Architecture Study

NASA Technical Reports Server (NTRS)

Hanford, Anthony J.; Ewert, Michael K.

1996-01-01

The Johnson Space Center (JSC) initiated a dynamic study to determine possible improvements available through advanced technologies (not used on previous or current human vehicles), identify promising development initiatives for advanced active thermal control systems (ATCS's), and help prioritize funding and personnel distribution among many research projects by providing a common basis to compare several diverse technologies. Some technologies included were two-phase thermal control systems, light-weight radiators, phase-change thermal storage, rotary fluid coupler, and heat pumps. JSC designed the study to estimate potential benefits from these various proposed and under-development thermal control technologies for five possible human missions early in the next century. The study compared all the technologies to a baseline mission using mass as a basis. Each baseline mission assumed an internal thermal control system; an external thermal control system; and aluminum, flow-through radiators. Solar vapor compression heat pumps and light-weight radiators showed the greatest promise as general advanced thermal technologies which can be applied across a range of missions. This initial study identified several other promising ATCS technologies which offer mass savings and other savings compared to traditional thermal control systems. Because the study format compares various architectures with a commonly defined baseline, it is versatile and expandable, and is expected to be updated as needed.

Building clinicians-researchers partnerships: lessons from diverse natural settings and practice-oriented initiatives.

PubMed

Castonguay, Louis G; Youn, Soo Jeong; Xiao, Henry; Muran, J Christopher; Barber, Jacques P

2015-01-01

In this concluding paper, we identify the type of studies conducted by 11 teams of contributors to a special issue on building clinicians-researchers partnerships. Those studies were conducted across a variety of clinical settings. We also integrate the lessons that have emerged from their collaborative initiatives in terms of obstacles faced, strategies adopted to address these challenges, benefits gained, and general recommendations offered to facilitate studies conducted with or by clinicians. The paper ends with the authors' thoughts about the future success of practice-oriented research in general.

[Constraints and opportunities for inter-sector health promotion initiatives: a case study].

PubMed

Magalhães, Rosana

2015-07-01

This article analyzes the implementation of inter-sector initiatives linked to the Family Grant, Family Health, and School Health Programs in the Manguinhos neighborhood in the North Zone of Rio de Janeiro, Brazil. The study was conducted in 2010 and 2011 and included document review, local observation, and 25 interviews with program managers, professionals, and staff. This was an exploratory case study using a qualitative approach that identified constraints and opportunities for inter-sector health experiences, contributing to the debate on the effectiveness of health promotion and poverty relief programs.

England's Healthy Living Pharmacy (HLP) initiative: Facilitating the engagement of pharmacy support staff in public health.

PubMed

Donovan, G R; Paudyal, V

2016-01-01

The concept of the Healthy Living Pharmacy (HLP) in England was first piloted in Portsmouth in 2010. HLPs proactively promote health and wellbeing, offering brief advice, services or signposting on a range of health issues such as smoking, physical activity, sexual health, healthy eating and alcohol consumption. To explore the views and attitudes of pharmacy support staff on the Healthy Living Pharmacy (HLP) initiative. Qualitative semi-structured, face-to-face interviews were conducted with pharmacy support staff recruited from community pharmacies involved in the HLP initiative in the Northumberland region of England. A topic guide was developed which underwent face validity testing and piloting with one participant. Interviews were audio recorded, transcribed verbatim and analyzed using framework technique. A total of 21 pharmacy support staff from 12 HLPs participated in the study. Results suggest that involving pharmacy support staff at very early stages of the HLP planning process drives their motivation for service delivery. Level of engagement with HLP services was often related to support staff roles within pharmacy. Integration of public health roles with routine pharmacy activities was perceived to be more suited to pharmacy counter based roles than dispensing roles. Further training needs were identified around how to proactively deliver public health advice, mainly in service areas perceived 'difficult' by the participants, such as weight management. A total of 19 facilitators/barriers were identified from the data including training, access to information, client feedback, availability of space and facilities within pharmacies, time and competing priorities. Pharmacy support staff engagement with the HLP initiative can be promoted by involving them from the outset of the service introduction process. Support staff might benefit from targeted training around certain public health areas within the HLP initiative. Facilitators/barriers identified in this study will inform development and further roll out of HLP initiative in wider areas. Copyright © 2016 Elsevier Inc. All rights reserved.

Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases

PubMed Central

Huiart, Laetitia; Ferdynus, Cyril; Renoux, Christel; Beaugrand, Amélie; Lafarge, Sophie; Bruneau, Léa; Suissa, Samy; Maillard, Olivier; Ranouil, Xavier

2018-01-01

Objective Unlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period. Methods Based on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice. Results The cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011–2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54). Conclusion Despite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk–benefit assessment of DOACs. PMID:29602837

The Impact of Soil Moisture Initialization On Seasonal Precipitation Forecasts

NASA Technical Reports Server (NTRS)

Koster, R. D.; Suarez, M. J.; Tyahla, L.; Houser, Paul (Technical Monitor)

2002-01-01

Some studies suggest that the proper initialization of soil moisture in a forecasting model may contribute significantly to the accurate prediction of seasonal precipitation, especially over mid-latitude continents. In order for the initialization to have any impact at all, however, two conditions must be satisfied: (1) the initial soil moisture anomaly must be "remembered" into the forecasted season, and (2) the atmosphere must respond in a predictable way to the soil moisture anomaly. In our previous studies, we identified the key land surface and atmospheric properties needed to satisfy each condition. Here, we tie these studies together with an analysis of an ensemble of seasonal forecasts. Initial soil moisture conditions for the forecasts are established by forcing the land surface model with realistic precipitation prior to the start of the forecast period. As expected, the impacts on forecasted precipitation (relative to an ensemble of runs that do not utilize soil moisture information) tend to be localized over the small fraction of the earth with all of the required land and atmosphere properties.

Forced sexual initiation, sexual intimate partner violence and HIV risk in women: A global review of the literature

PubMed Central

Stockman, Jamila K.; Lucea, Marguerite B.; Campbell, Jacquelyn C.

2012-01-01

Coerced or forced sexual initiation and sexual intimate partner violence (sexual IPV) contribute significantly to a woman’s risk for HIV infection. This review systematically examines global research (n=21 studies) published since 2000 on the role of coerced/forced sexual initiation and sexual IPV on HIV risk in women. In predominantly low- and middle-income countries, coerced/forced sexual initiation was associated with HIV/STIs, multiple and high-risk sex partners, and no condom use. Most studies using behaviorally specific terms for sexual IPV found strong associations between sexual IPV and HIV risk behaviors. In contrast, studies using less specific definitions often failed to find these significant associations. To develop more comprehensive HIV prevention programs, future efforts should integrate behaviorally specific terms into assessing prevalence of sexual IPV and its association with HIV risk, consider cultural differences, and identify causal pathways between coerced or forced sexual initiation, HIV risk behaviors and HIV/STI infection. PMID:23143750

Primary care physician perspectives on basal insulin initiation and maintenance in patients with type 2 diabetes mellitus.

PubMed

Kalirai, Samaneh; Stephenson, Judith; Perez-Nieves, Magaly; Grabner, Michael; Hadjiyianni, Irene; Geremakis, Caroline; Pollom, Roy Daniel; Reed, Beverly; Fisher, Lawrence

2018-04-01

To describe primary care physicians' (PCPs) perceptions of patient reactions and concerns about insulin initiation and identify opportunities for increased support. Cross-sectional, online survey of PCPs prescribing basal insulin to adults with type 2 diabetes mellitus (T2DM). PCPs were identified from administrative claims of a large commercial health plan and descriptive results of PCP responses were reported. PCPs (N=100) treated an average of 17 patients receiving insulin during a typical week. More than 85% of insulin initiation recommendations originated with PCPs. Most offered glucose monitoring instructions (96%) and advice on diet, exercise, and diabetes management (96%); 35% provided insulin titration algorithms; 93% reported that patients often or always took their insulin daily within 3 months of initiation; 31% of PCPs reported monthly office contacts with patients for the first 3 months; 16% reported no outreach efforts; fewer than 20% connected patients with support groups. When starting basal insulin, PCPs reported patients feeling personal failure regarding their diabetes treatment (33% often/always) and lacking confidence in their ability to manage insulin therapy (38% often/always). Study results identify additional opportunities for assisting patients in making the transition to insulin, including more frequent direct outreach to monitor insulin usage. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Directed Evolution of a Cyclized Peptoid-Peptide Chimera against a Cell-Free Expressed Protein and Proteomic Profiling of the Interacting Proteins to Create a Protein-Protein Interaction Inhibitor.

PubMed

Kawakami, Takashi; Ogawa, Koji; Hatta, Tomohisa; Goshima, Naoki; Natsume, Tohru

2016-06-17

N-alkyl amino acids are useful building blocks for the in vitro display evolution of ribosomally synthesized peptides because they can increase the proteolytic stability and cell permeability of these peptides. However, the translation initiation substrate specificity of nonproteinogenic N-alkyl amino acids has not been investigated. In this study, we screened various N-alkyl amino acids and nonamino carboxylic acids for translation initiation with an Escherichia coli reconstituted cell-free translation system (PURE system) and identified those that efficiently initiated translation. Using seven of these efficiently initiating acids, we next performed in vitro display evolution of cyclized peptidomimetics against an arbitrarily chosen model human protein (β-catenin) cell-free expressed from its cloned cDNA (HUPEX) and identified a novel β-catenin-binding cyclized peptoid-peptide chimera. Furthermore, by a proteomic approach using direct nanoflow liquid chromatography-tandem mass spectrometry (DNLC-MS/MS), we successfully identified which protein-β-catenin interaction is inhibited by the chimera. The combination of in vitro display evolution of cyclized N-alkyl peptidomimetics and in vitro expression of human proteins would be a powerful approach for the high-speed discovery of diverse human protein-targeted cyclized N-alkyl peptidomimetics.

Self-Efficacy Enhanced in a Cross-Cultural Context through an Initiative in Under-Resourced Schools in Kwazulu-Natal, South Africa

ERIC Educational Resources Information Center

Maher, Marguerite

2016-01-01

This paper discusses the Khanyisa Programme, an initiative in KwaZulu-Natal, South Africa, where learners from under-resourced schools are supported by teachers and high achievers in Grade 11 and 12 from a previously advantaged state school under apartheid. A qualitative, evaluative study was undertaken to identify key elements in the ongoing…

Pedagogical Technology for Identifying the Level of Patriotism Formation in Senior School Students within Actualization of Social Commitment and Initiative

ERIC Educational Resources Information Center

Alieva, Sariyat A.; Bilalov, Magomed K.; Gadzhiev, Ramazan D.; Radzhabova, Raisa V.; Salmanova, Dzhamila A.

2018-01-01

The relevance of the problem under study stems from the new social and economic, moral and psychological situation in the society. In its development, the priority is currently given to both shared human values and national ones, to initiative and entrepreneurial spirit of the young people who can transform their homeland and improve Russia's life…

Fat embolism syndrome in femoral shaft fractures: does the initial treatment make a difference?

PubMed

Silva, Jânio José Alves Bezerra; Diana, Diogo de Almeida; Salas, Victor Eduardo Roman; Zamboni, Caio; Hungria Neto, José Soares; Christian, Ralph Walter

2017-01-01

To identify the risk factors correlated with the initial treatment performed. This is a retrospective study involving a total of 272 patients diagnosed with femoral shaft fractures. Of the patients, 14% were kept at rest until the surgical treatment, 52% underwent external fixation, 10% received immediate definitive treatment, and 23% remained in skeletal traction (23%) until definitive treatment. There were six cases of fat embolism syndrome (FES), which showed that polytrauma is the main risk factor for its development and that initial therapy was not important. Polytrauma patients have a greater chance of developing FES and there was no influence from the initial treatment.

Whose place is it anyway? Representational politics in a place-based health initiative.

PubMed

Rushton, Carole

2014-03-01

The association between place and poor health, such as chronic disease, is well documented and in recent years has given rise to public health strategies such as place-based initiatives (PBIs). This article reports on the emergence of one such initiative in Australia, in regions identified as culturally diverse and socially disadvantaged. The study draws on the intellectual resources provided by governmentality and actor-network theory to provide insights into the reasons why community actors were excluded from a new governance body established to represent their interests. Risk-thinking and representational politics determined who represented whom in the PBI partnership. Paradoxically, actors representing 'community', identified as being 'at risk', were excluded from the partnership during its translation because they were also identified as being 'a risk'. As a consequence, contrary to federal government health and social policy in Australia, it was state government interests rather than the interests of community actors that influenced decisions made in relation to local health planning and the allocation of resources. Copyright © 2013 Elsevier Ltd. All rights reserved.

Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

PubMed Central

Friesen, Kevin J.; Woelk, Cornelius; Bugden, Shawn

2016-01-01

Background: Although a convenient opioid delivery system, transdermal fentanyl patches have caused several deaths and resulted in safety warnings reminding prescribers that fentanyl patches should be prescribed only for patients who have adequate prior exposure to opioids. We conducted a longitudinal analysis of the safety of fentanyl initiation by examining past opioid exposure among patients newly prescribed fentanyl patches. Methods: We identified all patients in the province of Manitoba who were newly prescribed fentanyl patches between Apr. 1, 2001, and Mar. 31, 2013. We converted all prior opioid use to oral morphine equivalents and determined the average daily dose in the 7–30 days before initial fentanyl patch use. Fentanyl initiation was considered unsafe if the patient’s pre-fentanyl opioid exposure was below the recommended level. Results: We identified 11 063 patients who began using fentanyl patches during the study period. Overall, fentanyl initiation was deemed unsafe in 74.1% of cases because the patient’s prior opioid exposure was inadequate. Women and patients 65 years of age and older were more likely than men and younger patients, respectively, to have inadequate prior opioid exposure (p < 0.001 for each comparison). The proportion of patients who had unsafe prescriptions for fentanyl patches decreased significantly over the study period, from 87.0% in 2001 to 50.0% in 2012 (p < 0.001). Interpretation: The safety of fentanyl initiation improved over the study period, but still half of fentanyl patch prescriptions were written for patients with inadequate prior opioid exposure. Review of prior opioid exposure may be a simple but important way to improve the safe use of fentanyl patches. PMID:27044480

Factors which modulate the rates of skeletal muscle mass loss in non-small cell lung cancer patients: a pilot study.

PubMed

Atlan, Philippe; Bayar, Mohamed Amine; Lanoy, Emilie; Besse, Benjamin; Planchard, David; Ramon, Jordy; Raynard, Bruno; Antoun, Sami

2017-11-01

Advanced non-small cell lung cancer (NSCLC) is associated with weight loss which may reflect skeletal muscle mass (SMM) and/or total adipose tissue (TAT) depletion. This study aimed to describe changes in body composition (BC) parameters and to identify the factors unrelated to the tumor which modulate them. SMM, TAT, and the proportion of SMM to SMM + TAT were assessed with computed tomography. Estimates of each BC parameter at follow-up initiation and across time were derived from a mixed linear model of repeated measurements with a random intercept and a random slope. The same models were used to assess the independent effect of gender, age, body mass index (BMI), and initial values on changes in each BC parameter. Sixty-four patients with stage III or IV NSCLC were reviewed. The mean ± SD decreases in body weight and SMM were respectively 59 ± 3 g/week (P < 0.03) and 7 mm 2 /m 2 /week (P = 0.0003). During follow-up, no changes were identified in TAT nor in muscle density or in the proportion of SMM to SMM + TAT, estimated at 37 ± 2% at baseline. SMM loss was influenced by initial BMI (P < 0.0001) and SMM values (P = 0.0002): the higher the initial BMI or SMM values, the greater the loss observed. Weight loss was greater when the initial weight was heavier (P < 0.0001). Our results demonstrate that SMM wasting in NSCLC is lower when initial SMM and BMI values are low. These exploratory findings after our attempt to better understand the intrinsic factors associated with muscle mass depletion need to be confirmed in larger studies.

Competencies Required by Special Librarians: An Analysis by Educational Levels

ERIC Educational Resources Information Center

Peyvand Robati, Alireza; Singh, Diljit

2013-01-01

This paper presents the results of a study conducted with the aim of identifying competencies needed by special librarians in Iran at three different levels of library and information science education. A list of competencies was initially identified from the literature and 21 semi-structured interviews with managers of special libraries in Iran.…

Current Faculty Rank and Promotion Policies in Public Two-Year Colleges

ERIC Educational Resources Information Center

Hammons, James O.; Orf, Michael A.

2016-01-01

This study aimed: (a) to determine the prevalence of faculty rank among two-year colleges in the United States; (b) to identify the criteria used to determine faculty rank upon initial employment for transfer and vocational faculty; (c) to identify the criteria used to determine promotion for transfer and vocational faculty; and (d) to determine…

Teacher Quality: A Comparison of National Board--Certified and Non--Board--Certified Teachers of Deaf Students

ERIC Educational Resources Information Center

Scheetz, Nanci A.; Martin, David S.

2006-01-01

The study was designed to identify specific components of teacher excellence, focusing initially on the characteristics of the small number of teachers of the deaf who are certified by the National Board for Professional Teaching Standards (NBPTS), then comparing those with the characteristics of other teachers identified as master teachers by…

Functional SNP associated with birth weight in independent populations identified with a permutation step added to GBLUP-GWAS

USDA-ARS?s Scientific Manuscript database

This study was conducted as an initial assessment of a newly available genotyping assay containing about 34,000 common SNP included on previous SNP chips, and 199,000 sequence variants predicted to affect gene function. Objectives were to identify functional variants associated with birth weight in...

Analysis of copy number variations in Holstein cows identify potential mechanisms contributing to differences in residual feed intake

USDA-ARS?s Scientific Manuscript database

Genomic structural variation is an important and abundant source of genetic and phenotypic variation. In this study, we performed an initial analysis of CNVs using BovineHD SNP genotyping data from 147 Holstein cows identified as having high or low feed efficiency as estimated by residual feed intak...

A Canine Audience: The Effect of Animal-Assisted Therapy on Reading Progress among Students Identified with Learning Disabilities

ERIC Educational Resources Information Center

Griess, Julie Omodio

2010-01-01

This study explored the use of animal-assisted therapy with students identified with a learning disability and limited reading success. Initially, reading progress was defined as the participants' comprehension rate obtained from an oral Informal Reading Inventory (IRI) passage. The nature of the Informal Reading Inventory requires the…

STUDIES IN SUBCLINICAL LEAD EXPOSURE

EPA Science Inventory

The study was initiated to examine the utility of neuropsychologic testing in identifying deficits in children with asymptomatic elevations in blood lead levels. From the files of the Boston Lead Screening Project the authors selected black male children between the ages of six a...

Clinical significance of In vivo Cytarabine Induced Gene Expression Signature in AML

PubMed Central

Lamba, Jatinder K.; Pounds, Stanley; Cao, Xueyuan; Crews, Kristine R.; Cogle, Christopher R.; Bhise, Neha; Raimondi, Susana C.; Downing, James R.; Baker, Sharyn D.; Ribeiro, Raul C.; Rubnitz, Jeffrey E.

2016-01-01

Despite initial remission, approximately 60-70% of adult and 30% of pediatric patients experience relapse or refractory AML. Studies so far have identified base line gene expression profiles of pathogenic and prognostic significance in AML, however extent of change in gene expression post-initiation of treatment has not been investigated. Exposure of leukemic cells to chemotherapeutic agents such as cytarabine, a mainstay of AML chemotherapy can trigger adaptive response by influencing leukemic cell transcriptome and hence development of resistance or refractory disease. It is however challenging to perform such a study due to lack of availability of specimens post-drug treatment. In this study our primary objective was to identify in vivo cytarabine induced changes in leukemia cell transcriptome and to evaluate their impact on clinical outcome. Our results highlight genes relevant to cytarabine resistance and support the concept of targeting cytarabine-induced genes as a means of improving response. PMID:26366682

Clinical significance of in vivo cytarabine-induced gene expression signature in AML.

PubMed

Lamba, Jatinder K; Pounds, Stanley; Cao, Xueyuan; Crews, Kristine R; Cogle, Christopher R; Bhise, Neha; Raimondi, Susana C; Downing, James R; Baker, Sharyn D; Ribeiro, Raul C; Rubnitz, Jeffrey E

2016-01-01

Despite initial remission, ∼60-70% of adult and 30% of pediatric patients experience relapse or refractory AML. Studies so far have identified base line gene expression profiles of pathogenic and prognostic significance in AML; however, the extent of change in gene expression post-initiation of treatment has not been investigated. Exposure of leukemic cells to chemotherapeutic agents such as cytarabine, a mainstay of AML chemotherapy, can trigger adaptive response by influencing leukemic cell transcriptome and, hence, development of resistance or refractory disease. It is, however, challenging to perform such a study due to lack of availability of specimens post-drug treatment. The primary objective of this study was to identify in vivo cytarabine-induced changes in leukemia cell transcriptome and to evaluate their impact on clinical outcome. The results highlight genes relevant to cytarabine resistance and support the concept of targeting cytarabine-induced genes as a means of improving response.

Space Station Freedom Data Assessment Study

NASA Technical Reports Server (NTRS)

Johnson, Anngienetta R.; Deskevich, Joseph

1990-01-01

The SSF Data Assessment Study was initiated to identify payload and operations data requirements to be supported in the Space Station era. To initiate the study payload requirements from the projected SSF user community were obtained utilizing an electronic questionnaire. The results of the questionnaire were incorporated in a personal computer compatible database used for mission scheduling and end-to-end communications analyses. This paper discusses data flow paths and associated latencies, communications bottlenecks, resource needs versus availability, payload scheduling 'warning flags' and payload data loading requirements for each major milestone in the Space Station buildup sequence. This paper also presents the statistical and analytical assessments produced using the data base, an experiment scheduling program, and a Space Station unique end-to-end simulation model. The modeling concepts and simulation methodologies presented in this paper provide a foundation for forecasting communication requirements and identifying modeling tools to be used in the SSF Tactical Operations Planning (TOP) process.

Global teaching and training initiatives for emerging cohort studies

PubMed Central

Paulus, Jessica K.; Santoyo-Vistrain, Rocío; Havelick, David; Cohen, Amy; Kalyesubula, Robert; Ajayi, Ikeoluwapo O.; Mattsson, Jens G.; Adami, Hans-Olov; Dalal, Shona

2015-01-01

A striking disparity exists across the globe, with essentially no large-scale longitudinal studies ongoing in regions that will be significantly affected by the oncoming non-communicable disease epidemic. The successful implementation of cohort studies in most low-resource research environments presents unique challenges that may be aided by coordinated training programs. Leaders of emerging cohort studies attending the First World Cohort Integration Workshop were surveyed about training priorities, unmet needs and potential cross-cohort solutions to these barriers through an electronic pre-workshop questionnaire and focus groups. Cohort studies representing India, Mexico, Nigeria, South Africa, Sweden, Tanzania and Uganda described similar training needs, including on-the-job training, data analysis software instruction, and database and bio-bank management. A lack of funding and protected time for training activities were commonly identified constraints. Proposed solutions include a collaborative cross-cohort teaching platform with web-based content and interactive teaching methods for a range of research personnel. An international network for research mentorship and idea exchange, and modifying the graduate thesis structure were also identified as key initiatives. Cross-cohort integrated educational initiatives will efficiently meet shared needs, catalyze the development of emerging cohorts, speed closure of the global disparity in cohort research, and may fortify scientific capacity development in low-resource settings. PMID:23856451

Analysis of higher education policy frameworks for open and distance education in Pakistan.

PubMed

Ellahi, Abida; Zaka, Bilal

2015-04-01

The constant rise in demand for higher education has become the biggest challenge for educational planners. This high demand has paved a way for distance education across the globe. This article innovatively analyzes the policy documentation of a major distance education initiative in Pakistan for validity that will identify the utility of policy linkages. The study adopted a qualitative research design that consisted of two steps. In the first step, a content analysis of distance learning policy framework was made. For this purpose, two documents were accessed titled "Framework for Launching Distance Learning Programs in HEIs of Pakistan" and "Guideline on Quality of Distance Education for External Students at the HEIs of Pakistan." In the second step, the policy guidelines mentioned in these two documents were evaluated at two levels. At the first level, the overall policy documents were assessed against a criterion proposed by Cheung, Mirzaei, and Leeder. At the second level, the proposed program of distance learning was assessed against a criterion set by Gellman-Danley and Fetzner and Berge. The distance education program initiative in Pakistan is of promising nature which needs to be assessed regularly. This study has made an initial attempt to assess the policy document against a criterion identified from literature. The analysis shows that the current policy documents do offer some strengths at this initial level, however, they cannot be considered a comprehensive policy guide. The inclusion or correction of missing or vague areas identified in this study would make this policy guideline document a treasured tool for Higher Education Commission (HEC). For distance education policy makers, this distance education policy framework model recognizes several fundamental areas with which they should be concerned. The findings of this study in the light of two different policy framework measures highlight certain opportunities that can help strengthening the distance education policies. The criteria and findings are useful for the reviewers of policy proposals to identify the gaps where policy documents can be improved to bring the desired outcomes. © The Author(s) 2015.

Determinants of escalating costs in low risk workers' compensation claims.

PubMed

Bernacki, Edward J; Yuspeh, Larry; Tao, Xuguang

2007-07-01

To identify and quantify attributes that lead to unanticipated cost escalation in workers' compensation claims. We constructed four claim categories: low initial reserve/low cost, migrated catastrophic (low initial reserve/high cost), high initial reserve/low cost, and catastrophic (high initial reserve/high cost). To assess the attributes associated with the increased cost of migrated catastrophic claims, we analyzed 36,329 Louisiana workers' compensation claims in the four categories over a 5-year period. In the 729 claims initially thought to be low-cost claims (migrated catastrophic), the most significant predictors for cost escalation were attorney involvement and claim duration, followed by low back disorder, married/single/divorced status, male gender, small company size, high premium, reporting delays, and older age. These injuries accounted for 2% of all claims but 32.3% of the costs. Accelerated escalation of costs occurred late in the claim cycle (2 years). Certain attributes, particularly attorney involvement and claim duration, are associated with unanticipated cost escalation in a small number of claims that drastically affect overall losses. The results of this study suggest that these cases may be identified and addressed before rapid escalation occurs.

Parameter identification of thermophilic anaerobic degradation of valerate.

PubMed

Flotats, Xavier; Ahring, Birgitte K; Angelidaki, Irini

2003-01-01

The considered mathematical model of the decomposition of valerate presents three unknown kinetic parameters, two unknown stoichiometric coefficients, and three unknown initial concentrations for biomass. Applying a structural identifiability study, we concluded that it is necessary to perform simultaneous batch experiments with different initial conditions for estimating these parameters. Four simultaneous batch experiments were conducted at 55 degrees C, characterized by four different initial acetate concentrations. Product inhibition of valerate degradation by acetate was considered. Practical identification was done optimizing the sum of the multiple determination coefficients for all measured state variables and for all experiments simultaneously. The estimated values of kinetic parameters and stoichiometric coefficients were characterized by the parameter correlation matrix, the confidence interval, and the student's t-test at 5% significance level with positive results except for the saturation constant, for which more experiments for improving its identifiability should be conducted. In this article, we discuss kinetic parameter estimation methods.

Application of the accurate mass and time tag approach in studies of the human blood lipidome

PubMed Central

Ding, Jie; Sorensen, Christina M.; Jaitly, Navdeep; Jiang, Hongliang; Orton, Daniel J.; Monroe, Matthew E.; Moore, Ronald J.; Smith, Richard D.; Metz, Thomas O.

2008-01-01

We report a preliminary demonstration of the accurate mass and time (AMT) tag approach for lipidomics. Initial data-dependent LC-MS/MS analyses of human plasma, erythrocyte, and lymphocyte lipids were performed in order to identify lipid molecular species in conjunction with complementary accurate mass and isotopic distribution information. Identified lipids were used to populate initial lipid AMT tag databases containing 250 and 45 entries for those species detected in positive and negative electrospray ionization (ESI) modes, respectively. The positive ESI database was then utilized to identify human plasma, erythrocyte, and lymphocyte lipids in high-throughput LC-MS analyses based on the AMT tag approach. We were able to define the lipid profiles of human plasma, erythrocytes, and lymphocytes based on qualitative and quantitative differences in lipid abundance. PMID:18502191

Racial/Ethnic Differences in Cigarette Smoking Initiation and Progression to Daily Smoking: A Multilevel Analysis

PubMed Central

Kandel, Denise B.; Kiros, Gebre-Egziabher; Schaffran, Christine; Hu, Mei-Chen

2004-01-01

Objectives. We sought to identify individual and contextual predictors of adolescent smoking initiation and progression to daily smoking by race/ethnicity. Methods. We used data from the National Longitudinal Study of Adolescent Health to estimate the effects of individual (adolescent, family, peer) and contextual (school and state) factors on smoking onset among nonsmokers (n = 5374) and progression to daily smoking among smokers (n = 4474) with multilevel regression models. Results. Individual factors were more important predictors of smoking behaviors than were contextual factors. Predictors of smoking behaviors were mostly common across racial/ethnic groups. Conclusions. The few identified racial/ethnic differences in predictors of smoking behavior suggest that universal prevention and intervention efforts could reach most adolescents regardless of race/ethnicity. With 2 exceptions, important contextual factors remain to be identified. PMID:14713710

Workplace antistigma initiatives: a scoping study.

PubMed

Malachowski, Cindy; Kirsh, Bonnie

2013-07-01

The purpose of this scoping study was to identify and describe the principles and characteristics embedded in workplace mental health antistigma initiatives. Research in this area is diffuse and not well synthesized. Therefore, a scoping study is useful in generating a breadth of coverage and identifying all relevant literature on the topic regardless of study design. Results will inform evaluation strategies and can be used to distinguish the effectiveness of particular elements in future research. The "York Framework," a five-stage methodological design (with an optional sixth stage) was used as the structure for this study. Eleven peer-reviewed and gray-literature databases were searched (2000-2011), and an extensive Internet review was also conducted. Two reviewers independently reviewed all abstracts to determine study selection. A data chart consisting of key issues and themes was utilized to extract data from the included studies. Preliminary results were used to inform a stakeholder consultation with seven international experts. Twenty-two antistigma interventions were included in the study. Most of the initiatives have appeared in the past four years and across geographic boundaries, reflecting the growing international interest in mental health in the workplace. A large proportion of the interventions utilize educational approaches to reducing stigma, and a substantial number target military personnel. Stronger evidence for effective practices needs to be established through the use of standardized workplace-specific interventions, reliable and valid evaluation tools, and overall enhanced scientific rigor.

The Role of Hemoglobin Laboratory Test Results for the Detection of Upper Gastrointestinal Bleeding Outcomes Resulting from the Use of Medications in Observational Studies.

PubMed

Patorno, Elisabetta; Gagne, Joshua J; Lu, Christine Y; Haynes, Kevin; Sterrett, Andrew T; Roy, Jason; Wang, Xingmei; Raebel, Marsha A

2017-01-01

The identification of upper gastrointestinal (UGI) bleeding and perforated ulcers in claims data typically relies on inpatient diagnoses. The use of hemoglobin laboratory results might increase the detection of UGI events that do not lead to hospitalization. Our objective was to evaluate whether hemoglobin results increase UGI outcome identification in electronic databases, using non-steroidal anti-inflammatory drugs (NSAIDs) as a test case. From three data partner sites within the Mini-Sentinel Distributed Database, we identified NSAID initiators aged ≥18 years between 2008 and 2013. Numbers of events and risks within 30 days after NSAID initiation were calculated for four mutually exclusive outcomes: (1) inpatient UGI diagnosis of bleeding or gastric ulcer (standard claims-based definition without laboratory results); (2) non-inpatient UGI diagnosis AND ≥3 g/dl hemoglobin decrease; (3) ≥3 g/dl hemoglobin decrease without UGI diagnosis in any clinical setting; (4) non-inpatient UGI diagnosis, without ≥3 g/dl hemoglobin decrease. We identified 2,289,772 NSAID initiators across three sites. Overall, 45.3% had one or more hemoglobin result available within 365 days before or 30 days after NSAID initiation; only 6.8% had results before and after. Of 7637 potential outcomes identified, outcome 1 accounted for 21.7%, outcome 2 for 0.8%, outcome 3 for 34.3%, and outcome 4 for 43.3%. Potential cases identified by outcome 3 were largely not suggestive of UGI events. Outcomes 1, 2, and 4 had similar distributions of specific UGI diagnoses. Using available hemoglobin result values combined with non-inpatient UGI diagnoses identified few additional UGI cases. Non-inpatient UGI diagnostic codes may increase outcome detection but would require validation.

Increasing time to postoperative stereotactic radiation therapy for patients with resected brain metastases: investigating clinical outcomes and identifying predictors associated with time to initiation.

PubMed

Yusuf, Mehran B; Amsbaugh, Mark J; Burton, Eric; Nelson, Megan; Williams, Brian; Koutourousiou, Maria; Nauta, Haring; Woo, Shiao

2018-02-01

We sought to determine the impact of time to initiation (TTI) of post-operative radiosurgery on clinical outcomes for patients with resected brain metastases and to identify predictors associated with TTI. All patients with resected brain metastases treated with postoperative SRS or fractionated stereotactic radiation therapy (fSRT) from 2012 to 2016 at a single institution were reviewed. TTI was defined as the interval from resection to first day of radiosurgery. Receiver operating characteristic (ROC) curves were used to identify an optimal threshold for TTI with respect to local failure (LF). Survival outcomes were estimated using the Kaplan-Meier method and analyzed using the log-rank test and Cox proportional hazards models. Logistic regression models were used to identify factors associated with ROC-determined TTI covariates. A total of 79 resected lesions from 73 patients were evaluated. An ROC curve of LF and TTI identified an optimal threshold for TTI of 30.5 days, with an area under the curve of 0.637. TTI > 30 days was associated with an increased hazard of LF (HR 4.525, CI 1.239-16.527) but was not significantly associated with survival (HR 1.002, CI 0.547-1.823) or distant brain failure (DBF, HR 1.943, CI 0.989-3.816). Fifteen patients (20.5%) required post-operative inpatient rehabilitation. Post-operative rehabilitation was associated with TTI > 30 days (OR 1.48, CI 1.142-1.922). In our study of resected brain metastases, longer time to initiation of post-operative radiosurgery was associated with increased local failure. Ideally, post-op SRS should be initiated within 30 days of resection if feasible.

Comparing Web-Based Provider-Initiated and Patient-Initiated Survivorship Care Planning for Cancer Patients: A Randomized Controlled Trial

PubMed Central

Tolbert, Elliott; Hannum, Susan M; Radhakrishnan, Archana; Zorn, Kelsey; Blackford, Amanda; Greco, Stephen; Smith, Karen; Snyder, Claire F

2016-01-01

Background Survivorship care plans (SCPs) are intended to facilitate communication and coordination between patients, oncologists, and primary care providers. Most SCP initiatives have focused on oncology providers initiating the SCP process, but time and resource barriers have limited uptake. Objective This trial compares the feasibility and value of 2 Web-based SCP tools: provider-initiated versus patient-initiated. Methods This mixed-methods study recruited clinicians from 2 academically-affiliated community oncology practices. Eligible patients were treated by a participating oncologist, had nonmetastatic cancer, completed acute treatment ≤ 2 months before enrollment, and had no evidence of disease. Patients were randomized 1:1 to either provider-initiated or patient-initiated SCPs—both are Web-based tools. We conducted qualitative interviews with providers at baseline and follow-up and with patients 2 months after enrollment. In addition, patients were administered the Preparing for Life as a (New) Survivor (PLANS) and Cancer Survivors’ Unmet Needs (CaSUN) surveys at baseline and 2 months. Results A total of 40 providers were approached for the study, of whom 13 (33%) enrolled. Providers or clinic staff required researcher assistance to identify eligible patients; 41 patients were randomized, of whom 25 completed follow-up (61%; 13 provider-initiated, 12 patient-initiated). Of the 25, 11 (44%) had initiated the SCP; 5 (20%) provided the SCP to their primary care provider. On the Preparing for Life as a (New) Survivor and Cancer Survivors’ Unmet Needs, patients in both arms tended to report high knowledge and confidence and few unmet needs. In qualitative interviews, providers and patients discussed SCPs’ value. Conclusions Regardless of patient- versus provider-initiated templates and the Web-based design of these tools, barriers to survivorship care planning persist. Further efforts should emphasize workflow functions for identifying and completing SCPs—regardless of the SCP form used. Trial Registration ClinicalTrials.gov NCT02405819; https://clinicaltrials.gov/ct2/show/NCT02405819 (Archived by WebCite at http://www.webcitation.org/6jWqcWOvK) PMID:28410187

Using global unique identifiers to link autism collections.

PubMed

Johnson, Stephen B; Whitney, Glen; McAuliffe, Matthew; Wang, Hailong; McCreedy, Evan; Rozenblit, Leon; Evans, Clark C

2010-01-01

To propose a centralized method for generating global unique identifiers to link collections of research data and specimens. The work is a collaboration between the Simons Foundation Autism Research Initiative and the National Database for Autism Research. The system is implemented as a web service: an investigator inputs identifying information about a participant into a client application and sends encrypted information to a server application, which returns a generated global unique identifier. The authors evaluated the system using a volume test of one million simulated individuals and a field test on 2000 families (over 8000 individual participants) in an autism study. Inverse probability of hash codes; rate of false identity of two individuals; rate of false split of single individual; percentage of subjects for which identifying information could be collected; percentage of hash codes generated successfully. Large-volume simulation generated no false splits or false identity. Field testing in the Simons Foundation Autism Research Initiative Simplex Collection produced identifiers for 96% of children in the study and 77% of parents. On average, four out of five hash codes per subject were generated perfectly (only one perfect hash is required for subsequent matching). The system must achieve balance among the competing goals of distinguishing individuals, collecting accurate information for matching, and protecting confidentiality. Considerable effort is required to obtain approval from institutional review boards, obtain consent from participants, and to achieve compliance from sites during a multicenter study. Generic unique identifiers have the potential to link collections of research data, augment the amount and types of data available for individuals, support detection of overlap between collections, and facilitate replication of research findings.

How can we improve the recognition, reporting and resolution of medical device-related incidents in hospitals? A qualitative study of physicians and registered nurses.

PubMed

Polisena, Julie; Gagliardi, Anna; Clifford, Tammy

2015-06-06

To explore factors that influence and to identify initiatives to improve the recognition, reporting and resolution of device-related incidents. Semi-structured telephone interviews with 16 health professionals in two tertiary care hospitals were conducted. Purposive sampling was used to identify appropriate study participants. Transcribed interviews were read independently by one individual to identify, define and organize themes and verified by another reviewer. Themes related to incident recognition were the hospital staff's knowledge and professional experience, medical device performance and clinical manifestations of patients, while incident reporting was influenced by error severity, personal attitudes of clinicians, feedback received on the error reported. Physicians often discontinued using medical devices if they malfunctioned. Education and training and the implementation of registries were discussed as important initiatives to improve medical device surveillance in clinical practice. Results from the telephone interviews suggest that multiple factors that influence participation in medical device surveillance activities are consistent with results for medical errors as reported in previous studies. The study results helped to propose a conceptual framework for a medical device surveillance system in a hospital context that would enhance patient safety and health care delivery.

Care Provision and Prescribing Practices of Physicians Treating Children and Adolescents With ADHD.

PubMed

Patel, Ayush; Medhekar, Rohan; Ochoa-Perez, Melissa; Aparasu, Rajender R; Chan, Wenyaw; Sherer, Jeffrey T; Alonzo, Joy; Chen, Hua

2017-07-01

Care provision and prescribing practices of physicians treating children with attention-deficit hyperactivity disorder (ADHD) were compared. A retrospective cohort study was conducted with the 1995-2010 General Electric Centricity Electronic Medical Record database. The sample included children (≤18 years) with newly diagnosed ADHD (ICD-9-CM code 314.XX) who received a prescription for a stimulant or atomoxetine. Identification of comorbid psychiatric disorders, duration from initial ADHD diagnosis to treatment, prescription of other psychotropic medications, and follow-up care during the ten months after the ADHD treatment initiation were compared across provider type (primary care physicians [PCPs], child psychiatrists, and physicians with an unknown specialty). The associations between provider type and practice variations were further determined by multivariate logistic regression accounting for patient demographic characteristics, region, insurance type, and prior mental health care utilizations. Of the 66,719 children identified, 75.8% were diagnosed by PCPs, 2.6% by child psychiatrists, and 21.6% by physicians whose specialty was unknown. Child psychiatrists were less likely than PCPs to initiate ADHD medication immediately after the diagnosis. However, once the ADHD treatment was initiated, they were more likely to prescribe psychotropic polytherapy even after analyses accounted for the comorbid psychiatric disorders identified. Only one-third of ADHD cases identified by both PCPs and child psychiatrists have met the HEDIS quality measure for ADHD medication-related follow-up visits. Differences were found by physician type in care of children with ADHD. Additional studies are needed to understand clinical consequences of these differences and the implications for care coordination across provider specialties.

pH and Organic Carbon Dose Rates Control Microbially Driven Bioremediation Efficacy in Alkaline Bauxite Residue.

PubMed

Santini, Talitha C; Malcolm, Laura I; Tyson, Gene W; Warren, Lesley A

2016-10-18

Bioremediation of alkaline tailings, based on fermentative microbial metabolisms, is a novel strategy for achieving rapid pH neutralization and thus improving environmental outcomes associated with mining and refining activities. Laboratory-scale bioreactors containing bauxite residue (an alkaline, saline tailings material generated as a byproduct of alumina refining), to which a diverse microbial inoculum was added, were used in this study to identify key factors (pH, salinity, organic carbon supply) controlling the rates and extent of microbially driven pH neutralization (bioremediation) in alkaline tailings. Initial tailings pH and organic carbon dose rates both significantly affected bioremediation extent and efficiency with lower minimum pHs and higher extents of pH neutralization occurring under low initial pH or high organic carbon conditions. Rates of pH neutralization (up to 0.13 mM H + produced per day with pH decreasing from 9.5 to ≤6.5 in three days) were significantly higher in low initial pH treatments. Representatives of the Bacillaceae and Enterobacteriaceae, which contain many known facultative anaerobes and fermenters, were identified as key contributors to 2,3-butanediol and/or mixed acid fermentation as the major mechanism(s) of pH neutralization. Initial pH and salinity significantly influenced microbial community successional trajectories, and microbial community structure was significantly related to markers of fermentation activity. This study provides the first experimental demonstration of bioremediation in bauxite residue, identifying pH and organic carbon dose rates as key controls on bioremediation efficacy, and will enable future development of bioreactor technologies at full field scale.

Genome-wide Association Studies from the Cancer Genetic Markers of Susceptibility (CGEMS) Initiative | Office of Cancer Genomics

Cancer.gov

CGEMS identifies common inherited genetic variations associated with a number of cancers, including breast and prostate. Data from these genome-wide association studies (GWAS) are available through the Division of Cancer Epidemiology & Genetics website.

Screening for Psychological Inflexibility: Initial Validation of the Avoidance and Fusion Questionnaire for Youth as a School Mental Health Screener

ERIC Educational Resources Information Center

Renshaw, Tyler L.

2017-01-01

The present study reports on the initial validation of the eight-item version of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8) as a school mental health screener for identifying clinical-level depression and anxiety caseness within a sample of urban high school students (N = 219). Results indicated that responses to the AFQ-Y8 yielded…

Factors influencing initiation and duration of breast feeding in Ireland.

PubMed

Leahy-Warren, Patricia; Mulcahy, Helen; Phelan, Agnes; Corcoran, Paul

2014-03-01

The aim of this research was to identify factors associated with mothers breast feeding and to identify, for those who breast fed, factors associated with breast feeding for as long as planned. breast feeding rates in Ireland are amongst the lowest in Europe. Research evidence indicates that in order for mothers to be successful at breast feeding, multiplicities of supports are necessary for both initiation and duration. The nature of these supports in tandem with other influencing factors requires analysis from an Irish perspective. cross-sectional study involving public health nurses and mothers in Ireland. This paper presents the results of the mothers' evaluation. mothers (n=1715) with children less than three years were offered a choice of completing the self-report questionnaires online or by mail. Data were analysed and reported using descriptive and inferential statistics. four in every five participants breast fed their infant and two thirds of them breast fed as long as planned. The multivariate logistic regression analysis identified that third level education, being a first time mother or previously having breast fed, participating online, having more than two public health nurse visits, and having a positive infant feeding attitude were independently and statistically significantly associated with breast feeding. Among mothers who breast fed, being aged at least 35 years, participating online, having a positive infant feeding attitude and high breast feeding self-efficacy were independently and statistically significantly associated with breast feeding for as long as planned. findings from this study reinforce health inequalities therefore there needs to be a renewed commitment to reducing health inequalities in relation to breast feeding. this study has identified factors associated with initiation and duration of breast feeding that are potentially modifiable through public health interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Functional genetic studies of the tarnished plant bug

USDA-ARS?s Scientific Manuscript database

The tarnished plant bug (TPB), Lygus lineolaris (Palisot de Beuvois) has become a primary pest of cotton in the Mississippi Delta. To identify new techological and genetic methods to control TPB, studies have begun to focus on genes expressed by the insect. Initial studies on interference of transcr...

Environmental Sustainability Change Management in SMEs: Learning from Sustainability Champions

ERIC Educational Resources Information Center

Chadee, Doren; Wiesner, Retha; Roxas, Banjo

2011-01-01

This study identifies the change management processes involved in undertaking environmental sustainability (ES) initiatives within Small and Medium Size Enterprises (SMEs) and relate these to the main attributes of learning organisations. Using case study techniques, the study draws from the change management experiences of a sample of 12 ES…

Initiation & completion rates of hepatitis A vaccination among US pediatric populations born between 2005 and 2009.

PubMed

Weiss, Thomas; Zhang, Dongmu; Borse, Nagesh N; Walter, Emmanuel B

2015-11-27

To estimate hepatitis A vaccine series initiation and completion rates, assess time to vaccination, identify missed opportunities for the hepatitis A vaccine series, and examine factors associated with hepatitis A vaccine series initiation and completion. We conducted a retrospective, observational study using three healthcare claims databases separately. The study population was comprised of children born between years 2005 and 2009 that were continuously enrolled for at least three and a half years from the date of birth. Every child was followed from date of birth for three and a half years for hepatitis A vaccination. There were 93,735 eligible children from Clinformatics Data Mart, 202,513 from MarketScan Commercial, and 207,545 from MarketScan Medicaid. The overall hepatitis A vaccine series initiation rate was 63.8-79.4% and completion rate was 45.1-66.8% across the three databases. About 62.8-90.1% of the children who never initiated hepatitis A vaccine had at least one well visit from 1 year to three and a half years old. Children were more likely to initiate and complete the hepatitis A vaccine series if they were from more recent birth cohorts, from states with a hepatitis A vaccination recommendation prior to the ACIP universal recommendation, from states with daycare/school entry requirements, were enrolled in an HMO health plan, had pediatricians as primary providers, had more doctor's office/well visits and received MMR/Varicella vaccines. In this study, approximately one in every three to five children remained unvaccinated against hepatitis A. Although the hepatitis A vaccine series initiation and completion improved from 2005 to 2009, vaccine coverage has stabilized in recent years. It is important for providers to identify every opportunity for hepatitis A vaccination and to assure that children get protection from this vaccine-preventable disease. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Truck characteristics analysis

DOT National Transportation Integrated Search

1998-01-01

This report documents the early observations from the Long-Term Pavement Performance (LTPP) Specific Pavement Studies (SPS) conducted as part of the LTPP Program Data Insight conducted to identify initial findings from the test sections established f...

Smoking initiation among young adults in the United States and Canada, 1998-2010: a systematic review.

PubMed

Freedman, Kit S; Nelson, Nanette M; Feldman, Laura L

2012-01-01

Young adults have the highest smoking rate of any age group in the United States and Canada, and recent data indicate that they often initiate smoking as young adults. The objective of this study was to systematically review peer-reviewed articles on cigarette smoking initiation and effective prevention efforts among young adults. We searched 5 databases for research articles published in English between 1998 and 2010 on smoking initiation among young adults (aged 18-25) living in the United States or Canada. We extracted the following data from each study selected: the measure of initiation used, age range of initiation, age range of study population, data source, target population, sampling method, and sample size. We summarized the primary findings of each study according to 3 research questions and categories of data (eg, sociodemographic) that emerged during the data extraction process. Of 1,072 identified studies, we found 27 articles that met our search criteria, but several included a larger age range of initiation (eg, 18-30, 18-36) than we initially intended to include. Disparities in young adult smoking initiation existed according to sex, race, and educational attainment. The use of alcohol and illegal drugs was associated with smoking initiation. The risk of smoking initiation among young adults increased under the following circumstances: exposure to smoking, boredom or stress while serving in the military, attending tobacco-sponsored social events while in college, and exposure to social norms and perceptions that encourage smoking. Effective prevention efforts include exposure to counter-marketing, denormalization campaigns, taxation, and the presence of smoke-free policies. Much remains to be learned about young adult smoking initiation, particularly among young adults in the straight-to-work population. Dissimilar measures of smoking initiation limit our knowledge about smoking initiation among young adults. We recommend developing a standardized measure of initiation that indicates progression to regular established smoking.

Dollars and sense: the financial impact of Canadian wellness initiatives†.

PubMed

Wilkin, Christa L; Connelly, Catherine E

2015-09-01

The popular press reports anecdotal benefits of organizational initiatives that are designed to improve employees' work-life balance and wellness, but the long-term impact of these initiatives on firms' financial performance is unknown. Our longitudinal study of publicly traded Canadian organizations uses the strategic human resources management framework to explain why these initiatives may affect their financial performance. We use an exploratory factor analysis of three waves of archival data to identify two types of initiatives and regression to measure their impact on return on assets (ROA). Our findings suggest that, after 2 years, health promotion initiatives significantly decreased ROA, while work-life balance initiatives significantly increased it. Both effects became non-significant over the longer term. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Predictors and Outcomes Associated with Trajectories of Revenge Goals from Fourth Grade through Seventh Grade

ERIC Educational Resources Information Center

McDonald, Kristina L.; Lochman, John E.

2012-01-01

The present study identified longitudinal trajectories of revenge goals in a sample of at-risk youth (N = 240; 63.3% male) followed from fourth grade through seventh grade. Three revenge goal trajectory groups were identified: a low-stable group, an increasing group, and a decreasing group. The increasing and decreasing groups were initially more…

Exploring Partial School Autonomy: What Does It Mean for the Cypriot School of the Future?

ERIC Educational Resources Information Center

Theodorou, Theodoros; Pashiardis, Petros

2016-01-01

This paper examines the school of the future, aiming to identify and aid the implementation of the most desired version of school autonomy in Cyprus. More specifically, the study initially forecasts the areas of financial decisions that the school of the future might autonomously manage, identifies the negative effects that may appear along the…

Book Lovers, Technophiles, Pragmatists, and Printers: The Social and Demographic Structure of User Attitudes toward E-Books

ERIC Educational Resources Information Center

Revelle, Andy; Messner, Kevin; Shrimplin, Aaron; Hurst, Susan

2012-01-01

Q-methodology was used to identify clusters of opinions about e-books at Miami University. The research identified four distinct opinion types among those investigated: Book Lovers, Technophiles, Pragmatists, and Printers. The initial Q-methodology study results were then used as a basis for a large-n survey of undergraduates, graduate students,…

Microsatellite analysis of the EU1 lineage of Phytophthora ramorum in Washington state nurseries, landscapes, and waterways

Treesearch

Katie Coats; Marianne Elliott; Gary Chastagner

2017-01-01

Microsatellite analysis initially identified genetic variations within the NA1 clonal lineage of Phytophthora ramorum; however, in Washington nurseries, the genetic population of P. ramorum has shifted and is now dominated by two other lineages, NA2 and EU1. In this study, recently identified markers that are more variable, and...

The Development and Initial Use of a Survey of Student "Belongingness", Engagement and Self-Confidence in UK Higher Education

ERIC Educational Resources Information Center

Yorke, Mantz

2016-01-01

Students' sense of "belongingness" and their engagement in academic study have been identified as key contributors to student success. A short instrument that can identify changes over time in students' sense of belonging to their institution, their academic engagement and their self-confidence has been developed and used in conjunction…

A Blueprint for Human Resource Development in the Third Decade of the Ontario Colleges of Applied Arts and Technology: Executive Summary.

ERIC Educational Resources Information Center

Giroux, Roy F.

In 1987, a review of Ontario's community college system was initiated to assess the system's present human resource development practices and plan future directions. A field-based study was conducted to identify and assess current human resource development efforts, identify areas for improvement, and suggest possible future directions. Through…

Using the 3-Sigma Limit to Identify Significantly Long Pauses during Composing.

ERIC Educational Resources Information Center

Kelly, Leonard P.; Nolan, Thomas W.

Ten deaf college freshmen and a comparison group of five hearing students participated in a study of a method to identify long pauses in written composition that have important statistical properties. Subjects first wrote two initial drafts of short stories they had viewed on video tape. Later, they revised and recopied their two originals and one…

African American Young Adult Smoking Initiation: Identifying Intervention Points and Prevention Opportunities

ERIC Educational Resources Information Center

Cheney, Marshall K.; Mansker, Jacqueline

2014-01-01

Background: African Americans have one of the lowest smoking rates as teens yet have one of the highest smoking rates as adults. Approximately 40% of African Americans who have ever smoked started smoking between the ages of 18 and 21. Purpose: This study aimed to identify why African American young adults began smoking in young adulthood and what…

Linking initial microstructure and local response during quasistatic granular compaction

DOE PAGES

Hurley, R. C.; Lind, J.; Pagan, D. C.; ...

2017-07-24

In this study, we performed experiments combining three-dimensional x-ray diffraction and x-ray computed tomography to explore the relationship between microstructure and local force and strain during quasistatic granular compaction. We found that initial void space around a grain and contact coordination number before compaction can be used to predict regions vulnerable to above-average local force and strain at later stages of compaction. We also found correlations between void space around a grain and coordination number, and between grain stress and maximum interparticle force, at all stages of compaction. Finally, we observed grains that fracture to have an above-average initial localmore » void space and a below-average initial coordination number. In conclusion, our findings provide (1) a detailed description of microstructure evolution during quasistatic granular compaction, (2) an approach for identifying regions vulnerable to large values of strain and interparticle force, and (3) methods for identifying regions of a material with large interparticle forces and coordination numbers from measurements of grain stress and local porosity.« less

Alcohol industry corporate social responsibility initiatives and harmful drinking: a systematic review.

PubMed

Mialon, Melissa; McCambridge, Jim

2018-04-25

There is growing awareness of the detrimental effects of alcohol industry commercial activities, and concern about possible adverse impacts of its corporate social responsibility (CSR) initiatives, on public health. The aims of this systematic review were to summarize and examine what is known about CSR initiatives undertaken by alcohol industry actors in respect of harmful drinking globally. We searched for peer-reviewed studies published since 1980 of alcohol industry CSR initiatives in seven electronic databases. The basic search strategy was organized around the three constructs of 'alcohol', 'industry' and 'corporate social responsibility'. We performed the searches on 21 July 2017. Data from included studies were analyzed inductively, according to the extent to which they addressed specified research objectives. A total of 21 studies were included. We identified five types of CSR initiatives relevant to the reduction of harmful drinking: alcohol information and education provision; drink driving prevention; research involvement; policy involvement and the creation of social aspects organizations. Individual companies appear to undertake different CSR initiatives than do industry-funded social aspects organizations. There is no robust evidence that alcohol industry CSR initiatives reduce harmful drinking. There is good evidence, however, that CSR initiatives are used to influence the framing of the nature of alcohol-related issues in line with industry interests. This research literature is at an early stage of development. Alcohol policy measures to reduce harmful drinking are needed, and the alcohol industry CSR initiatives studied so far do not contribute to the attainment of this goal.

Overcoming Exclusion through Adult Learning.

ERIC Educational Resources Information Center

Nash, Ian; Walshe, John

Strategies for overcoming exclusion through adult learning were identified through case studies of 19 initiatives in the following countries: Belgium; Mexico; the Netherlands; Norway; Portugal; and the United Kingdom. The study programs involved a diverse array of formal, nonformal, and informal public sector, community, and enterprise-based…

Use of the initial trauma CT scan to aid in diagnosis of open pelvic fractures.

PubMed

Scolaro, John A; Wilson, David J; Routt, Milton Lee Chip; Firoozabadi, Reza

2015-10-01

Open pelvic disruptions represent high-energy injuries. The prompt identification and management of these injuries decreases their associated morbidity and mortality. Computed tomography (CT) scans are routinely obtained in the initial evaluation of patients with pelvic injuries. The purpose of this study is to identify the incidence and source of air densities noted on computed tomography (CT) scans of the abdominal and pelvic region in patients with pelvic fractures and evaluate the use of initial CT imaging as an adjunctive diagnostic tool to identify open injuries. A retrospective review of a prospectively collected database was performed at a single institution. Seven hundred and twenty-two consecutive patients with a pelvic disruption over a two-year period were included. Review of initial injury CT scans was performed using bone and lung viewing algorithms to identify the presence of extra-luminal air. The primary outcome was the presence, location and source of air identified on pre-operative CT scans. Secondary measurements were identification of air by plain radiograph and correlation between identified air densities on CT and clinically diagnosed open pelvic fractures. Ninety-eight patients were identified as having extra-luminal air densities on CT scans. Eighty-one patients were included in the final analysis following application of inclusion and exclusion criteria. Air was noted by the radiologist in forty-five (55.6%) instances. Six patients (7.4%) were clinically diagnosed with an open pelvic ring disruption; in two patients (2.4%) this diagnosis was delayed. In all patients, the CT was able to track air from its origin. In patients with pelvic disruptions, the injury CT should also be evaluated for the presence and source of extra-luminal air. In some patients, this finding may represent an open pelvic ring disruption. A complete physical exam and CT evaluation should be used to decrease the missed or delayed diagnosis of an open pelvic ring injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of Promotional Initiatives on Visits to a Dedicated Website for Physical Activity and Non-Communicable Disease in Luxembourg: An Event Study

PubMed Central

Lion, Alexis; Thornton, Jane S.; Vaillant, Michel; Pertuy, Juliette; Besenius, Eric; Hardy, Cyrille; Delagardelle, Charles; Seil, Romain; Urhausen, Axel; Theisen, Daniel

2017-01-01

The Sport-Santé project and its website (www.sport-sante.lu) promote physical activity for individuals with non-communicable diseases (NCDs) in Luxembourg. Our purpose was to perform an event study analysis to evaluate the effects of communication and promotional initiatives on the number of visits to the Sport-Santé website. Between September 2015 and May 2016, the Sport-Santé website was promoted during different initiatives, including participation in health-related events or publication of articles in local journals. The daily number of visits to www.sport-sante.lu website (i.e., our outcome) was recorded using Google Analytics and compared to a counterfactual collected with its benchmarking tool. The counterfactual was defined as the daily number of visits to websites in the same field. A model was created to evaluate the relationship between the number of visits to www.sport-sante.lu website and the number of visits to similar websites during a control period with no promotional initiatives (from July 2015 to September 2015). The effect of promotional initiatives was subsequently tested, by comparing the actual number of visits to our website (up to 2 days after each event) with the theoretical number of visits predicted by the model. Twenty-two initiatives were identified, of which 11 were participations at major health-related events and 11 publications of popular science articles. Of these 22 initiatives, the event study identified 2 popular science articles and 1 interactive workshop that significantly increased the daily number of visits to the www.sport-sante.lu website. One of the two articles was published on the day before the workshop was held, which did not allow us to distinguish its specific impact. The second article was published in the main national newspaper. This is the first time to our knowledge that an event study analysis has been used to evaluate the impact of promotional initiatives on the number of visits to a dedicated website for physical activity and NCDs. Our results indicate that some initiatives can aid in the number of visits, but in general their impact is limited. To observe an increased rate of participation in physical activity, additional promotional and evaluative strategies should be explored. PMID:28611975

Common Operating Picture: UAV Security Study

NASA Technical Reports Server (NTRS)

2004-01-01

This initial communication security study is a top-level assessment of basic security issues related to the operation of Unmanned Aerial Vehicles (UAVs) in the National Airspace System (NAS). Security considerations will include information relating to the use of International Civil Aviation Organization (ICAO) Aeronautical Telecommunications Network (ATN) protocols and applications identifying their maturity, as well as the use of IPV4 and a version of mobile IPV6. The purpose of this assessment is to provide an initial analysis of the security implications of introducing UAVs into the NAS.

The human genome project: Prospects and implications for clinical medicine

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

Green, E.D.; Waterston, R.H.

1991-10-09

The recently initiated human genome project is a large international effort to elucidate the genetic architecture of the genomes of man and several model organisms. The initial phases of this endeavor involve the establishment of rough blueprints (maps) of the genetic landscape of these genomes, with the long-term goal of determining their precise nucleotide sequences and identifying the genes. The knowledge gained by these studies will provide a vital tool for the study of many biologic processes and will have a profound impact on clinical medicine.

[Development of a Conceptual Framework for the Assessment of Chronic Care in the Spanish National Health System].

PubMed

Espallargues, Mireia; Serra-Sutton, Vicky; Solans-Domènech, Maite; Torrente, Elena; Moharra, Montse; Benítez, Dolors; Robles, Noemí; Domíngo, Laia; Escarrabill Sanglas, Joan

2016-07-07

The aim was to develop a conceptual framework for the assessment of new healthcare initiatives on chronic diseases within the Spanish National Health System. A comprehensive literature review between 2002 and 2013, including systematic reviews, meta-analysis, and reports with evaluation frameworks and/or assessment of initiatives was carried out; integrated care initiatives established in Catalonia were studied and described; and semistructured interviews with key stakeholders were performed. The scope and conceptual framework were defined by using the brainstorming approach.Of 910 abstracts identified, a total of 116 studies were included. They referred to several conceptual frameworks and/or assessment indicators at a national and international level. An overall of 24 established chronic care initiatives were identified (9 integrated care initiatives); 10 in-depth interviews were carried out. The proposed conceptual framework envisages: 1)the target population according to complexity levels; 2)an evaluation approach of the structure, processes, and outcomes considering the health status achieved, the recovery process and the maintenance of health; and 3)the dimensions or attributes to be assessed. The proposed conceptual framework will be helpful has been useful to develop indicators and implement them with a community-based and result-oriented approach and a territorial or population-based perspective within the Spanish Health System. This will be essential to know which are the most effective strategies, what are the key elements that determine greater success and what are the groups of patients who can most benefit.

An initial report on the intraoperative use of indocyanine green fluorescence imaging in the surgical management of liver tumorss.

PubMed

Takahashi, Hideo; Zaidi, Nisar; Berber, Eren

2016-10-01

There has been a recent interest in the use of Indocyanine green (ICG) imaging. The aim of this study is to review our initial experience in liver surgery. ICG fluorescent imaging was used in 15 patients undergoing surgical treatment of their liver tumors between 2015 and 2016. ICG imaging was initially performed, followed by intraoperative ultrasound (IOUS). Findings on fluorescence were compared with preoperative cross-sectional imaging and IOUS. Sixty-two lesions were identified, with 34 located superficially and 28 deeply in the liver. While 13 patients underwent surgery for malignant liver metastases, two patients had operations for benign liver diseases. Seven patients underwent open or robotic liver resections, five laparoscopic microwave liver ablation, and three diagnostic laparoscopy. ICG identified all of the superficial lesions. IOUS identified 98% of all lesions. The most benefit of ICG was in showing the margins of the superficial lesions in real-time and guiding surgical treatment, which was limited by IOUS. This is the first North American study to evaluate the potential utility of ICG during liver surgery. Its major benefit seems to be in providing real-time feedback to the surgeon about the margins of superficial tumors for resection or ablation. J. Surg. Oncol. 2016;114:625-629. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Views and Experiences of Malaysian Family Medicine Trainees of Female Sexual Dysfunction.

PubMed

Lai, Pauline Siew Mei; Tan, Sing Yee; Liew, Su May

2016-11-01

Sociocultural factors have been shown to be important influencers of sexual health and sexuality. Hence, the aim of our study was to explore the views and experiences of family medicine trainees regarding female sexual dysfunction (FSD) with a focus on the barriers and facilitators towards the initiation of conversation on this topic. A qualitative study design involving semi-structured focus group discussions (FGDs) was conducted with 19 family medicine trainees in Malaysia. The conceptual framework used was based on the Theory of Planned Behavior. Thematic approach was used to analyze the data. Participants perceived FSD as being uncommon and unimportant. According to our participants, patients often presented with indirect complaints, and doctors were not proactive in asking about FSD. Three main barriers were identified: doctor factors, perceived patient factors, and system factors. Lack of confidence, knowledge, experience, time, and embarrassment were the key barriers identified at the doctors' level. Lack of awareness, among patients regarding FSD, and local cultural and religious norms were the perceived patient barriers. System barriers were lack of time and privacy. Various facilitators, such as continuous medical education and public forums, were suggested as means to encourage family medicine trainees to initiate discussion on sexual matters during consultations. In conclusion, family medicine trainees found it difficult to initiate conversation on FSD with patients. Interventions to encourage conversation on FSD should target this and other identified barriers.

Predictors of provider- initiated HIV testing and counseling refusal by outpatient department clients in Wolaita zone, Southern Ethiopia: a case control study.

PubMed

Facha, Wolde; Kassahun, Wondewosen; Workicho, Abdulhalik

2016-08-12

Despite different strategies designed to rapidly identify HIV infected individuals, majority of HIV-infected people are unaware of their sero-status in developing countries. The objective of this study was to assess predictors of provider-initiated HIV testing and counseling (PITC) refusal by outpatient department (OPD) clients in Wolaita zone, Southern Ethiopia. Facility based unmatched case control study was conducted on outpatient department clients in randomly selected seven health facilities in Wolaita zone, Southern Ethiopia in February 2012. A total of 291 participants (97 cases and 194 controls) were included in our study. Cases were patients who refused HIV test while controls were patients who tested for HIV after provider-initiated HIV testing and counseling (PITC) recommendation by outpatient department (OPD) clinicians. We used both quantitative and qualitative methods of data collection. Pretested interviewer administered questionnaires were used to collect quantitative data by trained nurses, and in-depth interview with 14 OPD clinicians was conducted by principal investigator to supplement quantitative findings. Bivariate and multivariate analyses were done to identify independent predictors of provider-initiated HIV testing and counseling refusal by OPD clients. Study participants who had stigmatizing attitude [AOR = 6.09, (95 % CI: 1.70, 21.76)], who had perceived risk for HIV infection [AOR = 5.23, (95 % CI: 2.22, 12.32)], who did not perceive the benefits of provider-initiated HIV testing and counseling [AOR = 4.64, (95 % CI: 1.79, 12.01)], who did not get minimum recommended pretest information from their providers [AOR = 2.98, (95 % CI: 1.06, 8.35)], who ever not heard of provider-initiated HIV testing and counseling service [AOR = 2.41, (95 % CI: 1.14, 5.09)], and who were from urban area [AOR = 2.40, (95 % CI = 1.26, 4.57)] were more likely to refuse provider-initiated HIV testing and counseling service than their counterparts. Knowledge on HIV/AIDS, attitude towards people living with HIV/AIDS and perceived risk for HIV infection by clients were the major barriers for provider-initiated HIV testing and counseling acceptance. Health professionals working at outpatient department should give due attention to overcome these barriers so as to enhance HIV testing acceptance by their clients.

Linkage and retention in HCV care for HIV-infected populations: early data from the DAA era.

PubMed

Sacks-Davis, Rachel; Doyle, Joseph S; Rauch, Andri; Beguelin, Charles; Pedrana, Alisa E; Matthews, Gail V; Prins, Maria; van der Valk, Marc; Klein, Marina B; Saeed, Sahar; Lacombe, Karine; Chkhartishvili, Nikoloz; Altice, Frederick L; Hellard, Margaret E

2018-04-01

There is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV-infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co-infected populations in the context of implementation science theory. HCV elimination initiatives and studies in HIV co-infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks. Seven HCV elimination initiatives and studies were identified in HIV co-infected populations, mainly operating in high-income countries. Four were focused mainly on HCV elimination in HIV-infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV-infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV-infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%). Early results from emerging research on HCV elimination in HIV-infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Alternate methods of asphalt content determination.

DOT National Transportation Integrated Search

1996-01-01

This study identified an alternate method of asphalt content determination to replace chlorinated solvent extraction. The production of trichloroethane was outlawed on December 31, 1996 as part of the 1990 Clean Air Act Amendments. Initially, the stu...

Rapid replacement of bridge deck expansion joints study - phase I : [tech transfer summary].

DOT National Transportation Integrated Search

2014-12-01

This initial research phase focused on documenting the current : means and methods of bridge expansion joint deterioration, : maintenance, and replacement and on identifying improvements : through all of the input gathered.

Measuring, Achieving, And Promoting Smoothness Of Virginia's Asphalt Overlays

DOT National Transportation Integrated Search

1999-04-01

This study was initiated with the goal of identifying the predominant factors affecting the achievable smoothness of asphalt overlays. In addition, the researcher chronicles the evolution of Virginia's innovative special provision for smoothness, whi...

White spots in pharmaceutical pipelines-EMA identifies potential areas of unmet medical needs.

PubMed

Papaluca, Marisa; Greco, Martina; Tognana, Enrico; Ehmann, Falk; Saint-Raymond, Agnès

2015-05-01

Unmet medical needs are a priority for organizations such as the WHO and major public-private initiatives, such as Innovative Medicines Initiative, were established to speed up the development of better and safer medicines for patients. To assist such projects, the EMA in its 'Road Map to 2015' considered the mapping of unmet medical needs as a priority. This study has identified medical conditions for which the EMA could not identify developments in the pharmaceutical pipelines, that is, 'white spots'. Our analysis was made using external data sources as well as mining data of the EMA. The main areas for white spots were oncology, infectious diseases and certain psychiatric conditions. According to our data and a review of literature, in a number of these white spots, diagnostic tools may even be missing. The identification of those conditions will benefit stakeholders, including regulators, research funding bodies and patients' organizations.

Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis.

PubMed

Burton, Rachel A; Lallemand, Nicole M; Peters, Rebecca A; Zuckerman, Stephen

2018-02-05

Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.

Readiness of communities to engage with childhood obesity prevention initiatives in disadvantaged areas of Victoria, Australia.

PubMed

Cyril, Sheila; Polonsky, Michael; Green, Julie; Agho, Kingsley; Renzaho, Andre

2017-07-01

Objective Disadvantaged communities bear a disproportionate burden of childhood obesity and show low participation in childhood obesity prevention initiatives. This study aims to examine the level of readiness of disadvantaged communities to engage with childhood obesity prevention initiatives. Methods Using the community readiness model, 95 semi-structured interviews were conducted among communities in four disadvantaged areas of Victoria, Australia. Community readiness analysis and paired t-tests were performed to assess the readiness levels of disadvantaged communities to engage with childhood obesity prevention initiatives. Results The results showed that disadvantaged communities demonstrated low levels of readiness (readiness score=4/9, 44%) to engage with the existing childhood obesity prevention initiatives, lacked knowledge of childhood obesity and its prevention, and reported facing challenges in initiating and sustaining participation in obesity prevention initiatives. Conclusion This study highlights the need to improve community readiness by addressing low obesity-related literacy levels among disadvantaged communities and by facilitating the capacity-building of bicultural workers to deliver obesity prevention messages to these communities. Integrating these needs into existing Australian health policy and practice is of paramount importance for reducing obesity-related disparities currently prevailing in Australia. What is known about the topic? Childhood obesity prevalence is plateauing in developed countries including Australia; however, obesity-related inequalities continue to exist in Australia especially among communities living in disadvantaged areas, which experience poor engagement in childhood obesity prevention initiatives. Studies in the USA have found that assessing disadvantaged communities' readiness to participate in health programs is a critical initial step in reducing the disproportionate obesity burden among these communities. However, no studies in Australia have assessed disadvantaged communities' readiness to engage in obesity prevention initiatives. What does this paper add? This paper addresses the current gap in the knowledge of disadvantaged communities' level of readiness to engage in childhood obesity prevention initiatives in Australia. The study also identified the key factors responsible for low readiness of disadvantaged communities to participate in current childhood obesity prevention services. By using the Community Readiness model this study shows the readiness levels specific to the various dimensions of the model; Understanding dimension-specific readiness allows us to identify strategies that are tailored to each dimension, as guided by the model. What are the implications for practitioners? With the increasing burden of childhood obesity on disadvantaged communities, policymakers and health practitioners are facing a crisis in obesity prevention and management. Almost every year, new interventions are being planned and implemented. However if the target communities are not ready to participate in the available interventions these efforts are futile. This study exposes the key factors responsible for low readiness to participate in current obesity prevention services by disadvantaged communities. Addressing these key factors and improving readiness before designing new interventions will improve the participation of disadvantaged communities in those interventions. The study findings ultimately have the potential of reducing obesity-related disparities in Australia.

Risk for incident diabetes mellitus following initiation of second-generation antipsychotics among Medicaid-enrolled youths.

PubMed

Rubin, David M; Kreider, Amanda R; Matone, Meredith; Huang, Yuan-Shung; Feudtner, Chris; Ross, Michelle E; Localio, A Russell

2015-04-01

Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children, either singly or in a medication combination. Although metabolic adverse effects have been linked to SGA use in youths, estimating the risk for type 2 diabetes mellitus, a rarer outcome, has been challenging. To determine whether SGA initiation was associated with an increased risk for incident type 2 diabetes mellitus. Secondary analyses examined the risk associated with multiple-drug regimens, including stimulants and antidepressants, as well as individual SGAs. Retrospective national cohort study of Medicaid-enrolled youths between January 2003 and December 2007. In this observational study using national Medicaid Analytic eXtract data files, initiators and noninitiators of SGAs were identified in each month. Included in this study were US youths aged 10 to 18 years with a mental health diagnosis and enrolled in a Medicaid fee-for-service arrangement during the study. Those with chronic steroid exposure, a diagnosis of diabetes mellitus, or SGA use during a 1-year look-back period were ineligible. The mean follow-up time for all participants was 17.2 months. Youths were followed up until diagnosis of diabetes mellitus or end of follow-up owing to censoring caused by the transition into a Medicaid managed care arrangement or Medicaid ineligibility (the end of available data). Propensity weights were developed to balance observed demographic and clinical characteristics between exposure groups. Discrete failure time models were fitted using weighted logistic regression to estimate the risk for incident diabetes mellitus between initiators and noninitiators. A filled SGA prescription. Incident type 2 diabetes mellitus identified through visit and pharmacy claims during the observation period. Among 107,551 SGA initiators and 1,221,434 noninitiators, the risk for incident diabetes mellitus was increased among initiators (odds ratio [OR], 1.51; 95% CI, 1.35-1.69; P < .001). Compared with youths initiating only SGAs, the risk was higher among SGA initiators who used antidepressants concomitantly at the time of SGA initiation (OR, 1.54; 95% CI, 1.17-2.03; P = .002) but was not significantly different for SGA initiators who were concomitantly using stimulants. As compared with a reference group of risperidone initiators, the risk was higher among those initiating ziprasidone (OR, 1.61; 95% CI, 0.99-2.64; P = .06) and aripiprazole (OR, 1.58; 95% CI, 1.21-2.07; P = .001) but not quetiapine fumarate or olanzapine. The risk for incident type 2 diabetes mellitus was increased among youths initiating SGAs and was highest in those concomitantly using antidepressants. Compared with risperidone, newer antipsychotics were not associated with decreased risk.

Problem Definition Studies on Potential Environmental Pollutants. 6. Preliminary Assessment of Environmental Effects of Seven Substances Used in Pyrotechnic Compositions at Pine Bluff Arsenal

DTIC Science & Technology

1979-11-01

on reveryo if nec.,ary and identify by block number) FIELD GROUP SUB-GROUP Benzanthrone, 1-Methylaminoanthraquinone, Pyrotechnics 24 03 .uramine, 1,4...necessary and identify by block number) Procurement data for the period 1965-1975 are used to estimate soil contaminatior by pyrotechnic and smoke...Project Manager for Chemical Demilitarization and Installation Restoration, has identified an initial list of substances (Table 1) requiring assessment

Genetic and environmental influences on cannabis use initiation and problematic use: a meta-analysis of twin studies

PubMed Central

Verweij, Karin J.H.; Zietsch, Brendan P.; Lynskey, Michael T.; Medland, Sarah E.; Neale, Michael C.; Martin, Nicholas G.; Boomsma, Dorret I.; Vink, Jacqueline M.

2009-01-01

Background Because cannabis use is associated with social, physical and psychological problems, it is important to know what causes some individuals to initiate cannabis use and a subset of those to become problematic users. Previous twin studies found evidence for both genetic and environmental influences on vulnerability, but due to considerable variation in the results it is difficult to draw clear conclusions regarding the relative magnitude of these influences. Method A systematic literature search identified 28 twin studies on cannabis use initiation and 24 studies on problematic cannabis use. The proportion of total variance accounted for by genes (A), shared environment (C), and unshared environment (E) in (1) initiation of cannabis use and (2) problematic cannabis use was calculated by averaging corresponding A, C, and E estimates across studies from independent cohorts and weighting by sample size. Results For cannabis use initiation, A, C, and E estimates were 48%, 25% and 27% in males and 40%, 39% and 21% in females. For problematic cannabis use A, C, and E estimates were 51%, 20% and 29% for males and 59%, 15% and 26% for females. Confidence intervals of these estimates are considerably narrower than those in the source studies. Conclusions Our results indicate that vulnerability to both cannabis use initiation and problematic use was significantly influenced by A, C, and E. There was a trend for a greater C and lesser A component for cannabis initiation as compared to problematic use for females. PMID:20402985

The Precision Medicine Initiative's All of Us Research Program: an agenda for research on its ethical, legal, and social issues.

PubMed

Sankar, Pamela L; Parker, Lisa S

2017-07-01

The Precision Medicine Initiative (PMI) is an innovative approach to developing a new model of health care that takes into account individual differences in people's genes, environments, and lifestyles. A cornerstone of the initiative is the PMI All of Us Research Program (formerly known as PMI-Cohort Program) which will create a cohort of 1 million volunteers who will contribute their health data and biospecimens to a centralized national database to support precision medicine research. The PMI All of US Research Program is the largest longitudinal study in the history of the United States. The designers of the Program anticipated and addressed some of the ethical, legal, and social issues (ELSI) associated with the initiative. To date, however, there is no plan to call for research regarding ELSI associated with the Program-PMI All of Us program. Based on analysis of National Institutes of Health (NIH) funding announcements for the PMI All of Us program, we have identified three ELSI themes: cohort diversity and health disparities, participant engagement, and privacy and security. We review All of Us Research Program plans to address these issues and then identify additional ELSI within each domain that warrant ongoing investigation as the All of Us Research Program develops. We conclude that PMI's All of Us Research Program represents a significant opportunity and obligation to identify, analyze, and respond to ELSI, and we call on the PMI to initiate a research program capable of taking on these challenges.Genet Med advance online publication 01 December 2016.

Oral 5-Aminosalicylate, Mesalamine Suppository, and Mesalamine Enema as Initial Therapy for Ulcerative Proctitis in Clinical Practice with Quality of Care Implications.

PubMed

Richter, James M; Arshi, Nabeela K; Oster, Gerry

2016-01-01

Background. Ulcerative proctitis (UP) is typically treated initially with oral 5-aminosalicylate ("5-ASA"), mesalamine suppository, or mesalamine enema ("UP Rx"). Little is known about their effectiveness in practice. Methods. Using a US health insurance database, we identified new-onset UP patients between January 1, 2005, and December 31, 2007, based on the following: (1) initiation of UP Rx; (2) endoscopy in prior 30 days resulting in diagnosis of UP; and (3) no prior encounters for ulcerative colitis or Crohn's disease. We examined the incidence of therapy escalation and total costs in relation to initial UP Rx. Results. We identified 548 patients: 327 received mesalamine suppository, 138 received oral 5-ASA, and 83 received mesalamine enema, as initial UP Rx. One-third receiving oral 5-ASA experienced therapy escalation over 12 months, 21% for both mesalamine suppository and enema. Mean cumulative total cost of UP Rx over 12 months was $1552, $996, and $986 for patients beginning therapy with oral 5-ASA, mesalamine enema, and mesalamine suppository, respectively. Contrary to expert recommendations the treatments were often not continued prophylactically. Conclusions. Treatment escalation was common, and total costs of therapy were higher, in patients who initiated treatment with oral 5-ASA. Further study is necessary to assess the significance of these observations.

Oral 5-Aminosalicylate, Mesalamine Suppository, and Mesalamine Enema as Initial Therapy for Ulcerative Proctitis in Clinical Practice with Quality of Care Implications

PubMed Central

Richter, James M.; Arshi, Nabeela K.; Oster, Gerry

2016-01-01

Background. Ulcerative proctitis (UP) is typically treated initially with oral 5-aminosalicylate (“5-ASA”), mesalamine suppository, or mesalamine enema (“UP Rx”). Little is known about their effectiveness in practice. Methods. Using a US health insurance database, we identified new-onset UP patients between January 1, 2005, and December 31, 2007, based on the following: (1) initiation of UP Rx; (2) endoscopy in prior 30 days resulting in diagnosis of UP; and (3) no prior encounters for ulcerative colitis or Crohn's disease. We examined the incidence of therapy escalation and total costs in relation to initial UP Rx. Results. We identified 548 patients: 327 received mesalamine suppository, 138 received oral 5-ASA, and 83 received mesalamine enema, as initial UP Rx. One-third receiving oral 5-ASA experienced therapy escalation over 12 months, 21% for both mesalamine suppository and enema. Mean cumulative total cost of UP Rx over 12 months was $1552, $996, and $986 for patients beginning therapy with oral 5-ASA, mesalamine enema, and mesalamine suppository, respectively. Contrary to expert recommendations the treatments were often not continued prophylactically. Conclusions. Treatment escalation was common, and total costs of therapy were higher, in patients who initiated treatment with oral 5-ASA. Further study is necessary to assess the significance of these observations. PMID:27446860

FTIR Imaging Coupled with Multivariate Analysis for Study of Initial Diffusion of Different Solvents in Cellulose Acetate Butyrate Films

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

Lindblad, M.S.; Keyes, B.; Gedvilas, L.

Fourier transform infrared (FTIR) spectroscopic imaging was used to study the initial diffusion of different solvents in cellulose acetate butyrate (CAB) films containing different amounts of acetyl and butyryl substituents. Different solvents and solvent/non-solvent mixtures were also studied. The FTIR imaging system allowed acquisition of sequential images of the CAB films as solvent penetration proceeded without disturbing the system. The interface between the non-swollen polymer and the initial swelling front could be identified using multivariate data analysis tools. For a series of ketone solvents the initial diffusion coefficients and diffusion rates could be quantified and were found to be relatedmore » to the polar and hydrogen interaction parameters in the Hansen solubility parameters of the solvents. For the solvent/non-solvent system the initial diffusion rate decreased less than linearly with the weight-percent of non-solvent present in the solution, which probably was due to the swelling characteristic of the non-solvent. For a given solvent, increasing the butyryl content of the CAB increased the initial diffusion rate. Increasing the butyryl content from 17 wt.% butyryl to 37 wt.% butyryl produced a considerably larger increase in initial diffusion rate compared to an increase in butyryl content from 37 wt.% to 50 wt.% butyryl.« less

Applying shot boundary detection for automated crystal growth analysis during in situ transmission electron microscope experiments

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

Moeglein, W. A.; Griswold, R.; Mehdi, B. L.

In-situ (scanning) transmission electron microscopy (S/TEM) is being developed for numerous applications in the study of nucleation and growth under electrochemical driving forces. For this type of experiment, one of the key parameters is to identify when nucleation initiates. Typically the process of identifying the moment that crystals begin to form is a manual process requiring the user to perform an observation and respond accordingly (adjust focus, magnification, translate the stage etc.). However, as the speed of the cameras being used to perform these observations increases, the ability of a user to “catch” the important initial stage of nucleation decreasesmore » (there is more information that is available in the first few milliseconds of the process). Here we show that video shot boundary detection (SBD) can automatically detect frames where a change in the image occurs. We show that this method can be applied to quickly and accurately identify points of change during crystal growth. This technique allows for automated segmentation of a digital stream for further analysis and the assignment of arbitrary time stamps for the initiation of processes that are independent of the user’s ability to observe and react.« less

Search for and Study of Nearly Periodic Orbits in the Plane Problem of Three Equal-Mass Bodies

NASA Astrophysics Data System (ADS)

Martynova, A. I.; Orlov, V. V.

2005-09-01

We analyze nearly periodic solutions in the plane problem of three equal-mass bodies by numerically simulating the dynamics of triple systems. We identify families of orbits in which all three points are on one straight line (syzygy) at the initial time. In this case, at fixed total energy of a triple system, the set of initial conditions is a bounded region in four-dimensional parameter space. We scan this region and identify sets of trajectories in which the coordinates and velocities of all bodies are close to their initial values at certain times (which are approximately multiples of the period). We classify the nearly periodic orbits by the structure of trajectory loops over one period. We have found the families of orbits generated by von Schubart’s stable periodic orbit revealed in the rectilinear three-body problem. We have also found families of hierarchical, nearly periodic trajectories with prograde and retrograde motions. In the orbits with prograde motions, the trajectory loops of two close bodies form looplike structures. The trajectories with retrograde motions are characterized by leafed structures. Orbits with central and axial symmetries are identified among the families found.

Opportunities for strengthening provider-initiated testing and counselling for HIV in Namibia

PubMed Central

Davyduke, Tracy; Pietersen, Ismelda; Lowrance, David; Amwaama, Selma; Taegtmeyer, Miriam

2015-01-01

This short report identifies enablers and barriers to the uptake of provider-initiated testing and counselling for HIV (PITC) in Namibia and identifies key opportunities for strengthening this vital aspect of the national HIV response. We explored this through facility mapping, register reviews and qualitative methods including focus group discussions and in-depth interviews. Four health facilities (clinics and hospitals) in two regions were included in the study. We identified that PITC in Namibia was largely delivered by lay counsellors operating in designated rapid testing rooms located in health facilities and found a large number of missed opportunities for HIV testing through this model. Nurses did not see it as an integral part of their role, were not aware of HIV testing and counselling policy, felt inadequately trained and supported, and experienced staffing shortages. Institutional issues also acted as barriers to nurses performing or initiating discussions about PITC. Wider dissemination and implementation of policy, increasing privacy of consultation spaces and community sensitisation are simple measures that represent opportunities for strengthening this response and ensuring that symptomatic individuals who are unaware of their HIV status do not fall through the net. PMID:25771903

Getting right to the point: identifying Australian outpatients' priorities and preferences for patient-centred quality improvement in chronic disease care.

PubMed

Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Oldmeadow, Christopher

2016-09-01

To identify specific actions for patient-centred quality improvement in chronic disease outpatient settings, this study identified patients' general and specific preferences among a comprehensive suite of initiatives for change. A cross-sectional survey was conducted in three hospital-based clinics specializing in oncology, neurology and cardiology care located in New South Wales, Australia. Adult English-speaking outpatients completed the touch-screen Consumer Preferences Survey in waiting rooms or treatment areas. Participants selected up to 23 general initiatives that would improve their experience. Using adaptive branching, participants could select an additional 110 detailed initiatives and complete a relative prioritization exercise. A total of 541 individuals completed the survey (71.1% consent, 73.1% completion). Commonly selected general initiatives, presented in order of decreasing priority (along with sample proportion), included: improved parking (60.3%), up-to-date information provision (15.0%), ease of clinic contact (12.9%), access to information at home (12.8%), convenient appointment scheduling (14.2%), reduced wait-times (19.8%) and information on medical emergencies (11.1%). To address these general initiatives, 40 detailed initiatives were selected by respondents. Initiatives targeting service accessibility and information provision, such as parking and up-to-date information on patient prognoses and progress, were commonly selected and perceived to be of relatively greater priority. Specific preferences included the need for clinics to provide patient-designated parking in close proximity to the clinic, information on treatment progress and test results (potentially in the form of designated brief appointments or via telehealth) and comprehensive and trustworthy lists of information sources to access at home. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Human colonic myocytes are involved in postischemic inflammation through ADAM17-dependent TNFα production

PubMed Central

Jarry, Anne; Bach-Ngohou, Kalyane; Masson, Damien; Dejoie, Thomas; Lehur, Paul-Antoine; Mosnier, Jean-François; Denis, Marc G; Laboisse, Christian L

2005-01-01

The aim of this study was to identify human colonic resident cells able to initiate an inflammatory response in postischemic injury. Postischemic colonic injury, a condition relevant to various clinical settings, involves an inflammatory cascade in intestinal tissues through the recruitment of circulating inflammatory cells. However, there is no information on the nature of resident cells of the different intestinal layers able to initiate a postischemic inflammatory response. It is however an important issue in the context of a pharmacological approach of the early phase of intestinal ischemia. We reasoned that maintaining the different colonic layers as explant cultures in an oxygenated medium immediately after colonic resection, that is, after an ischemic period, would allow one to identify the resident cells able to initiate an inflammatory cascade, without interference of recruited inflammatory/immune cells. To this end, we designed an explant culture system that operationally defines three compartments in surgical specimens of the human colon, based on the microdissected layers, that is, mucosa, submucosa (containing muscularis mucosae) and muscularis propria. To validate the results obtained in explant cultures in the clinical setting of ischemic colitis, eight cases of sigmoid volvulus were examined. Only the myocytes-containing explants produced tumor necrosis factor alpha (TNFα), via an ADAM17 (a disintegrin and metalloproteinase-17)-dependent pathway, as shown by the abrogation of TNFα production by the inhibitor Tapi-2. Immunofluorescence studies identified nonvascular and vascular myocytes as resident cells coexpressing TNFα and ADAM17, both in our postischemic explant system and in surgical specimens from ischemic colitis patients. Finally, time-course experiments on explanted tissues showed that TNFα production by myocytes was an early event triggered by a postischemic oxidative stress involving nuclear factor kappa B (NF-κB). In conclusion, this study identifies human intestinal myocytes as resident cells able to initiate an inflammatory reaction through TNFα production in postischemic conditions, and delineates two points of control in TNFα production, NF-κB and ADAM17, which can be targeted by pharmacological manipulation. PMID:16273118

Nuclear safety for the space exploration initiative

NASA Technical Reports Server (NTRS)

Dix, Terry E.

1991-01-01

The results of a study to identify potential hazards arising from nuclear reactor power systems for use on the lunar and Martian surfaces, related safety issues, and resolutions of such issues by system design changes, operating procedures, and other means are presented. All safety aspects of nuclear reactor power systems from prelaunch ground handling to eventual disposal were examined consistent with the level of detail for SP-100 reactor design at the 1988 System Design Review and for launch vehicle and space transport vehicle designs and mission descriptions as defined in the 90-day Space Exploration Initiative (SEI) study. Information from previous aerospace nuclear safety studies was used where appropriate. Safety requirements for the SP-100 space nuclear reactor system were compiled. Mission profiles were defined with emphasis on activities after low earth orbit insertion. Accident scenarios were then qualitatively defined for each mission phase. Safety issues were identified for all mission phases with the aid of simplified event trees. Safety issue resolution approaches of the SP-100 program were compiled. Resolution approaches for those safety issues not covered by the SP-100 program were identified. Additionally, the resolution approaches of the SP-100 program were examined in light of the moon and Mars missions.

The Role of Family on Hookah Smoking Initiation in Women: A Qualitative Study.

PubMed

Baheiraei, Azam; Shahbazi Sighaldeh, Shirin; Ebadi, Abbas; Kelishadi, Roya; Majdzadeh, Reza

2015-02-24

Hookah smoking has recently emerged as a popular alternative to cigarette smoking particularly among young adults and women. This study focused on the role of family members' smoking behaviours as a possible risk factor for initiation of hookah smoking in women. 36 in-depth interviews were conducted with Iranian women of diverse ages for understanding the factors contributing to the initiation of hookah smoking. Four main themes were identified from the data. This study focused on the role of family as a facilitator for hookah smoking initiation. The results of this study indicate that the entry of hookah into homes can be effective in the spread of hookah smoking among adult and young women, in three ways: Girls' participation in the preparation of hookah and the frequent observation of people who smoke hookah at home can be effective in hookah smoking initiation among young girls; the husband of a young woman has an important role in the initiation of smoking hookah; when parents invite children to smoke hookah at home, in order to protect them against public censure, the mother (a middle aged woman) may intend to start smoking hookah. Therefore, tobacco use prevention interventions should be focused on targeting the family as well.

The Role of Family on Hookah Smoking Initiation in Women: A Qualitative Study

PubMed Central

Baheiraei, Azam; Sighaldeh, Shirin Shahbazi; Ebadi, Abbas; Kelishadi, Roya; Majdzadeh, Reza

2015-01-01

Hookah smoking has recently emerged as a popular alternative to cigarette smoking particularly among young adults and women. This study focused on the role of family members’ smoking behaviours as a possible risk factor for initiation of hookah smoking in women. 36 in-depth interviews were conducted with Iranian women of diverse ages for understanding the factors contributing to the initiation of hookah smoking. Four main themes were identified from the data. This study focused on the role of family as a facilitator for hookah smoking initiation. The results of this study indicate that the entry of hookah into homes can be effective in the spread of hookah smoking among adult and young women, in three ways: Girls’ participation in the preparation of hookah and the frequent observation of people who smoke hookah at home can be effective in hookah smoking initiation among young girls; the husband of a young woman has an important role in the initiation of smoking hookah; when parents invite children to smoke hookah at home, in order to protect them against public censure, the mother (a middle aged woman) may intend to start smoking hookah. Therefore, tobacco use prevention interventions should be focused on targeting the family as well. PMID:26156895

Review Article: Influenza Transmission on Aircraft: A Systematic Literature Review.

PubMed

Leitmeyer, Katrin; Adlhoch, Cornelia

2016-09-01

Air travel is associated with the spread of influenza through infected passengers and potentially through in-flight transmission. Contact tracing after exposure to influenza is not performed systematically. We performed a systematic literature review to evaluate the evidence for influenza transmission aboard aircraft. Using PubMed and EMBASE databases, we identified and critically appraised identified records to assess the evidence of such transmission to passengers seated in close proximity to the index cases. We also developed a bias assessment tool to evaluate the quality of evidence provided in the retrieved studies. We identified 14 peer-reviewed publications describing contact tracing of passengers after possible exposure to influenza virus aboard an aircraft. Contact tracing during the initial phase of the influenza A(H1N1)pdm09 pandemic was described in 11 publications. The studies describe the follow-up of 2,165 (51%) of 4,252 traceable passengers. Altogether, 163 secondary cases were identified resulting in an overall secondary attack rate among traced passengers of 7.5%. Of these secondary cases, 68 (42%) were seated within two rows of the index case. We found an overall moderate quality of evidence for transmission of influenza virus aboard an aircraft. The major limiting factor was the comparability of the studies. A majority of secondary cases was identified at a greater distance than two rows from the index case. A standardized approach for initiating, conducting, and reporting contact tracing could help to increase the evidence base for better assessing influenza transmission aboard aircraft.

Review Article: Influenza Transmission on Aircraft

PubMed Central

Adlhoch, Cornelia

2016-01-01

Background: Air travel is associated with the spread of influenza through infected passengers and potentially through in-flight transmission. Contact tracing after exposure to influenza is not performed systematically. We performed a systematic literature review to evaluate the evidence for influenza transmission aboard aircraft. Methods: Using PubMed and EMBASE databases, we identified and critically appraised identified records to assess the evidence of such transmission to passengers seated in close proximity to the index cases. We also developed a bias assessment tool to evaluate the quality of evidence provided in the retrieved studies. Results: We identified 14 peer-reviewed publications describing contact tracing of passengers after possible exposure to influenza virus aboard an aircraft. Contact tracing during the initial phase of the influenza A(H1N1)pdm09 pandemic was described in 11 publications. The studies describe the follow-up of 2,165 (51%) of 4,252 traceable passengers. Altogether, 163 secondary cases were identified resulting in an overall secondary attack rate among traced passengers of 7.5%. Of these secondary cases, 68 (42%) were seated within two rows of the index case. Conclusion: We found an overall moderate quality of evidence for transmission of influenza virus aboard an aircraft. The major limiting factor was the comparability of the studies. A majority of secondary cases was identified at a greater distance than two rows from the index case. A standardized approach for initiating, conducting, and reporting contact tracing could help to increase the evidence base for better assessing influenza transmission aboard aircraft. PMID:27253070

Development of mining guidance and control systems

NASA Technical Reports Server (NTRS)

1979-01-01

New fundamental interface sensor concepts were identified and investigated including tabulation of the physical and performance characteristics of two new interface detector concepts: - natural background radiation and magnetic spin resonance. Studies of guidance and control techniques for the longwall miner identified three basic systems for use in automated/remote controlled longwall mining. The following projects were initiated: system study which will more completely define the longwall guidance and control system design concepts; integration of the various control functions (vertical, yaw, and roll); and hardware technical requirements.

Space Station crew safety alternatives study. Volume 4: Appendices

NASA Technical Reports Server (NTRS)

Peercy, R. L., Jr.; Raasch, R. F.; Rockoff, L. A.

1985-01-01

The scope of this study considered the first 15 years of accumulated space station concepts for Initial Operational Capability (10C) during the early 1990's. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration and debris.

The Delphi Technique in Identifying Learning Objectives for the Development of Science, Technology and Society Modules for Palestinian Ninth Grade Science Curriculum

ERIC Educational Resources Information Center

Abualrob, Marwan M. A.; Daniel, Esther Gnanamalar Sarojini

2013-01-01

This article outlines how learning objectives based upon science, technology and society (STS) elements for Palestinian ninth grade science textbooks were identified, which was part of a bigger study to establish an STS foundation in the ninth grade science curriculum in Palestine. First, an initial list of STS elements was determined. Second,…

Continuous Subcutaneous Insulin Infusion in Children: A Pilot Study Validating a Protocol to Avoid Hypoglycemia at Initiation.

PubMed

Manousaki, Despoina; Deladoëy, Johnny; Geoffroy, Louis; Olivier, Patricia

2017-01-01

The occurrence of hypoglycemia and hyperglycemia during the first days after transition to continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes has not been systematically studied in children. The aim of this prospective study was to demonstrate that the protocol applied in our diabetes clinic is safe at CSII initiation in children. We assessed 22 pediatric patients with type 1 diabetes, using continuous glucose monitoring (CGM) before and after CSII initiation (±3 days). After CSII initiation, there was no difference in the rates of hypoglycemic events expressed as relative rates (RRs) per person-reading (RR = 0.85, p  = 0.52, 95% CI 0.52-1.39), as well as in the number of prolonged hypoglycemic events (>1 h) per day (RR = 1.12, p  = 0.56, 95% CI 0.75-1.68). We observed only a trend toward prolonged episodes of hyperglycemia after pump initiation (RR = 1.52, p  = 0.06, 95% CI 0.97-2.35). Our study is the first to assess, through CGM and in a prospective way, the impact of a CSII initiation protocol on glycemic values. Our protocol provides a safe model to avoid hypoglycemia at CSII initiation in children. www.ClinicalTrials.gov, identifier NCT01840358.

Building Bridges in Social Studies Education: Professional Development School Partnerships

ERIC Educational Resources Information Center

Vontz, Thomas S.; Franke, Jim; Burenheide, Brad; Bietau, Lisa

2007-01-01

The authors explore the extent to which a mature professional development school (PDS) partnership at Kansas State University (KSU) helps link the disparate parts of the social studies education community. The authors initially identify and describe the divisions or "gulfs" that commonly plague social studies education, such as the gulfs…

Getting in Touch with Paramedic Student Career Intentions

ERIC Educational Resources Information Center

O'Meara, Peter; Tourle, Vianne; Madigan, Veronica; Lighton, David

2012-01-01

Objective: This study of paramedic and nursing/paramedic students aimed to determine the initial career intentions of full-time paramedic students and to identify the key factors that influence their career choices. Design: A longitudinal study design, utilizing surveys and a focus group, was employed. Setting: The study was conducted in an…

A Mental Health Training Format for Adult Education Teachers

ERIC Educational Resources Information Center

Meek, Fiona; Specht, Jacqueline; Rodger, Susan

2017-01-01

The present study investigated the needs of adult education staff pertaining to adult students' mental health issues within a local school board. The study utilized mixed-methods design and was divided into progression of three separate studies. An initial focus group was conducted to identify the 12 participants' concerns and provide a direction…

Progression of trunk imbalance in adolescent idiopathic scoliosis with a thoracolumbar/lumbar curve: is it predictable at the initial visit?

PubMed

Hwang, Chang Ju; Lee, Choon Sung; Lee, Dong-Ho; Cho, Jae Hwan

2017-11-01

OBJECTIVE Progression of trunk imbalance is an important finding during follow-up of patients with adolescent idiopathic scoliosis (AIS). Nevertheless, no factors that predict progression of trunk imbalance have been identified. The purpose of this study was to identify parameters that predict progression of trunk imbalance in cases of AIS with a structural thoracolumbar/lumbar (TL/L) curve. METHODS This study included 105 patients with AIS and a structural TL/L curve who were followed up at an outpatient clinic. Patients with trunk imbalance (trunk shift ≥ 20 mm) at the initial visit were excluded. All patients were followed up for more than 2 years. Patients were divided into the following groups according to progression of trunk imbalance: 1) Group P, trunk shift ≥ 20 mm at the final visit and degree of progression ≥ 10 mm; and 2) Group NP, trunk shift < 20 mm at the final visit or degree of progression < 10 mm. Radiological parameters included Cobb angle, upper end vertebrae and lower end vertebrae (LEV), LEV tilt, disc wedge angle between LEV and LEV+1, trunk shift, apical vertebral translation, and apical vertebral rotation (AVR). Each parameter was compared between groups. Radiological parameters were assessed at every visit using whole-spine standing anteroposterior radiographs. RESULTS Among the 105 patients examined, 13 showed trunk imbalance with progression ≥ 10 mm at the final visit (Group P). Multivariate logistic regression analysis identified a lower Risser grade (p = 0.002) and a greater initial AVR (p = 0.020) as predictors of progressive trunk imbalance. A change in LEV tilt during follow-up was associated with trunk imbalance (p = 0.001). CONCLUSIONS Risser grade and AVR measured at the initial visit may predict progression of trunk imbalance. Surgeons should consider the risk of progressive trunk imbalance if patients show skeletal immaturity and a greater AVR at the initial visit.

Phase analysis in the Wolff-Parkinson-White syndrome with surgically proven accessory conduction pathways: concise communication

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

Nakajima, K.; Bunko, H.; Tada, A.

1984-01-01

Twenty-one patients with the Wolff-Parkinson-White (WPW) syndrome who underwent surgical division of the accessory conduction pathway (ACP) were studied by gated blood-pool scintigraphy. In each case, a functional image of the phase was generated, based on the fundamental frequency of the Fourier transform. The location of the ACP was confirmed by electrophysiologic study, epicardial mapping, and surgery. Phase analysis identified the side of preexcitation correctly in 16 out of 20 patients with WPW syndrome with a delta wave. All patients with right-cardiac type (N=9) had initial contraction in the right ventricle (RV). In patients with left-cardiac type (N=10), six hadmore » initial movement in the left ventricle (LV); but in the other four the ACPs in the anterior or lateral wall of the left ventricle (LV) could not be detected. In patients with multiple ACPs (N=2), one right-cardiac type had initial contraction in the RV, while in the other (with an intermittent WPW syndrome) the ACP was not detected. These observations indicate that abnormal wall motion is associated with the conduction anomalies of the WPW syndrome. We conclude that phase analysis can correctly identify the side of initial contraction in the WPW syndrome before and after surgery. However, as a method of preoperative study, it seems difficult to determine the precise site of the ACP by phase analysis alone.« less

Spallation Neutron Source Second Target Station Integrated Systems Update

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

Ankner, John Francis; An, Ke; Blokland, Willem

The Spallation Neutron Source (SNS) was designed from the beginning to accommodate both an accelerator upgrade to increase the proton power and a second target station (STS). Four workshops were organized in 2013 and 2014 to identify key science areas and challenges where neutrons will play a vital role [1-4]. Participants concluded that the addition of STS to the existing ORNL neutron sources was needed to complement the strengths of High Flux Isotope Reactor (HFIR) and the SNS first target station (FTS). To address the capability gaps identified in the workshops, a study was undertaken to identify instrument concepts thatmore » could provide the required new science capabilities. The study outlined 22 instrument concepts and presented an initial science case for STS [5]. These instrument concepts formed the basis of a planning suite of instruments whose requirements determined an initial site layout and moderator selection. An STS Technical Design Report (TDR) documented the STS concept based on those choices [6]. Since issue of the TDR, the STS concept has significantly matured as described in this document.« less

Evaluation of Fracture Initiation in the Mannesmann Piercing Process

NASA Astrophysics Data System (ADS)

Fanini, S.; Ghiotti, A.; Bruschi, S.

2007-04-01

One of the challenging objectives in studying the Mannesmann piercing process is to predict the fracture initiation, known as "Mannesmann effect", in order to design and optimize the working parameters of the piercing process. The objective of the paper is to investigate the workability of a tube steel tested in the same conditions of the Mannesman piercing process. The stress and strain states as well as temperature fields arising during the process are identified through numerical simulations. The hot tensile test is chosen for fundamental studies on fracture initiation, as a tensile state of stress in the centre of the billet in the first stages of the piercing process before the plug arrival seems to be one of the main causes of the crack initiation. The material constants of energy-based models implemented in FEM codes are calculated and numerical results are compared with non-plug piercing tests carried out on the industrial plant.

Initiation of Addiction Treatment and Access to Services: Young Adults' Accounts of Their Help-Seeking Experiences.

PubMed

Wagner, Vincent; Bertrand, Karine; Flores-Aranda, Jorge; Acier, Didier; Brunelle, Natacha; Landry, Michel; Brochu, Serge

2017-09-01

Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care.

Operationally Efficient Propulsion System Study (OEPSS) data book. Volume 3: Operations technology

NASA Technical Reports Server (NTRS)

Vilja, John O.

1990-01-01

The study was initiated to identify operational problems and cost drivers for current propulsion systems and to identify technology and design approaches to increase the operational efficiency and reduce operations costs for future propulsion systems. To provide readily usable data for the Advanced Launch System (ALS) program, the results of the OEPSS study were organized into a series of OEPSS Data Books. This volume describes operations technologies that will enhance operational efficiency of propulsion systems. A total of 15 operations technologies were identified that will eliminate or mitigate operations problems described in Volume 2. A recommended development plan is presented for eight promising technologies that will simplify the propulsion system and reduce operational requirements.

Evidence of reducing ethanol content in beverages to reduce harmful use of alcohol.

PubMed

Rehm, Jürgen; Lachenmeier, Dirk W; Llopis, Eva Jané; Imtiaz, Sameer; Anderson, Peter

2016-09-01

Alcohol use is a major contributor to the burden of gastrointestinal disease. WHO's global strategy to reduce harmful use of alcohol encourages the alcohol industry to contribute to this effort. However, evidence that alcohol producers have contributed to the reduction of harmful use of alcohol is scarce. Reduction of alcoholic strength of beer has been proposed and initiated as one potential way forward. We examine the evidence base for the success of such an initiative. Direct evidence from natural experiments or other controlled studies is scarce. We identified three potential mechanisms for how reduction of alcoholic strength could affect harmful use of alcohol: by current drinkers replacing standard alcoholic beverages with similar beverages of lower alcoholic strength, without increasing the quantity of liquid consumed; by current drinkers switching to no alcohol alternatives for part of the time, thereby reducing their average amount of ethanol consumed; and by initiating alcohol use in current abstainers. The first mechanism seems to be the most promising to potentially reduce harm, but much will depend on actual implementation, and only an independent assessment will be able to identify effects on harmful drinking. The potential of alcoholic strength reduction is independent of initiation by law or by self-initiative of the industry. Copyright © 2016 Elsevier Ltd. All rights reserved.

Student perception of initial transition into a nursing program: A mixed methods research study.

PubMed

McDonald, Meghan; Brown, Janine; Knihnitski, Crystal

2018-05-01

Transition into undergraduate education programs is stressful and impacts students' well-being and academic achievement. Previous research indicates nursing students experience stress, depression, anxiety, and poor lifestyle habits which interfere with learning. However, nursing students' experience of transition into nursing programs has not been well studied. Incongruence exists between this lack of research and the desire to foster student success. This study analyzed students' experiences of initial transition into a nursing program. An embedded mixed method design. A single site of a direct-entry, four year baccalaureate Canadian nursing program. All first year nursing students enrolled in the fall term of 2016. This study combined the Student Adaptation to College Questionnaire (SACQ) with a subset of participants participating in qualitative focus groups. Quantitative data was analyzed using descriptive statistics to identify statistically significant differences in full-scale and subscale scores. Qualitative data was analyzed utilizing thematic analysis. Significant differences were seen between those who moved to attend university and those who did not, with those who moved scoring lower on the Academic Adjustment subscale. Focus group thematic analysis highlighted how students experienced initial transition into a baccalaureate nursing program. Identified themes included reframing supports, splitting focus/finding focus, negotiating own expectations, negotiating others' expectations, and forming identity. These findings form the Undergraduate Nursing Initial Transition (UNIT) Framework. Significance of this research includes applications in faculty development and program supports to increase student success in the first year of nursing and to provide foundational success for ongoing nursing practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

Assessment of citizen group court monitoring programs

DOT National Transportation Integrated Search

1987-03-01

The purpose of the study is to determine whether the presence of a citizen group court monitoring program within a jurisdiction influences the disposition of driving while intoxicated cases. Initial research identified a number of citizens group cour...

Measuring, achieving and promoting smoothness of Virginia's asphalt overlays.

DOT National Transportation Integrated Search

1999-01-01

This study was initiated with the goal of identifying the predominant factors affecting the achievable smoothness of asphalt overlays. In addition, it chronicles the evolution of Virginia's innovative special provision for smoothness, which was devel...

Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for new-onset polyarticular juvenile idiopathic arthritis.

PubMed

Ringold, Sarah; Weiss, Pamela F; Colbert, Robert A; DeWitt, Esi Morgan; Lee, Tzielan; Onel, Karen; Prahalad, Sampath; Schneider, Rayfel; Shenoi, Susan; Vehe, Richard K; Kimura, Yukiko

2014-07-01

There is no standardized approach to the initial treatment of polyarticular juvenile idiopathic arthritis (JIA) among pediatric rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available will result in better health outcomes for polyarticular JIA. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for use in clinical practice to facilitate such studies. A case-based survey was administered to CARRA members to identify the common treatment approaches for new-onset polyarticular JIA. Two face-to-face consensus conferences employed modified nominal group technique to identify treatment strategies, operational case definition, end points, and data elements to be collected. A core workgroup reviewed the relevant literature, refined plans, and developed medication dosing and monitoring recommendations. The initial case-based survey identified significant variability among treatment approaches for new-onset polyarticular JIA. We developed 3 CTPs based on treatment strategies for the first 12 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The CTPs include a step-up plan (nonbiologic disease-modifying antirheumatic drug [DMARD] followed by a biologic DMARD), an early combination plan (nonbiologic and biologic DMARD combined within a month of treatment initiation), and a biologic only plan. This approach was approved by 96% of the CARRA JIA Research Committee members attending the 2013 CARRA face-to-face meeting. Three standardized CTPs were developed for new-onset polyarticular JIA. Coupled with data collection at defined intervals, use of these CTPs will enable the study of their comparative effectiveness in an observational setting to optimize initial management of polyarticular JIA. Copyright © 2014 by the American College of Rheumatology.

Initiation and adherence to secondary prevention pharmacotherapy after myocardial infarction in patients with rheumatoid arthritis: a nationwide cohort study.

PubMed

Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar; Madsen, Ole Rintek; Olesen, Jonas Bjerring; Torp-Pedersen, Christian; Hansen, Peter Riis

2012-09-01

To examine whether rheumatoid arthritis (RA) is associated with less optimal secondary prevention pharmacotherapy after first-time myocardial infarction (MI). The authors identified all patients with first-time MI in the Danish National Patient Register from 2002 to 2009 and gathered individual level information including pharmacy records from nationwide registers. Initiation of standard care post-MI secondary prevention drugs, that is, aspirin, β-blockers, clopidogrel, renin angiotensin system (RAS) blockers and statins, was determined after discharge. In addition, adherence to each drug was evaluated as the proportion of patients on treatment during follow-up and time to first treatment gap. A total of 66 107 MI patients (37% women) were discharged alive; 877 were identified as RA patients (59% women). Thirty days after discharge, RA was associated with significantly lower initiation of aspirin (OR 0.80 (0.67-0.96)), β-blockers (0.77 (0.65-0.92)) and statins (0.69 (0.58-0.82)), while initiation of RAS blockers (0.80 (0.57-1.11)) and clopidogrel (0.88 (0.75-1.02)) was non-significantly reduced. These estimates were virtually unchanged at day 180 and the results were corroborated by Cox regression analyses. Adherence to statins was lower in RA patients relative to non-RA patients (HR for treatment gap of 90 days: 1.26 (1.07-1.48)), while no significant differences were found in adherence to the other drugs. In this nationwide study of unselected patients with first-time MI, a reduced initiation of secondary prevention pharmacotherapy was observed in RA patients. This undertreatment may contribute to the increased cardiovascular disease burden in RA and the underlying mechanisms warrant further study.

Neuroplasticity in Human Alcoholism

PubMed Central

Fein, George; Cardenas, Valerie A.

2015-01-01

Alcoholism is characterized by a lack of control over excessive alcohol consumption despite significant negative consequences. This impulsive and compulsive behavior may be related to functional abnormalities within networks of brain regions responsible for how we make decisions. The abnormalities may result in strengthened networks related to appetitive drive—or the need to fulfill desires—and simultaneously weakened networks that exercise control over behaviors. Studies using functional magnetic resonance imaging (fMRI) in abstinent alcoholics suggest that abstinence is associated with changes in the tone of such networks, decreasing resting tone in appetitive drive networks, and increasing resting tone in inhibitory control networks to support continued abstinence. Identifying electroencephalographic (EEG) measures of resting tone in these networks initially identified using fMRI, and establishing in longitudinal studies that these abstinence-related changes in network tone are progressive would motivate treatment initiatives to facilitate these changes in network tone, thereby supporting successful ongoing abstinence. PMID:26259093

Producing a Data Dictionary from an Extensible Markup Language (XML) Schemain the Global Force Management Data Initiative

DTIC Science & Technology

2017-02-01

entity relationship (diagram) EwID Enterprise-wide Identifier FMID Force Management Identifier GFM Global Force Management HTML Hypertext Markup Language... Management Data Initiative by Frederick S Brundick Approved for public release; distribution is unlimited. NOTICES Disclaimers The findings in this report...Schema in the Global Force Management Data Initiative by Frederick S Brundick Computing and Information Sciences Directorate, ARL Approved for public

A US database study characterizing patients initiating a budesonide-formoterol combination versus tiotropium bromide as initial maintenance therapy for chronic obstructive pulmonary disease.

PubMed

Kern, David M; Williams, Setareh A; Tunceli, Ozgur; Wessman, Catrin; Zhou, Siting; Pethick, Ned; Elhefni, Hanaa; Trudo, Frank

2014-01-01

To compare clinical and demographic characteristics, resource utilization and costs of chronic obstructive pulmonary disease (COPD) patients prior to initiating budesonide-formoterol combination (BFC) or tiotropium-maintenance therapy. This cross-sectional study used claims-based diagnosis to identify COPD patients in the HealthCore Integrated Research Database who initiated BFC or tiotropium therapy between March 1, 2009 and January 31, 2012 (intake period); the index date was defined as the initial prescription fill for either agent. Patients diagnosed with respiratory tract cancer or receiving inhaled corticosteroids/long-acting β2-adrenergic agonists or tiotropium in 12 months prior to index date were excluded. Categorical variables were evaluated with χ(2) tests; mean cost differences were evaluated using γ-regression. Overall, 6,940 BFC and 10,831 tiotropium patients were identified. The BFC group was younger (mean age 64 versus 67 years), with a greater proportion of females (54% versus 51%). BFC-treated patients had more comorbid respiratory conditions, including asthma (25% versus 13%), but fewer comorbid cardiovascular conditions, including atherosclerosis (7% versus 10%) and myocardial infarction (4% versus 6%). A greater proportion of BFC patients received prior respiratory medication, including oral corticosteroids (46% versus 35%) and short-acting β2-agonists (44% versus 35%). Tiotropium-treated patients had a greater mean number of COPD-related outpatient visits (4.6 versus 4.1). BFC-treated patients had lower total all-cause ($17,259 versus $17,926) and COPD-related ($1,718 versus $1,930) health care costs, driven by lower all-cause and COPD-related inpatient expenditures. Initiators of BFC or tiotropium showed differences in clinical and demographic characteristics and health care utilization and costs prior to starting COPD maintenance therapy.

An instrumental case study examining the introduction and dissemination of the Baby Friendly Health Initiative in Australia: Participants' perspectives.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2018-06-01

Australia experiences high breastfeeding initiation but low duration rates. UNICEF introduced the global breastfeeding strategy, the Baby-Friendly Hospital Initiative, to Australia in 1992, transferring governance to the Australian College of Midwives (ACM) in 1995. In 2017 23% of facilities were registered as 'baby-friendly' accredited. To examine the introduction and dissemination of the Baby-friendly Hospital Initiative into the Australian national setting. An instrumental case study was conducted containing two components: analysis of historical documents pertaining to the Initiative and participant's interviews, reported here. A purposive sampling strategy identified 14 participants from UNICEF, ACM, maternity and community health services, the Australian government and volunteer organisations who took part in in-depth interviews. Thematic analysis explored participants' perceptions of factors influencing the uptake and future of the since renamed Baby Friendly Health Initiative (BFHI) and accreditation programme, BFHI Australia. Two broad categories, enablers and barriers, guided the interviews and analysis. Participants revealed a positive perception of the BFHI whilst identifying that its interpretation and expansion in Australia had been negatively influenced by intangible government support and suboptimal capacity building. BFHI's advocacy agenda competed with BFHI Australia's need for financial viability. Widespread stakeholder collaboration and tangible political endorsement was seen as a way to move the strategy forward. Dissemination of BFHI Australia is hampered by multi-level systems issues. Prioritisation, stakeholder collaboration and adequate resourcing of the BFHI is required to create a supportive and enabling environment for Australian women to determine and practice their preferred infant feeding method. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Thailand national programme of the Earth Resources Technology Satellite

NASA Technical Reports Server (NTRS)

Sabhasri, S. (Principal Investigator)

1976-01-01

The author has identified the following significant results. The study on locating hill tribe villages from LANDSAT imagery was successful and exceeded the initial expectations. Results of the study on land use and forest mapping using Skylab data demonstrated the capability and feasibility of large scale mapping with high accuracy.

Social conditions and trends in southeast Alaska.

Treesearch

Rhonda Mazza; Linda E. Kruger

2005-01-01

In 1997, scientists at the Pacific Northwest Research Station initiated several social science studies in response to information gaps identified while developing the Tongass Land Management Plan. Results presented here summarize findings from studies of demographic trends and tourism trends in the region based on data available through 2002. Demographic...

A Predictive Study of Pre-Service Teachers and Success in Final Student Internship

ERIC Educational Resources Information Center

Ingle, Karen M.

2017-01-01

Student teaching provides the final pre-service clinical teaching experience of an initial teacher preparation program. Research that specifically studies the pre-service student teacher and predictive factors of student teaching is limited. Identifying predictive factors that contribute to the success of student interns' student teaching…

Dental Hygienists' Perceptions of Preparedness for Clinical Practice: A Phenomenological Study

ERIC Educational Resources Information Center

Cantrell, Lezlie M.

2012-01-01

The purpose of this phenomenological study was to identify, compile, and describe how community college graduate dental hygienists perceived their initial dental hygiene curriculum preparation and how they subsequently adapted their curriculum preparation in order to perform their responsibilities in their first clinical dental hygiene job.…

Technology Leadership Is Just Good Leadership: Dispositions of Tech Savvy Superintendents

ERIC Educational Resources Information Center

Richardson, Jayson W.; McLeod, Scott; Sauers, Nick

2015-01-01

This study describes core dispositions of school district superintendents who have been identified as technology savvy leaders by a prominent educational technology newspaper. The superintendents in this study described how they accomplished their technology initiatives and offered suggestions for other superintendents who aspire to be more…

QTL analysis of ferric reductase activity in the model legume lotus japonicus

USDA-ARS?s Scientific Manuscript database

Physiological and molecular studies have demonstrated that iron accumulation from the soil into Strategy I plants can be limited by ferric reductase activity. An initial study of Lotus japonicus ecotypes Miyakojima MG-20 and Gifu B-129 identified significant leaf chlorosis and ferric reductase activ...

MUTAGENICITY OF EMISSIONS FROM THE SIMULATED OPEN BURNING OF SCRAP RUBBER TIRES

EPA Science Inventory

The report describes a follow-up to a small-scale combustion study to collect, identify, and quantify products emitted during the simulated open combustion of scrap tires. The initial study found that total estimated emissions of semi-volatile organics ranged from 10 to 50 g/kg o...

AN INTEGRATED SYNTHESIS OF KEY AND POLICY RELEVANT FINDINGS FROM EPA'S SUPERSITES PROGRAM AND RELATED STUDIES

EPA Science Inventory

This presentation provides an overview and initial insights into the findings based on results from EPA's PM Supersites Program and related studies. Many key atmospheric sciences findings have been identified through the research conducted during the last five years as part of t...

Reverse Engineering from Eminent Exemplars: How about a Retrospective Study Too?

ERIC Educational Resources Information Center

Simonton, Dean Keith

2017-01-01

In his target article, Sternberg (2017) quite rightly criticizes the approach to identifying giftedness that was initiated by Terman's (1925-1959) classic prospective study of high-IQ children. Sternberg then recommends a number of novel approaches to both identification and education. Nonetheless, this commentator recommends that future…

US EPA REGION 10 EJ INITIATIVE: NEEDS ASSESSMENT/SUMMIT

EPA Science Inventory

Milestones for Phase 1 (Needs Assessment) of the Initiative. Within 6 months, Region 10 will complete a written report that

1. identifies the key stakeholders,
2. identifies the issues and causes of conflict from the perspectives of those stakeholders ...

3. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study.

   PubMed

   Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

   2007-11-16

   As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives.

4. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

   PubMed Central

   Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

   2007-01-01

   Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives. PMID:18021393

5. Analysis of gene expression as relevant to cancer cells and circulating tumour cells.

   PubMed

   Friel, Anne M; Crown, John; O'Driscoll, Lorraine

   2011-01-01

   Current literature provides significant evidence to support the concept that there are limited subpopulations of cells within a solid tumour that have increased tumour-initiating potential relative to the total tumour population. Such tumour-initiating cells have been identified in leukaemia and in a variety of solid tumours using different combinations of cell surface markers, suggesting that a tumour-initiating cell heterogeneity exists for each specific tumour. These studies have been extended to endometrial cancer; and herein we present several experimental approaches, both in vitro and in vivo, that can be used to determine whether such populations exist, and if so, to characterize them. These methods are adaptable to the investigation of tumour-initiating cells from other tumour types.

6. Immunoproteomic identification of immunogenic proteins in Cronobacter sakazakii strain BAA-894.

   PubMed

   Wang, Jian; Du, Xin-Jun; Lu, Xiao-Nan; Wang, Shuo

   2013-03-01

   Cronobacter spp. are emerging opportunistic pathogens. Cronobacter sakazakii is considered as the predominant species in all infections. So far, our understanding of the species' immunogens and potential virulence factors of Cronobacter spp. remains limited. In this study, an immunoproteomic approach was used to investigate soluble and insoluble proteins from the genome-sequenced strain C. sakazakii ATCC BAA-894. Proteins were separated using two-dimensional electrophoresis, detected by Western blotting with polyclonal antibodies of C. sakazakii BAA-894, and identified using tandem mass spectrometry (MALDI-MS and MALDI-MS/MS, MS/MSMS). A total of 11 immunoreactive proteins were initially identified in C. sakazakii BAA-894, including two outer membrane proteins, four periplasmic proteins, and five cytoplasmic proteins. In silico functional analysis of the 11 identified proteins indicated three proteins that were initially described as immunogens of pathogenic bacteria. For the remaining eight proteins, one protein was categorized as a potential virulence factor involved in protection against reactive oxygen species, and seven proteins were considered to play potential roles in adhesion, invasion, and biofilm formation. To our knowledge, this is the first time that immunogenic proteins of C. sakazakii BAA-894 have been identified as immunogens and potential virulence factors by an immunoproteomics approach. Future studies should investigate the roles of these proteins in bacterial pathogenesis and modulation of host immune responses during infection to identify their potential as molecular therapeutic targets.

7. Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion.

   PubMed

   Ellis, Michael J; Cordingley, Dean M; Vis, Sara; Reimer, Karen M; Leiter, Jeff; Russell, Kelly

   2017-01-01

   OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS. METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting < 30 days postinjury, and PCS was defined according to the International Classification of Diseases, 10th Revision criteria and included being symptomatic 30 days or longer postinjury. The initial assessment included clinical history and physical examination performed by 1 neurosurgeon. Patients were assessed for VOD, defined as the presence of more than 1 subjective vestibular and oculomotor complaint (dizziness, diplopia, blurred vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS. RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury. CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the development of PCS. Future studies examining clinical prediction rules in pediatric concussion should include VOD. Additional research is needed to elucidate the natural history of VOD following SRC and establish evidence-based indications for targeted vestibular rehabilitation.

8. Field Artillery Ammunition Processing System (FAAPS) concept evaluation study

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

   Kring, C.T.; Babcock, S.M.; Watkin, D.C.

   1992-06-01

   The Field Artillery Ammunition Processing System (FAAPS) is an initiative to introduce a palletized load system (PLS) that is transportable with an automated ammunition processing and storage system for use on the battlefield. System proponents have targeted a 20% increase in the ammunition processing rate over the current operation while simultaneously reducing the total number of assigned field artillery battalion personnel by 30. The overall objective of the FAAPS Project is the development and demonstration of an improved process to accomplish these goals. The initial phase of the FAAPS Project and the subject of this study is the FAAPS conceptmore » evaluation. The concept evaluation consists of (1) identifying assumptions and requirements, (2) documenting the process flow, (3) identifying and evaluating technologies available to accomplish the necessary ammunition processing and storage operations, and (4) presenting alternative concepts with associated costs, processing rates, and manpower requirements for accomplishing the operation. This study provides insight into the achievability of the desired objectives.« less

9. Field Artillery Ammunition Processing System (FAAPS) concept evaluation study. Ammunition Logistics Program

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

   Kring, C.T.; Babcock, S.M.; Watkin, D.C.

   1992-06-01

   The Field Artillery Ammunition Processing System (FAAPS) is an initiative to introduce a palletized load system (PLS) that is transportable with an automated ammunition processing and storage system for use on the battlefield. System proponents have targeted a 20% increase in the ammunition processing rate over the current operation while simultaneously reducing the total number of assigned field artillery battalion personnel by 30. The overall objective of the FAAPS Project is the development and demonstration of an improved process to accomplish these goals. The initial phase of the FAAPS Project and the subject of this study is the FAAPS conceptmore » evaluation. The concept evaluation consists of (1) identifying assumptions and requirements, (2) documenting the process flow, (3) identifying and evaluating technologies available to accomplish the necessary ammunition processing and storage operations, and (4) presenting alternative concepts with associated costs, processing rates, and manpower requirements for accomplishing the operation. This study provides insight into the achievability of the desired objectives.« less

10. The impact of nurse prescribing on the clinical setting.

    PubMed

    Creedon, Rena; Byrne, Stephen; Kennedy, Julia; McCarthy, Suzanne

    To investigate the impact nurse prescribing has on the organisation, patient and health professional, and to identify factors associated with the growth of nurse prescribing. Systematic search and narrative review. Data obtained through CINAHL, PubMed, Science direct, Online Computer Library Centre (OCLC), databases/websites, and hand searching. English peer-reviewed quantitative, qualitative and mixed-method articles published from September 2009 through to August 2014 exploring nurse prescribing from the perspective of the organisation, health professional and patient were included. Following a systematic selection process, studies identified were also assessed for quality by applying Cardwell's framework. From the initial 443 citations 37 studies were included in the review. Most studies were descriptive in nature. Commonalities addressed were stakeholders' views, prescribing in practice, jurisdiction, education and benefits/barriers. Prescriptive authority for nurses continues to be a positive addition to clinical practice. However, concerns have emerged regarding appropriate support, relationships and jurisdictional issues. A more comprehensive understanding of nurse and midwife prescribing workloads is required to capture the true impact and cost-effectiveness of the initiative.

11. Optimizing Outcome Assessment in Multicenter TBI Trials: Perspectives From TRACK-TBI and the TBI Endpoints Development Initiative.

    PubMed

    Bodien, Yelena G; McCrea, Michael; Dikmen, Sureyya; Temkin, Nancy; Boase, Kim; Machamer, Joan; Taylor, Sabrina R; Sherer, Mark; Levin, Harvey; Kramer, Joel H; Corrigan, John D; McAllister, Thomas W; Whyte, John; Manley, Geoffrey T; Giacino, Joseph T

    Traumatic brain injury (TBI) is a global public health problem that affects the long-term cognitive, physical, and psychological health of patients, while also having a major impact on family and caregivers. In stark contrast to the effective trials that have been conducted in other neurological diseases, nearly 30 studies of interventions employed during acute hospital care for TBI have failed to identify treatments that improve outcome. Many factors may confound the ability to detect true and meaningful treatment effects. One promising area for improving the precision of intervention studies is to optimize the validity of the outcome assessment battery by using well-designed tools and data collection strategies to reduce variability in the outcome data. The Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, conducted at 18 sites across the United States, implemented a multidimensional outcome assessment battery with 22 measures aimed at characterizing TBI outcome up to 1 year postinjury. In parallel, through the TBI Endpoints Development (TED) Initiative, federal agencies and investigators have partnered to identify the most valid, reliable, and sensitive outcome assessments for TBI. Here, we present lessons learned from the TRACK-TBI and TED initiatives aimed at optimizing the validity of outcome assessment in TBI.

12. [Effect of rat intestinal flora on in vitro metabolic transformation of pumiloside].

    PubMed

    Fang, Hui; Li, Meng-Xuan; Li, Hai-Bo; Liu, Wen-Jun; Meng, Zhao-Qing; Huang, Wen-Zhe; Wang, Zhen-Zhong; Xiao, Wei

    2016-05-01

    To study the metabolic transformation of pumiloside by rat intestinal flora in vitro and identify its metabolites. Pumiloside was incubated in the rat intestinal flora in vitro. HPLC was used to monitor the metabolic process, and HPLC-Q-TOF-MS was used to identify the structures of biotransformation products. In vitro, pumiloside was easily metabolized by rat intestinal flora, and with the prolongation of metabolic time, pumiloside was transformed into several metabolites. Three metabolites were initially identified in this experiment. The study indicated that pumiloside could be extensively metabolized in the rat intestinal flora in vitro. Copyright© by the Chinese Pharmaceutical Association.

13. The enduring importance of animal modelsin understanding periodontal disease

    PubMed Central

    Hajishengallis, George; Lamont, Richard J; Graves, Dana T

    2015-01-01

    Whereas no single animal model can reproduce the complexity of periodontitis, different aspects of the disease can be addressed by distinct models. Despite their limitations, animal models are essential for testing the biological significance of in vitro findings and for establishing cause-and-effect relationships relevant to clinical observations, which are typically correlative. We provide evidence that animal-based studies have generated a durable framework for dissecting the mechanistic basis of periodontitis. These studies have solidified the etiologic role of bacteria in initiating the inflammatory response that leads to periodontal bone loss and have identified key mediators (IL-1, TNF, prostaglandins, complement, RANKL) that induce inflammatory breakdown. Moreover, animal studies suggest that dysbiosis, rather than individual bacterial species, are important in initiating periodontal bone loss and have introduced the concept that organisms previously considered commensals can play important roles as accessory pathogens or pathobionts. These studies have also provided insight as to how systemic conditions, such as diabetes or leukocyte adhesion deficiency, contribute to tissue destruction. In addition, animal studies have identified and been useful in testing therapeutic targets. PMID:25574929

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

    Southworth, G.R.; Loar, J.M.; Ryon, M.G.

    Ecological studies of the Bear Creek watershed, which drains the area surrounding several Oak Ridge Y-12 Plant waste disposal facilities, were initiated in May 1984 and are continuing at present. These studies consisted of an initial, detailed characterization of the benthic invertebrate and fish communities in Bear Creek, and they were followed by a presently ongoing monitoring phase that involves reduced sampling intensities. The characterization phase utilized two approaches: (1) instream sampling of benthic invertebrate and fish communities in Bear Creek to identify spatial and temporal patterns in distribution and abundance and (2) laboratory bioassays on water samples from Bearmore » Creek and selected tributaries to identify potential sources of toxicity to biota. The monitoring phase of the ecological program relates to the long-term goals of identifying and prioritizing contaminant sources and assessing the effectiveness of remedial actions. It continues activities of the characterization phase at less frequent intervals. The Bear Greek Valley is a watershed that drains the area surrounding several closed Oak Ridge Y-12 Plant waste disposal facilities. Past waste disposal practices in Bear Creek Valley resulted in contamination of Bear Creek and consequent ecological damage. Extensive remedial actions have been proposed at waste sites, and some of the have been implemented or are now underway. The proposed study plan consists of an initial, detailed characterization of the benthic invertebrate and fish communities in Bear Creek in the first year followed by a reduction in sampling intensity during the monitoring phase of the plan. The results of sampling conducted from May 1984 through early 1989 are presented in this report.« less

15. Defining the Predicted Protein Secretome of the Fungal Wheat Leaf Pathogen Mycosphaerella graminicola

    PubMed Central

    Morais do Amaral, Alexandre; Antoniw, John; Rudd, Jason J.; Hammond-Kosack, Kim E.

    2012-01-01

    The Dothideomycete fungus Mycosphaerella graminicola is the causal agent of Septoria tritici blotch, a devastating disease of wheat leaves that causes dramatic decreases in yield. Infection involves an initial extended period of symptomless intercellular colonisation prior to the development of visible necrotic disease lesions. Previous functional genomics and gene expression profiling studies have implicated the production of secreted virulence effector proteins as key facilitators of the initial symptomless growth phase. In order to identify additional candidate virulence effectors, we re-analysed and catalogued the predicted protein secretome of M. graminicola isolate IPO323, which is currently regarded as the reference strain for this species. We combined several bioinformatic approaches in order to increase the probability of identifying truly secreted proteins with either a predicted enzymatic function or an as yet unknown function. An initial secretome of 970 proteins was predicted, whilst further stringent selection criteria predicted 492 proteins. Of these, 321 possess some functional annotation, the composition of which may reflect the strictly intercellular growth habit of this pathogen, leaving 171 with no functional annotation. This analysis identified a protein family encoding secreted peroxidases/chloroperoxidases (PF01328) which is expanded within all members of the family Mycosphaerellaceae. Further analyses were done on the non-annotated proteins for size and cysteine content (effector protein hallmarks), and then by studying the distribution of homologues in 17 other sequenced Dothideomycete fungi within an overall total of 91 predicted proteomes from fungal, oomycete and nematode species. This detailed M. graminicola secretome analysis provides the basis for further functional and comparative genomics studies. PMID:23236356

16. PLATINO, a nine-year follow-up study of COPD in the city of São Paulo, Brazil: the problem of underdiagnosis*

    PubMed Central

    Moreira, Graciane Laender; Manzano, Beatriz Martins; Gazzotti, Mariana Rodrigues; Nascimento, Oliver Augusto; Perez-Padilla, Rogelio; Menezes, Ana Maria Baptista; Jardim, José Roberto

    2014-01-01

    OBJECTIVE: To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated "Projeto Latino-Americano de Investigação em Obstrução Pulmonar" (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase. METHODS: The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase. RESULTS: The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD. CONCLUSIONS: The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention. PMID:24626267

17. Neural Predictors of Initiating Alcohol Use During Adolescence.

    PubMed

    Squeglia, Lindsay M; Ball, Tali M; Jacobus, Joanna; Brumback, Ty; McKenna, Benjamin S; Nguyen-Louie, Tam T; Sorg, Scott F; Paulus, Martin P; Tapert, Susan F

    2017-02-01

    Underage drinking is widely recognized as a leading public health and social problem for adolescents in the United States. Being able to identify at-risk adolescents before they initiate heavy alcohol use could have important clinical and public health implications; however, few investigations have explored individual-level precursors of adolescent substance use. This prospective investigation used machine learning with demographic, neurocognitive, and neuroimaging data in substance-naive adolescents to identify predictors of alcohol use initiation by age 18. Participants (N=137) were healthy substance-naive adolescents (ages 12-14) who underwent neuropsychological testing and structural and functional magnetic resonance imaging (sMRI and fMRI), and then were followed annually. By age 18, 70 youths (51%) initiated moderate to heavy alcohol use, and 67 remained nonusers. Random forest classification models identified the most important predictors of alcohol use from a large set of demographic, neuropsychological, sMRI, and fMRI variables. Random forest models identified 34 predictors contributing to alcohol use by age 18, including several demographic and behavioral factors (being male, higher socioeconomic status, early dating, more externalizing behaviors, positive alcohol expectancies), worse executive functioning, and thinner cortices and less brain activation in diffusely distributed regions of the brain. Incorporating a mix of demographic, behavioral, neuropsychological, and neuroimaging data may be the best strategy for identifying youths at risk for initiating alcohol use during adolescence. The identified risk factors will be useful for alcohol prevention efforts and in research to address brain mechanisms that may contribute to early drinking.

18. Recruitment, selection and retention of nursing and midwifery students in Scottish Universities.

    PubMed

    Rodgers, Sheila; Stenhouse, Rosie; McCreaddie, May; Small, Pauline

    2013-11-01

    High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries. A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes. A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices. All universities in Scotland providing pre-registration nursing and/or midwifery programmes. All 10 identified universities agreed to take part and a total of 18 interviews were conducted. Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis. Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement. Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings. Copyright © 2013 Elsevier Ltd. All rights reserved.

19. Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory.

    PubMed

    Manski-Nankervis, Jo-Anne; Furler, John; Blackberry, Irene; Young, Doris; O'Neal, David; Patterson, Elizabeth

    2014-01-31

    The majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting. 21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis. There were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect. This study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational coordination provides a useful framework for exploring these issues.

20. The Challenge of Technological Superiority

    DTIC Science & Technology

    2015-08-01

    direct support to the Defense Innovation Initiative ( DII ). Former Defense Secretary Chuck Hagel launched the DII with a goal of identifying new and...warfighters. Defense Innovation Initiative The DII was launched to harness the brightest minds inside and outside the DoD to identify current and emerging

21. Determinants of initiation and progression of idiopathic pulmonary fibrosis

    PubMed Central

    Kottmann, Robert Matthew; Hogan, Christopher M.; Phipps, Richard P.; Sime, Patricia J.

    2013-01-01

    IPF is a devastating disease with few therapeutic options. The precise aetiology of IPF remains elusive. However, our understanding of the pathologic processes involved in the initiation and progression of this disease is improving. Data on the mechanisms underlying IPF have been generated from epidemiologic investigations as well as cellular and molecular studies of human tissues. Although no perfect animal model of human IPF exists, pre-clinical animal studies have helped define pathways which are likely important in human disease. Epithelial injury, fibroblast activation and repetitive cycles of injury and abnormal repair are almost certainly key events. Factors which have been associated with initiation and/or progression of IPF include viral infections, abnormal cytokine, chemokine and growth factor production, oxidant stress, autoimmunity, inhalational of toxicants and gastro-oesophageal reflux disease. Furthermore, recent evidence identifies a role for a variety of genetic and epigenetic abnormalities ranging from mutations in surfactant protein C to abnormalities in telomere length and telomerase activity. The challenge remains to identify additional inciting agents and key dysregulated pathways that lead to disease progression so that we can develop targeted therapies to treat or prevent this serious disease. PMID:19740254

Factors Influencing the Intention of Perinatal Nurses to Adopt the Baby-Friendly Hospital Initiative in Southeastern Quebec, Canada: Implications for Practice

PubMed Central

2014-01-01

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice. PMID:25101173

Factors influencing the intention of perinatal nurses to adopt the baby-friendly hospital initiative in southeastern quebec, Canada: implications for practice.

PubMed

Chabot, Guylaine; Lacombe, Marie

2014-01-01

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice.

The role of chief executive officers in a quality improvement initiative: a qualitative study

PubMed Central

Parand, Anam; Dopson, Sue; Vincent, Charles

2013-01-01

Objectives To identify the critical dimensions of hospital Chief Executive Officers’ (CEOs) involvement in a quality and safety initiative and to offer practical guidance to assist CEOs to fulfil their leadership role in quality improvement (QI). Design Qualitative interview study. Setting 20 organisations participating in the main phase of the Safer Patients Initiative (SPI) programme across the UK. Participants 17 CEOs overseeing 19 organisations participating in the main phase of the SPI programme and 36 staff (20 workstream leads, 10 coordinators and 6 managers) involved in SPI across all 20 participating organisations. Main outcome measure Self-reported perceptions of CEOs on their contribution and involvement within the SPI programme, supplemented by staff peer-reports. Results The CEOs recognised the importance of their part in the SPI programme and gave detailed accounts of the perceived value that their involvement had brought at all stages of the process. In exploring the parts played by the CEOs, five dimensions were identified: (1) resource provision; (2) staff motivation and engagement; (3) commitment and support; (4) monitoring progress and (5) embedding programme elements. Staff reports confirmed these dimensions; however, the weighting of the dimensions differed. The findings stress the importance of particular actions of support and monitoring such as constant communication through leadership walk rounds and reviewing programme progress and its related clinical outcomes at Board meetings. Conclusions This study addressed the call for more research-informed practical guidance on the role of senior management in QI initiatives. The findings show that the CEOs provided key participation considered to significantly contribute towards the SPI programme. CEOs and staff identified a number of clear and consistent themes essential to organisation safety improvement. Queries raised include the tangible benefits of executive involvement in changing structures and embedding for sustainability and the practical steps to creating the ‘right’ environment for QI. PMID:23293245

Future management strategies for state maintained wetlands and stream mitigation sites.

DOT National Transportation Integrated Search

2008-06-01

This study was to identify existing wetland/stream mitigation sites owned by the Kentucky Transportation Cabinet (KYTC) and assess performance of those sites including problems encountered and maintenance costs. Initial work determined that KYTC Dist...

Predictors of Treatment with Duloxetine or Venlafaxine XR among Adult Patients Treated for Depression in Primary Care Practices in the United Kingdom

PubMed Central

Shi, Nianwen; Durden, Emily; Torres, Amelito; Cao, Zhun; Happich, Michael

2012-01-01

Background. Knowledge about real-world use of duloxetine and venlafaxine XR to treat depression in the UK is limited. Aims. To identify predictors of duloxetine or venlafaxine XR initiation. Method. Adult depressed patients who initiated duloxetine or venlafaxine XR between January 1, 2006 and September 30, 2007 were identified in the UK's General Practice Research Database. Demographic and clinical predictors of treatment initiation with duloxetine and venlafaxine XR were identified using logistic regression. Results. Patients initiating duloxetine (n = 909) were 4 years older than venlafaxine XR recipients (n = 1286). Older age, preexisting unexplained pain, respiratory disease, and pre-period use of anticonvulsants, opioids, and antihyperlipidemics were associated with increased odds of initiating duloxetine compared to venlafaxine XR. Pre-period anxiety disorder was associated with decreased odds of receiving duloxetine. Conclusion. Initial treatment choice with duloxetine versus venlafaxine XR was primarily driven by patient-specific mental and medical health characteristics. General practitioners in the UK favor duloxetine over venlafaxine XR when pain conditions coexist with depression. PMID:22720149

Application of proteomics in the discovery of candidate protein biomarkers in a Diabetes Autoantibody Standardization Program (DASP) sample subset

PubMed Central

Metz, Thomas O.; Qian, Wei-Jun; Jacobs, Jon M.; Gritsenko, Marina A.; Moore, Ronald J.; Polpitiya, Ashoka D.; Monroe, Matthew E.; Camp, David G.; Mueller, Patricia W.; Smith, Richard D.

2009-01-01

Novel biomarkers of type 1 diabetes must be identified and validated in initial, exploratory studies before they can be assessed in proficiency evaluations. Currently, untargeted “-omics” approaches are under-utilized in profiling studies of clinical samples. This report describes the evaluation of capillary liquid chromatography (LC) coupled with mass spectrometry (MS) in a pilot proteomic analysis of human plasma and serum from a subset of control and type 1 diabetic individuals enrolled in the Diabetes Autoantibody Standardization Program with the goal of identifying candidate biomarkers of type 1 diabetes. Initial high-resolution capillary LC-MS/MS experiments were performed to augment an existing plasma peptide database, while subsequent LC-FTICR studies identified quantitative differences in the abundance of plasma proteins. Analysis of LC-FTICR proteomic data identified five candidate protein biomarkers of type 1 diabetes. Alpha-2-glycoprotein 1 (zinc), corticosteroid-binding globulin, and lumican were 2-fold up-regulated in type 1 diabetic samples relative to control samples, whereas clusterin and serotransferrin were 2-fold up-regulated in control samples relative to type 1 diabetic samples. Observed perturbations in the levels of all five proteins are consistent with the metabolic aberrations found in type 1 diabetes. While the discovery of these candidate protein biomarkers of type 1 diabetes is encouraging, follow up studies are required for validation in a larger population of individuals and for determination of laboratory-defined sensitivity and specificity values using blinded samples. PMID:18092746

Application of proteomics in the discovery of candidate protein biomarkers in a diabetes autoantibody standardization program sample subset.

PubMed

Metz, Thomas O; Qian, Wei-Jun; Jacobs, Jon M; Gritsenko, Marina A; Moore, Ronald J; Polpitiya, Ashoka D; Monroe, Matthew E; Camp, David G; Mueller, Patricia W; Smith, Richard D

2008-02-01

Novel biomarkers of type 1 diabetes must be identified and validated in initial, exploratory studies before they can be assessed in proficiency evaluations. Currently, untargeted "-omics" approaches are underutilized in profiling studies of clinical samples. This report describes the evaluation of capillary liquid chromatography (LC) coupled with mass spectrometry (MS) in a pilot proteomic analysis of human plasma and serum from a subset of control and type 1 diabetic individuals enrolled in the Diabetes Autoantibody Standardization Program, with the goal of identifying candidate biomarkers of type 1 diabetes. Initial high-resolution capillary LC-MS/MS experiments were performed to augment an existing plasma peptide database, while subsequent LC-FTICR studies identified quantitative differences in the abundance of plasma proteins. Analysis of LC-FTICR proteomic data identified five candidate protein biomarkers of type 1 diabetes. alpha-2-Glycoprotein 1 (zinc), corticosteroid-binding globulin, and lumican were 2-fold up-regulated in type 1 diabetic samples relative to control samples, whereas clusterin and serotransferrin were 2-fold up-regulated in control samples relative to type 1 diabetic samples. Observed perturbations in the levels of all five proteins are consistent with the metabolic aberrations found in type 1 diabetes. While the discovery of these candidate protein biomarkers of type 1 diabetes is encouraging, follow up studies are required for validation in a larger population of individuals and for determination of laboratory-defined sensitivity and specificity values using blinded samples.

Initial apixaban dosing in patients with atrial fibrillation.

PubMed

Buchholz, Alexander; Ueberham, Laura; Gorczynska, Kaja; Dinov, Borislav; Hilbert, Sebastian; Dagres, Nikolaos; Husser, Daniela; Hindricks, Gerhard; Bollmann, Andreas

2018-05-01

Apixaban is a non-vitamin K oral anticoagulant approved for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). Current labeling recommends dose reduction based on patient age, weight, and renal function. The aim of this study was to analyze adherence to current labeling instructions concerning initial apixaban dosing in clinical practice and identify factors associated with inappropriate dose reduction. Patients with AF initiated on apixaban in 2016 were identified in the Heart Center Leipzig database. Records were screened to identify patient characteristics, prescribed apixaban dose, renal function, and further dosing-relevant secondary diagnoses and co-medication. We identified 569 consecutive patients with AF initiated on apixaban. In 301 (52.9%) patients, apixaban was prescribed in standard dose (5 mg b.i.d.) and in 268 (47.1%) in a reduced dose (2.5 mg b.i.d.). Of 268 patients receiving a reduced dose, 163 (60.8%) did not meet labeling criteria for dose reduction. In univariate and multivariate regression analysis, age (OR: 0.736, 95% CI: 0.664-0.816, P < 0.0001), patient weight (OR: 1.120, 95% CI: 1.076-1.166, P < 0.0001), and serum creatinine level (OR: 0.910, 95% CI: 0.881-0.940, P < 0.0001) were independent predictors for apixaban underdosage. In clinical practice, apixaban dosing is frequently inconsistent with labeling. Factors associated with inappropriate dose reduction are age, patient weight, and serum creatinine level, the same factors used as criteria for dose adjustment. However, in underdosed patients, the 3 factors did not meet the criteria for dose reduction. © 2018 Wiley Periodicals, Inc.

UK end-of-life care services in dementia, initiatives and sustainability: results of a national online survey.

PubMed

Amador, Sarah; Goodman, Claire; Robinson, Louise; Sampson, Elizabeth L

2016-10-14

People living and dying with non-cancer diagnoses, including dementia, have poorer access to generalist and specialist palliative care than people with cancer, and experience worse outcomes in terms of pain and symptom control, and quality and experience of care. In the UK, the National Council for Palliative Care (NCPC) ran a national survey of services for end-of-life care for people with dementia (2008) in which 16 services were identified, and reported on case studies and examples of good practice. We updated the NCPC survey to review progress in previously identified services, identify factors that lead to sustainable services and identify new initiatives in this area of care. An online survey was developed and piloted before use. Initiatives were contacted via targeted (N=63) and open call invitations. The survey was made up of 5 sections. Quantitative data were analysed using descriptive statistics. 15 services responded. They engaged in a wide range of activities predominately providing direct care (80%) and workforce development/advisory or educational activities (87%). Results suggest that sustainability of services is reliant on clinicians with a leadership role and wider system support through funding mechanisms and a minimum level of integration within normal service provision. Recent initiatives are largely built on the expertise of the nursing profession (with or without input from medical consultants), and driven mainly by the charity and hospice sector. This has generated a potential new model of care provision in end of life dementia care, 'Hospice-enabled Dementia Care'. 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/.

Perceptions of Writing by Exceptional Cases of Adult Returning Women in a Rural Community College: Differences between Persisters and Leavers.

ERIC Educational Resources Information Center

Starks, Gretchen

A study was conducted at a rural community college to explore the process by which adult women who had returned to college decided whether to persist or drop out. In-depth interviews were conducted with 17 women who had been identified as exceptional in that they either persisted and graduated even though they had been initially identified as…

Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco

PubMed Central

2011-01-01

Background Patients with tuberculosis require retreatment if they fail or default from initial treatment or if they relapse following initial treatment success. Outcomes among patients receiving a standard World Health Organization Category II retreatment regimen are suboptimal, resulting in increased risk of morbidity, drug resistance, and transmission.. In this study, we evaluated the risk factors for initial treatment failure, default, or early relapse leading to the need for tuberculosis retreatment in Morocco. We also assessed retreatment outcomes and drug susceptibility testing use for retreatment patients in urban centers in Morocco, where tuberculosis incidence is stubbornly high. Methods Patients with smear- or culture-positive pulmonary tuberculosis presenting for retreatment were identified using clinic registries in nine urban public clinics in Morocco. Demographic and outcomes data were collected from clinical charts and reference laboratories. To identify factors that had put these individuals at risk for failure, default, or early relapse in the first place, initial treatment records were also abstracted (if retreatment began within two years of initial treatment), and patient characteristics were compared with controls who successfully completed initial treatment without early relapse. Results 291 patients presenting for retreatment were included; 93% received a standard Category II regimen. Retreatment was successful in 74% of relapse patients, 48% of failure patients, and 41% of default patients. 25% of retreatment patients defaulted, higher than previous estimates. Retreatment failure was most common among patients who had failed initial treatment (24%), and default from retreatment was most frequent among patients with initial treatment default (57%). Drug susceptibility testing was performed in only 10% of retreatment patients. Independent risk factors for failure, default, or early relapse after initial treatment included male gender (aOR = 2.29, 95% CI 1.10-4.77), positive sputum smear after 3 months of treatment (OR 7.14, 95% CI 4.04-13.2), and hospitalization (OR 2.09, 95% CI 1.01-4.34). Higher weight at treatment initiation was protective. Male sex, substance use, missed doses, and hospitalization appeared to be risk factors for default, but subgroup analyses were limited by small numbers. Conclusions Outcomes of retreatment with a Category II regimen are suboptimal and vary by subgroup. Default among patients receiving tuberculosis retreatment is unacceptably high in urban areas in Morocco, and patients who fail initial tuberculosis treatment are at especially high risk of retreatment failure. Strategies to address risk factors for initial treatment default and to identify patients at risk for failure (including expanded use of drug susceptibility testing) are important given suboptimal retreatment outcomes in these groups. PMID:21356062

Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco.

PubMed

Dooley, Kelly E; Lahlou, Ouafae; Ghali, Iraqi; Knudsen, Janine; Elmessaoudi, My Driss; Cherkaoui, Imad; El Aouad, Rajae

2011-02-28

Patients with tuberculosis require retreatment if they fail or default from initial treatment or if they relapse following initial treatment success. Outcomes among patients receiving a standard World Health Organization Category II retreatment regimen are suboptimal, resulting in increased risk of morbidity, drug resistance, and transmission.. In this study, we evaluated the risk factors for initial treatment failure, default, or early relapse leading to the need for tuberculosis retreatment in Morocco. We also assessed retreatment outcomes and drug susceptibility testing use for retreatment patients in urban centers in Morocco, where tuberculosis incidence is stubbornly high. Patients with smear- or culture-positive pulmonary tuberculosis presenting for retreatment were identified using clinic registries in nine urban public clinics in Morocco. Demographic and outcomes data were collected from clinical charts and reference laboratories. To identify factors that had put these individuals at risk for failure, default, or early relapse in the first place, initial treatment records were also abstracted (if retreatment began within two years of initial treatment), and patient characteristics were compared with controls who successfully completed initial treatment without early relapse. 291 patients presenting for retreatment were included; 93% received a standard Category II regimen. Retreatment was successful in 74% of relapse patients, 48% of failure patients, and 41% of default patients. 25% of retreatment patients defaulted, higher than previous estimates. Retreatment failure was most common among patients who had failed initial treatment (24%), and default from retreatment was most frequent among patients with initial treatment default (57%). Drug susceptibility testing was performed in only 10% of retreatment patients. Independent risk factors for failure, default, or early relapse after initial treatment included male gender (aOR = 2.29, 95% CI 1.10-4.77), positive sputum smear after 3 months of treatment (OR 7.14, 95% CI 4.04-13.2), and hospitalization (OR 2.09, 95% CI 1.01-4.34). Higher weight at treatment initiation was protective. Male sex, substance use, missed doses, and hospitalization appeared to be risk factors for default, but subgroup analyses were limited by small numbers. Outcomes of retreatment with a Category II regimen are suboptimal and vary by subgroup. Default among patients receiving tuberculosis retreatment is unacceptably high in urban areas in Morocco, and patients who fail initial tuberculosis treatment are at especially high risk of retreatment failure. Strategies to address risk factors for initial treatment default and to identify patients at risk for failure (including expanded use of drug susceptibility testing) are important given suboptimal retreatment outcomes in these groups.

Phase B - final definition and preliminary design study for the initial Atmospheric Cloud Physics Laboratory (ACPL): A spacelab mission payload. Work breakdown structure for phase C/D DR-MA-06 (preliminary issue)

NASA Technical Reports Server (NTRS)

1976-01-01

The Work Breakdown Structure (WBS) and Dictionary (DR-MA-06) for initial and subsequent flights of the Atmospheric Cloud Physics Laboratory (ACPL) is presented. An attempt is made to identify specific equipment and components in each of the eleven subsystems; they are listed under the appropriate subdivisions of the WBS. The reader is cautioned that some of these components are likely to change substantially during the course of the study, and the list provided should only be considered representative.

Improving Air Quality Forecasts with AURA Observations

NASA Technical Reports Server (NTRS)

Newchurch, M. J.; Biazer, A.; Khan, M.; Koshak, W. J.; Nair, U.; Fuller, K.; Wang, L.; Parker, Y.; Williams, R.; Liu, X.

2008-01-01

Past studies have identified model initial and boundary conditions as sources of reducible errors in air-quality simulations. In particular, improving the initial condition improves the accuracy of short-term forecasts as it allows for the impact of local emissions to be realized by the model and improving boundary conditions improves long range transport through the model domain, especially in recirculating anticyclones. During the August 2006 period, we use AURA/OMI ozone measurements along with MODIS and CALIPSO aerosol observations to improve the initial and boundary conditions of ozone and Particulate Matter. Assessment of the model by comparison of the control run and satellite assimilation run to the IONS06 network of ozonesonde observations, which comprise the densest ozone sounding campaign ever conducted in North America, to AURA/TES ozone profile measurements, and to the EPA ground network of ozone and PM measurements will show significant improvement in the CMAQ calculations that use AURA initial and boundary conditions. Further analyses of lightning occurrences from ground and satellite observations and AURA/OMI NO2 column abundances will identify the lightning NOx signal evident in OMI measurements and suggest pathways for incorporating the lightning and NO2 data into the CMAQ simulations.

Implications of genome wide association studies for addiction: are our a priori assumptions all wrong?

PubMed

Hall, F Scott; Drgonova, Jana; Jain, Siddharth; Uhl, George R

2013-12-01

Substantial genetic contributions to addiction vulnerability are supported by data from twin studies, linkage studies, candidate gene association studies and, more recently, Genome Wide Association Studies (GWAS). Parallel to this work, animal studies have attempted to identify the genes that may contribute to responses to addictive drugs and addiction liability, initially focusing upon genes for the targets of the major drugs of abuse. These studies identified genes/proteins that affect responses to drugs of abuse; however, this does not necessarily mean that variation in these genes contributes to the genetic component of addiction liability. One of the major problems with initial linkage and candidate gene studies was an a priori focus on the genes thought to be involved in addiction based upon the known contributions of those proteins to drug actions, making the identification of novel genes unlikely. The GWAS approach is systematic and agnostic to such a priori assumptions. From the numerous GWAS now completed several conclusions may be drawn: (1) addiction is highly polygenic; each allelic variant contributing in a small, additive fashion to addiction vulnerability; (2) unexpected, compared to our a priori assumptions, classes of genes are most important in explaining addiction vulnerability; (3) although substantial genetic heterogeneity exists, there is substantial convergence of GWAS signals on particular genes. This review traces the history of this research; from initial transgenic mouse models based upon candidate gene and linkage studies, through the progression of GWAS for addiction and nicotine cessation, to the current human and transgenic mouse studies post-GWAS. © 2013.

A Case Study of a National University Research Project and Its Technological Innovation

ERIC Educational Resources Information Center

Ziegel, Melina

2012-01-01

This case study examined the implementation of a major research endeavor in an institution of higher education, Trinity College, Dublin, in Ireland, with particular focus on the change process during the initiation of the project and the subsequent needs assessment and implementation of technological solutions. This study identified the stages,…

Digital and Online Learning in Vocational Education and Training in Serbia: A Case Study

ERIC Educational Resources Information Center

Brolpito, Alessandro; Lightfoot, Michael; Radišic, Jelena; Šcepanovic, Danijela

2016-01-01

This case study aims to identify relevant policies and practices for digital and online learning (DOL) in vocational education and training (VET) in Serbia, with a focus on initial VET (IVET). The study was commissioned by the European Training Foundation (ETF) with the following specific objectives: (1) gather information and analyse DOL…

Relative risk of home hemodialysis attrition in patients using a telehealth platform.

PubMed

Weinhandl, Eric D; Collins, Allan J

2017-12-06

Home hemodialysis (HHD) facilitates increased treatment frequency, which may improve patient outcomes. However, attrition due to technique failure limits the clinical effectiveness of the modality. Nx2me Connected Health is a telehealth platform that enables ongoing assessment of HHD patients using NxStage equipment, and that may reduce patient burden. We aimed to assess whether use of Nx2me was associated with risk of HHD attrition. We compared risks of all-cause attrition, dialysis cessation (i.e., death or transplant), and technique failure in Nx2me users and matched control patients, using a retrospective cohort study. We also compared the likelihood of HHD training graduation in patients who initiated use of Nx2me during training with the likelihood in matched control patients. Matching factors included date of HHD initiation, NxStage treatment duration at initiation of follow-up, and prescribed treatment frequency. We used stratified Fine-Gray and Cox regression to compare risks, with adjustment for demographic factors and vascular access modality, and stratification by matched cluster. We identified 606 Nx2me users; 49.5% initiated use of Nx2me in <3 months after initiation of HHD with NxStage equipment. Adjusted hazard ratios (AHRs) of all-cause attrition, dialysis cessation, and technique failure were 0.80 (95% confidence interval, 0.68-0.95), 1.10 (0.86-1.41), and 0.71 (0.57-0.87), respectively, for Nx2me users vs. matched controls. AHRs were similar in patients who initiated use of Nx2me in <3 months after initiation of HHD. The AHR of HHD training graduation was 1.61 (1.10-2.36) in patients who initiated use of Nx2me within 2 weeks of training initiation vs. matched controls. Use of Nx2me was associated with lower risk of all-cause attrition, lower risk of technique failure, and higher likelihood of HHD training graduation. Further studies are needed to identify the mechanisms by which use of a telehealth platform may improve clinical outcomes and reduce patient burden. © 2017 The Authors Hemodialysis International published by Wiley Periodicals, Inc. on behalf of International Society for Hemodialysis.

The expression patterns of aquaporin 9, vacuolar H+-ATPase, and cytokeratin 5 in the epididymis of the common vampire bat.

PubMed

Castro, Mariana M; Kim, Bongki; Hill, Eric; Fialho, Maria C Q; Puga, Luciano C H P; Freitas, Mariella B; Breton, Sylvie; Machado-Neves, Mariana

2017-01-01

Desmodus rotundus is a vampire bat species that inhabits Latin America. Some basic aspects of this species' biology are still unknown, as the histophysiological characteristics of the male reproductive tract. Our study has focused on its epididymis, which is an important organ for performing a variety of functions, especially the sperm maturation and storage. The aim of this study was to identify principal, narrow, clear, and basal cells using cell-specific markers such as aquaporin 9 (AQP9), vacuolar H + -ATPase (V-ATPase), and cytokeratin 5 (KRT5). Principal cells were labeled by AQP9 from initial segment to cauda region in their stereocilia. They were shown with a columnar shape, whereas V-ATPase-rich cells were identified with a goblet-shaped body along the entire epididymis, including the initial segment, which were named as clear cells. Pencil-shaped V-ATPase-rich cells (narrow cells) were not detected in the initial segment of the bat epididymis, unlike in the rodent. Basal cells were labeled by KRT5 and were located at the basal portion of the epithelium forming a dense network. However, no basal cells with a luminal-reaching body extension were observed in the bat epididymis. In summary, epithelial cells were identified by their specific markers in the vampire bat epididymis. Principal and basal cells were labeled by AQP9 and KRT5, respectively. Narrow cells were not observed in the vampire bat epididymis, whereas clear cells were identified by V-ATPase labeling along the entire duct in a goblet-shaped body. In addition, no luminal-reaching basal cells were observed in the vampire bat epididymis.

A Study to Determine the Mental Models in Preschool Children's Conceptualization of a Desert Environment

ERIC Educational Resources Information Center

Ahi, Berat

2016-01-01

This study aimed to determine mental models and identify codes (schemes) used in conceptualizing a desert environment. The sample for this study consisted of 184--out of a total population of 3,630--children in preschool education in the central district of Kastamonu, Turkey. Within the scope of this study, the children were initially asked to…

Genetic insights into age-related macular degeneration: Controversies addressing Risk, Causality, and Therapeutics

PubMed Central

Gorin, Michael B.

2012-01-01

Age-related macular degeneration (AMD) is a common condition among the elderly population that leads to the progressive central vision loss and serious compromise of quality of life for its sufferers. It is also one of the few disorders for whom the investigation of its genetics has yielded rich insights into its diversity and causality and holds the promise of enabling clinicians to provide better risk assessments for individuals as well as to develop and selectively deploy new therapeutics to either prevent or slow the development of disease and lessen the threat of vision loss. The genetics of AMD began initially with the appreciation of familial aggregation and increase risk and expanded with the initial association of APOE variants with the disease. The first major breakthroughs came with family-based linkage studies of affected (and discordant) sibs, which identified a number of genetic loci and led to the targeted search of the 1q31 and 10q26 loci for associated variants. Three of the initial four reports for the CFH variant, Y402H, were based on regional candidate searches, as were the two initial reports of the ARMS2/HTRA1 locus variants. Case-control association studies initially also played a role in discovering the major genetic variants for AMD, and the success of those early studies have been used to fuel enthusiasm for the methodology for a number of diseases. Until 2010, all of the subsequent genetic variants associated with AMD came from candidate gene testing based on the complement factor pathway. In 2010, several large-scale genome-wide association studies (GWAS) identified genes that had not been previously identified. Much of this historical information is available in a number of recent reviews.(Chen et al., 2010b; Deangelis et al., 2011; Fafowora and Gorin, 2012b; Francis and Klein, 2011; Kokotas et al., 2011) Large meta analysis of AMD GWAS has added new loci and variants to this collection.(Chen et al., 2010a; Kopplin et al., 2010; Yu et al., 2011) This paper will focus on the ongoing controversies that are confronting AMD genetics at this time, rather than attempting to summarize this field, which has exploded in the past 5 years. PMID:22561651

Church-Based Recruitment to Reach Korean Immigrants: An Integrative Review.

PubMed

Park, Chorong; Jang, Myoungock; Nam, Soohyun; Grey, Margaret; Whittemore, Robin

2017-04-01

Although the Korean church has been frequently used to recruit Korean immigrants in research, little is known about the specific strategies and process. The purpose of this integrative review was to describe recruitment strategies in studies of Korean immigrants and to identify the process of Korean church-based recruitment. Thirty-three studies met inclusion criteria. Four stages of church-based recruitment were identified: initiation, endorsement, advertisement, and implementation. This review identified aspects of the church-based recruitment process in Korean immigrants, which are different from the Black and Hispanic literature, due to their hierarchical culture and language barriers. Getting permission from pastors and announcing the study by pastors at Sunday services were identified as the key components of the process. Using the church newsletter to advertise the study was the most effective strategy for the advertisement stage. Despite several limitations, church-based recruitment is a very feasible and effective way to recruit Korean immigrants.

Improving Cardiac Surgical Site Infection Reporting and Prevention By Using Registry Data for Case Ascertainment.

PubMed

Nayar, Vaidehi; Kennedy, Andrea; Pappas, Janine; Atchley, Krista D; Field, Cynthia; Smathers, Sarah; Teszner, Eva E; Sammons, Julia S; Coffin, Susan E; Gerber, Jeffrey S; Spray, Thomas L; Steven, James M; Bell, Louis M; Forrer, Joan; Gonzalez, Fernando; Chi, Albert; Nieczpiel, William J; Martin, John N; Gaynor, J William

2016-01-01

The use of administrative data for surgical site infection (SSI) surveillance leads to inaccurate reporting of SSI rates [1]. A quality improvement (QI) initiative was conducted linking clinical registry and administrative databases to improve reporting and reduce the incidence of SSI [2]. At our institution, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and infection surveillance database (ISD) were linked to the enterprise data warehouse containing electronic health record (EHR) billing data. A data visualization tool was created to (1) use the STS-CHSD for case ascertainment, (2) resolve discrepancies between the databases, and (3) assess impact of QI initiatives, including wound alert reports, bedside reviews, prevention bundles, and billing coder education. Over the 24-month study period, 1,715 surgical cases were ascertained according to the STS-CHSD clinical criteria, with 23 SSIs identified through the STS-CHSD, 20 SSIs identified through the ISD, and 32 SSIs identified through the billing database. The rolling 12-month STS-CHSD SSI rate decreased from 2.73% (21 of 769 as of January 2013) to 1.11% (9 of 813 as of December 2014). Thirty reporting discrepancies were reviewed to ensure accuracy. Workflow changes facilitated communication and improved adjudication of suspected SSIs. Billing coder education increased coding accuracy and narrowed variation between the 3 SSI sources. The data visualization tool demonstrated temporal relationships between QI initiatives and SSI rate reductions. Linkage of registry and infection control surveillance data with the EHR improves SSI surveillance. The visualization tool and workflow changes facilitated communication, SSI adjudication, and assessment of the QI initiatives. Implementation of these initiatives was associated with decreased SSI rates. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Resting-state regional cerebral blood flow during adolescence: associations with initiation of substance use and prediction of future use disorders.

PubMed

Ramage, Amy E; Lin, Ai-Ling; Olvera, Rene L; Fox, Peter T; Williamson, Douglas E

2015-04-01

Adolescence is a period of developmental flux when brain systems are vulnerable to influences of early substance use, which in turn relays increased risk for substance use disorders. Our study intent was to assess adolescent regional cerebral blood flow (rCBF) as it relates to current and future alcohol use. The aim was to identify brain-based predictors for initiation of alcohol use and onset of future substance use disorders. Quantitative rCBF was assessed in 100 adolescents (age 12-15). Prospective behavioral assessments were conducted annually over a three-year follow-up period to characterize onset of alcohol initiation, future drinking patterns and use disorders. Comparisons amongst use groups (i.e., current-, future-, and non-alcohol using adolescents) identified rCBF associated with initiation of alcohol use. Regression by future drinking patterns identified rCBF predictive of heavier drinking. Survival analysis determined whether or not baseline rCBF predicted later development of use disorders. Baseline rCBF was decreased to the parietal cortex and increased to mesolimbic regions in adolescents currently using alcohol as well as those who would use alcohol in the future. Higher baseline rCBF to the left fusiform gyrus and lower rCBF to the right inferior parietal cortex and left cerebellum was associated with future drinking patterns as well as predicted the onset of alcohol and substance use disorders in this cohort. Variations in resting rCBF to regions within reward and default mode or control networks appear to represent trait markers of alcohol use initiation and are predictive of future development of use disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Identifying Candidate Chemical-Disease Linkages ...

EPA Pesticide Factsheets

Presentation at meeting on Environmental and Epigenetic Determinants of IBD in New York, NY on identifying candidate chemical-disease linkages by using AOPs to identify molecular initiating events and using relevant high throughput assays to screen for candidate chemicals. This hazard information is combined with exposure models to inform risk assessment. Presentation at meeting on Environmental and Epigenetic Determinants of IBD in New York, NY on identifying candidate chemical-disease linkages by using AOPs to identify molecular initiating events and using relevant high throughput assays to screen for candidate chemicals. This hazard information is combined with exposure models to inform risk assessment.

Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke.

PubMed

Rajachandrakumar, Roshanth; Fraser, Julia E; Schinkel-Ivy, Alison; Inness, Elizabeth L; Biasin, Lou; Brunton, Karen; McIlroy, William E; Mansfield, Avril

2017-02-01

Anticipatory postural adjustments, executed prior to gait initiation, help preserve lateral stability when stepping. Atypical patterns of anticipatory activity prior to gait initiation may occur in individuals with unilateral impairment (e.g., stroke). This study aimed to determine the prevalence, correlates, and consequences of atypical anticipatory postural adjustment patterns prior to gait initiation in a sub-acute stroke population. Forty independently-ambulatory individuals with sub-acute stroke stood on two force plates and initiated gait at a self-selected speed. Medio-lateral centre of pressure displacement was calculated and used to define anticipatory postural adjustments (shift in medio-lateral centre of pressure >10mm from baseline). Stroke severity, motor recovery, and functional balance and mobility status were also obtained. Three patterns were identified: single (typical), absent (atypical), and multiple (atypical) anticipatory postural adjustments. Thirty-five percent of trials had atypical anticipatory postural adjustments (absent and multiple). Frequency of absent anticipatory postural adjustments was negatively correlated with walking speed. Multiple anticipatory postural adjustments were more prevalent when leading with the non-paretic than the paretic limb. Trials with multiple anticipatory postural adjustments had longer duration of anticipatory postural adjustment and time to foot-off, and shorter unloading time than trials with single anticipatory postural adjustments. A high prevalence of atypical anticipatory control prior to gait initiation was found in individuals with stroke. Temporal differences were identified with multiple anticipatory postural adjustments, indicating altered gait initiation. These findings provide insight into postural control during gait initiation in individuals with sub-acute stroke, and may inform interventions to improve ambulation in this population. Copyright © 2016 Elsevier B.V. All rights reserved.

Biosafety Initiatives in BMENA Region: Identification of Gaps and Advances.

PubMed

Khan, Erum; Ahmed, Nayla; Temsamani, Khalid R; El-Gendy, Atef; Cohen, Murray; Hasan, Ariba; Gastfriend, Hilliard; Cole, Jennifer

2016-01-01

The objectives of this study were to identify and assess the impact of capacity-building biosafety initiatives and programs that have taken place in the broader Middle East and North Africa (BMENA) region between 2001 and 2013, to highlight gaps that require further development, and to suggest sustainable ways to build cooperative regional biosafety opportunities. A cross-sectional study was conducted with two aspects (1) thorough desktop review of literature for all biosafety/biosecurity-related activities in the study countries, such as seminars, conferences, workshops, policy documents, technology transfer, sustained scientific endeavors between countries, etc. and (2) an online survey of scientists in countries in the region to get first-hand information about biosafety and biosecurity initiatives and gaps in their country. A total of 1832 initiatives of biosafety/biosecurity were recorded from 97 web links; 70.68% (n = 1295) initiatives were focused on raising general awareness among the scientific community about biosafety/biosecurity/biocontainment. The most frequent areas of interest were biorisk management in biomedical and biotechnology laboratories 13% (n = 239), followed by living modified organisms (LMOs) 9.17% (n = 168). Hands-on training accounted for 2.67% (n = 49) of initiatives. Online survey results confirmed desktop review findings; however, the response rate was 11%.

Perceived behavioural predictors of late initiation to HIV/AIDS care in Gurage zone public health facilities: a cohort study using health belief model.

PubMed

Gebru, Teklemichael; Lentiro, Kifle; Jemal, Abdulewhab

2018-05-22

The study was aimed to measure incidence density rate and identify perceived behavioural believes of late initiation to HIV/AIDS care in Gurage zone public health facilities from September 2015 to November 2016. The incidence density rates of late initiation to HIV/AIDS care were 2.21 per 100 person-months of observation. HIV positive individuals who did not perceived susceptibility were 8.46 times more likely delay to start HIV/AIDS care than their counter parts [OR = 8.46 (95% CI 3.92, 18.26)]. HIV infected individuals who did not perceived severity of delayed ART initiation were 6.13 time more likely to delay than HIV infected individuals who perceived its severity [OR = 6.13 (95% CI 2.95, 12.73)]. HIV positive individuals who didn't have self-efficacy were 2.35 times more likely delay to start HIV/AIDS care than HIV positive individuals who have self-efficacy [OR = 2.35 (95% CI 1.09, 5.05)]. The study revealed that high incidence density rates of delayed initiation for HIV care and variations were explained by poor wealth, and perceived threat and benefit. Therefore, interventions should be designed to initiate care at their diagnosis time.

Full-Thickness Macular Hole Formation in the Postoperative Period After Initial Vitrectomy for Rhegmatogenous Retinal Detachment.

PubMed

Takashina, Hirotsugu; Watanabe, Akira; Tsuneoka, Hiroshi

2017-01-01

To evaluate full-thickness macular hole (MH) formation in the postoperative period after initial vitrectomy for rhegmatogenous retinal detachment (rRD). We retrospectively reviewed the medical records of 4 consecutive eyes that required additional vitrectomy for full-thickness MH between April 2013 and March 2016 after undergoing an initial vitrectomy for rRD. Epiretinal membrane (ERM) was identified by preoperative optical coherence tomography or intraoperative dye staining in each case. Photocoagulation of retinal breaks prior to initial vitrectomy was performed in Cases 1, 2, and 3 (4-16 days), with yttrium-aluminum-garnet capsulotomy after cataract extraction also performed prior to the retinal break formation in Case 3. At the initial vitrectomy, there was a superior retinal break which crossed the equator in Case 2, and an intentional hole was created in Cases 1 and 4. The mean interval from the initial vitrectomy until MH formation was 27.5 ± 15.8 months. As with Case 2, the intervals in Cases 1 and 4, in which an intentional hole was created, were clearly shorter than in those in Case 3. Finally, MH closure was achieved after an additional vitrectomy (removal of the internal limiting membrane with ERM and gas tamponade) and best-corrected visual acuity improved in each case. ERM was identified in the cases examined in our study. The presence of an intentional hole might shorten the interval of MH formation after vitrectomy for rRD.

Network Expands Links on DNA Variants and Cancer Risk

Cancer.gov

Researchers with the NCI-supported GAME-ON initiative and OncoArray Network are publishing studies identifying dozens of new genetic variants associated with the risk for developing some of the most common cancers, as this Cancer Currents blog post reports.

Recommendations on dram shop liability and overservice law enforcement initiatives to prevent excessive alcohol consumption and related harms.

PubMed

2011-09-01

The Task Force on Community Preventive Services recommends the use of dram shop liability laws, on the basis of strong evidence of effectiveness in preventing and reducing alcohol-related harms. The Task Force found insufficient evidence to determine the effectiveness of overservice law enforcement initiatives as a means to reduce excessive alcohol consumption and related harms, because too few studies were identified and findings were inconsistent. Published by Elsevier Inc.

A High School and Community College Articulation Agreement Targeting Disaffected Students

ERIC Educational Resources Information Center

Irvine, Jeff

2017-01-01

This study examined a linkage program between a secondary school and a community college in Ontario, Canada. The study sought to identify (a) appropriate success criteria to evaluate a high school-community college program and (b) the attributes that promote or ensure a program's sustainability. Though initially successful, the investigated…

Six Stages for Learning To Use Technology.

ERIC Educational Resources Information Center

Russell, Anne L.

Learning to use technology can be traumatic for adults. This study is qualitative and based on personal e-mail diaries written by adult learners. It identifies six stages adults may go through as they learn to use technology to communicate electronically. Initially, 30 teachers studying in a post-graduate university course were involved in a…

Vocational Training of Young Migrants in Denmark.

ERIC Educational Resources Information Center

Koefoed, Else

A study looked at the overall situation of the immigrant population, and young immigrants in particular, and analyzed such problem areas as the transition from school to working life and the inadequacies of initial training with relation to the situation in Denmark. The study identified the following problem areas: (1) problems relating to the…

Establishing a leaf proteome reference map for Ginkgo biloba provides insight into potential ethnobotanical uses

USDA-ARS?s Scientific Manuscript database

Although ginkgo (Maidenhair tree, Ginkgo biloba L.) is an ancient medicinal and ornamental tree, there has not previously been any systematic proteomic study of the leaves. Herein we describe results from the initial study identifying abundant ginkgo leaf proteins and present a gel reference map. Pr...

Vocational Training of Young Migrants in the United Kingdom.

ERIC Educational Resources Information Center

Cross, Malcolm

This study looked at the overall situation of the immigrant population, and young immigrants in particular, and analyzed such problem areas as the transition from school to working life and the inadequacies of initial training with relation to the situation in the United Kingdom. The study identified the following problem areas: (1) problems…

Students, Learning, and Race-Based Public Policy: A Look at Diversity Curriculum and Co-Curriculum.

ERIC Educational Resources Information Center

DeAngelo, Linda

This study is an attempt to bring together research examining diversity initiatives in curriculum and co-curriculum with research on race-based policies, specifically the policy of affirmative action in college admissions. The study attempted to identify and confirm unique background characteristics, beliefs, and predispositions that students…

Blended Learning from Design to Evaluation: International Case Studies of Evidence-Based Practice

ERIC Educational Resources Information Center

Vaughan, Norman; Reali, Aline; Stenbom, Stefan; Van Vuuren, Marieta Jansen; MacDonald, David

2017-01-01

This study compares and contrasts four international faculty development programs for blended learning in order to understand the benefits, challenges, lessons learned, and recommendations from such initiatives. The benefits identified for faculty members, who participated in these programs, were that they became more reflective of their teaching…

The Psychological Effects of Meditation: A Meta-Analysis

ERIC Educational Resources Information Center

Sedlmeier, Peter; Eberth, Juliane; Schwarz, Marcus; Zimmermann, Doreen; Haarig, Frederik; Jaeger, Sonia; Kunze, Sonja

2012-01-01

In this meta-analysis, we give a comprehensive overview of the effects of meditation on psychological variables that can be extracted from empirical studies, concentrating on the effects of meditation on nonclinical groups of adult meditators. Mostly because of methodological problems, almost 3/4 of an initially identified 595 studies had to be…

There's More Than One Way To Skin a Cat: How Community College Presidents Frame Change.

ERIC Educational Resources Information Center

Eddy, Pamela L.

This paper presents a study that analyzed the ways in which community college presidents define and disseminate information on institutional and organizational change. It identifies three courses of change on community college campuses: presidential initiatives, internal pressures, and external pressures. The study centered on the presidents'…

Retention Initiatives Used by Professional Bachelor's Athletic Training Program Directors

ERIC Educational Resources Information Center

Bowman, Thomas G.; Mazerolle, Stephanie M.; Dodge, Thomas M.

2016-01-01

Context: Retaining athletic training students has been identified as problematic by approximately half of athletic training program (ATP) directors. It is unknown what ATP directors do to improve athletic training student retention. Objective: To identify initiatives that ATP directors use to improve the retention rates of athletic training…

77 FR 20822 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... announced below concerns Identifying Modifiable Protective Factors for Intimate Partner Violence or Sexual Violence Perpetration, Funding Opportunity Announcement (FOA) CE12-003, Initial Review In accordance with... in response to ``Identifying Modifiable Protective Factors for Intimate Partner Violence or Sexual...

GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

PubMed Central

Susantitaphong, Paweena; Altamimi, Sarah; Ashkar, Motaz; Balk, Ethan M.; Stel, Vianda S.; Wright, Seth; Jaber, Bertrand L.

2012-01-01

Background The proportion of patients with advanced chronic kidney disease (CKD) initiating dialysis at higher glomerular filtration rate (GFR) has increased over the past decade. Recent data suggest that higher GFR may be associated with increased mortality. Study Design A meta-analysis of cohort studies and trials. Setting & Population Patients with advanced CKD. Selection Criteria for Studies We performed a systematic literature search in MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, American Society of Nephrology abstracts, and bibliographies of retrieved articles to identify studies reporting on GFR at dialysis initiation and mortality. Predictor estimated or calculated GFR at dialysis initiation. Outcome Pooled adjusted hazard ratio (HR) of continuous GFR for all-cause mortality. Results Sixteen cohort studies and one randomized controlled trial were identified (n=1,081,116). By meta-analysis, restricted to the 15 cohorts (n=1,079,917), higher GFR at dialysis initiation was associated with a higher pooled adjusted HR for all-cause mortality (1.04; 95% CI, 1.03–1.05; P<0.001). However, there was significant heterogeneity (I2=97%; P<0.001). The association persisted among the 9 cohorts that adjusted analytically for nutritional covariates (HR 1.03; 95% CI 1.02, 1.04; P<0.001; residual I2=97%). The highest mortality risk was observed in hemodialysis cohorts (HR 1.05; 95% CI 1.02, 1.08; P<0.001) whereas there was no association between GFR and mortality in peritoneal dialysis cohorts (HR 1.04; 95% CI 0.99, 1.08, P=0.11; residual I2=98%). Finally, higher GFR was associated with a lower mortality risk in cohorts that calculated GFR (HR 0.80; 95% CI 0.71, 0.91; P=0.003), contrasting with a higher mortality risk in cohorts that estimated GFR (HR 1.04; 95% CI 1.03, 1.05; P<0.001; residual I2=97%). Limitations Paucity of randomized controlled trials; different methods for determining GFR; and substantial heterogeneity. Conclusions Higher estimated rather than calculated GFR at dialysis initiation is associated with a higher mortality risk among patients with advanced CKD, independent of nutritional status. Although there was substantial heterogeneity of effect size estimates across studies, this observation requires further study. PMID:22465328

Corporate social responsibility initiatives addressing social exclusion in Bangladesh.

PubMed

Werner, Wendy J

2009-08-01

The private sector is often seen as a driver of exclusionary processes rather than a partner in improving the health and welfare of socially-excluded populations. However, private-sector initiatives and partnerships- collectively labelled corporate social responsibility (CSR) initiatives-may be able to positively impact social status, earning potential, and access to services and resources for socially-excluded populations. This paper presents case studies of CSR projects in Bangladesh that are designed to reduce social exclusion among marginalized populations and explores whether CSR initiatives can increase economic and social capabilities to reduce exclusion. The examples provide snapshots of projects that (a) increase job-skills and employment opportunities for women, disabled women, and rehabilitated drug-users and (b) provide healthcare services to female workers and their communities. The CSR case studies cover a limited number of people but characteristics and practices replicable and scaleable across different industries, countries, and populations are identified. Common success factors from the case studies form the basis for recommendations to design and implement more CSR initiatives targeting socially-excluded groups. The analysis found that CSR has potential for positive and lasting impact on developing countries, especifically on socially-excluded populations. However, there is a need for additional monitoring and critical evaluation.

Factors influencing timely initiation and completion of gestational diabetes mellitus screening and diagnosis - a qualitative study from Tamil Nadu, India.

PubMed

Nielsen, Karoline Kragelund; Rheinländer, Thilde; Kapur, Anil; Damm, Peter; Seshiah, Veerasamy; Bygbjerg, Ib C

2017-08-01

In 2007, universal screening for gestational diabetes mellitus (GDM) was introduced in Tamil Nadu, India. To identify factors hindering or facilitating timely initiation and completion of the GDM screening and diagnosis process, our study investigated how pregnant women in rural and urban Tamil Nadu access and navigate different GDM related health services. The study was carried out in two settings: an urban private diabetes centre and a rural government primary health centre. Observations of the process of screening and diagnosis at the health centres as well as semi-structured interviews with 30 pregnant women and nine health care providers were conducted. Data was analysed using qualitative content analysis. There were significant differences in the process of GDM screening and diagnosis in the urban and rural settings. Several factors hindering or facilitating timely initiation and completion of the process were identified. Timely attendance required awareness, motivation and opportunity to attend. Women had to attend the health centre at the right time and sometimes at the right gestational age to initiate the test, wait to complete the test and obtain the test report in time to initiate further action. All these steps and requirements were influenced by factors within and outside the health system such as getting right information from health care providers, clinic timings, characteristics of the test, availability of transport, social network and support, and social norms and cultural practices. Minimising and aligning complex stepwise processes of prenatal care and GDM screening delivery and attention to the factors influencing it are important for further improving and expanding GDM screening and related services, not only in Tamil Nadu but in other similar low and middle income settings. This study stresses the importance of guidelines and diagnostic criteria which are simple and feasible on the ground.

A prospective pilot study of genome-wide exome and transcriptome profiling in patients with small cell lung cancer progressing after first-line therapy.

PubMed

Weiss, Glen J; Byron, Sara A; Aldrich, Jessica; Sangal, Ashish; Barilla, Heather; Kiefer, Jeffrey A; Carpten, John D; Craig, David W; Whitsett, Timothy G

2017-01-01

Small cell lung cancer (SCLC) that has progressed after first-line therapy is an aggressive disease with few effective therapeutic strategies. In this prospective study, we employed next-generation sequencing (NGS) to identify therapeutically actionable alterations to guide treatment for advanced SCLC patients. Twelve patients with SCLC were enrolled after failing platinum-based chemotherapy. Following informed consent, genome-wide exome and RNA-sequencing was performed in a CLIA-certified, CAP-accredited environment. Actionable targets were identified and therapeutic recommendations made from a pharmacopeia of FDA-approved drugs. Clinical response to genomically-guided treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The study completed its accrual goal of 12 evaluable patients. The minimum tumor content for successful NGS was 20%, with a median turnaround time from sample collection to genomics-based treatment recommendation of 27 days. At least two clinically actionable targets were identified in each patient, and six patients (50%) received treatment identified by NGS. Two had partial responses by RECIST 1.1 on a clinical trial involving a PD-1 inhibitor + irinotecan (indicated by MLH1 alteration). The remaining patients had clinical deterioration before NGS recommended therapy could be initiated. Comprehensive genomic profiling using NGS identified clinically-actionable alterations in SCLC patients who progressed on initial therapy. Recommended PD-1 therapy generated partial responses in two patients. Earlier access to NGS guided therapy, along with improved understanding of those SCLC patients likely to respond to immune-based therapies, should help to extend survival in these cases with poor outcomes.

Space Station needs, attributes and architectural options. Volume 2, book 2, part 3: Communication system

NASA Technical Reports Server (NTRS)

1983-01-01

Preliminary results of the study of the architecture and attributes of the RF communications and tracking subsystem of the space station are summarized. Only communications between the space station and other external elements such as TDRSS satellites, low-orbit spacecraft, OTV, MOTV, in the general environment of the space station are considered. The RF communications subsystem attributes and characteristics are defined and analyzed key issues are identified for evolution from an initial space station (1990) to a year 2000 space station. The mass and power characteristics of the communications subsystem for the initial space station are assessed as well as the impact of advanced technology developments. Changes needed to the second generation TDRSS to accommodate the evolutionary space station of the year 2000 are also identified.

Microhistological characteristics of selected aquatic plants of Florida, with techniques for the study of manatee food habits

USGS Publications Warehouse

Hurst, L.A.; Beck, C.A.

1988-01-01

This study was initiated in 1978 to develop a technique of identifying and quantifying the digestive tract contents of Florida manatees (Trichechus manatus latirostris) and to serve as a manual for the identification and analysis of ingesta collected from manatee carcasses salvaged in Florida. This report includes key microhistological characters found useful in identifying fragments of 83 plant species and three invertebrate groups. Many species of aquatic and wetland plants and invertebrates are available to manatees in Florida as potential foods.

Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis

PubMed Central

Reardon, David C; Thorp, John M

2017-01-01

Objectives: Measures of pregnancy associated deaths provide important guidance for public health initiatives. Record linkage studies have significantly improved identification of deaths associated with childbirth but relatively few have also examined deaths associated with pregnancy loss even though higher rates of maternal death have been associated with the latter. Following PRISMA guidelines we undertook a systematic review of record linkage studies examining the relative mortality risks associated with pregnancy loss to develop a narrative synthesis, a meta-analysis, and to identify research opportunities. Methods: MEDLINE and SCOPUS were searched in July 2015 using combinations of: mortality, maternal death, record linkage, linked records, pregnancy associated mortality, and pregnancy associated death to identify papers using linkage of death certificates to independent records identifying pregnancy outcomes. Additional studies were identified by examining all citations for relevant studies. Results: Of 989 studies, 11 studies from three countries reported mortality rates associated with termination of pregnancy, miscarriage or failed pregnancy. Within a year of their pregnancy outcomes, women experiencing a pregnancy loss are over twice as likely to die compared to women giving birth. The heightened risk is apparent within 180 days and remains elevated for many years. There is a dose effect, with exposure to each pregnancy loss associated with increasing risk of death. Higher rates of death from suicide, accidents, homicide and some natural causes, such as circulatory diseases, may be from elevated stress and risk taking behaviors. Conclusions: Both miscarriage and termination of pregnancy are markers for reduced life expectancy. This association should inform research and new public health initiatives including screening and interventions for patients exhibiting known risk factors. PMID:29163945

Factors Influencing Hospital Stay for Pulmonary Embolism. A Cohort Study.

PubMed

Rodríguez-Núñez, Nuria; Ruano-Raviña, Alberto; Abelleira, Romina; Ferreiro, Lucía; Lama, Adriana; González-Barcala, Francisco J; Golpe, Antonio; Toubes, María E; Álvarez-Dobaño, José M; Valdés, Luis

2017-08-01

The aim of this study was to identify factors influencing hospital stay due to pulmonary embolism. We performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19). We included 965 patients with a median stay of 8 days (IQR 6-13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42-13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07-2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07-2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85-3.48) when oral anticoagulation (OAC) was initiated 2-3 days after admission, and 2.43 (95% CI: 1.16-5.07) when initiated at 4-5 days, compared to OAC initiation at 0-1 days. sPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Effects of pill burden on discontinuation of the initial HAART regimen in minority female patients prescribed 1 pill/day versus any other pill burden.

PubMed

Hill, Seth; Kavookjian, Jan; Qian, Jingjing; Chung, Allison; Vandewaa, John

2014-01-01

Highly active antiretroviral therapy (HAART) is a mainstay of treatment for patients with Human Immunodeficiency Virus (HIV). Since second line HAART therapies can be costlier and less effective, it is essential to understand the duration of initial HAART therapies. The overall aim of this study was to estimate the effects of daily pill burden on the time to discontinuation of the initial HAART regimen. Patients were initially identified through the clinic's CAREWARE database. A chart review was conducted for data collection, where only adult, female, HIV-positive patients initiating therapy at the study clinic between 1 January 2001 and 31 December 2011 were included. All study subjects were followed up from the initiation of HAART to treatment discontinuation. A Kaplan-Meier curve was generated to describe time to discontinuation by regimens, and a Cox proportional hazards model was developed to assess the impact of different regimen and patient demographic characteristics on the hazard of discontinuation of the initial regimen. A total of 498 charts were initially reviewed. After assessment of these patients for inclusion criteria, a cohort of 115 adult female patients who initiated HAART at the study clinic was included. Patients treated with 1 pill/day regimen had a significantly longer time to discontinuation than regimens of >1 pills/day (mean duration of initial therapy was 1062.56 days vs. 631.70 days, respectively, p = 0.003). Compared to 1 pill/day regimens, >1 pills/day regimens were associated with a higher hazard of discontinuation (hazard ratio (HR) =3.44 with 95% confidence interval (CI) = 1.25, 9.48). A higher viral load and patients without insurance were also found to be significantly associated with increased hazards of discontinuation. Overall, female HIV patients initiating therapy with the 1 pill/day HAART regimen were less likely to discontinue their treatment compared to patients initiating with >1 pills/day HAART regimen.

Comparative Study on Synergetic Degradation of a Reactive Dye Using Different Types of Fly Ash in Combined Adsorption and Photocatalysis

NASA Astrophysics Data System (ADS)

Giri Babu, P. V. S.; Swaminathan, G.

2016-09-01

A comprehensive study was carried out on four different fly ashes used as a catalyst for the degradation of Acid Red 1 using ultraviolet rays. These fly ashes are collected from different thermal power stations located at various places in India and having different chemical compositions. Three fly ashes are from lignite-based thermal power plants, and one is from the coal-based power plant. One fly ash is classified as Class F, two fly ashes are classified as Class C and remaining one is not conforming to ASTM C618 classification. X-Ray Fluorescence analysis was used to identify the chemical composition of fly ashes and SiO2, Al2O3, CaO, Fe2O3 and TiO2 were found to be the major elements present in different proportions. Various analysis were carried out on all the fly ashes like Scanning Electron Microscopy to identify the microphysical properties, Energy Dispersive X-Ray spectroscopy to quantify the elements present in the catalyst and X-Ray Diffraction to identify the catalyst phase analysis. The radical generated during the reaction was identified by Electron paramagnetic resonance spectroscopy. The parameters such as initial pH of the dye solution, catalyst dosage and initial dye concentration which influence the dye degradation efficiency were studied and optimised. In 60 min duration, the dye degradation efficiency at optimum parametric values of pH 2.5, initial dye concentration of 10 mg/L and catalyst dosage of 1.0 g/L using various fly ashes, i.e., Salam Power Plant, Barmer Lignite Power Plant, Kutch Lignite Power Plant and Neyveli Lignite Thermal Power plant (NLTP) were found to be 40, 60, 67 and 95 % respectively. The contribution of adsorption alone was 18 % at the above mentioned optimum parametric values. Among the above four fly ash NLTP fly ashes proved to be most efficient.

Economic gains stimulate negative evaluations of corporate sustainability initiatives

NASA Astrophysics Data System (ADS)

Makov, Tamar; Newman, George E.

2016-09-01

In recent years, many organizations have sought to align their financial goals with environmental ones by identifying strategies that maximize profits while minimizing environmental impacts. Examples of this `win-win' approach can be found across a wide range of industries, from encouraging the reuse of hotel towels, to the construction of energy efficient buildings, to the large-scale initiatives of multi-national corporations. Although win-win strategies are generally thought to reflect positively on the organizations that employ them, here we find that people tend to respond negatively to the notion of profiting from environmental initiatives. In fact, observers may evaluate environmental win-wins less favourably than profit-seeking strategies that have no environmental benefits. The present studies suggest that how those initiatives are communicated to the general public may be of central importance. Therefore, organizations would benefit from carefully crafting the discourse around their win-win initiatives to ensure that they avoid this type of backlash.

The Role for Community-Based Participatory Research in Formulating Policy Initiatives: Promoting Safety and Health for In-Home Care Workers and Their Consumers

PubMed Central

Gong, Fang; Ayala, Linda; Stock, Laura; McDevitt, Susannah; Heaney, Cathy

2009-01-01

Although community-based participatory research (CBPR) can be effective in influencing policy, the process of formulating policy initiatives through CBPR is understudied. We describe a case study to illustrate how alliances among various community partners could be united to formulate policy directions. In collaboration with partners, the National Institute for Occupational Safety and Health initiated a project aimed at improving health and safety for low-income elderly and disabled persons and their in-home care workers. Community partners and stakeholders participated in focus groups, stakeholder interviews, and meetings; they played multiple roles including identifying organizational policy changes the partners could initiate immediately, as well as broader public policy goals. Results indicated that a strong community partnership, participation, and shared values contributed to successful formulation of policy initiatives. PMID:19890153

Association of Modality with Mortality among Canadian Aboriginals

PubMed Central

Hemmelgarn, Brenda; Rigatto, Claudio; Komenda, Paul; Yeates, Karen; Promislow, Steven; Mojica, Julie; Tangri, Navdeep

2012-01-01

Summary Background and objectives Previous studies have shown that Aboriginals and Caucasians experience similar outcome on dialysis in Canada. Using the Canadian Organ Replacement Registry, this study examined whether dialysis modality (peritoneal or hemodialysis) impacted mortality in Aboriginal patients. Design, setting, participants, & measurements This study identified 31,576 adult patients (hemodialysis: Aboriginal=1839, Caucasian=21,430; peritoneal dialysis: Aboriginal=554, Caucasian=6769) who initiated dialysis between January of 2000 and December of 2009. Aboriginal status was identified by self-report. Dialysis modality was determined 90 days after dialysis initiation. Multivariate Cox proportional hazards and competing risk models were constructed to determine the association between race and mortality by dialysis modality. Results During the study period, 939 (51.1%) Aboriginals and 12,798 (53.3%) Caucasians initiating hemodialysis died, whereas 166 (30.0%) and 2037 (30.1%), respectively, initiating peritoneal dialysis died. Compared with Caucasians, Aboriginals on hemodialysis had a comparable risk of mortality (adjusted hazards ratio=1.04, 95% confidence interval=0.96–1.11, P=0.37). However, on peritoneal dialysis, Aboriginals experienced a higher risk of mortality (adjusted hazards ratio=1.36, 95% confidence interval=1.13–1.62, P=0.001) and technique failure (adjusted hazards ratio=1.29, 95% confidence interval=1.03–1.60, P=0.03) than Caucasians. The risk of technique failure varied by patient age, with younger Aboriginals (<50 years old) more likely to develop technique failure than Caucasians (adjusted hazards ratio=1.76, 95% confidence interval=1.23–2.52, P=0.002). Conclusions Aboriginals on peritoneal dialysis experience higher mortality and technique failure relative to Caucasians. Reasons for this race disparity in peritoneal dialysis outcomes are unclear. PMID:22997343

Evaluation of the RapID-ANA system for identification of anaerobic bacteria of veterinary origin.

PubMed

Adney, W S; Jones, R L

1985-12-01

This study evaluated the ability of the RapID-ANA system (Innovative Diagnostic Systems, Inc., Atlanta, Ga.) to accurately identify a spectrum of freshly isolated veterinary anaerobes. A total of 183 isolates were tested and included 7 Actinomyces spp., 53 Bacteroides spp., 32 Clostridium spp., 2 Eubacterium spp., 65 Fusobacterium spp., 1 Peptococcus spp., 22 Peptostreptococcus spp., and 1 Propionibacterium spp. All isolates were initially identified by conventional biochemical testing and gas-liquid chromatography of short-chain fatty acid metabolites. Additional tests were performed as required by the RapID-ANA system. Of these isolates, 81.4% were correctly identified to the genus level, including 59.6% to the species level, 14.2% were incorrectly identified at the genus level, and 4.4% were not identified. Initially, 20.2% of the strains were not identified because the microcodes were not in the code book. The majority of the incorrect identifications were caused by the misidentification of Fusobacterium spp. as Bacteroides spp. Errors also occurred when veterinary anaerobes not included in the data base were assigned an identification from the existing data base. The RapID-ANA system appears to be a promising new method for rapid identification of veterinary anaerobes; however, further evaluation with an extended data base is needed before the system can accurately identify all clinically significant anaerobes.

Application of the transtheoretical model of behaviour change for identifying older clients' readiness for hearing rehabilitation during history-taking in audiology appointments.

PubMed

Ekberg, Katie; Grenness, Caitlin; Hickson, Louise

2016-07-01

The transtheoretical model (TTM) of behaviour change focuses on clients' readiness for adopting new health behaviours. This study explores how clients' readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients' readiness has consequences for the rehabilitation decisions they make within the initial appointment. Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment. The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments. Clients' readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined). The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients' needs, attitudes, desires, and psychological readiness for action in order to optimize clients' hearing outcomes.

Studer Group® ' s evidence-based leadership initiatives.

PubMed

Schuller, Kristin A; Kash, Bita A; Gamm, Larry D

2015-01-01

The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer Group®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.

Industry self-regulation of food marketing to children: reading the fine print.

PubMed

Hebden, Lana; King, Lesley; Kelly, Bridget; Chapman, Kathy; Innes-Hughes, Christine

2010-12-01

despite the evidence showing the negative influences of food marketing on children's dietary beliefs and behaviours, and risk of adiposity, regulatory action to limit unhealthy food marketing has made little progress within Australia. Our aim was to describe and critically examine the Australian Food and Grocery Council's (AFGC) approach to self-regulate food marketing to Australian children through the Responsible Marketing to Children Initiative (Initiative). the Initiative's core principles and the commitments of the 16 signatory companies (as at December 2009) were assessed in terms of their capacity to limit unhealthy food advertising in media accessed by children. All information was publicly available from AFGC and signatory company websites (September- December 2009). limitations of the Initiative included inadequate definitions for when and where food marketing to children can occur, and permissive definitions of foods considered appropriate for advertising. The study also identified numerous examples of ongoing food marketing to children by AFGC companies that illustrate these limitations. until one reads the fine print, the self-regulatory commitments of companies signed to the AFGC Initiative may appear to be responsible. However, this study shows that the commitments are permissive and allow companies to circumvent the stated intent of the Initiative.

Challenges to Breastfeeding Initiation and Duration for Teen Mothers.

PubMed

Cota-Robles, Sonia; Pedersen, Laura; LeCroy, Craig Winston

The purpose of this study was to evaluate breastfeeding practices of teen mothers in a pre- and postnatal education and support program. We studied breastfeeding practices of primarily Hispanic and non-Hispanic White teen mothers who participated in the Teen Outreach Pregnancy Services (TOPS) program, which promoted breastfeeding through prenatal programming and postpartum support. Analyses identified the most common reasons participants had not breastfed and, for those who initiated breastfeeding, the most common reasons they stopped. Participants (g = 314) reported on whether and for how long they breastfed. Nearly all participants reported initiating breastfeeding but few breastfed to 6 months. For the most part, reasons they reported stopping breastfeeding paralleled those previously reported for adult mothers across the first several months of motherhood. We found that teen mothers can initiate breastfeeding at high rates. Results highlight areas in which teen mothers' knowledge and skills can be supported to promote breastfeeding duration, including pain management and better recognizing infant cues. Our findings expand limited previous research investigating reasons that teen mothers who initiate breastfeeding stop before 6 months.

Comparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions.

PubMed

Moffett, Bryan K; Panchabhai, Tanmay S; Nakamatsu, Raul; Arnold, Forest W; Peyrani, Paula; Wiemken, Timothy; Guardiola, Juan; Ramirez, Julio A

2016-12-01

It is unclear whether anteroposterior (AP) or posteroanterior with lateral (PA/Lat) chest radiographs are superior in the early detection of clinically relevant parapneumonic effusions (CR-PPEs). The objective of this study was to identify which technique is preferred for detection of PPEs using chest computed tomography (CCT) as a reference standard. A secondary analysis of a pneumonia database was conducted to identify patients who received a CCT within 24 hours of presentation and also received AP or PA/Lat chest radiographs within 24 hours of CCT. Sensitivity and specificity were then calculated by comparing the radiographic diagnosis of PPEs of both types of radiographs compared with CCT by using the existing attending radiologist interpretation. Clinical relevance of effusions was determined by CCT effusion measurement of >2.5 cm or presence of loculation. There was a statistically significant difference between the sensitivity of AP (67.3%) and PA/Lat (83.9%) chest radiography for the initial detection of CR-PPE. Of 16 CR-PPEs initially missed by AP radiography, 7 either required drainage initially or developed empyema within 30 days, whereas no complicated PPE or empyema was found in those missed by PA/Lat radiography. PA/Lat chest radiography should be the initial imaging of choice in pneumonia patients for detection of PPEs because it appears to be statistically superior to AP chest radiography. Published by Elsevier Inc.

"I Love Fruit But I Can't Afford It": Using Participatory Action Research to Develop Community-Based Initiatives to Mitigate Challenges to Chronic Disease Management in an African American Community Living in Public Housing.

PubMed

Rogers, Courtney; Johnson, Joy; Nueslein, Brianne; Edmunds, David; Valdez, Rupa S

2018-03-12

As chronic conditions are on the rise in the USA, management initiatives outside of the inpatient setting should be explored to reduce associated cost and access disparities. Chronic conditions disproportionately affect African American public housing residents due to the effects of historical marginalization on the manifestation of economic and social problems exacerbating health disparities and outcomes. Informed by participatory research action tenets, this study focused on identifying the challenges to management of chronic conditions and developing community-envisioned initiatives to address these challenges in a predominantly African American public housing community. Two focus groups were conducted with former and current public housing residents and were analyzed using inductive content analysis. Physical activity, the cost associated with healthy eating, and lack of information were noted as challenges to chronic disease management. Initiatives discussed were the formation of a walking partner's program to promote physical activity, a shopper's club to exchange coupons and learn how to prepare healthy meals, and a natural remedy's book to share information intergenerationally about management tactics. Challenges identified existed predominantly on the individual and the system level, while the initiatives generated target engaging interpersonal and community relationships. These community-envisioned approaches should be explored to facilitate chronic disease management in public housing neighborhoods.

Veterans' experiences initiating VA-based mental health care.

PubMed

Bovin, Michelle J; Miller, Christopher J; Koenig, Christopher J; Lipschitz, Jessica M; Zamora, Kara A; Wright, Patricia B; Pyne, Jeffrey M; Burgess, James F

2018-05-21

Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department of Veterans Affairs (VA) care, including those specific to accessing mental health care (e.g., fear of stigmatization). More work is needed to streamline access to VA mental health-care services for veterans. In the current study, we interviewed 80 veterans from 9 clinics across the United States about initiation of VA mental health care to identify barriers to access. Results suggested that five predominant factors influenced veterans' decisions to initiate care: (a) awareness of VA mental health services; (b) fear of negative consequences of seeking care; (c) personal beliefs about mental health treatment; (d) input from family and friends; and (e) motivation for treatment. Veterans also spoke about the pathways they used to access this care. The four most commonly reported pathways included (a) physical health-care appointments; (b) the service connection disability system; (c) non-VA care; and (d) being mandated to care. Taken together, these data lend themselves to a model that describes both modifiers of, and pathways to, VA mental health care. The model suggests that interventions aimed at the identified pathways, in concert with efforts designed to reduce barriers, may increase initiation of VA mental health-care services by veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Structuring Cooperative Nuclear RIsk Reduction Initiatives with China.

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

Brandt, Larry; Reinhardt, Jason Christian; Hecker, Siegfried

The Stanford Center for International Security and Cooperation engaged several Chinese nuclear organizations in cooperative research that focused on responses to radiological and nuclear terrorism. The objective was to identify joint research initiatives to reduce the global dangers of such threats and to pursue initial technical collaborations in several high priority areas. Initiatives were identified in three primary research areas: 1) detection and interdiction of smuggled nuclear materials; 2) nuclear forensics; and 3) radiological (“dirty bomb”) threats and countermeasures. Initial work emphasized the application of systems and risk analysis tools, which proved effective in structuring the collaborations. The extensive engagementsmore » between national security nuclear experts in China and the U.S. during the research strengthened professional relationships between these important communities.« less

Sticker charts: a method for improving adherence to treatment of chronic diseases in children.

PubMed

Luersen, Kara; Davis, Scott A; Kaplan, Sebastian G; Abel, Troy D; Winchester, Woodrow W; Feldman, Steven R

2012-01-01

Poor adherence is a common problem and may be an underlying cause of poor clinical outcomes. In pediatric populations, positive reinforcement techniques such as sticker charts may increase motivation to adhere to treatment regimens. To review the use of sticker charts to improve adherence in children with chronic disease, Medline and PsycINFO searches were conducted using the key words "positive reinforcement OR behavior therapy" and "adherence OR patient compliance" and "child." Randomized controlled retrospective cohort or single-subject-design studies were selected. Studies reporting adherence to the medical treatment of chronic disease in children using positive reinforcement techniques were included in the analysis. The systematic search was supplemented by identifying additional studies identified through the reference lists and authors of the initial articles found. Positive reinforcement techniques such as sticker charts increase adherence to medical treatment regimens. In several studies, this effect was maintained for months after the initial intervention. Better adherence correlated with better clinical outcomes in some, but not all, studies. Few studies examining the use of sticker charts were identified. Although single-subject-design studies are useful in establishing the effect of a behavioral intervention, larger randomized controlled trials would help determine the precise efficacy of sticker chart interventions. Adherence to medical treatments in children can be increased using sticker charts or other positive reinforcement techniques. This may be an effective means to encourage children with atopic dermatitis to apply their medications and improve clinical outcomes. © 2012 Wiley Periodicals, Inc.

Internet sexuality research with rural men who have sex with men: can we recruit and retain them?

PubMed

Bowen, Anne

2005-11-01

This study examines the utility of internet banner ads for recruiting rural MSM and identifies correlates of internet HIV risk survey initiation and completion. Banner ads were shown on a popular internet dating site for one month and resulted in 1,045 rural MSM, from 49 States, Canada, Australia/New Zealand, and 5 from other countries initiating the questionnaire. Logistic regression indicated that progression beyond screening questions was negatively related to "expecting pay, but not being paid" and positively related to "using chat rooms to find friends" and identifying as gay. Linear regression indicated that the absolute number of responses by consenting participants was positively correlated with reimbursement, number of sexual partners, motivated by money, and having been HIV tested. Overall, this sample represents one of the largest rural MSM samples; survey completion was high and strengthened by reimbursement and possibly by awareness of HIV risk. Generalizability was limited by low participation of minority and non-gay identified MSM.

Combining medical informatics and bioinformatics toward tools for personalized medicine.

PubMed

Sarachan, B D; Simmons, M K; Subramanian, P; Temkin, J M

2003-01-01

Key bioinformatics and medical informatics research areas need to be identified to advance knowledge and understanding of disease risk factors and molecular disease pathology in the 21 st century toward new diagnoses, prognoses, and treatments. Three high-impact informatics areas are identified: predictive medicine (to identify significant correlations within clinical data using statistical and artificial intelligence methods), along with pathway informatics and cellular simulations (that combine biological knowledge with advanced informatics to elucidate molecular disease pathology). Initial predictive models have been developed for a pilot study in Huntington's disease. An initial bioinformatics platform has been developed for the reconstruction and analysis of pathways, and work has begun on pathway simulation. A bioinformatics research program has been established at GE Global Research Center as an important technology toward next generation medical diagnostics. We anticipate that 21 st century medical research will be a combination of informatics tools with traditional biology wet lab research, and that this will translate to increased use of informatics techniques in the clinic.

Predictors of residential treatment retention among individuals with co-occurring substance abuse and mental health disorders.

PubMed

Choi, Sam; Adams, Susie M; MacMaster, Samuel A; Seiters, John

2013-01-01

A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.

New use of an old drug: inhibition of breast cancer stem cells by benztropine mesylate.

PubMed

Cui, Jihong; Hollmén, Maija; Li, Lina; Chen, Yong; Proulx, Steven T; Reker, Daniel; Schneider, Gisbert; Detmar, Michael

2017-01-03

Cancer stem cells (CSCs) play major roles in cancer initiation, metastasis, recurrence and therapeutic resistance. Targeting CSCs represents a promising strategy for cancer treatment. The purpose of this study was to identify selective inhibitors of breast CSCs (BCSCs). We carried out a cell-based phenotypic screening with cell viability as a primary endpoint, using a collection of 2,546 FDA-approved drugs and drug-like molecules in spheres formed by malignant human breast gland-derived cells (HMLER-shEcad cells, representing BCSCs) and control immortalized non-tumorigenic human mammary cells (HMLE cells, representing normal stem cells). 19 compounds were identified from screening. The chemically related molecules benztropine mesylate and deptropine citrate were selected for further validation and both potently inhibited sphere formation and self-renewal of BCSCs in vitro. Benztropine mesylate treatment decreased cell subpopulations with high ALDH activity and with a CD44+/CD24- phenotype. In vivo, benztropine mesylate inhibited tumor-initiating potential in a 4T1 mouse model. Functional studies indicated that benztropine mesylate inhibits functions of CSCs via the acetylcholine receptors, dopamine transporters/receptors, and/or histamine receptors. In summary, our findings identify benztropine mesylate as an inhibitor of BCSCs in vitro and in vivo. This study also provides a screening platform for identification of additional anti-CSC agents.

Enhancement of utilization of encryption engine

DOEpatents

Robertson, Robert J.; Witzke, Edward L.

2008-04-22

A method of enhancing throughput of a pipelined encryption/decryption engine for an encryption/decryption process has a predetermined number of stages and provides feedback around the stages (and of such an encryption/decryption engine) by receiving a source datablock for a given stage and encryption/decryption context identifier; indexing according to the encryption/decryption context identifier into a bank of initial variables to retrieve an initial variable for the source datablock; and generating an output datablock from the source datablock and its corresponding initial variable.

Community Rates of Breastfeeding Initiation.

PubMed

Grubesic, Tony H; Durbin, Kelly M

2016-11-01

Breastfeeding initiation rates vary considerably across racial and ethnic groups, maternal age, and education level, yet there are limited data concerning the influence of geography on community rates of breastfeeding initiation. This study aimed to describe how community rates of breastfeeding initiation vary in geographic space, highlighting "hot spots" and "cool spots" of initiation and exploring the potential connections between race, socioeconomic status, and urbanization levels on these patterns. Birth certificate data from the Kentucky Department of Health for 2004-2010 were combined with county-level geographic base files, Census 2010 demographic and socioeconomic data, and Rural-Urban Continuum Codes to conduct a spatial statistical analysis of community rates of breastfeeding initiation. Between 2004 and 2010, the average rate of breastfeeding initiation for Kentucky increased from 43.84% to 49.22%. Simultaneously, the number of counties identified as breastfeeding initiation hot spots also increased, displaying a systematic geographic pattern in doing so. Cool spots of breastfeeding initiation persisted in rural, Appalachian Kentucky. Spatial regression results suggested that unemployment, income, race, education, location, and the availability of International Board Certified Lactation Consultants are connected to breastfeeding initiation. Not only do spatial analytics facilitate the identification of breastfeeding initiation hot spots and cool spots, but they can be used to better understand the landscape of breastfeeding initiation and help target breastfeeding education and/or support efforts.

The Global Evidence Mapping Initiative: scoping research in broad topic areas.

PubMed

Bragge, Peter; Clavisi, Ornella; Turner, Tari; Tavender, Emma; Collie, Alex; Gruen, Russell L

2011-06-17

Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM) Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI). The GEM evidence mapping method involved three core tasks:1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers) who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60) and low (n = 69) importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority questions. GEM Initiative evidence maps have a broad range of potential end-users including funding agencies, researchers and clinicians. Evidence mapping is at least as resource-intensive as systematic reviewing. The GEM Initiative has made advancements in evidence mapping, most notably in the area of question development and prioritisation. Evidence mapping complements other review methods for describing existing research, informing future research efforts, and addressing evidence gaps.

The Global Evidence Mapping Initiative: Scoping research in broad topic areas

PubMed Central

2011-01-01

Background Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM) Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI). Methods The GEM evidence mapping method involved three core tasks: 1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers) who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. Results One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60) and low (n = 69) importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority questions. Conclusions GEM Initiative evidence maps have a broad range of potential end-users including funding agencies, researchers and clinicians. Evidence mapping is at least as resource-intensive as systematic reviewing. The GEM Initiative has made advancements in evidence mapping, most notably in the area of question development and prioritisation. Evidence mapping complements other review methods for describing existing research, informing future research efforts, and addressing evidence gaps. PMID:21682870

ECOTOXICOGENOMICS: EXPOSURE INDICATORS USING ESTS AND SUBTRACTIVE LIBRARIES FOR MULTI-LIFE STAGES OF PIMEPHALES

EPA Science Inventory

Ecotoxicogenomics is research that identifies patterns of gene expression in wildlife and predicts effects of environmental stressors. We are developing a multiple stressor, multiple life stage exposure model using the fathead minnow (Pimephales promelas), initially studying fou...

USEPA RESEARCH ON FISH - HABITAT RELATIONSHIPS IN GREAT LAKES COASTAL MARSHES

EPA Science Inventory

Despite numerous studies documenting fish use of particular habitat elements, the role of habitat mosaics in supporting wetland fishes is poorly understood. USEPA's Mid-Continent Ecology Division has initiated research to identify relationships of fish and habitat in coastal mars...

SORBENTS FOR FLUORIDE, METAL FINISHING, AND PETROLEUM SLUDGE LEACHATE CONTAMINANT CONTROL

EPA Science Inventory

This report covers the initial laboratory studies carried out to identify the most promising sorbents that may be used to significantly reduce the concentration of measurable contaminant in calcium fluoride sludge leachate, metal finishing sludge leachate, and petroleum sludge le...

An initial survey of national airspace system auditory alarm issues in terminal air traffic control.

DOT National Transportation Integrated Search

2003-04-01

A researcher from the Research Development & Human Factors Laboratory of the William J. Hughes Technical Center conducted an exploratory study to examine current National Airspace System (NAS) auditory alarm issues. The purpose was to identify proble...

Keys to Sustaining Successful School Turnarounds

ERIC Educational Resources Information Center

Duke, Daniel L.

2006-01-01

To identify the changes associated with the school turnaround process, this article reviewed 15 case studies of elementary school turnaround initiatives that sustained improvements for at least two years. Changes were clustered into eight categories: leadership, school policy, programs, organizational processes, staffing, classroom practices,…

A Study of Superintendents' Power and Leadership Styles as Perceived by Local Teacher Association Representatives and Secondary School Principals in Alabama Public Schools.

ERIC Educational Resources Information Center

Pounders, Barbara; And Others

The situational leadership model identifies four leadership styles--telling, selling, participating, and delegating. This paper discusses the initial findings of a study that examined the role of superintendents in Alabama. The study sought to determine if secondary school principals and local teacher-association representatives differed in their…

Establishment and maintenance of asepsis in endodontics - a review of the literature.

PubMed

Malmberg, Leona; Björkner, Annika Elisabeth; Bergenholtz, Gunnar

2016-08-01

Successful endodontic treatment depends on effective measures to eliminate and prevent infection of root canals. Initially treatment should start with isolation and disinfection of the operating field. This review makes an inventory of the available knowledge regarding its establishment and maintenance. A literature search was conducted in the PubMed database in order to identify clinical trials examining disinfection or unintentional contamination of the endodontic operative field. A list of 115 articles was obtained and screened. Five relevant articles were identified. These articles were read in full text. The reference lists from these articles were checked manually for additional studies and three studies were obtained. A total of eight articles met the inclusion criteria. There was a great variety in terms of aim, method, and material of the included studies. None could prove a totally reliable aseptic operative field and not one chemical, or combination of chemicals, were found in more than one study. No study documented complete asepsis following initial disinfection, and no study could document predictable maintenance of an established bacteria-free surface. Critical appraisal and standardization of the disinfection and aseptic procedures in endodontics are needed.

Person-centred care during prolonged weaning from mechanical ventilation, nurses' views: an interview study.

PubMed

Cederwall, Carl-Johan; Olausson, Sepideh; Rose, Louise; Naredi, Silvana; Ringdal, Mona

2018-06-01

To determine: 1) if the three elements of person-centred care (initiating, working and safeguarding the partnership) were present, and 2) to identify evidence of barriers to person-centred care during prolonged weaning from mechanical ventilation. Secondary analysis of semi structured interviews with 19 critical care nurses using theoretical thematic analysis. This study was conducted in three Swedish intensive care units, one in a regional hospital and two in a university hospital. Three themes and nine subthemes related to person-centred care were identified. The three themes included: 1) 'finding a person behind the patient' related to the 'initiating the partnership' phase, 2) 'striving to restore patient́s sense of control' related to 'working the partnership' phase and 3) 'impact of patient involvement' related to 'safeguarding the partnership' phase of person-centred care'. Additionally a further theme 'barriers to person-centred care' was identified. We found evidence of all three person-centred care routines. Barriers to person-centred care comprised of lack team collaboration and resources. Facilitating patients to actively participate in decision-making during the weaning process may optimise weaning outcomes and warrants further research. Copyright © 2017 Elsevier Ltd. All rights reserved.

Feasibility Study of Anaerobic Digestion of Food Waste in St. Bernard, Louisiana. A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites

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

Moriarty, K.

The U.S. Environmental Protection Agency (EPA) developed the RE-Powering America's Land initiative to re-use contaminated sites for renewable energy generation when aligned with the community's vision for the site. The former Kaiser Aluminum Landfill in St. Bernard Parish, Louisiana, was selected for a feasibility study under the program. Preliminary work focused on selecting a biomass feedstock. Discussions with area experts, universities, and the project team identified food wastes as the feedstock and anaerobic digestion (AD) as the technology.

Orbital transfer vehicle concept definition and systems analysis study. Volume 11: Study extension 2 results

NASA Technical Reports Server (NTRS)

Willcockson, W. H.

1988-01-01

Work conducted in the second extension of the Phase A Orbit Transfer Vehicle Concept Definition and Systems Analysis Study is summarized. Four major tasks were identified: (1) define an initial OTV program consistent with near term Civil Space Leadership Initiative missions; (2) develop program evolution to long term advanced missions; (3) investigate the implications of current STS safety policy on an Aft Cargo Carrier based OTV; and (4) expand the analysis of high entry velocity aeroassist. An increased emphasis on the breath of OTV applications was undertaken to show the need for the program on the basis of the expansion of the nation's capabilities in space.

Whole-Genome Sequencing and Variant Analysis of Human Papillomavirus 16 Infections.

PubMed

van der Weele, Pascal; Meijer, Chris J L M; King, Audrey J

2017-10-01

Human papillomavirus (HPV) is a strongly conserved DNA virus, high-risk types of which can cause cervical cancer in persistent infections. The most common type found in HPV-attributable cancer is HPV16, which can be subdivided into four lineages (A to D) with different carcinogenic properties. Studies have shown HPV16 sequence diversity in different geographical areas, but only limited information is available regarding HPV16 diversity within a population, especially at the whole-genome level. We analyzed HPV16 major variant diversity and conservation in persistent infections and performed a single nucleotide polymorphism (SNP) comparison between persistent and clearing infections. Materials were obtained in the Netherlands from a cohort study with longitudinal follow-up for up to 3 years. Our analysis shows a remarkably large variant diversity in the population. Whole-genome sequences were obtained for 57 persistent and 59 clearing HPV16 infections, resulting in 109 unique variants. Interestingly, persistent infections were completely conserved through time. One reinfection event was identified where the initial and follow-up samples clustered differently. Non-A1/A2 variants seemed to clear preferentially ( P = 0.02). Our analysis shows that population-wide HPV16 sequence diversity is very large. In persistent infections, the HPV16 sequence was fully conserved. Sequencing can identify HPV16 reinfections, although occurrence is rare. SNP comparison identified no strongly acting effect of the viral genome affecting HPV16 infection clearance or persistence in up to 3 years of follow-up. These findings suggest the progression of an early HPV16 infection could be host related. IMPORTANCE Human papillomavirus 16 (HPV16) is the predominant type found in cervical cancer. Progression of initial infection to cervical cancer has been linked to sequence properties; however, knowledge of variants circulating in European populations, especially with longitudinal follow-up, is limited. By sequencing a number of infections with known follow-up for up to 3 years, we gained initial insights into the genetic diversity of HPV16 and the effects of the viral genome on the persistence of infections. A SNP comparison between sequences obtained from clearing and persistent infections did not identify strongly acting DNA variations responsible for these infection outcomes. In addition, we identified an HPV16 reinfection event where sequencing of initial and follow-up samples showed different HPV16 variants. Based on conventional genotyping, this infection would incorrectly be considered a persistent HPV16 infection. In the context of vaccine efficacy and monitoring studies, such infections could potentially cause reduced reported efficacy or efficiency. Copyright © 2017 van der Weele et al.

A simple method for identifying parameter correlations in partially observed linear dynamic models.

PubMed

Li, Pu; Vu, Quoc Dong

2015-12-14

Parameter estimation represents one of the most significant challenges in systems biology. This is because biological models commonly contain a large number of parameters among which there may be functional interrelationships, thus leading to the problem of non-identifiability. Although identifiability analysis has been extensively studied by analytical as well as numerical approaches, systematic methods for remedying practically non-identifiable models have rarely been investigated. We propose a simple method for identifying pairwise correlations and higher order interrelationships of parameters in partially observed linear dynamic models. This is made by derivation of the output sensitivity matrix and analysis of the linear dependencies of its columns. Consequently, analytical relations between the identifiability of the model parameters and the initial conditions as well as the input functions can be achieved. In the case of structural non-identifiability, identifiable combinations can be obtained by solving the resulting homogenous linear equations. In the case of practical non-identifiability, experiment conditions (i.e. initial condition and constant control signals) can be provided which are necessary for remedying the non-identifiability and unique parameter estimation. It is noted that the approach does not consider noisy data. In this way, the practical non-identifiability issue, which is popular for linear biological models, can be remedied. Several linear compartment models including an insulin receptor dynamics model are taken to illustrate the application of the proposed approach. Both structural and practical identifiability of partially observed linear dynamic models can be clarified by the proposed method. The result of this method provides important information for experimental design to remedy the practical non-identifiability if applicable. The derivation of the method is straightforward and thus the algorithm can be easily implemented into a software packet.

76 FR 58716 - Interpretation of Transmission Planning Reliability Standard

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-22

... directs NERC and Commission staff to initiate a process to identify any reliability issues, as discussed... Commission directs NERC and Commission staff to initiate a process to identify any reliability issues, as... established a process to select and certify an ERO,\\5\\ and subsequently certified NERC.\\6\\ On April 4, 2006...

Addressing poverty through disease control programmes: examples from Tuberculosis control in India.

PubMed

Kamineni, Vishnu Vardhan; Wilson, Nevin; Das, Anand; Satyanarayana, Srinath; Chadha, Sarabjit; Sachdeva, Kuldeep Singh; Chauhan, Lakbir Singh

2012-03-26

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.

Effective heart disease prevention: lessons from a qualitative study of user perspectives in Bangladeshi, Indian and Pakistani communities.

PubMed

Netto, G; McCloughan, L; Bhatnagar, A

2007-03-01

Coronary heart disease (CHD) has a high mortality, incidence and prevalence among Indian, Pakistani and Bangladeshi communities in the UK, indicating the need for effective heart disease prevention initiatives for these communities. This paper considers how service user perspectives can be used to develop effective, culturally focused CHD prevention interventions for these target groups by addressing identified barriers, including deeply held cultural beliefs. A qualitative research study, using a longitudinal action research approach. This was a community-based study in Edinburgh. Six focus group discussions--two for each community--were organized with participants from these communities at the beginning of the project. A further six focus group discussions for the same communities were organized six months later. Over the period examined, participants reported varying changes in levels of knowledge relating to the nature, causes and symptoms of CHD. Some participants reported taking slight to significant steps to reduce or prevent heart disease, while others did not. The project was viewed as helpful in increasing knowledge about CHD and preventive measures and encouraging healthier lifestyles. However, persistent barriers to change were also identified, requiring changes to the project that involved not only matching intervention materials and messages to observable, superficial characteristics of the target population, but more fundamental changes that address the cultural, social, historical, environmental and psychological forces that influence health behaviour. CHD prevention initiatives need to identify and respond to deep-rooted influences on health-behaviour in 'at-risk' groups, in addition to superficial characteristics of the target populations. It is important for specific prevention initiatives to be linked into wider CHD frameworks to ensure transferability of learning and integration within wider service provision.

A prospective observational cohort study in primary care practices to identify factors associated with treatment failure in Staphylococcus aureus skin and soft tissue infections.

PubMed

Lee, Grace C; Hall, Ronald G; Boyd, Natalie K; Dallas, Steven D; Du, Liem C; Treviño, Lucina B; Treviño, Sylvia B; Retzloff, Chad; Lawson, Kenneth A; Wilson, James; Olsen, Randall J; Wang, Yufeng; Frei, Christopher R

2016-11-22

The incidence of outpatient visits for skin and soft tissue infections (SSTIs) has substantially increased over the last decade. The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has made the management of S. aureus SSTIs complex and challenging. The objective of this study was to identify risk factors contributing to treatment failures associated with community-associated S. aureus skin and soft tissue infections SSTIs. This was a prospective, observational study among 14 primary care clinics within the South Texas Ambulatory Research Network. The primary outcome was treatment failure within 90 days of the initial visit. Univariate associations between the explanatory variables and treatment failure were examined. A generalized linear mixed-effect model was developed to identify independent risk factors associated with treatment failure. Overall, 21% (22/106) patients with S. aureus SSTIs experienced treatment failure. The occurrence of treatment failure was similar among patients with methicillin-resistant S. aureus and those with methicillin-susceptible S. aureus SSTIs (19 vs. 24%; p = 0.70). Independent predictors of treatment failure among cases with S. aureus SSTIs was a duration of infection of ≥7 days prior to initial visit [aOR, 6.02 (95% CI 1.74-19.61)] and a lesion diameter size ≥5 cm [5.25 (1.58-17.20)]. Predictors for treatment failure included a duration of infection for ≥7 days prior to the initial visit and a wound diameter of ≥5 cm. A heightened awareness of these risk factors could help direct targeted interventions in high-risk populations.

Pore structures in an implantable sol gel titania ceramic device used in controlled drug release applications: A modeling study

NASA Astrophysics Data System (ADS)

Peterson, Aaron; Lopez, Tessy; Islas, Emma Ortiz; Gonzalez, Richard D.

2007-04-01

Several process variables, which may be helpful in optimizing the rate at which drugs are released from implantable, sol-gel titania devices have been identified in this study. The controlled rate of drug release is compared for two different anticonvulsant drugs, valproic acid and sodic phenytoin. Contrary to what one might expect, when the concentration is increased in the titania reservoir the rate of initial drug delivery decreases. This is a desirable result, because it may reduce the danger of a high initial discharge, which may harm the epileptic rat. The structure of the porous structure within the titania network has been studied using a generalized form of the BET equation which considers only n layers. In general, following an initial discharge, the rate at which the drug is released will increase with the increasing concentration. Pore mouth blocking can present a problem. However, this problem tends to disappear following the initial discharge. The extent of drug loading is a useful variable parameter, which can be adjusted in order to deliver the amount of drug required in a given application.

Predicting High Imaging Utilization Based on Initial Radiology Reports: A Feasibility Study of Machine Learning.

PubMed

Hassanpour, Saeed; Langlotz, Curtis P

2016-01-01

Imaging utilization has significantly increased over the last two decades, and is only recently showing signs of moderating. To help healthcare providers identify patients at risk for high imaging utilization, we developed a prediction model to recognize high imaging utilizers based on their initial imaging reports. The prediction model uses a machine learning text classification framework. In this study, we used radiology reports from 18,384 patients with at least one abdomen computed tomography study in their imaging record at Stanford Health Care as the training set. We modeled the radiology reports in a vector space and trained a support vector machine classifier for this prediction task. We evaluated our model on a separate test set of 4791 patients. In addition to high prediction accuracy, in our method, we aimed at achieving high specificity to identify patients at high risk for high imaging utilization. Our results (accuracy: 94.0%, sensitivity: 74.4%, specificity: 97.9%, positive predictive value: 87.3%, negative predictive value: 95.1%) show that a prediction model can enable healthcare providers to identify in advance patients who are likely to be high utilizers of imaging services. Machine learning classifiers developed from narrative radiology reports are feasible methods to predict imaging utilization. Such systems can be used to identify high utilizers, inform future image ordering behavior, and encourage judicious use of imaging. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Red maple (Acer rubrum) leaf toxicosis in horses: a retrospective study of 32 cases.

PubMed

Alward, Ashley; Corriher, Candice A; Barton, Michelle H; Sellon, Debra C; Blikslager, Anthony T; Jones, Samuel L

2006-01-01

Ingestion of wilted red maple leaves by horses can result in severe hemolytic anemia and methemoglobinemia. Little is known about what factors influence the outcome of red maple leaf toxicosis in horses. Our hypothesis was that physical examination findings, clinicopathologic variables or therapeutic modalities may predict outcome in horses with red maple leaf toxicity. Horses with red maple leaf toxicosis presented to referral hospitals in the southeast region of the United States. A multi-institutional retrospective study was designed to identify factors that predict mortality in horses with red maple toxicosis. Thirty-two horses with red maple toxicosis were identified, 19 of which died. Twenty-nine horses presented with anemia and 24 had clinicopathologic evidence of systemic inflammation. Renal insufficiency was identified in 12/30 (41%) horses. Laminitis (9/28) and colic (13/30) also were identified in horses with red maple toxicosis, but development of these 2 conditions did not have a negative effect on short-term survival. Horses with red maple toxicosis that survived to discharge were likely to have developed pyrexia during hospitalization (P = .030). Horses that were treated with a corticosteroid had a significantly increased likelihood of death (P = .045). There was no significant relationship between initial serum hemoglobin concentration, methemoglobin concentration, or percentage methemoglobin and mortality in this horse series. This study suggests that information obtained on initial examination cannot be used to accurately predict survival in horses with red maple toxicosis, but horses that receive corticosteroids are unlikely to survive.

Identification of EhTIF-IA: The putative E. histolytica orthologue of the human ribosomal RNA transcription initiation factor-IA.

PubMed

Srivastava, Ankita; Bhattacharya, Alok; Bhattacharya, Sudha; Jhingan, Gagan Deep

2016-03-01

Initiation of rDNA transcription requires the assembly of a specific multi-protein complex at the rDNA promoter containing the RNA Pol I with auxiliary factors. One of these factors is known as Rrn3P in yeast and Transcription Initiation Factor IA (TIF-IA) in mammals. Rrn3p/TIF-IA serves as a bridge between RNA Pol I and the pre-initiation complex at the promoter. It is phosphorylated at multiple sites and is involved in regulation of rDNA transcription in a growth-dependent manner. In the early branching parasitic protist Entamoeba histolytica, the rRNA genes are present exclusively on circular extra chromosomal plasmids. The protein factors involved in regulation of rDNA transcription in E. histolytica are not known. We have identified the E. histolytica equivalent of TIF-1A (EhTIF-IA) by homology search within the database and was further cloned and expressed. Immuno-localization studies showed that EhTIF-IA co-localized partially with fibrillarin in the peripherally localized nucleolus. EhTIF-IA was shown to interact with the RNA Pol I-specific subunit RPA12 both in vivo and in vitro. Mass spectroscopy data identified RNA Pol I-specific subunits and other nucleolar proteins to be the interacting partners of EhTIF-IA. Our study demonstrates for the first time a conserved putative RNA Pol I transcription factor TIF-IA in E. histolytica.

Initial locomotor sensitivity to cocaine varies widely among inbred mouse strains.

PubMed

Wiltshire, T; Ervin, R B; Duan, H; Bogue, M A; Zamboni, W C; Cook, S; Chung, W; Zou, F; Tarantino, L M

2015-03-01

Initial sensitivity to psychostimulants can predict subsequent use and abuse in humans. Acute locomotor activation in response to psychostimulants is commonly used as an animal model of initial drug sensitivity and has been shown to have a substantial genetic component. Identifying the specific genetic differences that lead to phenotypic differences in initial drug sensitivity can advance our understanding of the processes that lead to addiction. Phenotyping inbred mouse strain panels are frequently used as a first step for studying the genetic architecture of complex traits. We assessed locomotor activation following a single, acute 20 mg/kg dose of cocaine (COC) in males from 45 inbred mouse strains and observed significant phenotypic variation across strains indicating a substantial genetic component. We also measured levels of COC, the active metabolite, norcocaine and the major inactive metabolite, benzoylecgonine, in plasma and brain in the same set of inbred strains. Pharmacokinetic (PK) and behavioral data were significantly correlated, but at a level that indicates that PK alone does not account for the behavioral differences observed across strains. Phenotypic data from this reference population of inbred strains can be utilized in studies aimed at examining the role of psychostimulant-induced locomotor activation on drug reward and reinforcement and to test theories about addiction processes. Moreover, these data serve as a starting point for identifying genes that alter sensitivity to the locomotor stimulatory effects of COC. © 2015 John Wiley & Sons Ltd and International Behavioural and Neural Genetics Society.

Sexual behaviors, sexual orientation and gender identity in adult intersexuals: a pilot study.

PubMed

Schober, J M

2001-06-01

Sexual preference and adjustment of intersexuals have rarely been investigated. Interview techniques were used to explore these issues. Ten adult intersexuals (average age 34.2 years) were randomly selected from Intersex Society of North America members. Of the 10 subjects 8 had initially been gender assigned as female and 2 as male. A structured telephone interview was used to assess sexual orientation, sexual activity and satisfaction with gender assignment. Sexual debut occurred at age 18.1 years (range 15 to 22). At debut, 4 females and 2 males engaged in heterosexual intercourse, and 4 females engaged in gynephilic (female) sexual contact. Despite female gender assignment of 8 and initial heterosexual activity by 4 subjects, the final choice of a sexual partner was female in all 8. Both males had initial heterosexual contact but only 1 continued to prefer female partners. Current number of sexual partners averaged 0.9 (range 0 to 2) and total number of sexual partners ranged from 1 to 300. Currently, 9 subjects are in a committed sexual relationship and 8 are able to achieve orgasm. Of the subjects 8 preferred being identified as intersexual, 1 male as male and 1 female as female. Two intersexuals with initial female gender assignment were undergoing male reassignment. Most intersexuals preferred being identified as intersexual and had female partners. Most reported being satisfied with overall physical appearance but satisfaction with genitalia was highly variable. Based on these results, further study of a larger population is warranted.

Baseline Characteristics of Patients Predicting Suitability for Rapid Naltrexone Induction

PubMed Central

Mogali, Shanthi; Khan, Nabil A.; Drill, Esther S.; Pavlicova, Martina; Sullivan, Maria A.; Nunes, Edward; Bisaga, Adam

2015-01-01

Background and Objectives Extended-release (XR) injection naltrexone has proved promising in the treatment of opioid dependence. Induction onto naltrexone is often accomplished with a procedure known as rapid naltrexone induction. The purpose of this study was to evaluate pre-treatment patient characteristics as predictors of successful completion of a rapid naltrexone induction procedure prior to XR naltrexone treatment. Methods A chart review of 150 consecutive research participants (N = 84 completers and N = 66 non-completers) undergoing a rapid naltrexone induction with the buprenorphone-clonidine procedure were compared on a number of baseline demographic, clinical and psychosocial factors. Logistic regression was used to identify client characteristics that may predict successful initiation of naltrexone after a rapid induction-detoxification. Results Patients who failed to successfully initiate naltrexone were younger (AOR: 1.040, CI: 1.006, 1.075), and using 10 or more bags of heroin (or equivalent) per day (AOR: 0.881, CI: 0.820, 0.946). Drug use other than opioids was also predictive of failure to initiate naltrexone in simple bivariate analyses, but was no longer significant when controlling for age and opioid use level. Conclusions Younger age, and indicators of greater substance dependence severity (more current opioid use, other substance use) predict difficulty completing a rapid naltrexone induction procedure. Such patients might require a longer period of stabilization and/or more gradual detoxification prior to initiating naltrexone. Scientific Significance Our study findings identify specific characteristics of patients who responded positively to rapid naltrexone induction. PMID:25907815

Prioritizing the School Environment in School Violence Prevention Efforts

PubMed Central

Burke, Jessica Griffin; Gielen, Andrea Carlson

2015-01-01

Background Numerous studies have demonstrated an association between characteristics of the school environment and the likelihood of school violence. However, little is known about the relative importance of various characteristics of the school environment or their differential impact on multiple violence outcomes. Methods Primarily African-American students (n=27) from Baltimore City high schools participated in concept mapping sessions, which produced interpretable maps of the school environment's contribution to school violence. Participants generated statements about their school environment's influence on school violence and with the assistance of quantitative methods grouped these statements according to their similarity. Participants provided information about the importance of each of these statements for the initiation, cessation, and severity of the violence that occurs at school. Results More than half of the 132 statements generated by students were rated as school environment characteristics highly important for the initiation, cessation, and/or severity of school violence. Participants identified students' own actions, expectations for disruptive behavior, and the environment outside the school as characteristics most important for the initiation and increased severity of violence that occurs in school. Participants had a more difficult time identifying school environment characteristics important for the cessation of school violence. Conclusion This study provides support from students for the role of the school environment in school violence prevention, particularly in preventing the initiation and reducing the severity of school violence. Schools can utilize the information presented in this paper to begin discussions with students and staff about prioritizing school environment changes to reduce school violence. PMID:21592128

Feasibility of Combining Common Data Elements Across Studies to Test a Hypothesis.

PubMed

Corwin, Elizabeth J; Moore, Shirley M; Plotsky, Andrea; Heitkemper, Margaret M; Dorsey, Susan G; Waldrop-Valverde, Drenna; Bailey, Donald E; Docherty, Sharron L; Whitney, Joanne D; Musil, Carol M; Dougherty, Cynthia M; McCloskey, Donna J; Austin, Joan K; Grady, Patricia A

2017-05-01

The purpose of this article is to describe the outcomes of a collaborative initiative to share data across five schools of nursing in order to evaluate the feasibility of collecting common data elements (CDEs) and developing a common data repository to test hypotheses of interest to nursing scientists. This initiative extended work already completed by the National Institute of Nursing Research CDE Working Group that successfully identified CDEs related to symptoms and self-management, with the goal of supporting more complex, reproducible, and patient-focused research. Two exemplars describing the group's efforts are presented. The first highlights a pilot study wherein data sets from various studies by the represented schools were collected retrospectively, and merging of the CDEs was attempted. The second exemplar describes the methods and results of an initiative at one school that utilized a prospective design for the collection and merging of CDEs. Methods for identifying a common symptom to be studied across schools and for collecting the data dictionaries for the related data elements are presented for the first exemplar. The processes for defining and comparing the concepts and acceptable values, and for evaluating the potential to combine and compare the data elements are also described. Presented next are the steps undertaken in the second exemplar to prospectively identify CDEs and establish the data dictionaries. Methods for common measurement and analysis strategies are included. Findings from the first exemplar indicated that without plans in place a priori to ensure the ability to combine and compare data from disparate sources, doing so retrospectively may not be possible, and as a result hypothesis testing across studies may be prohibited. Findings from the second exemplar, however, indicated that a plan developed prospectively to combine and compare data sets is feasible and conducive to merged hypothesis testing. Although challenges exist in combining CDEs across studies into a common data repository, a prospective, well-designed protocol for identifying, coding, and comparing CDEs is feasible and supports the development of a common data repository and the testing of important hypotheses to advance nursing science. Incorporating CDEs across studies will increase sample size and improve data validity, reliability, transparency, and reproducibility, all of which will increase the scientific rigor of the study and the likelihood of impacting clinical practice and patient care. © 2017 Sigma Theta Tau International.

Factors Associated With Contraceptive Method Choice and Initiation in Adolescents and Young Women.

PubMed

Cohen, Rebecca; Sheeder, Jeanelle; Kane, Meghan; Teal, Stephanie B

2017-10-01

The purpose of the study was to identify factors associated with uptake of contraceptive implants or intrauterine devices (IUDs) by adolescents and young women. For this prospective cohort study, we recruited English-speaking female contraceptive initiators aged 14-24 years attending a Title X-supported, youth-focused clinic. Immediately prior to their visits, participants completed surveys assessing demographic and reproductive characteristics and awareness of, interest in, and intent to initiate specific contraceptive methods. Participants also answered questions about their social contacts' contraceptive experiences. Following the visit, participants reported the method initiated and the perceived importance of provider counseling. We used a multivariable regression model to ascertain factors associated with initiation of an IUD, an implant, or a short-acting reversible method. We enrolled 1,048 contraceptive initiators: 277 initiated short-acting methods, 384 IUDs, and 387 implants. High previsit personal acceptability of the method was associated with choosing that method for both implants and IUDs. Knowing someone who uses a specific method and likes it was predictive of personal acceptability of that method (IUD adjusted odds ratio: 10.9, 95% confidence interval: 3.8-31.1; implant adjusted odds ratio: 7.0, 95% confidence interval: 2.3-21.0). However, 10.4% of those initiating IUDs and 14.2% of those initiating implants had never heard of the method before their appointment. Even women with previsit intent to initiate a specific method found importance in contraceptive counseling. Previsit personal acceptability, which was associated with social contacts' experiences, was the strongest predictor of specific method uptake in our study. However, counseling informed the decisions of those with low previsit awareness and supported patients with formed intent. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Multivariate Protein Signatures of Pre-Clinical Alzheimer's Disease in the Alzheimer's Disease Neuroimaging Initiative (ADNI) Plasma Proteome Dataset

PubMed Central

Johnstone, Daniel; Milward, Elizabeth A.; Berretta, Regina; Moscato, Pablo

2012-01-01

Background Recent Alzheimer's disease (AD) research has focused on finding biomarkers to identify disease at the pre-clinical stage of mild cognitive impairment (MCI), allowing treatment to be initiated before irreversible damage occurs. Many studies have examined brain imaging or cerebrospinal fluid but there is also growing interest in blood biomarkers. The Alzheimer's Disease Neuroimaging Initiative (ADNI) has generated data on 190 plasma analytes in 566 individuals with MCI, AD or normal cognition. We conducted independent analyses of this dataset to identify plasma protein signatures predicting pre-clinical AD. Methods and Findings We focused on identifying signatures that discriminate cognitively normal controls (n = 54) from individuals with MCI who subsequently progress to AD (n = 163). Based on p value, apolipoprotein E (APOE) showed the strongest difference between these groups (p = 2.3×10−13). We applied a multivariate approach based on combinatorial optimization ((α,β)-k Feature Set Selection), which retains information about individual participants and maintains the context of interrelationships between different analytes, to identify the optimal set of analytes (signature) to discriminate these two groups. We identified 11-analyte signatures achieving values of sensitivity and specificity between 65% and 86% for both MCI and AD groups, depending on whether APOE was included and other factors. Classification accuracy was improved by considering “meta-features,” representing the difference in relative abundance of two analytes, with an 8-meta-feature signature consistently achieving sensitivity and specificity both over 85%. Generating signatures based on longitudinal rather than cross-sectional data further improved classification accuracy, returning sensitivities and specificities of approximately 90%. Conclusions Applying these novel analysis approaches to the powerful and well-characterized ADNI dataset has identified sets of plasma biomarkers for pre-clinical AD. While studies of independent test sets are required to validate the signatures, these analyses provide a starting point for developing a cost-effective and minimally invasive test capable of diagnosing AD in its pre-clinical stages. PMID:22485168

Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews.

PubMed

Fisher, Edwin B; Boothroyd, Renée I; Elstad, Emily A; Hays, Laura; Henes, Amy; Maslow, Gary R; Velicer, Clayton

2017-01-01

Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.

Failure mechanisms of uni-ply composite plates with a circular hole under static compressive loading

NASA Technical Reports Server (NTRS)

Khamseh, A. R.; Waas, A. M.

1992-01-01

The objective of the study was to identify and study the failure mechanisms associated with compressive-loaded uniply graphite/epoxy square plates with a central circular hole. It is found that the type of compressive failure depends on the hole size. For large holes with the diameter/width ratio exceeding 0.062, fiber buckling/kinking initiated at the hole is found to be the dominant failure mechanism. In plates with smaller hole sizes, failure initiates away from the hole edge or complete global failure occurs. Critical buckle wavelengths at failure are presented as a function of the normalized hole diameter.

Predictors of needle exchange program utilization during its implementation and expansion in Tijuana, Mexico.

PubMed

Smith, Danielle M; Werb, Dan; Abramovitz, Daniela; Magis-Rodriguez, Carlos; Vera, Alicia; Patterson, Thomas L; Strathdee, Steffanie A

2016-03-01

Until the early 2000s, there was only one needle exchange program (NEP) offered in Mexico. In 2004, the second Mexican NEP opened in Tijuana, but its utilization has not been studied. We studied predictors of initiating NEP during its early expansion in Tijuana, Mexico. From April 2006 to April 2007, people who inject drugs (PWID) residing in Tijuana who had injected within the last month were recruited using respondent-driven sampling. Weighted Poisson regression incorporating generalized estimating equations was used to identify predictors of initiating NEP, while accounting for correlation between recruiter and recruits. NEP uptake increased from 20% at baseline to 59% after 6 months. Among a subsample of PWID not accessing NEP at baseline (n = 480), 83% were male and median age was 37 years (Interquartile Range: 32-43). At baseline, 4.4% were HIV-infected and 5.9% had syphilis titers >1:8. In multivariate models, factors associated with NEP initiation (p < .05) were attending shooting galleries (Adjusted Relative Risk [ARR]: 1.54); arrest for track-marks (ARR: 1.38); having a family member that ever used drugs (ARR: 1.37); and having a larger PWID network (ARR: 1.01 per 10 persons). NEP initiation was inversely associated with obtaining syringes at pharmacies (ARR: .56); earning >2500 pesos/month (ARR: .66); and reporting needle sharing (ARR: .71). Uptake of NEP expansion in Tijuana was vigorous among PWID. We identified a range of factors that influenced the likelihood of NEP initiation, including police interaction. These findings have important implications for the scale-up of NEP in Mexico. © American Academy of Addiction Psychiatry.

Receptivity to Library Involvement in Scientific Data Curation: A Case Study at the University of Colorado Boulder

ERIC Educational Resources Information Center

Lage, Kathryn; Losoff, Barbara; Maness, Jack

2011-01-01

Increasingly libraries are expected to play a role in scientific data curation initiatives, i.e., "the management and preservation of digital data over the long-term." This case study offers a novel approach for identifying researchers who are receptive toward library involvement in data curation. The authors interviewed researchers at…

Policies Related to Active Transport to and from School: A Multisite Case Study

ERIC Educational Resources Information Center

Eyler, Amy A.; Brownson, Ross C.; Doescher, Mark P.; Evenson, Kelly R.; Fesperman, Carrie E.; Litt, Jill S.; Pluto, Delores; Steinman, Lesley E.; Terpstra, Jennifer L.; Troped, Philip J.; Schmid, Thomas L.

2008-01-01

Active transportation to and from school (ATS) is a viable strategy to help increase physical activity among youth. ATS can be challenging because initiatives require transdisciplinary collaboration, are influenced by the built environment and are affected by numerous policies. The purpose of this study is to identify policies and factors that…

Effects of logging debris treatments on five-year development of competing vegetation and planted Douglas-fir

Treesearch

Timothy B. Harrington; Stephen H. Schoenholtz

2010-01-01

Although considerable research has focused on the influences of logging debris treatments on soil and forest regeneration responses, few studies have identified whether debris effects are mediated by associated changes in competing vegetation abundance. At sites near Matlock, Washington, and Molalla, Oregon, studies were initiated after timber harvest to quantify the...

University Teachers' Conceptions of "Changemaker": A Starting Point for Embedding Social Innovation in Learning and Teaching

ERIC Educational Resources Information Center

Alden Rivers, Bethany; Nie, Ming; Armellini, Alejandro

2015-01-01

Purpose: The purpose of this paper is to report on a study aimed at understanding the different conceptions that University of Northampton teachers hold of "Changemaker", an institutional initiative to develop capacities for social innovation. Design/methodology/approach: The study took a phenomenographic approach to identify a small…

The Role of the Company in Generating Skills. The Learning Effects of Work Organization. Portugal.

ERIC Educational Resources Information Center

Rodriguez, Maria Joao; Lopes, Helena

The impact of changes in work organization on development of Portugese workers' skills was examined. At the macro level, a national study was conducted to identify current and possible future relationships among initial training, continuing training, the labor market, and industrial relations in Portugal. At the micro level, cases studies of three…

The successful implementation of STEM initiatives in lower income schools

NASA Astrophysics Data System (ADS)

Bakshi, Leena

The purpose of this study was to examine the leadership strategies utilized by superintendents, district administrators and school principals and the impact of these identified strategies on implementing STEM initiatives specifically for lower-income students. This study set out to determine (a) What role does district leadership play in the implementation of STEM initiatives in lower income secondary schools; (b) What internal systems of accountability exist in successful lower income secondary schools' STEM programs; (c) What leadership strategies are used to implement STEM curriculum initiatives; (d) How do school and district leadership support staff in order to achieve student engagement in STEM Initiative curriculum. This study used a mixed-methods approach to determine the impact of leadership strategies utilized by superintendents, district administrators and school principals on implementing STEM initiatives. Quantitative data analyzed survey questionnaires to determine the degree of correlation between the school districts that have demonstrated the successful implementation of STEM initiatives at the school and district levels. Qualitative data was collected using highly structured participant interviews and purposeful sampling of four district superintendents, one district-level administrator and five school leaders to capture the key strategies in implementing STEM initiatives in lower income secondary schools. Through the process of triangulation, the results of the study revealed that superintendents and principals should consider the characteristics of effective STEM initiatives that have shown a considerable degree of correlation with positive outcomes for lower income students. These included the leadership strategies of personnel's making decisions about the district's and school's instructional direction and an emphasis on the conceptual development of scientific principles using the Next Generation Science Standards coupled with the Common Core State Standards across the grade levels. It also emphasized the importance of establishing community partnerships as a primary resource. This study highlighted the criteria district and school leadership should include in implementing STEM initiatives and designing professional development models that result in meaningful instructional practices of STEM curriculum for secondary lower income students. Overall, this study provides insight for superintendents, district leaders and school administrators that can play an integral role in implementing STEM initiatives with access for socioeconomically disadvantaged students.

5 Indicators of Decimal Understandings

ERIC Educational Resources Information Center

Cramer, Kathleen; Monson, Debra; Ahrendt, Sue; Colum, Karen; Wiley, Bethann; Wyberg, Terry

2015-01-01

The authors of this article collaborated with fourth-grade teachers from two schools to support implementation of a research-based fraction and decimal curriculum (Rational Number Project: Fraction Operations and Initial Decimal Ideas). Through this study, they identified five indicators of rich conceptual understanding of decimals, which are…

Erectable space platform for space sciences and applications

NASA Technical Reports Server (NTRS)

1979-01-01

The specific objectives of the study were to: (1) identify a viable conceptual design for the service module/platform; (2) assess the technology issues that must be faced in planning development; and (3) prepare an initial plan for bringing critical technologies up to acceptable levels.

Vocational Education and Training and the Therapeutic Turn

ERIC Educational Resources Information Center

Hyland, Terry

2006-01-01

The concept of "therapeutic education" is being increasingly used in contemporary education policy studies to identify learning initiatives which are dominated by objectives linked to personal and social skills, emotional intelligence and building self-esteem. Contemporary educational goals connected with such strategies have been…

Exploring Organizational Approaches to Dissemination and Training.

ERIC Educational Resources Information Center

Firestone, William A.; Rossman, Gretchen B.

1986-01-01

Discusses four case studies of regional educational service agencies in their role as disseminators of new knowledge. Three characteristic approaches to dissemination were identified, namely, laissez-faire, entrepreneurial, and authoritarian. These approaches were shaped by five factors in the agency's context: state policy initiatives; client…

Lifestyles/Personal Health Care in Different Occupations.

ERIC Educational Resources Information Center

Anderson, Stuart A.

1981-01-01

The American Academy of Family Physicians initiated a study to identify and examine certain life-style patterns in representative groups of people. This article presents the responses from teachers, including their perceptions of factors contributing to stress, problems at home, and allocation of time. (WD)

Self-Directed Teacher Learning in Collaborative Contexts

ERIC Educational Resources Information Center

Slavit, David; Roth McDuffie, Amy

2013-01-01

Two related case studies of secondary mathematics teachers examine the roles and conditions helpful in initiating, directing, and/or supporting teachers' own professional development. Using multiple data sources from school-based and professional settings, we applied analytic induction to identify patterns of similarities and differences in…

Communication strategies for a successful inpatient dermatology consultative service: a narrative review.

PubMed

Afifi, Ladan; Shinkai, Kanade

2017-03-01

Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must develop strong relationships with primary inpatient teams requesting consults in order to provide optimal patient care. Prior studies have identified effective communication practices for inpatient consultative services. This narrative review provides a summary of effective communication practices for an inpatient dermatology consultation service organized into 5 domains: (1) features of the initial consult request; (2) best practices in responding to the initial consult; (3) effective communication of recommendations; (4) interventions to improve consultations; and (5) handling curbside consultations. Recommendations include identifying the specific reason for consult; establishing urgency; secure sharing of sensitive clinical information such as photographs; ensuring timely responses; providing clear yet brief documentation of the differential diagnosis, problem list, final diagnosis and recommendations; and limiting curbside consultations. Future studies are needed to validate effective strategies to enhance communication practices within an inpatient dermatology consultative service. ©2017 Frontline Medical Communications.

Waste minimization/pollution prevention study of high-priority waste streams

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

Ogle, R.B.

1994-03-01

Although waste minimization has been practiced by the Metals and Ceramics (M&C) Division in the past, the effort has not been uniform or formalized. To establish the groundwork for continuous improvement, the Division Director initiated a more formalized waste minimization and pollution prevention program. Formalization of the division`s pollution prevention efforts in fiscal year (FY) 1993 was initiated by a more concerted effort to determine the status of waste generation from division activities. The goal for this effort was to reduce or minimize the wastes identified as having the greatest impact on human health, the environment, and costs. Two broadmore » categories of division wastes were identified as solid/liquid wastes and those relating to energy use (primarily electricity and steam). This report presents information on the nonradioactive solid and liquid wastes generated by division activities. More specifically, the information presented was generated by teams of M&C staff members empowered by the Division Director to study specific waste streams.« less

Cultural Awareness Among Nursing Staff at an Academic Medical Center.

PubMed

McElroy, Jennifer; Smith-Miller, Cheryl A; Madigan, Catherine K; Li, Yin

2016-03-01

The goal is to identify areas for targeted improvement in regard to cultural awareness and competence among nursing staff and in the work environment. Many facilities have initiated programs to facilitate cultural competence development among nursing staff; however, there has been little examination of the effect of these initiatives, assessment of experienced nurses' cultural awareness, or investigation of nurse leader's role in promoting cultural competence in the literature. In this cross-sectional descriptive study, a cultural awareness survey was modified and electronically distributed to all registered nurses and assistive personnel at an academic medical center. The modified survey instrument showed good reliability and validity among the study population. Most nursing staff exhibited a moderate to high level of cultural awareness and held positive opinions about nursing leadership and the work environment with regard to cultural issues. In increasingly diverse work environments, assessing the cultural awareness of nursing staff enables nurse leaders to evaluate efforts in promoting cultural competence and to identify specific areas in which to target staff development efforts and leadership training.

Factors associated with difficulty achieving initial control with crotalidae polyvalent immune fab antivenom in snakebite patients.

PubMed

Yin, Shan; Kokko, Jamie; Lavonas, Eric; Mlynarchek, Sara; Bogdan, Greg; Schaeffer, Tammi

2011-01-01

The prescribing information for Crotalidae Fab antivenom (FabAV) instructs clinicians to administer FabAV until initial control of the envenomation syndrome is achieved. Risk factors for difficulty achieving initial control are not known. The study aim was to identify factors present before administration of antivenom associated with difficulty achieving initial control. The authors conducted a retrospective study of all patients presenting to any one of 17 centers and receiving FabAV from 2002 to 2004. Demographic and historical information, as well as data about nine specific venom effects, were collected prior to the administration of antivenom. An expert panel used standard criteria to determine if initial control was achieved. The patient group that had difficulty achieving initial control was compared to the group that achieved initial control, and adjusted odds ratios were calculated using stepwise logistic regression. A total of 247 patients were included in the final analysis. The majority of patients were envenomated on the upper extremity and were young males. A total of 203 patients (82.2%) achieved initial control. In univariate analysis, thrombocytopenia, bleeding, neurologic effects, and a severe bite were significantly associated with difficulty achieving initial control. After logistic regression, the presence of neurologic effects and thrombocytopenia remained significantly associated with difficulty achieving initial control. When both factors were present, the patient was 13.8 times more likely to have difficulty achieving initial control. A number of factors were present before the administration of FabAV that were independently associated with difficulty achieving initial control of the envenomation syndrome. Predicting which patients will have difficulty achieving initial control has important ramifications for patient disposition and may provide insight into the mechanisms for lack of antivenom efficacy. © 2010 by the Society for Academic Emergency Medicine.

Epidemiological Patterns of Initial and Subsequent Injuries in Collegiate Football Athletes.

PubMed

Williams, Jacob Z; Singichetti, Bhavna; Li, Hongmei; Xiang, Henry; Klingele, Kevin E; Yang, Jingzhen

2017-04-01

A body of epidemiological studies has examined football injuries and associated risk factors among collegiate athletes. However, few existing studies specifically analyzed injury risk in terms of initial or subsequent injuries. To determine athlete-exposures (AEs) and rates of initial and subsequent injury among collegiate football athletes. Descriptive epidemiological study. Injury and exposure data collected from collegiate football players from two Division I universities (2007-2011) were analyzed. Rate of initial injury was calculated as the number of initial injuries divided by the total number of AEs for initial injuries, while the rate for subsequent injury was calculated as the number of subsequent injuries divided by the total number of AEs for subsequent injury. Poisson regression was used to determine injury rate ratio (subsequent vs initial injury), with adjustment for other covariates. The total AEs during the study period were 67,564, resulting in an overall injury rate of 35.2 per 10,000 AEs. Rates for initial and subsequent injuries were 31.7 and 45.3 per 10,000 AEs, respectively, with a rate ratio (RR) of 1.4 for rate of subsequent injury vs rate of initial injury (95% CI, 1.1-1.9). Rate of injury appeared to increase with each successive injury. RR during games was 1.8 (95% CI, 1.1-3.0). The rate of subsequent injuries to the head, neck, and face was 10.9 per 10,000 AEs, nearly double the rate of initial injuries to the same sites (RR = 2.0; 95% CI, 1.1-3.5). For wide receivers, the rate of subsequent injuries was 2.2 times the rate of initial injuries (95% CI, 1.3-3.8), and for defensive linemen, the rate of subsequent injuries was 2.1 times the rate of initial injuries (95% CI, 1.1-3.9). The method used in this study allows for a more accurate determination of injury risk among football players who have already been injured at least once. Further research is warranted to better identify which specific factors contribute to this increased risk for subsequent injury.

EVIDENCE FOR NEWLY INITIATED RECONNECTION IN THE SOLAR WIND AT 1 AU

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

Xu, Xiaojun; Ma, Yonghui; Wong, Hon-Cheng

2015-08-10

We report the first evidence for a large-scale reconnection exhaust newly initiated in the solar wind using observations from three spacecraft: ACE, Wind, and ARTEMIS P2. We identified a well-structured X-line exhaust using measurements from ARTEMIS P2 in the downstream solar wind. However, in the upstream solar wind, ACE detected the same current sheet that corresponds to the exhaust identified by ARTEMIS P2 data without showing any reconnection signals. We cannot find any reconnection signals from Wind located between ACE and ARTEMIS P2. Within the exhaust, a magnetic island is identified, which is not consistent with the quasi-steady feature asmore » previously reported and provides further evidence that the reconnection is newly initiated. Our observations show that the entering of energetic particles, probably from Earth's bow shock, makes the crucial difference between the non-reconnecting current sheet and the exhaust. Since no obvious driving factors are responsible for the reconnection initiation, we infer that these energetic particles probably play an important role in the reconnection initiation. Theoretical analysis also shows support for this potential mechanism.« less

Longitudinal Investigation of Smoking Initiation and Relapse Among Younger and Older US Military Personnel

PubMed Central

Trone, Daniel W.; Peterson, Arthur V.; Jacobson, Isabel G.; Littman, Alyson J.; Maynard, Charles; Seelig, Amber D.; Crum-Cianflone, Nancy F.; Bricker, Jonathan B.

2015-01-01

Objectives. We examined whether military service, including deployment and combat experience, were related to smoking initiation and relapse. Methods. We included older (panel 1) and younger (panel 2) participants in the Millennium Cohort Study. Never smokers were followed for 3 to 6 years for smoking initiation, and former smokers were followed for relapse. Complementary log-log regression models estimated the relative risk (RR) of initiation and relapse by military exposure while adjusting for demographic, health, and lifestyle factors. Results. Deployment with combat experience predicted higher initiation rate (panel 1: RR = 1.44; 95% confidence interval [CI] = 1.28, 1.62; panel 2: RR = 1.26; 95% CI = 1.04, 1.54) and relapse rate (panel 1 only: RR = 1.48; 95% CI = 1.36, 1.62). Depending on the panel, previous mental health disorders, life stressors, and other military and nonmilitary characteristics independently predicted initiation and relapse. Conclusions. Deployment with combat experience and previous mental disorder may identify military service members in need of intervention to prevent smoking initiation and relapse. PMID:25880953

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention.

PubMed

Montague, Enid; Asan, Onur

2014-03-01

The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients' and physicians' gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor-technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. Published by Elsevier Ireland Ltd.

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention

PubMed Central

Montague, Enid; Asan, Onur

2014-01-01

Objective The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. Background Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. Methods A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients’ and physicians’ gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. Results Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor- technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. Conclusion This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. PMID:24380671

Space Station crew safety alternatives study. Volume 2: Threat development

NASA Technical Reports Server (NTRS)

Raasch, R. F.; Peercy, R. L., Jr.; Rockoff, L. A.

1985-01-01

The first 15 years of accumulated space station concepts for initial operational capability (IOC) during the early 1990's were considered. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration, and debris.

Space station crew safety alternatives study, volume 1

NASA Technical Reports Server (NTRS)

Peercy, R. L., Jr.; Raasch, R. F.; Rockoff, L. A.

1985-01-01

The first 15 years of accumulated space station concepts for initial operational capability (IOC) during the early 1990's were considered. Twenty-five threats to the space station are identified and selected threats addressed as impacting safety criteria, escape and rescue, and human factors safety concerns. Of the 25 threats identified, eight are discussed including strategy options for threat control: fire, biological or toxic contamination, injury/illness, explosion, loss of pressurization, radiation, meteoroid penetration and debris.

How cigarette design can affect youth initiation into smoking: Camel cigarettes 1983-93

PubMed Central

Wayne, G; Connolly, G

2002-01-01

Objective: To determine changes in the design of Camel cigarettes in the period surrounding the "Smooth Character" advertising campaign and to assess the impact of these changes on youth smoking. Data sources: Internal documents made available through the document website maintained by RJ Reynolds, manufacturer of Camel cigarettes. Study selection: Electronic searches using keywords to identify relevant data. Data extraction: A web based index search of documents targeting "smoothness" or "harshness" and "younger adult smokers" ("YAS") or "first usual brand younger adult smokers" ("FUBYAS") in the 10 year period surrounding the introduction of the "Smooth Character" campaign was used to identify Camel related product design research projects. A snowball methodology was used: initial documents were identified by focusing on key words, codes, researchers, committees, meetings, and gaps in overall chronology; a second set of documents was culled from these initial documents, and so on. Data synthesis: Product design research led to the introduction of redesigned Camel cigarettes targeted to younger adult males coinciding with the "Smooth Character" campaign. Further refinements in Camel cigarettes during the following five year period continued to emphasise the smoothness of the cigarette, utilising additives and blends which reduced throat irritation but increased or retained nicotine impact. Conclusions: Industry competition for market share among younger adult smokers may have contributed to the reversal of a decline in youth smoking rates during the late 1980s through development of products which were more appealing to youth smokers and which aided in initiation by reducing harshness and irritation. PMID:11893812

Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.

PubMed

Clair, Andrew J; Evangelista, Perry J; Lajam, Claudette M; Slover, James D; Bosco, Joseph A; Iorio, Richard

2016-09-01

The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed. Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

[Identification of hexavalent chromium reducing bacteria Cr4-1 and optimization of its reduction conditions].

PubMed

Zhu, Peilei; Jiao, Shilin; Jiang, Pu; Zeng, Xin; Luo, Qifang; Wang, Lin

2015-03-01

To identify the hexavalent chromium reduction Cr4-1, and to study the better conditions of the bacterial growth and its Cr(VI) reduction. The physiological and biochemical methods and 16s rDNA sequencing were used for identification of bacteria Cr4-1. The influence of temperature, pH, initial Cr (VI) concentration and shaking speed on bacterial growth and Cr (VI) reduction were studied. Mass balance analysis was used to analyze the end products of the reduction reaction. A Cr(VI) reducing bacteria Cr4-1, screened from acclimated activated sludge, was identified as Bacillus cereus. The appropriate conditions of bacterial growth was 25 °C, pH 7 to 8, shaking speed 150 r/min, while the suitable conditions for Cr(VI) reduction was 35 °C, pH 8 to 9. When the initial Cr(VI) concentration increased from 20 mg/L to 60 mg/L, the reduction rate decreased gradually. Under the suitable reducing conditions, when the initial concentration of Cr (VI) was 30 mg/L, the reduction rate could up to 100% in 9 h. The end product was soluble trivalent chromium. Strain Cr4-1 had a good effect on Cr (VI) reduction and the final product was soluble trivalent chromium.

Factors affecting science reform: Bridging the gap between reform initiatives and teaching practices

NASA Astrophysics Data System (ADS)

Pensak, Karl John

In response to the perceived deficiencies in science education today, and to the expressed need for research into the culture of schools (due primarily to the failure of many science reforms in the past), this study used a broad based approach to study the gap between science education research and science education practice. This study identified 47 factors that may encourage or inhibit science curriculum reform. A survey was conducted to determine which factors were perceived to be important by local and national K-12 classroom teachers, science supervisors/coordinators, and college/university professors. Continual staff development (scheduled as part of teachers' work day/week/month), funding (for long-term staff development, teacher training and support, science laboratory facilities and materials), teacher motivation and "ownership" of the reform, the need for collaborative opportunities for classroom teachers, teachers' college preparation, textbook reform, community support, and reform initiatives that are "in tune" with assessment, are major factors identified as having a substantial affect on the successful adoption, implementation, and institutionalization of science reforms.

National Institutes of Health Blood and Marrow Transplant Late Effects Initiative: The Healthcare Delivery Working Group Report

PubMed Central

Hashmi, Shahrukh K; Bredeson, Christopher; Duarte, Rafael F; Farnia, Stephanie; Ferrey, Susan; Fitzhugh, Courtney; Flowers, Mary ED; Gajewski, James; Gastineau, Dennis; Greenwald, Melissa; Jagasia, Madan; Martin, Patricia; Rizzo, J Douglas; Schmit-Pokorny, Kimberly; Majhail, Navneet S

2016-01-01

Hematopoietic cell transplantation (HCT) survivors are at risk for development of late complications and require lifelong monitoring for screening and prevention of late effects. There is an increasing appreciation of the issues related to healthcare delivery and coverage that are faced by HCT survivors. The 2016 National Institutes of Health Blood and Marrow Transplant Late Effects Initiative included an international and broadly representative Healthcare Delivery Working Group that was tasked with identifying research gaps pertaining to healthcare delivery and to identify initiatives that may yield a better understanding of the long-term value and costs of care for HCT survivors. There is a paucity of literature in this area. Critical areas in need of research include pilot studies of novel and information technology supported models of care delivery and coverage for HCT survivors along with development and validation of instruments that capture patient reported outcomes. Investment in infrastructure to support this research such as linkage of databases including electronic health records and routine inclusion of endpoints that will inform analyses focused around care delivery and coverage are required. PMID:27713091

Marijuana Use, Recent Marijuana Initiation, and Progression to Marijuana Use Disorder Among Young Male and Female Adolescents Aged 12–14 Living in US Households

PubMed Central

Forman-Hoffman, Valerie L; Glasheen, Cristie; Batts, Kathryn R

2017-01-01

Marijuana initiation during adolescence, and early adolescence in particular, is associated with adverse health consequences. Our study used 2005–2014 data from the annual, cross-sectional National Survey on Drug Use and Health to study the prevalence and correlates of marijuana initiation, use, and marijuana use disorder (MUD; abuse or dependence) among 12- to 14-year olds living in civilian US households (n = 84 954). Examined correlates included age, sex, race/ethnicity, poverty status, metropolitan status, year of survey, depression, tobacco use, alcohol use, and fighting at school. Sex differences in the correlates of lifetime use and past year marijuana initiation were tested via interaction. Lifetime prevalence of marijuana use was 5.5%; 3.2% reported past year initiation. About 1 in 6 (16.8%) past year initiates progressed to MUD within 12 months of first use. Although men had higher prevalence of lifetime use than women, past year initiation did not differ by sex. On examining the sex*race/ethnicity interaction effects, findings determined that non-Hispanic black and Hispanic men had higher prevalence estimates of ever using marijuana and incidence of past year initiation as compared with non-Hispanic white men; these race/ethnicity differences were not found among women. Identifying correlates of initiation and progression to MUD among young adolescents is critical to improve prevention and treatment program targets. PMID:28615948

Impact of an emergency medicine pharmacist on initial antibiotic prophylaxis for open fractures in trauma patients.

PubMed

Harvey, Somer; Brad Hall, A; Wilson, Kayla

2018-02-01

Targeted antibiotic treatment reduces the infection risk of open fractures when soft tissue and bone are exposed to the environment. The risk of infection increases with higher degrees of injury. The Gustilo-Anderson system was developed to identify the degree of injury of open fractures and can be utilized to guide initial antibiotic therapy. Few studies have been published evaluating the potential impact of emergency medicine pharmacists in trauma, and currently no study has evaluated a pharmacist's influence on antibiotic selection and timing for open fractures. The objective of this study was to determine the impact of an emergency medicine pharmacist on initial antibiotic selection and timing in trauma patients with open fractures. This was a retrospective cohort study. Trauma alerts with open fractures from May 1, 2014 to June 30, 2016 were eligible for inclusion. The primary outcome was to determine if pharmacist participation during trauma resuscitation was associated with an increased proportion of initial antibiotic selection meeting guideline recommendations. The secondary outcome was the door-to-antibiotic administration time during resuscitation. Initial prophylactic antibiotic recommendations were met in 81% of trauma resuscitations when a pharmacist was present versus 47% without a pharmacist present (p<0.01). The median door-to-antibiotic time was 14min in the PHARM group versus 20min in the NO-PHARM group (p=0.02). The participation of an EM pharmacist during initial trauma resuscitation resulted in improved initial antibiotic selection and faster door-to-antibiotic administration times in trauma patients with open fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

Development and psychometric evaluation of the Personal Growth Initiative Scale-II.

PubMed

Robitschek, Christine; Ashton, Matthew W; Spering, Cynthia C; Geiger, Nathaniel; Byers, Danielle; Schotts, G Christian; Thoen, Megan A

2012-04-01

The original Personal Growth Initiative Scale (PGIS; Robitschek, 1998) was unidimensional, despite theory identifying multiple components (e.g., cognition and behavior) of personal growth initiative (PGI). The present research developed a multidimensional measure of the complex process of PGI, while retaining the brief and psychometrically sound properties of the original scale. Study 1 focused on scale development, including theoretical derivation of items, assessing factor structure, reducing number of items, and refining the scale length using samples of college students. Study 2 consisted of confirmatory factor analysis with 3 independent samples of college students and community members. Lastly, Study 3 assessed test-retest reliability over 1-, 2-, 4-, and 6-week periods and tests of concurrent and discriminant validity using samples of college students. The final measure, the Personal Growth Initiative Scale-II (PGIS-II), includes 4 subscales: Readiness for Change, Planfulness, Using Resources, and Intentional Behavior. These studies provide exploratory and confirmatory evidence for the 4-factor structure, strong internal consistency for the subscales and overall score across samples, acceptable temporal stability at all assessed intervals, and concurrent and discriminant validity of the PGIS-II. Future directions for research and clinical practice are discussed.

Initiating/maintaining long-acting injectable antipsychotics in schizophrenia/schizoaffective or bipolar disorder - expert consensus survey part 2.

PubMed

Sajatovic, Martha; Ross, Ruth; Legacy, Susan N; Byerly, Matthew; Kane, John M; DiBiasi, Faith; Fitzgerald, Heather; Correll, Christoph U

2018-01-01

The aim of this study was to provide recommendations on initiating and maintaining long-acting injectable antipsychotics (LAIs) in individuals with schizophrenia/schizoaffective or bipolar disorder. A 50-question survey comprising 916 response options was completed by 34 expert researchers and high prescribers with extensive LAI experience, rating relative appropriateness/importance on a 9-point scale. Consensus was determined using chi-square test of score distributions. Results of 21 questions comprising 339 response options regarding LAI initiation, maintenance treatment, adequate trial definition, identifying treatment nonresponse, and switching are reported. Experts agreed that the most important LAI selection factor was patient response/tolerability to previous antipsychotics. An adequate therapeutic LAI trial was defined as the time to steady state ± 1-2 injection cycles. Experts suggested that oral efficacy and tolerability should be established before switching to an LAI, without consensus on the required time, and that the time for oral supplementation and next injection interval should be determined by the time to attainment of therapeutic LAI levels. Most experts agreed that ≥1 adequate LAI trial is needed to identify the lack of efficacy. There was little agreement about strategies for switching between LAIs. Expert guidance may aid clinicians in their decisions regarding initiating/maintaining LAIs in individuals with schizophrenia/schizoaffective or bipolar disorder.

Barriers and facilitators to childhood obesity prevention among culturally and linguistically diverse (CALD) communities in Victoria, Australia.

PubMed

Cyril, Sheila; Nicholson, Jan M; Agho, Kingsley; Polonsky, Michael; Renzaho, Andre M

2017-06-01

Childhood obesity is rising among culturally and linguistically diverse (CALD) groups who show poor engagement in obesity prevention initiatives. We examined the barriers and facilitators to the engagement of CALD communities in obesity prevention initiatives. We used the nominal group technique to collect data from 39 participants from Vietnamese, Burmese, African, Afghani and Indian origins living in disadvantaged areas of Victoria, Australia. Data analysis revealed ranked priorities for barriers and facilitators for CALD community engagement in obesity prevention initiatives. CALD parents identified key barriers as being: competing priorities in the post-migration settlement phase; language, cultural and program accessibility barriers; low levels of food and health literacy; junk food advertisement targeting children; and lack of mandatory weight checks for schoolchildren. Key facilitators emerged as: bicultural playgroup leaders; ethnic community groups; and school-based healthy lunch box initiatives. This study has identified several policy recommendations including: the implementation of robust food taxation policies; consistent control of food advertising targeting children; improving CALD health literacy using bicultural workers; and matching health promotional materials with CALD community literacy levels. Implications for Public Health: These recommendations can directly influence public health policy to improve the engagement of CALD communities in obesity prevention services and ultimately reduce the widening obesity disparities in Australia. © 2017 The Authors.

Stress and death of cnidarian host cells play a role in cnidarian bleaching.

PubMed

Paxton, Camille W; Davy, Simon K; Weis, Virginia M

2013-08-01

Coral bleaching occurs when there is a breakdown of the symbiosis between cnidarian hosts and resident Symbiodinium spp. Multiple mechanisms for the bleaching process have been identified, including apoptosis and autophagy, and most previous work has focused on the Symbiodinium cell as the initiator of the bleaching cascade. In this work we show that it is possible for host cells to initiate apoptosis that can contribute to death of the Symbiodinium cell. First we found that colchicine, which results in apoptosis in other animals, causes cell death in the model anemone Aiptasia sp. but not in cultured Symbiodinium CCMP-830 cells or in cells freshly isolated from host Aiptasia (at least within the time frame of our study). In contrast, when symbiotic Aiptasia were incubated in colchicine, cell death in the resident Symbiodinium cells was observed, suggesting a host effect on symbiont mortality. Using live-cell confocal imaging of macerated symbiotic host cell isolates, we identified a pattern where the initiation of host cell death was followed by mortality of the resident Symbiodinium cells. This same pattern was observed in symbiotic host cells that were subjected to temperature stress. This research suggests that mortality of symbionts during temperature-induced bleaching can be initiated in part by host cell apoptosis.

Military Training Time and Cost Should Be Reduced Through Improved Management.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

The report on the management of recruit and initial skill training identifies delays in training cycles, their causes, and resultant costs. In visits to four recruit training centers, eight initial skill training schools, and various headquarters offices, the General Accounting Office (GAO) identified 1,979,000 man-days per year that new members…

Program Evaluation: A Variety of Rigorous Methods Can Help Identify Effective Interventions. Report to Congressional Requesters. GAO-10-30

ERIC Educational Resources Information Center

Kingsbury, Nancy

2009-01-01

Recent congressional initiatives seek to focus funds for certain federal social programs on interventions for which randomized experiments show sizable, sustained benefits to participants or society. The private, nonprofit Coalition for Evidence-Based Policy undertook the Top Tier Evidence initiative to help federal programs identify interventions…

Transcription initiation from the dihydrofolate reductase promoter is positioned by HIP1 binding at the initiation site.

PubMed

Means, A L; Farnham, P J

1990-02-01

We have identified a sequence element that specifies the position of transcription initiation for the dihydrofolate reductase gene. Unlike the functionally analogous TATA box that directs RNA polymerase II to initiate transcription 30 nucleotides downstream, the positioning element of the dihydrofolate reductase promoter is located directly at the site of transcription initiation. By using DNase I footprint analysis, we have shown that a protein binds to this initiator element. Transcription initiated at the dihydrofolate reductase initiator element when 28 nucleotides were inserted between it and all other upstream sequences, or when it was placed on either side of the DNA helix, suggesting that there is no strict spatial requirement between the initiator and an upstream element. Although neither a single Sp1-binding site nor a single initiator element was sufficient for transcriptional activity, the combination of one Sp1-binding site and the dihydrofolate reductase initiator element cloned into a plasmid vector resulted in transcription starting at the initiator element. We have also shown that the simian virus 40 late major initiation site has striking sequence homology to the dihydrofolate reductase initiation site and that the same, or a similar, protein binds to both sites. Examination of the sequences at other RNA polymerase II initiation sites suggests that we have identified an element that is important in the transcription of other housekeeping genes. We have thus named the protein that binds to the initiator element HIP1 (Housekeeping Initiator Protein 1).

Toward a Cognitive Task Analysis for Biomedical Query Mediation

PubMed Central

Hruby, Gregory W.; Cimino, James J.; Patel, Vimla; Weng, Chunhua

2014-01-01

In many institutions, data analysts use a Biomedical Query Mediation (BQM) process to facilitate data access for medical researchers. However, understanding of the BQM process is limited in the literature. To bridge this gap, we performed the initial steps of a cognitive task analysis using 31 BQM instances conducted between one analyst and 22 researchers in one academic department. We identified five top-level tasks, i.e., clarify research statement, explain clinical process, identify related data elements, locate EHR data element, and end BQM with either a database query or unmet, infeasible information needs, and 10 sub-tasks. We evaluated the BQM task model with seven data analysts from different clinical research institutions. Evaluators found all the tasks completely or semi-valid. This study contributes initial knowledge towards the development of a generalizable cognitive task representation for BQM. PMID:25954589

Toward a cognitive task analysis for biomedical query mediation.

PubMed

Hruby, Gregory W; Cimino, James J; Patel, Vimla; Weng, Chunhua

2014-01-01

In many institutions, data analysts use a Biomedical Query Mediation (BQM) process to facilitate data access for medical researchers. However, understanding of the BQM process is limited in the literature. To bridge this gap, we performed the initial steps of a cognitive task analysis using 31 BQM instances conducted between one analyst and 22 researchers in one academic department. We identified five top-level tasks, i.e., clarify research statement, explain clinical process, identify related data elements, locate EHR data element, and end BQM with either a database query or unmet, infeasible information needs, and 10 sub-tasks. We evaluated the BQM task model with seven data analysts from different clinical research institutions. Evaluators found all the tasks completely or semi-valid. This study contributes initial knowledge towards the development of a generalizable cognitive task representation for BQM.

High temperature molten salt containment

NASA Astrophysics Data System (ADS)

Wang, K. Y.; West, R. E.; Kreith, F.; Lynn, P. P.

1985-05-01

The feasibility of several design options for high-temperature, sensible heat storage containment is examined. The major concerns for a successful containment design include heat loss, corrosive tolerance, structural integrity, and cost. This study is aimed at identifying the most promising high-temperature storage tank among eight designs initially proposed. The study is based on the heat transfer calculations and the structure study of the tank wall and the tank foundation and the overall cost analyses. The results indicate that the single-tank, two-media sloped wall tank has the potential of being lowest in cost. Several relevant technical uncertainties that warrant further research efforts are also identified.

Reconnaissance geochemical survey of the At Taif-Al Bahah region, southern Hijaz, Kingdom of Saudi Arabia

USGS Publications Warehouse

Du Bray, E.A.; Doebrich, J.L.

1982-01-01

An area south of At Taif containing significant tungsten was confirmed and found to be larger than initially determined. A possible porphyry copper pluton was discovered 50 km south-southeast of At Taif. Thirty kilometers south of At Taif, a low-grade tin anomaly associated with an S-type granite was identified. In addition, the sampling identified seven anomalous areas attributable to rock geochemically atypical of the study region. Finally, although samples from the A1 Lith-Hajrah area collected for an earlier study were found to contain anomalous concentrations of tungsten, samples collected there during this study do not support those findings.

Leading change: 1--identifying the issue.

PubMed

Kerridge, Joanna

To enable sustainable change, nurses need to take the lead in managing it. Recent national initiatives have emphasised the importance of frontline staff in service improvement. The ability to influence and manage change has been identified as an essential skill for delivering new models of care. This article is the first in a three-part series designed to help nurses at all levels develop the knowledge and skills they will need to initiate and manage change. This article focuses on identifying what needs to be changed and why.

Factors associated with psychoactive drug initiation in a sample of workers in France: results of the VISAT cohort study.

PubMed

Boeuf-Cazou, O; Niezborala, M; Marquie, J C; Lapeyre-Mestre, M

2010-03-01

To identify which psychosocial factors at work are associated with the initiation of psychoactive drug use in a cohort of healthy French workers. This study used data collected from the VISAT ('Vieillissement, Santé, Travail') cohort which included workers aged 32, 42, 52 and 62 years in 1996 with follow-ups conducted over the following 5 years. Data were collected through interviews and five standardized questionnaires in annual occupational medical examinations in 1996, 1999 and 2001. We defined new consumers of psychoactive drugs according to their answers during the follow-ups and compared their psychosocial and working characteristics to non-consumers. A multivariate logistic regression analysis was performed to investigate factors related to a psychoactive drug initiation. Among 1533 subjects, 5.4% began consuming psychoactive drugs during the follow-up with a twofold rate for women than for men. Factors related to psychoactive drug initiation were different according to gender. In men, initiation was mainly found in participants who were separated, showed high emotional reaction scores and were members of the white-collar working class. We did not find any other occupational factors associated to psychoactive drug initiation in men. By contrast, among women, drug initiation was more frequent in participants who were 52 years old and over, and whose job control-reward level was lower. Psychoactive drug initiation concerned 5.4% of workers within the 5-year interval in this study. The pressure of psychosocial environment was more important in men, whereas age and work-related psychosocial factors were the main factors associated with new consumption among women.

Systematic Review of Smoking Initiation among Asian Adolescents, 20052015: Utilizing the Frameworks of Triadic Influence and Planned Behavior.

PubMed

Talip, Tajidah; Murang, Zaidah; Kifli, Nurolaini; Naing, Lin

2016-01-01

A recent WHO data report on mortality attributable to tobacco use including cigarette smoking indicated a very high burden of deaths in Asia and that people often initiate smoking as early as young adolescents. The objectives of this study were to systematically review peerreviewed articles on cigarette smoking initiation among Asian adolescents and to develop a conceptual model of factors influencing smoking initiation by integrating all relevant factors based on existing data. Following a PRISMA guideline, a systematic review of articles published between 2005 and June 2015 was conducted using 5 databases on cigarette smoking initiation among adolescents (aged 1019 years) living in Asia. We summarized the main findings of each study according to our research questions and data that emerged during the data extraction process. Analysis and categorization were based on the TTI and TPB models and classification of factors extracted from the study, were as follows: personal factors, social factors, broader environmental factors, mediators, and intention to initiate smoking and smoking behavior. Of 1,227 identified studies, only 20 were included in this review. Our findings found that the mean age of cigarette smoking initiation ranged from 10 to 14 years and those who are more likely to initiate smoking are male, older adolescents, adolescents with low parental SES, individuals with low parental monitoring, low parental education level and having no discussion on smoking at home, those living in public housing and those exhibiting healthrisk behavior. Our study also revealed that the risk of smoking initiation increased when they are exposed to smokers, influenced by peers, exposed to tobacco advertisements, receive pocket money, have lack of knowledge about smoking, have poor school performance, have a family conflict and have psychological problems. The conceptual model developed demonstrated complex networks of factors influencing initiation. This systematic review presents various factors influencing smoking initiation of the Asian adolescents and provides a conceptual framework to further analyze factors. Future studies should have a standard measure of smoking initiation, should analyze interactions and the intensity of relationships between different factors or variables in the conceptual model. This will in turn consolidate the understanding of the different factors affecting smoking initiation and will help to improve interventions in this area.

Interventions to increase initial appointment attendance in mental health services: a systematic review.

PubMed

Schauman, Oliver; Aschan, Lisa Ellinor; Arias, Nicole; Beards, Stephanie; Clement, Sarah

2013-12-01

OBJECTIVE Although nonattendance at initial appointments in mental health services is a substantial problem, the phenomenon is poorly understood. This review synthesized findings of randomized controlled trials (RCTs) of interventions to increase initial appointment attendance and determined whether theories or models contributed to intervention design. METHODS Six electronic databases were systematically searched, and reference lists of identified studies were also examined. Studies included were RCTs (including "quasi-randomized" controlled trials) that compared standard practice with an intervention to increase attendance at initial appointments in a sample of adults who had a scheduled initial appointment in a mental health or substance abuse service setting. RESULTS Of 144 potentially relevant studies, 21 met inclusion criteria. These studies were reported in 20 different research papers. Of these, 16 studies (N=3,673 participants) were included in the analyses (five were excluded because they reported only nonattendance at the initial appointment). Separate analyses were conducted for each intervention type (opt-in systems, telephone reminders and prompts, orientation and reminder letters, accelerated intake, preappointment completion of psychodynamic questionnaires, and "other"). Narrative synthesis was used for analysis because the high level of heterogeneity between studies precluded a meta-analysis. The results were mixed for all types of intervention. Some isolated high-quality studies of opt-in systems, orientation and reminder letters, and more novel interventions demonstrated a beneficial effect. CONCLUSIONS The synthesized findings indicated that orientation and reminder letters may have a small beneficial effect. Consistent evidence for the efficacy of other types of common interventions is lacking. More novel interventions, such as asking clients to formulate plans to deal with obstacles to attendance and giving clients a choice of therapist style, showed some promise, but studies require replication.

Understanding the investigators: a qualitative study investigating the barriers and enablers to the implementation of local investigator-initiated clinical trials in Ethiopia

PubMed Central

Franzen, Samuel R P; Chandler, Clare; Enquselassie, Fikre; Siribaddana, Sisira; Atashili, Julius; Angus, Brian; Lang, Trudie

2013-01-01

Objectives Clinical trials provide ‘gold standard’ evidence for policy, but insufficient locally relevant trials are conducted in low-income and middle-income countries. Local investigator-initiated trials could generate highly relevant data for national governments, but information is lacking on how to facilitate them. We aimed to identify barriers and enablers to investigator-initiated trials in Ethiopia to inform and direct capacity strengthening initiatives. Design Exploratory, qualitative study comprising of in-depth interviews (n=7) and focus group discussions (n=3). Setting Fieldwork took place in Ethiopia during March 2011. Participants Local health researchers with previous experiences of clinical trials or stakeholders with an interest in trials were recruited through snowball sampling (n=20). Outcome measures Detailed discussion notes were analysed using thematic coding analysis and key themes were identified. Results All participants perceived investigator-initiated trials as important for generating local evidence. System and organisational barriers included: limited funding allocation, weak regulatory and administrative systems, few learning opportunities, limited human and material capacity and poor incentives for conducting research. Operational hurdles were symptomatic of these barriers. Lack of awareness, confidence and motivation to undertake trials were important individual barriers. Training, knowledge sharing and experience exchange were key enablers to trial conduct and collaboration was unanimously regarded as important for improving capacity. Conclusions Barriers to trial conduct were found at individual, operational, organisational and system levels. These findings indicate that to increase locally led trial conduct in Ethiopia, system wide changes are needed to create a more receptive and enabling research environment. Crucially, the creation of research networks between potential trial groups could provide much needed practical collaborative support through sharing of financial and project management burdens, knowledge and resources. These findings could have important implications for capacity-strengthening initiatives but further research is needed before the results can be generalised more widely. PMID:24285629

Repeat Chlamydia trachomatis testing among heterosexual STI outpatient clinic visitors in the Netherlands: a longitudinal study.

PubMed

Visser, Maartje; van Aar, Fleur; Koedijk, Femke D H; Kampman, Carolina J G; Heijne, Janneke C M

2017-12-20

Chlamydia infections are common in both men and women, are often asymptomatic and can cause serious complications. Repeat testing in high-risk groups is therefore indicated. In the Netherlands, guidelines on repeat chlamydia testing differ between testing facilities, and knowledge on repeat testing behaviour is limited. Here, we analyse the current repeat testing behaviour of heterosexual STI clinic visitors, and aim to identify groups for which repeat testing advice could be advantageous. Longitudinal surveillance data from all Dutch STI outpatient clinics were used, which included all STI clinic consultations carried out among heterosexual men and women between June 2014 and December 2015. Repeat testing was defined as returning to the same STI clinic between 35 days and 12 months after initial consultation. We calculated chlamydia positivity at repeat test stratified by initial test result and time between consultations. Logistic regression analyses were used to identify predictors of repeat testing, and predictors of having a chlamydia positive repeat test. In total, 140,486 consultations in 75,487 women and 46,286 men were available for analyses. Overall, 15.4% of women and 11.1% of men returned to the STI clinic within the study period. Highest chlamydia positivity at repeat test was seen 3-5 months after initial positive test. Among both women and men, repeat testing was associated with non-Western ethnicity, having had more than two sex partners in the past 6 months, reporting STI symptoms, having a history of STI, and having a chlamydia positive initial test. Among repeat testers, chlamydia positive repeat test was most strongly associated with younger age, followed by a chlamydia positive initial test. Repeat testing most often resulted in a positive test result among young heterosexuals (<25) and heterosexuals of any age with a chlamydia infection at the initial consultation. Further efforts are needed to determine optimal repeat testing strategies.

Prevalence of illicit drug use in pregnant women in a Wisconsin private practice setting.

PubMed

Schauberger, Charles W; Newbury, Emily J; Colburn, Jean M; Al-Hamadani, Mohammed

2014-09-01

We sought to measure the prevalence of illicit drug use in our obstetric population, to identify the drugs being used, and to determine whether a modified version of the 4Ps Plus screening tool could serve as an initial screen. In this prospective study, urine samples of 200 unselected patients presenting for initiation of prenatal care in a Wisconsin private practice were analyzed for evidence of the use of illicit drugs. Of 200 patients, 26 (13%) had evidence of drugs of abuse in their urine samples. Marijuana (7%) and opioids (6.5%) were the most commonly identified drugs. Adding 5 questions about drug or alcohol use to the obstetric intake questionnaire proved sensitive in identifying patients with high risks of having a positive drug screen. The rate of drug use in our low-risk population was higher than expected and may reflect increasing rates of drug use across the United States. Enhanced screening should be performed to identify patients using illicit drugs in pregnancy to improve their care. Medical centers and communities may benefit from periodic testing of their community prevalence rates to aid in appropriate care planning. Copyright © 2014 Mosby, Inc. All rights reserved.

Challenges and opportunities of health care supply chain management in the United States.

PubMed

Elmuti, Dean; Khoury, Grace; Omran, Omar; Abou-Zaid, Ahmed S

2013-01-01

This article explores current supply chain management challenges and initiatives and identifies problems that affect supply chain management success in the U.S. health-care industry. In addition, it investigates the impact of health care supply chain management (SCM) initiatives on the overall organizational effectiveness. The attitudinal results, as well as the performance results presented in this study support the claim of health care proponents that the SCM allows organizations to reduce cost, improve quality, and reduce cycle time, and leads to high performance.

Developing a taxonomy for mission architecture definition

NASA Technical Reports Server (NTRS)

Neubek, Deborah J.

1990-01-01

The Lunar and Mars Exploration Program Office (LMEPO) was tasked to define candidate architectures for the Space Exploration Initiative to submit to NASA senior management and an externally constituted Outreach Synthesis Group. A systematic, structured process for developing, characterizing, and describing the alternate mission architectures, and applying this process to future studies was developed. The work was done in two phases: (1) national needs were identified and categorized into objectives achievable by the Space Exploration Initiative; and (2) a program development process was created which both hierarchically and iteratively describes the program planning process.

Epigenetic Transgenerational Actions of Vinclozolin on Promoter Regions of the Sperm Epigenome

PubMed Central

Guerrero-Bosagna, Carlos; Settles, Matthew; Lucker, Ben; Skinner, Michael K.

2010-01-01

Previous observations have demonstrated that embryonic exposure to the endocrine disruptor vinclozolin during gonadal sex determination promotes transgenerational adult onset disease such as male infertility, kidney disease, prostate disease, immune abnormalities and tumor development. The current study investigates genome-wide promoter DNA methylation alterations in the sperm of F3 generation rats whose F0 generation mother was exposed to vinclozolin. A methylated DNA immunoprecipitation with methyl-cytosine antibody followed by a promoter tilling microarray (MeDIP-Chip) procedure was used to identify 52 different regions with statistically significant altered methylation in the sperm promoter epigenome. Mass spectrometry bisulfite analysis was used to map the CpG DNA methylation and 16 differential DNA methylation regions were confirmed, while the remainder could not be analyzed due to bisulfite technical limitations. Analysis of these validated regions identified a consensus DNA sequence (motif) that associated with 75% of the promoters. Interestingly, only 16.8% of a random set of 125 promoters contained this motif. One candidate promoter (Fam111a) was found to be due to a copy number variation (CNV) and not a methylation change, suggesting initial alterations in the germline epigenome may promote genetic abnormalities such as induced CNV in later generations. This study identifies differential DNA methylation sites in promoter regions three generations after the initial exposure and identifies common genome features present in these regions. In addition to primary epimutations, a potential indirect genetic abnormality was identified, and both are postulated to be involved in the epigenetic transgenerational inheritance observed. This study confirms that an environmental agent has the ability to induce epigenetic transgenerational changes in the sperm epigenome. PMID:20927350

Epigenetic transgenerational actions of vinclozolin on promoter regions of the sperm epigenome.

PubMed

Guerrero-Bosagna, Carlos; Settles, Matthew; Lucker, Ben; Skinner, Michael K

2010-09-30

Previous observations have demonstrated that embryonic exposure to the endocrine disruptor vinclozolin during gonadal sex determination promotes transgenerational adult onset disease such as male infertility, kidney disease, prostate disease, immune abnormalities and tumor development. The current study investigates genome-wide promoter DNA methylation alterations in the sperm of F3 generation rats whose F0 generation mother was exposed to vinclozolin. A methylated DNA immunoprecipitation with methyl-cytosine antibody followed by a promoter tilling microarray (MeDIP-Chip) procedure was used to identify 52 different regions with statistically significant altered methylation in the sperm promoter epigenome. Mass spectrometry bisulfite analysis was used to map the CpG DNA methylation and 16 differential DNA methylation regions were confirmed, while the remainder could not be analyzed due to bisulfite technical limitations. Analysis of these validated regions identified a consensus DNA sequence (motif) that associated with 75% of the promoters. Interestingly, only 16.8% of a random set of 125 promoters contained this motif. One candidate promoter (Fam111a) was found to be due to a copy number variation (CNV) and not a methylation change, suggesting initial alterations in the germline epigenome may promote genetic abnormalities such as induced CNV in later generations. This study identifies differential DNA methylation sites in promoter regions three generations after the initial exposure and identifies common genome features present in these regions. In addition to primary epimutations, a potential indirect genetic abnormality was identified, and both are postulated to be involved in the epigenetic transgenerational inheritance observed. This study confirms that an environmental agent has the ability to induce epigenetic transgenerational changes in the sperm epigenome.

A prospective pilot study of genome-wide exome and transcriptome profiling in patients with small cell lung cancer progressing after first-line therapy

PubMed Central

Byron, Sara A.; Aldrich, Jessica; Sangal, Ashish; Barilla, Heather; Kiefer, Jeffrey A.; Carpten, John D.; Craig, David W.; Whitsett, Timothy G.

2017-01-01

Background Small cell lung cancer (SCLC) that has progressed after first-line therapy is an aggressive disease with few effective therapeutic strategies. In this prospective study, we employed next-generation sequencing (NGS) to identify therapeutically actionable alterations to guide treatment for advanced SCLC patients. Methods Twelve patients with SCLC were enrolled after failing platinum-based chemotherapy. Following informed consent, genome-wide exome and RNA-sequencing was performed in a CLIA-certified, CAP-accredited environment. Actionable targets were identified and therapeutic recommendations made from a pharmacopeia of FDA-approved drugs. Clinical response to genomically-guided treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Results The study completed its accrual goal of 12 evaluable patients. The minimum tumor content for successful NGS was 20%, with a median turnaround time from sample collection to genomics-based treatment recommendation of 27 days. At least two clinically actionable targets were identified in each patient, and six patients (50%) received treatment identified by NGS. Two had partial responses by RECIST 1.1 on a clinical trial involving a PD-1 inhibitor + irinotecan (indicated by MLH1 alteration). The remaining patients had clinical deterioration before NGS recommended therapy could be initiated. Conclusions Comprehensive genomic profiling using NGS identified clinically-actionable alterations in SCLC patients who progressed on initial therapy. Recommended PD-1 therapy generated partial responses in two patients. Earlier access to NGS guided therapy, along with improved understanding of those SCLC patients likely to respond to immune-based therapies, should help to extend survival in these cases with poor outcomes. PMID:28586388

Challenges in the Implementation of Green Home Development in Malaysia: Perspective of Developers

NASA Astrophysics Data System (ADS)

Nordin, Rumaizah Mohd; Halim, Ahmad Hafizi Abd; Yunus, Julitta

2017-12-01

The construction industry is the main contributor to Malaysian economic growth. One of the main sectors to be highlighted by the Government is housing sector. The population in Malaysia is increasing year by year, thus the demand for houses also rises significantly. However, the fulfilment of basic needs for people normally gives the adverse impacts to the environment. Green home concept is introduced with a purpose to create an acceptable standard of living as well as to preserve nature from destruction, whilst to promote efficiency of energy, water and other natural resources. The study aims to identify current level of awareness and understanding regarding the Green Home concept, together with identifying the challenges that contribute to lack of initiatives in implementation of green home development. This study utilizes the qualitative methodology utilising interviews with housing developers operating in Klang Valley. 20 respondents were interviewed with a semi-structured interview. This study found that level of awareness and understanding on green home concept among construction players and public is low to moderate level. However, it shows improvement in terms of its implementation with all respondents agreed that cost factor is greatest challenge to its implementation. Other challenges identified from the study are low awareness and understanding among construction players and public, low demand for green home, and lack of Government enforcement and initiatives. The study is eventually intended to enhance and improve the sustainable practice in Malaysian’s construction industry.

Confirming the timing of phase-based costing in oncology studies: a case example in advanced melanoma.

PubMed

Atkins, Michael; Coutinho, Anna D; Nunna, Sasikiran; Gupte-Singh, Komal; Eaddy, Michael

2018-02-01

The utilization of healthcare services and costs among patients with cancer is often estimated by the phase of care: initial, interim, or terminal. Although their durations are often set arbitrarily, we sought to establish data-driven phases of care using joinpoint regression in an advanced melanoma population as a case example. A retrospective claims database study was conducted to assess the costs of advanced melanoma from distant metastasis diagnosis to death during January 2010-September 2014. Joinpoint regression analysis was applied to identify the best-fitting points, where statistically significant changes in the trend of average monthly costs occurred. To identify the initial phase, average monthly costs were modeled from metastasis diagnosis to death; and were modeled backward from death to metastasis diagnosis for the terminal phase. Points of monthly cost trend inflection denoted ending and starting points. The months between represented the interim phase. A total of 1,671 patients with advanced melanoma who died met the eligibility criteria. Initial phase was identified as the 5-month period starting with diagnosis of metastasis, after which there was a sharp, significant decline in monthly cost trend (monthly percent change [MPC] = -13.0%; 95% CI = -16.9% to -8.8%). Terminal phase was defined as the 5-month period before death (MPC = -14.0%; 95% CI = -17.6% to -10.2%). The claims-based algorithm may under-estimate patients due to misclassifications, and may over-estimate terminal phase costs because hospital and emergency visits were used as a death proxy. Also, recently approved therapies were not included, which may under-estimate advanced melanoma costs. In this advanced melanoma population, optimal duration of the initial and terminal phases of care was 5 months immediately after diagnosis of metastasis and before death, respectively. Joinpoint regression can be used to provide data-supported phase of cancer care durations, but should be combined with clinical judgement.

Interprofessional Care and Teamwork in the ICU.

PubMed

Donovan, Anne L; Aldrich, J Matthew; Gross, A Kendall; Barchas, Denise M; Thornton, Kevin C; Schell-Chaple, Hildy M; Gropper, Michael A; Lipshutz, Angela K M

2018-06-01

We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. Original articles, review articles, and systematic reviews were considered. Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.

Children's Well-Being in Day Care Centres: An Exploratory Empirical Study.

ERIC Educational Resources Information Center

Mayr, Toni; Ulich, Michaela

1999-01-01

Used educators' ratings to describe preschool children's well-being in day care centers. Identified 11 independent dimensions of well-being: empathic, prosocial behavior; social initiative and vitality; self-assertiveness, openness; pleasure in exploring; coping with stress; positive self-defense; pleasure in sensory experiences;…