A Qualitative Study of Psychosocial Problems among Parents of Children with Cerebral Palsy Attending Two Tertiary Care Hospitals in Western India

PubMed Central

Panchal, Dhara Antani

2014-01-01

Objective. To explore the psychosocial problems faced by the parents of children with cerebral palsy (CP) in rural and urban settings. Design. Qualitative research design using focus group discussions (FGDs) was used for the study. Setting. Two FGDs comprising one at a rural tertiary level care hospital and the other at an urban tertiary level care hospital were conducted. Participants. A total of thirteen parents participated in the two FGDs. Main Outcome Measured. Psychosocial problems experienced by the parents of children suffering from CP were measured. Results. The problems experienced by the mothers were associated with common themes such as disturbed social relationships, health problems, financial problems, moments of happiness, worries about future of the child, need for more support services, and lack of adequate number of trained physiotherapists. All the parents had children with problems since birth and most had approached various health care providers for a cure for their child. Conclusions. A wide range of psychosocial problems are experienced by the parents of children with CP. Studies like this can provide valuable information for designing a family centered care programme for children with CP. PMID:24967331

Mental health consumers' with medical co‐morbidity experience of the transition through tertiary medical services to primary care

PubMed Central

Cranwell, Kate; Polacsek, Meg

2016-01-01

Abstract Medical comorbidity in people with long‐term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health‐care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video‐recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers’ experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments. PMID:26735771

Integrated use of remotely sensed imagery and other data sets to infer the tectonics, structural style, and hydrocarbon habitats of the basins of the Tien Shan orogenic belt, Western China: A case study

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

Berry, J.L.; Nishidai, T.

1996-08-01

Remotely sensed imagery and various other published regional data sets (gravity, magnetics, earthquake data) were integrated in order to interpret the structural style, both at deep crustal levels and at the relatively shallow levels of interest to explorationists, of the Tien Shan. Cross-sections through the range were systematically prepared, and then palinspastically restored, constrained by the remote sensing interpretation, potential fields data, and published microplate movement vectors. Since large portions of the area are covered by late Tertiary orogenic sediments, the resulting interpretation focused on these areas, and what and how much geology lies concealed beneath them. We were ablemore » to demonstrate the likely consumption in the late Tertiary of over 100 km of Tarim Basin west along a broad front south of the Tien Shan, as well as within the Kuruktag area, where basins are compressional rather than extensional. There are also local areas of extension within the orogenic zone, and these can be explained using the known microplate boundaries, backward extrapolation of present microplate motions, and the type and extent of late Tertiary deformation within the plates as constraints. Relative and absolute microplate motions have to change greatly through Tertiary time in order to comply with these constraints. The results of this work allow one to infer the affinities, and hence something of the hydrocarbon potential, of fragmentary plates by reconstructing their motions. They also allow one to infer the nature of the stratigraphy, the likely depth of burial, and something of the maturation history of pre-Tertiary rocks buried by Tertiary sediments deposited in both compressional and extensional regimes.« less

Educational Marketing: A Review and Implications for Supporting Practice in Tertiary Education

ERIC Educational Resources Information Center

Stachowski, Christopher Allen

2011-01-01

This article reviews the existing educational marketing literature in the leading tertiary educational management journals. A discussion of the implications for supporting practitioners in non-university settings is presented. (Contains 1 table.)

Efficacy of sequential three-step empirical therapy for chronic cough.

PubMed

Yu, Li; Xu, Xianghuai; Hang, Jingqing; Cheng, Kewen; Jin, Xiaoyan; Chen, Qiang; Lv, Hanjing; Qiu, Zhongmin

2017-06-01

Empirical three-step therapy has been proved in just one hospital. This study aimed to demonstrate applicability of the sequential empirical three-step therapy for chronic cough in different clinical settings. Sequential empirical three-step therapy was given to patients with chronic cough in one tertiary and three secondary care respiratory clinics. Recruiters were initially treated with methoxyphenamine compound as the first-step therapy, followed by corticosteroids as the second-step therapy and the combination of a proton-pump inhibitor and a prokinetic agent as the third-step therapy. The efficacy of the therapy was verified according to the changes in cough symptom score between pre- and post-treatment, and compared among the different clinics. In total 155 patients in one tertiary clinic and 193 patients in secondary care clinics were recruited. The total dropout ratio is significantly higher in the secondary care clinics than that in the tertiary clinic (9.3% versus 3.2%, p = 0.023). The therapeutic success rate for cough was 38.7% at first-step therapy, 32.3% at second-step therapy and 20.0% at third-step therapy in the tertiary clinic, and comparable to corresponding 49.7%, 31.1% and 4.1% in secondary care clinics. Furthermore, the overall cough resolution rate was not significantly different (91.0% versus 85.0%, p = 0.091). However, the efficacy of the third-step therapy is much higher (20.0% versus 4.1%, p = 0.001) in the tertiary clinic than in the secondary care clinics. Sequential empirical three-step therapy is universally efficacious and useful for management of chronic cough in different clinical settings.

Tertiary paediatric hospital health professionals' attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children.

PubMed

Nicol, Pam; Chapman, Rose; Watkins, Rochelle; Young, Jeanine; Shields, Linda

2013-12-01

To ascertain health professionals' knowledge, attitudes and beliefs towards lesbian, gay, bisexual and transgender parents seeking health care for their children in a paediatric tertiary hospital setting which practises family-centred care. Lesbian, gay, bisexual and transgender parents are often reluctant to disclose their sexual orientation to health professionals for fear of discrimination and compromised quality of care. Staff knowledge, attitudes and beliefs can influence disclosure by parents, but little is known about knowledge, attitudes and beliefs in paediatric tertiary hospital staff towards lesbian, gay, bisexual and transgender parents accessing care for their children. Descriptive comparative study of health staff using a cross-sectional survey. A set of validated anonymous questionnaires was used to assess knowledge about homosexuality, attitudes towards lesbians and gay men, and gay affirmative practice. Three open-ended questions were also used to assess beliefs about encouraging disclosure of lesbian, gay, bisexual and transgender parenting roles and how this may impact on care. Of the 646 staff surveyed, 212 (32.8%) responded. Knowledge and attitudes were significantly associated with professional group, gender, Caucasian race, political voting behaviour, presence of religious beliefs, the frequency of attendance at religious services, the frequency of praying, and having a friend who was openly lesbian, gay, bisexual and transgender. This study highlighted that staff working in a tertiary paediatric hospital setting, with family-centred care models in place, held attitudes and beliefs that may impact on the experience of hospitalisation for lesbian, gay, bisexual and transgender parents, and the quality of care received by their children. To promote equitable care to all families, organisations should ensure that family-centred care policies and guidelines are adopted and appropriately implemented. In addition to formal education, affirmative health service action and innovative methods may be required. © 2013 John Wiley & Sons Ltd.

[Decomposition model of energy-related carbon emissions in tertiary industry for China].

PubMed

Lu, Yuan-Qing; Shi, Jun

2012-07-01

Tertiary industry has been developed in recent years. And it is very important to find the factors influenced the energy-related carbon emissions in tertiary industry. A decomposition model of energy-related carbon emissions for China is set up by adopting logarithmic mean weight Divisia method based on the identity of carbon emissions. The model is adopted to analyze the influence of energy structure, energy efficiency, tertiary industry structure and economic output to energy-related carbon emissions in China from 2000 to 2009. Results show that the contribution rate of economic output and energy structure to energy-related carbon emissions increases year by year. Either is the contribution rate of energy efficiency or the tertiary industry restraining to energy-related carbon emissions. However, the restrain effect is weakening.

Predictive Role of Personality Traits on Internet Addiction

ERIC Educational Resources Information Center

Celik, Serkan; Atak, Hasan; Basal, Ahmet

2012-01-01

Aiming to develop a model seeking to investigate the direct effects of personality types on internet addiction, this study was set and tested on tertiary level students receiving education within two learning modes: face to face and distance education. The participants of the study, selected through maximum variety method within purposive…

Six-month outcome in patients with myocardial infarction initially admitted to tertiary and nontertiary hospitals. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.

PubMed

Marrugat, J; Sanz, G; Masiá, R; Valle, V; Molina, L; Cardona, M; Sala, J; Serés, L; Szescielinski, L; Albert, X; Lupón, J; Alonso, J

1997-11-01

The aim of the present study was to ascertain whether the degree of accessibility to coronary angiography and revascularization results in differing usages or outcomes, or both, in the setting of a high coverage national health system. The selective use of coronary angiography and revascularization procedures in the management of acute myocardial infarction (MI) remains controversial. A cohort of 1,460 consecutive patients with a first MI admitted to four referral teaching hospitals (one with tertiary facilities) were followed up for 6 months after admission. Only patients initially admitted to each of the study hospitals were retained for analysis in the original hospital's cohort. End points were 6-month mortality and readmission for reinfarction, unstable angina, heart failure or severe ventricular arrhythmia. Patients admitted to the tertiary hospital were more likely to undergo coronary angiography (adjusted relative risk 4.22, 95% confidence interval [CI] 3.37 to 5.45) than those admitted to the nontertiary sites (use rate: 22.1% for nontertiary care, 55.5% for tertiary care). Revascularization procedures were performed in 21.2% of patients in the tertiary hospital and in 8.3% in the nontertiary hospitals (p < 0.0001). Median delay for emergency coronary angiography was shorter in the tertiary hospital (within 1 vs. 2 days, p < 0.0001). Six-month mortality or readmission rates were similar (23.7% and 24.7% for tertiary and nontertiary care, respectively). After adjustment for comorbidity and disease severity, the relative risk of death or readmission for the tertiary hospital was 1.03 (95% CI 0.69 to 1.53) times that of the nontertiary hospitals. Selective use of coronary angiography and revascularization procedures may be as effective as less restricted use in the management of acute MI.

Predicting Acceptance of Mobile Technology for Aiding Student-Lecturer Interactions: An Empirical Study

ERIC Educational Resources Information Center

Gan, Chin Lay; Balakrishnan, Vimala

2017-01-01

The current study sets out to identify determinants affecting tertiary students' behavioural intentions to use mobile technology in lectures. The study emphasises that the reason for using mobile technology in classrooms with large numbers of students is to facilitate interactions among students and lecturers. The proposed conceptual framework has…

Profiles of Opportunities to Learn for TEDS-M Future Secondary Mathematics Teachers

ERIC Educational Resources Information Center

Wang, Ting-Ying; Tang, Shu-Jyh

2013-01-01

This study used the data set from the Teacher Education and Development Study in Mathematics to identify the profiles of opportunities to learn (OTL) regarding topics studied in teacher preparation programs by future secondary mathematics teachers from 15 participating countries. The topics of inquiry covered tertiary-level mathematics,…

Occupational Exposure to Infection: A study on Healthcare Waste Handlers of a Tertiary Care Hospital in South India.

PubMed

Shivalli, Siddharudha; Sowmyashree, H

2015-11-01

Occupational exposure to infection is an important public health concern. Such accidents are associated with a few, but pose significant risk to worker's health, family and the community. 1) To assess the knowledge and attitude of waste handlers regarding healthcare waste management in tertiary care hospital of Mangalore. 2) To assess the occupational risk of exposure to infection in their work setting. A cross-sectional study was conducted among healthcare waste handlers (involved in collection, storage and safe disposal) in a tertiary care hospital of Mangalore, India. A semi-structured and pre-tested proforma was used to assess respondents' knowledge and percentage score was calculated based on a scoring system. Chi square and independent sample t tests were applied to judge the association of study variables with knowledge and occupational risk of infection. A total of 43 healthcare waste handlers participated in the study and all were females. Almost half of them had poor knowledge (< 50% score) about healthcare waste management. As much as 41.8% of them had exposure to healthcare waste and 'needle stick injury' was the most common type. Age, literacy and experience did not significantly (p>0.05) influence the knowledge and occupational risk of infection. Respondents' knowledge regarding healthcare waste management was unsatisfactory. They were at high risk of occupational exposure to infection. It emphasizes the need of refresher training and reinforcement of personal protection measures in their work setting. © Journal of the Association of Physicians of India 2011.

A case study of pedagogy of mathematics support tutors without a background in mathematics education

NASA Astrophysics Data System (ADS)

Walsh, Richard

2017-01-01

This study investigates the pedagogical skills and knowledge of three tertiary-level mathematics support tutors in a large group classroom setting. This is achieved through the use of video analysis and a theoretical framework comprising Rowland's Knowledge Quartet and general pedagogical knowledge. The study reports on the findings in relation to these tutors' provision of mathematics support to first and second year undergraduate engineering students and second year undergraduate science students. It was found that tutors are lacking in various pedagogical skills which are needed for high-quality learning amongst service mathematics students (e.g. engineering/science/technology students), a demographic which have low levels of mathematics upon entering university. Tutors teach their support classes in a very fast didactic way with minimal opportunities for students to ask questions or to attempt problems. It was also found that this teaching method is even more so exaggerated in mandatory departmental mathematics tutorials that students take as part of their mathematics studies at tertiary level. The implications of the findings on mathematics tutor training at tertiary level are also discussed.

Student Learning Approaches in the UAE: The Case for the Achieving Domain

ERIC Educational Resources Information Center

McLaughlin, James; Durrant, Philip

2017-01-01

The deep versus surface learning approach dichotomy has dominated recent research in student learning approach dimensions. However, the achievement dimension may differ in importance in non-Western and vocational tertiary settings. The aim was to assess how Emirati tertiary students could be characterized in terms of their learning approaches. The…

Tertiary Excess of Fibroblast Growth Factor 23 and Hypophosphatemia Following Kidney Transplantation

PubMed Central

Seeherunvong, Wacharee; Wolf, Myles

2010-01-01

Hypophosphatemia due to inappropriate urinary phosphate wasting is a frequent metabolic complication of the early period following kidney transplantation. Although previously considered to be caused by tertiary hyperparathyroidism, recent evidence suggests a primary role for persistently elevated circulating levels of the phosphorus-regulating hormone, fibroblast growth factors 23 (FGF23). In the setting of a healthy renal allograft, markedly increased FGF23 levels from the dialysis period induce renal phosphate wasting and inhibition of calcitriol production, which contribute to hypophosphatemia. While such tertiary FGF23 excess and resultant hypophosphatemia typically abates within the first few weeks to months post-transplant, some recipients manifest persistent renal phosphate wasting. Furthermore, increased FGF23 levels have been associated with increased risk of kidney disease progression, cardiovascular disease and death outside of the transplant setting. Whether tertiary FGF23 excess is associated with adverse transplant outcomes is unknown. In this article, we review the physiology of FGF23, summarize its relationship with hypophosphatemia after kidney transplantation, and speculate on its potential impact on long term outcomes of renal allograft recipients. PMID:20946192

Endosymbiotic gene transfer in tertiary plastid-containing dinoflagellates.

PubMed

Burki, Fabien; Imanian, Behzad; Hehenberger, Elisabeth; Hirakawa, Yoshihisa; Maruyama, Shinichiro; Keeling, Patrick J

2014-02-01

Plastid establishment involves the transfer of endosymbiotic genes to the host nucleus, a process known as endosymbiotic gene transfer (EGT). Large amounts of EGT have been shown in several photosynthetic lineages but also in present-day plastid-lacking organisms, supporting the notion that endosymbiotic genes leave a substantial genetic footprint in the host nucleus. Yet the extent of this genetic relocation remains debated, largely because the long period that has passed since most plastids originated has erased many of the clues to how this process unfolded. Among the dinoflagellates, however, the ancestral peridinin-containing plastid has been replaced by tertiary plastids on several more recent occasions, giving us a less ancient window to examine plastid origins. In this study, we evaluated the endosymbiotic contribution to the host genome in two dinoflagellate lineages with tertiary plastids. We generated the first nuclear transcriptome data sets for the "dinotoms," which harbor diatom-derived plastids, and analyzed these data in combination with the available transcriptomes for kareniaceans, which harbor haptophyte-derived plastids. We found low level of detectable EGT in both dinoflagellate lineages, with only 9 genes and 90 genes of possible tertiary endosymbiotic origin in dinotoms and kareniaceans, respectively, suggesting that tertiary endosymbioses did not heavily impact the host dinoflagellate genomes.

Systematic analysis of mutation distribution in three dimensional protein structures identifies cancer driver genes.

PubMed

Fujimoto, Akihiro; Okada, Yukinori; Boroevich, Keith A; Tsunoda, Tatsuhiko; Taniguchi, Hiroaki; Nakagawa, Hidewaki

2016-05-26

Protein tertiary structure determines molecular function, interaction, and stability of the protein, therefore distribution of mutation in the tertiary structure can facilitate the identification of new driver genes in cancer. To analyze mutation distribution in protein tertiary structures, we applied a novel three dimensional permutation test to the mutation positions. We analyzed somatic mutation datasets of 21 types of cancers obtained from exome sequencing conducted by the TCGA project. Of the 3,622 genes that had ≥3 mutations in the regions with tertiary structure data, 106 genes showed significant skew in mutation distribution. Known tumor suppressors and oncogenes were significantly enriched in these identified cancer gene sets. Physical distances between mutations in known oncogenes were significantly smaller than those of tumor suppressors. Twenty-three genes were detected in multiple cancers. Candidate genes with significant skew of the 3D mutation distribution included kinases (MAPK1, EPHA5, ERBB3, and ERBB4), an apoptosis related gene (APP), an RNA splicing factor (SF1), a miRNA processing factor (DICER1), an E3 ubiquitin ligase (CUL1) and transcription factors (KLF5 and EEF1B2). Our study suggests that systematic analysis of mutation distribution in the tertiary protein structure can help identify cancer driver genes.

Systematic analysis of mutation distribution in three dimensional protein structures identifies cancer driver genes

PubMed Central

Fujimoto, Akihiro; Okada, Yukinori; Boroevich, Keith A.; Tsunoda, Tatsuhiko; Taniguchi, Hiroaki; Nakagawa, Hidewaki

2016-01-01

Protein tertiary structure determines molecular function, interaction, and stability of the protein, therefore distribution of mutation in the tertiary structure can facilitate the identification of new driver genes in cancer. To analyze mutation distribution in protein tertiary structures, we applied a novel three dimensional permutation test to the mutation positions. We analyzed somatic mutation datasets of 21 types of cancers obtained from exome sequencing conducted by the TCGA project. Of the 3,622 genes that had ≥3 mutations in the regions with tertiary structure data, 106 genes showed significant skew in mutation distribution. Known tumor suppressors and oncogenes were significantly enriched in these identified cancer gene sets. Physical distances between mutations in known oncogenes were significantly smaller than those of tumor suppressors. Twenty-three genes were detected in multiple cancers. Candidate genes with significant skew of the 3D mutation distribution included kinases (MAPK1, EPHA5, ERBB3, and ERBB4), an apoptosis related gene (APP), an RNA splicing factor (SF1), a miRNA processing factor (DICER1), an E3 ubiquitin ligase (CUL1) and transcription factors (KLF5 and EEF1B2). Our study suggests that systematic analysis of mutation distribution in the tertiary protein structure can help identify cancer driver genes. PMID:27225414

The Current State of Sustainability in Bioscience Laboratories: A Statistical Examination of a UK Tertiary Institute

ERIC Educational Resources Information Center

Wright, Hazel A.; Ironside, Joseph E.; Gwynn-Jones, Dylan

2008-01-01

Purpose: This study aims to identify the current barriers to sustainability in the bioscience laboratory setting and to determine which mechanisms are likely to increase sustainable behaviours in this specialised environment. Design/methodology/approach: The study gathers qualitative data from a sample of laboratory researchers presently…

A Case Study of Pedagogy of Mathematics Support Tutors without a Background in Mathematics Education

ERIC Educational Resources Information Center

Walsh, Richard

2017-01-01

This study investigates the pedagogical skills and knowledge of three tertiary-level mathematics support tutors in a large group classroom setting. This is achieved through the use of video analysis and a theoretical framework comprising Rowland's Knowledge Quartet and general pedagogical knowledge. The study reports on the findings in relation to…

Prevalence, Causes and Effects of Bullying in Tertiary Institutions in Cross River State, Nigeria

ERIC Educational Resources Information Center

Ada, Mary Juliana; Okoli, Georgina; Obeten, Okoi Okorn; Akeke, M. N. G.

2016-01-01

This research is an evaluation of the impact of causes, consequences and effects of bullying in academic setting on student academic performance in tertiary institutions in Cross River State, Nigeria. The research made use of purposive and random sampling techniques made up of 302 students. Questionnaire served as the data collection instrument.…

Co-Construction of Knowledge in Tertiary Online Settings: An Ecology of Resources Perspective

ERIC Educational Resources Information Center

Westberry, Nicola; Franken, Margaret

2013-01-01

Tertiary education has seen a shift toward pedagogies that make use of social interaction. As part of the shift, teachers have considered re-framing their role in the teaching process, and giving more attention to ways in which knowledge construction amongst students can be supported. While many online technologies are well positioned to support…

Direct Enrollments at Twenty-two Colleges and Universities Test Society's Confidence

ERIC Educational Resources Information Center

Chunlin, Yuan

2005-01-01

This article examines the direct admission process and the selection criteria set by the tertiary institutions in China. As the name suggests, "direct admissions" means that it is up to the institution to decide which students to enroll. Tertiary institutions also have the right to decide the number of admissions, and not all schools are…

Reducing inpatient heritable thrombophilia testing using a clinical decision-making tool.

PubMed

Smith, Tyler W; Pi, David; Hudoba, Monika; Lee, Agnes Y Y

2014-04-01

To evaluate the impact of a clinical decision-making tool, designed to educate physicians regarding heritable thrombophilia (HT) testing, on the volume of testing in hospitalised patients in the tertiary care setting. We performed a retrospective cohort study over a 6-year period (2007-2012) at a single tertiary care centre intervention site and two regional control sites. In January 2010, the intervention site instituted a policy change whereby physicians ordering HT testing on inpatients needed to complete a pre-preprinted order (PPO) form that outlined the limitations of HT testing in the hospitalised setting. Failure to complete the PPO within 24 h resulted in test cancellation. Our main outcome measure was the volume of HT testing performed at the three study sites. Introduction of the PPO resulted in a 79.4% (95% CI 71.2% to 87.6%) reduction in factor V Leiden (FVL) testing at the intervention site. This decrease was significantly greater compared with those in the two control teaching hospitals over the same time periods (33.7% and 43.6%; both p<0.001). Reductions in FVL testing postintervention were observed among all ordering specialists. Similar postintervention reductions in testing volumes were observed for antithrombin (57.4%), protein C (61.9%) and protein S (62.2%) activity assays. In a large tertiary care hospital, the introduction of a clinical decision-making tool significantly reduced HT testing in inpatients across clinical specialties. The impact on patient outcome should be assessed in further studies.

Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre.

PubMed

Baltatzis, Minas; Mason, J M; Chandrabalan, Vishnu; Stathakis, Panagiotis; McIntyre, Ben; Jegatheeswaran, Santhalingam; Jamdar, Saurabh; O'Reilly, Derek A; Siriwardena, Ajith K

Intravenous antibiotic prophylaxis is not recommended in acute pancreatitis. According to current international guidelines antibiotics together with further intervention should be considered in the setting of infected necrosis. Appropriate antibiotic therapy particularly avoiding over-prescription is important. This study examines antibiotic use in acute pancreatitis in a tertiary centre using the current IAP/APA guidelines for reference. Data were collected on a consecutive series of patients admitted with acute pancreatitis over a 12 month period. Data were dichotomized by patients admitted directly to the centre and tertiary transfers. Information was collected on clinical course with specific reference to antibiotic use, episode severity, intervention and outcome. 111 consecutive episodes of acute pancreatitis constitute the reported population. 31 (28%) were tertiary transfers. Overall 65 (58.5%) patients received antibiotics. Significantly more tertiary transfer patients received antibiotics. Mean person-days of antibiotic use was 23.9 (sd 29.7) days in the overall study group but there was significantly more use in the tertiary transfer group as compared to patients having their index admission to the centre (40.9 sd 37.1 vs 10.2 sd 8.9; P < 0.005). Thirty four (44%) of patients with clinically mild acute pancreatitis received antibiotics. There is substantial use of antibiotics in acute pancreatitis, in particular in patients with severe disease. Over-use is seen in mild acute pancreatitis. Better consideration must be given to identification of prophylaxis or therapy as indication. In relation to repeated courses of antibiotics in severe disease there must be clear indications for use. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

The Antecedents of Organizational Commitment: The Case of Australian Casual Academics

ERIC Educational Resources Information Center

Joiner, Therese A.; Bakalis, Steve

2006-01-01

Purpose: Despite the increasing attention of organizational commitment in the management literature, most studies predominantly focus on full-time workers in traditional work settings. This paper examined the antecedents of organizational commitment among casual academics working in the tertiary education sector in Australia.…

Tertiary paediatric emergency department use in children and young people with cerebral palsy.

PubMed

Meehan, Elaine; Reid, Susan M; Williams, Katrina; Freed, Gary L; Babl, Franz E; Sewell, Jillian R; Rawicki, Barry; Reddihough, Dinah S

2015-10-01

The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Experiences of Intellectually Gifted Students in an Egalitarian and Inclusive Educational System: A Survey Study

ERIC Educational Resources Information Center

Persson, Roland S.

2010-01-01

A study was launched in an educational setting where giftedness is not officially recognized o explore intellectually gifted students' experience of family background and support, their age and means of identification, the degree of support received in school, and the understanding they experienced from a primary to a tertiary education level. In…

Teachers Matter: Expectancy Effects in Chinese University English-as-a-Foreign-Language Classrooms

ERIC Educational Resources Information Center

Li, Zheng; Rubie-Davies, Christine Margaret

2017-01-01

This study was designed to investigate teacher expectation effects for intact student groups (rather than individuals) in tertiary settings, which have been little studied in the literature. The participants were 50 teachers and their 4617 first-year undergraduate students learning English as a foreign language at two universities in China.…

Comparative Studies on the Roles of Linguistic Knowledge and Sentence Processing Speed in L2 Listening and Reading Comprehension in an EFL Tertiary Setting

ERIC Educational Resources Information Center

Oh, Eunjou

2016-01-01

The present study investigated the relative contributions of vocabulary knowledge, grammar knowledge, and processing speed to second language listening and reading comprehension. Seventy-five Korean university students participated in the study. Results showed the three tested components had a significant portion of shared variance in explaining…

Chinese Students' Perception of Out-of-Class Groupwork in Australia

ERIC Educational Resources Information Center

Li, Dongmei; Remedios, Louisa; Clarke, David

2010-01-01

Despite increasing number of mainland Chinese students studying in western tertiary settings, there is limited information available on their learning experiences and responses to popular educational practices in these contexts. There is an assumption in the literature that Chinese students respond well to the collaborative demands of groupwork…

Calculus Students' and Instructors' Conceptualizations of Slope: A Comparison across Academic Levels

ERIC Educational Resources Information Center

Nagle, Courtney; Moore-Russo, Deborah; Viglietti, Janine; Martin, Kristi

2013-01-01

This study considers tertiary calculus students' and instructors' conceptualizations of slope. Qualitative techniques were employed to classify responses to 5 items using conceptualizations of slope identified across various research settings. Students' responses suggest that they rely on procedurally based conceptualizations of…

Implementing a Batterer's Intervention Program in a Correctional Setting: A Tertiary Prevention Model

ERIC Educational Resources Information Center

Yorke, Nada J.; Friedman, Bruce D.; Hurt, Pat

2010-01-01

This study discusses the pretest and posttest results of a batterer's intervention program (BIP) implemented within a California state prison substance abuse program (SAP), with a recommendation for further programs to be implemented within correctional institutions. The efficacy of utilizing correctional facilities to reach offenders who…

Coordinated, Collaborative and Coherent: Developing and Implementing E-Learning Guidelines within a National Tertiary Education System

ERIC Educational Resources Information Center

Suddaby, Gordon; Milne, John

2008-01-01

Purpose: The paper aims to discusses two complementary initiatives focussed on developing and implementing e-learning guidelines to support good pedagogy in e-learning practice. Design/methodology/approach: The first initiative is the development of a coherent set of open access e-learning guidelines for the New Zealand tertiary sector. The second…

Developing a core outcome set for infant colic for primary, secondary and tertiary care settings: a prospective study.

PubMed

Steutel, Nina F; Benninga, Marc A; Langendam, Miranda W; Korterink, Judith J; Indrio, Flavia; Szajewska, Hania; Tabbers, Merit M

2017-05-29

Infant colic (IC) is defined as recurrent and prolonged crying without an obvious cause or evidence of failure to thrive or illness. It is a common problem with a prevalence of 5%-25%. The unknown aetiology results in a wide variety in interventions and use of heterogeneous outcome measures across therapeutic trials. Our aim was to develop a core outcome set (COS) for IC to facilitate and improve evidence synthesis. Prospective study design; primary, secondary and tertiary care. The COS was developed using a modified Delphi technique. First, healthcare professionals (HCPs) and parents of infants with IC were asked to list up to five outcomes they considered relevant in the treatment of IC. Outcomes mentioned by >10% of participants were forwarded to a shortlist. In the second round, outcomes on this shortlist were rated and prioritised. The final COS was defined in a face-to-face expert meeting of paediatricians. F of invited stakeholders (133 HCPs and 55 parents of infants with IC) completed both Delphi rounds. Duration of crying, family stress, sleeping time of infant, quality of life (of family), discomfort of infant and hospital admission/duration were rated as most important outcomes in IC, framing the final COS. The use of this COS should serve as a minimum of outcomes to be measured and reported. This will benefit evidence synthesis, by enhancing homogeneity of outcomes, and enable evaluation of success in therapeutic trials on IC. Researchers are strongly encouraged to use this COS when setting up a clinical trial in primary, secondary and/or tertiary care or performing a systematic review on IC. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Progression of major depression during pregnancy and postpartum: a preliminary study.

PubMed

Shivakumar, Geetha; Johnson, Neysa L; McIntire, Donald D; Leveno, Kenneth

2014-04-01

The purpose of this pilot study was to investigate major depressive symptoms among a high-risk group of pregnant women managed at a tertiary care setting. The study prospectively evaluated pregnant women who met DSM-IV criteria for a major depressive episode (MDE). Psychiatric measures for depression, anxiety and social impairment were administered at monthly intervals during pregnancy and immediate postpartum period. Twenty-four women provided longitudinal data from mid pregnancy to 2 months of postpartum period. 86% of women were clinically symptomatic at the beginning of study during pregnancy and only 32% remained clinically symptomatic at 2 months following delivery reaching. This difference reached a statistical significance level p < 0.001. Pregnant women with prior histories of major depression, comorbid anxiety disorder, histories of domestic violence, and those with uninvolved spouse or partners were more at-risk to be clinically symptomatic in the immediate postpartum period. In a group consisting of largely Latina women at a tertiary care setting, progression of major depression when treated with antidepressant medication(s) is that of an improvement from pregnancy to immediate postpartum period. Further longitudinal studies are needed to assess impact of clinical characteristics and treatment on major depression in larger diverse obstetric group.

Rocky Mountain Tertiary coal-basin models and their applicability to some world basins

USGS Publications Warehouse

Flores, R.M.

1989-01-01

Tertiary intermontane basins in the Rocky Mountain region of the United States contain large amounts of coal resources. The first major type of Tertiary coal basin is closed and lake-dominated, either mud-rich (e.g., North Park Basin, Colorado) or mud plus carbonate (e.g., Medicine Lodge Basin, Montana), which are both infilled by deltas. The second major type of Tertiary coal basin is open and characterized by a preponderance of sediments that were deposited by flow-through fluvial systems (e.g., Raton Basin, Colorado and New Mexico, and Powder River Basin, Wyoming and Montana). The setting for the formation of these coals varies with the type of basin sedimentation, paleotectonism, and paleoclimate. The mud-rich lake-dominated closed basin (transpressional paleotectonism and warm, humid paleoclimate), where infilled by sandy "Gilbert-type" deltas, contains thick coals (low ash and low sulfur) formed in swamps of the prograding fluvial systems. The mud- and carbonate-rich lake-dominated closed basin is infilled by carbonate precipitates plus coarse-grained fan deltas and fine-grained deltas. Here, thin coals (high ash and high sulfur) formed in swamps of the fine-grained deltas. The coarse-clastic, open basins (compressional paleotectonism and warm, paratropical paleoclimate) associated with flow-through fluvial systems contain moderately to anomalously thick coals (high to low ash and low sulfur) formed in swamps developed in intermittently abandoned portions of the fluvial systems. These coal development patterns from the Tertiary Rocky Mountain basins, although occurring in completely different paleotectonic settings, are similar to that found in the Tertiary, Cretaceous, and Permian intermontane coal basins in China, New Zealand, and India. ?? 1989.

The Local "War for Talent"--Recruitment of Recent Tertiary Education Graduates from a Regional Perspective: Some Evidence from the German Case

ERIC Educational Resources Information Center

Winterhager, Nicolas; Krücken, Georg

2015-01-01

We analyse recruitment of recent tertiary education graduates drawing on a rich set of interviews with human resource managers of 46 large- and medium-sized firms in different regions across Germany. Specifically, we address the question of which higher education institutions' managers choose for campus recruiting and which criteria managers use…

Employing the EPEC Hierarchy of Conditions (Version II) to Evaluate the Effectiveness of Using Synchronous Technologies with Multi-Location Student Cohorts in the Tertiary Education Setting

ERIC Educational Resources Information Center

Eady, Michelle J.; Woodcock, Stuart; Sisco, Ashley

2017-01-01

As e-learning maintains its popularity worldwide, and university enrolments continue to rise, online tertiary level coursework is increasingly being designed for groups of distributed learners, as opposed to individual students. Many institutions struggle with incorporating all facets of online learning and teaching capabilities with the range and…

Determinants of career satisfaction among pediatric hospitalists: a qualitative exploration

PubMed Central

Leyenaar, JoAnna K.; Capra, Lisa A.; O'Brien, Emily R.; Leslie, Laurel K.; Mackie, Thomas I.

2014-01-01

Objectives To characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings, and to develop a framework to conceptualize factors influencing career satisfaction. Methods Semi-structured interviews were conducted with community and tertiary care hospitalists, using purposeful sampling to attain maximum response diversity. We employed close- and open-ended questions to assess levels of career satisfaction and its determinants. Interviews were conducted by telephone, recorded, and transcribed verbatim. Emergent themes were identified and analyzed using an inductive approach to qualitative analysis. Results A total of 30 interviews were conducted with community and tertiary care hospitalists, representing 20 hospital medicine programs and 7 Northeastern states. Qualitative analysis yielded 657 excerpts which were coded and categorized into four domains and associated determinants of career satisfaction: (i) professional responsibilities; (ii) hospital medicine program administration; (iii) hospital and healthcare systems; and (iv) career development. While community and tertiary care hospitalists reported similar levels of career satisfaction, they expressed variation in perspectives across these four domains. While the role of hospital medicine program administration was consistently emphasized by all hospitalists, community hospitalists prioritized resource availability, work schedule and clinical responsibilities while tertiary care hospitalists prioritized diversity in non-clinical responsibilities and career development. Conclusions We illustrate how hospitalists in different organizational settings prioritize both consistent and unique determinants of career satisfaction. Given associations between physician satisfaction and healthcare quality, efforts to optimize modifiable factors within this framework, at both community and tertiary care hospitals, may have broad impacts. PMID:24976348

Exploring the Oral Communication Strategies Used by Turkish EFL Learners: A Mixed Methods Study

ERIC Educational Resources Information Center

Demir, Yusuf; Mutlu, Gülçin; Sisman, Yavuz Selim

2018-01-01

This study set out with a threefold purpose: to examine (1) the oral communication strategies (CSs) employed by tertiary-level Turkish EFL learners, (2) the use of CSs based on exposure to English through audio-visual tools, university subject domain and gender differences, (3) the correlation between use of CSs and oral proficiency scores. To…

Outcomes of antiretroviral therapy in a northern Indian urban clinic

PubMed Central

Dhooria, Sahajal; Prasad, KT; George, Ninoo; Ranjan, Sanjay; Gupta, Deepak; Sreenivas, Vishnubhatla; Kadhiravan, Tamilarasu; Miglani, Sunita; Sinha, Sanjeev; Wig, Naveet; Biswas, Ashutosh; Vajpayee, Madhu

2010-01-01

Abstract Problem Antiretroviral therapy (ART) programmes have been successful in several countries. However, whether they would succeed as part of a national programme in a resource-constrained setting such as India is not clear. The outcomes and specific problems encountered in such a setting have not been adequately studied. Approach We assessed the efficacy and functioning of India’s national ART programme in a tertiary care centre in northern India. All ART-naive patients started on ART between May 2005 and October 2006 were included in the study and were followed until 31 April 2008. Periodic clinical and laboratory evaluations were carried out in accordance with national guidelines. Changes in CD4+ lymphocyte count, body weight and body mass index were assessed at follow-up, and the operational problems analysed. Local setting The setting was a tertiary care centre in northern India with a mixed population of patients, mostly of low socioeconomic status. The centre is reasonably well resourced but faces constraints in health-care delivery, such as lack of adequate human resources and a high patient load. Relevant changes The response to ART in the cohort studied was comparable to that reported from other countries. However, the programme had a high attrition rate, possibly due to patient-related factors and operational constraints. Lessons learnt A high rate of attrition can affect the overall efficacy and functioning of an ART programme. Addressing the issues causing attrition might improve patient outcomes in India and in other resource-constrained countries. PMID:20428391

Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities.

PubMed

Furuya-Kanamori, Luis; Riley, Thomas V; Paterson, David L; Foster, Niki F; Huber, Charlotte A; Hong, Stacey; Harris-Brown, Tiffany; Robson, Jenny; Clements, Archie C A

2017-01-01

Clostridium difficile infection (CDI) is becoming less exclusively a health care-associated CDI (HA-CDI). The incidence of community-associated CDI (CA-CDI) has increased over the past few decades. It has been postulated that asymptomatic toxigenic C. difficile (TCD)-colonized patients may play a role in the transfer of C. difficile between the hospital setting and the community. Thus, to investigate the relatedness of C. difficile across the hospital and community settings, we compared the characteristics of symptomatic and asymptomatic host patients and the pathogens from these patients in these two settings over a 3-year period. Two studies were simultaneously conducted; the first study enrolled symptomatic CDI patients from two tertiary care hospitals and the community in two Australian states, while the second study enrolled asymptomatic TCD-colonized patients from the same tertiary care hospitals. A total of 324 patients (96 with HA-CDI, 152 with CA-CDI, and 76 colonized with TCD) were enrolled. The predominant C. difficile ribotypes isolated in the hospital setting corresponded with those isolated in the community, as it was found that for 79% of the C. difficile isolates from hospitals, an isolate with a matching ribotype was isolated in the community, suggesting that transmission between these two settings is occurring. The toxigenic C. difficile strains causing symptomatic infection were similar to those causing asymptomatic infection, and patients exposed to antimicrobials prior to admission were more likely to develop a symptomatic infection (odds ratio, 2.94; 95% confidence interval, 1.20 to 7.14). Our findings suggest that the development of CDI symptoms in a setting without establishment of hospital epidemics with binary toxin-producing C. difficile strains may be driven mainly by host susceptibility and exposure to antimicrobials, rather than by C. difficile strain characteristics. Copyright © 2016 American Society for Microbiology.

The Challenge of Writing Remediation: Can Composition Research Inform Higher Education Policy?

ERIC Educational Resources Information Center

Relles, Stefani R.; Tierney, William G.

2013-01-01

Background/Context: This article presents a review of research relevant to postsecondary writing remediation. The purpose of the review is to assess empirical support for policy aimed at improving the degree completion rates of students who arrive at tertiary settings underprepared to write. Purpose/Objective/Research Question/Focus of Study: Our…

Prediction of protein tertiary structure from sequences using a very large back-propagation neural network

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

Liu, X.; Wilcox, G.L.

1993-12-31

We have implemented large scale back-propagation neural networks on a 544 node Connection Machine, CM-5, using the C language in MIMD mode. The program running on 512 processors performs backpropagation learning at 0.53 Gflops, which provides 76 million connection updates per second. We have applied the network to the prediction of protein tertiary structure from sequence information alone. A neural network with one hidden layer and 40 million connections is trained to learn the relationship between sequence and tertiary structure. The trained network yields predicted structures of some proteins on which it has not been trained given only their sequences.more » Presentation of the Fourier transform of the sequences accentuates periodicity in the sequence and yields good generalization with greatly increased training efficiency. Training simulations with a large, heterologous set of protein structures (111 proteins from CM-5 time) to solutions with under 2% RMS residual error within the training set (random responses give an RMS error of about 20%). Presentation of 15 sequences of related proteins in a testing set of 24 proteins yields predicted structures with less than 8% RMS residual error, indicating good apparent generalization.« less

Paediatric surgery outreach: analysis of referrals to a tertiary paediatric surgery service to plan an outreach programme Kwa-Zulu Natal, South Africa.

PubMed

Manickchund, Yashoda; Hadley, G P

2017-10-01

Paediatric surgical disease is a neglected health problem. Patients travel great distances to tertiary level care for management. This study aimed at analysing referral patterns to design an outreach programme for paediatric surgery in KwaZulu Natal. Data forms of patients referred to the service between January and July 2016 were correlated with the clinical record. Delays in management were compared to morbidity and mortality. Out of 781, 158 referrals were accepted as emergencies. The majority (62%) were children aged < 1 year. Gastro-intestinal problems (38.4%) and congenital anomalies (26.9%) formed the majority. Patients who died had a significantly longer delay in transfer. Longer total delay was associated with statistically significant greater morbidity. In a setting where a large rural population is served by single-centre tertiary care, delays exist and contribute to morbidity. The authors advocate the establishment of an outreach programme to address these issues.

Non-invasive ventilation in amyotrophic lateral sclerosis: a 10 year population based study.

PubMed

Chiò, Adriano; Calvo, Andrea; Moglia, Cristina; Gamna, Federica; Mattei, Alessio; Mazzini, Letizia; Mora, Gabriele

2012-04-01

To evaluate the clinical characteristics and outcome of non-invasive ventilation (NIV) in an epidemiological based series of amyotrophic lateral sclerosis (ALS) patients. The study was performed using data from the Piemonte and Valle d'Aosta Register for ALS, a prospective epidemiological register enrolling all ALS incident cases in two Italian regions. Among the 1260 patients incident in the period 1995-2004, 259 (20.6%) underwent NIV. Young male patients and subjects attending the tertiary ALS centres were more likely to undergo NIV. There was a progressive significant increase in the use of NIV during the study but was limited to patients attending the ALS tertiary centres. Median survival after NIV was 289 days (95% CI 255 to 333). In an epidemiological setting, NIV represents an increasingly utilised option for the treatment of respiratory disturbances in ALS and has favourable effects on survival, in particular among patients followed by tertiary ALS centres. Sociocultural factors, such as age, gender and marital status, strongly influence the probability of undergoing NIV. Efforts should be made to remove these obstacles in order to spread the use of NIV in all ALS patients with respiratory failure.

Large eddy simulation study of spanwise spacing effects on secondary flows in turbulent channel flow

NASA Astrophysics Data System (ADS)

Aliakbarimiyanmahaleh, Mohammad; Anderson, William

2015-11-01

The structure of turbulent flow over a complex topography composed of streamwise-aligned rows of cones with varying spanwise spacing, s is studied with large-eddy simulation (LES). Similar to the experimental study of Vanderwel and Ganapathisubramani, 2015: J. Fluid Mech., we investigate the relationship between secondary flow and s, for 0 . 25 <= s / δ <= 5 . For cases with s / δ > 2 , domain-scale rollers freely exist. These had previously been called ``turbulent secondary flows'' (Willingham et al., 2014: Phys. Fluids; Barros and Christensen, 2014: J. Fluid Mech.; Anderson et al., 2015: J. Fluid Mech.), but closer inspection of the statistics indicates these are a turbulent tertiary flow: they only remain ``anchored'' to the conical roughness elements for s / δ > 2 . For s / δ < 2 , turbulent tertiary flows are prevented from occupying the domain by virtue of proximity to adjacent, counter-rotating tertiary flows. Turbulent secondary flows are associated with the conical roughness elements. These turbulent secondary flows emanate from individual conical topographic elements and set the roughness sublayer depth. The turbulent secondary flows remain intact for large and small spacing. For s / δ < 1 , a mean tertiary flow is not present. This work was supported by the Air Force Office of Sci. Research, Young Inv. Program (PM: Dr. R. Ponnoppan and Ms. E. Montomery) under Grant # FA9550-14-1-0394. Computational resources were provided by the Texas Adv. Comp. Center at the Univ. of Texas.

Tertiary work-up of apparent treatment-resistant hypertension.

PubMed

Heimark, Sondre; Eskås, Per Anders; Mariampillai, Julian Eek; Larstorp, Anne Cecilie K; Høieggen, Aud; Fadl Elmula, Fadl Elmula M

2016-10-01

Treatment-resistant hypertension (TRH) has regained attention with development of new methods for treatment. However, the prevalence of TRH varies considerably from primary to secondary and tertiary care. We aimed to assess the prevalence of true TRH in a population of patients with apparent TRH in a university hospital setting of tertiary work-up and also investigate reasons for poor BP control and evaluate how work-up can be performed in general practice and secondary care. In this cohort study, we characterize a study population from Oslo Renal Denervation (RDN) Study. Patients (n = 83) were referred for RDN from secondary care. All patients underwent thorough medical investigation and 24-h ambulatory blood pressure measurements (24ABPM) after directly observed therapy (DOT). We then assessed reasons for lack of BP control. Fifty-three of 83 patients did not have true TRH. Main reasons for non-TRH were poor drug adherence (32%), secondary hypertension (30%) and white coat hypertension (15%). Forty-seven percent achieved blood pressure control after DOT with subsequent 24ABPM. There were otherwise no statistically significant differences in patient characteristics between the true TRH and the non-TRH group. Despite being a highly selected cohort referred for tertiary work-up of apparent TRH, BP control was achieved or secondary causes were identified in almost two thirds of the patients. Thorough investigation according to guidelines and DOT with subsequent 24ABPM is needed in work-up of apparent TRH.

Self-reported verbal abuse in 1300+ older women within a private, tertiary women's health clinic.

PubMed

Sood, Richa; Novotny, Paul; Faubion, Stephanie S; Thielen, Jacqueline M; Shuster, Lynne T; Kuhle, Carol L; Kapoor, Ekta; Marnach, Mary; Barrette, Brigitte; Jatoi, Aminah

2016-01-01

Several studies describe "elder abuse" among residents of nursing homes, but this issue is less well studied among independently functioning, community-based women. The current study was undertaken to report rates of self-reported intimate partner violence - with a focus on verbal abuse - among older women within a private tertiary women's health clinic. This study focused on women who completed a questionnaire on domestic abuse. A total of 1389 women with a median age of 55 years (range: 50, 90) are the focus of this report. Most 1102 (79%) were married. Within this group, 100 (7%) women reported verbal abuse within the last year. Rates of physical and sexual abuse were much lower with 9 women (1%) and 2 (<1%), respectively. In univariate analyses, being divorced, being an alcoholic, and having suffered prior abuse were associated with reported verbal abuse. In multivariate analyses, self-reported alcoholism and physical abuse were independently associated with reported verbal abuse. This study found a notable rate of patient-reported verbal abuse in older women within a private, tertiary women's health clinic. This observation should prompt healthcare providers to ask about intimate partner violence - and specifically verbal abuse - regardless of healthcare setting. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Use of multiplex PCR based molecular diagnostics in diagnosis of suspected CNS infections in tertiary care setting-A retrospective study.

PubMed

Javali, Mahendra; Acharya, Purushottam; Mehta, Aneesh; John, Aju Abraham; Mahale, Rohan; Srinivasa, R

2017-10-01

CNS infections like meningitis and encephalitis pose enormous healthcare challenges due to mortality, sequelae and socioeconomic burden. In tertiary setting, clinical, microbiological, cytological and radiological investigations are not distinctive enough for diagnosing microbial etiology. Molecular diagnostics is filling this gap. We evaluated the clinical impact of a commercially available multiplex molecular diagnostic system - SES for diagnosing suspected CNS infections. This study was conducted in our tertiary level Neurology ICU. 110 patients admitted during Nov-2010 to April-2014 were included. CSF samples of patients clinically suspected of having CNS infections were subjected to routine investigation in our laboratory and SES test at XCyton Diagnostics. We studied the impact of SES in diagnosis of CNS infections and its efficacy in helping therapeutic management. SES showed detection rate of 42.18% and clinical specificity of 100%. It had 10 times higher detection rate than conventional tests. Streptococcus pneumoniae and Mycobacterium tuberculosis were two top bacterial pathogens. VZV was most detected viral pathogen. SES results elicited changes in therapy in both positive and negative cases. We observed superior patient outcomes as measured by GCS scale. 75% and 82.14% of the patients positive and negative on SES respectively, recovered fully. Detecting causative organism and ruling out infectious etiology remain the most critical aspect for management and prognosis of patients with suspected CNS infections. In this study, we observed higher detection rate of pathogens, target specific escalation and evidence based de-escalation of antimicrobials using SES. Institution of appropriate therapy helped reduce unnecessary use of antimicrobials. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors contributing to nursing team work in an acute care tertiary hospital.

PubMed

Polis, Suzanne; Higgs, Megan; Manning, Vicki; Netto, Gayle; Fernandez, Ritin

Effective nursing teamwork is an essential component of quality health care and patient safety. Understanding which factors foster team work ensures teamwork qualities are cultivated and sustained. This study aims to investigate which factors are associated with team work in an Australian acute care tertiary hospital across all inpatient and outpatient settings. All nurses and midwives rostered to inpatient and outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Data were collected, collated, checked and analysed using Statistical Package for the Social Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p < 0.05 were analysed in a multiple regression model. A total of 501 surveys were returned. Nursing teamwork scores ranged between 3.32 and 4.08. Teamwork subscale Shared Mental Model consistently rated the highest. Mean scores for overall communication between nurses and team leadership were 3.6 (S.D. 0.57) and 3.8 (SD 0.6) respectively. Leadership and communication between nurses were significant predictors of team work p < 0.001. Our findings describe factors predictive of teamwork in an acute care tertiary based hospital setting across inpatient and outpatient specialty units. Our findings are of particular relevance in identifying areas of nurse education and workforce planning to improve nursing team work.

Tertiary-Tier PBIS in Alternative, Residential and Correctional School Settings: Considering Intensity in the Delivery of Evidence-Based Practice

ERIC Educational Resources Information Center

Scott, Terrance M.; Cooper, Justin

2013-01-01

Students in alternative, residential, and correctional settings present challenges in the classroom and facility due to the complexity and intensity of their behaviors. In addition, the factors typically associated with these settings including crowding, inconsistency, and conflicting staff perspectives on education and discipline present…

"It Depends on the Students Themselves": Independent Language Learning at an Indonesian State School

ERIC Educational Resources Information Center

Lamb, Martin

2004-01-01

There is continuing interest in the notion of learner autonomy, both as an effective means and valid goal of a language learning curriculum. However, the concept is recognised as emanating from Western tertiary educational contexts and as open to question in different sociocultural settings. This paper reports on a study of language learning…

An Exploratory Study of Students' Constructions of Gender in Science, Engineering and Technology

ERIC Educational Resources Information Center

Lynch, Ingrid; Nowosenetz, Tessa

2009-01-01

Despite an appreciation of the need to increase gender sensitivity and awareness among tertiary students in the field of science, engineering and technology (SET), there is a paucity of research that explores how students in this field construct gender. A greater understanding of such constructions can assist in transforming gender relations and…

TNE-Trans-National Education or Tensions between National and External? a Case Study of Malaysia

ERIC Educational Resources Information Center

Hill, Christopher; Cheong, Kee-Cheok; Leong, Yin-Ching; Fernandez-Chung, Rozilini

2014-01-01

Transnational education, primarily at the tertiary level, has been growing rapidly, bringing with it high hopes and expectations of benefits to institutions in the countries of origin and destination. However, these potential benefits come with a set of challenges that must be overcome. These challenges include the need to reconcile the…

Code-Switching in Vietnamese University EFL Teachers' Classroom Instruction: A Pedagogical Focus

ERIC Educational Resources Information Center

Grant, Lynn E.; Nguyen, Thi Hang

2017-01-01

This study examines the under-explored phenomenon in Vietnamese tertiary settings of code-switching practised by EFL (English as a foreign language) teachers in classroom instruction, as well as their awareness of this practice. Among the foreign languages taught and learned in Vietnamese universities, English is the most popular. The research…

The Impact of Higher Secondary Assessment Systems on the Tertiary-Level Academic Performance: An Empirical Study

ERIC Educational Resources Information Center

Mir, Monir; Fan, Hai Wei; Daly, Anne; Boland, Greg

2014-01-01

In Australia there is no centrally administered nationwide assessment system for students who complete their final year (Year 12) of high school. Each state and territory uses its own Year 12 assessment system. Apart from Queensland and the Australian Capital Territory, all states and territories use externally set competitive examinations. The…

Alcohol consumption in tertiary education students.

PubMed

Reavley, Nicola J; Jorm, Anthony F; McCann, Terence V; Lubman, Dan I

2011-07-09

Heavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC) guidelines for alcohol consumption and intentions to seek help for alcohol problems. Students of an Australian metropolitan university (with staff as a comparison group) participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed. Of the completed interviews, 774 (65%) were students and 422 (35%) were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students. Our findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among young men.

Family practice obstetrics in a teaching hospital. Does a tertiary care environment make a difference?

PubMed Central

Jordan, J. M.; Gaspar, D.

1995-01-01

OBJECTIVE: To determine referral rates, to study the nature of consultations with obstetricians, and to examine how both patient and physician characteristics affect referrals. DESIGN: Case series. Retrospective review of hospital records. SETTING: Victoria Hospital, a tertiary care centre affiliated with the University of Western Ontario in London, Ont. PARTICIPANTS: Five hundred forty-two women admitted consecutively for delivery under the care of family physicians from October 1, 1990, to September 31, 1991. OUTCOME MEASURE: The number and types of obstetrical consultations obtained for the study population. RESULTS: Of the 50.7% of cases requiring consultation, half were delivered by obstetricians. The most common reasons for consultation were failure to progress in labour, induction of labour, posterior presentation, fetal distress, and pregnancy-induced hypertension. The most common reasons for obstetricians to attend delivery were to perform forceps rotations and cesarean sections. CONCLUSIONS: Parity and risk classification were the two most important factors for predicting whether consultation would occur. The high rate of consultation in this study might relate to ease of access to consultation in a tertiary care environment. More study is needed to examine the reasons for consultation because it seems that some of the situations for which obstetricians were consulted could have been safely managed by family physicians. PMID:7787491

Geologic and biostratigraphic framework of the non-marine Cretaceous-Tertiary boundary interval in western North America

USGS Publications Warehouse

Nichols, D.J.

1990-01-01

Palynologically defined Cretaceous-Tertiary boundary sites in nonmarine rocks in western North America exhibit similar characteristics. All are marked by abrupt disappearance of the regional uppermost Cretaceous palynoflora at the level of an iridium anomaly; most also yeild shock-metamorphosed minerals. All are in coal-bearing, fluvial or paludal depositional settings, although the boundary horizon may be below, within, above, or at some stratigraphic distance from coal seams. At many sites the lowermost Tertiary beds contain assemblages overwhelmed by fern spores that, together with extinctions of some groups of angiosperms, are taken as evidence of regional devastation of terrestrial plant communities and subsequent recolonization by pioneer species. ?? 1990.

Primary Immunodeficiency Diseases in Oman: 10-Year Experience in a Tertiary Care Hospital.

PubMed

Al-Tamemi, Salem; Naseem, Shafiq Ur Rehman; Al-Siyabi, Nabila; El-Nour, Ibtisam; Al-Rawas, Abdulhakim; Dennison, David

2016-11-01

Primary immunodeficiency (PID) diseases are rare, complex medical disorders that often are overlooked in clinical settings. There are emerging reports of PID from Middle Eastern populations. This study describes the features of PID patients in a tertiary care setting in Oman and compares them with regional and worldwide reports. Sultan Qaboos University Hospital (SQUH) is an academic tertiary care-level hospital for specialized healthcare, including PID patients. At the time of diagnosis, patients' sociodemographics, clinical features, laboratory investigations, and management were entered in electronic form. This study included patients seen between August 2005 and July 2015. One hundred forty patients were registered with a minimum estimated population prevalence of 7.0/100,000. The male/female ratio was 1.6:1, the median age of onset of symptoms was 8 months, and diagnosis was 21 months with a delay of 13 months. Family history was positive in 44 %, consanguinity was present in 76 %, death of a previous sibling was present in 36 %, and there was an overall mortality in 18 %, with an 85 % probability of survival 10 years following diagnosis. The most common type of immunodeficiency was phagocytic disorders (35.0 %), followed by predominantly antibody disorders (20.7 %), combined immunodeficiency (17.8 %), other well-defined PID syndromes (15.0 %), immune dysregulation syndromes (3.5 %), complement deficiencies (3.5 %), and unclassified immunodeficiency (4.2 %). The commonest presenting infection was pneumonia (47.1 %). PID is not a rare condition in Oman. The prevalence is in concordance with reports from the region but higher than in Western populations. The findings of the current study would help to improve the awareness and management of, and policy making for PID.

Walking a Tightrope: The Balancing Act of Learning Advising. Refereed Proceedings of the 2007 Annual International Conference of the Association of Tertiary Learning Advisors of Aotearoa New Zealand. Volume 3

ERIC Educational Resources Information Center

Manalo, Emmanuel, Ed.; Bartlett-Trafford, Julie, Ed.; Crozier, Susan, Ed.

2008-01-01

This volume comprises the refereed proceedings of the 2007 ATLAANZ (Association of Tertiary Learning Advisors of Aotearoa/New Zealand) conference. The first three chapters set the scene well for the breadth and depth of issues addressed by the authors. In Chapter 1, Andy Begg refers to his own educational journey in discussing the inseparability…

[Development of an index system for the comprehensive evaluation on public health emergency events surveillance system in China].

PubMed

Hong, Zhiheng; Ni, Daxin; Cao, Yang; Meng, Ling; Tu, Wenxiao; Li, Leilei; Li, Qun; Jin, Lianmei

2015-06-01

To establish a comprehensive evaluation index system for the China Public Health Emergency Events Surveillance System (CPHEESS). A draft index system was built through literature review and under the consideration of the characteristics on CPHEESS. Delphi method was adapted to determine the final index system. The index system was divided into primary, secondary and tertiary levels. There were 4 primary indicators: System structure, Network platform, Surveillance implementation reports with Data analysis and utilization. There were 16 secondary and 70 tertiary indicators being set, with System structure including 14 tertiary indicators (accounted for 20.00%), 21 Network platforms (accounted for 30.00%). Twenty-four Surveillance implementation reports (accounted for 34.29%), 11 Data analysis and utilization (accounted for 15.71%). The average score of importance of each indicators was 4.29 (3.77-4.94), with an average coefficient variation as 0.14 (0.12-0.16). The mean Chronbach's α index was 0.84 (0.81-0.89). The adaptability of each related facilities indicator was specified. The primary indicators were set in accordance with the characteristics and goals of the surveillance systems. Secondary indicators provided key elements in the management and control of the system while the tertiary indicators were available and operative. The agreement rate of experts was high with good validity and reliability. This index system could be used for CPHEESS in future.

Vocational Qualifications and Progression to Higher Education: The Case of the 14-19 Diplomas in the English System

ERIC Educational Resources Information Center

Hodgson, Ann; Spours, Ken

2010-01-01

Ensuring effective progression from vocational qualifications to higher education has become an important issue internationally as a part of government strategies to raise skill levels and to provide more equitable access to tertiary level study. From September 2008, the Government in England has begun to introduce a new set of qualifications for…

Analysis of Formant Frequencies in Patients with Oral or Oropharyngeal Cancers Treated by Glossectomy

ERIC Educational Resources Information Center

Kazi, Rehan; Prasad, Vyas M. N.; Kanagalingam, Jeeve; Georgalas, Christos; Venkitaraman, Ramachandran; Nutting, Christopher M.; Clarke, Peter; Rhys-Evans, Peter; Harrington, Kevin J.

2007-01-01

Aims: To compare voice quality as defined by formant analysis using a sustained vowel in patients who have undergone a partial glossectomy with a group of normal subjects. Methods & Procedures: The design consisted of a single centre, cross-sectional cohort study. The setting was an Adult Tertiary Referral Unit. A total of 26 patients (19…

Lessons in Effective Practical Chemistry at Tertiary Level: Case Studies from a Chemistry Outreach Program

ERIC Educational Resources Information Center

Shallcross, D. E.; Harrison, T. G.; Shaw, A. J.; Shallcross, K. L.; Croker, S. J.; Norman, N. C.

2013-01-01

Two summer schools focused on practical chemistry, one involving secondary school students and one involving visually impaired adults (i.e., not involving undergraduates) have produced students that appeared to be on the way to achieving the basic criteria set out by Buckley and Kempa (1971) in terms of practical skills. These criteria being that…

Perceived Views of Language Teachers on the Use of Needs Analysis in ESP Materials Writing

ERIC Educational Resources Information Center

Ali, Holi Ibrahim Holi; Salih, Abdel Rahman Abdalla

2013-01-01

Needs analysis is generally believed to be important in ESP/EAP context because it enables practitioners and materials writers to find out about their real learners' needs. Therefore, this study is set out to investigate EFL teachers' beliefs and views about need analysis use and practices, specifically in the ESP/EAP tertiary context of the…

The Use of an Educational Social Networking Site for English Language Learning beyond the Classroom in a Japanese University Setting

ERIC Educational Resources Information Center

Okumura, Shinji

2016-01-01

This study describes an attempt of using an educational social networking platform, which is called Edmodo, for English language learning outside classrooms at tertiary level. Considering the notion of communicative competence, the instructor incorporated Edmodo into his English classes as a project which is a formal assignment. In the project,…

Regional Tectonic Control of Tertiary Mineralization and Recent Faulting in the Southern Basin-Range Province, an Application of ERTS-1 Data

NASA Technical Reports Server (NTRS)

Bechtold, I. C.; Liggett, M. A.; Childs, J. F.

1973-01-01

Research based on ERTS-1 MSS imagery and field work in the southern Basin-Range Province of California, Nevada and Arizona has shown regional tectonic control of volcanism, plutonism, mineralization and faulting. This paper covers an area centered on the Colorado River between 34 15' N and 36 45' N. During the mid-Tertiary, the area was the site of plutonism and genetically related volcanism fed by fissure systems now exposed as dike swarms. Dikes, elongate plutons, and coeval normal faults trend generally northward and are believed to have resulted from east-west crustal extension. In the extensional province, gold silver mineralization is closely related to Tertiary igneous activity. Similarities in ore, structural setting, and rock types define a metallogenic district of high potential for exploration. The ERTS imagery also provides a basis for regional inventory of small faults which cut alluvium. This capability for efficient regional surveys of Recent faulting should be considered in land use planning, geologic hazards study, civil engineering and hydrology.

A multifaceted strategy for implementation of the Ottawa ankle rules in two emergency departments

PubMed Central

Clark, Robyn; Shakib, Sepehr; Hughes, Geoffrey

2009-01-01

Problem Despite widespread acceptance of the Ottawa ankle rules for assessment of acute ankle injuries, their application varies considerably. Design Before and after study. Background and setting Emergency departments of a tertiary teaching hospital and a community hospital in Australia. Key measures for improvement Documentation of the Ottawa ankle rules, proportion of patients referred for radiography, proportion of radiographs showing a fracture. Strategies for change Education, a problem specific radiography request form, reminders, audit and feedback, and using radiographers as “gatekeepers.” Effects of change Documentation of the Ottawa ankle rules improved from 57.5% to 94.7% at the tertiary hospital, and 51.6% to 80.8% at the community hospital (P<0.001 for both). The proportion of patients undergoing radiography fell from 95.8% to 87.2% at the tertiary hospital, and from 91.4% to 78.9% at the community hospital (P<0.001 for both). The proportion of radiographs showing a fracture increased from 20.4% to 27.1% at the tertiary hospital (P=0.069), and 15.2% to 27.2% (P=0.002) at the community hospital. The missed fracture rate increased from 0% to 2.9% at the tertiary hospital and from 0% to 1.6% at the community hospital compared with baseline (P=0.783 and P=0.747). Lessons learnt Assessment of case note documentation has limitations. Clinician groups seem to differ in their capacity and willingness to change their practice. A multifaceted change strategy including a problem specific radiography request form can improve the selection of patients for radiography. PMID:19675080

Outcomes of antiretroviral therapy in a northern Indian urban clinic.

PubMed

Sharma, Surendra K; Dhooria, Sahajal; Prasad, K T; George, Ninoo; Ranjan, Sanjay; Gupta, Deepak; Sreenivas, Vishnubhatla; Kadhiravan, Tamilarasu; Miglani, Sunita; Sinha, Sanjeev; Wig, Naveet; Biswas, Ashutosh; Vajpayee, Madhu

2010-03-01

Antiretroviral therapy (ART) programmes have been successful in several countries. However, whether they would succeed as part of a national programme in a resource-constrained setting such as India is not clear. The outcomes and specific problems encountered in such a setting have not been adequately studied. We assessed the efficacy and functioning of India's national ART programme in a tertiary care centre in northern India. All ART-naive patients started on ART between May 2005 and October 2006 were included in the study and were followed until 31 April 2008. Periodic clinical and laboratory evaluations were carried out in accordance with national guidelines. Changes in CD4+ lymphocyte count, body weight and body mass index were assessed at follow-up, and the operational problems analysed. The setting was a tertiary care centre in northern India with a mixed population of patients, mostly of low socioeconomic status. The centre is reasonably well resourced but faces constraints in health-care delivery, such as lack of adequate human resources and a high patient load. The response to ART in the cohort studied was comparable to that reported from other countries. However, the programme had a high attrition rate, possibly due to patient-related factors and operational constraints. A high rate of attrition can affect the overall efficacy and functioning of an ART programme. Addressing the issues causing attrition might improve patient outcomes in India and in other resource-constrained countries.

Analysis of gravity data beneath Endut geothermal prospect using horizontal gradient and Euler deconvolution

NASA Astrophysics Data System (ADS)

Supriyanto, Noor, T.; Suhanto, E.

2017-07-01

The Endut geothermal prospect is located in Banten Province, Indonesia. The geological setting of the area is dominated by quaternary volcanic, tertiary sediments and tertiary rock intrusion. This area has been in the preliminary study phase of geology, geochemistry, and geophysics. As one of the geophysical study, the gravity data measurement has been carried out and analyzed in order to understand geological condition especially subsurface fault structure that control the geothermal system in Endut area. After precondition applied to gravity data, the complete Bouguer anomaly have been analyzed using advanced derivatives method such as Horizontal Gradient (HG) and Euler Deconvolution (ED) to clarify the existance of fault structures. These techniques detected boundaries of body anomalies and faults structure that were compared with the lithologies in the geology map. The analysis result will be useful in making a further realistic conceptual model of the Endut geothermal area.

Hierarchy in factors affecting fish biodiversity in floodplain lakes of the Mississippi Alluvial Valley

USGS Publications Warehouse

Dembkowski, D.J.; Miranda, L.E.

2012-01-01

River-floodplain ecosystems offer some of the most diverse and dynamic environments in the world. Accordingly, floodplain habitats harbor diverse fish assemblages. Fish biodiversity in floodplain lakes may be influenced by multiple variables operating on disparate scales, and these variables may exhibit a hierarchical organization depending on whether one variable governs another. In this study, we examined the interaction between primary variables descriptive of floodplain lake large-scale features, suites of secondary variables descriptive of water quality and primary productivity, and a set of tertiary variables descriptive of fish biodiversity across a range of floodplain lakes in the Mississippi Alluvial Valley of Mississippi and Arkansas (USA). Lakes varied considerably in their representation of primary, secondary, and tertiary variables. Multivariate direct gradient analyses indicated that lake maximum depth and the percentage of agricultural land surrounding a lake were the most important factors controlling variation in suites of secondary and tertiary variables, followed to a lesser extent by lake surface area. Fish biodiversity was generally greatest in large, deep lakes with lower proportions of watershed agricultural land. Our results may help foster a holistic approach to floodplain lake management and suggest the framework for a feedback model wherein primary variables can be manipulated for conservation and restoration purposes and secondary and tertiary variables can be used to monitor the success of such efforts. ?? 2011 Springer Science+Business Media B.V.

Factors affecting fish biodiversity in floodplain lakes of the Mississippi Alluvial Valley

USGS Publications Warehouse

Miranda, Leandro E.; Dembkowski, Daniel J.

2012-01-01

River-floodplain ecosystems offer some of the most diverse and dynamic environments in the world. Accordingly, floodplain habitats harbor diverse fish assemblages. Fish biodiversity in floodplain lakes may be influenced by multiple variables operating on disparate scales, and these variables may exhibit a hierarchical organization depending on whether one variable governs another. In this study, we examined the interaction between primary variables descriptive of floodplain lake large-scale features, suites of secondary variables descriptive of water quality and primary productivity, and a set of tertiary variables descriptive of fish biodiversity across a range of floodplain lakes in the Mississippi Alluvial Valley of Mississippi and Arkansas (USA). Lakes varied considerably in their representation of primary, secondary, and tertiary variables. Multivariate direct gradient analyses indicated that lake maximum depth and the percentage of agricultural land surrounding a lake were the most important factors controlling variation in suites of secondary and tertiary variables, followed to a lesser extent by lake surface area. Fish biodiversity was generally greatest in large, deep lakes with lower proportions of watershed agricultural land. Our results may help foster a holistic approach to floodplain lake management and suggest the framework for a feedback model wherein primary variables can be manipulated for conservation and restoration purposes and secondary and tertiary variables can be used to monitor the success of such efforts.

Eportfolios as Evidence of Standards and Outcomes in Work-Integrated Learning

ERIC Educational Resources Information Center

Ferns, Sonia; Comfort, Jude

2014-01-01

Electronic portfolios (ePortfolios) are a student focused tool which support and evidence work-integrated learning (WIL) experiences and capabilities in a tertiary education setting. Such settings are increasingly faced by a regulatory framework requiring evidence of student competency and skill acquisition. The commitment of educational…

The desirable qualities of future doctors--a study of medical student perceptions.

PubMed

Hurwitz, Steven; Kelly, Brian; Powis, David; Smyth, Robyn; Lewin, Terry

2013-07-01

There is a lack of consensus regarding the qualities possessed by the ideal doctor, and very limited research regarding the views of medical students on these qualities. To investigate the views of commencing medical students regarding the desirable qualities of doctors. A survey containing a set of proposed desirable qualities of doctors identified from the existing literature was completed by 158 first-year medical students. The survey had a 75% response rate. Students rated the individual qualities of empathy, motivation to be a doctor, good verbal communication, ethically sound, integrity and honesty as the most important. A factor analysis identified six categories of qualities: methodical processing, cognitive capacity, people skills, generic work ethic, role certainty and warmth. Significant differences in factor scores were found across subgroups of students (international and domestic students, with and without prior tertiary studies) on the following factors: methodical processing, which was scored highest by domestic students with prior tertiary studies, cognitive capacity, which was scored highest by domestic students without prior tertiary studies and generic work ethic, which was scored highest by international students. Medical students identified a range of desirable personal qualities of a doctor which varied according to student characteristics, including their prior educational experience. Future research aiming to define such desirable qualities should include a broader range of stakeholders, including students at different training levels and institutions.

What, How and Why? A Multi-Dimensional Case Analysis of the Challenges Facing Native and Non- Native EFL Teachers

ERIC Educational Resources Information Center

Demir, Yusuf

2017-01-01

On a multifaceted basis, this paper explores the challenges experienced by native and non-native English language teachers (NESTs and NNESTs) in a tertiary-level EFL setting in Turkey. Adopting a qualitative case study design, the data were gathered from five NESTs through interviews and from five NNESTs through hand-written accounts based on the…

Teaching Data Science to Post Graduate Students: A Preliminary Study Using a "F-L-I-P" Class Room Approach

ERIC Educational Resources Information Center

Eybers, Sunet; Hattingh, Mariè

2016-01-01

Data is everywhere. As a result the need for data scientists with the correct skill set to analyze and interpret the data has escalated. Not surprisingly, data scientists are currently one of the most wanted professions. Tertiary institutions are faced with the challenge of producing students with the correct blend of theoretical knowledge and…

A cross–sectional study on the prevalence and associated risk factors for workplace violence against Chinese nurses

PubMed Central

Shi, Lei; Zhang, Danyang; Zhou, Chenyu; Yang, Libin; Sun, Tao; Hao, Tianjun; Peng, Xiangwen; Gao, Lei; Liu, Wenhui; Mu, Yi; Han, Yuzhen; Fan, Lihua

2017-01-01

Objectives The purpose of the present study was to explore the characteristics of workplace violence that Chinese nurses at tertiary and county–level hospitals encountered in the 12 months from December 2014 to January 2016, to identify and analyse risk factors for workplace violence, and to establish the basis for future preventive strategies. Design A cross–sectional study. Setting A total of 44 tertiary hospitals and 90 county–level hospitals in 16 provinces (municipalities or autonomous regions) in China. Methods We used stratified random sampling to collect data from December 2014 to January 2016. We distributed 21 360 questionnaires, and 15 970 participants provided valid data (effective response rate=74.77%). We conducted binary logistic regression analyses on the risk factors for workplace violence among the nurses in our sample and analysed the reasons for aggression. Results The prevalence of workplace violence was 65.8%; of this, 64.9% was verbal violence, and physical violence and sexual harassment accounted for 11.8% and 3.9%, respectively. Frequent workplace violence occurred primarily in emergency and paediatric departments. Respondents reported that patients’ relatives were the main perpetrators in tertiary and county–level hospitals. Logistic regression analysis showed that respondents’ age, department, years of experience and direct contact with patients were common risk factors at different levels of hospitals. Conclusions Workplace violence is frequent in China’s tertiary and county–level hospitals; its occurrence is especially frequent in the emergency and paediatric departments. It is necessary to cope with workplace violence by developing effective control strategies at individual, hospital and national levels. PMID:28647719

Awareness of cervical cancer and Pap smear among nursing staff at a rural tertiary care hospital in Central India.

PubMed

Jain, S M; Bagde, M N; Bagde, N D

2016-01-01

Cancer cervix is the leading cause of cancer deaths in females in developing countries and one in five women suffering from cervical cancer lives in India. The aim of this study is to determine the awareness about cervical cancer and Pap smear among nurses working in a tertiary care institute. Study Setting and Design: Cross-sectional survey in a tertiary care institute. Nurses working at our institute excluding those who have worked or working in the Obstetrics and Gynecology department were provided with a pre-designed questionnaire testing their knowledge about cervical cancer. Approximately, 86% were aware about cancer cervix and 69% were aware of a pre-cancerous stage. 42.3% were not aware of any risk factor and 27.6% were not aware of any symptom of cancer cervix. 86.2% were aware about Pap smear, but only 58.6% were aware that facilities of Pap smear were available at our hospital. Knowledge about cervical cancer and awareness of Pap smear as screening test was inadequate in nursing staff. Awareness programs about cervical cancer and screening are needed to increase awareness for this preventable condition. There is a need to arrange reorientation programs to sensitize nurses and establish cytology clinics to offer facilities for easily accessible and affordable screening.

Surface water data and geographic relation to Tertiary age intrusions and hydrothermal alteration in the Grand Mesa, Uncompahgre, and Gunnison National Forests (GMUG) and intervening Bureau of Land Management (BLM) lands

USGS Publications Warehouse

Bove, Dana J.; Knepper, Daniel H.

2000-01-01

This data set covering the western part of Colorado includes water quality data from eight different sources (points), nine U.S. Geological Survey Digital Raster Graph (DRG) files for topographic bases, a compilation of Tertiary age intrusions (polygons and lines), and two geotiff files showing areas of hydrothermally altered rock. These data were compiled for use with an ongoing mineral resource assessment of theGrand Mesa, Uncompahgre, and Gunnison National Forests (GMUG) and intervening Bureau of Land Management(BLM) lands. This compilation was assembled to give federal land managers a preliminary view of water within sub-basinal areas, and to show possible relationships to Tertiary age intrusion and areas of hydrothermal alteration.

Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery.

PubMed

Kilcullen, Meegan; Ireland, Susan

2017-05-11

Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit. The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework. Six themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care. This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.

What Predicts Health Students' Self-Reported Preparedness to Work in Indigenous Health Settings?

ERIC Educational Resources Information Center

Bullen, Jonathan; Roberts, Lynne; Hoffman, Julie

2017-01-01

Australian undergraduate programs are implementing curriculum aimed at better preparing graduates to work in culturally diverse settings, but there remains uncertainty over the role of extant student attitudes towards Indigenous Australians. To begin to address this, we obtained baseline data on student attitudes upon entry to tertiary education.…

Wraparound: As a Tertiary Level Intervention for Students with Emotional/Behavioral Needs

ERIC Educational Resources Information Center

Eber, Lucille; Breen, Kimberli; Rose, Jennifer; Unizycki, Renee M.; London, Tasha H.

2008-01-01

If a student has multiple behavior problems that escalate over time and across different settings, school-based problem-solving teams can become quickly overwhelmed, especially when educators identify "setting events" for problem behaviors that have occurred outside of school and are beyond the control of school personnel. Instead of resorting to…

Screening for Body Dysmorphic Disorder in a Dermatology Outpatient Setting at a Tertiary Care Centre

PubMed Central

Thanveer, Fibin; Khunger, Niti

2016-01-01

Context: A distressing pre-occupation with an imagined or slight defect in appearance with a marked negative effect on the patient's life is the core symptom of body dysmorphic disorder (BDD). Aim: To screen the patients attending a dermatology clinic at a tertiary care centre for BDD using the BDD-dermatology version (DV) questionnaire. Settings and Design: This cross-sectional study enrolled 245 consecutive patients from the dermatology outpatients clinic. Methods: The demographic details were collected and the DV of BDD screening questionnaire was administered. A 5-point Likert scale was used for objective scoring of the stated concern and patients who scored ≥3 were excluded from the study. Statistical Analysis Used: The results were statistically analysed. Differences between the groups were investigated by Chi-square analysis for categorical variables, and Fisher exact test wherever required. Results: A total of 177 patients completed the study, and of these, eight patients screened positive for BDD. The rate of BDD in patients presenting with cosmetic complaints was 7.5% and in those with general dermatology, complaints were 2.1%, with no significant difference between the two groups (P = 0.156). Facial flaws (62.5%) were the most common concern followed by body asymmetry (25%). Conclusion: The rates of BDD found in this study are comparable but at a lower rate than that reported in literature data. PMID:27761090

Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

PubMed

Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin

2016-12-01

This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

Thermochronological evidence for polyphase post-rift reactivation in SE Brazil

NASA Astrophysics Data System (ADS)

Cogné, N.; Gallagher, K.; Cobbold, P. R.; Riccomini, C.

2012-04-01

The continental margin of SE Brazil shows good evidence for tectonic activity well after the break-up of Western Gondwana (see Cobbold et al., 2001 for a review). Additionally, SE Brazil ranks as an HEPM (high elevation passive margin), summits reaching 2800 m. To constrain the onshore evolution of the margin, especially during the Tertiary, we did a new thermochronological and structural study. After an initial regional study, during which we found additional evidence for a major phase of exhumation during the Late Cretaceous to Early Tertiary (Cogné et al., 2011), we focussed on a region that was clearly subject to Tertiary tectonics. This region includes the Tertiary Taubaté basin and the adjacent Serra do Mar and Serra da Mantiqueira. We used two thermochronolgical methods on the same samples, apatite fission tracks (AFT) and U-Th/He on apatite (AHe). AFT ages range from 129.3±4.3 Ma to 60.7±1.9 Ma with mean track lengths (MTL) from 14.31±0.24 μm to 11.41±0.23 μm, whereas AHe ages range from 519.6±16.6 to 10.1±0.1 Ma. A subset of AHe ages, selected on the basis of data consistency and geological arguments, has a smaller range (122.4±2.5 to 45.1±1.5 Ma). We have combined inverse and forward modelling to assess the range of acceptable thermal histories. Results of inverse modelling confirm our earlier study by showing a Late Cretaceous phase of cooling. Around the onshore Taubaté Basin, for a limited number of samples, another period of cooling occurred during the Early Tertiary, around the time when the basin formed. The inferred thermal histories for most of the samples also imply a later reheating, followed by a Neogene cooling. According to forward modelling, the evidence for reheating seems to be robust around the margins of the Taubaté Basin, but elsewhere the data cannot really discriminate between this and a less complex thermal history. However forward modelling and geologically independent information support the conclusion that the whole area cooled and uplifted during the Neogene. The synchronicity of the cooling phases with tectonic pulses in the Andes and in NE Brazil, as well as the tectonic setting of the Tertiary basins (Cogné et al., submitted) lead us to attribute these phases to a plate-wide compressive stress, which reactivated inherited structures during the Late Cretaceous and Tertiary. The relief of the margin is therefore due, more to polyphase post-rift reactivation and uplift, than to rifting itself. - Cobbold, P.R., Meisling, K.E., Mount, V.S., 2001. Reactivation of an obliquely rifted margin, Campos and Santos Basins, Southeastern Brazil. AAPG Bulletin 85, 1925-1944. - Cogné, N., Gallagher, K., Cobbold, P.R., 2011. Post-rift reactivation of the onshore margin of southeast Brazil: Evidence from apatite (U-Th)/He and fission-track data. Earth and Planetary Science Letters 309, 118-130. - Cogné, N., Cobbold, P.R., Riccomini, C., Gallagher, K. Tectonic setting of the Taubaté basin (southeastern Brazil): insights from regional seismic profiles and outcrop data. Submitted to Journal of South American Earth Sciences.

Was it easy to use an Asthma Control Test (ACT) in different clinical practice settings in a tertiary hospital in Singapore?

PubMed

Prabhakaran, Lathy; Earnest, Arul; Abisheganaden, John; Chee, Jane

2009-12-01

The Asthma Control Test (ACT) is a 5-item self-administered tool designed to assess asthma control. It is said to be simple, easy and can be administered quickly by patients in the clinical practice setting. This stated benefit has yet to be demonstrated in our local clinical practice setting. The aim was to identify factors associated with difficulty in the administration of the ACT in different clinical practice settings in a tertiary hospital in Singapore. This is a prospective study performed from April to June 2008. All patients diagnosed with asthma and referred to an asthma nurse from the in-patient and out-patient clinical practice setting in Tan Tock Seng Hospital were enrolled. Four hundred and thirty-four patients were asked to complete the ACT tool. In the univariate model, we found that age, clinical setting and medical history to be significantly associated with the completion of the ACT. The odds of completion decreased by a factor of 0.92 (95% CI, 0.89 to 0.94) for every year's increase in age, and this was statistically significant (P <0.001). Similarly, the odds ratio of completion for those with more than 3 medical conditions by history were 0.59 (95% CI, 0.48 to 0.71) as compared to those with less than 3 medical conditions by history, and this was also significant (P <0.001). In the multivariate model, we only found age to be an independent and significant factor. After adjusting for age, none of the other variables initially significant in the univariate model remained significant. The results show that the ACT was simple and easy to be administered in younger-aged patients.

Flow Field and Acoustic Predictions for Three-Stream Jets

NASA Technical Reports Server (NTRS)

Simmons, Shaun Patrick; Henderson, Brenda S.; Khavaran, Abbas

2014-01-01

Computational fluid dynamics was used to analyze a three-stream nozzle parametric design space. The study varied bypass-to-core area ratio, tertiary-to-core area ratio and jet operating conditions. The flowfield solutions from the Reynolds-Averaged Navier-Stokes (RANS) code Overflow 2.2e were used to pre-screen experimental models for a future test in the Aero-Acoustic Propulsion Laboratory (AAPL) at the NASA Glenn Research Center (GRC). Flowfield solutions were considered in conjunction with the jet-noise-prediction code JeNo to screen the design concepts. A two-stream versus three-stream computation based on equal mass flow rates showed a reduction in peak turbulent kinetic energy (TKE) for the three-stream jet relative to that for the two-stream jet which resulted in reduced acoustic emission. Additional three-stream solutions were analyzed for salient flowfield features expected to impact farfield noise. As tertiary power settings were increased there was a corresponding near nozzle increase in shear rate that resulted in an increase in high frequency noise and a reduction in peak TKE. As tertiary-to-core area ratio was increased the tertiary potential core elongated and the peak TKE was reduced. The most noticeable change occurred as secondary-to-core area ratio was increased thickening the secondary potential core, elongating the primary potential core and reducing peak TKE. As forward flight Mach number was increased the jet plume region decreased and reduced peak TKE.

Obstetric hemorrhage and shock management: using the low technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian tertiary care facilities.

PubMed

Miller, Suellen; Fathalla, Mohamed M F; Ojengbede, Oladosu A; Camlin, Carol; Mourad-Youssif, Mohammed; Morhason-Bello, Imran O; Galadanci, Hadiza; Nsima, David; Butrick, Elizabeth; Al Hussaini, Tarek; Turan, Janet; Meyer, Carinne; Martin, Hilarie; Mohammed, Aminu I

2010-10-18

Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings. This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression. Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure <60 mmHg vs. 29.9% in the pre-intervention phase (p = 0.001). Despite this, negative outcomes were significantly reduced in the NASG phase: mean measured blood loss decreased from 444 mL to 240 mL (p < 0.001), maternal mortality decreased from 6.3% to 3.5% (RR 0.56, 95% CI 0.35-0.89), severe morbidities from 3.7% to 0.7% (RR 0.20, 95% CI 0.08-0.50), and emergency hysterectomy from 8.9% to 4.0% (RR 0.44, 0.23-0.86). In multiple logistic regression, there was a 55% reduced odds of mortality during the NASG phase (aOR 0.45, 0.27-0.77). The NNTb to prevent either mortality or severe morbidity was 18 (12-36). Adding the NASG to standard shock and hemorrhage management may significantly improve maternal outcomes from hypovolemic shock secondary to obstetric hemorrhage at tertiary care facilities in low-resource settings.

A Mixed-methods Study to Assess Interrater Reliability and Nurse Perception of the Braden Scale in a Tertiary Acute Care Setting.

PubMed

Ho, Chester H; Cheung, Amanda; Southern, Danielle; Ocampo, Wrechelle; Kaufman, Jaime; Hogan, David B; Baylis, Barry; Conly, John M; Stelfox, Henry T; Ghali, William A

2016-12-01

Research regarding the reliability of the Braden Scale and nurses' perspectives on the instrument for predicting pressure ulcer (PU) risk in acute care settings is limited. A mixed-methods study was conducted in a tertiary acute care facility to examine interrater reliability (IRR) of the Braden Scale and its subscales, and a qualitative survey using semi-structured interviews was conducted among nurses caring for patients in acute care units to gain nurse perspective regarding scale usability. Data were extracted from a previous retrospective, randomized, controlled trial involving adult patients with compromised mobility receiving care in a tertiary acute care hospital in Canada. One-way, intraclass correlation coefficients (ICCs) were calculated on item and total scores, and kappa statistics were used to determine reliability of categorizing patients on their risk. Interview results were categorized by common themes. Reliability was assessed on 64 patients, where nurses and research staff independently assessed enrolled participants at baseline and after 72 hours using the Braden Scale as it appeared on an electronic medical record. IRR for the total score was high (ICC = 0.807). The friction and shear item had the lowest reliability (ICC = 0.266). Reliability of categorizing patients' level of risk had moderate agreement (κ = 0.408). Three (3) major and 12 subthemes emerged from the 14 nurse interviews; nurses were aware of the scale's purpose but were uncertain of its effectiveness, some items were difficult to rate, and questions were raised as to whether using the scale enhanced patient care. Aspects identified by nurses to enhance usability included: 1) changes to the electronic version (incorporating the scale into daily assessment documents with readily available item descriptions), 2) additional training, and 3) easily available resource material to improve reliability and usability of scale. These findings need to be considered when using the Braden Scale in clinical practice. Further study of the value of the total Braden Scale and its subscales is warranted.

Utilizing Positive Behavior Supports in High School Settings to Improve School Completion Rates for Students with High Incidence Conditions

ERIC Educational Resources Information Center

Bohanon, Hank; Flannery, K. Brigid; Malloy, JoAnne; Fenning, Pamela

2009-01-01

The integration of primary, secondary, and tertiary interventions through positive behavior supports (PBS) can provide benefit for students, staff, and families (Bohanon et al., 2006; Turnbull et al., 2002). However, there is limited application of PBS to high schools settings (Sugai, Flannery, & Bohanon, 2004). However, preliminary data is…

Towards a Dynamic Conceptual Framework for English-Medium Education in Multilingual University Settings

ERIC Educational Resources Information Center

Dafouz, Emma; Smit, Ute

2016-01-01

At a time of increasing internationalization in tertiary education, English-Medium Education in Multilingual University Settings (EMEMUS) has become a common practice. While there is already ample research describing this phenomenon at a local level (Smit and Dafouz 2012a), the theoretical side needs to be elaborated. This article thus aims to…

A Review of Criteria for Outdoor Classroom in Selected Tertiary Educational Institutions in Kuala Lumpur

NASA Astrophysics Data System (ADS)

Maheran, Y.; Fadzidah, A.; Nur Fadhilah, R.; Farha, S.

2017-12-01

A proper design outdoor environment in higher institutions contributes to the students’ learning performances and produce better learning outcomes. Campus surrounding has the potential to provide an informal outdoor learning environment, especially when it has the existing physical element, like open spaces and natural features, that may support the learning process. However, scholarly discourses on environmental aspects in tertiary education have minimal environmental inputs to fulfill students’ needs for outdoor exposure. Universities have always emphasized on traditional instructional methods in classroom settings, without concerning the importance of outdoor classroom towards students’ learning needs. Moreover, the inconvenience and discomfort outdoor surrounding in campus environment offers a minimal opportunity for students to study outside the classroom, and students eventually do not favor to utilize the spaces because no learning facility is provided. Hence, the objective of this study is to identify the appropriate criteria of outdoor areas that could be converted to be outdoor classrooms in tertiary institutions. This paper presents a review of scholars’ work in regards to the characteristics of the outdoor classrooms that could be designed as part of contemporary effective learning space, for the development of students’ learning performances. The information gathered from this study will become useful knowledge in promoting effective outdoor classroom and create successful outdoor learning space in landscape campus design. It I hoped that the finding of this study could provide guidelines on how outdoor classrooms should be designed to improve students’ academic achievement.

Micelles for the self-assembly of "off-on-off" fluorescent sensors for pH windows.

PubMed

Diaz-Fernandez, Yuri; Foti, Francesco; Mangano, Carlo; Pallavicini, Piersandro; Patroni, Stefano; Perez-Gramatges, Aurora; Rodriguez-Calvo, Simon

2006-01-11

A micellar approach is proposed to build a series of systems featuring an "off-on-off" fluorescent window response with changes in pH. The solubilizing properties of micelles are used to self-assemble, in water, plain pyrene with lipophilized pyridine and tertiary amine moieties. Since these components are contained in the small volume of the same micelle, pyrene fluorescence is influenced by the basic moieties: protonated pyridines and free tertiary amines behave as quenchers. Accordingly, fluorescence transitions from the "off" to the "on" state, and viceversa, take place when the pH crosses the pK(a) values of the amine and pyridine fragments. To obtain an "off-on-off" fluorescent response in this investigation we use either a set of dibasic lipophilic molecules (containing covalently linked pyridine and tertiary amine groups) or combinations of separate, lipophilic pyridines and tertiary amines. The use of combinations of dibasic and monobasic lipophilic molecules also gives a window-shaped fluorescence response with changes in pH: it is the highest pyridine pK(a) and the lowest tertiary amine pK(a) that determine the window limits. The pK(a) values of all the examined lipophilic molecules were determined in micelles, and compared with the values found for the same molecules in solvent mixtures in which they are molecularly dispersed. The effect of micellization is to significantly lower the observed protonation constants of the lipophilized species. Moreover, the more lipophilic a molecule is, the lower the observed logK value is. Accordingly, changing the substituents on the basic moieties or modifying their structure, tuning the lipophilicity of the mono- or dibases, and choosing among a large set of possible combination of lipophilized mono- and dibases have allowed us to tune, almost at will, both the width and the position along the pH axis of the obtained fluorescent window.

Acid-base disorders in critically ill neonates

PubMed Central

Lekhwani, S.; Shanker, V.; Gathwala, G.; Vaswani, N. D.

2010-01-01

Objective: To study acid–base imbalance in common pediatric diseases (such as sepsis, bronchopneumonia, diarrhea, birth-asphyxia etc.) in neonates. Design and Setting: An observational study was conducted in an emergency room of a tertiary teaching care hospital in Haryana, India. Patients and Methods: Fifty neonates (from first hour to one month) attending pediatric emergency services with various ailments. Blood gas analysis, electrolytes, plasma lactate, and plasma albumin were estimated in neonates. Results: Metabolic acidosis was the most common acid–base disorder. Hyperlactatemia was observed in more than half of such cases. Birth asphyxia was another common disorder with the highest mortality in neonates followed by bronchopneumonia and sepsis. Significant correlation between mortality and critical values of lactate was observed. Conclusion: Birth asphyxia with high-lactate levels in neonates constituted major alterations in acid–base disorders seen in an emergency room of a tertiary teaching care hospital. Plasma lactate concentration measurement provides an invaluable tool to assess type of metabolic acidosis in addition to predicting mortality in these neonates. PMID:20859489

Development of chemistry attitudes and experiences questionnaire (CAEQ)

NASA Astrophysics Data System (ADS)

Dalgety, Jacinta; Coll, Richard K.; Jones, Alister

2003-09-01

In this article we describe the development of the Chemistry Attitudes and Experiences Questionnaire (CAEQ) that measures first-year university chemistry students' attitude toward chemistry, chemistry self-efficacy, and learning experiences. The instrument was developed as part of a larger study and sought to fulfill a need for an instrument to investigate factors that influence student enrollment choice. We set out to design the instrument in a manner that would maximize construct validity. The CAEQ was piloted with a cohort of science and technology students (n = 129) at the end of their first year. Based on statistical analysis the instrument was modified and subsequently administered on two occasions at two tertiary institutions (n = 669). Statistical data along with additional data gathered from interviews suggest that the CAEQ possesses good construct validity and will prove a useful tool for tertiary level educators who wish to gain an understanding of factors that influence student choice of chemistry enrolment.

Assessment of Social Media Utilization and Study Habit of Students of Tertiary Institutions in Katsina State

ERIC Educational Resources Information Center

Olutola, Adekunle Thomas; Olatoye, Olufunke Omotoke; Olatoye, Rafiu Ademola

2016-01-01

This study investigated assessment of social media utilization and study habits of students of tertiary institutions in Katsina State. The descriptive survey design was adopted for this study. Three hundred and eighty-one (381) students' of tertiary institutions in Katsina State were randomly selected for the study. Researchers'-designed…

Buckets and Fire: Metaphors in Tertiary Teaching

ERIC Educational Resources Information Center

Emerson, Lisa; Mansvelt, Juliana

2015-01-01

This paper examines New Zealand tertiary teachers' use of metaphor and their attitudes to the consumer metaphor in relation to teaching. Based on interviews with 16 tertiary teachers, this study shows that although teachers believe the consumer metaphor is accepted by students, tertiary institutions and policy makers, and that it has affected…

Long-term healthcare cost reduction with Intensive Short-term Dynamic Psychotherapy in a tertiary psychiatric service.

PubMed

Abbass, Allan; Kisely, Steve; Rasic, Daniel; Town, Joel M; Johansson, Robert

2015-05-01

To evaluate whether a mixed population of patients treated with Intensive Short-term Dynamic Psychotherapy (ISTDP) would exhibit reduced healthcare costs in long-term follow-up. A quasi-experimental design was employed in which data on pre- and post-treatment healthcare cost were compared for all ISTDP cases treated in a tertiary care service over a nine year period. Observed cost changes were compared with those of a control group of patients referred but never treated. Physician and hospital costs were compared to treatment cost estimates and normal population cost figures. 1082 patients were included; 890 treated cases for a broad range of somatic and psychiatric disorders and 192 controls. The treatment averaged 7.3 sessions and measures of symptoms and interpersonal problems significantly improved. The average cost reduction per treated case was $12,628 over 3 follow-up years: this compared favorably with the estimated treatment cost of $708 per patient. Significant differences were seen between groups for follow-up hospital costs. ISTDP in this setting appears to facilitate reductions in healthcare costs, supporting the notion that brief dynamic psychotherapy provided in a tertiary setting can be beneficial to health care systems overall. CLINICALTRIALS. NCT01924715. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system.

PubMed

Trock, Bruce J; Guo, Charles C; Gonzalgo, Mark L; Magheli, Ahmed; Loeb, Stacy; Epstein, Jonathan I

2009-10-01

We investigated the relationship between the tertiary Gleason component in radical prostatectomy specimens and biochemical recurrence in what is to our knowledge the largest single institution cohort to date. We evaluated data on 3,230 men who underwent radical prostatectomy at our institution from 2000 to 2005. Tertiary Gleason component was defined as Gleason grade pattern 4 or greater for Gleason score 6 and Gleason grade pattern 5 for Gleason score 7 or 8. Biochemical recurrence curves for cancer with tertiary Gleason component were intermediate between those of cancer without a tertiary Gleason component in the same Gleason score category and cancer in the next higher Gleason score category. The only exception was that Gleason score 4 + 3 = 7 with a tertiary Gleason component behaved like Gleason score 8. The tertiary Gleason component independently predicted recurrence when factoring in radical prostatectomy Gleason score, radical prostatectomy stage and prostate specific antigen (HR 1.45, p = 0.029). Furthermore, the magnitude of the tertiary Gleason component effect on recurrence did not differ by Gleason score category (p = 0.593). Although the tertiary Gleason component is frequently included in pathology reports, it is routinely omitted in other situations, such as predictive nomograms, research studies and patient counseling. The current study adds to a growing body of evidence highlighting the importance of the tertiary Gleason component in radical prostatectomy specimens. Accordingly consideration should be given to a modified radical prostatectomy Gleason scoring system that incorporates tertiary Gleason component in intuitive fashion, including Gleason score 6, 6.5 (Gleason score 6 with tertiary Gleason component), 7 (Gleason score 3 + 4 = 7), 7.25 (Gleason score 3 + 4 = 7 with tertiary Gleason component), 7.5 (Gleason score 4 + 3), 8 (Gleason score 4 + 3 with tertiary Gleason component or Gleason score 8), 8.5 (Gleason score 8 with tertiary Gleason component), 9 (Gleason score 4 + 5 or 5 + 4) and 10.

Back to the future: A practice led transition program from Assistant in Nursing to Enrolled Nurse.

PubMed

Faithfull-Byrne, Annette; Thompson, Lorraine; Welch, Tony; Williamson, Moira; Schafer, Keppel; Hallinan, Claire

2017-01-01

Continuing professional development is an essential element in professional nursing practice. In our Hospital and Health service, a gap in existing nursing pathways was identified for Assistants in Nursing (AINs), who wished to further their career in nursing and progress to Enrolled Nurse (EN). There is also little in the literature that addresses Assistants in Nursing wishing to progress their career to Enrolled Nurses. This article describes a quality improvement project designed to address this gap. The project was a collaborative venture between a Queensland Hospital and Health Service and an Institute of Tertiary and Further Education (TAFE). The focus was on creating a flexible career path for Assistants in Nursing, wishing to become Enrolled Nurses. The project resulted in the Diploma of Nursing program (theory and practice) being delivered within the hospital setting by nurse educators and clinical nurse consultants. This is unusual in that the program is normally delivered in the tertiary setting, by academic staff from the Institute of Further Education. Program implementation is described along with the challenges encountered. Outcomes from the project were: 78% completion rate; 100% employment on completion of their course of study; and 18% progressing to further their education such as Advance Enrolled Nurse or Registered Nurse. Student satisfaction regarding the program was also positive. The initiative established a local career path for Assistants in Nursing wishing to progress to Enrolled Nurse. This quality project demonstrates that collaborative ventures between the tertiary sector and hospital and health services, can create innovative flexible solutions for staff wishing to further their career in nursing. Copyright © 2016 Elsevier Ltd. All rights reserved.

Steroid profiling for congenital adrenal hyperplasia by tandem mass spectrometry as a second-tier test reduces follow-up burdens in a tertiary care hospital: a retrospective and prospective evaluation.

PubMed

Seo, Ja Young; Park, Hyung-Doo; Kim, Jong Won; Oh, Hyeon Ju; Yang, Jeong Soo; Chang, Yun Sil; Park, Won Soon; Lee, Soo-Youn

2014-01-01

Newborn screening for congenital adrenal hyperplasia (CAH) based on measuring 17-hydroxyprogesterone (17-OHP) by immunoassay generates a number of false-positive results, especially in preterm neonates. We applied steroid profiling by using liquid chromatography-tandem mass spectrometry (LC-MS/MS) as a second-tier test in newborns with positive CAH screening and evaluated its clinical utility in a tertiary care hospital setting. By performing a 4-year retrospective data review, we were able to test 121 dried blood spots from newborns with positive CAH screening for 17-OHP, androstenedione and cortisol levels by LC-MS/MS. We prospectively evaluated the clinical utility of steroid profiling after the implementation of steroid profiling as a second-tier test in our routine clinical practice. During the 2-year prospective study period, 104 cases with positive initial screening by FIA were tested by LC-MS/MS. Clinical and laboratory follow-up were performed for at least 6 months. The preterm neonates accounted for 50.7% (76/150) and 70.4% (88/125) of screening-positive cases in retrospective and prospective cohorts, respectively. By applying steroid profiling as a second-tier test for positive CAH screening, we eliminated all false-positive results and decreased the median follow-up time from 75 to 8 days. Our data showed that steroid profiling reduced the burden of follow-up exams by improving the positive predictive value of the CAH screening program. The use of steroid profiling as a second-tier test for positive CAH screening will improve clinical practice particularly in a tertiary care hospital setting where positive CAH screening from preterm neonates is frequently encountered.

Geography does not limit optimal diabetes care: use of a tertiary centre model of care in an outreach service for type 1 diabetes mellitus.

PubMed

Simm, Peter J; Wong, Nicole; Fraser, Lynne; Kearney, John; Fenton, Judy; Jachno, Kim; Cameron, Fergus J

2014-06-01

Young people with type 1 diabetes mellitus living in rural and regional Australia have previously been shown to have limited access to specialised diabetes services. The Royal Children's Hospital Melbourne has been running diabetes outreach clinics to Western Victoria, Australia, for over 13 years. We aim to evaluate this service by comparing the outcomes of three outreach clinics with our urban diabetes clinic at the Royal Children's Hospital Melbourne. We examine our tertiary, multidisciplinary team-based model of care, where visiting specialist medical staff work alongside local allied health teams. The local teams provide interim care between clinics utilising the same protocols and treatment practices as the tertiary centre. Longitudinal data encapsulating the years 2005-2010, as a cohort study with a control group, are reviewed. A total of 69 rural patients were compared with 1387 metropolitan patients. Metabolic control was comparable, with no difference in mean HbA1c (8.3%/67 mmol/mol for both groups). Treatment options varied slightly at diagnosis, while insulin pump usage was comparable between treatment settings (20.3% rural compared with 27.6% urban, P = 0.19). Of note was that the number of visits per year was higher in the rural group (3.3 per year rural compared with 2.7 urban, P < 0.001). We conclude that the outreach service is able to provide a comparable level of care when the urban model is translated to a rural setting. This model may be further able to be extrapolated to other geographic areas and also other chronic health conditions of childhood. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Towards a rational antimicrobial testing policy in the laboratory.

PubMed

Banaji, N; Oommen, S

2011-01-01

Antimicrobial policy for prophylactic and therapeutic use of antimicrobials in a tertiary care setting has gained importance. A hospital's antimicrobial policy as laid down by its hospital infection control team needs to include inputs from the microbiology laboratory, besides the pharmacy and therapeutic committee. Therefore, it is of utmost importance that clinical microbiologists across India follow international guidelines and also take into account local settings, especially detection and presence of resistance enzymes. This article draws a framework for rational antimicrobial testing in our laboratories in tertiary care centers, from the Clinical and Laboratory Standards Institute guidelines. It does not address testing methodologies but suggests ways and means by which antimicrobial susceptibility reporting can be rendered meaningful not only to the treating physician but also to the resistance monitoring epidemiologist. It hopes to initiate some standardization in rational choice of antimicrobial testing in laboratories in the country pertaining to nonfastidious bacteria.

Utilization of arterial blood gas measurements in a large tertiary care hospital.

PubMed

Melanson, Stacy E F; Szymanski, Trevor; Rogers, Selwyn O; Jarolim, Petr; Frendl, Gyorgy; Rawn, James D; Cooper, Zara; Ferrigno, Massimo

2007-04-01

We describe the patterns of utilization of arterial blood gas (ABG) tests in a large tertiary care hospital. To our knowledge, no hospital-wide analysis of ABG test utilization has been published. We analyzed 491 ABG tests performed during 24 two-hour intervals, representative of different staff shifts throughout the 7-day week. The clinician ordering each ABG test was asked to fill out a utilization survey. The most common reasons for requesting an ABG test were changes in ventilator settings (27.6%), respiratory events (26.4%), and routine (25.7%). Of the results, approximately 79% were expected, and a change in patient management (eg, a change in ventilator settings) occurred in 42% of cases. Many ABG tests were ordered as part of a clinical routine or to monitor parameters that can be assessed clinically or through less invasive testing. Implementation of practice guidelines may prove useful in controlling test utilization and in decreasing costs.

Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting.

PubMed

DiPiro, Pamela J; Krajewski, Katherine M; Giardino, Angela A; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H

2017-01-01

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

Transition from Senior Secondary to Tertiary Languages Study: Student Attitudes in Three Sydney Schools

ERIC Educational Resources Information Center

Moloney, Robyn; Harbon, Lesley

2014-01-01

This paper reports on a small study of attitudes to tertiary language study amongst senior secondary language learners in three independent New South Wales schools. The study examines what elements of preparedness may be the most effective in supporting transition to tertiary study for this sample of languages students. An analysis of survey data…

Epilepsy in Ireland: towards the primary-tertiary care continuum.

PubMed

Varley, Jarlath; Delanty, Norman; Normand, Charles; Coyne, Imelda; McQuaid, Louise; Collins, Claire; Boland, Michael; Grimson, Jane; Fitzsimons, Mary

2010-01-01

Epilepsy is a chronic neurological disease affecting people of every age, gender, race and socio-economic background. The diagnosis and optimal management relies on contribution from a number of healthcare disciplines in a variety of healthcare settings. To explore the interface between primary care and specialist epilepsy services in Ireland. Using appreciative inquiry, focus groups were held with healthcare professionals (n=33) from both primary and tertiary epilepsy specialist services in Ireland. There are significant challenges to delivering a consistent high standard of epilepsy care in Ireland. The barriers that were identified are: the stigma of epilepsy, unequal access to care services, insufficient human resources, unclear communication between primary-tertiary services and lack of knowledge. Improving the management of people with epilepsy requires reconfiguration of the primary-tertiary interface and establishing clearly defined roles and formalised clinical pathways. Such initiatives require resources in the form of further education and training and increased usage of information communication technology (ICT). Epilepsy services across the primary-tertiary interface can be significantly enhanced through the implementation of a shared model of care underpinned by an electronic patient record (EPR) system and information communication technology (ICT). Better chronic disease management has the potential to halt the progression of epilepsy with ensuing benefits for patients and the healthcare system. Copyright 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

An Amino Acid Code to Define a Protein’s Tertiary Packing Surface

PubMed Central

Fraga, Keith J.; Joo, Hyun; Tsai, Jerry

2015-01-01

One difficult aspect of the protein-folding problem is characterizing the non-specific interactions that define packing in protein tertiary structure. To better understand tertiary structure, this work extends the knob-socket model by classifying the interactions of a single knob residue packed into a set of contiguous sockets, or a pocket made up of 4 or more residues. The knob-socket construct allows for a symbolic two-dimensional mapping of pockets. The two-dimensional mapping of pockets provides a simple method to investigate the variety of pocket shapes in order to understand the geometry of protein tertiary surfaces. The diversity of pocket geometries can be organized into groups of pockets that share a common core, which suggests that some interactions in pockets are ancillary to packing. Further analysis of pocket geometries displays a preferred configuration that is right-handed in α-helices and left-handed in β-sheets. The amino acid composition of pockets illustrates the importance of non-polar amino acids in packing as well as position specificity. As expected, all pocket shapes prefer to pack with hydrophobic knobs; however, knobs are not selective for the pockets they pack. Investigating side-chain rotamer preferences for certain pocket shapes uncovers no strong correlations. These findings allow a simple vocabulary based on knobs and sockets to describe protein tertiary packing that supports improved analysis, design and prediction of protein structure. PMID:26575337

Agriculture Canada Central Saskatchewan Vector Soils Data

NASA Technical Reports Server (NTRS)

Knapp, David; Hall, Forrest G. (Editor); Rostad, Harold

2000-01-01

This data set consists of GIS layers that describe the soils of the BOREAS SSA. These original data layers were submitted as vector data in ARC/INFO EXPORT format. These data also include the soil name and soil layer files, which provide additional information about the soils. There are three sets of attributes that include information on the primary, secondary, and tertiary soil type within each polygon. Thus, there is a total of nine main attributes in this data set.

Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting.

PubMed

Hammond, Athena; Homer, Caroline S E; Foureur, Maralyn

2017-07-01

to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews and a thematic analysis guided by study objectives and the aims of exploratory research was undertaken. the study was set at a recently renovated tertiary hospital in a large Australian city. participants were 16 registered midwives working in a tertiary hospital; seven in delivery suite and nine in birth centre settings. Experience as a midwife ranged from three to 39 years and the sample included midwives in diverse roles such as educator, student support and unit manager. three design characteristics were identified that supported midwifery practice. They were friendliness, functionality and freedom. Friendly rooms reduced stress and increased midwives' feelings of safety. Functional rooms enabled choice and provided options to better meet the needs of labouring women. And freedom allowed for flexible, spontaneous and responsive midwifery practice. hospital birth rooms that possess the characteristics of friendliness, functionality and freedom offer enhanced support for midwives and may therefore increase effective care provision. new and existing birth rooms can be designed or adapted to better support the wellbeing and effectiveness of midwives and may thereby enhance the quality of midwifery care delivered in the hospital. Quality midwifery care is associated with positive outcomes and experiences for labouring women. Further research is required to investigate the benefit that may be transmitted to women by implementing design intended to support and enhance midwifery practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Analysis of Management Practices in Lagos State Tertiary Institutions through Total Quality Management Structural Framework

ERIC Educational Resources Information Center

AbdulAzeez, Abbas Tunde

2016-01-01

This research investigated total quality management practices and quality teacher education in public tertiary institutions in Lagos State. The study was therefore designed to analyse management practices in Lagos state tertiary institutions through total quality management structural framework. The selected public tertiary institutions in Lagos…

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

Kim, Chun-Hwey; Song, Mi-Hwa; Yoon, Jo-Na

A photometric study of BD And was made through the analysis of two sets of new BVR light curves. The light curves with migrating photometric waves outside eclipse show that BD And is a short-period RS CVn-type binary star. The analysis of all available timings reveals that the orbital period has varied in a strictly cyclical way with a period of 9.2 yr. The periodic variation most likely arises from the light-time effect due to a tertiary moving in a highly elliptical orbit (e {sub 3} = 0.76). The Applegate mechanism could not operate properly in the eclipsing pair. Themore » light curves were modeled with two large spots on the hotter star and a large third light amounting to about 14% of the total systemic light. BD And is a triple system: a detached binary system consisting of two nearly equal solar-type stars with an active primary star and a G6-G7 tertiary dwarf. The absolute dimensions of the eclipsing pair and tertiary components were determined. The three components with a mean age of about 5.8 Gyr are located at midpositions in main-sequence bands. The radius of the secondary is about 17% larger than that deduced from stellar models. The orbital and radiometric characteristics of the tertiary are intensively investigated. One important feature is that the mutual inclination between two orbits is larger than 60°, implying that Kozai cycles had occurred very efficiently in the past. The possible past and future evolutions of the BD And system, driven by KCTF and MBTF, are also discussed.« less

Formation Mechanism of NDMA from Ranitidine, Trimethylamine, and Other Tertiary Amines during Chloramination: A Computational Study

PubMed Central

2015-01-01

Chloramination of drinking waters has been associated with N-nitrosodimethylamine (NDMA) formation as a disinfection byproduct. NDMA is classified as a probable carcinogen and thus its formation during chloramination has recently become the focus of considerable research interest. In this study, the formation mechanisms of NDMA from ranitidine and trimethylamine (TMA), as models of tertiary amines, during chloramination were investigated by using density functional theory (DFT). A new four-step formation pathway of NDMA was proposed involving nucleophilic substitution by chloramine, oxidation, and dehydration followed by nitrosation. The results suggested that nitrosation reaction is the rate-limiting step and determines the NDMA yield for tertiary amines. When 45 other tertiary amines were examined, the proposed mechanism was found to be more applicable to aromatic tertiary amines, and there may be still some additional factors or pathways that need to be considered for aliphatic tertiary amines. The heterolytic ONN(Me)2–R+ bond dissociation energy to release NDMA and carbocation R+ was found to be a criterion for evaluating the reactivity of aromatic tertiary amines. A structure–activity study indicates that tertiary amines with benzyl, aromatic heterocyclic ring, and diene-substituted methenyl adjacent to the DMA moiety are potentially significant NDMA precursors. The findings of this study are helpful for understanding NDMA formation mechanism and predicting NDMA yield of a precursor. PMID:24968236

Formation mechanism of NDMA from ranitidine, trimethylamine, and other tertiary amines during chloramination: a computational study.

PubMed

Liu, Yong Dong; Selbes, Meric; Zeng, Chengchu; Zhong, Rugang; Karanfil, Tanju

2014-01-01

Chloramination of drinking waters has been associated with N-nitrosodimethylamine (NDMA) formation as a disinfection byproduct. NDMA is classified as a probable carcinogen and thus its formation during chloramination has recently become the focus of considerable research interest. In this study, the formation mechanisms of NDMA from ranitidine and trimethylamine (TMA), as models of tertiary amines, during chloramination were investigated by using density functional theory (DFT). A new four-step formation pathway of NDMA was proposed involving nucleophilic substitution by chloramine, oxidation, and dehydration followed by nitrosation. The results suggested that nitrosation reaction is the rate-limiting step and determines the NDMA yield for tertiary amines. When 45 other tertiary amines were examined, the proposed mechanism was found to be more applicable to aromatic tertiary amines, and there may be still some additional factors or pathways that need to be considered for aliphatic tertiary amines. The heterolytic ONN(Me)2-R(+) bond dissociation energy to release NDMA and carbocation R(+) was found to be a criterion for evaluating the reactivity of aromatic tertiary amines. A structure-activity study indicates that tertiary amines with benzyl, aromatic heterocyclic ring, and diene-substituted methenyl adjacent to the DMA moiety are potentially significant NDMA precursors. The findings of this study are helpful for understanding NDMA formation mechanism and predicting NDMA yield of a precursor.

Characteristics of patients with diabetes screened for tuberculosis in a tertiary care hospital in South India

PubMed Central

Kumpatla, S.; Sekar, A.; Achanta, S.; Sharath, B. N.; Kumar, A. M. V.; Harries, A. D.

2013-01-01

Setting: Tertiary care hospital for diabetes mellitus (DM) in Tamil Nadu, South India. Objective: To compare the socio-demographic, clinical and biochemical characteristics in DM patients with and without tuberculosis (TB). Design: A descriptive study involving a review of routinely maintained records to capture the results of screening of DM patients for TB between March and December 2012. DM patients were first asked whether they already had TB, and if not they were screened for TB symptoms, followed by investigations for and possible diagnosis of TB. Results: Of 7083 DM patients, 38 already had TB. Of the remainder, 125 (1.8%) had TB symptoms; 71 were investigated and 12 were newly diagnosed with TB. Of the 50 TB patients, 64% had smear-positive pulmonary TB (PTB). DM-TB patients were older, and had lower education level and economic status, a higher frequency of alcohol use, lower body mass index, a longer duration of DM, a greater likelihood of receiving insulin and poorer glycaemic control. Conclusion: Screening of DM patients for TB was feasible in a tertiary care hospital. The yield of new TB cases was low and merits further investigation. Socio-demographic and clinical characteristics were different in patients with DM and TB compared to those with DM only. PMID:26393064

Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores.

PubMed

Samanamalee, Samitha; Sigera, Ponsuge Chathurani; De Silva, Ambepitiyawaduge Pubudu; Thilakasiri, Kaushila; Rashan, Aasiyah; Wadanambi, Saman; Jayasinghe, Kosala Saroj Amarasiri; Dondorp, Arjen M; Haniffa, Rashan

2018-01-08

This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting. Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited. A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury. One hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3 months after injury, 43 (86%) were living at home. Only 19 (38%) patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become "economically dependent". Selected trauma scores had poor discriminatory ability in predicting mortality. This observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6 months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.

Identifying Facilitating Factors and Barriers to Improving Student Retention Rates in Tertiary Teaching Courses: A Systematic Review

ERIC Educational Resources Information Center

Bowles, Terence V.; Brindle, Kimberley A.

2017-01-01

Factors which impact student retention in tertiary level teaching courses are complex. This study examined facilitating factors and barriers to student retention for students studying education. Due to a limited number of studies, the search was extended to factors impacting students undertaking tertiary education. A systematic review was…

Policy Innovation and Tertiary Education Graduation Rates: A Cross-Country Analysis

ERIC Educational Resources Information Center

Delaney, Jennifer A.; Yu, Patricia

2013-01-01

This study extends Trow's theory of higher education development to examine changes in national-level tertiary education graduation rates. Applying Trow's framework we arrive at three stages: (1) elite systems with gross tertiary graduation rates less than 15%, (2) massified systems with gross tertiary graduation rates between 15% and 50%, and (3)…

A Comparison of Career Success between Graduates of Vocational and Academic Tertiary Education

ERIC Educational Resources Information Center

Backes-Gellner, Uschi; Geel, Regula

2014-01-01

This paper analyses whether tertiary education of different types, i.e., academic or vocational tertiary education, leads to more or less favorable labor market outcomes. We study the problem for Switzerland, where more than two thirds of the workforce gain vocational secondary degrees and a substantial number go on to a vocational tertiary degree…

Idiopathic dental pulp calcifications in a tertiary care setting in South India.

PubMed

Satheeshkumar, P S; Mohan, Minu P; Saji, Sweta; Sadanandan, Sudheesh; George, Giju

2013-01-01

Dental pulp calcifications are unique and represent the dental pulp regenerative process. Dental pulp calcifications are sometimes routine findings in oral radiographs and may later serve as an important diagnostic criterion for a hidden aspect of systemic illness. The purpose of this study was to assess the patterns and prevalence of idiopathic dental pulp calcifications in a tertiary care setting in South India. A total of 227 patients were included in the study fulfilling the inclusion criteria. Age range of the study population was from 15 to 70 years. Teeth were examined under digital panoramic radiograph. The presence or absence of pulp stones was recorded. The presence of pulp stone were categorized according to the types classified as Type I, Type IA, Type II, Type IIA, Type II B, and Type III. The frequency of occurrence of pulp stones with sex, tooth type, dental arches, and types were compared with the types of calcification. Total no. of patients with pulpal calcification were 227 [females 133 (58.59%) and males 94 (41.40%)]. The most common type between both sexes was Type I (48%). Total no. of teeth with calcification was 697; maxilla (48%), mandible (52%). The prevalence of pulp stone was found to be higher in the molars in both the arches. Most no. of pulp stones are reported at the third and fourth decade of life. Idiopathic dental pulp calcifications are incidental radiographic findings of the pulp tissue and also may be an indicator of underlying disease.

Immunization Status of NICU Graduates at a Tertiary Care Children's Hospital.

PubMed

Macintosh, Janelle L B; Huggins, Leslie J; Eden, Lacey M; Merrill, Katreena Collette; Luthy, Karlen E Beth

2017-04-01

Approximately 500,000 infants are born prematurely each year in the United States. Immunization of infants in a neonatal intensive care unit (NICU) set a precedence for future immunizations. The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were aged 60 days or older at time of discharge. This descriptive pilot study utilized retrospective paper medical record review in one tertiary children's hospital. The relationships between immunization status and study variables were examined using t tests and logistic regression. Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were fully immunized in accordance with American Academy of Pediatrics (AAP) recommendations. Significant predictors were age at discharge for immunization and steroid use for nonimmunization. Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status. Nurses need to implement hospital policies ensuring immunizations of NICU graduates. Future studies should focus on samples from diverse hospitals and levels of NICUs. Qualitative studies exploring and describing parent and provider knowledge of current AAP guidelines will strengthen our understanding of potential barriers to immunization.

Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

PubMed

Apker, Julie; Propp, Kathleen M; Zabava Ford, Wendy S; Hofmeister, Nancee

2006-01-01

This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.

Rapid Syphilis Testing Is Cost-Effective Even in Low-Prevalence Settings: The CISNE-PERU Experience.

PubMed

Mallma, Patricia; Garcia, Patricia; Carcamo, Cesar; Torres-Rueda, Sergio; Peeling, Rosanna; Mabey, David; Terris-Prestholt, Fern

2016-01-01

Studies have addressed cost-effectiveness of syphilis testing of pregnant women in high-prevalence settings. This study compares costs of rapid syphilis testing (RST) with laboratory-based rapid plasma reagin (RPR) tests in low-prevalence settings in Peru. The RST was introduced in a tertiary-level maternity hospital and in the Ventanilla Network of primary health centers, where syphilis prevalence is approximately 1%. The costs per woman tested and treated with RST at the hospital were $2.70 and $369 respectively compared with $3.60 and $740 for RPR. For the Ventanilla Network the costs per woman tested and treated with RST were $3.19 and $295 respectively compared with $5.55 and $1454 for RPR. The cost per DALY averted using RST was $46 vs. $109 for RPR. RST showed lower costs compared to the WHO standard costs per DALY ($64). Findings suggest syphilis screening with RST is cost-effective in low-prevalence settings.

Rapid Syphilis Testing Is Cost-Effective Even in Low-Prevalence Settings: The CISNE-PERU Experience

PubMed Central

Mallma, Patricia; Garcia, Patricia; Carcamo, Cesar; Torres-Rueda, Sergio; Peeling, Rosanna; Mabey, David; Terris-Prestholt, Fern

2016-01-01

Studies have addressed cost-effectiveness of syphilis testing of pregnant women in high-prevalence settings. This study compares costs of rapid syphilis testing (RST) with laboratory-based rapid plasma reagin (RPR) tests in low-prevalence settings in Peru. The RST was introduced in a tertiary-level maternity hospital and in the Ventanilla Network of primary health centers, where syphilis prevalence is approximately 1%. The costs per woman tested and treated with RST at the hospital were $2.70 and $369 respectively compared with $3.60 and $740 for RPR. For the Ventanilla Network the costs per woman tested and treated with RST were $3.19 and $295 respectively compared with $5.55 and $1454 for RPR. The cost per DALY averted using RST was $46 vs. $109 for RPR. RST showed lower costs compared to the WHO standard costs per DALY ($64). Findings suggest syphilis screening with RST is cost-effective in low-prevalence settings. PMID:26949941

Impact of social media usage on daytime sleepiness: A study in a sample of tertiary students in Singapore.

PubMed

Nasirudeen, A M A; Lee Chin Adeline, Lau; Wat Neo Josephine, Koh; Lay Seng, Lim; Wenjie, Li

2017-01-01

Many tertiary students access social networking sites on a daily basis. With the increased usage of smartphones, accessing social networking sites while commuting, in schools, waiting for friends, television commercial breaks has become prevalent among tertiary students. What started as a lifestyle choice has now become a daily necessity. Such behavior among tertiary students raises an important question for educators: how does social media usage affect tertiary students' sleep patterns and daytime sleepiness, their attention difficulties, especially in school? Thus, the aim of this study was to examine the relationships between tertiary students' self-reports of social media usage and daytime sleepiness. The design was a cross-sectional, quantitative research study. We used a survey that contained questions concerning demographic data, daytime sleepiness, total sleep time and social media usage and a version of the Cleveland Adolescent Sleepiness Questionnaire, modified for use in tertiary students, were used for data collection ( n  = 969). The most preferred tool for accessing social networking sites was smartphones and WhatsApp was the most accessed site. Results indicated that nocturnal technology use has a weak, negative impact on tertiary students' quantity of sleep that may lead to daytime sleepiness. Local Singapore students spent significantly more time on social networking sites at night compared to foreign students. As a result, local students experienced more daytime sleepiness compared to foreign students. Prolonged social media usage, especially in bed, has a negative impact on tertiary students' daytime sleepiness. Since the technology is such an integral part of most tertiary students' lives, it is important to understand the impact it has on their sleep and daytime sleepiness.

Birth setting, labour experience, and postpartum psychological distress.

PubMed

MacKinnon, Anna L; Yang, Lisa; Feeley, Nancy; Gold, Ian; Hayton, Barbara; Zelkowitz, Phyllis

2017-07-01

although psychosocial risk factors have been identified for postpartum depression (PPD) and perinatal posttraumatic stress disorder (PTSD), the role of labour- and birth-related factors remains unclear. The present investigation explored the impact of birth setting, subjective childbirth experience, and their interplay, on PPD and postpartum PTSD. in this prospective longitudinal cohort study, three groups of women who had vaginal births at a tertiary care hospital, a birthing center, and those transferred from the birthing centre to the tertiary care hospital were compared. Participants were followed twice during pregnancy (12-14 and 32-34 weeks gestation) and twice after childbirth (1-3 and 7-9 weeks postpartum). symptoms of PPD and PTSD did not significantly differ between birth groups; however, measures of subjective childbirth experience and obstetric factors did. Moderation analyses indicated a significant interaction between pain and birth group, such that higher ratings of pain among women who were transferred was associated with greater symptoms of postpartum PTSD. women who are transferred appear to have a unique experience that may put them at greater risk for postpartum psychological distress. It may be beneficial for care providers to help prepare women for pain management and potential unexpected complications, particularly if it is their first childbirth. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Biome map for Modelling Global Mid-Pliocene Climate Change

NASA Astrophysics Data System (ADS)

Salzmann, U.; Haywood, A. M.

2006-12-01

The importance of vegetation-climate feedbacks was highlighted by several paleo-climate modelling exercises but their role as a boundary condition in Tertiary modelling has not been fully recognised or explored. Several paleo-vegetation datasets and maps have been produced for specific time slabs or regions for the Tertiary, but the vegetation classifications that have been used differ, thus making meaningful comparisons difficult. In order to facilitate further investigations into Tertiary climate and environmental change we are presently implementing the comprehensive GIS database TEVIS (Tertiary Environment and Vegetation Information System). TEVIS integrates marine and terrestrial vegetation data, taken from fossil pollen, leaf or wood, into an internally consistent classification scheme to produce for different time slabs global Tertiary Biome and Mega- Biome maps (Harrison & Prentice, 2003). In the frame of our ongoing 5-year programme we present a first global vegetation map for the mid-Pliocene time slab, a period of sustained global warmth. Data were synthesised from the PRISM data set (Thompson and Fleming 1996) after translating them to the Biome classification scheme and from new literature. The outcomes of the Biome map are compared with modelling results using an advanced numerical general circulation model (HadAM3) and the BIOME 4 vegetation model. Our combined proxy data and modelling approach will provide new palaeoclimate datasets to test models that are used to predict future climate change, and provide a more rigorous picture of climate and environmental changes during the Neogene.

Reflections on the Efficacy of a Constructivist Approach to Teaching and Learning in a First-Year Bachelor of Environmental Management Topic

ERIC Educational Resources Information Center

Szili, Gertrude; Sobels, Jonathan

2011-01-01

The dynamism of Environmental Management in the 21st century has predicted the need for students to emerge from tertiary programmes with a set of skills that are functional and more widely applicable in the contemporary workplace. To foster the development of such tools and skill sets, there has been an increasing trend amongst teaching…

Expanding the Range of the First Step to Success Intervention: Tertiary-Level Support for Children, Teachers, and Families

ERIC Educational Resources Information Center

Frey, Andy J.; Small, Jason W.; Lee, Jon; Walker, Hill M.; Seeley, John R.; Feil, Edward G.; Golly, Annemeike

2015-01-01

This study presents the findings of a quasi-experimental feasibility study examining the Tertiary First Step intervention, an enhanced version of the First Step to Success early intervention program. Tertiary FirstStep was developed to engage families more effectively and influence and improve parenting practices for children having challenging…

Expanding the Range of the First Step to Success Intervention: Tertiary-Level Support for Children, Teachers, and Families

ERIC Educational Resources Information Center

Frey, Andy J.; Small, Jason W.; Lee, Jon; Walker, Hill M.; Seeley, John R.; Feil, Edward G.; Golly, Annemeike

2015-01-01

This study presents the findings of a quasi-experimental feasibility study examining the Tertiary First Step intervention, an enhanced version of the First Step to Success early intervention program. Tertiary First Step was developed to engage families more effectively and influence and improve parenting practices for children having challenging…

Tertiary Students' ICT Self-Efficacy Beliefs and the Factors Affecting Their ICT-Use

ERIC Educational Resources Information Center

Turel, Vehbi; Calik, Sinan; Doganer, Adem

2015-01-01

This study looked at tertiary (i.e. undergraduate /a four-year degree) students' information and communication technology (ICT) self-efficacy beliefs and their level in use of certain common programmes at a newly established (i.e. 2007) university in Turkey in the spring of 2012. The study examined the tertiary students' (a) demographic…

Assessing Readiness for Integration of Electronic Learning into Business Education Programmes in Tertiary Institutions in Ebonyi State

ERIC Educational Resources Information Center

Nwagwu, Lazarus; Azih, Nonye

2015-01-01

The study was conducted to assess readiness for integration of electronic learning into business education programmes in tertiary institutions in Ebonyi State. Two research questions and two hypotheses guided the study. The population was 37 business education lecturers and 748 Business Education Students in tertiary institutions that offer…

Pressure ulcer and patient characteristics--A point prevalence study in a tertiary hospital of India based on the European Pressure Ulcer Advisory Panel minimum data set.

PubMed

Mehta, Chitra; George, Joby V; Mehta, Yatin; Wangmo, Namgyal

2015-08-01

Pressure ulcers is a frequent problem in hospitalized patients. Several prevalence studies have been conducted across the globe. Little information is available regarding prevalence of pressure ulcers in India. The aim was to identify the prevalence of pressure ulcers in one of the tertiary hospital in northern India and the factors associated with its development. A cross sectional point prevalence study. European Pressure Ulcer Advisory Panel (EPUAP) data collection form. Ethics approval was obtained prior to start of the study. Total of 358 patients were enrolled in the study. All patients above 18 years of age admitted in intensive care units and wards were included in the study. Patients admitted in emergency, day care, coronary care unit were excluded because of their short duration of hospital stay (varies from 24 to 72 h usually). All patients admitted before midnight on the predetermined day were included. The Braden scale was used to identify the risk of developing pressure ulcers. European Pressure ulcer advisory panel (EPUAP) minimum data set was used to collect prevalence data. The overall prevalence rate was 7.8%.The sacrum and heel were more commonly affected. Grade III pressure ulcers were the most common (42.8%). The pressure ulcer prevalence rate in our hospital was lower than that published in international studies. Severe forms of pressure ulcers were commonly encountered This data provides background information that may help us in developing protocols for applying effective practices for prevention of pressure ulcers. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Analysis of colonoscopic perforations at a local clinic and a tertiary hospital.

PubMed

Sagawa, Toshihiko; Kakizaki, Satoru; Iizuka, Haruhisa; Onozato, Yasuhiro; Sohara, Naondo; Okamura, Shinichi; Mori, Masatomo

2012-09-21

To define the clinical characteristics, and to assess the management of colonoscopic complications at a local clinic. A retrospective review of the medical records was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic between April 2006 and December 2010. Data obtained from a tertiary hospital in the same region were also analyzed. The underlying conditions, clinical presentations, perforation locations, treatment types (operative or conservative) and outcome data for patients at the local clinic and the tertiary hospital were compared. A total of 10  826 colonoscopies, and 2625 therapeutic procedures were performed at a local clinic and 32  148 colonoscopies, and 7787 therapeutic procedures were performed at the tertiary hospital. The clinic had no perforations during diagnostic colonoscopy and 8 (0.3%) perforations were determined to be related to therapeutic procedures. The perforation rates in each therapeutic procedure were 0.06% (1/1609) in polypectomy, 0.2% (2/885) in endoscopic mucosal resection (EMR), and 3.8% (5/131) in endoscopic submucosal dissection (ESD). Perforation rates for ESD were significantly higher than those for polypectomy or EMR (P < 0.01). All of these patients were treated conservatively. On the other hand, three (0.01%) perforation cases were observed among the 24  361 diagnostic procedures performed, and these cases were treated with surgery in a tertiary hospital. Six perforations occurred with therapeutic endoscopy (perforation rate, 0.08%; 1 per 1298 procedures). Perforation rates for specific procedure types were 0.02% (1 per 5500) for polypectomy, 0.17% (1 per 561) for EMR, 2.3% (1 per 43) for ESD in the tertiary hospital. There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital. The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital. No procedure-related mortalities occurred. Performing closure with endoscopic clipping reduced the C-reactive protein (CRP) titers. The mean maximum CRP titer was 2.9 ± 1.6 mg/dL with clipping and 9.7 ± 6.2 mg/dL without clipping, respectively (P < 0.05). An operation is indicated in the presence of a large perforation, and in the setting of generalized peritonitis or ongoing sepsis. Although we did not experience such case in the clinic, patients with large perforations should be immediately transferred to a tertiary hospital. Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained. It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.

Peripherally Inserted Central Venous Catheters in Pediatric Hematology/Oncology Patients in Tertiary Care Setting: A Developing Country Experience.

PubMed

Fadoo, Zehra; Nisar, Muhammad I; Iftikhar, Raza; Ali, Sajida; Mushtaq, Naureen; Sayani, Raza

2015-10-01

Peripherally inserted central venous catheters (PICC) have been successfully used to provide central access for chemotherapy and frequent transfusions. The purpose of this study was to assess the feasibility of PICCs and determine PICC-related complications in pediatric hematology/oncology patients in a resource-poor setting. All pediatric patients (age below 16 y) with hematologic and malignant disorders who underwent PICC line insertion at Aga Khan University Hospital from January 2008 to June 2010 were enrolled in the study. Demographic features, primary diagnosis, catheter days, complications, and reasons for removal of device were recorded. Total of 36 PICC lines were inserted in 32 pediatric patients. Complication rate of 5.29/1000 catheter days was recorded. Our study showed comparable complication profile such as infection rate, occlusion, breakage, and dislodgement. The median catheter life was found to be 69 days. We conclude that PICC lines are feasible in a resource-poor setting and recommend its use for chemotherapy administration and prolonged venous access.

Efficient synthesis of anacardic acid analogues and their antibacterial activities.

PubMed

Mamidyala, Sreeman K; Ramu, Soumya; Huang, Johnny X; Robertson, Avril A B; Cooper, Matthew A

2013-03-15

Anacardic acid derivatives exhibit a broad range of biological activities. In this report, an efficient method for the synthesis of anacardic acid derivatives was explored, and a small set of salicylic acid variants synthesised retaining a constant hydrophobic element (a naphthyl tail). The naphthyl side chain was introduced via Wittig reaction and the aldehyde installed using directed ortho-metalation reaction of the substituted o-anisic acids. The failure of ortho-metalation using unprotected carboxylic acid group compelled us to use directed ortho-metalation in which a tertiary amide was used as a strong ortho-directing group. In the initial route, tertiary amide cleavage during final step was challenging, but cleaving the tertiary amide before Wittig reaction was beneficial. The Wittig reaction with protected carboxylic group (methyl ester) resulted in side-products whereas using sodium salt resulted in higher yields. The novel compounds were screened for antibacterial activity and cytotoxicity. Although substitution on the salicylic head group enhanced antibacterial activities they also enhanced cytotoxicity. Copyright © 2013 Elsevier Ltd. All rights reserved.

Stratigraphy of the pedogenic manganese nodules in the Carletonville area, North West Province of South Africa: A case study of the General Nice Manganese Mine

NASA Astrophysics Data System (ADS)

Pharoe, Benedict Kinshasa; Liu, Kuiwu

2018-07-01

The lithostratigraphy of pedogenic manganese (Mn) nodules in the Carletonville area is similar to the Klipkuil, Ryedale, Wes Wits, and Houtkoppies deposits in the West Rand region of the Gauteng and North West Provinces and to a lesser extent the Bronkhorstfontein manganese deposit in the Limpopo Province of South Africa. The lithostratigraphy of the ore deposit at the General Nice Manganese Mine consists of a basal manganese wad, preserved in a typical karst setting on top of the underlying Malmani stromatolitic dolomites and Tertiary fluvial and secondary mineral deposits consisting of manganese nodules of variable size in a finer-grained soil matrix. At the top of the deposit is a Mn-depleted Quaternary sand cover. The Tertiary alluvial succession hosting Mn nodules was informally subdivided into A, B, C, D, E, F, G and H zones on the basis of geochemical analyses (XRD, XRF and SEM) of bulk zone samples and the manganese nodule size and concentration.

Policy and Practice of Tertiary Literacy. Selected Proceedings of the First National Conference on Tertiary Literacy: Research and Practice, Volume 1 (1st, Melbourne, Australia, March 14-16, 1996).

ERIC Educational Resources Information Center

Golebiowski, Zofia, Ed.

This selection of papers from the First Conference on Tertiary Literacy, which examined the role of literacy as a foundation for knowledge acquisition and dissemination that influences the academic success of tertiary students, presents a number of case studies of policy and practice in Australian universities. Keynote addresses included:…

Why Do Tertiary Education Graduates Regret Their Study Program? A Comparison between Spain and the Netherlands

ERIC Educational Resources Information Center

Kucel, Aleksander; Vilalta-Bufi, Montserrat

2013-01-01

In this paper we investigate the determinants of regret of study program for tertiary education graduates in Spain and the Netherlands. These two countries differ in their educational system in terms of the tracking structure in their secondary education and the strength of their education-labor market linkages in tertiary education. Therefore, by…

Is It Ever Too Late to Study? The Economic Returns on Late Tertiary Degrees in Sweden

ERIC Educational Resources Information Center

Hallsten, Martin

2012-01-01

This paper addresses the economic returns on tertiary degrees obtained in ages above 30 for individuals with upper-secondary schooling in light of current ideas on lifelong learning. Sweden is a case in point: Swedish tertiary education is open to older students, and labor market legislation supports employees who take a leave to study. The…

Improving Tertiary Student Outcomes in the First Year of Study: What Your Students May Not Tell You

ERIC Educational Resources Information Center

Dewart, Bonnie; Rowan, Linda

2008-01-01

There has been increased interest in retention and completion with regard to tertiary student outcomes in relation to students' successful completion of their study and what influences this. In New Zealand, the government through the Tertiary Education Commission (TEC) has made it clear that it expects institutions to meet retention and completion…

Entrepreneurship Education in Delta State Tertiary Institution as a Means of Achieving National Growth and Development

ERIC Educational Resources Information Center

Osakwe, Regina N.

2015-01-01

This study examined entrepreneurship education in Delta Sate tertiary institutions as a means of national growth and development. Two research questions were asked to guide the study. The population comprised all the 1,898 academic staff in eight tertiary institutions in the state. A sample of 800 lecturers was drawn through the multi stage and…

Students' Conceptions of the Particulate Nature of Matter at Secondary and Tertiary Level

ERIC Educational Resources Information Center

Ayas, Alipasa; Ozmen, Haluk; Calik, Muammer

2010-01-01

The aim of the present study is to elicit students' understanding of the particulate nature of matter via a cross-age study ranging from secondary to tertiary educational levels. A questionnaire with five-item open-ended questions was administered to 166 students from the secondary to tertiary levels of education. In light of the findings, it can…

Administrative Strategies of Departmental Heads as Determinants for the Effective Management of Human Resources in Tertiary Institutions in Delta State, Nigeria

ERIC Educational Resources Information Center

Osakwe, Regina N.

2015-01-01

This study investigated administrative strategies of departmental heads as determinants of effective management of human resources in tertiary institutions. Four research questions were asked and four hypotheses were formulated to guide the study. As a descriptive survey, the population comprised all the eight tertiary institutions in the state…

On Progress of Mass Tertiary Education: Case of Lebanon, Kenya and Oman

ERIC Educational Resources Information Center

Liu, Zhimin; Mutinda, Gladys

2016-01-01

Mass higher education is a huge force to be reckoned with and its existence, already in the expansion of tertiary institutions is undeniable. This study will focus on three countries: Lebanon, Kenya and Oman. The purpose of this study is to evaluate mass tertiary education progress in these countries. It will synthesize data results of gross…

Liver transplantation in the treatment of severe iatrogenic liver injuries

PubMed Central

Lauterio, Andrea; De Carlis, Riccardo; Di Sandro, Stefano; Ferla, Fabio; Buscemi, Vincenzo; De Carlis, Luciano

2017-01-01

The place of liver transplantation in the treatment of severe iatrogenic liver injuries has not yet been widely discussed in the literature. Bile duct injuries during cholecystectomy represent the leading cause of liver transplantation in this setting, while other indications after abdominal surgery are less common. Urgent liver transplantation for the treatment of severe iatrogenic liver injury may-represent a surgical challenge requiring technically difficult and time consuming procedures. A debate is ongoing on the need for centralization of complex surgery in tertiary referral centers. The early referral of patients with severe iatrogenic liver injuries to a tertiary center with experienced hepato-pancreato-biliary and transplant surgery has emerged as the best treatment of care. Despite widespread interest in the use of liver transplantation as a treatment option for severe iatrogenic injuries, reported experiences indicate few liver transplants are performed. This review analyzes the literature on liver transplantation after hepatic injury and discusses our own experience along with surgical advances and future prospects in this uncommon transplant setting. PMID:28932348

Rhodamine Inhibitors of P-glycoprotein: An Amide/Thioamide “Switch” for ATPase Activity

PubMed Central

Gannon, Michael K.; Holt, Jason J.; Bennett, Stephanie M.; Wetzel, Bryan R.; Loo, Tip W.; Bartlett, M. Claire; Clarke, David M.; Sawada, Geri A.; Higgins, J. William; Tombline, Gregory; Raub, Thomas J.; Detty, Michael R.

2012-01-01

We have examined 46 tetramethylrosamine/rhodamine derivatives with structural diversity in the heteroatom of the xanthylium core, the amino substituents of the 3- and 6-positions, and the alkyl, aryl, or heteroaryl group at the 9-substituent. These compounds were examined for affinity and ATPase stimulation in isolated MDR3 CL P-gp and human P-gp-His10, for their ability to promote uptake of calcein AM and vinblastine in multidrug-resistant MDCKII-MDR1 cells, and for transport in monolayers of MDCKII-MDR1 cells. Thioamide 31-S gave KM of 0.087 μM in human P-gp. Small changes in structure among this set of compounds affected affinity as well as transport rate (or flux) even though all derivatives examined were substrates for P-gp. With isolated protein, tertiary amide groups dictate high affinity and high stimulation while tertiary thioamide groups give high affinity and inhibition of ATPase activity. In MDCKII-MDR1 cells, the tertiary thioamide-containing derivatives promote uptake of calcein AM and have very slow passive, absorptive, and secretory rates of transport relative to transport rates for tertiary amide-containing derivatives. Thioamide 31-S promoted uptake of calcein AM and inhibited efflux of vinblastine with IC50’s of ~2 μM in MDCKII-MDR1 cells. PMID:19402665

Leprosy: diagnosis and management in a developed setting.

PubMed

Turner, D; McGuinness, S L; McGuiness, S; Leder, K

2015-01-01

Leprosy remains an important global health concern, but little has been published about its diagnosis and management in developed settings. It has been postulated that delay in diagnosis is common in developed settings. We reviewed all the cases of leprosy seen at a major tertiary referral centre between 1999 and 2013 and demonstrated that delay in diagnosis is common, especially when patients present with symptoms of leprosy reactions rather than classical symptoms, such as hypo-pigmented hypo-aesthetic skin lesions and neuropathy. © 2015 Royal Australasian College of Physicians.

Tertiary Education and Training in Australia, 2010

ERIC Educational Resources Information Center

National Centre for Vocational Education Research (NCVER), 2012

2012-01-01

This publication presents information on tertiary education and training during 2010, including statistics on participation and outcomes. The definition of tertiary education and training adopted for this publication is formal study in vocational education and training (VET) and higher education, including enrolments in Australian Qualifications…

Optimizing perioperative Crohn's disease management: role of coordinated medical and surgical care.

PubMed

Bennett, Jennifer L; Ha, Christina Y; Efron, Jonathan E; Gearhart, Susan L; Lazarev, Mark G; Wick, Elizabeth C

2015-01-28

To investigate rates of re-establishing gastroenterology care, colonoscopy, and/or initiating medical therapy after Crohn's disease (CD) surgery at a tertiary care referral center. CD patients having small bowel or ileocolonic resections with a primary anastomosis between 2009-2012 were identified from a tertiary academic referral center. CD-specific features, medications, and surgical outcomes were abstracted from the medical record. The primary outcome measure was compliance rates with medical follow-up within 4 wk of hospital discharge and surveillance colonoscopy within 12 mo of surgery. Eighty-eight patients met study inclusion criteria with 92% (n=81) of patients returning for surgical follow-up compared to only 41% (n=36) of patients with documented gastroenterology follow-up within four-weeks of hospital discharge, P<0.05. Factors associated with more timely postoperative medical follow-up included younger age, longer length of hospitalization, postoperative biologic use and academic center patients. In the study cohort, 75.0% of patients resumed medical therapy within 12 mo, whereas only 53.4% of patients underwent a colonoscopy within 12 mo of surgery. Our study highlights the need for coordinated CD multidisciplinary clinics and structured handoffs among providers to improve of quality of care in the postoperative setting.

Clinicoepidemiological and Mycological Study of Tinea Capitis in the Pediatric Population of Kashmir Valley: A Study from a Tertiary Care Centre

PubMed Central

Bhat, Yasmeen J.; Zeerak, Sumaya; Kanth, Farhat; Yaseen, Atiya; Hassan, Iffat; Hakak, Rubina

2017-01-01

Background: Tinea capitis is a superficial fungal infection that predominantly affects the pediatric population. The etiological factors vary from region to region, and the exact incidence remains obscure. The clinicoepidemiological and mycological aspects of this dermatophytosis were studied in a tertiary care centre in Kashmir valley. Aim: To determine the clinicoepidemiological aspects and mycological findings of dermatophytes involved in tinea capitis cases in Kashmir valley. Materials and Methods: Wood's lamp examination, KOH examination, and fungal culture were performed in one hundred fifty clinically diagnosed cases of tinea capitis with patients’ age upto 14 years over a period of 6 months. The epidemiological factors associated with the disease were also evaluated. Results: Tinea capitis was predominant in the 3–6 and 6–9 years age groups with a male preponderance. Grey patch tinea capitis was the most common variant. KOH positivity was 76%, and Trichophyton tonsurans was the most common fungal isolate. Conclusion: Tinea capitis is a very common fungal infection in our setting. Early detection and diagnosis is mandatory to prevent its spread in the community as well as the development of scarring alopecia in the affected individual. PMID:28405548

Clinicoepidemiological and Mycological Study of Tinea Capitis in the Pediatric Population of Kashmir Valley: A Study from a Tertiary Care Centre.

PubMed

Bhat, Yasmeen J; Zeerak, Sumaya; Kanth, Farhat; Yaseen, Atiya; Hassan, Iffat; Hakak, Rubina

2017-01-01

Tinea capitis is a superficial fungal infection that predominantly affects the pediatric population. The etiological factors vary from region to region, and the exact incidence remains obscure. The clinicoepidemiological and mycological aspects of this dermatophytosis were studied in a tertiary care centre in Kashmir valley. To determine the clinicoepidemiological aspects and mycological findings of dermatophytes involved in tinea capitis cases in Kashmir valley. Wood's lamp examination, KOH examination, and fungal culture were performed in one hundred fifty clinically diagnosed cases of tinea capitis with patients' age upto 14 years over a period of 6 months. The epidemiological factors associated with the disease were also evaluated. Tinea capitis was predominant in the 3-6 and 6-9 years age groups with a male preponderance. Grey patch tinea capitis was the most common variant. KOH positivity was 76%, and Trichophyton tonsurans was the most common fungal isolate. Tinea capitis is a very common fungal infection in our setting. Early detection and diagnosis is mandatory to prevent its spread in the community as well as the development of scarring alopecia in the affected individual.

Causes of chronic orthostatic hypotension

NASA Technical Reports Server (NTRS)

Robertson, D.; Robertson, R. M.

1994-01-01

OBJECTIVE: To determine the frequency of various causes of orthostatic hypotension. DESIGN: Survey. SETTING: Tertiary referral center. PATIENTS: One hundred patients with moderate to severe orthostatic hypotension. RESULTS: Twenty-seven percent of the patients had primary autonomic failure, 35% had secondary autonomic failure, and 38% had hypotension without evidence of generalized autonomic degeneration. CONCLUSIONS: In a tertiary referral center, only a minority of patients with severe orthostatic hypotension will have Shy-Drager syndrome or Bradbury-Eggleston syndrome as their primary disease. Occasional patients who initially appear to have Bradbury-Eggleston syndrome ultimately prove to have Shy-Drager syndrome or paraneoplastic autonomic failure. Antidepressant drugs, even in low doses, remain a major overlooked cause of orthostatic hypotension.

Depositional setting and diagenetic evolution of some Tertiary unconventional reservoir rocks, Uinta Basin, Utah.

USGS Publications Warehouse

Pitman, Janet K.; Fouch, T.D.; Goldhaber, M.B.

1982-01-01

The Douglas Creek Member of the Tertiary Green River Formation underlies much of the Uinta basin, Utah, and contains large volumes of oil and gas trapped in a complex of fractured low-permeability sandstone reservoirs. In the SE part of the basin at Pariette Bench, the Eocene Douglas Creek Member is a thick sequence of fine- grained alluvial sandstone complexly intercalated with lacustrine claystone and carbonate rock. Sediments were deposited in a subsiding intermontane basin along the shallow fluctuating margin of ancient Lake Uinta. Although the Uinta basin has undergone postdepositional uplift and erosion, the deepest cored rocks at Pariette Bench have never been buried more than 3000m.-from Authors

Periodic limb movements and insomnia, a common but under-recognized association

PubMed Central

Varadharajulu, Saravanan; Chandrasekaran, Baskaran

2015-01-01

Periodic limb movements unlike restless leg syndrome is under diagnosed and unrecognized in medical arena. While robust Western trials have elucidated the association between periodic limb movements and sleep disturbances, it is not well received and recognized in India even in well sophisticated tertiary care hospital. We report a chronic insomnia patient who had sleep disturbances for past 30 years due to periodic limb movements alone. This was diagnosed through polysomnography. This case emphasizes monitoring leg movements during sleep study. This report may open new horizons in improving monitoring in sleep study in clinical setting. PMID:26124530

Improving mental health service users' with medical co-morbidity transition between tertiary medical hospital and primary care services: a qualitative study.

PubMed

Cranwell, Kate; Polacsek, Meg; McCann, Terence V

2016-07-26

Mental health service users have high rates of medical co-morbidity but frequently experience problems accessing and transitioning between tertiary medical and primary care services. The aim of this study was to identify ways to improve service users' with medical co-morbidity care and experience during their transition between tertiary medical hospitals and primary care services. Experience-based co-design (EBCD) qualitative study incorporating a focus group discussion. The study took place in a large tertiary medical service, incorporating three medical hospitals, and primary care services, in Melbourne, Australia. A purposive sample of service users and their caregivers and tertiary medical and primary care clinicians participated in the focus group discussion, in August 2014. A semi-structured interview guide was used to inform data collection. A thematic analysis of the data was undertaken. Thirteen participants took part in the focus group interview, comprising 5 service users, 2 caregivers and 6 clinicians. Five themes were abstracted from the data, illustrating participants' perspectives about factors that facilitated (clinicians' expertise, engagement and accessibility enhancing transition) and presented as barriers (improving access pathways; enhancing communication and continuity of care; improving clinicians' attitudes; and increasing caregiver participation) to service users' progress through tertiary medical and primary care services. A sixth theme, enhancing service users' transition, incorporated three strategies to enhance their transition through tertiary medical and primary care services. EBCD is a useful approach to collaboratively develop strategies to improve service users' with medical co-morbidity and their caregivers' transition between tertiary medical and primary care services. A whole-of-service approach, incorporating policy development and implementation, change of practice philosophy, professional development education and support for clinicians, and acceptance of the need for caregiver participation, is required to improve service users' transition.

Diversification of Tertiary Education in Switzerland.

ERIC Educational Resources Information Center

Crausaz, Roselyne

The structure of Switzerland's educational system is described including the types of secondary schools and/or courses and the system of tertiary education. Fields of study, types of institutions, and characteristics of tertiary education in Switzerland are discussed. The chapter on students covers admission procedures, trends in enrollment,…

Interactional aspects of care during hospitalization: perspectives of family caregivers of psychiatrically ill in a tertiary care setting in India.

PubMed

Dinakaran, P; Mehrotra, Seema; Bharath, Srikala

2014-12-01

There are very few studies on user-perspectives about mental health care services that explore perspectives of family caregivers in India. An exploratory study was undertaken to understand the perceived importance of various aspects of interactions with mental health service providers during hospitalization, from the perspectives of family caregivers. In addition, it also aimed at documenting their actual experience of interactional aspects of care during the hospitalization of their relatives. The study was conducted on fifty family caregivers of patients with varied psychiatric diagnoses hospitalized in a tertiary psychiatric care setting in South India. Measures of Interactional aspects of care were developed to assess perceived importance of six different interactional domains of care and the actual experience of care in these domains. Provision of informational inputs and addressing of concerns raised emerged as the domains of care given highest importance. The item pertaining to 'sharing with the caregiver about different alternatives for treatment' received negative ratings in terms of actual experience by maximum number of participants (18%). Significant differences on perceived importance of four domains of interactional aspects of care (dignity, confidentiality and fairness, addressing concerns raised, informational inputs and prompt attention and consistent care) emerged between caregiver subgroups based on educational level of the caregiver, socio-economic status, hospitalization history and broad diagnostic categories. In addition, the care givers of patients with psychoses assigned significantly more positive ratings on actual experience for all the domains of interactional aspects of care. The findings have implications for further research and practice. Copyright © 2014 Elsevier B.V. All rights reserved.

Cross cultural comparison of constipation profiles at tertiary care centers between India and USA.

PubMed

Singh, P; Surana, R; Soni, S; Agnihotri, A; Ahuja, V; Makharia, G K; Staller, K; Kuo, B

2018-03-09

Despite potential differences in patient perception of chronic constipation (CC) in geographically and culturally distinct regions, head-to-head studies comparing the clinical profile, constipation severity, impact on quality of life (QOL) and economic impact are lacking. We conducted a cross-sectional cohort study of patients presenting with CC to tertiary care centers in the USA and India. Standardized instruments were used to assess constipation subtype, disease severity, disease-specific QOL, somatization, and psychiatric comorbidities. We used multivariable linear regression to determine the predictors of QOL and number of healthcare visits. Sixty-six and 98 patients with CC were enrolled in the USA and India, respectively. Indian patients with CC had significantly more frequent bowel movements/week compared to their USA counterparts (Median 5 vs 3, P < .0001). The proportion of patients with Bristol stool form scale type 1 and 2 was significantly higher in the USA compared to India (65.5% vs 48%, P = .04). Higher depression score (P = .001), more severe constipation symptoms (P = .001) and site of the study being USA (P = .008) independently predicted worse QOL. Indian patients (P < .001) and worse QOL (P = .02) were independent predictors of number of healthcare visits in the last 12 months. Indian patients with CC have more frequent and softer bowel movements compared to those in the USA suggesting significant differences in perception of CC in different geographic and cultural settings. QOL and economic impact related to constipation varies with geographic/cultural setting irrespective of other clinical and psychosomatic features. © 2018 John Wiley & Sons Ltd.

Idiopathic dental pulp calcifications in a tertiary care setting in South India

PubMed Central

Satheeshkumar, PS; Mohan, Minu P; Saji, Sweta; Sadanandan, Sudheesh; George, Giju

2013-01-01

Background: Dental pulp calcifications are unique and represent the dental pulp regenerative process. Dental pulp calcifications are sometimes routine findings in oral radiographs and may later serve as an important diagnostic criterion for a hidden aspect of systemic illness. Objective: The purpose of this study was to assess the patterns and prevalence of idiopathic dental pulp calcifications in a tertiary care setting in South India. Materials and Methods: A total of 227 patients were included in the study fulfilling the inclusion criteria. Age range of the study population was from 15 to 70 years. Teeth were examined under digital panoramic radiograph. The presence or absence of pulp stones was recorded. The presence of pulp stone were categorized according to the types classified as Type I, Type IA, Type II, Type IIA, Type II B, and Type III. The frequency of occurrence of pulp stones with sex, tooth type, dental arches, and types were compared with the types of calcification. Results: Total no. of patients with pulpal calcification were 227 [females 133 (58.59%) and males 94 (41.40%)]. The most common type between both sexes was Type I (48%). Total no. of teeth with calcification was 697; maxilla (48%), mandible (52%). The prevalence of pulp stone was found to be higher in the molars in both the arches. Most no. of pulp stones are reported at the third and fourth decade of life. Conclusion: Idiopathic dental pulp calcifications are incidental radiographic findings of the pulp tissue and also may be an indicator of underlying disease. PMID:23349577

Helicopter Electromagnetic Surveys for Hydrological Framework Studies in Nebraska

NASA Astrophysics Data System (ADS)

Smith, B. D.; Abraham, J. A.; Cannia, J. C.; Steele, G. V.; Peterson, S. M.

2008-12-01

Management and allocation of water resources in Nebraska is based in part on understanding the relation between surface-water and ground-water systems. To help understand these complex relations, the U.S. Geological Survey (USGS) conducted airborne resistivity and magnetic (frequency domain helicopter electromagnetic, HEM) surveys in Eastern (2007) and Western (2008) Nebraska. These surveys were integrated with hydrologic studies (aquifer characteristics and modeling), and ground and borehole geophysical surveys to characterize and map the hydrogeologic framework in three-dimensions. The three study areas selected in Eastern Nebraska (Ashland, Firth, and Oakland) have glacial terrains and bedrock that typify different hydrogeologic settings for surface and ground water. The Eastern Nebraska Water Resources Assessment is a joint State of Nebraska and USGS study including the Conservation and Survey Division (University of Nebraska) and the following Natural Resources Districts (NRD): Lower Platte South, Lower Platte North, Lower Elkhorn, Lewis and Clark, Nemaha, and Papio-Missouri River. Approximately 600 line km were flown with HEM in each of the three glacial terrains with a line spacing of approximately 270 m and samples every three meters. One dimensional imaging was done along the flight lines for the HEM in each area. Models were compared to ground resistivity and time domain electromagnetic soundings and to borehole lithologic and geophysical logs. The map of the subsurface hydrogeologic properties inferred from the HEM modeling significantly improves the resolution of hydrologic models and understanding of ground-water resources. Surveys in western Nebraska panhandle, were done along the North Platte River and Lodgepole Creek Valleys. The geology consists of Quaternary alluvium, and interbeded Tertiary sandstones and siltstones above Cretaceous shale. The Quaternary alluvium comprises the primary aquifer in the North Platte River Valley, whereas thin alluvial sediments and Tertiary sandstone channels comprise the primary aquifers in Lodgepole Creek Valley. Locally, Tertiary Siltstone and Cretaceous shale is weathered and incised. A prominent factor in the hydrologic setting of the North Platte River Valley is recharge through un-lined irrigation canals. Surveys in western Nebraska were funded by the North Platte and South Platte NRDs. These NRDS have employed the best in science-based integrated water resources management. The ground-water flow modeling study in western Nebraska will use the HEM data as part of model datasets, to create a tool used to evaluate implications of water management options over most of the surface-water irrigated area.

National Rules for Drug–Drug Interactions: Are They Appropriate for Tertiary Hospitals?

PubMed Central

2016-01-01

The application of appropriate rules for drug–drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed. PMID:27822925

Diversification of Tertiary Education in Norway, Case Study.

ERIC Educational Resources Information Center

Ottosen, Kristian

The educational system of Norway, which is organized into primary, secondary and higher education, is reviewed. Types of schools and/or courses in secondary education are listed including present enrollment figures by main types of secondary education and transfer rates of secondary to tertiary education. The system of tertiary education is…

Evaluation of the Special Tertiary Admissions Test (STAT)

ERIC Educational Resources Information Center

Coates, Hamish; Friedman, Tim

2010-01-01

This paper reports findings from the first national Australian study of the predictive validity of the Special Tertiary Admissions Test (STAT). Background on tertiary admissions procedures in Australia is presented, followed by information on STAT and the research methods. The results affirm that STAT, through the provision of baseline and…

Employee Engagement and Performance of Lecturers in Nigerian Tertiary Institutions

ERIC Educational Resources Information Center

Agbionu, Uchenna Clementina; Anyalor, Maureen; Nwali, Anthony Chukwuma

2018-01-01

The study investigated employee engagement and performance of lecturers in Nigerian Tertiary Institutions. It employed descriptive and correlation research designs. Stratified random sampling was used to select three tertiary institutions in Nigeria and the sample size of 314 lecturers was obtained through Taro Yamane. Questionnaires were…

An Exploratory Study of Collaboration in New Zealand Tertiary Libraries

ERIC Educational Resources Information Center

Finnerty, Colleen

2005-01-01

The shift in policy from market driven behaviour towards a more cooperative tertiary sector is having an effect on New Zealand academic libraries and their relationships. Despite this, there has been no investigation of collaboration specifically targeting New Zealand tertiary libraries. This research project examine the state of collaboration…

The Impediments Facing Community Engagement in Omani Educational Tertiary Institutions

ERIC Educational Resources Information Center

Issa, Jinan Hatem

2016-01-01

Prior to the vital role that social capital plays in accomplishing prosperity for any educational tertiary institution, it was emphasised in several countries' agendas, including the Sultanate of Oman. This study endeavours to explore the impediments facing the enhancement of the social capital in Omani educational tertiary institutions through…

Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana.

PubMed

Kallam, Brianne; Pettitt-Schieber, Christie; Owen, Medge; Agyare Asante, Rebecca; Darko, Elizabeth; Ramaswamy, Rohit

2018-05-19

Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections. A multi-modal change package of World Health Organization-recommended solutions was created to address this issue. To ensure that the outputs of the QI effort were adopted within the organization, leaders at RRH and Kybele, Inc. used an implementation science framework called the 'Interactive Systems Framework for Dissemination and Implementation' (ISF) to create a package of locally acceptable implementation strategies. The ISF has never been used before to guide implementation in low-resource settings. Hand hygiene compliance rose from 67% to 92% overall, including a 36% increase during the night shifts-a group of healthcare workers with typically very low levels of compliance. The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.

Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Incidence and Predictive Factors Using the Modified Gleason Grading System and Factoring in Tertiary Grades

PubMed Central

Epstein, Jonathan I.; Feng, Zhaoyong; Trock, Bruce J.; Pierorazio, Phillip M.

2015-01-01

Background Prior studies assessing the correlation of Gleason score (GS) at needle biopsy and corresponding radical prostatectomy (RP) predated the use of the modified Gleason scoring system and did not factor in tertiary grade patterns. Objective To assess the relation of biopsy and RP grade in the largest study to date. Design, setting, and participants A total of 7643 totally embedded RP and corresponding needle biopsies (2004–2010) were analyzed according to the updated Gleason system. Interventions All patients underwent prostate biopsy prior to RP. Measurements The relation of upgrading or downgrading to patient and cancer characteristics was compared using the chi-square test, Student t test, and multivariable logistic regression. Results and limitations A total of 36.3% of cases were upgraded from a needle biopsy GS 5–6 to a higher grade at RP (11.2% with GS 6 plus tertiary). Half of the cases had matching GS 3 + 4 = 7 at biopsy and RP with an approximately equal number of cases downgraded and upgraded at RP. With biopsy GS 4 + 3 = 7, RP GS was almost equally 3 + 4 = 7 and 4 + 3 = 7. Biopsy GS 8 led to an almost equal distribution between RP GS 4 + 3 = 7, 8, and 9–10. A total of 58% of the cases had matching GS 9–10 at biopsy and RP. In multivariable analysis, increasing age (p < 0.0001), increasing serum prostate-specific antigen level (p < 0.0001), decreasing RP weight (p < 0.0001), and increasing maximum percentage cancer/core (p < 0.0001) predicted the upgrade from biopsy GS 5–6 to higher at RP. Despite factoring in multiple variables including the number of positive cores and the maximum percentage of cancer per core, the concordance indexes were not sufficiently high to justify the use of nomograms for predicting upgrading and downgrading for the individual patient. Conclusions Almost 20% of RP cases have tertiary patterns. A needle biopsy can sample a tertiary higher Gleason pattern in the RP, which is then not recorded in the standard GS reporting, resulting in an apparent overgrading on the needle biopsy. PMID:22336380

Older Australian's Motivation for University Enrollment and Their Perception of the Role of Tertiary Education in Promoting Healthy Aging: A National Cross-Sectional Study

ERIC Educational Resources Information Center

Brownie, Sonya

2014-01-01

The aims of this study were to describe the characteristics of older Australian university students (aged 60+ years); to identify the factors that motivate late-life, tertiary-level learning; and to capture older students' views about the role of tertiary-level learning in promoting healthy aging. In 2012, an invitation to participate in the study…

Enabling factors for specialist outreach in western KwaZulu-Natal

PubMed Central

2018-01-01

Background There exists a major disparity in access to specialist care between patients in urban and rural areas. Specialists are a scarce resource and are concentrated in urban areas. Specialist outreach attempts to fill the gap in service provision for patients situated remotely. While there is international evidence that multifaceted specialist outreach has achieved varying levels of success, factors that influence the effectiveness of outreach have not yet been fully elucidated in South Africa. Aim This study attempts to uncover some of the factors that enable good multifaceted specialist outreach. Setting The study was conducted in hospitals in western KwaZulu-Natal province. This health area is served by a tertiary hospital and 20 peripheral hospitals; three of these are regional level and the majority are district level hospitals. Specialist outreach emanates from the tertiary hospital. Methods Specialists providing outreach services from the tertiary hospital and medical officers at seven receiving hospitals were interviewed to explore perceptions regarding factors that might enable successful specialist outreach. Framework analysis on the transcribed interviews was carried out using NVivo version 11. Results A major positive finding concerns the relationships formed between outreach specialists and doctors at the recipient hospitals. The management of the programme with respect to structure, dependability, data management, transport provision, communication technology and public health systems was also seen as beneficial in specialist outreach. Conclusion Specialist outreach plays an essential role in providing equality in health care. To enable effectiveness, it is important to make full use of the multifaceted nature of this intervention. PMID:29781691

Implosion symmetry and ρR measurements on the National Ignition Facility from nascent 27-31 MeV tertiary protons (invited) (abstract)

NASA Astrophysics Data System (ADS)

Petrasso, Richard D.

1997-01-01

Tertiary protons with birth energies from ˜27 to 30.8 MeV result from the implosion of ignition-scale inertial confinement fusion targets, such as those planned for the National Ignition Facility (NIF). Measurement of the tertiaries' slowing can provide a determination of the imploded areal density of the fuel capsule, as well as implosion asymmetry that results from anisotropy of the areal density and plasma temperature. In order to determine the utility of tertiaries for all phases of the NIF, we analyze three representative cases: a gas capsule (0.7 kJ yield); a cryogenic fuel capsule that fails to ignite (15 kJ); and a cryogenic fuel capsule that ignites and burns (13 000 kJ). In each case, tertiaries escape from the capsule and convey critical information about implosion dynamics. In addition, we show that for some gas-capsule implosions anticipated on OMEGA, tertiaries may be the only species of energetic charged particles that can determine the fuel areal density. Presently, we are building a charge-coupled device (CCD)-based charged particle spectrometer for OMEGA and for NOVA. In addition to the tertiaries, the spectrometers are sensitive to a variety of the energetic charged particles, such as knock-on protons, deuterons, and tritons, and 3He-burnup protons. In fact the latter set of charged particles will usually be the dominant signal. We will describe the basic features of the spectrometers and the measured response of the CCDs to 1-5 MeV protons, 1-5 MeV alphas, and 14 MeV neutrons (and associated gammas), the latter constitute the principal source of noise. This work is done in collaboration with C. K. Li, D. Hicks, and F. Seguin of MIT; with B. Burke of LL/MIT; with M. Cable, S. Pollaine, S. Haan, T. Bernat, T. Phillips, and J. Kilkenny of LLNL; with J, Knauer, S. Cremer, C. Verdon, and B. Kremens of University of Rochester; and with C. Ruiz and R. Leeper of SNL. This work is supported in part by LLNL Subcontract B313875 and University of Rochester Subcontract 410025-G.

Medical tourism in India: perceptions of physicians in tertiary care hospitals.

PubMed

Qadeer, Imrana; Reddy, Sunita

2013-12-17

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.

Medical tourism in india: perceptions of physicians in tertiary care hospitals

PubMed Central

2013-01-01

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. PMID:24345280

Unpredictable Feelings: Academic Women under Research Audit

ERIC Educational Resources Information Center

Grant, Barbara M.; Elizabeth, Vivienne

2015-01-01

Academic research is subject to audit in many national settings. In Aotearoa/New Zealand, the government regulates the flow of publicly funded research income into tertiary institutions through the Performance-Based Research Fund (PBRF). This article enquires into the effects of the PBRF by exploring data collected from 16 academic women of…

The Quest for Powerful Learning Environments in Higher Education

ERIC Educational Resources Information Center

Slabbert, J. A.; Gouws, D. G.

2006-01-01

An introductory course in on tertiary level inadvertently sets the scene for the demands of the corresponding profession. Unfortunately, it seems as though these courses do not prepare learners adequately to acquire the demanding professional competences required for professional success. This problem has been a subject of contention especially in…

Self-Employment among Italian Female Graduates

ERIC Educational Resources Information Center

Rosti, Luisa; Chelli, Francesco

2009-01-01

Purpose: The purpose of this paper is to investigate the gender impact of tertiary education on the probability of entering and remaining in self-employment. Design/methodology/approach: A data set on labour market flows produced by the Italian National Statistical Office is exploited by interviewing about 62,000 graduate and non-graduate…

Social Ecology as Innovative Tertiary Environmental Education.

ERIC Educational Resources Information Center

White, Lesley

1992-01-01

This paper explains the origin of the University of West Sidney's Bachelor of Applied Science in Social Ecology degree, and describes underlying philosophical framework, the major course organizing principles, and the proposed structure of the course. Highlights the problematic nature of setting up a dialectical, nondisciplinary-based program.…

The Prevalence and Symptoms Characteristic of Functional Constipation Using Rome III Diagnostic Criteria among Tertiary Education Students

PubMed Central

2016-01-01

Background and Aims Functional constipation is very common with heterogeneous symptoms that have substantial impact on patient quality of life as well as medical resources which are rarely reported as life-threatening. The aim of this study is to examine the prevalence and symptoms characteristic of functional constipation (FC) by using Rome III diagnostic criteria among tertiary education students with an intention to introduce treatment in the future. Methods Demographic, socio-economics characteristics and symptoms of FC using the Rome III criteria were sought using a questionnaire administered to Malaysian students in a tertiary education setting. Other data obtained were the general health status, lifestyle factors and anthropometric measurements. Using a simple random sampling method, a total of 1662 students were recruited in the study with a response rate of 95.0%. Sampled data are presented as frequency and percentage and stratified accordingly into categories for Chi-square analysis. Results The prevalence of functional constipation among the students was 16.2%, with a significantly higher prevalence among women (17.4%) than men (12.5%). Hard or lumpy stool, incomplete evacuation, anorectal obstruction and straining were reported as the commonest symptoms experienced. Type 3 was the most frequent stool consistency experienced among the constipated individuals (35.2%). Only 4.4% of individuals reported having less than three defecations per week. Using univariable analysis, FC was significantly associated with sex (odds ratio: 1.48, 95% CI: 1.06–2.06) and age group (odds ratio: 1.34, 95% CI: 1.01–1.79) with P value < 0.05 significance level. In multivariate logistic regression analysis, only sex was found significantly associated with FC (adjusted odds ratio: 1.53, 95% CI: 1.08–2.17, P < 0.05). Conclusions Based on the prevalence rate, constipation is a common problem among tertiary education students (16.2%), with significantly more prevalence among the female respondents. Early detection of symptoms and further intervention studies focusing on treatment recommendation in improving the symptoms are essential. PMID:27997551

Mapping the Typology of Transition Systems in a Liberal Market Economy: The Case of Canada

ERIC Educational Resources Information Center

Arnold, Christine Helen; Wheelahan, Leesa; Moodie, Gavin; Beaulieu, Jacqueline; Taylor-Cline, Jean-Claude

2018-01-01

This research explores links between tertiary education institutions and between tertiary education and the labour market as determinants of provincial and national transition patterns in Canada. The study consists of a provincial analysis that maps the typology of transition systems across Canada's devolved federated tertiary education structure.…

Tertiary network in mammalian mitochondrial tRNAAsp revealed by solution probing and phylogeny

PubMed Central

Messmer, Marie; Pütz, Joern; Suzuki, Takeo; Suzuki, Tsutomu; Sauter, Claude; Sissler, Marie; Catherine, Florentz

2009-01-01

Primary and secondary structures of mammalian mitochondrial (mt) tRNAs are divergent from canonical tRNA structures due to highly skewed nucleotide content and large size variability of D- and T-loops. The nonconservation of nucleotides involved in the expected network of tertiary interactions calls into question the rules governing a functional L-shaped three-dimensional (3D) structure. Here, we report the solution structure of human mt-tRNAAsp in its native post-transcriptionally modified form and as an in vitro transcript. Probing performed with nuclease S1, ribonuclease V1, dimethylsulfate, diethylpyrocarbonate and lead, revealed several secondary structures for the in vitro transcribed mt-tRNAAsp including predominantly the cloverleaf. On the contrary, the native tRNAAsp folds into a single cloverleaf structure, highlighting the contribution of the four newly identified post-transcriptional modifications to correct folding. Reactivities of nucleotides and phosphodiester bonds in the native tRNA favor existence of a full set of six classical tertiary interactions between the D-domain and the variable region, forming the core of the 3D structure. Reactivities of D- and T-loop nucleotides support an absence of interactions between these domains. According to multiple sequence alignments and search for conservation of Leontis–Westhof interactions, the tertiary network core building rules apply to all tRNAAsp from mammalian mitochondria. PMID:19767615

VizieR Online Data Catalog: SNLS and SDSS SN surveys photometric calibration (Betoule+, 2013)

NASA Astrophysics Data System (ADS)

Betoule, M.; Marriner, J.; Regnault, N.; Cuillandre, J.-C.; Astier, P.; Guy, J.; Balland, C.; El, Hage P.; Hardin, D.; Kessler, R.; Le Guillou, L.; Mosher, J.; Pain, R.; Rocci, P.-F.; Sako, M.; Schahmaneche, K.

2012-11-01

We present a joined photometric calibration for the SNLS and the SDSS supernova surveys. Our main delivery are catalogs of natural AB magnitudes for a large set of selected tertiary standard stars covering the science field of both surveys. Those catalogs are calibrated to the AB flux scale through observations of 5 primary spectrophotometric standard stars, for which HST-STIS spectra are available in the CALSPEC database. The estimate of the uncertainties associated to this calibration are delivered as a single covariance matrix. We also provide a model of the transmission efficiency of the SNLS photometric instrument MegaCam. Those transmission functions are required for the interpretation of MegaCam natural magnitudes in term of physical fluxes. Similar curves for the SDSS photometric instrument have been published in Doi et al. (2010AJ....139.1628D). Last, we release the measured magnitudes of the five CALSPEC standard stars in the magnitude system of the tertiary catalogs. This makes it possible to update the calibration of the tertiary catalogs if CALSPEC spectra for the primary standards are revised. (11 data files).

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review.

PubMed

Bonanni, L; Bontempo, G; Borrelli, I; Bifolchetti, S; Buongarzone, M P; Carlesi, N; Carolei, A; Ciccocioppo, F; Colangelo, U; Colonna, G; Desiderio, M; Ferretti, S; Fiorelli, L; D'Alessio, O; D'Amico, A; D'Amico, M C; De Lucia, R; Del Re, L; Di Blasio, F; Di Giacomo, R; Di Iorio, A; Di Santo, E; Di Giuseppe, M; Felice, N; Litterio, P; Gabriele, A; Mancino, E; Manzoli, L; Maruotti, V; Mearelli, S; Molino, G; Monaco, D; Nuccetelli, F; Onofrj, M; Perfetti, B; Sacchet, C; Sensi, F; Sensi, S; Sucapane, P; Taylor, J P; Thomas, A; Viola, P; Viola, S; Zito, M; Zhuzhuni, H

2013-06-01

Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.

Level of adherence to an extravasation protocol over 10 years in a tertiary care hospital.

PubMed

Molas-Ferrer, Gloria; Farré-Ayuso, Elisabet; doPazo-Oubiña, Fernando; deAndrés-Lázaro, Ana; Guell-Picazo, Jaume; Borrás-Maixenchs, Núria; Corominas-Bosch, Lourdes; Valverde-Bosch, Montserrat; Creus-Baró, Natalia

2015-04-01

Extravasation of chemotherapy is an undesirable complication related to the administration of antineoplastic therapy. Establishing the real incidence is difficult. Because of the importance of a quick intervention after an extravasation, every hospital should have an extravasation protocol. The purpose of this study was to determine the degree of observance of an extravasation protocol by nursing staff and to determine extravasation incidence. This descriptive, longitudinal, retrospective study was set in a tertiary-level hospital. The researchers reviewed 117 extravasation notification forms received by the pharmacy department during a 10-year period. Nursing actuation, particularly observance of the extravasation protocol, was analyzed. Protocol adherence was 89%. Twelve deviations from the protocol in the application of recommended measures were detected. An antidote was used in 41 patients, and temperature measures were applied in 14 cases. Ninety-nine patients had at least one episode of reported follow-up. No cases of necrosis or skin ulcers were described, except by one patient, who developed a delayed skin ulcer to vinorelbine. Drugs most frequently reported were etoposide, carboplatin, and paclitaxel. Nursing staff should be continuously trained in extravasation protocol because a rapid actuation can prevent skin lesions.

Factors that hinder organ donation: religio-cultural or lack of information and trust.

PubMed

Tumin, Makmor; Noh, Abdillah; Jajri, Idris; Chong, Chin-Sieng; Manikam, Rishya; Abdullah, Nawi

2013-06-01

This paper examines factors that influence Malaysian persons with a tertiary level of education on their willingness to donate organs. A survey was done in the Klang Valley (Kuala Lumpur and its suburbs) at several designated locations. A total of 1420 people were approached, and we focused the sample of 688 respondents with a tertiary level of education. Respondents were given 2 sets of answers: (1) a religio-cultural category and (2) a structural category. They were allowed to choose more than 1 reason. Our findings revealed that only 47.5 percent of respondents declined becoming organ donors. The highest frequency recorded was "I am not convinced that my body part will be used beneficially " (30.1%), followed by "I do not have enough access to information " (29.2%), "I want my body to remain intact after death " (16.9%), and "It is against my religion " (9.9%). Our study revealed that religio-cultural factors are not a prime explanation for the lack of organ donation in the Malaysian case. This study suggests that better procurement methods used by dedicated agencies, as well as better education, could reduce the shortage between organ supply and demand.

Extent of Information and Communication Technology (ICT) Utilization for Students' Learning in Tertiary Institutions in Ondo State, Nigeria

ERIC Educational Resources Information Center

Victor, Akinfolarin Akinwale; Bolanle, Rufai Rukayat

2017-01-01

This study investigated the extent of information and communication technology (ICT) utilization for students' learning in Ondo State tertiary institutions. The research design was descriptive survey. The target population comprises of all students in tertiary institutions of learning in Ondo State. A sample of two hundred (200) undergraduate…

Exploring the Relationship between Goal Orientations for Teaching of Tertiary Teachers and Their Teaching Approaches in China

ERIC Educational Resources Information Center

Han, Jiying; Yin, Hongbiao; Wang, Wenlan

2015-01-01

This study addresses a paucity of research into teacher motivation in higher education by exploring the relationship between tertiary teachers' goal orientations for teaching and their approaches to teaching in China. A questionnaire gathered responses from 262 Chinese tertiary teachers, and the results showed these teachers reporting higher…

Chinese Tertiary Teachers' Goal Orientations for Teaching and Teaching Approaches: The Mediation of Teacher Engagement

ERIC Educational Resources Information Center

Yin, Hongbiao; Han, Jiying; Lu, Genshu

2017-01-01

This study investigated the effects of Chinese tertiary teachers' goal orientations for teaching on their approaches to teaching mediated by teacher engagement. In a survey of 597 Chinese tertiary teachers, the respondents placed particular emphasis on relational and mastery goals and expressed a preference for student-focused approaches to…

Tertiary Education Policy in Ghana. An Assessment: 1988-1998.

ERIC Educational Resources Information Center

Girdwood, Alison

This study was one of several activities conducted at the end of a 5-year World Bank/Government of Ghana project, the Tertiary Education Project (TEP). This project was designed to assist the government of Ghana with the restructuring and quality enhancement of its tertiary education sector. Although the government had prepared an ambitious reform…

Exploding the Myth: Enhancing the Expression of Faith and Spirituality through the Study of Dance Composition in Christian Tertiary Education

ERIC Educational Resources Information Center

Coleman, Lucinda

2011-01-01

For dance educators engaged in teaching choreography in Christian tertiary institutes, encouraging students to develop foundational compositional skills whilst exploring personal expression of the Christian faith is undoubtedly a challenging objective. In 2005, a Christian tertiary education provider in South Australia enrolled six female dance…

Emotional Intelligence and the Conflict Resolution Repertoire of Couples in Tertiary Institutions in Imo State

ERIC Educational Resources Information Center

Nnodum, B. I.; Ugwuegbulam, C. N.; Agbaenyi, I. G.

2016-01-01

This study is a descriptive survey that investigated the relationship between emotional intelligence and conflict resolution repertoire of couples in tertiary institutions. A sample of 250 married people were drawn from the population of couples in tertiary institutions in Imo State. Two researcher made and validated instruments were used in…

Understanding and Enhancing Learning Communities in Tertiary Education in Science and Engineering

ERIC Educational Resources Information Center

Forret, Michael; Eames, Chris; Coll, Richard

2007-01-01

This research aims to build upon current research in the area of teaching and learning at tertiary level and explore the nature of learning communities in tertiary science and engineering. This study uses a sociocultural approach to address the following question: "What are teachers' and learners' perceptions of the nature of the learning…

Student Expectations of Tertiary Institutions: A Case Study of the Fiji National University (FNU)

ERIC Educational Resources Information Center

Khan, Shana Nigar

2012-01-01

Education is a human right and Fiji's tertiary education board recently declared that all tertiary institutions in Fiji must abide by the framework in order to meet student-customers' needs. The Fiji National University's (FNU's) destiny to be Fiji's leading higher education provider could be a reality if students and staff's expectations are…

A detailed taxonomy of Upper Cretaceous and lower Tertiary Crassatellidae in the Eastern United States; an example of the nature of extinction at the boundary

USGS Publications Warehouse

Wingard, G. Lynn

1993-01-01

Current theories on the causes of extinction at the CretaceousTertiary boundary have been based on previously published data; however, few workers have stopped to ask the question, 'How good is the basic data set?' To test the accuracy of the published record, a quantitative and qualitative analysis of the Crassatellidae (Mollusca, Bivalvia) of the Gulf and Mid-Atlantic Coastal Plains of the United States for the Upper Cretaceous and lower Tertiary was conducted. Thirty-eight species names and four generic names are used in publications for the Crassatellidae within the geographic and stratigraphic constraints of this analysis. Fourteen of the 38 species names are represented by statistically valid numbers of specimens and were tested by using canonical discriminant analysis. All 38 names, with the exception of 1 invalid name and 4 names for which no representative specimen could be located, were evaluated qualitatively. The results show that the published fossil record is highly inaccurate. Only 8 valid, recognizable species exist in the Crassatellidae within the limits of this study, 14 names are synonymized, and 11 names are represented by indeterminate molds or poorly preserved specimens. Three of the four genera are well founded; the fourth is based on the juvenile of another genus and therefore synonymized. This detailed taxonomic analysis of the Crassatellidae illustrates that the published fossil record is not reliable. Calculations of evolutionary and paleobiologic significance based on poorly defined, overly split fossil groups, such as the Crassatellidae, are biased in the following ways: Rates of evolution and extinction are higher, Faunal turnover at mass extinctions appears more catastrophic, Species diversity is high, Average species durations are shortened, and Geographic ranges are restricted. The data on the taxonomically standardized Crassatellidae show evolutionary rates one-quarter to one-half that of the published fossil record; faunal change at the Cretaceous-Tertiary boundary that was not catastrophic; a constant number of species on each side of the Cretaceous-Tertiary boundary; a decrease in abundance in the Tertiary; and lower species diversity, longer average species durations, and expanded geographic ranges. Similar detailed taxonomic studies need to be conducted on other groups of organisms to test the patterns illustrated for the Crassatellidae and to determine the extent and direction of the bias in the published fossil record. Answers to our questions about evolutionary change cannot be found in the literature but rather with the fossils themselves. Evolution and extinction occur within small populations of species groups, and it is only through detailed analysis of these groups that we can achieve an understanding of the causes and effects of evolution and extinction.

New Mexico structural zone - An analogue of the Colorado mineral belt

USGS Publications Warehouse

Sims, P.K.; Stein, H.J.; Finn, C.A.

2002-01-01

Updated aeromagnetic maps of New Mexico together with current knowledge of the basement geology in the northern part of the state (Sangre de Cristo and Sandia-Manzano Mountains)-where basement rocks were exposed in Precambrian-cored uplifts-indicate that the northeast-trending Proterozoic shear zones that controlled localization of ore deposits in the Colorado mineral belt extend laterally into New Mexico. The shear zones in New Mexico coincide spatially with known epigenetic precious- and base-metal ore deposits; thus, the mineralized belts in the two states share a common inherited basement tectonic setting. Reactivation of the basement structures in Late Cretaceous-Eocene and Mid-Tertiary times provided zones of weakness for emplacement of magmas and conduits for ore-forming solutions. Ore deposits in the Colorado mineral belt are of both Late Cretaceous-Eocene and Mid-Tertiary age; those in New Mexico are predominantly Mid-Tertiary in age, but include Late Cretaceous porphyry-copper deposits in southwestern New Mexico. The mineralized belt in New Mexico, named the New Mexico structural zone, is 250-km wide. The northwest boundary is the Jemez subzone (or the approximately equivalent Globe belt), and the southeastern boundary was approximately marked by the Santa Rita belt. Three groups (subzones) of mineral deposits characterize the structural zone: (1) Mid-Tertiary porphyry molybdenite and alkaline-precious-metal deposits, in the northeast segment of the Jemez zone; (2) Mid-Tertiary epithermal precious-metal deposits in the Tijeras (intermediate) zone; and (3) Late Cretaceous porphyry-copper deposits in the Santa Rita zone. The structural zone was inferred to extend from New Mexico into adjacent Arizona. The structural zone provides favorable sites for exploration, particularly those parts of the Jemez subzone covered by Neogene volcanic and sedimentary rocks. ?? 2002 Published by Elsevier Science B.V.

High prevalence of undiagnosed diabetes among tuberculosis patients in peripheral health facilities in Kerala

PubMed Central

Kumari, A. K.; Subramonianpillai, J.; Shabna, D. S.; Kumar, S. M.; Balakrishnan, S.; Naik, B.; Kumar, A. M. V.; Isaakidis, P.; Satyanarayana, S.

2013-01-01

Setting: Two tertiary care hospitals and 12 peripheral health institutions (PHIs) in Trivandrum, Kerala, India. Objective: To determine factors associated with the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients and examine differences in the proportion of new DM cases among TB patients diagnosed at tertiary care centres and PHIs. Design: A descriptive study: TB patients diagnosed during March–September 2012 were screened for known DM. Those with unknown DM status were tested for random blood glucose and fasting blood glucose (FBG); FBG ≥ 126 mg/dl was diagnosed as new DM. Results: Of 920 TB patients, 689 (72%) were male and the mean (standard deviation) age was 47.6 (16.4) years. Of these, 298 (32.4%) were diabetic: 235 (26%) had previously known DM and 63 (7%) were newly diagnosed. During the screening at PHIs and tertiary care hospitals, respectively 30/183 (16.4%) and 33/737 (4.5%) were newly diagnosed with DM (OR 3.71; 95%CI 2.17–6.32). Overall, age >50 years and pulmonary tuberculosis were independently associated with a higher prevalence of diabetes. Conclusion: As nearly one in three TB patients had DM, we recommend that TB patients should be routinely screened for DM in Kerala. As the proportion of new DM was higher among TB patients diagnosed at PHIs, we would recommend that specific attention and investment be directed to PHIs. PMID:26393068

Tertiary education and its association with mental health indicators and educational factors among Arctic young adults: the NAAHS cohort study.

PubMed

Bania, Elisabeth Valmyr; Kvernmo, Siv Eli

2016-01-01

Background Completed tertiary education is closely associated with employment and influences income, health and personal well-being. Objective The purpose of the study is to explore predictors for completed tertiary education among indigenous Sami and non-indigenous young people in relation to mental health indicators and educational factors in sociocultural rural and urban contexts across the Arctic part of Norway. Design The Norwegian Arctic Adolescent Health Study (NAAHS) is a cross-sectional, school-based survey that was conducted in 2003-2005. Of all 5,877 10th graders (aged 15-16 years) in north Norway, 83% from all 87 municipalities participated; 450 (9.2%) reported indigenous Sami ethnicity, and 304 (6.2%) reported Laestadian affiliation. Data from NAAHS were merged with registry data from the National Education Database and Norwegian Patient Register for 3,987 adolescents who gave their consent for follow-up studies. Results Completion of upper secondary school is the only common predictor of a completed tertiary education degree for both genders. Among females, conduct problems was a significant predictor of lower level education, typically vocational professions, while among males severe mental health problems requiring treatment by the specialist health care system reduced the opportunity to complete tertiary education at intermediate and higher level. Parental higher educational level was associated with less lower education among females and less higher education among males. Men residing in the northernmost and remote areas were less likely to complete education on higher level. Males' completion of higher level education was strongly but not significantly associated (p=0.057) with higher average marks in lower secondary school. Conclusions The gender differences found in this study emphasize the need for gender-specific interventions to encourage, support and empower young people to attend and complete tertiary education. Young females with conduct problems choose lower or intermediate education, and males in need of specialist mental health care have half the chance to complete intermediate tertiary education compared with males not in contact with the mental health service. Closer cooperation between low threshold social services, general practitioners, mental health services and higher study institutions can help young male adults complete tertiary education.

Ecotoxicity assessment of artificial groundwater recharge with reclaimed water: a pilot-scale study.

PubMed

Zhang, Xue; Zhao, Xuan

2013-11-01

A demonstration of artificial groundwater recharge with tertiary effluent was evaluated using a set of bioassays (acute toxicity to Daphnia, genotoxicity, estrogenic and antiestrogenic toxicity). Around 95 % genotoxicity and 53 % antiestrogenicity were removed from the feed water by ozonation, whereas significant reduction of acute toxicity to Daphnia magna was achieved during a 3 days vadose soil treatment. The toxicity was further removed to the same level as the local groundwater during a 20 days aquifer soil treatment. The pilot study has shown that ozonation and soil treatments can improve the quality of municipal wastewater treatment plant effluents for possible groundwater recharge purposes.

Reflections and New Directions

ERIC Educational Resources Information Center

Black, Paul; McCormick, Robert

2010-01-01

In introducing the articles in this issue, Black and McCormick are struck by two features. The first is that they comprise a rich set of resources for stimulating further thinking about tertiary education. The second, which follows from the first, is that they raise possibilities for further development of this field. They draw attention, in…

E-learning Constructive Role Plays for EFL Learners in China's Tertiary Education

ERIC Educational Resources Information Center

Shen, Lin; Suwanthep, Jitpanat

2011-01-01

Recently, speaking has played an increasingly important role in second/foreign language settings. However, in many Chinese universities, EFL students rarely communicate in English with other people effectively. The existing behavioristic role plays on New Horizon College English (NHCE) e-learning do not function successfully in supplementing EFL…

New Technology, Changing Pedagogies? Exploring the Concept of Remote Teaching Placement Supervision

ERIC Educational Resources Information Center

Chilton, Helen; McCracken, Wendy

2017-01-01

Mobile technologies continue to have a growing influence on contemporary society, are becoming more commonplace within tertiary educational settings and hold the potential to impact on the learning process. This project evaluation considers the perspectives of participants who trialled the use of new technology to enable remote supervision and…

ICT in EMI Programmes at Tertiary Level in Spain: A Holistic Model

ERIC Educational Resources Information Center

Hernandez-Nanclares, Nuria; Jimenez-Munoz, Antonio

2016-01-01

The European Higher Education Area (EHEA) in Spain has increased the number of degrees taught through English, although secondary schools do not ensure an appropriate set of linguistic skills for bilingual degrees. A holistic, accountable model for Information and Communications Technology (ICT)-supported learning can give students the adequate…

A Compound Herbal Preparation (CHP) in the Treatment of Children with ADHD: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Katz, M.; Adar Levine, A.; Kol-Degani, H.; Kav-Venaki, L.

2010-01-01

Objective: Evaluation of the efficacy of a patented, compound herbal preparation (CHP) in improving attention, cognition, and impulse control in children with ADHD. Method: Design: A randomized, double-blind, placebo-controlled trial. Setting: University-affiliated tertiary medical center. Participants: 120 children newly diagnosed with ADHD,…

Tertiary Education in Australia: Part II

ERIC Educational Resources Information Center

Berends, Willem

2012-01-01

Australia has no Christian universities or Christian liberal arts colleges other than Australian Catholic University, which has six campuses in five cities. This paper examines one long-term attempt to set up such an institution, which ended in the project being abandoned for lack of progress. Some likely reasons for failure are identified in the…

Transformational leadership: effect on the job satisfaction of Registered Nurses in a hospital in China.

PubMed

Wang, Xiaohui; Chontawan, Ratanawadee; Nantsupawat, Raymoul

2012-02-01

The aim of this study was to describe the relationship between the transformational leadership of nurse managers and job satisfaction among clinical Registered Nurses at a tertiary care hospital in China. The healthcare system is changing rapidly. Research in Western countries has shown that transformational leadership affects job satisfaction. However, very little research related to this subject has been conducted in healthcare settings in China. The sample consisted of 238 nurses who work at a tertiary care hospital in China. Data were collected from April to August 2006. Research instruments included a demographic data form, a Leadership Practice Inventory and a Job Satisfaction Scale for clinical registered nurses. Both the transformational leadership of nurse managers and job satisfaction among clinical Registered Nurses were at a moderate level. There was a statistically significant positive correlation between the transformational leadership of nurse managers and job satisfaction (r = 0·556, P < 0·001). The findings indicate that the transformational leadership of nurse managers could have an effect on the job satisfaction of clinical Registered Nurses. © 2011 Blackwell Publishing Ltd.

Extreme close approaches in hierarchical triple systems with comparable masses

NASA Astrophysics Data System (ADS)

Haim, Niv; Katz, Boaz

2018-06-01

We study close approaches in hierarchical triple systems with comparable masses using full N-body simulations, motivated by a recent model for type Ia supernovae involving direct collisions of white dwarfs (WDs). For stable hierarchical systems where the inner binary components have equal masses, we show that the ability of the inner binary to achieve very close approaches, where the separation between the components of the inner binary reaches values which are orders of magnitude smaller than the semi-major axis, can be analytically predicted from initial conditions. The rate of close approaches is found to be roughly linear with the mass of the tertiary. The rate increases in systems with unequal inner binaries by a marginal factor of ≲ 2 for mass ratios 0.5 ≤ m1/m2 ≤ 1 relevant for the inner white-dwarf binaries. For an average tertiary mass of ˜0.3M⊙ which is representative of typical M-dwarfs, the chance for clean collisions is ˜1% setting challenging constraints on the collisional model for type Ia's.

Staff Perception on Biomedical or Health Care Waste Management: A Qualitative Study in a Rural Tertiary Care Hospital in India

PubMed Central

Joshi, Rita; Shah, Harshada; Sharma, Megha; Pathak, Ashish; Macaden, Ragini; Stålsby Lundborg, Cecilia

2015-01-01

Background Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management. Method A qualitative study was conducted using 10 focus group discussions (FGDs), with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i) role of Health Care Waste Management (HCWM) in prevention of health care associated infections, (ii) awareness of and views about HCWM-related guidelines/legislation, (iii) current HCWM practices, (iv) perception and preparedness related to improvements of the current practices, and (v) proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi) and analysed using content analysis. Results Two themes were identified: Theme (A), ‘Challenges in integration of HCWM in organizational practice,’ with the categories (I) Awareness and views about HCWM, (II) Organizational practices regarding HCWM, and (III) Challenges in Implementation of HCWM; and Theme (B), ‘Interventions to improve HCWM,’ with three categories, (I) Educational and motivational interventions, (II) Organizational culture change, and (III) Policy-related interventions. Conclusion A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings. PMID:26023783

The Effect of Tertiary Teachers' Goal Orientations for Teaching on Their Commitment: The Mediating Role of Teacher Engagement

ERIC Educational Resources Information Center

Han, Jiying; Yin, Hongbiao; Wang, Wenlan

2016-01-01

This study explored the effect of tertiary teachers' goal orientations for teaching on their commitment, with a particular focus on the mediating role of teacher engagement. The results of a survey of 597 Chinese tertiary teachers indicated that teacher commitment was positively predicted by ability approach, mastery and relational goals, but was…

Lecturers' Job Satisfaction in a Public Tertiary Institution in Singapore: Ambivalent and Non-Ambivalent Relationships between Job Satisfaction and Demographic Variables

ERIC Educational Resources Information Center

Paul, Emily Pakivathy; Phua, Seok Kheng

2011-01-01

Increasing lecturer turnover rates and fewer qualified recruits choosing a career in academia threaten the integrity of the tertiary education system in Singapore. The purpose of this study was to ascertain the relationship between lecturers' job satisfaction levels in a public tertiary institution and selected demographic variables. The study…

Standardization or Localization: A Study of Online Learning Programmes by Tertiary Institutions in Ghana

ERIC Educational Resources Information Center

Djan, Josephine; George, Babu

2016-01-01

Many universities in Ghana have had a desire to ensure equitable access to formal tertiary education for the growing number of the working public who have sought to improve or better their educational status in tertiary institutions. For many of these working public or individuals, it is almost impossible to stay off work to enrol in these…

A Comparison of Teacher and Lecturer Perspectives on the Transition from Secondary to Tertiary Mathematics Education

ERIC Educational Resources Information Center

Hong, Ye Yoon; Kerr, Suzanne; Klymchuk, Sergiy; McHardy, Johanna; Murphy, Priscilla; Spencer, Sue; Thomas, Michael O. J.; Watson, Peter

2009-01-01

The transition from school to tertiary study of mathematics comes under increasing scrutiny in research. This article reports on some findings from a project analysing the transition from secondary to tertiary education in mathematics. One key variable in this transition is the teacher or lecturer. This article deals with a small part of the data…

The Incidence and Management of Conflicts in Secular and Non-Secular Tertiary Institutions in South West Nigeria

ERIC Educational Resources Information Center

Ayodele, Joseph Babatola; Adewumi, Joseph Olukayode

2007-01-01

This paper compared the incidence and management of conflicts in secular and non-secular tertiary institutions in Nigeria. The sample of this study was made of sixty staff, and two hundred and forty students randomly selected each from two secular and two non-secular tertiary institutions in south western Nigeria. A validated questionnaire was…

Difference between Japanese Secondary and Tertiary Medical Facilities Regarding Changes in the Hospitalization of Children for Pneumonia after the Introduction of the Pneumococcal Conjugate Vaccine.

PubMed

Haro, Kaoru; Ogawa, Masato; Hoshina, Takayuki; Kojiro, Masumi; Kusuhara, Koichi

2017-05-24

This study aimed to compare hospitalization of children for pneumonia between secondary and tertiary medical facilities, which hospitalize many children without and with underlying diseases, respectively, after the introduction of the pneumococcal conjugate vaccine (PCV). Our retrospective study included children admitted to the Department of Pediatrics at Kitakyushu General Hospital, a secondary medical facility, and the Hospital of the University of Occupational and Environment Health, Japan, a tertiary medical facility, from 2009 to 2013 for pneumonia. We compared the change in the rate of hospitalization for pneumonia after the introduction of the 7-valent PCV between the secondary and tertiary medical facilities. Hospitalization of patients with pneumonia declined by 28.8% in our secondary medical facility. In particular, hospitalization for pneumonia other than confirmed mycoplasmal or viral pneumonia was significantly reduced by 49.2%. In contrast, hospitalization of patients with pneumonia did not decline in our tertiary medical facility. After the introduction of PCV, hospitalization of children for pneumonia was not reduced at the tertiary medical facility. Various other pathogens besides pneumococcus may be associated with the development of pneumonia in children with underlying diseases.

SARS and hospital priority setting: a qualitative case study and evaluation.

PubMed

Bell, Jennifer A H; Hyland, Sylvia; DePellegrin, Tania; Upshur, Ross E G; Bernstein, Mark; Martin, Douglas K

2004-12-19

Priority setting is one of the most difficult issues facing hospitals because of funding restrictions and changing patient need. A deadly communicable disease outbreak, such as the Severe Acute Respiratory Syndrome (SARS) in Toronto in 2003, amplifies the difficulties of hospital priority setting. The purpose of this study is to describe and evaluate priority setting in a hospital in response to SARS using the ethical framework 'accountability for reasonableness'. This study was conducted at a large tertiary hospital in Toronto, Canada. There were two data sources: 1) over 200 key documents (e.g. emails, bulletins), and 2) 35 interviews with key informants. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Participants described the types of priority setting decisions, the decision making process and the reasoning used. Although the hospital leadership made an effort to meet the conditions of 'accountability for reasonableness', they acknowledged that the decision making was not ideal. We described good practices and opportunities for improvement. 'Accountability for reasonableness' is a framework that can be used to guide fair priority setting in health care organizations, such as hospitals. In the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain, and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less.

Tertiary alphabet for the observable protein structural universe.

PubMed

Mackenzie, Craig O; Zhou, Jianfu; Grigoryan, Gevorg

2016-11-22

Here, we systematically decompose the known protein structural universe into its basic elements, which we dub tertiary structural motifs (TERMs). A TERM is a compact backbone fragment that captures the secondary, tertiary, and quaternary environments around a given residue, comprising one or more disjoint segments (three on average). We seek the set of universal TERMs that capture all structure in the Protein Data Bank (PDB), finding remarkable degeneracy. Only ∼600 TERMs are sufficient to describe 50% of the PDB at sub-Angstrom resolution. However, more rare geometries also exist, and the overall structural coverage grows logarithmically with the number of TERMs. We go on to show that universal TERMs provide an effective mapping between sequence and structure. We demonstrate that TERM-based statistics alone are sufficient to recapitulate close-to-native sequences given either NMR or X-ray backbones. Furthermore, sequence variability predicted from TERM data agrees closely with evolutionary variation. Finally, locations of TERMs in protein chains can be predicted from sequence alone based on sequence signatures emergent from TERM instances in the PDB. For multisegment motifs, this method identifies spatially adjacent fragments that are not contiguous in sequence-a major bottleneck in structure prediction. Although all TERMs recur in diverse proteins, some appear specialized for certain functions, such as interface formation, metal coordination, or even water binding. Structural biology has benefited greatly from previously observed degeneracies in structure. The decomposition of the known structural universe into a finite set of compact TERMs offers exciting opportunities toward better understanding, design, and prediction of protein structure.

Tertiary alphabet for the observable protein structural universe

PubMed Central

Mackenzie, Craig O.; Zhou, Jianfu; Grigoryan, Gevorg

2016-01-01

Here, we systematically decompose the known protein structural universe into its basic elements, which we dub tertiary structural motifs (TERMs). A TERM is a compact backbone fragment that captures the secondary, tertiary, and quaternary environments around a given residue, comprising one or more disjoint segments (three on average). We seek the set of universal TERMs that capture all structure in the Protein Data Bank (PDB), finding remarkable degeneracy. Only ∼600 TERMs are sufficient to describe 50% of the PDB at sub-Angstrom resolution. However, more rare geometries also exist, and the overall structural coverage grows logarithmically with the number of TERMs. We go on to show that universal TERMs provide an effective mapping between sequence and structure. We demonstrate that TERM-based statistics alone are sufficient to recapitulate close-to-native sequences given either NMR or X-ray backbones. Furthermore, sequence variability predicted from TERM data agrees closely with evolutionary variation. Finally, locations of TERMs in protein chains can be predicted from sequence alone based on sequence signatures emergent from TERM instances in the PDB. For multisegment motifs, this method identifies spatially adjacent fragments that are not contiguous in sequence—a major bottleneck in structure prediction. Although all TERMs recur in diverse proteins, some appear specialized for certain functions, such as interface formation, metal coordination, or even water binding. Structural biology has benefited greatly from previously observed degeneracies in structure. The decomposition of the known structural universe into a finite set of compact TERMs offers exciting opportunities toward better understanding, design, and prediction of protein structure. PMID:27810958

A hybrid MD-kMC algorithm for folding proteins in explicit solvent.

PubMed

Peter, Emanuel Karl; Shea, Joan-Emma

2014-04-14

We present a novel hybrid MD-kMC algorithm that is capable of efficiently folding proteins in explicit solvent. We apply this algorithm to the folding of a small protein, Trp-Cage. Different kMC move sets that capture different possible rate limiting steps are implemented. The first uses secondary structure formation as a relevant rate event (a combination of dihedral rotations and hydrogen-bonding formation and breakage). The second uses tertiary structure formation events through formation of contacts via translational moves. Both methods fold the protein, but via different mechanisms and with different folding kinetics. The first method leads to folding via a structured helical state, with kinetics fit by a single exponential. The second method leads to folding via a collapsed loop, with kinetics poorly fit by single or double exponentials. In both cases, folding times are faster than experimentally reported values, The secondary and tertiary move sets are integrated in a third MD-kMC implementation, which now leads to folding of the protein via both pathways, with single and double-exponential fits to the rates, and to folding rates in good agreement with experimental values. The competition between secondary and tertiary structure leads to a longer search for the helix-rich intermediate in the case of the first pathway, and to the emergence of a kinetically trapped long-lived molten-globule collapsed state in the case of the second pathway. The algorithm presented not only captures experimentally observed folding intermediates and kinetics, but yields insights into the relative roles of local and global interactions in determining folding mechanisms and rates.

Secondary structure encodes a cooperative tertiary folding funnel in the Azoarcus ribozyme

PubMed Central

Mustoe, Anthony M.; Al-Hashimi, Hashim M.; Brooks, Charles L.

2016-01-01

A requirement for specific RNA folding is that the free-energy landscape discriminate against non-native folds. While tertiary interactions are critical for stabilizing the native fold, they are relatively non-specific, suggesting additional mechanisms contribute to tertiary folding specificity. In this study, we use coarse-grained molecular dynamics simulations to explore how secondary structure shapes the tertiary free-energy landscape of the Azoarcus ribozyme. We show that steric and connectivity constraints posed by secondary structure strongly limit the accessible conformational space of the ribozyme, and that these so-called topological constraints in turn pose strong free-energy penalties on forming different tertiary contacts. Notably, native A-minor and base-triple interactions form with low conformational free energy, while non-native tetraloop/tetraloop–receptor interactions are penalized by high conformational free energies. Topological constraints also give rise to strong cooperativity between distal tertiary interactions, quantitatively matching prior experimental measurements. The specificity of the folding landscape is further enhanced as tertiary contacts place additional constraints on the conformational space, progressively funneling the molecule to the native state. These results indicate that secondary structure assists the ribozyme in navigating the otherwise rugged tertiary folding landscape, and further emphasize topological constraints as a key force in RNA folding. PMID:26481360

A systematic study on the prevention and treatment of retinopathy of prematurity in China.

PubMed

Xu, Shuman; Liang, Zhijiang; Du, Qiyun; Li, Zhankui; Tan, Guangming; Nie, Chuan; Yang, Yang; Lv, Xuzai; Zhang, Chunyi; Luo, Xianqiong

2018-02-14

To identify the prevention situation, the main factors influencing prevention effects and to develop control measures over retinopathy of prematurity in China. Using stratified random sampling method, we randomly selected 23 provincial and ministerial hospitals (8 in Guangdong province, 5 in Hunan province and 10 in Shaanxi province), 81 municipal hospitals (38 in Guangdong province, 19 in Hunan province and 24 in Shaanxi province), 180 district and county hospitals (76 in Guangdong province, 57 in Hunan province and 47 in Shaanxi province) in China. A total of 284 hospitals were enrolled in the study, with questionnaires distributed investigating the status and constrain factors of ROP presentation. Significant outcomes were analyzed thereafter by SPSS 19.0. The screening rate of ROP in medical institutions from eastern, central and western China were 84.6%, 35.0% and 56.7%, respectively. The screening rate of tertiary and secondary medical institutions were 84.6% and 25.7% in the eastern, 35.0% and 4.9% in the central, 56.7% and 5.9% in the western region. Screening was carried out better in the tertiary than that in the secondary and primary institutions. Treatment for ROP was available in 15.7% of all the tertiary hospitals surveyed. Lack of professionals, equipments and technologies were considered to be major restrain factors for screening. The ROP screening and treatment status have demonstrated significant regional diversity due to uneven distribution of medical resources in China. Developed areas had established intraregional cooperation models, whereas less-developed areas should consider set up a large-scale, three-level ROP prevention network. It is of paramount importance that education and training towards ophthalmologists should be vigorously strengthened. It is strongly recommended that implement ROP telemedicine and integrated ROP prevention and management platforms through the Internet should be established.

Introduction of the Misgav Ladach caesarean section at an African tertiary centre: a randomised controlled trial.

PubMed

Björklund, K; Kimaro, M; Urassa, E; Lindmark, G

2000-02-01

To determine whether the Misgav Ladach caesarean section technique can offer benefits compared with conventional caesarean section technique in the prevailing conditions of a busy African tertiary centre. A randomised controlled trial. A tertiary African obstetric unit with 18,000 deliveries annually. Three hundred and thirty-nine women undergoing caesarean section. Eight residents and registrars were instructed in the Misgav Ladach technique for caesarean section during one week, after which the study commenced. The course participants instructed their colleagues; in total, 16 doctors participated. Women requiring caesarean section were randomised to Misgav Ladach or to the conventional lower midline incision procedure, excluding those with a previous scar. During 11 weeks 339 randomised procedures (328 of which were emergency procedures) were carried out. Mean operating time was 25 x 3 minutes for Misgav Ladach and 32 x 6 minutes for the lower midline incision procedure (95% CI -8 x 3; -6 x 3). Mean blood loss was 354 mL and 447 mL (-133; -53), and the number of sutures 3 x 1 and 6 x 1 (-3 x 1; -2 x 9), respectively. No significant difference was found in Apgar scores. Mobilisation was earlier with the Misgav Ladach procedure. No difference was found in overall post-operative infection rates i.e. wound infection or febrile illness, but the combination of wound infection and fever was more common in the Misgav Ladach group. The Misgav Ladach caesarean section confers benefits such as reduced blood loss, conservation of time and suture material, and rapid mobilisation, but more studies are needed to explore modifications aimed at reducing post-operative infections in settings with limited resources.

Consumer satisfaction with tertiary healthcare in China: findings from the 2015 China National Patient Survey.

PubMed

Sun, Jing; Hu, Guangyu; Ma, Jing; Chen, Yin; Wu, Laiyang; Liu, Qiannan; Hu, Jia; Livoti, Christine; Jiang, Yu; Liu, Yuanli

2017-04-01

This study aims to develop understanding of Chinese patient satisfaction with tertiary hospitals. The study draws on data collected from the 2015 China National Patient Survey. A Likert five-point scale was used to formulate the questionnaires. Descriptive analysis and logistic regression analysis were conducted. A structured questionnaire was used by 1432 interviewers to interview 27 475 outpatients and 19 938 inpatients in 136 tertiary hospitals from 31 provinces. Outpatients in the dispensing area and inpatients in the discharging area were randomly interviewed. Key domains of the questionnaire include the layout of service functions, environment maintenance, process management, quality of care, humane care and the patient-doctor relationship. Within each domain, several indicators were set, and each indicator was given a statement. The overall satisfaction scores are 4.42 ± 0.68 and 4.67 ± 0.62 for outpatient and inpatient, respectively. The domains with highest satisfaction are 'diagnosis and treatment' for outpatient and 'nursing care' for inpatient. Outpatients were least satisfied with long waiting time, while inpatients were least satisfied with the food. The strongest predictor of overall satisfaction appears to be 'patient-doctor relationship' for both outpatients (OR = 3.53, 95% CI: 3.17-3.92) and inpatients (OR = 7.34, 95% CI: 5.55-9.70). Chinese hospitals need to pay more attention to offering more humane care to patients, hospital environment and process management improvement, reducing waiting times for seeing doctors and outpatient testing, and improving amenity services such as better food in the wards. © The Author 2017. 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

Distinguishing between tertiary and secondary facilities: a case study of cardiac diagnostic-related groups (DRGs).

PubMed

Rouse, Paul; Arulambalam, Ajit; Correa, Ralph; Ullman, Cornelia

2010-05-14

To develop a classification of tertiary cardiac DRGs in order to investigate differences in tertiary/secondary product mix across New Zealand district health boards (DHBs). 67 DRGs from 85,442 cardiac cases were analysed using cost weights and patient comorbidity complexity levels, which were used as a proxy for complexity. The research found high variability of severity within some DRGs. 5 DHBs are the main providers of 27 DRGs which are high cost and identified as tertiary by several ADHB clinicians; the same 5 DHBs have on average higher severity by DRG than the other DHBs. NZ tertiary hospitals have a product mix of DRGs with higher complexity than secondary hospitals. Funding based on case weights needs to recognise the additional resource requirements for this higher complexity.

Secondary and Tertiary Citing: A Study of Referencing Behavior in the Literature of Citation Analysis Deriving from the Ortega Hypothesis of Cole and Cole.

ERIC Educational Resources Information Center

Hoerman, Heidi Lee; Nowicke, Carole Elizabeth

1995-01-01

Examines documents and citations relating to literature of the Ortega Hypothesis, reviews citing behaviors and errors of individual citations, and includes analysis of the occurrences of secondary and tertiary citing. Findings show there is little evidence to prove that secondary and tertiary citing is not occurring and suggests that further…

The Spread of Higher Education around the Globe: A Cross- Country Analysis of Gross Tertiary Education Enrollment, 1999-2005

ERIC Educational Resources Information Center

Yu, Patricia; Delaney, Jennifer A.

2016-01-01

Many nation-states have realized the importance of tertiary education and the world has seen a corollary increase in tertiary education enrollments. Using Berry and Berry's event history model as a framework, this study tests both the internal features of each country and the influence that nation-states have on each other with regard to setting…

Exploration of Novel Chemical Space: Synthesis and in vitro Evaluation of N-Functionalized Tertiary Sulfonimidamides.

PubMed

Izzo, Flavia; Schäfer, Martina; Lienau, Philip; Ganzer, Ursula; Stockman, Robert; Lücking, Ulrich

2018-05-04

An unprecedented set of structurally diverse sulfonimidamides (47 compounds) has been prepared by various N-functionalization reactions of tertiary =NH sulfonimidamide 2 aa. These N-functionalization reactions of model compound 2 aa include arylation, alkylation, trifluoromethylation, cyanation, sulfonylation, alkoxycarbonylation (carbamate formation) and aminocarbonylation (urea formation). Small molecule X-ray analyses of selected N-functionalized products are reported. To gain further insight into the properties of sulfonimidamides relevant to medicinal chemistry, a variety of structurally diverse reaction products were tested in selected in vitro assays. The described N-functionalization reactions provide a short and efficient approach to structurally diverse sulfonimidamides which have been the subject of recent, growing interest in the life sciences. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Power to the paediatricians: the Australian Paediatric Research Network is born.

PubMed

Hiscock, Harriet; Efron, Daryl; Wasserman, Richard; Wake, Melissa

2012-01-01

In late 2007, we established the Australian Paediatric Research Network (APRN) - a 350 member strong research network - which aims to facilitate high quality research into common, child health conditions seen in secondary care settings. Through this network we hope to engage paediatricians working at 'the coal face' to generate research ideas, take part in projects and ultimately contribute to better health care and policy for Australian children. As for adults, tertiary institutions remain the predominant site of paediatric research. Tertiary research however, is biased towards severe illness, isolated conditions, highly selected patients and single interventions. This is not always relevant to the real world that paediatricians confront every day. The APRN is off to a strong start. We have worked with members to establish their research priorities and conducted a prospective audit of their caseload to inform the relevance, feasibility and design of future APRN studies. We have developed a website (http://www.aprn.org.au) which will house useful tools for conducting research including child health measures and project design needs. We plan to call for member-initiated research proposals on an annual basis and to conduct a 'multi-topic' survey addressing up to six research topics at any one time. Although conducting research in secondary care settings poses time, cost and process challenges, all of these are firmly within the APRN's sights. © 2010 The Authors. Journal compilation © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Otolaryngology Service Usage in Children With Cleft Palate.

PubMed

Whittemore, Kenneth R; Dargie, Jenna M; Dornan, Briana K; Boudreau, Brian

2018-05-01

To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Retrospective case series. Specialty clinic at a pediatric tertiary care hospital. Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.

Factors Associated with Failure to Achieve SVR in Hepatitis C Genotype 3 Patients Within an Integrated Care Delivery System.

PubMed

Cheetham, T Craig; Niu, Fang; Chiang, Kevin; Yuan, Yong; Kalsekar, Anu; Hechter, Rulin; Hay, Joel W; Nyberg, Lisa

2015-08-01

Achievement of sustained virologic response (SVR) and factors associated with treatment failure in hepatitis C virus (HCV) genotype 3 have been described in tertiary and referral care settings, with rates of SVR reported to range between 72% and 89%. Fewer data exist on SVR outside of these settings. To describe rates of SVR and characterize factors associated with achievement of SVR within an integrated health care delivery system. A retrospective cohort study of genotype 3 HCV patients treated with dual therapy (pegylated interferon-alpha plus ribavirin) was conducted at Kaiser Permanente Southern California. Adult patients diagnosed with HCV and testing positive for HCV-RNA genotype 3 were identified from electronic medical records. Data were collected on patient demographics, baseline health status, and comorbid conditions. A multivariate logistic regression model was used to determine the association between baseline patient factors and SVR. A total of 484 HCV genotype 3 patients met the eligibility criteria. The median age was 49 years, and 65.7% were male. Overall, 252 (52.1%) achieved SVR. Aged ≥ 45 years and male gender were associated with lower rates of SVR; cirrhosis and chronic diseases (diabetes and chronic obstructive pulmonary disease) were also associated with lower rates of SVR. SVR was lower in patients within an integrated care delivery system than in those in tertiary and referral centers. Males and older patients had lower rates of SVR, as well as patients with cirrhosis, diabetes, and chronic obstructive pulmonary disease.

Comparison of Ramadan-specific education level in patients with diabetes seen at a Primary and a Tertiary care center of Karachi-Pakistan.

PubMed

Masood, Shabeen Naz; Alvi, Syed Faraz Danish; Ahmedani, Muhammad Yakoob; Kiran, Shazia; Zeeshan, Nimra Fatima; Basit, Abdul; Shera, A Samad

2014-01-01

To compare Ramadan-specific education level in fasting patients with diabetes at a Primary and a Tertiary care center. An observational study was conducted in the Outpatient departments of a Primary care center and a Tertiary care center in Karachi-Pakistan. Recruitment of patients started at the end of Ramadan 2011 and continued till three months after Ramadan 2011. All patients with diabetes who observed fast during the month of Ramadan 2011 were included in the study. In Primary care center, patients were attended by physicians only, while at Tertiary care center patients were seen by physicians, diabetes educator and dietician. For data collection, standardized questionnaire based interview was conducted on one to one basis by trained healthcare professionals. Same questionnaire was used at both the centers. A total of 392 and 199 patients with diabetes recruited at Primary and Tertiary care centers, respectively. Ramadan-specific diabetes education received by 213 (55%) and 123 (61.80%) patients with diabetes at Primary and Tertiary care centers, respectively. Compared to Primary care center, patients at Tertiary care centers were more aware about components of Ramadan-specific diabetes education such as signs and symptoms of hypoglycemia and hyperglycemia, dose of medicines/insulin during Ramadan fasting, dose of medicines/insulin when not fasting, self-monitoring of blood glucose, dietary modifications, physical activity, adequate nutrition and adequate hydration during Ramadan (p<0.05). It was observed that Ramadan-specific education level of patients at Tertiary care center was significantly better compared to patients at Primary care center. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

A Multivariate Analysis of Secondary Students' Experience of Web-Based Language Acquisition

ERIC Educational Resources Information Center

Felix, Uschi

2004-01-01

This paper reports on a large-scale project designed to replicate an earlier investigation of tertiary students (Felix, 2001) in a secondary school environment. The new project was carried out in five settings, again investigating the potential of the Web as a medium of language instruction. Data was collected by questionnaires and observational…

Development of Critical Thinking through Aesthetic Experience: The Case of Students of an Educational Department

ERIC Educational Resources Information Center

Raikou, Natassa

2016-01-01

This article addresses an application performed in tertiary education--a department of pedagogical and educational sciences--of a contemporary method, Transformative Learning through Aesthetic Experience. The method is based on the use of art and aims to reinforce and promote the development of critical thinking within educational settings.…

Functional Behavior Assessments and Behavior Intervention Plans in Rural Schools: An Exploration of the Need, Barriers, and Recommendations

ERIC Educational Resources Information Center

Oram, Lindsay; Owens, Sarah; Maras, Melissa

2016-01-01

A wealth of research highlights negative outcomes associated with mental and behavioral health problems in children and adolescents. Prevention-based frameworks have been developed to provide prevention and early intervention in the school setting. Tertiary behavioral supports often include the use of functional behavior assessments (FBAs) and…

Explaining the uptake of paediatric guidelines in a Kenyan tertiary hospital--mixed methods research.

PubMed

Irimu, Grace W; Greene, Alexandra; Gathara, David; Kihara, Harrison; Maina, Christopher; Mbori-Ngacha, Dorothy; Zurovac, Dejan; Santau, Migiro; Todd, Jim; English, Mike

2014-03-10

Evidence-based standards for management of the seriously sick child have existed for decades, yet their translation in clinical practice is a challenge. The context and organization of institutions are known determinants of successful translation, however, research using adequate methodologies to explain the dynamic nature of these determinants in the quality-of-care improvement process is rarely performed. We conducted mixed methods research in a tertiary hospital in a low-income country to explore the uptake of locally adapted paediatric guidelines. The quantitative component was an uncontrolled before and after intervention study that included an exploration of the intervention dose-effect relationship. The qualitative component was an ethnographic research based on the theoretical perspective of participatory action research. Interpretive integration was employed to derive meta-inferences that provided a more complete picture of the overall study results that reflect the complexity and the multifaceted ontology of the phenomenon studied. The improvement in health workers' performance in relation to the intensity of the intervention was not linear and was characterized by improved and occasionally declining performance. Possible root causes of this performance variability included challenges in keeping knowledge and clinical skills updated, inadequate commitment of the staff to continued improvement, limited exposure to positive professional role models, poor teamwork, failure to maintain professional integrity and mal-adaptation to institutional pressures. Implementation of best-practices is a complex process that is largely unpredictable, attributed to the complexity of contextual factors operating predominantly at professional and organizational levels. There is no simple solution to implementation of best-practices. Tackling root causes of inadequate knowledge translation in this tertiary care setting will require long-term planning, with emphasis on promotion of professional ethics and values and establishing an organizational framework that enhances positive aspects of professionalism. This study has significant implications for the quality of training in medical institutions and the development of hospital leadership.

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital.

PubMed

Wong, Nola; Browne, Jenny; Ferguson, Sally; Taylor, Jan; Davis, Deborah

2015-12-01

There is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth. The aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital. A retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05. Data for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p=0.002) and spontaneous vaginal birth (38% vs. 22.4% p=<0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p=0.050) and caesarean sections (18.8% vs. 22.5% p=0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes. Strategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Long-term Clinical and Cost Outcomes of a Pharmacist-managed Risk Factor Management Clinic in Singapore: An Observational Study.

PubMed

Tan, She Hui; Kng, Kwee Keng; Lim, Sze Mian; Chan, Alexandre; Loh, Jason Kwok Kong; Lee, Joyce Yu-Chia

2017-12-01

Few studies have determined the benefits of pharmacist-run clinics within a tertiary institution, and specifically on their capability to improve clinical outcomes as well as reduce the cost of illness. This study was designed to investigate the effectiveness of a pharmacist-managed risk factor management clinic (RFMP) in an acute care setting through the comparison of clinical (improvement in glycosylated hemoglobin level) and cost outcomes with patients receiving usual care. This single-center, observational study included patients aged ≥21 years old and diagnosed with type 2 diabetes mellitus (DM) who received care within the cardiology department of a tertiary institution between January 1, 2014, and December 31, 2015. The intervention group comprised patients who attended the RFMP for 3 to 6 months, and the usual-care group comprised patients who received standard cardiologist care. Univariate analysis and multiple linear regression were conducted to analyze the clinical and cost outcomes. A total of 142 patients with DM (71 patients in the intervention group and 71 patients in the usual-care group) with similar baseline characteristics were included. After adjusting for differences in baseline systolic blood pressure and triglyceride levels, the mean reduction in glycosylated hemoglobin level at 6 months from baseline in the intervention group was significantly lower by 0.78% compared with the usual-care group. Patients in the usual-care group had a significantly higher risk of hospital admissions within the 12 months from baseline compared with the intervention group (odds ratio, 3.84 [95% CI, 1.17-12.57]; P = 0.026). Significantly lower mean annual direct medical costs were also observed in the intervention group (US $8667.03 [$17,416.20] vs US $56,665.02 [$127,250.10]; P = 0.001). The pharmacist-managed RFMP exhibited improved clinical outcomes and reduced health care costs compared with usual care within a tertiary institute. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Results from a retrospective analysis of colonoscopies for Inflammatory bowel disease and colorectal cancer in a Lebanese tertiary care centre.

PubMed

Saber, Toufic; Bedran, Khalil; Ghandour, Fatima; El Khoury, Mansour; Bou Khalil, Roula; Farhat, Said

2017-01-01

Inflammatory bowel diseases (IBDs) and colorectal cancer have an increased impact on the Lebanese population's morbidity and mortality. This study evaluated the situation of IBD and colorectal cancer at a tertiary hospital centre in Lebanon. 1007 patients underwent colonoscopy over a period of 12 months by qualified physicians. 91 patients were excluded from the study. Biopsy results were divided into normal versus abnormal colonic tissue. The abnormal section was further subdivided into number of polyps, IBD, dysplasia and cancer. Out of 916 individuals included, 61 cases of Crohn's colitis (CC) (6.7%) and 24 cases of ulcerative colitis (UC) (2.7%) were identified. A total of 92 cases of colorectal cancer (10.04%) were also identified. There was a slight male predominance in both groups of IBD without any statistical significance. One statistical significance was reported in favour to age<50 years in both IBD groups with a mean age of 37.9±9.7 years and 34.4±6.4 years for CC and UC, respectively. The incidence of granuloma in the CC group was 8.9% without any correlation compared with age or gender. No correlation was made between colorectal cancer and the existence of any IBD type. The data showed that age >50 years and male gender significantly correlate with an increased incidence of precancerous and cancerous polyps in the colon. They significantly correlate with adenocarcinoma. The estimated incidence of colorectal cancer, CC and UC was 54.1, 35.8 and 14.1 per 100 000, respectively, with a denominator of 169 959 patients per year. Within the limitations of this study, the incidence of colorectal cancer and IBD falls in the high range compared with similar European and American studies. Our data are biased because of the tertiary centre setting but they can be considered as base for further investigations.

Explaining the uptake of paediatric guidelines in a Kenyan tertiary hospital – mixed methods research

PubMed Central

2014-01-01

Background Evidence-based standards for management of the seriously sick child have existed for decades, yet their translation in clinical practice is a challenge. The context and organization of institutions are known determinants of successful translation, however, research using adequate methodologies to explain the dynamic nature of these determinants in the quality-of-care improvement process is rarely performed. Methods We conducted mixed methods research in a tertiary hospital in a low-income country to explore the uptake of locally adapted paediatric guidelines. The quantitative component was an uncontrolled before and after intervention study that included an exploration of the intervention dose-effect relationship. The qualitative component was an ethnographic research based on the theoretical perspective of participatory action research. Interpretive integration was employed to derive meta-inferences that provided a more complete picture of the overall study results that reflect the complexity and the multifaceted ontology of the phenomenon studied. Results The improvement in health workers’ performance in relation to the intensity of the intervention was not linear and was characterized by improved and occasionally declining performance. Possible root causes of this performance variability included challenges in keeping knowledge and clinical skills updated, inadequate commitment of the staff to continued improvement, limited exposure to positive professional role models, poor teamwork, failure to maintain professional integrity and mal-adaptation to institutional pressures. Conclusion Implementation of best-practices is a complex process that is largely unpredictable, attributed to the complexity of contextual factors operating predominantly at professional and organizational levels. There is no simple solution to implementation of best-practices. Tackling root causes of inadequate knowledge translation in this tertiary care setting will require long-term planning, with emphasis on promotion of professional ethics and values and establishing an organizational framework that enhances positive aspects of professionalism. This study has significant implications for the quality of training in medical institutions and the development of hospital leadership. PMID:24613001

Awareness of Breast Cancer among Female Care Givers in Tertiary Cancer Hospital, China

PubMed Central

Dinegde, Negalign Getahun; Xuying, Li

2017-01-01

Objective: Breast cancer is a worldwide public health issue and most common cancer diagnosed among women including China, where advanced stages at diagnosis appears to be increasing and an ever-rising incidence twice as fast as global rates. The study was conducted to describe the awareness of breast cancer and associated factors among care giver women in tertiary Cancer Hospital, China. Methods: Institutional based cross-sectional study was conducted among 261 women selected by systematic random sampling. Information provided by the participants was converted into awareness scores for analysis using SPSS version 23. Awareness scores were dichotomized in to ‘good awareness and ‘poor awareness’ taking median score=11 as the cut-off point. Data analysis was performed using the binary logistic regression. A p-value of <0.05 was considered statistically significant. Result: The study showed that 46.7% of the respondents had good awareness. Breast lump was the most commonly known symptom of cancer by 61.7% of the respondents. Slightly more than half of the study participants acknowledged having a past history of breast cancer, drinking alcohol and having close relative with breast cancer as potential risk factors for breast cancer (63.6%, 58.6%, and 55.6% respectively). Nevertheless, a vast majority of the study participants were unable to appreciate modifiable risk factors of the disease. More than half of the participants had never/rarely checked their breasts and all of the participants wrongly answered breast cancer knowledge age related risk. Awareness level was significantly associated with entertainment preference (OR=3.57; 95%CI=1.71, 7.44) and residence setting areas (OR=2.4; 95%CI=1.04, 5.69). Conclusion: The study indicated suboptimal awareness while entertainment preference and residence setting were significantly associated with awareness level. Public awareness campaigns should be made by dissemination of information about breast cancer through health education and printed Medias with great emphases on women living in rural areas. PMID:28749635

Tertiary education and its association with mental health indicators and educational factors among Arctic young adults: the NAAHS cohort study

PubMed Central

Bania, Elisabeth Valmyr; Kvernmo, Siv Eli

2016-01-01

Background Completed tertiary education is closely associated with employment and influences income, health and personal well-being. Objective The purpose of the study is to explore predictors for completed tertiary education among indigenous Sami and non-indigenous young people in relation to mental health indicators and educational factors in sociocultural rural and urban contexts across the Arctic part of Norway. Design The Norwegian Arctic Adolescent Health Study (NAAHS) is a cross-sectional, school-based survey that was conducted in 2003–2005. Of all 5,877 10th graders (aged 15–16 years) in north Norway, 83% from all 87 municipalities participated; 450 (9.2%) reported indigenous Sami ethnicity, and 304 (6.2%) reported Laestadian affiliation. Data from NAAHS were merged with registry data from the National Education Database and Norwegian Patient Register for 3,987 adolescents who gave their consent for follow-up studies. Results Completion of upper secondary school is the only common predictor of a completed tertiary education degree for both genders. Among females, conduct problems was a significant predictor of lower level education, typically vocational professions, while among males severe mental health problems requiring treatment by the specialist health care system reduced the opportunity to complete tertiary education at intermediate and higher level. Parental higher educational level was associated with less lower education among females and less higher education among males. Men residing in the northernmost and remote areas were less likely to complete education on higher level. Males’ completion of higher level education was strongly but not significantly associated (p=0.057) with higher average marks in lower secondary school. Conclusions The gender differences found in this study emphasize the need for gender-specific interventions to encourage, support and empower young people to attend and complete tertiary education. Young females with conduct problems choose lower or intermediate education, and males in need of specialist mental health care have half the chance to complete intermediate tertiary education compared with males not in contact with the mental health service. Closer cooperation between low threshold social services, general practitioners, mental health services and higher study institutions can help young male adults complete tertiary education. PMID:28156413

Adolescent smoking and tertiary education: opposing pathways linking socio-economic background to alcohol consumption.

PubMed

Green, Michael J; Leyland, Alastair H; Sweeting, Helen; Benzeval, Michaela

2016-08-01

If socio-economic disadvantage is associated with more adolescent smoking, but less participation in tertiary education, and smoking and tertiary education are both associated with heavier drinking, these may represent opposing pathways to heavy drinking. This paper examines contextual variation in the magnitude and direction of these associations. Comparing cohort studies. United Kingdom. Participants were from the 1958 National Child Development Study (NCDS58; n = 15 672), the British birth cohort study (BCS70; n = 12 735) and the West of Scotland Twenty-07 1970s cohort (T07; n = 1515). Participants self-reported daily smoking and weekly drinking in adolescence (age 16 years) and heavy drinking (> 14/21 units in past week) in early adulthood (ages 22-26 years). Parental occupational class (manual versus non-manual) indicated socio-economic background. Education beyond age 18 was coded as tertiary. Models were adjusted for parental smoking and drinking, family structure and adolescent psychiatric distress. Respondents from a manual class were more likely to smoke and less likely to enter tertiary education (e.g. in NCDS58, probit coefficients were 0.201 and -0.765, respectively; P < 0.001 for both) than respondents from a non-manual class. Adolescent smokers were more likely to drink weekly in adolescence (0.346; P < 0.001) and more likely to drink heavily in early adulthood (0.178; P < 0.001) than adolescent non-smokers. Respondents who participated in tertiary education were more likely to drink heavily in early adulthood (0.110 for males, 0.182 for females; P < 0.001 for both) than respondents with no tertiary education. With some variation in magnitude, these associations were consistent across all three cohorts. In Britain, young adults are more likely to drink heavily both if they smoke and participate in tertiary education (college and university) despite socio-economic background being associated in opposite directions with these risk factors. © 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Dissemination of an innovative mastery learning curriculum grounded in implementation science principles: a case study.

PubMed

McGaghie, William C; Barsuk, Jeffrey H; Cohen, Elaine R; Kristopaitis, Theresa; Wayne, Diane B

2015-11-01

Dissemination of a medical education innovation, such as mastery learning, from a setting where it has been used successfully to a new and different medical education environment is not easy. This article describes the uneven yet successful dissemination of a simulation-based mastery learning (SBML) curriculum on central venous catheter (CVC) insertion for internal medicine and emergency medicine residents across medical education settings. The dissemination program was grounded in implementation science principles. The article begins by describing implementation science which addresses the mechanisms of medical education and health care delivery. The authors then present a mastery learning case study in two phases: (1) the development, implementation, and evaluation of the SBML CVC curriculum at a tertiary care academic medical center; and (2) the dissemination of the SBML CVC curriculum to an academic community hospital setting. Contextual information about the drivers and barriers that affected the SBML CVC curriculum dissemination is presented. This work demonstrates that dissemination of mastery learning curricula, like all other medical education innovations, will fail without active educational leadership, personal contacts, dedication, hard work, rigorous measurement, and attention to implementation science principles. The article concludes by presenting a set of lessons learned about disseminating an SBML CVC curriculum across different medical education settings.

Presence and Accuracy of Drug Dosage Recommendations for Continuous Renal Replacement Therapy in Tertiary Drug Information References

PubMed Central

Gorman, Sean K; Slavik, Richard S; Lam, Stefanie

2012-01-01

Background: Clinicians commonly rely on tertiary drug information references to guide drug dosages for patients who are receiving continuous renal replacement therapy (CRRT). It is unknown whether the dosage recommendations in these frequently used references reflect the most current evidence. Objective: To determine the presence and accuracy of drug dosage recommendations for patients undergoing CRRT in 4 drug information references. Methods: Medications commonly prescribed during CRRT were identified from an institutional medication inventory database, and evidence-based dosage recommendations for this setting were developed from the primary and secondary literature. The American Hospital Formulary System—Drug Information (AHFS–DI), Micromedex 2.0 (specifically the DRUGDEX and Martindale databases), and the 5th edition of Drug Prescribing in Renal Failure (DPRF5) were assessed for the presence of drug dosage recommendations in the CRRT setting. The dosage recommendations in these tertiary references were compared with the recommendations derived from the primary and secondary literature to determine concordance. Results: Evidence-based drug dosage recommendations were developed for 33 medications administered in patients undergoing CRRT. The AHFS–DI provided no dosage recommendations specific to CRRT, whereas the DPRF5 provided recommendations for 27 (82%) of the medications and the Micromedex 2.0 application for 20 (61%) (13 [39%] in the DRUGDEX database and 16 [48%] in the Martindale database, with 9 medications covered by both). The dosage recommendations were in concordance with evidence-based recommendations for 12 (92%) of the 13 medications in the DRUGDEX database, 26 (96%) of the 27 in the DPRF5, and all 16 (100%) of those in the Martindale database. Conclusions: One prominent tertiary drug information resource provided no drug dosage recommendations for patients undergoing CRRT. However, 2 of the databases in an Internet-based medical information application and the latest edition of a renal specialty drug information resource provided recommendations for a majority of the medications investigated. Most dosage recommendations were similar to those derived from the primary and secondary literature. The most recent edition of the DPRF is the preferred source of information when prescribing dosage regimens for patients receiving CRRT. PMID:22783029

New Mapping in the Sand Springs Range of Western Nevada Clarifies and Constrains Regional Deformation Sequences of the Luning-Fencemaker Thrust Belt

NASA Astrophysics Data System (ADS)

Czarnecki, S.; Jarvis, J.; Satterfield, J. I.

2016-12-01

The Sand Springs Range in western Nevada exposes Mesozoic through Cenozoic structures of the eastern Sierra Nevada, Luning-Fencemaker Thrust Belt (LFTB), Basin and Range province, and Walker Lane. A recent undergraduate geologic mapping project in the northern Sand Springs Range (nSSR) set out to map igneous intrusions in detail, specifically smaller intrusions which had not been a focus in previous work. This was accomplished using different techniques including mapping at a smaller scale (1:8000 vs. 1:24000), locating contacts and faults using handheld GPS, and focusing on relationships between metamorphic tectonites and igneous units. This revealed key cross-cutting relations between structures and diverse Triassic through Tertiary igneous rocks as well as distinctions between the nSSR and the surrounding LFTB assemblages. During our mapping we identified four metamorphic tectonite map units, Cretaceous granitoid and diorite plutons and sills, Tertiary rhyolite sills and dikes, and interbedded Tertiary basalt and ash flow tuff. The cross-cutting relations of these units overturn previously published sequences of events and constrain the timing of a deformation sequence which differs from the surrounding LFTB assemblages. We found that the nSSR contains three phases of deformation: a pre-LFTB syn-metamorphic event which achieved amphibolite facies that is not described elsewhere in the LFTB (D1), followed by two non-metamorphic folding and thrusting phases characteristic of the LFTB (D2 and D3). Our mapping provided four key timing constraints. First, D1 axial-planar cleavage (S1) deformed Triassic intrusions. Second, Cretaceous granitoid and diorite units cross-cut S1 foliation, D1 folds, and low-angle faults. Third, Cretaceous and Tertiary sills that locally terminate at a low-angle fault actually post-dated faulting. Fourth, cross-cutting relations showed a basaltic lava previously mapped as Jurassic is actually Tertiary. The large Sand Springs Pluton was the only intrusion mapped in detail during previous studies; but our mapping has demonstrated the importance of both small and large intrusions in understanding the overall structural history of a complex area. This project was supported by research grants from Angelo State University and the Southwest Section AAPG.

Being, becoming and belonging: Some thoughts on academic disciplinary effects

NASA Astrophysics Data System (ADS)

Slay, Jill

2011-12-01

In this paper I reflect on perspectives presented by John Settlage as he examines the truth of the proposition that `many teacher educators harbour deficit perspectives about their pre-service teachers, presuming that their lack of exposure to economically, ethnically and linguistically diverse settings renders them deficient as future educators.' In the study presented in his paper, he `uncovered shifting identities that indicate that mainstream future teachers do not fit the ``damaged goods'' label that ardent multiculturalists might be tempted to impose.' One of his conclusions was that `the practices of essentializing education majors because of their perceived deficiencies born of privilege are inaccurate and unproductive.' My reflections focus on tertiary teacher-researchers in mathematics, information technology, environmental sciences and engineering, their students and racism, and broaden Settlage's context to teaching and research relationships in this setting.

Technology-based interventions for mental health in tertiary students: systematic review.

PubMed

Farrer, Louise; Gulliver, Amelia; Chan, Jade K Y; Batterham, Philip J; Reynolds, Julia; Calear, Alison; Tait, Robert; Bennett, Kylie; Griffiths, Kathleen M

2013-05-27

Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed. To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders. The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder. A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range -0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range -0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses. The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed.

Deliberate Self-Harm among Children in Tertiary Care Residential Treatment: Prevalence and Correlates

ERIC Educational Resources Information Center

Stewart, Shannon L.; Baiden, Philip; Theall-Honey, Laura; den Dunnen, Wendy

2014-01-01

Background: Few studies have examined deliberate self-harm (DSH) among children in residential treatment in Canada. Most of the existing studies examined adolescent students or children from pediatric emergency departments. Objectives: The objectives of this study were to examine the prevalence of DSH among children in tertiary care residential…

Variation in Inflammatory/Regulatory Cytokines in Secondary, Tertiary, and Quaternary Challenges with Dengue Virus

PubMed Central

Sierra, Beatriz; Pérez, Ana B.; Alvarez, Mayling; García, Gissel; Vogt, Katrin; Aguirre, Eglys; Schmolke, Kathrin; Volk, Hans-Dieter; Guzmán, María G.

2012-01-01

Secondary heterologous dengue infection is a risk factor for severe disease manifestations because of the immune-enhancement phenomenon. Succeeding clinical infections are seldom reported, and the clinical course of tertiary and quaternary dengue infections is not clear. Cuba represents a unique environment to study tertiary/quaternary dengue infections in a population with known clinical and serologic dengue markers and no dengue endemicity. We took advantage of this exceptional epidemiologic condition to study the effect of primary, secondary, tertiary, and quaternary dengue infection exposure on the expression of pro-inflammatory and regulatory cytokines, critical in dengue infection pathogenesis, by using a dengue infection ex vivo model. Whereas secondary exposure induced a high cytokine response, we found a significantly lower expression of tumor necrosis factor-α, interferon-γ, interleukin-10, and tumor growth factor-β after tertiary and quaternary infectious challenge. Significant differences in expression of the cytokines were seen between the dengue immune profiles, suggesting that the sequence in which the immune system encounters serotypes may be important in determining the nature of the immune response to subsequent infections. PMID:22802438

Diversification of Tertiary Education in France.

ERIC Educational Resources Information Center

Didier, Paul

Following an outline of education, particularly secondary education, the French system of tertiary education is described. The orientation of studies offered in the three two-year cycles of study is described. The differences between the national institutes and the universities are explained. The remainder of the report contains admission…

Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study

PubMed Central

Dohbit, Julius Sama; Foumane, Pascal; Mamoudou, Fadimatou; Temgoua, Mazou N; Tankeu, Ronni; Aletum, Veronica; Mboudou, Emile

2017-01-01

Background and objectives Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon. Design A retrospective cohort study. Setting A tertiary hospital in Yaounde, Cameroon. Participants Cases of VBD of newborns weighing 2500–3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500–3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery. Outcome measures Neonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction. Results Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001). Conclusion The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications. PMID:29170287

Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals.

PubMed

Chandran, S; Parker, F; Lontos, S; Vaughan, R; Efthymiou, M

2015-12-01

Polyps identified at colonoscopy are predominantly diminutive (<5 mm) with a small risk (>1%) of high-grade dysplasia or carcinoma; however, the cost of histological assessment is substantial. The aim of this study was to determine whether prediction of colonoscopy surveillance intervals based on real-time endoscopic assessment of polyp histology is accurate and cost effective. A prospective cohort study was conducted across a tertiary care and private community hospital. Ninety-four patients underwent colonoscopy and polypectomy of diminutive (≤5 mm) polyps from October 2012 to July 2013, yielding a total of 159 polyps. Polyps were examined and classified according to the Sano-Emura classification system. The endoscopic assessment (optical diagnosis) of polyp histology was used to predict appropriate colonoscopy surveillance intervals. The main outcome measure was the accuracy of optical diagnosis of diminutive colonic polyps against the gold standard of histological assessment. Optical diagnosis was correct in 105/108 (97.2%) adenomas. This yielded a sensitivity, specificity and positive and negative predictive values (with 95%CI) of 97.2% (92.1-99.4%), 78.4% (64.7-88.7%), 90.5% (83.7-95.2%) and 93% (80.9-98.5%) respectively. Ninety-two (98%) patients were correctly triaged to their repeat surveillance colonoscopy. Based on these findings, a cut and discard approach would have resulted in a saving of $319.77 per patient. Endoscopists within a tertiary care setting can accurately predict diminutive polyp histology and confer an appropriate surveillance interval with an associated financial benefit to the healthcare system. However, limitations to its application in the community setting exist, which may improve with further training and high-definition colonoscopes. © 2015 Royal Australasian College of Physicians.

Intestinal parasitoses in a tertiary-care hospital located in a non-endemic setting during 2006–2010

PubMed Central

2014-01-01

Background The aim of this study was to assess the epidemiology of intestinal parasitoses during a 5-year period in patients attending a tertiary-care hospital in a non-endemic setting. Methods In the period 2006–2010, 15,752 samples from 8,886 patients with clinically suspected parasitosis were subjected to macroscopic and microscopic examination, to parasitic antigen detection assays, and to cultures for protozoa and nematodes. Real-time PCR assays for the differentiation of Entamoeba histolytica and E. dispar and for the detection of Dientamoeba fragilis were also used. A statistical analysis evaluating the demographic data of the patients with intestinal parasitic infections was performed. Results Intestinal parasitic infections were diagnosed in 1,477 patients (16.6% prevalence), mainly adults and immigrants from endemic areas for faecal-oral infections; protozoa were detected in 93.4% and helminths in 6.6% of the cases, the latter especially in immigrants. Blastocystis hominis was the most common intestinal protozoan, and G. intestinalis was the most frequently detected among pathogenic protozoa, prevalent in immigrants, males, and pediatric patients. Both single (77.9%) and mixed (22.1%) parasitic infections were observed, the latter prevalent in immigrants. Conclusions Despite the importance of the knowledge about the epidemiology of intestinal parasitoses in order to adopt appropriate control measures and adequate patient care all over the world, data regarding industrialized countries are rarely reported in the literature. The data presented in this study indicate that intestinal parasitic infections are frequently diagnosed in our laboratory and could make a contribution to stimulate the attention by physicians working in non-endemic areas on the importance of suspecting intestinal parasitoses. PMID:24886502

Intestinal parasitoses in a tertiary-care hospital located in a non-endemic setting during 2006-2010.

PubMed

Calderaro, Adriana; Montecchini, Sara; Rossi, Sabina; Gorrini, Chiara; De Conto, Flora; Medici, Maria Cristina; Chezzi, Carlo; Arcangeletti, Maria Cristina

2014-05-16

The aim of this study was to assess the epidemiology of intestinal parasitoses during a 5-year period in patients attending a tertiary-care hospital in a non-endemic setting. In the period 2006-2010, 15,752 samples from 8,886 patients with clinically suspected parasitosis were subjected to macroscopic and microscopic examination, to parasitic antigen detection assays, and to cultures for protozoa and nematodes. Real-time PCR assays for the differentiation of Entamoeba histolytica and E. dispar and for the detection of Dientamoeba fragilis were also used.A statistical analysis evaluating the demographic data of the patients with intestinal parasitic infections was performed. Intestinal parasitic infections were diagnosed in 1,477 patients (16.6% prevalence), mainly adults and immigrants from endemic areas for faecal-oral infections; protozoa were detected in 93.4% and helminths in 6.6% of the cases, the latter especially in immigrants. Blastocystis hominis was the most common intestinal protozoan, and G. intestinalis was the most frequently detected among pathogenic protozoa, prevalent in immigrants, males, and pediatric patients. Both single (77.9%) and mixed (22.1%) parasitic infections were observed, the latter prevalent in immigrants. Despite the importance of the knowledge about the epidemiology of intestinal parasitoses in order to adopt appropriate control measures and adequate patient care all over the world, data regarding industrialized countries are rarely reported in the literature. The data presented in this study indicate that intestinal parasitic infections are frequently diagnosed in our laboratory and could make a contribution to stimulate the attention by physicians working in non-endemic areas on the importance of suspecting intestinal parasitoses.

Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort study.

PubMed

Kelfve, Susanne; Wastesson, Jonas; Fors, Stefan; Johnell, Kristina; Morin, Lucas

2018-02-01

End-of-life transitions between care settings can be burdensome for older adults and their relatives. To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. Nationwide, retrospective cohort study using register data. Older adults (⩾65 years) who died in Sweden in 2013 ( n = 75,722). Place of death was the primary outcome. Institutionalization and multiple hospital admissions during the final months of life were defined as secondary outcomes. The decedents' level of education (primary, secondary, or tertiary education) was considered as the main exposure. Multivariable analyses were stratified by living arrangement and adjusted for sex, age at time of death, illness trajectory, and number of chronic diseases. Among community-dwellers, older adults with tertiary education were more likely to die in hospitals than those with primary education (55.6% vs 49.9%; odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.14-1.28), but less likely to be institutionalized during the final month before death (OR = 0.83, 95% CI = 0.76-0.91). Decedents with higher education had greater odds of remaining hospitalized continuously during their final 2 weeks of life (OR = 1.12, 95% CI = 1.02-1.22). Among older adults living in nursing homes, we found no association between the decedents' level of education and their likelihood to be hospitalized or to die in hospitals. Compared with those who completed only primary education, individuals with higher educational attainment were more likely to live at home until the end of life, but also more likely to be hospitalized and die in hospitals.

Development of an instrument to measure patient perception of the quality of nursing care and related hospital services at the national hospital of sri lanka.

PubMed

Senarat, Upul; Gunawardena, Nalika S

2011-06-01

This study aimed to develop and validate an instrument to measure patient perception of quality of nursing care and related hospital services in a tertiary care setting. We compiled an instrument with 72 items that patients may perceive as quality of nursing care and related hospital services, following an extensive literature search, discussions with patients and care pro-I viders and a brainstorming session with an expert panel. A cross-sectional study was conducted at the National Hospital of Sri Lanka. A sample (n = 120) of patients stayed in general surgical or medical units responded to the interviewer administered instrument upon discharge. Item analysis and principal component factor analysis were performed to assess validity, and internal consistency was calculated to measure reliability. Of the 72 items, 18 had greater than 20% of responses as 'not relevant'. A further 11 items were eliminated since item-total correlations were less than .2. Factor analysis was performed on remaining 43 items which resulted in 36 items classifying into eight factors accounting for 71% of the variation. Factor loadings in the final solution after Varimax rotation were interpersonal aspects (.68-.85), efficiency (.62-.79), competency (.66-.68), comfort (.60-.84), physical environment (.65-.82), cleanliness (.81-.85), personalized information (.76-.83), and general instructions (.61-.78). The instrument had high Internal consistency (Cronbach's alpha = .91). We developed a comprehensive, reliable and valid, 36-item instrument that may be used to measure patient perception of quality of nursing care in tertiary care settings. Copyright © 2011 Korean Society of Nursing Science. Published by Elsevier B.V. All rights reserved.

"Actually, I May be Clever Enough to do it". Using Identity as a Lens to Investigate Students' Trajectories Towards Science and University

NASA Astrophysics Data System (ADS)

Krogh, Lars Brian; Andersen, Hanne Moeller

2013-04-01

We have followed a group of students in the potential pipeline for science through their last years of upper secondary school and in the context of a university mentorship program. The student group is defined by their choice of Mathematics at A-level which is mandatory for admission to tertiary STEM education in Denmark. Rich data (repeated interviews, questionnaires (pre-and post-) and observations) from 14 target students have been collected. Using Late Modern identity theory as a lens, we have analysed students' identity narratives in order to establish their trajectories in relation to university in general, and towards science studies and science careers in particular. We find that the diversity of students' educational identity narratives can be characterized and their trajectories understood in terms of a Four Factor Framework comprising: general identity process orientations (reflecting, committing, exploring), personal values, subject self-concepts and subject interests. In various ways these constructs interact and set the range and direction of the students' searches for future education and careers. Our longitudinal study suggests that they have enough permanence to enable us to hypothesize more or less secured paths of individual students to tertiary science (or other areas of academia).

Clostridium difficile Infection in Older Adults: Systematic Review of Efforts to Reduce Occurrence and Improve Outcomes.

PubMed

Marshall, Leisa L; Peasah, Samuel; Stevens, Gregg A

2017-01-01

Provide a systematic review of the primary literature on efforts to reduce Clostridium difficile infection (CDI) occurrence and improve outcomes in older adults. PubMed and CINAHL databases were searched for research studies using search terms CDI, CDI prevention, reduction, control, management, geriatric, elderly, adults 65 years of age and older. The MeSH categories Aged and Aged, 80 and older, were used. A second search of PubMed, CINAHL, National Guideline Clearinghouse, and TRIP databases was conducted for primary, secondary, and tertiary literature for CDI epidemiology, burden, and management in adults of all ages, and prevention and management guidelines. Of the 2,263 articles located, 105 were selected for full review: 55 primary and 50 secondary, tertiary. Primary literature selected for full review included studies of interventions to prevent, reduce occurrence, control, manage, or improve outcomes in adults 65 years of age and older. Patient settings included the community, assisted living, nursing facility, subacute care, or hospital. The main outcome measures for research studies were whether the studied intervention prevented, reduced occurrence, controlled, managed, or improved outcomes. Studies were conducted in acute or long-term hospitals, with a few in nursing facilities. Interventions that prevented or reduced CDI included antibiotic policy changes, education, procedure changes, infection control, and multi-intervention approaches. There were few management studies for adults 65 years of age and older or for all adults with results stratified by age. Treatments studied included efficacy of fidaxomicin, metronidazole, vancomycin, and fecal microbiota transplant. Though clinical outcomes were slightly less robust in those 65 years of age and older, age was not an independent predictor of success or failure. The current prevention and management guidelines for adults of all ages, as well as special considerations in skilled nursing facilities, extracted from the secondary/tertiary literature selected, are summarized. There are a limited number of studies designed for older adults. Our findings suggest that guideline recommendations for adults are adequate and appropriate for older adults. Exposure to antibiotics and Clostridium difficile remain the two major risk factors for CDI, reinforcing the importance of antibiotic stewardship and infection control.

The Misis-Andırın Complex: a Mid-Tertiary melange related to late-stage subduction of the Southern Neotethys in S Turkey

NASA Astrophysics Data System (ADS)

Robertson, Alastair; Unlügenç, Ülvi Can; İnan, Nurdan; Ta ṡli, Kemal

2004-01-01

The Mid-Tertiary (Mid-Eocene to earliest Miocene) Misis-Andırın Complex documents tectonic-sedimentary processes affecting the northerly, active margin of the South Tethys (Neotethys) in the easternmost Mediterranean region. Each of three orogenic segments, Misis (in the SW), Andırın (central) and Engizek (in the NE) represent parts of an originally continuous active continental margin. A structurally lower Volcanic-Sedimentary Unit includes Late Cretaceous arc-related extrusives and their Lower Tertiary pelagic cover. This unit is interpreted as an Early Tertiary remnant of the Mesozoic South Tethys. The overlying melange unit is dominated by tectonically brecciated blocks (>100 m across) of Mesozoic neritic limestone that were derived from the Tauride carbonate platform to the north, together with accreted ophiolitic material. The melange matrix comprises polymict debris flows, high- to low-density turbidites and minor hemipelagic sediments. The Misis-Andırın Complex is interpreted as an accretionary prism related to the latest stages of northward subduction of the South Tethys and diachronous continental collision of the Tauride (Eurasian) and Arabian (African) plates during Mid-Eocene to earliest Miocene time. Slivers of Upper Cretaceous oceanic crust and its Early Tertiary pelagic cover were accreted, while blocks of Mesozoic platform carbonates slid from the overriding plate. Tectonic mixing and sedimentary recycling took place within a trench. Subduction culminated in large-scale collapse of the overriding (northern) margin and foundering of vast blocks of neritic carbonate into the trench. A possible cause was rapid roll back of dense downgoing Mesozoic oceanic crust, such that the accretionary wedge taper was extended leading to gravity collapse. Melange formation was terminated by underthrusting of the Arabian plate from the south during earliest Miocene time. Collision was diachronous. In the east (Engizek Range and SE Anatolia) collision generated a Lower Miocene flexural basin infilled with turbidites and a flexural bulge to the south. Miocene turbiditic sediments also covered the former accretionary prism. Further west (Misis Range) the easternmost Mediterranean remained in a pre-collisional setting with northward underthrusting (incipient subduction) along the Cyprus arc. The Lower Miocene basins to the north (Misis and Adana) indicate an extensional (to transtensional) setting. The NE-SW linking segment (Andırın) probably originated as a Mesozoic palaeogeographic offset of the Tauride margin. This was reactivated by strike-slip (and transtension) during Later Tertiary diachronous collision. Related to on-going plate convergence the former accretionary wedge (upper plate) was thrust over the Lower Miocene turbiditic basins in Mid-Late Miocene time. The Plio-Quaternary was dominated by left-lateral strike-slip along the East Anatolian transform fault and also along fault strands cutting the Misis-Andırın Complex.

Tectonic setting of the Taubaté Basin (Southeastern Brazil): Insights from regional seismic profiles and outcrop data

NASA Astrophysics Data System (ADS)

Cogné, Nathan; Cobbold, Peter R.; Riccomini, Claudio; Gallagher, Kerry

2013-03-01

In southeastern Brazil, a series of onshore Tertiary basins provides good evidence for post-rift tectonic activity. So as better to constrain their tectonic setting, we have revisited outcrops in the Taubaté and Resende basins and have reinterpreted 11 seismic profiles of the Taubaté Basin. Where Eocene to Oligocene strata crop out, syn-sedimentary faults are common and their senses of slip are mainly normal. In contrast, for two outcrops in particular, where syn-sedimentary faults have put Precambrian crystalline basement against Eocene strata, senses of slip are strongly left-lateral, as well as normal. Thus we distinguish between thin-skinned and thick-skinned faulting. Furthermore, at four outcrops, Precambrian basement has overthrust Tertiary or Quaternary strata. On the seismic profiles, basal strata onlap basement highs. Structures and stratigraphic relationships are not typical of a rift basin. Although normal faults are common, they tend to be steeply dipping, their stratigraphic offsets are small (tens of metres) and the faults do not bound large stratigraphic wedges or tilted blocks. At the edges of the basin, Eocene or Oligocene strata dip basinward, have been subject to exhumation, and in places form gentle anticlines, so that we infer post-Oligocene inversion. We conclude that, after an earlier phase of deformation, probably during the Late Cretaceous, the Taubaté Basin formed under left-lateral transtension during the Palaeogene, but was subject to right-lateral transpression during the Neogene. Thus the principal directions of stress varied in time. Because they did so consistently with those of the adjacent regions, as well as those of the Incaic and Quechua phases of Andean orogeny, we argue that the Tertiary basins of southeast Brazil have resulted from reactivation of Precambrian shear zones under plate-wide stress.

Computational study of stability of an H-H-type pseudoknot motif.

PubMed

Wang, Jun; Zhao, Yunjie; Wang, Jian; Xiao, Yi

2015-12-01

Motifs in RNA tertiary structures are important to their structural organizations and biological functions. Here we consider an H-H-type pseudoknot (HHpk) motif that consists of two hairpins connected by a junction loop and with kissing interactions between the two hairpin loops. Such a tertiary structural motif is recurrently found in RNA tertiary structures, but is difficult to predict computationally. So it is important to understand the mechanism of its formation and stability. Here we investigate the stability of the HHpk tertiary structure by using an all-atom molecular dynamics simulation. The results indicate that the HHpk tertiary structure is stable. However, it is found that this stability is not due to the helix-helix packing, as is usually expected, but is maintained by the combined action of the kissing hairpin loops and junctions, although the former plays the main role. Stable HHpk motifs may form structural platforms for the molecules to realize their biological functions. These results are useful for understanding the construction principle of RNA tertiary structures and structure prediction.

Improving Aboriginal maternal and infant health services in the 'Top End' of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change.

PubMed

Barclay, Lesley; Kruske, Sue; Bar-Zeev, Sarah; Steenkamp, Malinda; Josif, Cathryn; Narjic, Concepta Wulili; Wardaguga, Molly; Belton, Suzanne; Gao, Yu; Dunbar, Terry; Kildea, Sue

2014-06-02

Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of 'out of hospital' or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the required skills for providing care for infants, and an 'outpatient' model of care. Services were also characterised by absent Aboriginal leadership and inadequate coordination between remote and tertiary services that is essential to improve quality of care and reduce 'system-introduced' risk. Evidence-informed redesign of maternity services and delivery of care has improved clinical effectiveness and quality for women. However, more work is needed to address substandard care provided for infants and their parents.

Evaluating the Development of Science Research Skills in Work-Integrated Learning through the Use of Workplace Science Tools

ERIC Educational Resources Information Center

McCurdy, Susan M.; Zegwaard, Karsten E.; Dalgety, Jacinta

2013-01-01

Concept understanding, the development of analytical skills and a research mind set are explored through the use of academic tools common in a tertiary science education and relevant work-integrated learning (WIL) experiences. The use and development of the tools; laboratory book, technical report, and literature review are examined by way of…

Perceptions and Career Prospects of the Distance Doctor of Education Degree: Voices from the Mid-Career ELT Tertiary Practitioners

ERIC Educational Resources Information Center

Kung, Fan-Wei

2017-01-01

The advancement of computer technologies has brought a plethora of technological innovations in educational settings. It is no exception in teacher training and education programmes around the world as the growth of professionalism has made the distance doctoral programmes possible for mid-career English language teaching (ELT) practitioners. The…

Competency-Based English Teaching and Learning: Investigating Pre-Service Teachers of Chinese's Learning Experience

ERIC Educational Resources Information Center

Wong, Ruth M. H.

2008-01-01

English competency is known as one of the crucial skills in various social contexts in Hong Kong. In tertiary educational setting, English courses do not focus solely on the development of the four language skills. Rather, they put emphasis on the application of English Language for academic use or instrumental use. This paper will investigate the…

Improving On-Task Behavior Using a Functional Assessment-Based Intervention in an Inclusive High School Setting

ERIC Educational Resources Information Center

Majeika, Caitlyn E.; Walder, Jessica P.; Hubbard, Jessica P.; Steeb, Kelly M.; Ferris, Geoffrey J.; Oakes, Wendy P.; Lane, Kathleen Lynne

2011-01-01

A comprehensive, integrated, three-tiered model (CI3T) of prevention is a framework for proactively meeting students' academic, behavioral, and social skills. At the tertiary (Tier 3) level of prevention, functional-assessment based interventions (FABIs) may be used to identify, develop, and implement supports based on the function, or purpose, of…

Evaluating the Treatment Fidelity of Parents Who Conduct In-Home Functional Communication Training with Coaching via Telehealth

ERIC Educational Resources Information Center

Suess, Alyssa N.; Romani, Patrick W.; Wacker, David P.; Dyson, Shannon M.; Kuhle, Jennifer L.; Lee, John F.; Lindgren, Scott D.; Kopelman, Todd G.; Pelzel, Kelly E.; Waldron, Debra B.

2014-01-01

We conducted a retrospective, descriptive evaluation of the fidelity with which parents of three children with autism spectrum disorders conducted functional communication training (FCT) in their homes. All training was provided to the parents via telehealth by a behavior consultant in a tertiary-level hospital setting. FCT trials coached by the…

Induction of labour: a continuous quality improvement and peer review program to improve the quality of care

PubMed Central

Harris, Susan; Buchinski, Bev; Gryzbowski, Stefan; Janssen, Patti; Mitchell, G.W. Erle; Farquharson, Duncan

2000-01-01

This article describes a program developed to improve the process of planned induction of labour and to reduce the rates of inappropriate induction. The setting is a tertiary-care maternity hospital in urban Vancouver, BC, in which 7000 deliveries take place annually. Approximately 65% of these can be considered primary care; the remainder are secondary- or tertiary-level cases. Continuous quality improvement (CQI) methods were used by a multidisciplinary team, which included nursing staff, physicians, health records personnel and a CQI facilitator. Interventions included the development of a new induction-booking process, clear criteria for induction, feedback to caregivers about changes and a peer review system to oversee and maintain improvement. The overall induction rate for the institution decreased, and this change has been maintained. PMID:11079064

DETECTION OF INFECTIOUS ADENOVIRUS IN TERTIARY TREATED AND UV DISINFECTED WASTEWATER DURING A UV DISINFECTION PILOT STUDY

EPA Science Inventory

An infectious enteric adenovirus was isolated from urban wastewater receiving tertiary treatment and ultraviolet (UV) disinfection. A pilot study was undertaken to investigate the efficacy of UV disinfection (low pressure, high intensity radiation) of total and fecal coliform bac...

Effectiveness of Using Games in Tertiary-Level Mathematics Classrooms

ERIC Educational Resources Information Center

Afari, Ernest; Aldridge, Jill M.; Fraser, Barry J.

2012-01-01

The primary focus of this study was to investigate the effectiveness of games when used in tertiary-level mathematics classes in the United Arab Emirates. Our study incorporated a mixed-method approach that involved surveys (to assess students' perceptions of the learning environment and attitudes towards mathematics), interviews, observations of…

Higher Education and Entrepreneurial Studies: A Hallmark for National Development

ERIC Educational Resources Information Center

Akinwumi, Femi Sunday; Adebayo, Timothy Afolami

2014-01-01

This paper posits an articulation between skill acquisition and development. It attempts to critically reposition tertiary education curriculum in order to avert mass production of academic dregs in Nigeria. The issue of unemployment in Nigeria and the need for restructuring tertiary institutions' curricula to include entrepreneurial studies as…

Upper GI tract lesions in familial adenomatous polyposis (FAP): enrichment of pyloric gland adenomas and other gastric and duodenal neoplasms.

PubMed

Wood, Laura D; Salaria, Safia N; Cruise, Michael W; Giardiello, Francis M; Montgomery, Elizabeth A

2014-03-01

Patients with familial adenomatous polyposis (FAP), an autosomal dominant cancer predisposition syndrome caused by mutations in the APC gene, develop neoplasms in both the upper and lower gastrointestinal (GI) tract. To clarify the upper GI tract lesions in FAP patients in a tertiary care setting, we reviewed specimens from 321 endoscopies in 66 patients with FAP. Tubular adenomas in the small bowel were the most common neoplasms (present in 89% of patients), although only 1 patient developed invasive carcinoma of the small bowel. Several types of gastric neoplasms were identified--65% of patients had at least 1 fundic gland polyp, and 23% of patients had at least 1 gastric foveolar-type gastric adenoma. Pyloric gland adenomas were also enriched, occurring in 6% of patients--this is a novel finding in FAP patients. Despite the high frequency of gastric neoplasms, only 1 patient developed carcinoma in the stomach. The very low frequency of carcinoma in these patients suggests that current screening procedures prevent the vast majority of upper GI tract carcinomas in patients with FAP, at least in the tertiary care setting.

Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study.

PubMed

Sun, Jing; Lin, Qian; Zhao, Pengyu; Zhang, Qiongyao; Xu, Kai; Chen, Huiying; Hu, Cecile Jia; Stuntz, Mark; Li, Hong; Liu, Yuanli

2017-08-22

It is globally agreed that a well-designed health system deliver timely and convenient access to health services for all patients. Many interventions aiming to reduce waiting times have been implemented in Chinese public tertiary hospitals to improve patients' satisfaction. However, few were well-documented, and the effects were rarely measured with robust methods. We conducted a longitudinal study of the length of waiting times in a public tertiary hospital in Southern China which developed comprehensive data collection systems. Around an average of 60,000 outpatients and 70,000 prescribed outpatients per month were targeted for the study during Oct 2014-February 2017. We analyzed longitudinal time series data using a segmented linear regression model to assess changes in levels and trends of waiting times before and after the introduction of waiting time reduction interventions. Pearson correlation analysis was conducted to indicate the strength of association between waiting times and patient satisfactions. The statistical significance level was set at 0.05. The monthly average length of waiting time decreased 3.49 min (P = 0.003) for consultations and 8.70 min (P = 0.02) for filling prescriptions in the corresponding month when respective interventions were introduced. The trend shifted from baseline slight increasing to afterwards significant decreasing for filling prescriptions (P =0.003). There was a significant negative correlation between waiting time of filling prescriptions and outpatient satisfaction towards pharmacy services (r = -0.71, P = 0.004). The interventions aimed at reducing waiting time and raising patient satisfaction in Fujian Provincial Hospital are effective. A long-lasting reduction effect on waiting time for filling prescriptions was observed because of carefully designed continuous efforts, rather than a one-time campaign, and with appropriate incentives implemented by a taskforce authorized by the hospital managers. This case provides a model of carrying out continuous quality improvement and optimizing management process with the support of relevant evidence.

Contact Prediction for Beta and Alpha-Beta Proteins Using Integer Linear Optimization and its Impact on the First Principles 3D Structure Prediction Method ASTRO-FOLD

PubMed Central

Rajgaria, R.; Wei, Y.; Floudas, C. A.

2010-01-01

An integer linear optimization model is presented to predict residue contacts in β, α + β, and α/β proteins. The total energy of a protein is expressed as sum of a Cα – Cα distance dependent contact energy contribution and a hydrophobic contribution. The model selects contacts that assign lowest energy to the protein structure while satisfying a set of constraints that are included to enforce certain physically observed topological information. A new method based on hydrophobicity is proposed to find the β-sheet alignments. These β-sheet alignments are used as constraints for contacts between residues of β-sheets. This model was tested on three independent protein test sets and CASP8 test proteins consisting of β, α + β, α/β proteins and was found to perform very well. The average accuracy of the predictions (separated by at least six residues) was approximately 61%. The average true positive and false positive distances were also calculated for each of the test sets and they are 7.58 Å and 15.88 Å, respectively. Residue contact prediction can be directly used to facilitate the protein tertiary structure prediction. This proposed residue contact prediction model is incorporated into the first principles protein tertiary structure prediction approach, ASTRO-FOLD. The effectiveness of the contact prediction model was further demonstrated by the improvement in the quality of the protein structure ensemble generated using the predicted residue contacts for a test set of 10 proteins. PMID:20225257

Effects of Glosses on Vocabulary Gain and Retention among Tertiary Level EFL Learners

ERIC Educational Resources Information Center

Azari, Foroogh; Abdullah, Faiz Sathi; Heng, Chan Swee; Hoon, Tan Bee

2012-01-01

This paper reports on a study that aimed to investigate the effects of textual glosses on the lexical development of EFL learners. Given the importance of the English language for tertiary level study, it is necessary for EFL learners to read independently and to acquire the vocabulary they need for disciplinary study. Many studies have reported…

The Impact of Tertiary Education on Development of Moderate Society in Pakistan

ERIC Educational Resources Information Center

Atika, Samrana

2010-01-01

The study aimed to find out the impact of tertiary education on development of moderate Islamic society in Pakistan. The population of the study constituted of all the teachers engaged on teaching and all the students studying in the colleges. The study was delimited to the area of public sector college education. Cluster sampling technique was…

Assessment of Utilization of ICT Resources in Teaching among Tertiary Institution Business Educators in South Nigeria

ERIC Educational Resources Information Center

Okolocha, Chimezie Comfort; Nwadiani, Comfort Onaigho

2015-01-01

This study assessed the utilization of ICT resources in teaching among business educators in tertiary institutions in south Nigeria. Two research questions and two null hypotheses guided the study. Descriptive survey research design was adopted for the study. The population and sample for the study comprised all 240 business educators in colleges…

The Relevance of English Language Instruction in a Changing Linguistic Environment in Iceland: The L2 Self of Young Icelanders

ERIC Educational Resources Information Center

Jeeves, Anna

2014-01-01

In this study perceptions of post-compulsory school studies in Iceland were investigated through semi-structured interviews. While colloquial English suffices for entertainment, hobbies and Internet use in Iceland, a high level of proficiency is required for employment and tertiary study. School learners and young people in tertiary study and…

Methods for selecting fixed-effect models for heterogeneous codon evolution, with comments on their application to gene and genome data.

PubMed

Bao, Le; Gu, Hong; Dunn, Katherine A; Bielawski, Joseph P

2007-02-08

Models of codon evolution have proven useful for investigating the strength and direction of natural selection. In some cases, a priori biological knowledge has been used successfully to model heterogeneous evolutionary dynamics among codon sites. These are called fixed-effect models, and they require that all codon sites are assigned to one of several partitions which are permitted to have independent parameters for selection pressure, evolutionary rate, transition to transversion ratio or codon frequencies. For single gene analysis, partitions might be defined according to protein tertiary structure, and for multiple gene analysis partitions might be defined according to a gene's functional category. Given a set of related fixed-effect models, the task of selecting the model that best fits the data is not trivial. In this study, we implement a set of fixed-effect codon models which allow for different levels of heterogeneity among partitions in the substitution process. We describe strategies for selecting among these models by a backward elimination procedure, Akaike information criterion (AIC) or a corrected Akaike information criterion (AICc). We evaluate the performance of these model selection methods via a simulation study, and make several recommendations for real data analysis. Our simulation study indicates that the backward elimination procedure can provide a reliable method for model selection in this setting. We also demonstrate the utility of these models by application to a single-gene dataset partitioned according to tertiary structure (abalone sperm lysin), and a multi-gene dataset partitioned according to the functional category of the gene (flagellar-related proteins of Listeria). Fixed-effect models have advantages and disadvantages. Fixed-effect models are desirable when data partitions are known to exhibit significant heterogeneity or when a statistical test of such heterogeneity is desired. They have the disadvantage of requiring a priori knowledge for partitioning sites. We recommend: (i) selection of models by using backward elimination rather than AIC or AICc, (ii) use a stringent cut-off, e.g., p = 0.0001, and (iii) conduct sensitivity analysis of results. With thoughtful application, fixed-effect codon models should provide a useful tool for large scale multi-gene analyses.

Psychological Strategies for Resolving Interpersonal Conflicts among Administrators in Tertiary Institutions: A Case of Nnamdi Azikiwe University Awka, Nigeria

ERIC Educational Resources Information Center

Obi, Joy Sylvia C.; Obineli, Amaka S.

2015-01-01

The study was aimed at studying the psychological strategies for resolving interpersonal conflict among administrators in Tertiary Institutions with Nnamdi Azikiwe University as the case study. Gaining an understanding of these strategies may assist administrators of educational programs in handling interpersonal conflicts in more constructive and…

A Study of the Transition Pathways of School Level Scholarship Recipients into Work and Tertiary Education

ERIC Educational Resources Information Center

Hobden, Sally; Hobden, Paul

2015-01-01

School-level educational interventions targeting learners from low socioeconomic backgrounds often have the long-term goal of enabling access to, and successful completion of tertiary studies. This study tracked the progress of alumni of an educational intervention two or three years post school, in order to investigate their pathways to their…

Introductory Statistics Course Tertiary Students' Understanding of P-Values

ERIC Educational Resources Information Center

Reaburn, Robyn

2014-01-01

This study aimed to gain knowledge of students' beliefs and difficulties in understanding p-values, and to use this knowledge to develop improved teaching programs. This study took place over four consecutive teaching semesters of a one-semester tertiary statistics unit. The study was cyclical, in that the results of each semester were used to…

Examination of factors predicting secondary students' interest in tertiary STEM education

NASA Astrophysics Data System (ADS)

Chachashvili-Bolotin, Svetlana; Milner-Bolotin, Marina; Lissitsa, Sabina

2016-02-01

Based on the Social Cognitive Career Theory (SCCT), the study aims to investigate factors that predict students' interest in pursuing science, technology, engineering, and mathematics (STEM) fields in tertiary education both in general and in relation to their gender and socio-economic background. The results of the analysis of survey responses of 2458 secondary public school students in the fifth-largest Israeli city indicate that STEM learning experience positively associates with students' interest in pursuing STEM fields in tertiary education as opposed to non-STEM fields. Moreover, studying advanced science courses at the secondary school level decreases (but does not eliminate) the gender gap and eliminates the effect of family background on students' interest in pursuing STEM fields in the future. Findings regarding outcome expectations and self-efficacy beliefs only partially support the SCCT model. Outcome expectations and self-efficacy beliefs positively correlate with students' entering tertiary education but did not differentiate between their interests in the fields of study.

Xpert(®) MTB/RIF for improved case detection of extra-pulmonary TB in a tertiary care setting in urban India.

PubMed

Nataraj, G; Kanade, S; Mehta, P

2016-07-01

Department of microbiology at a tertiary care hospital, Mumbai, India. To determine 1) the sensitivity and specificity of the Xpert(®) MTB/RIF assay in comparison with microscopy and culture in extra-pulmonary tuberculosis (EPTB), and 2) the number of additional cases of EPTB and rifampicin (RMP) resistance detected using this assay. The study was conducted from July 2013 to April 2015. All consecutive patients with clinically suspected EPTB referred for microscopic examination to the Department of Microbiology that were sufficient in specimen volume were included in the study. Of the 728 specimens included in the study, respectively 5.5%, 23.5% and 20.9% were positive on smear, culture and Xpert. Compared to culture, Xpert had a sensitivity of 84.2% (95%CI 81.4-86.6) and specificity of 98.2% (95%CI 90-104). All specimens with high and medium load on assay were positive on culture; 28 (18.4%) specimens were RMP-resistant and 124 (81.6%) were Xpert-susceptible. No additional RMP-resistant cases were detected using Xpert as compared to phenotypic drug susceptibility testing. The ability of the Xpert assay to rapidly detect a significantly greater number of bacteriologically confirmed EPTB cases, including RMP-resistant cases, makes it an important diagnostic tool in a TB-endemic country.

Geochemical processes controlling water salinization in an irrigated basin in Spain: identification of natural and anthropogenic influence.

PubMed

Merchán, D; Auqué, L F; Acero, P; Gimeno, M J; Causapé, J

2015-01-01

Salinization of water bodies represents a significant risk in water systems. The salinization of waters in a small irrigated hydrological basin is studied herein through an integrated hydrogeochemical study including multivariate statistical analyses and geochemical modeling. The study zone has two well differentiated geologic materials: (i) Quaternary sediments of low salinity and high permeability and (ii) Tertiary sediments of high salinity and very low permeability. In this work, soil samples were collected and leaching experiments conducted on them in the laboratory. In addition, water samples were collected from precipitation, irrigation, groundwater, spring and surface waters. The waters show an increase in salinity from precipitation and irrigation water to ground- and, finally, surface water. The enrichment in salinity is related to the dissolution of soluble mineral present mainly in the Tertiary materials. Cation exchange, precipitation of calcite and, probably, incongruent dissolution of dolomite, have been inferred from the hydrochemical data set. Multivariate statistical analysis provided information about the structure of the data, differentiating the group of surface waters from the groundwaters and the salinization from the nitrate pollution processes. The available information was included in geochemical models in which hypothesis of consistency and thermodynamic feasibility were checked. The assessment of the collected information pointed to a natural control on salinization processes in the Lerma Basin with minimal influence of anthropogenic factors. Copyright © 2014 Elsevier B.V. All rights reserved.

Use of Treated Municipal Wastewater as Power Plant Cooling System Makeup Water: Tertiary Treatment versus Expanded Chemical Regimen for Recirculating Water Quality Management

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

David Dzombak; Radisav Vidic; Amy Landis

Treated municipal wastewater is a common, widely available alternative source of cooling water for thermoelectric power plants across the U.S. However, the biodegradable organic matter, ammonia-nitrogen, carbonate and phosphates in the treated wastewater pose challenges with respect to enhanced biofouling, corrosion, and scaling, respectively. The overall objective of this study was to evaluate the benefits and life cycle costs of implementing tertiary treatment of secondary treated municipal wastewater prior to use in recirculating cooling systems. The study comprised bench- and pilot-scale experimental studies with three different tertiary treated municipal wastewaters, and life cycle costing and environmental analyses of various tertiarymore » treatment schemes. Sustainability factors and metrics for reuse of treated wastewater in power plant cooling systems were also evaluated. The three tertiary treated wastewaters studied were: secondary treated municipal wastewater subjected to acid addition for pH control (MWW_pH); secondary treated municipal wastewater subjected to nitrification and sand filtration (MWW_NF); and secondary treated municipal wastewater subjected nitrification, sand filtration, and GAC adsorption (MWW_NFG). Tertiary treatment was determined to be essential to achieve appropriate corrosion, scaling, and biofouling control for use of secondary treated municipal wastewater in power plant cooling systems. The ability to control scaling, in particular, was found to be significantly enhanced with tertiary treated wastewater compared to secondary treated wastewater. MWW_pH treated water (adjustment to pH 7.8) was effective in reducing scale formation, but increased corrosion and the amount of biocide required to achieve appropriate biofouling control. Corrosion could be adequately controlled with tolytriazole addition (4-5 ppm TTA), however, which was the case for all of the tertiary treated waters. For MWW_NF treated water, the removal of ammonia by nitrification helped to reduce the corrosivity and biocide demand. Also, the lower pH and alkalinity resulting from nitrification reduced the scaling to an acceptable level, without the addition of anti-scalant chemicals. Additional GAC adsorption treatment, MWW_NFG, yielded no net benefit. Removal of organic matter resulted in pitting corrosion in copper and cupronickel alloys. Negligible improvement was observed in scaling control and biofouling control. For all of the tertiary treatments, biofouling control was achievable, and most effectively with pre-formed monochloramine (2-3 ppm) in comparison with NaOCl and ClO2. Life cycle cost (LCC) analyses were performed for the tertiary treatment systems studied experimentally and for several other treatment options. A public domain conceptual costing tool (LC3 model) was developed for this purpose. MWW_SF (lime softening and sand filtration) and MWW_NF were the most cost-effective treatment options among the tertiary treatment alternatives considered because of the higher effluent quality with moderate infrastructure costs and the relatively low doses of conditioning chemicals required. Life cycle inventory (LCI) analysis along with integration of external costs of emissions with direct costs was performed to evaluate relative emissions to the environment and external costs associated with construction and operation of tertiary treatment alternatives. Integrated LCI and LCC analysis indicated that three-tiered treatment alternatives such as MWW_NSF and MWW_NFG, with regular chemical addition for treatment and conditioning and/or regeneration, tend to increase the impact costs and in turn the overall costs of tertiary treatment. River water supply and MWW_F alternatives with a single step of tertiary treatment were associated with lower impact costs, but the contribution of impact costs to overall annual costs was higher than all other treatment alternatives. MWW_NF and MWW_SF alternatives exhibited moderate external impact costs with moderate infrastructure and chemical conditioner dosing, which makes them (especially MWW_NF) better treatment alternatives from the environmental sustainability perspective since they exhibited minimal contribution to environmental damage from emissions.« less

BOREAS Soils Data over the SSA in Raster Format and AEAC Projection

NASA Technical Reports Server (NTRS)

Knapp, David; Rostad, Harold; Hall, Forrest G. (Editor)

2000-01-01

This data set consists of GIS layers that describe the soils of the BOREAS SSA. The original data were submitted as vector layers that were gridded by BOREAS staff to a 30-meter pixel size in the AEAC projection. These data layers include the soil code (which relates to the soil name), modifier (which also relates to the soil name), and extent (indicating the extent that this soil exists within the polygon). There are three sets of these layers representing the primary, secondary, and tertiary soil characteristics. Thus, there is a total of nine layers in this data set along with supporting files. The data are stored in binary, image format files.

Structure-Function Study of Tertiary Amines as Switchable Polarity Solvents

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

Aaron D. Wilson; Frederick F. Stewart

2014-02-01

A series of tertiary amines have been screened for their function as switchable polarity solvents (SPS). The relative ratios of tertiary amine and carbonate species as well as maximum possible concentration were determined through quantitative 1H and 13C NMR spectroscopy. The viscosities of the polar SPS solutions were measured and ranged from near water in dilute systems through to gel formation at high concentrations. The van't Hoff indices for SPS solutions were measured through freezing point depression studies as a proxy for osmotic pressures. A new form of SPS with an amine : carbonate ratio significantly greater than unity hasmore » been identified. Tertiary amines that function as SPS at ambient pressures appear to be limited to molecules with fewer than 12 carbons. The N,N-dimethyl-n-alkylamine structure has been identified as important to the function of an SPS.« less

Impact of health insurance for tertiary care on postoperative outcomes and seeking care for symptoms: quasi-experimental evidence from Karnataka, India

PubMed Central

Sood, Neeraj; Wagner, Zachary

2016-01-01

Objectives To evaluate the effects of a government insurance programme covering tertiary care for the poor in Karnataka, India—Vajpayee Arogyashree Scheme (VAS)—on treatment seeking and postoperative outcomes. Design Geographic regression discontinuity. Setting 572 villages in Karnataka, India. Participants 3478 households in 300 villages where VAS was implemented and 3486 households in 272 neighbouring matched villages ineligible for VAS. Intervention A government insurance programme that provided free tertiary care to households below the poverty line in half of villages in Karnataka from February 2010 to August 2012. Main outcome measure Seeking treatment for symptoms, posthospitalisation well-being, occurrence of infections during hospitalisation and need for rehospitalisation. Results The prevalence of symptoms was nearly identical for households in VAS-eligible villages compared with households in VAS-ineligible villages. However, households eligible for VAS were 4.96 percentage points (95% CI 1 to 8.9; p=0.014) more likely to seek treatment for their symptoms. The increase in treatment seeking was more pronounced for symptoms of cardiac conditions, the condition most frequently covered by VAS. Respondents from VAS-eligible villages reported greater improvements in well-being after a hospitalisation in all categories assessed and they were statistically significant in 3 of the 6 categories (walking ability, pain and anxiety). Respondents eligible for VAS were 9.4 percentage points less likely to report any infection after their hospitalisation (95% CI −20.2 to 1.4; p=0.087) and 16.5 percentage points less likely to have to be rehospitalised after the initial hospitalisation (95% CI −28.7 to −4.3; p<0.01). Conclusions Insurance for tertiary care increased treatment seeking among eligible households. Moreover, insured patients experienced better posthospitalisation outcomes, suggesting better quality of care received. These results suggest that there are several pathways through which tertiary care insurance could improve health, aside from increasing utilisation of the services that the programme directly subsidises. PMID:26739744

Tertiary-amine-containing thermo- and pH-sensitive hydrophilic ABA triblock copolymers: effect of different tertiary amines on thermally induced sol-gel transitions.

PubMed

Henn, Daniel M; Wright, Roger A E; Woodcock, Jeremiah W; Hu, Bin; Zhao, Bin

2014-03-11

This Article reports on the synthesis of a series of well-defined, tertiary-amine-containing ABA triblock copolymers, composed of a poly(ethylene oxide) (PEO) central block and thermo- and pH-sensitive outer blocks, and the study of the effect of different tertiary amines on thermally induced sol-gel transition temperatures (T(sol-gel)) of their 10 wt % aqueous solutions. The doubly responsive ABA triblock copolymers were prepared from a difunctional PEO macroinitiator by atom transfer radical polymerization of methoxydi(ethylene glycol) methacrylate and ethoxydi(ethylene glycol) methacrylate at a feed molar ratio of 30:70 with ∼5 mol % of either N,N-diethylaminoethyl methacrylate (DEAEMA), N,N-diisopropylaminoethyl methacrylate, or N,N-di(n-butyl)aminoethyl methacrylate. The chain lengths of thermosensitive outer blocks and the molar contents of tertiary amines were very similar for all copolymers. Using rheological measurements, we determined the pH dependences of T(sol-gel) of 10 wt % aqueous solutions of these copolymers in a phosphate buffer. The T(sol-gel) versus pH curves of all polymers exhibited a sigmoidal shape. The T(sol-gel) increased with decreasing pH; the changes were small on both high and low pH sides. At a specific pH, the T(sol-gel) decreased with increasing the hydrophobicity of the tertiary amine, and upon decreasing pH the onset pH value for the T(sol-gel) to begin to increase noticeably was lower for the more hydrophobic tertiary amine-containing copolymer. In addition, we studied the effect of different tertiary amines on the release behavior of FITC-dextran from 10 wt % micellar gels in an acidic medium at 37 and 27 °C. The release profiles for three studied hydrogels at 37 °C were essentially the same, suggesting that the release was dominated by the diffusion of FITC-dextran. At 27 °C, the release was significantly faster for the DEAEMA-containing copolymer, indicating that both diffusion and gel dissolution contributed to the release at this temperature.

Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan.

PubMed

Wali, A; Kumar, A M V; Hinderaker, S G; Heldal, E; Qadeer, E; Fatima, R; Ullah, A; Safdar, N; Yaqoob, A; Anwar, K; Ul Haq, M

2017-03-21

Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective.

Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan

PubMed Central

Kumar, A. M. V.; Hinderaker, S. G.; Heldal, E.; Qadeer, E.; Fatima, R.; Ullah, A.; Safdar, N.; Yaqoob, A.; Anwar, K.; Ul Haq, M.

2017-01-01

Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective. PMID:28775939

Educational differences in dietary intake and compliance with dietary recommendations in a Swiss adult population.

PubMed

Mayén, Ana-Lucia; Guessous, Idris; Paccaud, Fred; Stringhini, Silvia; Marques-Vidal, Pedro

2016-12-01

This study assessed the impact of education on diet and compliance with the national recommendations. The study included 4338 adult participants of the Colaus study, a cross-sectional, population-based study conducted between 2009 and 2012 in Lausanne (Switzerland). Education was categorized as primary, apprenticeship, secondary, and tertiary. Men with primary vs. tertiary education had a lower intake of monounsaturated fatty acids (29.4 vs. 30.9 g/day), iron (11.4 vs. 11.8 mg/day), vitamin A (758.2 vs. 904.2 retinol equivalents/day), and vitamin D (2.3 vs. 3.0 μg/day). Women with primary vs. tertiary education had a lower intake of monounsaturated fatty acids (25.5 vs. 27.4 g/day), fiber (15.6 vs. 17.2 g/day) and iron (9.8 vs. 10.3 mg/day). Men with primary vs. tertiary education had a better compliance with protein recommendations [odds ratio (95 % CI): 2.31 (1.37; 3.90)], while women with primary vs. tertiary education had a better compliance with vitamin A recommendations [odds ratio 1.74 (1.15; 2.65)]. Overall, our results do not confirm a unidirectional association between education and diet, and question the approach of targeted interventions alone in selected educational groups to prevent chronic diseases.

Childhood leprosy: a retrospective descriptive study from Government Medical College, Kozhikode, Kerala, India.

PubMed

Sasidharanpillai, Sarita; Binitha, Manikoth Payyanadan; Riyaz, Najeeba; Ambooken, Betsy; Mariyath, Olasseri Kalathingal Reena; George, Biju; Janardhanan, Anisha Kanhirangattil; Sherjeena, Pentam Veli Beegum

2014-06-01

To assess the profile and describe the clinical presentations and complications of childhood leprosy in a tertiary care hospital in North Kerala, South India during 2003-2012 and to analyse any change in the age-sex profile and the clinical pattern of leprosy in children below the age of 15 years over the 10-year study period. A retrospective descriptive study of children less than 15 years of age diagnosed with leprosy and registered for treatment in a tertiary care institution from 2003 to 2012. Demographic, clinical, investigative and treatment data were collected using a pre-set proforma. 138 (12.1%) of the total 1143 leprosy cases registered for treatment during the 10-year period were below 15 years of age. The 10-year study period witnessed a statistically insignificant decrease in the new childhood leprosy cases registered for treatment in our tertiary care institution. The majority of cases belonged to the 6-12 year age group (61.6%) with a male predominance. Borderline tuberculoid (BT) was the commonest clinical type (65.9%) followed by indeterminate leprosy (18.8%); 101 patients required paucibacillary (PB) and 37 needed multibacillary (MB) treatment. The number of patients requiring MB treatment showed a statistically significant increase and there was a significant decline in number of cases requiring PB treatment. During the entire study period no Type 2 lepra reaction was documented in patients below Hema 15 years and only two patients manifested Type 1 reaction. Ten (7.2%) out of the 138 patients were cases of relapse. There was a clear female predilection among relapse cases with the majority belonging to the adolescent age. Childhood leprosy still contributes to a significant proportion of the total case load denoting the continuing active horizontal transmission of leprosy. The rise in number of patients with more extensive disease in the background of declining disease prevalence is suggestive of the delay in diagnosis and treatment. A high relapse rate noted in the present study may be due to incorrect classification and treatment of MB as PB leprosy which in turn might have resulted in treatment failure due to inadequate treatment.

Experiences of Chinese International Students Learning English at South African Tertiary Institutions

ERIC Educational Resources Information Center

Ayliff, D.; Wang, G.

2006-01-01

This article aims to provide insight into the experiences of Chinese international students in some South African tertiary institutions. The study investigates their successes and failures in endeavouring to learn English and the culture shock and "learning shock" they endure when registering to study in an African country with an…

Food Insecurity: Is It an Issue among Tertiary Students?

ERIC Educational Resources Information Center

Gallegos, Danielle; Ramsey, Rebecca; Ong, Kai Wen

2014-01-01

Insufficient access to food is known to compromise tertiary studies. Students often belong to groups known to have poor food security such as those renting or relying on government payments. The present study administered a cross-sectional survey incorporating the USDA food security survey module (FSSM) to 810 students at a metropolitan university…

Lecturers' Perception of Strategies for Enhancing Business Education Research in Tertiary Institutions in Nigeria

ERIC Educational Resources Information Center

Okoro, James

2013-01-01

Business education programme seems to have been faced with inadequate qualitative research in tertiary institution in Nigeria. The study therefore, assessed the strategies for enhancing Business Education research. Two research questions and six hypotheses guided the study. A 66 item questionnaire was administered to 164 colleges of education and…

Learning Assessment in Tertiary Business Education with Revised Taxonomy

ERIC Educational Resources Information Center

Hossain, Md. Shajjad

2017-01-01

The goal of this study was to evaluate the assessment criteria of learning in tertiary education of Bangladesh. The study was aimed at identifying percentage of questions during learning assessment of business graduates following cognitive levels of Bloom's in revised Taxonomy and to test whether there was any significant difference in the…

Adults Studying Pure Mathematics in Adult Tertiary Preparation.

ERIC Educational Resources Information Center

Bennison, Anne

2002-01-01

Investigated the experiences of a group of adults enrolled in the Pure Mathematics module of the Certificate IV in Adult Tertiary Preparation in 2000 at one of the Institutes of TAFE in Brisbane, Australia. Classroom learning experiences, exposure to technology, and the impact of returning to study on other facets of students' lives were…

Tertiary Student Transitions: Sectors, Fields, Impacts of and Reasons for Study--Support Document

ERIC Educational Resources Information Center

Fredman, Nick

2012-01-01

This paper examines the relationships between post-school educational fields and sectors and labour market considerations that appear to shape students' study decisions. It was found that pathways taken vary considerably by age, suggesting changes over time to patterns in tertiary education towards greater participation overall, a greater extent…

Indigenous Tutorial Assistance Scheme. Tertiary Tuition and Beyond: Transitioning with Strengths and Promoting Opportunities

ERIC Educational Resources Information Center

Wilks, Judith; Fleeton, Ellen Radnidge; Wilson, Katie

2017-01-01

The Indigenous Tutorial Assistance Scheme-Tertiary Tuition (ITAS-TT) has provided Australian government funding for one-to-one and group tutorial study support for Aboriginal and Torres Strait Islander students attending Australian universities since 1989. It has been a central plank supporting Indigenous university students in their studies.…

PASS Student Leader and Mentor Roles: A Tertiary Leadership Pathway

ERIC Educational Resources Information Center

Skalicky, Jane; Caney, Annaliese

2010-01-01

In relation to developing leadership skills during tertiary studies, this paper considers the leadership pathway afforded by a Peer Assisted Study Sessions (PASS) program which includes the traditional PASS Leader role and a more senior PASS Mentor role. Data was collected using a structured survey with open-ended questions designed to capture the…

A Study of Macao Tertiary Students' Language Attitudes after the Handover

ERIC Educational Resources Information Center

Yan, Xi

2017-01-01

This study investigates Macao tertiary students' language attitudes under the dynamic interplay of local, national, and global forces. The Portuguese established their settlement at Macao during the mid-sixteenth century and their colonial rule over Macao during the mid-nineteenth century. Macao's sovereignty was transferred to China at midnight…

Expansion tunnel performance with and without an electromagnetically opened tertiary diaphragm

NASA Technical Reports Server (NTRS)

Miller, C. G.

1977-01-01

A study was conducted to examine the effect of synchronization of an electromagnetically opened tertiary diaphragm with flow arrival at the diaphragm on the pitot pressure measured at the test section of an expansion tunnel. The effect of tertiary diaphragm pressure ratio (ratio of initial nozzle pressure to quiescent acceleration section pressure) on the pitot pressure time history is also determined. The inadequacy of a pressure transducer protection arrangement used in previous expansion tube and expansion tunnel tests was revealed.

Application of Tryptophan Fluorescence Bandwidth-Maximum Plot in Analysis of Monoclonal Antibody Structure.

PubMed

Huang, Cheng-Yen; Hsieh, Ming-Ching; Zhou, Qinwei

2017-04-01

Monoclonal antibodies have become the fastest growing protein therapeutics in recent years. The stability and heterogeneity pertaining to its physical and chemical structures remain a big challenge. Tryptophan fluorescence has been proven to be a versatile tool to monitor protein tertiary structure. By modeling the tryptophan fluorescence emission envelope with log-normal distribution curves, the quantitative measure can be exercised for the routine characterization of monoclonal antibody overall tertiary structure. Furthermore, the log-normal deconvolution results can be presented as a two-dimensional plot with tryptophan emission bandwidth vs. emission maximum to enhance the resolution when comparing samples or as a function of applied perturbations. We demonstrate this by studying four different monoclonal antibodies, which show the distinction on emission bandwidth-maximum plot despite their similarity in overall amino acid sequences and tertiary structures. This strategy is also used to demonstrate the tertiary structure comparability between different lots manufactured for one of the monoclonal antibodies (mAb2). In addition, in the unfolding transition studies of mAb2 as a function of guanidine hydrochloride concentration, the evolution of the tertiary structure can be clearly traced in the emission bandwidth-maximum plot.

Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury

PubMed Central

Hobart-Porter, Laura; Wade, Shari; Minich, Nori; Kirkwood, Michael; Stancin, Terry; Taylor, Hudson Gerry

2017-01-01

Objective To characterize the effects of caregiver mental health and coping strategies on interactions with an injured adolescent acutely after traumatic brain injury (TBI). Design Multi-site, cross-sectional study. Setting Outpatient setting of 3 tertiary pediatric hospitals and 2 tertiary general medical centers. Participants Adolescents (N = 125) aged 12–17 years, 1–6 months after being hospitalized with complicated mild to severe TBI. Methods Data were collected as part of a multi-site clinical trial of family problem-solving therapy after TBI. Multiple regression analyses were used to examine the relationship of caregiver and environmental characteristics to the dimensions of effective communication, warmth, and negativity during caregiver-adolescent problem-solving discussions. Main Outcomes Measures Adolescent and caregiver interactions, as measured by the Iowa Family Interaction Rating Scales. Results Caregivers who utilized problem-focused coping strategies were rated as having higher levels of effective communication (P <.01), as were those with higher socioeconomic status (P <.01). Problem-focused coping style and higher socioeconomic status were also associated lower levels of negative interactions (P < .01 and P < .05, respectively). Female gender of the adolescent and fewer children in the home were associated with increased parental warmth during the interaction (P < .01 and P < .05, respectively). Neither adolescent TBI severity nor caregiver depression significantly influenced caregiver-teen interactions. Conclusions Problem-focused coping strategies are associated with higher levels of effective communication and lower levels of caregiver negativity during the initial months after adolescent TBI, suggesting that effective caregiver coping may facilitate better caregiver-adolescent interactions after TBI. PMID:25687111

The vocational education setting for health promotion: a survey of students' health risk behaviours and preferences for help.

PubMed

Bonevski, Billie; Guillaumier, Ashleigh; Paul, Christine; Walsh, Raoul

2013-12-01

Adolescence and young adulthood is a time of risky health behaviour initiation and experimentation. Smoking, risky drinking, poor nutrition and physical activity, and a lack of sun protection behaviour, often become established in early adulthood. Levels of health risk behaviours occurring amongst tertiary education and training students and their preferences for types of on-campus health promotion programs were examined. A cross-sectional pen-and-paper classroom survey was conducted at one Sydney-based TAFE New South Wales Institute campus in May 2010. The survey assessed demographics, smoking, alcohol use, sun protection, nutrition, physical activity and health promotion program preferences. Two hundred and twenty-four students participated (97% consent); the majority were aged 16-24 years (59%) and female (51%). Current smoking (35%), risky drinking (49%) and inadequate physical activity (88%) rates were high. Adequate vegetable intake (3.6%) and sun protection behaviours (5.4%) were low and 33% of students were overweight or obese. Popular health promotion programs included food and activity subsidies, practical skills classes and social outings. Participation in health risk behaviours among this sample was high. The setting of tertiary education and workplace training represents an opportunity for early intervention into risky health behaviours among young people. SO WHAT?: This study is the first to provide information on the prevalence of health risk behaviours and preferences for types of health promoting programs among students of an Australian community college. The results show that young adults regularly participate in multiple health risk behaviours, such as smoking, drinking, poor nutrition, physical activity and lack of sun protection.

Inpatient Complexity in Radiology-a Practical Application of the Case Mix Index Metric.

PubMed

Mabotuwana, Thusitha; Hall, Christopher S; Flacke, Sebastian; Thomas, Shiby; Wald, Christoph

2017-06-01

With ongoing healthcare payment reforms in the USA, radiology is moving from its current state of a revenue generating department to a new reality of a cost-center. Under bundled payment methods, radiology does not get reimbursed for each and every inpatient procedure, but rather, the hospital gets reimbursed for the entire hospital stay under an applicable diagnosis-related group code. The hospital case mix index (CMI) metric, as defined by the Centers for Medicare and Medicaid Services, has a significant impact on how much hospitals get reimbursed for an inpatient stay. Oftentimes, patients with the highest disease acuity are treated in tertiary care radiology departments. Therefore, the average hospital CMI based on the entire inpatient population may not be adequate to determine department-level resource utilization, such as the number of technologists and nurses, as case length and staffing intensity gets quite high for sicker patients. In this study, we determine CMI for the overall radiology department in a tertiary care setting based on inpatients undergoing radiology procedures. Between April and September 2015, CMI for radiology was 1.93. With an average of 2.81, interventional neuroradiology had the highest CMI out of the ten radiology sections. CMI was consistently higher across seven of the radiology sections than the average hospital CMI of 1.81. Our results suggest that inpatients undergoing radiology procedures were on average more complex in this hospital setting during the time period considered. This finding is relevant for accurate calculation of labor analytics and other predictive resource utilization tools.

Counselling for Sustainable Peace in Tertiary Institutions in Nigeria

ERIC Educational Resources Information Center

Nduka-Ozo, Stella Ngozi

2016-01-01

This study reviewed the nature of peace in Tertiary Institutions in Nigeria using Ebonyi State University as a case study. The purpose of the study was to review the various factors responsible for lack of peace. The sample was drawn from the three hundred level students of the Faculty of Education. Thirty students were selected from each of the…

Peace Management and Enhanced Academic Performance of Tertiary Institutions in South-South Nigeria

ERIC Educational Resources Information Center

Ebuara, Victor Obule; Ekpoh, Uduak Imo

2011-01-01

This study was embarked upon with a view to examining the need for peace in the management of tertiary institutions towards enhancing academic performance in south-south Nigeria. Three hypotheses and one research question guided the study. One thousand, two hundred and nineteen (1219) academic and non-academic staff were selected for the study. A…

BLUE RANGE WILDERNESS, ARIZONA AND NEW MEXICO.

USGS Publications Warehouse

Ratte, James C.; Raabe, R.G.

1984-01-01

A mineral survey of the area was completed and it was determined that a probable resource potential for molybdenum, copper, and silver is present in volcanic rocks of middle Tertiary age in the southern and southwestern parts of the area. There is also a likelihood for the occurrence of base-metal resources (including porphyry copper deposits) of Laramide age beneath the middle Tertiary volcanic rocks that cover the area, but data are insufficient to assess the resource potential. Improved techniques for interpreting geophysical data collected over complex volcanic terranes should be applied in an effort to identify Laramide intrusives beneath the middle Tertiary rocks. Additional geologic studies of the major faults and volcanic centers might enhance mineral-deposit target definition in the middle Tertiary rocks.

Direct cost comparison of totally endoscopic versus open ear surgery.

PubMed

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Large-Scale Assessment of Language Proficiency: Theoretical and Pedagogical Reflections on the Use of Multiple-Choice Tests

ERIC Educational Resources Information Center

Argüelles Álvarez, Irina

2013-01-01

The new requirement placed on students in tertiary settings in Spain to demonstrate a B1 or a B2 proficiency level of English, in accordance with the Common European Framework of Reference for Languages (CEFRL), has led most Spanish universities to develop a program of certification or accreditation of the required level. The first part of this…

Generation Y Students: Appropriate Learning Styles and Teaching Approaches in the Economic and Management Sciences Faculty

ERIC Educational Resources Information Center

Wessels, P. L.; Steenkamp, L. P.

2009-01-01

Generation Y students (born after 1982) have developed a different set of attitudes and aptitudes as a result of growing up in an IT and media-rich environment. This article has two objectives: firstly to discuss the learning styles preferred by generation Y students in order to identify the effect of these preferences on tertiary education in…

Computer-Mediated Communication and Culture: A Comparison of "Confucian-Heritage" and "Western" Learner Attitudes to Asynchronous E-Discussions Undertaken in an Australian Higher Educational Setting

ERIC Educational Resources Information Center

Ramsay, Guy

2005-01-01

While the internationalisation of higher education has made learner diversity a key consideration in tertiary pedagogical practice, research into the application of computer-mediated technologies in this domain has rarely taken into account culture. This article responds to this gap in the research by comparing "Confucian-heritage" and…

Quantitative tests of a reconstitution model for RNA folding thermodynamics and kinetics.

PubMed

Bisaria, Namita; Greenfeld, Max; Limouse, Charles; Mabuchi, Hideo; Herschlag, Daniel

2017-09-12

Decades of study of the architecture and function of structured RNAs have led to the perspective that RNA tertiary structure is modular, made of locally stable domains that retain their structure across RNAs. We formalize a hypothesis inspired by this modularity-that RNA folding thermodynamics and kinetics can be quantitatively predicted from separable energetic contributions of the individual components of a complex RNA. This reconstitution hypothesis considers RNA tertiary folding in terms of ΔG align , the probability of aligning tertiary contact partners, and ΔG tert , the favorable energetic contribution from the formation of tertiary contacts in an aligned state. This hypothesis predicts that changes in the alignment of tertiary contacts from different connecting helices and junctions (ΔG HJH ) or from changes in the electrostatic environment (ΔG +/- ) will not affect the energetic perturbation from a mutation in a tertiary contact (ΔΔG tert ). Consistent with these predictions, single-molecule FRET measurements of folding of model RNAs revealed constant ΔΔG tert values for mutations in a tertiary contact embedded in different structural contexts and under different electrostatic conditions. The kinetic effects of these mutations provide further support for modular behavior of RNA elements and suggest that tertiary mutations may be used to identify rate-limiting steps and dissect folding and assembly pathways for complex RNAs. Overall, our model and results are foundational for a predictive understanding of RNA folding that will allow manipulation of RNA folding thermodynamics and kinetics. Conversely, the approaches herein can identify cases where an independent, additive model cannot be applied and so require additional investigation.

Facility Benchmarking Trends in Tertiary Education - An Australian Case Study.

ERIC Educational Resources Information Center

Fisher, Kenn

2001-01-01

Presents how Australia's facility managers are responding to the growing impact of tertiary education participation and the increase in educational facility usage. Topics cover strategic asset management and the benchmarking of education physical assets and postsecondary institutions. (GR)

Folding associated with extensional faulting: Sheep Range detachment, southern Nevada

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

Guth, P.L.

1985-01-01

The Sheep Range detachment is a major Miocene extensional fault system of the Great Basin. Its major faults have a scoop shape, with straight, N-S traces extending 15-30 km and then abruptly turning to strike E-W. Tertiary deformation involved simultaneous normal faulting, sedimentation, landsliding, and strike-slip faulting. Folds occur in two settings: landslide blocks and drag along major faults. Folds occur in landslide blocks and beneath them. Most folds within landslide blocks are tight anticlines, with limbs dipping 40-60 degrees. Brecciation of the folds and landslide blocks suggests brittle deformation. Near Quijinump Canyon in the Sheep Range, at least threemore » landslide blocks (up to 500 by 1500 m) slid into a small Tertiary basin. Tertiary limestone beneath the Paleozoic blocks was isoclinally folded. Westward dips reveal drag folds along major normal faults, as regional dips are consistently to the east. The Chowderhead anticline is the largest drag fold, along an extensional fault that offsets Ordovician units 8 km. East-dipping Ordovician and Silurian rocks in the Desert Range form the hanging wall. East-dipping Cambrian and Ordovician units in the East Desert Range form the foot wall and east limb of the anticline. Caught along the fault plane, the anticline's west-dipping west limb contains mostly Cambrian units.« less

Assessing Manual and Online Course Registration in Nigeria Tertiary Institutions

ERIC Educational Resources Information Center

Oladunjoye, Patrick; Omemu, Felix

2013-01-01

The study is aimed at assessing the perceptions of male and female students on manual and online course registration systems in tertiary institutions in Nigeria. One research question was formulated to guide the study. A questionnaire containing 20 items on assessing the perceptions of students on manual and online course registration was drawn.…

Student Preferences and Expectations: Some Practical Tips for Designers of English Enhancement Programmes

ERIC Educational Resources Information Center

Yeung, Marine; Li, Tilo

2018-01-01

As one of the essential skills for success in work and studies, English communication is often made a key component in the GE curriculum of tertiary study programmes. In addition to the provision of required English proficiency courses, many tertiary institutions have established English centres of some description to promote English learning on…

The Use of Peer Assessment in a Regional Australian University Tertiary Bridging Course

ERIC Educational Resources Information Center

Chambers, Kelly; Whannell, Robert; Whannell, Patricia

2014-01-01

This paper presents the findings from research on peer assessment practice that was specifically focussed on improving the experience in a tertiary bridging course. The objective of the study was to examine the impact of this assessment approach on student social relationships and the overall assessment experience. The study also examined whether…

The Relationship between Feedback and Change in Tertiary Student Writing in the Disciplines

ERIC Educational Resources Information Center

Vardi, Iris

2008-01-01

This study examined the relationship between teacher written feedback and change in the disciplinary writing of tertiary students in their final year of undergraduate study. The student texts and teacher written feedback examined arose naturally out of a third year disciplinary-based unit in which each student submitted a text three times over the…

Online Computer Games as Collaborative Learning Environments: Prospects and Challenges for Tertiary Education

ERIC Educational Resources Information Center

Papastergiou, Marina

2009-01-01

This study is aimed at presenting a critical overview of recent research studies on the use of educational online games as collaborative learning environments in Tertiary Education (TE), namely higher education and vocational training, with a view to identifying: a) the elements that online games should include in order to support fruitful and…

A Study of First-Year Chemistry Students' Understanding of Solution Concentration at the Tertiary Level

ERIC Educational Resources Information Center

de Berg, Kevin

2012-01-01

This paper reports on students' understanding of sugar concentration in aqueous solutions presented in two different modes: a visual submicroscopic mode for particles and a verbal mode referring to macroscopic amounts of sugar. One hundred and forty-five tertiary college students studying some form of first-year chemistry participated in the…

Abusive Head Trauma at a Tertiary Care Children's Hospital in Mexico City. A Preliminary Study

ERIC Educational Resources Information Center

Diaz-Olavarrieta, Claudia; Garcia-Pina, Corina A.; Loredo-Abdala, Arturo; Paz, Francisco; Garcia, Sandra G.; Schilmann, Astrid

2011-01-01

Objectives: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. Methods: This is a cross-sectional descriptive study of infants and children under 5,…

Exploring Vocational and Academic Fields of Study: Development and Validation of the Flemish SIMON Interest Inventory (SIMON-I)

ERIC Educational Resources Information Center

Fonteyne, Lot; Wille, Bart; Duyck, Wouter; De Fruyt, Filip

2017-01-01

A new, Holland-based Interest Inventory is proposed, intended to facilitate the transition from secondary to tertiary education. Specific interest items were designed to grasp activities that are prevalent during tertiary studies, including an Academic-track-scale to assist in the choice between academic and vocational-oriented programs. Interest…

Asian Students' Perceptions of Group Work and Group Assignments in a New Zealand Tertiary Institution

ERIC Educational Resources Information Center

Li, Mingsheng; Campbell, Jacqui

2008-01-01

This study, conducted in 2005 in a New Zealand tertiary institution, examines Asian students' perceptions of the much-promulgated cooperative learning concepts in the form of group work and group assignments. Twenty-two Asian students participated in one-hour individual face-to-face semi-structured interviews. The study found that Asian students…

The Professionalization of Educational Leaders through Postgraduate Study and Professional Development Opportunities in New Zealand Tertiary Education Institutions

ERIC Educational Resources Information Center

Macpherson, Reynold

2010-01-01

This paper reports a review of the professionalization services in educational leadership available from New Zealand's tertiary institutions at a time of accelerating retirements and turnover. Case studies of current programs identified six urgent policy issues: the need for research-based provisions in early childhood education (ECE); potential…

Job burnout among critical care nurses from 14 adult intensive care units in northeastern China: a cross-sectional survey

PubMed Central

Zhang, Xiao-Chun; Huang, De-Sheng; Guan, Peng

2014-01-01

Objectives The shortage of qualified nurses is one of the critical challenges in the field of healthcare. Among the contributing factors, job burnout has been indicated as a risk factor for the intention to leave. The purpose of this study was to provide a better understanding of the local status and reference data for coping strategies for intensive care unit (ICU)-nurse burnout among Liaoning ICU nurses. Design Observational study. Setting 17 ICUs from 10 tertiary-level hospitals in Liaoning, China. Participants 431 ICU nurses from 14 ICUs nested in 10 tertiary-level hospitals in Liaoning, China, were invited during October and November 2010. Primary measures Burnout was measured using the 22-item Chinese version of Maslach Burnout Inventory-Health Service Survey (MBI-HSS) questionnaires. Results 14 ICUs responded actively and were included; the response rate was 87.7% among the 486 invited participants from these 17 ICUs. The study population was a young population, with the median age 25 years, IQR 23–28 years and female nurses accounted for the major part (88.5%). 68 nurses (16%) were found to have a high degree of burnout, earning high emotional exhaustion and depersonalisation scores together with a low personal accomplishment score. Conclusions The present study indicated a moderate distribution of burnout among ICU nurses in Liaoning, China. An investigation into the burnout levels of this population could bring more attention to ICU caregivers. PMID:24948747

Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study.

PubMed

Fanning, Laura; Jones, Nick; Manias, Elizabeth

2016-04-01

The implementation of automated dispensing cabinets (ADCs) in healthcare facilities appears to be increasing, in particular within Australian hospital emergency departments (EDs). While the investment in ADCs is on the increase, no studies have specifically investigated the impacts of ADCs on medication selection and preparation error rates in EDs. Our aim was to assess the impact of ADCs on medication selection and preparation error rates in an ED of a tertiary teaching hospital. Pre intervention and post intervention study involving direct observations of nurses completing medication selection and preparation activities before and after the implementation of ADCs in the original and new emergency departments within a 377-bed tertiary teaching hospital in Australia. Medication selection and preparation error rates were calculated and compared between these two periods. Secondary end points included the impact on medication error type and severity. A total of 2087 medication selection and preparations were observed among 808 patients pre and post intervention. Implementation of ADCs in the new ED resulted in a 64.7% (1.96% versus 0.69%, respectively, P = 0.017) reduction in medication selection and preparation errors. All medication error types were reduced in the post intervention study period. There was an insignificant impact on medication error severity as all errors detected were categorised as minor. The implementation of ADCs could reduce medication selection and preparation errors and improve medication safety in an ED setting. © 2015 John Wiley & Sons, Ltd.

Determination of Cenozoic sedimentary structures using integrated geophysical surveys: A case study in the Barkol Basin, Xinjiang, China

NASA Astrophysics Data System (ADS)

Sun, Kai; Chen, Chao; Du, Jinsong; Wang, Limin; Lei, Binhua

2018-01-01

Thickness estimation of sedimentary basin is a complex geological problem, especially in an orogenic environment. Intense and multiple tectonic movements and climate changes result in inhomogeneity of sedimentary layers and basement configurations, which making sedimentary structure modelling difficult. In this study, integrated geophysical methods, including gravity, magnetotelluric (MT) sounding and electrical resistivity tomography (ERT), were used to estimate basement relief to understand the geological structure and evolution of the eastern Barkol Basin in China. This basin formed with the uplift of the eastern Tianshan during the Cenozoic. Gravity anomaly map revealed the framework of the entire area, and ERT as well as MT sections reflected the geoelectric features of the Cenozoic two-layer distribution. Therefore, gravity data, constrained by MT, ERT and boreholes, were utilized to estimate the spatial distribution of the Quaternary layer. The gravity effect of the Quaternary layer related to the Tertiary layer was later subtracted to obtain the residual anomaly for inversion. For the Tertiary layer, the study area was divided into several parts because of lateral difference of density contrasts. Gravity data were interpreted to determine the density contrast constrained by the MT results. The basement relief can be verified by geological investigation, including the uplift process and regional tectonic setting. The agreement between geophysical survey and prior information from geology emphasizes the importance of integrated geophysical survey as a complementary means of geological studies in this region.

Online problem-solving therapy for executive dysfunction after child traumatic brain injury.

PubMed

Kurowski, Brad G; Wade, Shari L; Kirkwood, Michael W; Brown, Tanya M; Stancin, Terry; Taylor, H Gerry

2013-07-01

Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant problems in functioning across multiple settings. The objective of this study was to evaluate the efficacy of a web-based counselor-assisted problem solving (CAPS) intervention compared with an Internet resource comparison (IRC) for treatment of executive dysfunction within 12 months after complicated mild to severe TBI in adolescents. We hypothesized that CAPS would significantly improve parent ratings of executive dysfunction compared with an IRC. Participants included 132 adolescents aged 12 to 17 years who sustained a complicated mild to severe TBI within 1 to 6 months before study enrollment. Study design was a multisite, assessor-blinded, randomized controlled trial. Study sites included 3 tertiary pediatric hospitals and 2 tertiary general medical centers. The main outcome measure was primary caregiver Behavioral Rating Inventory of Executive Function Global Executive Composite at baseline and 6-month follow-up. Generalized linear models that controlled for baseline scores were used to compare the CAPS and IRC scores. In older teens, the CAPS group showed significant improvement in executive function behaviors at 6-month follow-up compared with the IRC group (F = 6.74, P = .01, Cohen's d = 0.63). Findings indicate that web-based CAPS improves primary caregiver-rated executive functioning within the first 12 months after TBI in older adolescents. Future research needs to define the optimal timing after injury for delivery of CAPS and characteristics of individuals and families who are most likely to benefit from CAPS.

Developing and evaluating effective bioscience learning activities for nursing students.

PubMed

Salvage-Jones, Judith; Hamill, Jessie; Todorovic, Michael; Barton, Matthew J; Johnston, Amy N B

2016-07-01

Effective engagement of nursing students in the study of biosciences remains a challenge for many tertiary institutes. In this study we attempted to implement and then evaluate a simple hands-on intervention, consisting of a series of hands-on games and puzzles, to increase nursing student engagement with core concepts and anatomical learning involved in clinical anatomy and physiology. The study used a quazi-experimental longitudinal before and after design, to explore the effect of a learning intervention on student performance. Set across three different campuses of the same University, it included 1320 first year undergraduate nursing students from 2013 to 2014 who were studying Anatomy and Physiology. Students were exposed to the interventions or not, and concomitant academic performance, weekly quiz scores, performance in fortnightly worksheets and, across the semester, exam performance were compared. The results show that while the intervention appeared to increase academic performance in students on one campus (2013) compared to the other two, this difference was not sustained into 2014 when a bigger cohort was examined. Despite significant subjective student satisfaction and enthusiasm about these learning and teaching interventions, the data does not support the capacity of these activities to enhance student academic performance. Tertiary entrance scores, being a non-native English speakers and socio-economic status all had a bigger impact on student performance than engagement with fun anatomy and physiology activities. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Use of English Vocabulary Learning Strategies by Thai Tertiary-Level Students in Relation to Fields of Study and Language-Learning Experiences

ERIC Educational Resources Information Center

Boonkongsaen, Nathaya; Intaraprasert, Channarong

2014-01-01

The present study was intended to examine the effects of 1) fields of study (arts, business and science-oriented); and 2) language-learning experiences (whether limited or non-limited to formal classroom instructions) on the use of VLSs among Thai tertiary-level students. The participants were 905 Thai EFL students studying in the Northeast of…

Influence of Marital Stressors on Role Performance of Married Academic Women in Tertiary Institutions in Cross River State and Need for Counselling Therein

ERIC Educational Resources Information Center

Okpechi, Philip A.; Usani, Michael Okoi

2015-01-01

This study investigated the influence of marital stressors on role performance of married academic women of tertiary institutions in Cross River State. In order to accomplish the purpose of the study, two objectives and corresponding two hypotheses were postulated to guide the study. The survey research design was adopted in the study. A total of…

What is the role of general internists in the tertiary or academic setting?

PubMed

Tanriover, Mine Durusu; Rigby, Shirley; van Hulsteijn, L Harry; Ferreira, Faustino; Oliveira, Narcisso; Schumm-Draeger, Petra-Maria; Weidanz, Frauke; Kramer, Mark H H

2015-01-01

The changing demography of European populations mandates a vital role for internists in caring for patients in each level of healthcare. Internists in the tertiary or academic setting are highly ranked in terms of their responsibilities: they are clinicians, educators, researchers, role models, mentors and administrators. Contrary to the highly focused approach of sub-specialties, general internists working in academic settings can ensure that coordinated care is delivered in the most cost-conscious and efficient way. Moreover, internal medicine is one of the most appropriate specialties in which to teach clinical reasoning skills, decision-making and analytical thinking, as well as evidence based, patient oriented medicine. Internists deal with challenging patients of the new millennium with a high burden of chronic diseases and polypharmacy; practice personalised medicine with a wide scientific background and so they are the perfect fit to establish and implement new tools for scientific research. In conclusion, internal medicine is developing a new identity as a specialty in its own right. The European Federation of Internal Medicine supports the concept of academic internists and calls upon the member countries to construct academic (general) internal medicine departments in their respective countries. As 'internal medicine is the cornerstone of every national healthcare system', academic (general) internal medicine should strive to be the cornerstone of every integrated, patient-centred, modern medical care and training system. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Severe Traumatic Brain Injury at a Tertiary Referral Center in Tanzania: Epidemiology and Adherence to Brain Trauma Foundation Guidelines.

PubMed

Smart, Luke R; Mangat, Halinder S; Issarow, Benson; McClelland, Paul; Mayaya, Gerald; Kanumba, Emmanuel; Gerber, Linda M; Wu, Xian; Peck, Robert N; Ngayomela, Isidore; Fakhar, Malik; Stieg, Philip E; Härtl, Roger

2017-09-01

Severe traumatic brain injury (TBI) is a major cause of death and disability worldwide. Prospective TBI data from sub-Saharan Africa are sparse. This study examines epidemiology and explores management of patients with severe TBI and adherence to Brain Trauma Foundation Guidelines at a tertiary care referral hospital in Tanzania. Patients with severe TBI hospitalized at Bugando Medical Centre were recorded in a prospective registry including epidemiologic, clinical, treatment, and outcome data. Between September 2013 and October 2015, 371 patients with TBI were admitted; 33% (115/371) had severe TBI. Mean age was 32.0 years ± 20.1, and most patients were male (80.0%). Vehicular injuries were the most common cause of injury (65.2%). Approximately half of the patients (47.8%) were hospitalized on the day of injury. Computed tomography of the brain was performed in 49.6% of patients, and 58.3% were admitted to the intensive care unit. Continuous arterial blood pressure monitoring and intracranial pressure monitoring were not performed in any patient. Of patients with severe TBI, 38.3% received hyperosmolar therapy, and 35.7% underwent craniotomy. The 2-week mortality was 34.8%. Mortality of patients with severe TBI at Bugando Medical Centre, Tanzania, is approximately twice that in high-income countries. Intensive care unit care, computed tomography imaging, and continuous arterial blood pressure and intracranial pressure monitoring are underused or unavailable in the tertiary referral hospital setting. Improving outcomes after severe TBI will require concerted investment in prehospital care and improvement in availability of intensive care unit resources, computed tomography, and expertise in multidisciplinary care. Copyright © 2017 Elsevier Inc. All rights reserved.

Outcomes from Combining Work and Tertiary Study. A National Vocational Education and Training Research and Evaluation Program Report

ERIC Educational Resources Information Center

Polidano, Cain; Zakirova, Rezida

2011-01-01

Working in some capacity is almost considered de rigueur for tertiary students. The reasons for working and the impact this has on both an individual's ability to complete their studies and on their post-study labour market outcomes are only recently receiving attention. Using the 1995 and 1998 cohorts of the Longitudinal Surveys of Australian…

Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians.

PubMed

Tillekeratne, L Gayani; Bodinayake, Champica K; Dabrera, Thushani; Nagahawatte, Ajith; Arachchi, Wasantha Kodikara; Sooriyaarachchi, Anoji; Stewart, Kearsley; Watt, Melissa; Østbye, Truls; Woods, Christopher W

2017-03-16

Acute respiratory tract infections (ARTIs) are a common reason for antibiotic overuse worldwide. We previously showed that over 80% of outpatients presenting to a tertiary care hospital in Sri Lanka with influenza-like illness received antibiotic prescriptions, although almost half were later confirmed to have influenza. The purpose of this qualitative study was to assess Sri Lankan patients' and physicians' attitudes towards ARTI diagnosis and treatment. Semi-structured interviews were conducted with 50 outpatients with ARTIs and five physicians in the Outpatient Department (OPD) at a large, public tertiary care hospital in southern Sri Lanka. Interviews were audio-recorded, transcribed, and analyzed for themes related to ARTI diagnosis and treatment. Patients frequently sought ARTI care in the public sector due to the receipt of free care and the perception that government hospitals carried a sense of responsibility for patients' health. Patients reported multiple medical visits for their illnesses of short duration and many indicated that they were seeking care in the OPD while at the hospital for another reason. While patients generally expected to receive medication prescriptions at their visit, most patients were not specifically seeking an antibiotic prescription. However, more than 70% of patients received antibiotic prescriptions at their OPD visit. Physicians incorrectly perceived that patients desired antibiotics or "capsules," a common formulation of antibiotics dispensed in this outpatient setting, and cited patient demand as an important cause of antibiotic overuse. Physicians also indicated that high patient volume and fear of bacterial superinfection drove antibiotic overuse. Patients in this study were seeking medication prescriptions for their ARTIs, but physicians incorrectly perceived that antibiotic prescriptions were desired. High patient volume and fear of bacterial superinfection were also important factors in antibiotic overuse. Training of physicians regarding guideline-concordant management and dealing with diagnostic uncertainty, education of patients regarding ARTI etiology and management, and systematic changes in the public outpatient care structure may help decrease unnecessary antibiotic prescriptions for ARTIs in this setting.

Monitoring HIV Drug Resistance Early Warning Indicators in Cameroon: A Study Following the Revised World Health Organization Recommendations

PubMed Central

Fokam, Joseph; Elat, Jean-Bosco N.; Billong, Serge C.; Kembou, Etienne; Nkwescheu, Armand S.; Obam, Nicolas M.; Essiane, André; Torimiro, Judith N.; Ekanmian, Gatien K.; Ndjolo, Alexis; Shiro, Koulla S.; Bissek, Anne C. Z-K.

2015-01-01

Background The majority (>95%) of new HIV infection occurs in resource-limited settings, and Cameroon is still experiencing a generalized epidemic with ~122,638 patients receiving antiretroviral therapy (ART). A detrimental outcome in scaling-up ART is the emergence HIV drug resistance (HIVDR), suggesting the need for pragmatic approaches in sustaining a successful ART performance. Methods A survey was conducted in 15 ART sites of the Centre and Littoral regions of Cameroon in 2013 (10 urban versus 05 rural settings; 8 at tertiary/secondary versus 7 at primary healthcare levels), evaluating HIVDR-early warning indicators (EWIs) as-per the 2012 revised World Health Organization’s guidelines: EWI1 (on-time pill pick-up), EWI2 (retention in care), EWI3 (no pharmacy stock-outs), EWI4 (dispensing practices), EWI5 (virological suppression). Poor performance was interpreted as potential HIVDR. Results Only 33.3% (4/12) of sites reached the desirable performance for “on-time pill pick-up” (57.1% urban versus 0% rural; p<0.0001) besides 25% (3/12) with fair performance. 69.2% (9/13) reached the desirable performance for “retention in care” (77.8% urban versus 50% rural; p=0.01) beside 7.7% (1/13) with fair performance. Only 14.4% (2/13) reached the desirable performance of “no pharmacy stock-outs” (11.1% urban versus 25% rural; p=0.02). All 15 sites reached the desirable performance of 0% “dispensing mono- or dual-therapy”. Data were unavailable to evaluate “virological suppression” due to limited access to viral load testing (min-max: <1%-15%). Potential HIVDR was higher in rural (57.9%) compared to urban (27.8%) settings, p=0.02; and at primary (57.9%) compared to secondary/tertiary (33.3%) healthcare levels, p=0.09. Conclusions Delayed pill pick-up and pharmacy stock-outs are major factors favoring HIVDR emergence, with higher risks in rural settings and at primary healthcare. Retention in care appears acceptable in general while ART dispensing practices are standard. There is need to support patient-adherence to pharmacy appointments while reinforcing the national drug supply system. PMID:26083364

Frozen Chirality of Tertiary Aromatic Amides: Access to Enantioenriched Tertiary α-Amino Acid or Amino Alcohol without Chiral Reagent.

PubMed

Mai, Thi Thoa; Viswambharan, Baby; Gori, Didier; Guillot, Régis; Naubron, Jean-Valère; Kouklovsky, Cyrille; Alezra, Valérie

2017-04-27

One of the fundamental and intriguing aspects of life is the homochirality of the essential molecules. In this field, the absolute asymmetric synthesis of α-amino acids is a major challenge. Herein, we report access, by chemical means, to tertiary α-amino acid derivatives in up to 96 % ee without using any chiral reagent. In our strategy, the dynamic axial chirality of tertiary aromatic amides is frozen in a crystal and is responsible for the stereoselectivity of the subsequent steps. Furthermore, we could control the configuration of the final product by manually sorting and selecting the initial crystals. Based on vibrational circular dichroism studies, we could rationalize the observed stereoselectivity. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

An analytic model for limiting high density LH transition by the onset of the tertiary instability

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

Singh, Raghvendra, E-mail: rsingh129@gmail.com; Jhang, Hogun; Kaang, Helen H.

2016-07-15

We perform an analytic study of the tertiary instability driven by a strong excitation of zonal flows during high density low to high (LH) mode transition. The drift resistive ballooning mode is assumed to be a dominant edge turbulence driver. The analysis reproduces main qualitative features of early computational results [Rogers and Drake, Phys. Rev. Lett. 81, 4396 (1998); Guzdar et al., Phys. Plasmas 14, 020701 (2007)], as well as new characteristics of the maximum edge density due to the onset of the tertiary instability. An analytical scaling indicates that the density scaling of LH transition power may be determinedmore » by the onset condition of the tertiary instability when the operating density approaches to the Greenwald density.« less

Tension-compression-tension tertiary twins in coarse-grained polycrystalline pure magnesium at room temperature

DOE PAGES

Yu, Qin; Jiang, Yanyao; Wang, Jian

2015-04-07

Using electron backscatter diffraction, the microstructural features of tension–compression–tension (T–C–T) tertiary twins are studied in coarse-grained pure polycrystalline magnesium subjected to monotonic compression along the extrusion direction in ambient air. T–C–T tertiary twins are developed due to the formation of a compression–tension double twin inside a primary tension twin. All the observed T–C–T twin variants are of T iC jT j type. T iC i+1T i+1 (or T iC i–1T i–1) variants are observed more frequently than T iC i+2T i+2 (or T iC i–2T i–2) variants. Moreover, the number of tertiary twin lamellae increases with the applied compressive strain.

Impact of long-stay beds on the performance of a tertiary hospital in emergencies

PubMed Central

Pazin, Antonio; de Almeida, Edna; Cirilo, Leni Peres; Lourençato, Frederica Montanari; Baptista, Lisandra Maria; Pintyá, José Paulo; Capeli, Ronaldo Dias; da Silva, Sonia Maria Pirani Felix; Wolf, Claudia Maria; Dinardi, Marcelo Marcos; Scarpelini, Sandro; Damasceno, Maria Cecília

2015-01-01

ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors. PMID:26603353

The Usage and Impact of Internet Enabled Phones on Academic Concentration among Students of Tertiary Institutions: A Study at the University of Ibadan, Nigeria

ERIC Educational Resources Information Center

Ezemenaka, Emeka

2013-01-01

The usage of Internet enabled phones has been a 21st century phenomenon that spreads for different purposes and functions. This study looks into the usage and perceived effect implications internet enabled phones have on the academic performance of the tertiary students using University of Ibadan students in Nigeria as a case study. The study was…

Neuropsychology Within a Tertiary Care Epilepsy Center.

PubMed

Morrison, Chris E; MacAllister, William S; Barr, William B

2018-05-01

Epilepsy is a prevalent condition characterized by variations in its clinical presentation, etiology, and amenability to treatment. Through history, neuropsychologists have played a significant role in performing research studies on changes in language, memory, and executive functioning in patients with epilepsy, including those undergoing surgical treatment for medically refractory seizures. These studies provided a foundation for establishing neuropsychologists as critical members of interdisciplinary clinical teams specializing in evaluation and treatment of epilepsy. This article describes a number of elements of specialized neuropsychological practice that have evolved over the years within a tertiary care epilepsy center. Through diagnostic interview and objective testing, the neuropsychologist is able to provide a more complete and objective understanding of a patient's cognitive and behavioral functioning than what is obtained by other clinicians through brief office visits. While assessment of cognition, mood, and behavior is the most commonly provided service to patients with epilepsy from all age groups, there are many instances when neuropsychologists in surgical settings are called to perform more specialized procedures, including the intracarotid amytal (Wada) procedure, electrocortical stimulation mapping of language eloquent brain regions, and functional brain imaging procedures. While working as a neuropsychologist on an interdisciplinary epilepsy care team requires specialized knowledge and clinical training, it is extremely satisfying due to the diversity of the patient population and the particular challenges resulting from the often unique manner that cognition and behavior can be affected in patients with epilepsy across the lifespan.

Tertiary treatment and dual disinfection to improve microbial quality of reclaimed water for potable and non-potable reuse: A case study of facilities in North Carolina.

PubMed

Bailey, Emily S; Casanova, Lisa M; Simmons, Otto D; Sobsey, Mark D

2018-07-15

Treated wastewater is increasingly of interest for either nonpotable purposes, such as agriculture and industrial use, or as source water for drinking water supplies; however, this type of advanced treatment for water supply is not always possible for many low resource settings. As an alternative, multiple barriers of physical, chemical and biological treatment with lower cost and simpler operation and maintenance have been proposed as more globally applicable. One such water reclamation system for both non-potable and potable reuse, is that approved by the State of North Carolina "for Type 2" reclaimed water (NCT2RW). NC Type 2 potable reuse systems consist of a sequence of tertiary treatment to produce well oxidized reclaimed water that is then then further treated by two steps of disinfection, typically UV radiation and chlorination. In this case study, the log10 microbial reduction performance of NCT2RW producing water reclamation facilities is evaluated. Based on the results presented here, NCT2RW consistently achieved high (6 for bacteria, 4 for virus and 4 for protozoan parasite surrogates) log10 reductions using the NC proposed treatment methods. Additionally, lower but significant log10 reduction performance was also documented for protozoan parasites and human enteric viruses. Copyright © 2018 Elsevier B.V. All rights reserved.

Evaluation of Baseline CD4+ T Cell Counts and ART Requirement in Newly Diagnosed HIV Seropositive Individuals in a Tertiary Care Hospital of Northern India.

PubMed

Bhattar, Sonali; Mehra, Bhanu; Bhalla, Preena; Rawat, Deepti

2016-11-01

Antiretroviral Therapy (ART) has changed the outlook of Human Immune-deficiency Virus (HIV)/Acquired Immuno Deficiency Syndrome (AIDS) patients worldwide. To analyse the trends in baseline CD4+ T cell counts and ART requirements in newly diagnosed HIV seropositive individuals in a Tertiary care hospital of Northern India. Out of 1263 HIV seropositive clients identified from January 2012 to June 2014, the baseline CD4+ T cell counts of only those 470 clients were analysed, who registered at the linked ART centre. The mean baseline CD4+ count of the study group was 249.77±216.0cells/mm 3 and that of male and female were 300.31±240.47cells/mm 3 and 232.38±204.25cells/mm 3 respectively. A total of 259 of 334 (77.54%) HIV reactive males, 83 of 130 (63.85%) HIV reactive females and overall 348 of 470 (74.04%) required antiretroviral treatment on enrolment. In the present study, about three-fourth of newly diagnosed HIV positive Indian patients required initiation of ART at registration. The relatively low baseline CD4+ T cell counts in this population highlights the need for timely baseline CD4+ counts testing of HIV positive patients and the urgency of initiating treatment in HIV reactive individuals in Indian health care settings.

Is panic disorder associated with clinical severity of fibromyalgia? A preliminary study in a tertiary-care centre.

PubMed

Alciati, Alessandra; Caldirola, Daniela; Sarzi-Puttini, Piercarlo; Atzeni, Fabiola; Grassi, Massimiliano; Perna, Giampaolo

2016-01-01

To investigate the influence of panic disorder (PD) with/without agoraphobia on the clinical severity of fibromyalgia (FM). Eighty-one patients with FM, among those consecutively referring to a tertiary-care setting, were included in this cross-sectional study. Psychiatric diagnoses were made by the structured clinical interview in accordance with the 4th-TR version of the diagnostic and statistical manual of mental disorders. The clinical severity of FM was measured by means of the following self-administered scales: Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Status (FAS), Health Assessment Questionnaire (HAQ). A final sample of 66 females with FM with or without past PD was included in the analyses. The two groups did not significantly differ in age, years of education, length of illness or medication distribution. We did not find significant differences between the two groups in the FIQ and FAS scale scores, whereas subjects with FM and past PD showed significantly higher HAQ scale scores than those without past PD (p<.001). A history of PD in patients with FM increases the severity of functional impairment in performing a wide range of daily-life activities, as measured by the HAQ scale, with no effects on the severity of other clinical dimensions of FM. Potential underlying mechanisms and clinical implications will be discussed.

Associations between Psychosocial Aspects of English Classroom Environments and Motivation Types of Chinese Tertiary-Level English Majors

ERIC Educational Resources Information Center

Bi, Xuefei

2015-01-01

This study involved whether psychosocial aspects of English classroom environments had associations with the English learning motivation types of Chinese tertiary-level English majors based on a case study of approximate 1,000 English majors in their first 2 years at one of the key universities located in South China. Canonical correlation…

Good and Caring Teaching Behaviours as Perceived by Business Education Students in Tertiary Institutions in the North Eastern Nigeria

ERIC Educational Resources Information Center

Udo, Magnus P.; Samson, Agatha; Baraya, Abdulmutallib Umar

2016-01-01

This study investigated good and caring teaching behaviours as perceived by Business Education students in Tertiary Institutions in the North Eastern Nigeria. The latter needed good and caring teaching behaviours to reform the education sector that had been devastated by Boko Haram insurgency. The design of the study was survey. The research…

A Qualitative Study of Persistence and Performance: Factors in the Motivation of First Year Tertiary Education Students

ERIC Educational Resources Information Center

Holden, Helen

2005-01-01

The dilemma of student motivation at regional university sites needs to be examined to expose peculiarities in regional areas that impact on the future sustainability of tertiary education programs in those areas. The focus of this phenomenographic study was the persistence and performance of 11 first year university students. Interviews with…

Use of L1 in L2 Reading Comprehension among Tertiary ESL Learners

ERIC Educational Resources Information Center

Seng, Goh Hock; Hashim, Fatimah

2006-01-01

This study is an attempt to provide insights into the extent of first language (L1) use while reading second language (L2) texts in a collaborative situation among tertiary ESL learners. Through the identification of reading strategies utilized by the subjects, the study is also aimed at discovering possible reasons for the use of L1 while…

Secondary-to-Tertiary Comparison through the Lens of Ways of Doing Mathematics in Relation to Functions: A Study in Collaboration with Teachers

ERIC Educational Resources Information Center

Corriveau, Claudia

2017-01-01

This article addresses the issue of transition from secondary to post-secondary education through collaborative research with teachers from both levels. It takes into account implicit elements in this transition. Research on the transition in mathematics education tends to focus more on the tertiary level, studying difficulties encountered by…

A Survey on the Levels of Questioning of ELT: A Case Study in an Indonesian Tertiary Education

ERIC Educational Resources Information Center

Ashadi, Rido Imam; Lubis, Nazriani

2017-01-01

This present study focused on examining the levels of questions in Indonesia tertiary education. A survey research was conducted in one of the private universities in North Sumatra. The English summative assessment in an undergraduate education was used as target of survey. There were a collection of questions that had been administered by four…

An Integrated Skills Approach Using Feature Movies in EFL at Tertiary Level

ERIC Educational Resources Information Center

Tuncay, Hidayet

2014-01-01

This paper presents the results of a case study based on an integrated skills approach using feature movies (DVDs) in EFL syllabi at the tertiary level. 100 students took part in the study and the data was collected through a three - section survey questionnaire: demographic items, 18 likert scale questions and an open-ended question. The data…

Technology-Based Interventions for Mental Health in Tertiary Students: Systematic Review

PubMed Central

Gulliver, Amelia; Chan, Jade KY; Batterham, Philip J; Reynolds, Julia; Calear, Alison; Tait, Robert; Bennett, Kylie; Griffiths, Kathleen M

2013-01-01

Background Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed. Objective To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders. Methods The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder. Results A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range –0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range –0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses. Conclusions The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed. PMID:23711740

Speciation and fate of copper in sewage treatment works with and without tertiary treatment: the effect of return flows.

PubMed

Innaa, D; Lester, J N; Scrimshawb, M D; Cartmell, E

2014-01-01

The removal of metals from wastewaters is becoming an important issue, with new environmental quality standards putting increased regulatory pressure on operators of sewage treatment works. The use of additional processes (tertiary treatment) following two-stage biological treatment is frequently seen as a way of improving effluent quality for nutrients and suspended solids, and this study investigates the impact of how back washes from these tertiary processes may impact the removal of copper during primary sedimentation. Seven sites were studied, three conventional two-stage biological treatment, and four with tertiary processes. It was apparent that fluxes of copper in traditional return flows made a significant contribution to the load to the primary treatment tanks, and that <1% of this was in the dissolved phase. Where tertiary processes were used, back wash liquors were also returned to the primary tanks. These return flows had an impact on copper removal in the primary tanks, probably due to their aerobic nature. Returning such aerobic back wash flows to the main process stream after primary treatment may therefore be worth consideration. The opportunity to treat consolidated liquor and sludge.flows in side-stream processes to remove toxic elements, as they are relatively concentrated, low volume flow streams, should also be evaluated.

Knowledge and pharmacological management of Alzheimer's disease by managing community pharmacists: a nationwide study.

PubMed

Zerafa, Natalie; Scerri, Charles

2016-12-01

Background Managing community pharmacists can play a leading role in supporting community dwelling individuals with Alzheimer's disease and their caregivers. Objective The main purpose of this study was to assess knowledge of managing community pharmacists towards Alzheimer's disease and its pharmacological management. Setting Community pharmacies in the Maltese islands. Method A nationwide survey was conducted with full-time managing community pharmacists in possession of a tertiary education degree in pharmacy studies. The level of knowledge was investigated using the Alzheimer's Disease Knowledge Scale and the Alzheimer's Disease Pharmacotherapy Measure. Participants were also asked to rate a number of statements related to disease management. Results Maltese managing community pharmacists (57 % response rate) had inadequate knowledge on risk factors, caregiving issues and pharmacological management of Alzheimer's disease. Age and number of years working in a community pharmacy setting were found to be negatively correlated with increased knowledge. Conclusion The findings highlight the need of providing training and continued educational support to managing community pharmacists in order to provide quality advice to individuals with dementia and their caregivers in the community.

Textural and mineralogical study of sandstones from the onshore Gulf of Alaska Tertiary Province, southern Alaska

USGS Publications Warehouse

Winkler, Gary R.; McLean, Hugh; Plafker, George

1976-01-01

Petrographic examination of 74 outcrop samples of Paleocene through Pliocene age from the onshore Gulf of Alaska Tertiary Province indicates that sandstones of the province characteristically are texturally immature and mineralogically unstable. Diagenetic alteration of framework grains throughout the stratigraphic sequence has produced widespread zeolite cement or phyllosilicate grain coatings and pseudomatrix. Multiple deformation and deep burial of the older Tertiary sequence--the Orca Group, the shale of Haydon Peak, and the Kulthieth and Tokun Formations--caused extensive alteration and grain interpenetration, resulting in low porosity values. Less intense deformation and intermediate depth of burial of the younger Tertiary sequence--the Katalla, Poul Creek, Redwood, and Yakataga Formations--has resulted in a greater range in textural properties. Most sandstone samples in the younger Tertiary sequence are poorly sorted, tightly packed, and have strongly appressed framework grains, but some are less tightly packed and contain less matrix. Soft and mineralogically unstable framework grains have undergone considerable alteration, reducing pore space even in the youngest rocks. Measurements of porosity, permeability, grain density, and sonic velocity of outcrop samples of the younger Tertiary sequence indicate a modest up-section improvement in sandstone reservoir characteristics. Nonetheless porosity and permeability values typically are below 16 percent and 15 millidarcies respectively and grain densities are consistently high, about 2.7 gm/cc. Low permeability and porosity values, and high grain densities and sonic velocities appear to be typical of most outcrop areas throughout the onshore Gulf of Alaska Tertiary Province.

Evaluation of a cardiopulmonary resuscitation curriculum in a low resource environment.

PubMed

Chang, Mary P; Lyon, Camila B; Janiszewski, David; Aksamit, Deborah; Kateh, Francis; Sampson, John

2015-11-07

To evaluate whether a 2-day International Liaison Committee on Resuscitation (ILCOR) Universal Algorithm-based curriculum taught in a tertiary care hospital in Liberia increases local health care provider knowledge and skill comfort level. A combined basic and advanced cardiopulmonary resuscitation (CPR) curriculum was developed for low-resource settings that included lectures and low-fidelity manikin-based simulations. In March 2014, the curriculum was taught to healthcare providers in a tertiary care hospital in Liberia. In a quality assurance review, participants were evaluated for knowledge and comfort levels with resuscitation before and after the workshop. They were also videotaped during simulation sessions and evaluated on standardized performance metrics. Fifty-two hospital staff completed both pre-and post-curriculum surveys. The median score was 45% pre-curriculum and 82% post-curriculum (p<0.00001). The median provider comfort level score was 4 of 5 pre-curriculum and 5 of 5 post-curriculum (p<0.00001). During simulations, 93.2% of participants performed the pulse check within 10 seconds, and 97.7% performed defibrillation within 180 seconds. Clinician knowledge of and comfort level with CPR increased significantly after participating in our curriculum. A CPR curriculum based on lectures and low-fidelity manikin simulations may be an effective way to teach resuscitation in this low-resource setting.

Rheumatic heart disease: infectious disease origin, chronic care approach.

PubMed

Katzenellenbogen, Judith M; Ralph, Anna P; Wyber, Rosemary; Carapetis, Jonathan R

2017-11-29

Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are young and associated morbidity is high. However, RHD is relatively neglected due to the populations involved and its lower incidence relative to other heart diseases. In this narrative review, we describe how RHD care can be informed by and integrated with models of care developed for priority non-communicable diseases (coronary heart disease), and high-burden communicable diseases (tuberculosis). Examining the four-level prevention model (primordial through tertiary prevention) suggests primordial and primary prevention of RHD can leverage off existing tuberculosis control efforts, given shared risk factors. Successes in coronary heart disease control provide inspiration for similarly bold initiatives for RHD. Further, we illustrate how the Chronic Care Model (CCM), developed for use in non-communicable diseases, offers a relevant framework to approach RHD care. Systems strengthening through greater integration of services can improve RHD programs. Strengthening of systems through integration/linkages with other well-performing and resourced services in conjunction with policies to adopt the CCM framework for the secondary and tertiary prevention of RHD in settings with limited resources, has the potential to significantly reduce the burden of RHD globally. More research is required to provide evidence-based recommendations for policy and service design.

Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD

PubMed Central

Morton, Rachael L.; Schlackow, Iryna; Staplin, Natalie; Gray, Alastair; Cass, Alan; Haynes, Richard; Emberson, Jonathan; Herrington, William; Landray, Martin J.; Baigent, Colin; Mihaylova, Borislava

2016-01-01

Background The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression. Study Design Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial. Setting & Participants 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand. Predictor Highest educational attainment measured at study entry using 6 levels that ranged from “no formal education” to “tertiary education.” Outcomes Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years’ median follow-up. Results There was a significant trend (P < 0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P < 0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95% CI, 1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with progression to end-stage renal disease or doubling of creatinine level (P for trend = 0.4). Limitations No data for employment or health insurance coverage. Conclusions Lower educational attainment is associated with increased risk of adverse health outcomes in individuals with CKD. PMID:26385817

Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China

PubMed Central

2014-01-01

Background Hospital disaster resilience can be defined as a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. Methods A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. Results A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a ‘portable hospital’ function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. Conclusions This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas. PMID:24661641

Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China.

PubMed

Zhong, Shuang; Hou, Xiang-Yu; Clark, Michele; Zang, Yu-Li; Wang, Lu; Xu, Ling-Zhong; FitzGerald, Gerard

2014-03-25

Hospital disaster resilience can be defined as a hospital's ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a 'portable hospital' function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.

Effort-Reward Imbalance, Work-Privacy Conflict, and Burnout Among Hospital Employees.

PubMed

Häusler, Nadine; Bopp, Matthias; Hämmig, Oliver

2018-04-01

Studies investigating the relative importance of effort-reward imbalance and work-privacy conflict for burnout risk between professional groups in the health care sector are rare and analyses by educational attainment within professional groups are lacking. The study population consists of 1422 hospital employees in Switzerland. Multivariate linear regression analyses with standardized coefficients were performed for the overall study population and stratified for professional groups refined for educational attainment. Work-privacy conflict is a strong predictor for burnout and more strongly associated with burnout than effort-reward imbalance in the overall study population and across all professional groups. Effort-reward imbalance only had a minor effect on burnout in tertiary-educated medical professionals. Interventions aiming at increasing the compatibility of work and private life may substantially help to decrease burnout risk of professionals working in a health care setting.

Geologic evolution and sequence stratigraphy of the offshore Pelotas Basin, southeast Brazil

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

Abreu, V.S.

1996-01-01

The Brazilian marginal basins have been studied since the beginning of the 70s. At least nine large basins are distributed along the entire Eastern continental margin. The sedimentary infill of these basins consists of lower Cretaceous (continental/lacustrine) rift section underlying marine upper Cretaceous (carbonate platforms) and marine upper Cretaceous/Tertiary sections, corresponding to the drift phase. The sedimentary deposits are a direct result of the Jurassic to lower Cretaceous break-up of the Pangea. This study will focus on the geologic evolution and sequence stratigraphic analysis of the Pelotas basin (offshore), located in the Southeast portion of the Brazilian continental margin betweenmore » 28[degrees] and 34[degrees] S, covering approximately 50,000 Km[sup 2]. During the early Cretaceous, when the break-up of the continent began in the south, thick basaltic layers were deposited in the Pelotas basin. These basalts form a thick and broad wedge of dipping seaward reflections interpreted as a transitional crust. During Albian to Turonian times, due to thermal subsidence, an extensive clastic/carbonate platform was developed, in an early drift stage. The sedimentation from the upper Cretaceous to Tertiary was characterized by a predominance of siliciclastics in the southeast margin, marking an accentuate deepening of the basin, showing several cycles related to eustatic fluctuations. Studies have addressed the problems of hydrocarbon exploration in deep water setting within a sequence stratigraphic framework. Thus Pelotas basin can provide a useful analogue for exploration efforts worldwide in offshore passive margins.« less

Geologic evolution and sequence stratigraphy of the offshore Pelotas Basin, southeast Brazil

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

Abreu, V.S.

1996-12-31

The Brazilian marginal basins have been studied since the beginning of the 70s. At least nine large basins are distributed along the entire Eastern continental margin. The sedimentary infill of these basins consists of lower Cretaceous (continental/lacustrine) rift section underlying marine upper Cretaceous (carbonate platforms) and marine upper Cretaceous/Tertiary sections, corresponding to the drift phase. The sedimentary deposits are a direct result of the Jurassic to lower Cretaceous break-up of the Pangea. This study will focus on the geologic evolution and sequence stratigraphic analysis of the Pelotas basin (offshore), located in the Southeast portion of the Brazilian continental margin betweenmore » 28{degrees} and 34{degrees} S, covering approximately 50,000 Km{sup 2}. During the early Cretaceous, when the break-up of the continent began in the south, thick basaltic layers were deposited in the Pelotas basin. These basalts form a thick and broad wedge of dipping seaward reflections interpreted as a transitional crust. During Albian to Turonian times, due to thermal subsidence, an extensive clastic/carbonate platform was developed, in an early drift stage. The sedimentation from the upper Cretaceous to Tertiary was characterized by a predominance of siliciclastics in the southeast margin, marking an accentuate deepening of the basin, showing several cycles related to eustatic fluctuations. Studies have addressed the problems of hydrocarbon exploration in deep water setting within a sequence stratigraphic framework. Thus Pelotas basin can provide a useful analogue for exploration efforts worldwide in offshore passive margins.« less

[Cultural adaptation of 2 questionnaires for health measurement in patients with vertigo].

PubMed

Pérez, N; Garmendia, I; Martín, E; García-Tapia, R

2000-10-01

To perform a transcultural adaptation form English to Spanish of two common questionnaires of handicap assessment in vestibular disorders. Prospective study. 337 patients seen for non-acute dizziness from peripheral or central origin in a tertiary referral setting. Dizziness Handicap Inventory test and UCLA-Dizziness Questionnaire after transcultural adaptation following the method of translation-backtranslation, expert assessment and statistical validation. The results after cultural adaptation and reliability assessment provide a firm basis to demonstrate the close relation of the Spanish and English version in all the items and their meaning. This adapted questionnaires can be used to assess vestibular disability with no loss of metric values of the original version.

End-of-life practices at a Lebanese hospital: courage or knowledge?

PubMed

Gebara, Jouhayna; Tashjian, Hera

2006-10-01

End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.

The Effects of Accelerated Learning on Tertiary Students Learning To Write.

ERIC Educational Resources Information Center

Fretz, Barbara L.

A study investigated how Accelerated Learning (AL), a teaching methodology that purports to increase the quantity and improve the quality of learning, affected tertiary students' knowledge of and skills in writing and their feelings towards writing. AL has its origins in G. Lozanov's "suggestopedia." Believing that formal teaching…

Hong Kong Tertiary Students' Conceptions of Assessment of Academic Ability

ERIC Educational Resources Information Center

Wang, Zhenlin; Brown, Gavin T. L.

2014-01-01

Students' beliefs, attitudes, experiences and responses towards assessment reflect the ecology of their specific context. The study examines Hong Kong tertiary students' conceptions of assessment using focus group interviews and the content analysis technique. Using six focus groups, 26 Hong Kong university students were interviewed. Hong Kong…

Massification and Diversification as Complementary Strategies for Economic Growth in Developed and Developing Countries

ERIC Educational Resources Information Center

Tyndorf, Darryl; Glass, Chris R.

2016-01-01

Numerous microeconomic studies demonstrate the significant individual returns to tertiary education; however, little empirical evidence exists regarding the effects of higher education massification and diversification agendas on long-term macroeconomic growth. The researchers used the Uzawa-Lucas endogenous growth model to tertiary education…

Assessment of Validity and Reliability of IMNCI Algorithm in Comparison to Provisional Diagnosis of Senior Pediatricians in a Tertiary Hospital of Kolkata.

PubMed

Bhattacharyya, Agnihotri; Mukherjee, Shuvankar; Chatterjee, Chitra; Dasgupta, Samir

2013-04-01

Integrated management of childhood illness (IMNCI) is already operational in many states of India, but there are only limited studies in Indian scenario comparing its validity and reliability with the decisions of pediatricians. Aims and. To assess the validity and reliability of the IMNCI algorithm with provisional diagnosis of senior pediatricians for each IMNCI classifications. The present study is done with all the young infants between 0-2 months presented during the study period with a fresh episode of illness to test the validity and reliability of the algorithm in comparison to provisional diagnoses of senior pediatricians. The study was done in a tertiary care hospital. Validity characteristics such as sensitivity, specificity, positive predictive value, negative predictive value, and reliability characteristics such as percent agreement and Kappa were assessed for individual IMNCI classifications. The sensitivity of possible serious bacterial infection, local bacterial infection, jaundice, no dehydration and possible serious bacterial infection, not able to feed were 88.89, 14.29, 66.67, 25 and 44.44% respectively. The specificities for the same conditions were 71.72, 99.09, 99.07, 94.50 and 86.87%. Percent agreements for similar conditions were 74, 94, 97, 90 and 80% respectively and the Kappa ratios were 0.38, 0.20, 0.73, 0.19 and 0.29 respectively. It could be concluded that IMNCI is quite a sensitive strategy and could identify severe illnesses of young infants requiring referral to higher facility. Further studies, particularly in primary health care setting, are required.

Factors Influencing Changes in Eating Patterns Among Hong Kong Young Adults Transitioning to Tertiary Education.

PubMed

Kwok, Sin Tung; Capra, Sandra; Leveritt, Michael

2016-05-01

Transitioning to tertiary education is a significant life course event that has the potential to influence lifelong eating patterns. This study used a theoretic model developed from a life course perspective to examine factors influencing the change of food choices among 31 young adults in Hong Kong after they moved on to tertiary education. Qualitative analysis of transcripts based on the constant comparative method revealed that present life course experiences, especially increased autonomy, and social-environmental factors strongly influenced young adults' present food choices. A model was developed from life course theory and social-ecological theory to reflect the factors that led to change of food choices among participants. The model provides unique insights on food choices of the future adult population. It could also be used as a reference for the development of nutrition education interventions targeting tertiary students as they experience increased autonomy. In conclusion, food choices of young adults on transitioning to tertiary education are strongly influenced by increased autonomy and change of social and environmental factors. © 2016 APJPH.

Use of Social Media and Its Impact on Academic Performance of Tertiary Institution Students: A Study of Students of Koforidua Polytechnic, Ghana

ERIC Educational Resources Information Center

Owusu-Acheaw, M.; Larson, Agatha Gifty

2015-01-01

The study sought to assess students' use of social media and its effect on academic performance of tertiary institutions students in Ghana with a focus on Koforidua Polytechnic students. Questionnaire was used for collecting data. Out of one thousand five hundred and seventy-eight copies of the questionnaire distributed, one thousand five hundred…

The Heterogeneous Effect of Information on Student Performance: Evidence from a Randomized Control Trial in Mexico. Policy Research Working Paper 7422

ERIC Educational Resources Information Center

Avitabile, Ciro; de Hoyos, Rafael

2015-01-01

A randomized control trial was conducted to study whether providing 10th grade students with information about the returns to upper secondary and tertiary education, and a source of financial aid for tertiary education, can contribute to improve student performance. The study finds that the intervention had no effects on the probability of taking…

Emotions or Science? Pre-Tertiary Males' Accounts of Psychology as a Subject Choice

ERIC Educational Resources Information Center

Mercer, Jenny; Sander, Paul; Williams, Stella; Jones, Tim

2013-01-01

It is well established that the number of males studying psychology in the UK, both at A-level and on degree courses, is disproportionately low compared to females. There is a paucity of research, however, which discusses how psychology is viewed by this group. The present study employed focus groups with 35 pre-tertiary males (some of whom were…

Planning and Management in Tertiary Education. Report on Study Tour. Cost Effectiveness in Colleges of Advanced Education.

ERIC Educational Resources Information Center

Peters, Howard

This document presents the data gathered by the author when he made an international study tour in 1970. The purpose of the tour was the investigation of planning and management in tertiary education, with particular reference to the cost effectiveness of colleges of higher education in Australia. The tour began with visits to the cities of…

The Use of Public Enlightenment Campaign Strategy and School Disciplinary Measures in the Management of Cultism in Tertiary Institutions in Nigeria

ERIC Educational Resources Information Center

Omemu, Felix

2015-01-01

The study investigated the perceptions of staff and students on the use of school disciplinary measures and public awareness campaign strategy in the management of cultism in tertiary institutions in Nigeria. The study is guided by two hypotheses tested using the t-test statistics. An instrument containing 10 items properly validated was used in…

Appropriateness of gram-negative agent use at a tertiary care hospital in the setting of significant antimicrobial resistance.

PubMed

Vora, Neil M; Kubin, Christine J; Furuya, E Yoko

2015-01-01

Background.  Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods.  We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ(2) or Fischer's exact test for categorical variables and Student t test or Mann-Whitney U test for continuous variables. Results.  A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29-.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28-.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09-.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35-5.16) was associated with suboptimal use. Conclusions.  Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

Child and family characteristics associated with age of diagnosis of an autism spectrum disorder in a tertiary care setting.

PubMed

Bickel, Julie; Bridgemohan, Carolyn; Sideridis, Georgios; Huntington, Noelle

2015-01-01

To identify child and family characteristics associated with age of diagnosis of autism spectrum disorder (ASD) in a tertiary care setting using objective, standardized assessments ensuring diagnostic validity and timing. The authors conducted a chart review of children who received their initial ASD diagnosis from 2007 to 2011. Child variables included gender, birth order, cognitive functioning, and for children ≤36 months, language and adaptive assessments. Family variables included insurance, maternal age, maternal education, sibling or family member with ASD, and number of children in the house. Primary outcome was age of ASD diagnosis. The authors ran multiple regression models evaluating the impact of child and family variables on the total sample and on the subsample of children ≤36 months. Median age of diagnosis was 2.9 years (range, 15 mo-13.8 yr; n = 591). In the total sample, significant predictors of earlier age of diagnosis were later birth order, higher maternal education, fewer children in the house, and a sibling with ASD. In a separate analysis of children ≤36 months of age (n = 315) with additional data for language and adaptive assessments, significant predictors of younger age of diagnosis were higher cognitive and adaptive functioning, lower receptive and expressive language, and having a sibling with ASD. This study suggests that both family and child characteristics play an important role in the early identification of ASD and that predictive variables may vary based on a child's age. Future research should help to elucidate this finding so that screening measures and policies aimed at early identification can target the most predictive factors.

Neodymium isotopic study of rare earth element sources and mobility in hydrothermal Fe-oxide (Fe-P-REE) systems

NASA Astrophysics Data System (ADS)

Gleason, James D.; Marikos, Mark A.; Barton, Mark D.; Johnson, David A.

2000-03-01

Rare earth element (REE)-enriched, igneous-related hydrothermal Fe-oxide hosted (Fe-P-REE) systems from four areas in North America have been analyzed for their neodymium isotopic composition to constrain REE sources and mobility in these systems. The Nd isotopic results evidence a common pattern of REE concentration from igneous sources despite large differences in age (Proterozoic to Tertiary), tectonic setting (subduction vs. intraplate), and magmatic style (mafic vs. felsic). In the Middle Proterozoic St. Francois Mountains terrane of southeastern Missouri, ɛ Nd for Fe-P-REE (apatite, monazite, xenotime) deposits ranges from +3.5 to +5.1, similar to associated felsic to intermediate igneous rocks of the same age (ɛ Nd = +2.6 to +6.2). At the mid-Jurassic Humboldt mafic complex in western Nevada, ɛ Nd for Fe-P-REE (apatite) mineralization varies between +1.1 and +2.4, similar to associated mafic igneous rocks (-1.0 to +3.5). In the nearby Cortez Mountains in central Nevada, mid-Jurassic felsic volcanic and plutonic rocks (ɛ Nd = -2.0 to -4.4) are associated with Fe-P-REE (apatite-monazite) mineralization having similar ɛ Nd (-1.7 to -2.4). At Cerro de Mercado, Durango, Mexico, all assemblages analyzed in this Tertiary rhyolite-hosted Fe oxide deposit have identical isotopic compositions with ɛ Nd = -2.5. These data are consistent with coeval igneous host rocks being the primary source of REE in all four regions, and are inconsistent with a significant contribution of REE from other sources. Interpretations of the origin of these hydrothermal systems and their concomitant REE mobility must account for nonspecialized igneous sources and varied tectonic settings.

Neodymium isotopic study of rare earth element sources and mobility in hydrothermal Fe oxide (Fe-P-REE) systems

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

Gleason, J.D.; Marikos, M.A.; Barton, M.D.

2000-03-01

Rare earth element (REE)-enriched, igneous-related hydrothermal Fe-oxide hosted (Fe-P-REE) systems from four areas in North America have been analyzed for their neodymium iosotopic composition to constrain REE sources and mobility in these systems. The Nd isotopic results evidence a common pattern of REE concentration from igneous sources despite large differences in age (Proterozoic to Tertiary), tectonic setting (subduction vs. intraplate), and magmatic style (mafic vs. felsic). In the Middle Proterozoic St. Francois Mountains terrane of southeastern Missouri, {epsilon}{sub Nd} for Fe-P-REE (apatite, monazite, xenotime) deposits ranges from +3.5 to +5.1, similar to associated felsic to intermediate igneous rocks of themore » same age ({epsilon}{sub Nd} = +2.6 to +6.2). At the mid-Jurassic Humboldt mafic complex in western Nevada, {epsilon}{sub Nd} for Fe-P-REE (apatite) mineralization varies between +1.1 and +2.4, similar to associated mafic igneous rocks ({minus}1.0 to +3.5). In the nearby Cortez Mountains in central Nevada, mid-Jurassic felsic volcanic and plutonic rocks ({epsilon}{sub Nd} = {minus}2.0 to {minus}4.4) are associated with Fe-P-REE (apatite-monazite) mineralization having similar {epsilon}{sub Nd}({minus}1.7 to {minus}2.4). At Cerro de Mercado, Durango, Mexico, all assemblages analyzed in this Tertiary rhyolite-hosted Fe oxide deposit have identical isotopic compositions with {epsilon}{sub Nd} = {minus}2.5. These data are consistent with coeval igneous host rocks being the primary source of REE in all four regions, and are inconsistent with a significant contribution of REE from other sources. Interpretations of the origin of these hydrothermal systems and their concomitant REE mobility must account for nonspecialized igneous sources and varied tectonic settings.« less

Endocrine surgery as a model for value-based health care delivery.

PubMed

Abdulla, Amer G; Ituarte, Philip H G; Wiggins, Randi; Teisberg, Elizabeth O; Harari, Avital; Yeh, Michael W

2012-01-01

Experts advocate restructuring health care in the United States into a value-based system that maximizes positive health outcomes achieved per dollar spent. We describe how a value-based system implemented by the University of California, Los Angeles UCLA Section of Endocrine Surgery (SES) has optimized both quality and costs while increasing patient volume. Two SES clinical pathways were studied, one allocating patients to the most appropriate surgical care setting based on clinical complexity, and another standardizing initial management of papillary thyroid carcinoma (PTC). The mean cost per endocrine case performed from 2005 to 2010 was determined at each of three care settings: A tertiary care inpatient facility, a community inpatient facility, and an ambulatory facility. Blood tumor marker levels (thyroglobulin, Tg) and reoperation rates were compared between PTC patients who underwent routine central neck dissection (CND) and those who did not. Surgical patient volume and regional market share were analyzed over time. The cost of care was substantially lower in both the community inpatient facility (14% cost savings) and the ambulatory facility (58% cost savings) in comparison with the tertiary care inpatient facility. Patients who underwent CND had lower Tg levels (6.6 vs 15.0 ng/mL; P = 0.024) and a reduced need for re-operation (1.5 vs 6.1%; P = 0.004) compared with those who did not undergo CND. UCLA maintained its position as the market leader in endocrine procedures while expanding its market share by 151% from 4.9% in 2003 to 7.4% in 2010. A value-driven health care delivery system can deliver improved clinical outcomes while reducing costs within a subspecialty surgical service. Broader application of these principles may contribute to resolving current dilemmas in the provision of care nationally.

Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital.

PubMed

Pang, Feng; Jia, Xiu-Qin; Song, Zhen-Zhu; Li, Yan-Hua; Wang, Bin; Zhao, Qi-Gang; Wang, Chuan-Xin; Zhang, Yi; Wang, Le-Xin

2016-03-01

The emergence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases is rare. We report an occurrence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases in a Chinese tertiary care hospital from November 2010 to December 2012. The clinical characteristics of 30 patients were described. The genetic relationship of isolates was determined by pulsed-field gel electrophoresis (PFGE). Carbapenemases were detected by modified Hodge test (MHT) and polymerase chain reactions (PCRs). Amplicons were sequenced and blasted to determine the genotype. Most infected patients were from intensive care unit and had complex and serious underlying illnesses requiring mechanical ventilation. PFGE revealed that Klebsiella pneumoniae showed two major PFGE types. Two Klebsiella oxytoca had an indistinguishable PFGE pattern, while four Enterobacter cloacae were different strains. The sequencing studies showed Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in the 23 infected patients. The majority of patients had infections with the carbapenemase-producing Enterobacteriaceae (CPE) strain, most were successfully treated with a range of antibiotics and discharged. It is important to maintain a high index of suspicion to screen for carbapenemase-producing Enterobacteriaceae strains. Rapid identification of these strains and implementation of stringent procedures are the key to prevent major outbreaks in a hospital setting.

Tandem catalytic allylic amination and [2,3]-Stevens rearrangement of tertiary amines.

PubMed

Soheili, Arash; Tambar, Uttam K

2011-08-24

We have developed a catalytic allylic amination involving tertiary aminoesters and allylcarbonates, which is the first example of the use of tertiary amines as intermolecular nucleophiles in metal-catalyzed allylic substitution chemistry. This process is employed in a tandem ammonium ylide generation/[2,3]-rearrangement reaction, which formally represents a palladium-catalyzed Stevens rearrangement. Low catalyst loadings and mild reaction conditions are compatible with an unprecedented substrate scope for the ammonium ylide functionality, and products are generated in high yields and diastereoselectivities. Mechanistic studies suggested the reversible formation of an ammonium intermediate.

Protein backbone engineering as a strategy to advance foldamers toward the frontier of protein-like tertiary structure.

PubMed

Reinert, Zachary E; Horne, W Seth

2014-11-28

A variety of non-biological structural motifs have been incorporated into the backbone of natural protein sequences. In parallel work, diverse unnatural oligomers of de novo design (termed "foldamers") have been developed that fold in defined ways. In this Perspective article, we survey foundational studies on protein backbone engineering, with a focus on alterations made in the context of complex tertiary folds. We go on to summarize recent work illustrating the potential promise of these methods to provide a general framework for the construction of foldamer mimics of protein tertiary structures.

Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change

PubMed Central

2014-01-01

Background Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. Methods A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of ‘out of hospital’ or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Results Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the required skills for providing care for infants, and an ‘outpatient’ model of care. Services were also characterised by absent Aboriginal leadership and inadequate coordination between remote and tertiary services that is essential to improve quality of care and reduce ‘system-introduced’ risk. Conclusion Evidence-informed redesign of maternity services and delivery of care has improved clinical effectiveness and quality for women. However, more work is needed to address substandard care provided for infants and their parents. PMID:24890910

Interpretation of a 3D Seismic-Reflection Volume in the Basin and Range, Hawthorne, Nevada

NASA Astrophysics Data System (ADS)

Louie, J. N.; Kell, A. M.; Pullammanappallil, S.; Oldow, J. S.; Sabin, A.; Lazaro, M.

2009-12-01

A collaborative effort by the Great Basin Center for Geothermal Energy at the University of Nevada, Reno, and Optim Inc. of Reno has interpreted a 3d seismic data set recorded by the U.S. Navy Geothermal Programs Office (GPO) at the Hawthorne Army Depot, Nevada. The 3d survey incorporated about 20 NNW-striking lines covering an area of approximately 3 by 10 km. The survey covered an alluvial area below the eastern flank of the Wassuk Range. In the reflection volume the most prominent events are interpreted to be the base of Quaternary alluvium, the Quaternary Wassuk Range-front normal fault zone, and sequences of intercalated Tertiary volcanic flows and sediments. Such a data set is rare in the Basin and Range. Our interpretation reveals structural and stratigraphic details that form a basis for rapid development of the geothermal-energy resources underlying the Depot. We interpret a map of the time-elevation of the Wassuk Range fault and its associated splays and basin-ward step faults. The range-front fault is the deepest, and its isochron map provides essentially a map of "economic basement" under the prospect area. There are three faults that are the most readily picked through vertical sections. The fault reflections show an uncertainty in the time-depth that we can interpret for them of 50 to 200 ms, due to the over-migrated appearance of the processing contractor’s prestack time-migrated data set. Proper assessment of velocities for mitigating the migration artifacts through prestack depth migration is not possible from this data set alone, as the offsets are not long enough for sufficiently deep velocity tomography. The three faults we interpreted appear as gradients in potential-field maps. In addition, the southern boundary of a major Tertiary graben may be seen within the volume as the northward termination of the strong reflections from older Tertiary volcanics. Using a transparent volume view across the survey gives a view of the volcanics in full, providing a clear picture of prominent structures. Potential drill targets and areas of development are defined within the data volume by the intersections of the fault surfaces with the tracked, strong stratigraphic reflections. Target volumes for drilling and development are defined by the intersections of the faults and bright-spot stratigraphy, and their uncertainty bounds. There are a few such intersections present within the 3d volume. Analyzing seismic attributes gives the opportunity to identify characteristics common in geothermal environments.

Paleomagnetism and tectonics of the Southern Tarim Basin, northwestern China

NASA Astrophysics Data System (ADS)

Gilder, Stuart; Zhao, Xixi; Coe, Robert; Meng, Zifang; Courtillot, Vincent; Besse, Jean

1996-10-01

We report Late Carboniferous, Permian, and early Tertiary paleomagnetic data from the southern Tarim basin. Prefolding magnetizations were isolated in each case. The Late Carboniferous-Permian and early Tertiary poles lie at 64.6°N, 166.5°E, A95 = 6.3° and 58.1°N, 202.0°E, A95 = 12.7°, respectively. The Late Jurassic to early Tertiary (J3-E1) paleolatitudes of Tarim and several basins throughout central Asia are similar, yet significantly (10° to 20°) shallower than those predicted by the Eurasian apparent polar wander path. Resolving this discrepancy remains a major problem in Asian paleomagnetism. Discordance of the late Paleozoic poles from Tarim and Siberia suggest that Tarim has rotated about 30° counterclockwise with respect to Siberia since the Permian. Where paleomagnetic samples of both Late Carboniferous to Early Triassic (C3-T1) and J3-E1 ages were collected from the same area of Tarim, a great circle passes through the means of the poles and the sampling locality. This suggests that (1) only a difference in inclination (and not declination) distinguishes the two data sets, and (2) vertical axis block rotations of the C3-E1 strata occurred after E1. Although based on data of lesser quality, the mean Early to Middle Jurassic (J1-2) pole from Tarim differs significantly from the Eurasian reference pole, requiring radical tectonic solutions to resolve them. The Tarim J1-2 pole is indistinguishable from both the mean J3-E1 and C3-T1 poles. The similarity of all the poles and the analogous tectonic setting of present-day central Asia to that of the late Paleozoic in eastern North America raises the question whether all the data from Tarim are overprinted.

[Health measurement instruments in patients with vertigo].

PubMed

Pérez, N; Garmendia, I; Martín, E; Boleas, M S; García-Tapia, R

2000-01-01

Compare disability and handicap in patients with dizziness by means of two questionnaires. Prospective study. 337 patients seen for non-acute dizziness from peripheral or central origin in a tertiary referral setting. Spanish version of the Dizziness Handicap Inventory test and UCLA-Dizziness Questionnaire after transcultural adaptation following the method of translation-back-translation. We obtained a good correlation between the frequency of dizzy spells and quality of health as perceived by the patient; also there was good correlation between the intensity of each spell and limitation for performance of daily activities. Quality of life is mainly related to handicap in these patients. Vertigo, as a non-fatal health outcome, can be studied following the two main conceptual frameworks of Impairment, Disabilities and Handicap and Health-Related Quality of Life.

Thyroid Surgery in a Resource-Limited Setting.

PubMed

Jafari, Aria; Campbell, David; Campbell, Bruce H; Ngoitsi, Henry Nono; Sisenda, Titus M; Denge, Makaya; James, Benjamin C; Cordes, Susan R

2017-03-01

Objective The present study reviews a series of patients who underwent thyroid surgery in Eldoret, Kenya, to demonstrate the feasibility of conducting long-term (>1 year) outcomes research in a resource-limited setting, impact on the quality of life of the recipient population, and inform future humanitarian collaborations. Study Design Case series with chart review. Setting Tertiary public referral hospital in Eldoret, Kenya. Subjects and Methods Twenty-one patients were enrolled during the study period. A retrospective chart review was performed for all adult patients who underwent thyroid surgery during humanitarian trips (2010-2015). Patients were contacted by mobile telephone. Medical history and physical examination, including laryngoscopy, were performed, and the SF-36 was administered (a quality-of-life questionnaire). Laboratory measurements of thyroid function and neck ultrasound were obtained. Results The mean follow-up was 33.6 ± 20.2 months after surgery: 37.5% of subtotal thyroidectomy patients and 15.4% of lobectomy patients were hypothyroid postoperatively according to serologic studies. There were no cases of goiter recurrence or malignancy. All patients reported postoperative symptomatic improvement and collectively showed positive pre- and postoperative score differences on the SF-36. Conclusion Although limited by a small sample size and the retrospective nature, our study demonstrates the feasibility of long-term surgical and quality-of-life outcomes research in a resource-limited setting. The low complication rates suggest minimal adverse effects of performing surgery in this context. Despite a considerable rate of postoperative hypothyroidism, it is in accordance with prior studies and emphasizes the need for individualized, longitudinal, and multidisciplinary care. Quality-of-life score improvements suggest benefit to the recipient population.

Geometry at the aliphatic tertiary carbon atom: computational and experimental test of the Walsh rule.

PubMed

Böhm, Stanislav; Exner, Otto

2004-02-01

The geometrical parameters of molecules of 2-substituted 2-methylpropanes and 1-substituted bicyclo[2.2.2]octanes were calculated at the B3LYP/6-311+G(d,p) level. They agreed reasonably well with the mean crystallographic values retrieved from the Cambridge Structural Database for a set of diverse non-cyclic structures with a tertiary C atom. The angle deformations at this C atom produced by the immediately bonded substituent are also closely related to those observed previously in benzene mono derivatives (either as calculated or as derived from crystallographic data). The calculated geometrical parameters were used to test the classical Walsh rule: It is evidently true that an electron-attracting substituent increases the proportion of C-atom p-electrons in the bond to the substituent and leaves more s-electrons to the remaining bonds; as a consequence the C-C-C angles at a tertiary carbon are widened and the C-C bonds shortened. However, this rule describes only part of the reality since the bond angles and lengths are controlled by other factors as well, for instance by steric crowding. Another imperfection of the Walsh rule is that the sequence of substituents does not correspond to their electronegativities, as measured by any known scale; more probably it is connected with the inductive effect, but then only very roughly.

A new way to see RNA

PubMed Central

Keating, Kevin S.; Humphris, Elisabeth L.; Pyle, Anna Marie

2015-01-01

Unlike proteins, the RNA backbone has numerous degrees of freedom (eight, if one counts the sugar pucker), making RNA modeling, structure building and prediction a multidimensional problem of exceptionally high complexity. And yet RNA tertiary structures are not infinite in their structural morphology; rather, they are built from a limited set of discrete units. In order to reduce the dimensionality of the RNA backbone in a physically reasonable way, a shorthand notation was created that reduced the RNA backbone torsion angles to two (η and θ, analogous to ϕ and ψ in proteins). When these torsion angles are calculated for nucleotides in a crystallographic database and plotted against one another, one obtains a plot analogous to a Ramachandran plot (the η/θ plot), with highly populated and unpopulated regions. Nucleotides that occupy proximal positions on the plot have identical structures and are found in the same units of tertiary structure. In this review, we describe the statistical validation of the η/θ formalism and the exploration of features within the η/θ plot. We also describe the application of the η/θ formalism in RNA motif discovery, structural comparison, RNA structure building and tertiary structure prediction. More than a tool, however, the η/θ formalism has provided new insights into RNA structure itself, revealing its fundamental components and the factors underlying RNA architectural form. PMID:21729350

Tele-cytology: An innovative approach for cervical cancer screening in resource-poor settings.

PubMed

Singh, Sandeep; Badaya, Sorabh

2016-01-01

Carcinoma cervix remains a leading cause of cancer mortality among women in countries lacking any screening program. The existing screening policy and approach via conventional cytology centered mainly in Tertiary Care Center, is totally unaffordable to Indian women, especially in the remote areas. This suggests the need of depolarizing the resources via generating the near real time modalities which could be used at the door step of the needy ones. For any screening modality to be effective it should be adequately sensitive, specific, reproducible, cheap, simple, affordable, and the most important is should be real time to ensure wide coverage and curtail loss to follow-up. Incorporating telecytology as a screening tool could make the dream come true. Telecytology is the interpretation of cytology material at a distance using digital images. Use of mobile telecytology unit housed in a van carrying satellite equipment and the automated image capturing systems is the central theme behind this idea. The imaging equipment would be carrying out the imaging of Papanicolaou smears prepared at the screening site and sending the images to the central laboratories situated at some tertiary care level. This concept could overcome the hindrance of trained cytology infrastructure in the resource poor settings and could provide an efficient and economical way of screening patients. There is possibility that the designed approach may not detect the entire women positive for the disease but if the desired objective was to diagnose as many cases as possible in resource poor setting, then this process offers an advantage over no screening at all.

Examination of Factors Predicting Secondary Students' Interest in Tertiary STEM Education

ERIC Educational Resources Information Center

Chachashvili-Bolotin, Svetlana; Milner-Bolotin, Marina; Lissitsa, Sabina

2016-01-01

Based on the Social Cognitive Career Theory (SCCT), the study aims to investigate factors that predict students' interest in pursuing science, technology, engineering, and mathematics (STEM) fields in tertiary education both in general and in relation to their gender and socio-economic background. The results of the analysis of survey responses of…

A Framework for Enabling Graduate Outcomes in Undergraduate Programmes

ERIC Educational Resources Information Center

Bond, C. H.; Spronken-Smith, R.; McLean, A.; Smith, N.; Frielick, S.; Jenkins, M.; Marshall, S.

2017-01-01

Our research aim was to determine what enables engagement with graduate outcomes in tertiary institutions in Aotearoa/New Zealand. We used a mixed methods approach comprising a survey sent to all tertiary institutions, follow-up interviews with 10 academic leaders and eight case studies of good practice of programmes engaged with graduate outcomes…

Tertiary Students' Entrepreneurial Career Intentions of Entrepreneurship-Embedded Internship Programs

ERIC Educational Resources Information Center

Chou, Chun-Mei; Shen, Chien-Hua; Hsiao, Hsi-Chi; Chen, Su-Chang

2017-01-01

This study examines 1630 tertiary students in regard to their entrepreneurial career intentions (ECIs) and their influencing factors. The findings may serve as academic reference for the development of entrepreneurship-related education. The results show that students' computer self-efficacy (CSE) has a significant direct effect on ECIs, and…

Interpreting Experiences of Students Using Educational Online Technologies to Interact with Teachers in Blended Tertiary Environments: A Phenomenological Study

ERIC Educational Resources Information Center

Tuapawa, Kimberley

2017-01-01

Although educational online technologies (EOTs) have transformed the delivery of learning in higher education, significant EOT challenges have impeded their effectiveness, preventing widespread implementation. The persistence of these challenges suggests that tertiary education institutes (TEIs) have experienced a gap in understandings about the…

Students' Perception on Library Service Quality: A Qualitative Study of IIUM Library

ERIC Educational Resources Information Center

Ahmed, Selim; Islam, Rafikul

2012-01-01

Academic libraries are currently facing their greatest challenge since the explosion in tertiary education and academic publishing, which began after World War II. The global digital revolution is affecting both the traditional forms of the creation, organisation, and dissemination of knowledge, and the world of tertiary education itself. In the…

Dance Students' Perceptions of Tertiary Education in England and in Greece

ERIC Educational Resources Information Center

Tsompanaki, Eleni; Benn, Tansin

2011-01-01

The comparative study examined dance students' views of their dance education and training in tertiary education (further and higher) and their perceptions about the opportunities offered in the their courses available in England (higher education) and in Greece (further education). The aim was to explore similarities and differences between…

An Effective Preparation for Tertiary Mathematics

ERIC Educational Resources Information Center

Parnell, Sheena; Statham, Moira

2007-01-01

The University of Auckland offers a one-year pre-degree Tertiary Foundation Certificate (TFC) Programme, for up to 200 students who are under-prepared for university study. The students may come straight from school without having gained a university entrance qualification, or they may be students returning to education who lack the confidence to…

Freezing-Induced Perturbation of Tertiary Structure of a Monoclonal Antibody

PubMed Central

LIU, LU; BRAUN, LATOYA JONES; WANG, WEI; RANDOLPH, THEODORE W.; CARPENTER, JOHN F.

2014-01-01

We studied the effects of pH and solution additives on freezing-induced perturbations in the tertiary structure of a monoclonal antibody (mAb) by intrinsic tryptophan fluorescence spectroscopy. In general, freezing caused perturbations in the tertiary structure of the mAb, which were reversible or irreversible depending on the pH or excipients present in the formulation. Protein aggregation occurred in freeze–thawed samples in which perturbations of the tertiary structure were observed, but the levels of protein aggregates formed were not proportional to the degree of structural perturbation. Protein aggregation also occurred in freeze–thawed samples without obvious structural perturbations, most likely because of freeze concentration of protein and salts, and thus reduced protein colloidal stability. Therefore, freezing-induced protein aggregation may or may not first involve the perturbation of its native structure, followed by the assembly processes to form aggregates. Depending on the solution conditions, either step can be rate limiting. Finally, this study demonstrates the potential of fluorescence spectroscopy as a valuable tool for screening therapeutic protein formulations subjected to freeze–thaw stress. PMID:24832730

Critical Features of Visualizations of Transport through the Cell Membrane--an Empirical Study of Upper Secondary and Tertiary Students' Meaning-Making of a Still Image and an Animation

ERIC Educational Resources Information Center

Rundgren, Carl-Johan; Tibell, Lena A. E.

2010-01-01

Images, diagrams, and other forms of visualization are playing increasingly important roles in molecular life science teaching and research, both for conveying information and as conceptual tools, transforming the way we think about the events and processes the subject covers. This study examines how upper secondary and tertiary students interpret…

Death of Metaphors in Life Science?--A Study of Upper Secondary and Tertiary Students' Use of Metaphors in Their Meaning-Making of Scientific Content

ERIC Educational Resources Information Center

Rundgren, Carl-Johan; Hirsch, Richard; Tibell, Lena A. E.

2009-01-01

The study reported in this article investigated the use of metaphors by upper secondary and tertiary students while learning a specific content area in molecular life science, protein function. Terms and expressions in science can be used in such precise and general senses that they are totally dissociated from their metaphoric origins. Beginners…

Social media use profile, social skills, and nurse-patient interaction among Registered Nurses in tertiary hospitals: A structural equation model analysis.

PubMed

Mariano, Micah Celine O; Maniego, John Christian M; Manila, Hariette Lou Marie D; Mapanoo, Ram Cedrick C; Maquiran, Kerwin Miguel A; Macindo, John Rey B; Tejero, Lourdes Marie S; Torres, Gian Carlo S

2018-04-01

Social media has become increasingly important over the past decades and has been integrated in various environments, including the healthcare setting. Yet, the influence of social media use on the social skills and nurse-patient interaction of nurses is an area in nursing that requires further studies. This study determined the interrelationships among social media use profile, social skills, and nurse-patient interaction of Registered Nurses in tertiary hospitals. Employing structural equation modeling, a descriptive-correlational study was conducted among 212 consecutively-selected nurses from two tertiary hospitals. Consenting respondents completed a two-part survey composed of the respondent profile sheet and the Social Skills Inventory. The respondent profile sheet assessed demographic profile and social media use profile in terms of the mode, frequency, and duration of utilization. Three trained team members observed each nurse-patient dyad and completed the Nurse-Patient Bonding Instrument. A good fit model illustrated the negative effects of frequent social media use to patient openness (β = -0.18, p < 0.05) and engagement (β = -0.11, p ≤ 0.05). Longer use of social media on a daily basis, however, positively affected both dimensions of social skills. Accessing social media platforms using non-handheld devices showed the most influential positive effects to social skills and nurse-patient interaction. Additionally, although verbal social skills positively affected most dimensions of nurse-patient interaction, non-verbal social skills negatively influenced patient engagement (β = -0.19, p = 0.019) and nurse openness (β = -0.38, p ≤ 0.05). The structural model illustrates the effects of using social media on the social skills and nurse-patient interaction of nurses and emphasizes the need for implementing institutional policies on the judicious use and application of social media in the workplace. Further, social skills development programs geared toward having a balanced social skill must be implemented. Copyright © 2018 Elsevier Ltd. All rights reserved.

Patient-appropriate health literacy educational materials in ophthalmology.

PubMed

Mikhail, David; Visscher, Kari L; Chen, Nancy; Wang, Joy; Emara, Barry Y; Hutnik, Cindy M

2015-02-01

To evaluate the literacy level of patients with glaucoma in a tertiary care teaching centre compared with a rural community centre and to assess comprehension of and preference for educational material written at different reading levels. Prospective, randomized, double-blinded study. Patients with glaucoma presenting for routine examination or referral at a tertiary care academic centre in southwestern Ontario and a single general ophthalmology clinic located in a moderately sized suburban community in Ontario, Canada, were invited to participate in this study. Patients aged 19 to 90 with sufficient visual acuity to read the pamphlets were recruited. Eligible and consenting participants underwent a validated literacy study, and their literacy levels were classified as adequate, barely adequate, marginal, or inadequate. They were then randomized to receive educational pamphlets written at either a grade 5 (intervention group) or grade 10 (control group) reading level. Comprehension of and preference for the material were determined by analysis of cloze testing and a feedback questionnaire. Of 199 participants, 179 were included in the analysis. The literacy testing found that 35% of patients in the community practice and 30% in the tertiary care academic centre had "marginal" or "inadequate" literacy skills, but there was no significant difference between sites (p = 0.77). Comprehension of the educational material was higher in the intervention group versus the control group (p = 0.0057), with a mean cloze score of 57.9% in the intervention group and 48.3% in the control group. The intervention group spent significantly less time reading the pamphlets (p < 0.0001), with an average of 2.52 minutes compared with 4.51 minutes. The feedback survey indicated that patients found the pamphlet with the lower reading level easier to read (p = 0.02), which was reflected in their comments as well. In both academic and community practice settings, about 30% of patients with glaucoma have marginal or inadequate literacy skills. However, regardless of practice, all patients better comprehend, and were more receptive to, educational material written at grade 5 reading level with illustrations, regardless of initial literacy level. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Generic Features of Tertiary Chromatin Structure as Detected in Natural Chromosomes

PubMed Central

Müller, Waltraud G.; Rieder, Dietmar; Kreth, Gregor; Cremer, Christoph; Trajanoski, Zlatko; McNally, James G.

2004-01-01

Knowledge of tertiary chromatin structure in mammalian interphase chromosomes is largely derived from artificial tandem arrays. In these model systems, light microscope images reveal fibers or beaded fibers after high-density targeting of transactivators to insertional domains spanning several megabases. These images of fibers have lent support to chromonema fiber models of tertiary structure. To assess the relevance of these studies to natural mammalian chromatin, we identified two different ∼400-kb regions on human chromosomes 6 and 22 and then examined light microscope images of interphase tertiary chromatin structure when the regions were transcriptionally active and inactive. When transcriptionally active, these natural chromosomal regions elongated, yielding images characterized by a series of adjacent puncta or “beads”, referred to hereafter as beaded images. These elongated structures required transcription for their maintenance. Thus, despite marked differences in the density and the mode of transactivation, the natural and artificial systems showed similarities, suggesting that beaded images are generic features of transcriptionally active tertiary chromatin. We show here, however, that these images do not necessarily favor chromonema fiber models but can also be explained by a radial-loop model or even a simple nucleosome affinity, random-chain model. Thus, light microscope images of tertiary structure cannot distinguish among competing models, although they do impose key constraints: chromatin must be clustered to yield beaded images and then packaged within each cluster to enable decondensation into adjacent clusters. PMID:15485905

Risk of malignancy index used as a diagnostic tool in a tertiary centre for patients with a pelvic mass.

PubMed

Håkansson, Fanny; Høgdall, Estrid V S; Nedergaard, Lotte; Lundvall, Lene; Engelholm, Svend A; Pedersen, Anette T; Hartwell, Dorthe; Høgdall, Claus

2012-04-01

Risk of malignancy index (RMI), based on a serum cancer antigen 125 level, ultrasound findings and menopausal status, is used to discriminate ovarian cancer from benign pelvic mass. In Denmark, patients with pelvic mass and RMI ≥200 are referred to tertiary gynecologic oncology centers according to the national guidelines for ovarian cancer treatment. The guidelines include recalculation of RMI at the tertiary center and, if indicated, positron emission tomography/computed tomography and fast-track surgery by specialists in cancer surgery. The aim of this study was to validate the use of RMI ≥200 as a tool for preoperative identification of ovarian cancer at a tertiary center. Prospective observational study. A tertiary center in Copenhagen, Denmark. One thousand one hundred and fifty-nine women with pelvic mass. The RMI was calculated after ultrasound examination and blood sampling for serum cancer antigen 125 analysis within two weeks before surgery. Sensitivity, specificity, positive and negative predictive values were calculated to evaluate the ability of RMI to distinguish between ovarian cancer and benign pelvic mass. There were 778 women diagnosed with benign pelvic mass, while 251 had ovarian cancer and 74 had borderline ovarian tumor. Fifty-six women were diagnosed with other forms of cancer. Sensitivity and specificity for ovarian cancer vs. benign pelvic mass for RMI ≥200 were 92 and 82%, respectively. Corresponding positive and negative predictive values were 62 and 97%. Risk of malignancy index ≥200 is a reliable tool for identifying patients with ovarian cancer pelvic masses at a tertiary centre to select patients for further preoperative examinations. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Freestanding midwifery units: Maternal and neonatal outcomes following transfer.

PubMed

Monk, Amy R; Grigg, Celia P; Foureur, Maralyn; Tracy, Mark; Tracy, Sally K

2017-03-01

the viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, require transfer. to compare the maternal and neonatal birth outcomes of women who planned, to give birth at freestanding midwifery units and subsequently, transferred to a tertiary maternity unit to the maternal and neonatal, outcomes of a low-risk cohort of women who planned to give birth in, tertiary maternity unit. a descriptive study compared two groups of women with low-risk singleton, pregnancies who were less than 28 weeks pregnant at booking: women who, planned to give birth at a freestanding midwifery unit (n=494) who, transferred to a tertiary maternity unit during the antenatal, intrapartum or postnatal periods (n=260) and women who planned to give, birth at a tertiary maternity unit (n=3157). Primary outcomes were mode, of birth, Apgar score of less than 7 at 5minutes and admission to, special care nursery or neonatal intensive care. the proportion of women who experienced a caesarean section was lower, among the freestanding midwifery unit women who transferred during the, intrapartum/postnatal period compared to women in the tertiary maternity, unit group (16.1% versus 24.8% respectively). Other outcomes were, comparable between the cohorts. Rates of primary outcomes in relation to, stage of transfer varied when stratified by parity. these descriptive results support the provision of care in freestanding, midwifery units as an alternative to tertiary maternity units for women, with low risk pregnancies at the time of booking. A larger study, powered, to determine statistical significance of any differences in outcomes, is, required. Copyright © 2017 Elsevier Ltd. All rights reserved.

Correlation between the radiological observation of isolated tertiary waves on an esophagram and findings on high-resolution esophageal manometry.

PubMed

Halland, M; Ravi, K; Barlow, J; Arora, A

2016-01-01

Barium esophagrams are a frequently performed test, and radiological observations about potential abnormal esophageal motility, such as tertiary contractions, are commonly reported. We sought to assess the correlation between tertiary waves, and in particular isolated tertiary waves, on esophagrams and findings on non-synchronous high-resolution esophageal manometry. We retrospectively reviewed reports of esophagrams performed at a tertiary referral center and identified patients in whom tertiary waves were observed and a high-resolution esophageal manometry had been performed. We defined two groups; group 1 was defined as patients with isolated tertiary waves, whereas group 2 had tertiary waves and evidence of achalasia or an obstructing structural abnormality on the esophagram. We collected data on demographics, dysphagia score, associated findings on esophagram, and need for intervention. We reviewed the reports of 2100 esophagrams of which tertiary waves were noted as an isolated abnormality in 92, and in association with achalasia or a structural obstruction in 61. High-resolution manometry was performed in 17 patients in group 1, and five had evidence of a significant esophageal motility disorder and 4 required any intervention. Twenty-one patients in group 2 underwent manometry, and 18 had a significant esophageal motility disorder. An isolated finding of tertiary waves on an esophagram is rarely associated with a significant esophageal motility disorder that requires intervention. All patients with isolated tertiary waves who required intervention had a dysphagia to liquids. Tertiary contractions, in the absence of dysphagia to liquids, indicate no significant esophageal motility disorder. © 2014 International Society for Diseases of the Esophagus.

Correlation of tertiary formations of Alaska

USGS Publications Warehouse

MacNeil, F.S.; Wolfe, J.A.; Miller, D.J.; Hopkins, D.M.

1961-01-01

Recent stratigraphic and paleontologic studies have resulted in substantial revision of the age assignments and inter-basin correlations of the Tertiary formations of Alaska as given in both an earlier compilation by P. S. Smith (1939) and a tentative chart prepared for distribution at the First International Symposium on Arctic Geology at Calgary, Alberta (Miller, MacNeil, and Wahrhaftig, 1960). Current work in Alaska by the U. S. Geological Survey and several oil companies is furnishing new information at a rapid rate and further revisions may be expected. The correlation chart (Fig. 1), the first published chart to deal exclusively with the Tertiary of Alaska, had the benefit of a considerable amount of stratigraphic data and fossil collections from some oil companies, but recent surface mapping and drilling by other oil companies in several Tertiary basins undoubtedly must have produced much more information. Nevertheless, the extent of available data justifies the publication of a revised correlation chart at this time.

The equity imperative in tertiary education: Promoting fairness and efficiency

NASA Astrophysics Data System (ADS)

Salmi, Jamil; Bassett, Roberta Malee

2014-06-01

While the share of the tertiary education age cohort (19-25) which is being given the opportunity to study has increased worldwide over the past two decades, this does not in fact translate into reduced inequality. For many young people, especially in the developing world, major obstacles such as disparities in terms of gender, minority population membership or disabilities as well as academic and financial barriers are still standing in their way. The authors of this article propose a conceptual framework to analyse equity issues in tertiary education and document the scope, significance and consequences of disparities in tertiary education opportunities. They throw some light on the main determinants of these inequalities and offer suggestions about effective equity promotion policies directed towards widening participation and improving the chances of success of underprivileged youths in order to create societies which uphold humanistic values.

Timing Discrepancies of Early Intervention Hearing Services in Urban and Rural Cochlear Implant Recipients

PubMed Central

Bush, Matthew L.; Burton, Mary; Loan, Ashley; Shinn, Jennifer B.

2013-01-01

Objective The purpose of this study was to examine the timing of early intervention diagnostic and therapeutic services in cochlear implant recipients from rural and urban areas. Study design Retrospective case series review Setting Tertiary referral center Patients Cochlear implant recipients from a single comprehensive hearing institute born with severe congenital sensorineural hearing loss were examined. Timing of diagnostic and therapeutic services was examined. Intervention(s) Diagnosis, amplification, and eventual cochlear implantation for all patients in the study Main outcome measure(s) Time points of definitive diagnosis, amplification, and cochlear implantation for children from urban and rural regions were examined. Correlation analysis of distance to testing center and timing of services was also assessed. Results 40 children born with congenital hearing loss were included in the study and were diagnosed at a median age of 13 weeks after birth. Children from rural regions obtained amplification at a median age of 47.7 weeks after birth, while urban children were amplified at 26 weeks after birth. Cochlear implantation was performed at a median age of 182 weeks after birth in those from rural areas and at 104 weeks after birth in urban-dwelling patients. A linear relationship was identified between distance to the implant center and timing of hearing aid amplification (r=0.5, p=0.033) and cochlear implantation (r=0.5, p=0.016). Conclusions Children residing outside of metro areas may be at higher risk of delayed rehabilitative services and cochlear implantation than those residing in urban areas that may be closer in proximity to tertiary care centers. PMID:24136305

Depression and posttraumatic stress disorder among road traffic accident victims managed in a Tertiary hospital in Southern Nigeria.

PubMed

Asuquo, J E; Edet, B E; Abang, I E; Essien, E A; Osakwe, O G; Aigbomain, E J; Chigbundu, K C

2017-02-01

Psychological responses to traumatic events vary widely across different cultures but studies in the developing countries are scant. The objective of this study is to determine prevalence of depression and posttraumatic stress disorder (PTSD) among patients involved in road traffic accident (RTA) compared with that of the general population using a matched control group. The study design was case control and employed the convenient sampling technique. All consecutive attendees of the trauma clinic of a Tertiary Hospital who had been involved in RTA in the previous year and met inclusion criteria were recruited to participate in the study. Controls were drawn from patient relatives attending other clinics in the same hospital. The final sample comprised of 46 cases and controls, totaling 92 participants. A Sociodemographic questionnaire, the PTSD, and depression modules of the Mini International neuropsychiatric interview were administered to both groups by trained research assistants. The data were analyzed using IBM SPSS version 22. Statistical significance was set at 0.05. The prevalence of PTSD among cases was 41.3% compared with 13% among controls, whereas the prevalence of depression among cases was 63% compared with 30.4% among the controls. Both of these findings were statistically significant (P < 0.002). Sociodemographic variables such as age, sex, marital status, religion, level of education, and occupation did not have statistically significant relationship with neither PTSD nor depression. Mental disorders such as PTSD and depression are common in victims of RTA. They would benefit from comanagement with mental health specialists.

Cenozoic Ignimbrites, Source Calderas, Relict Magma Chambers, and Tectonic Settings: Perspectives from Cordilleran North America (Invited)

NASA Astrophysics Data System (ADS)

Lipman, P. W.

2009-12-01

In the early 1960s, new concepts and innovative techniques coalesced spectacularly to improve understanding of Tertiary pyroclastic volcanism in North America. Spotty recognition of welded tuff, among rocks mostly described as silicic lava flows, exploded with identification of individual ignimbrite sheets, some having volumes >103 km3 and extending >100 km from source calderas. R.l. Smith, during study of the Bandelier Tuff in New Mexico, documented complexities of welding and crystallization zones that provided a genetic framework (cooling units) for ignimbrite studies (even while confusion continues in some areas where talus and vegetation obscure bench-forming contact zones between densely welded cliffs). Also in the 1960s, application of isotopic age determinations (initially K-Ar, now largely superceded by 40Ar/39Ar laser fusion) and precise paleomagnetic pole directions became key tools for correlating ignimbrites, deciphering eruptive histories, and determining volcano-tectonic patterns. Dated ignimbrites provide unique stratigraphic markers within volcanic field, as well as datums for regional structures and the shifting patterns of volcanism related to global plate motions--another happy coincidence in the 1960s as plate-tectonic models were formulated. Tertiary ignimbrite flare-ups along the Cordilleran margin increasingly are recognized as coinciding with inception of regional extension, especially during transitions from episodes of low-angle convergence. Many large caldera sources for the Tertiary ignimbrites have now been identified, in place of prior vague concepts of “volcano-tectonic depressions”, especially as the contrasts between thin outflow and thickly ponded intracaldera ignimbrite with interleaved collapse breccia became appreciated. Multi-km-thick fills in many calderas document that collapse begins early during large ignimbrite eruptions, and downsag inception was succeeded by breakage along ring faults. Resurgent uplift has been identified at many ignimbrite calderas, building on the pioneering observations of van Bemmelen at Lake Toba, Indonesia. Still many Tertiary caldera systems remain poorly understood where buried beneath younger rocks, others completely eroded to levels of subvolcanic granitic plutons. Links between silicic volcanism and batholith formation in continental crust continue a major research focus; improved petrologic, isotopic, and geophysical techniques are helping evaluate compositional and age relations between extrusive and intrusive components, as well as present-day intrusion geometry relative to times of peak volcanism. Ignimbrites that preserve quenched compositional gradients, commonly from rhyolite upward into crystal-rich dacite, were early recognized as special opportunities for magma-chamber studies, especially as analytical methods improved (XRF and INAA rock chemistry, microprobe mineral compositions, radiogenic and stable isotope geochemistry). These demonstrated the importance of mafic magma from the mantle, melting/assimilation in the lower crust, and mixing of diverse magmas during rise and eruption, even as recent studies by electron and/or ion probe documented complex crystal cargos (mixed phenocrysts, xenocrysts, and antecrysts).

Laryngoscope illuminance in a tertiary children's hospital: implications for quality laryngoscopy.

PubMed

Volsky, Peter G; Murphy, Michael K; Darrow, David H

2014-07-01

Laryngoscopes are used by otolaryngologists in a variety of hospital emergency and critical care settings. However, only rarely have quality-related aspects of laryngoscope function and application been studied. To compare the illuminance of laryngoscopes commonly used in a hospital setting to established standards and to assess the potential effects of maintenance practices on laryngoscope illuminance. Observational study of laryngoscope light output and cross-sectional survey of individuals charged with laryngoscope maintenance in a tertiary care children's hospital. Illuminance was chosen as the unit of measurement (lux). Laryngoscopes in the operating room, emergency department, and pediatric intensive care unit were tested according to a standard technique. Illuminance standards for laryngoscopes, published by the International Organization for Standardization (ISO) (500 lux) and in the medical literature (867 lux) were used as benchmarks. Mean laryngoscope illuminance by type of laryngoscope and light source and percentage of laryngoscopes with illuminance below established standards as well as nonfunctioning units. Maintenance practices were evaluated as a secondary outcome. A total of 319 laryngoscopes were tested; 283 were incandescent bulb units used by anesthesiologists, emergency physicians, and intensivists and 36 were xenon light units used by otolaryngologists. Mean (SD) illuminance was 1330 (1160) lux in the incandescent group and 16,600 (13,000) lux in the xenon group (P < .001). Substandard illuminance was observed only in the incandescent group, in 29% to 43% of laryngoscopes; 5% of the incandescent group did not turn on at all. Maintenance of laryngoscopes was performed on a reactive rather than a preventive basis. At our facility, approximately one-third of incandescent laryngoscopes exhibited substandard light output. On the basis of these findings, our hospital has converted all of its incandescent laryngoscopes to light-emitting diode (LED) devices. Such changes, as well as the institution of a quality-control program including scheduled laryngoscope inspection and battery and bulb replacement for incandescent laryngoscopes, may reduce adverse events associated with poor-quality direct laryngoscopy.

Behavioral predictors of outpatient mental health service utilization within 6 months after traumatic brain injury in adolescents.

PubMed

Kurowski, Brad G; Wade, Shari L; Kirkwood, Michael W; Brown, Tanya M; Stancin, Terry; Taylor, H Gerry

2013-12-01

To characterize utilization of mental health services and determine the ability of a behavior problem and clinical functioning assessment to predict utilization of such services within the first 6 months after moderate and severe traumatic brain injury in a large cohort of adolescents. Multicenter cross-sectional study. Outpatient setting of 4 tertiary pediatric hospitals, 2 tertiary general medical centers, and 1 specialized children's hospital. Adolescents age 12-17 years (n = 132), 1-6 months after moderate-to-severe traumatic brain injury. Logistic regression was used to determine the association of mental health service utilization with clinical functioning as assessed by the Child and Adolescent Functional Assessment Scale and behavior problems assessed by the Child Behavioral Checklist. Mental health service utilization measured by the Service Assessment for Children and Adolescents. Behavioral or functional impairment occurred in 37%-56%. Of the total study population, 24.2% reported receiving outpatient mental health services, 8.3% reported receiving school services, and 28.8% reported receiving any type of mental health service. Use of any (school or outpatient) mental health service was associated with borderline to impaired total Child and Adolescent Functional Assessment Scale (odds ratio 3.50 [95% confidence interval, 1.46-8.40]; P < .01) and the Child Behavioral Checklist Total Competence (odds ratio 5.08 [95% confidence interval, 2.02-12.76]; P < .01). A large proportion of participants had unmet mental health needs. Both the Child and Adolescent Functional Assessment Scale and the Child Behavioral Checklist identified individuals who would likely benefit from mental health services in outpatient or school settings. Future research should focus on methods to ensure early identification by health care providers of adolescents with traumatic brain injury in need of mental health services. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Endometrial lesions caused by catheters used for embryo transfers: a preliminary report.

PubMed

Marconi, Guillermo; Vilela, Martín; Belló, José; Diradourián, Marco; Quintana, Ramiro; Sueldo, Carlos

2003-08-01

To visualize by microhysteroscopy any possible lesions on the endocervix and endometrium made by the catheters commonly used for embryo transfer (ET). Prospective descriptive study. Tertiary fertility center (IFER). Twenty-three infertile patients underwent a mock transfer before a microhysteroscopy during the postovulatory phase (days 2-5 after ovulation) of the cycle with a Tomcat catheter (n = 5), Frydman's catheter (n = 5), Frydman's set (n = 3), or Wallace's catheter (n = 10). Mock ETs and subsequent mycrohysteroscopies.Visualization, description, and documentation of endocervical and endometrial lesions. The lesions in all 23 patients were described and documented (tunnel-like, groove-like, punch-out, crater-like). The Wallace catheter appears to be less traumatic to the endometrium (but it seems that it is important to take care to not pass the internal os with the outer sheath). The Tomcat catheter and the Frydman's set caused the more significant lesions that were observed. In this preliminary study, for the first time endometrial lesions caused by the ET catheters were directly visualized and documented. Some of these observed lesions appear to be capable of compromising the success of ET.

The Colorado front range: anatomy of a Laramide uplift

USGS Publications Warehouse

Kellogg, Karl; Bryant, Bruce; Reed, John C.

2004-01-01

Along a transect across the Front Range from Denver to the Blue River valley near Dillon, the trip explores the geologic framework and Laramide (Late Cretaceous to early Eocene) uplift history of this basement-cored mountain range. Specific items for discussion at various stops are (1) the sedimentary and structural record along the upturned eastern margin of the range, which contains several discontinuous, east-directed reverse faults; (2) the western structural margin of the range, which contains a minimum of 9 km of thrust overhang and is significantly different in structural style from the eastern margin; (3) mid- to late-Tertiary modifications to the western margin of the range from extensional faulting along the northern Rio Grande rift trend; (4) the thermal and uplift history of the range as revealed by apatite fission track analysis; (5) the Proterozoic basement of the range, including the significance of northeast-trending shear zones; and (6) the geologic setting of the Colorado mineral belt, formed during Laramide and mid-Tertiary igneous activity.

Ponseti treatment in the management of clubfoot deformity - a continuing role for paediatric orthopaedic services in secondary care centres.

PubMed

Docker, Charles E J; Lewthwaite, Simon; Kiely, Nigel T

2007-07-01

The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. This 'hub-and-spoke' approach would appear to be efficient in terms of resource utilisation. Additional benefits for patients and their carers include ease of access to services and reduced financial and transport burdens.

Delays in diagnosis and treatment of extrapulmonary tuberculosis in Guatemala.

PubMed

Shah, Pooja Ajay; Coj, Merida; Rohloff, Peter

2017-10-09

A 23-year-old indigenous Guatemalan man presented in 2016 to our clinic in Sololá, Guatemala, with 10 months of recurrent neck swelling, fevers, night sweats and weight loss. Previously, he had sought care in three different medical settings, including a private physician-run clinic, a tertiary private cancer treatment centre and, finally, a rural government health post. With assistance from our institution's accompaniment staff, the patient was admitted to a public tertiary care hospital for work-up. Rifampin-susceptible tuberculosis was diagnosed, and appropriate treatment was begun. The case illustrates how low tuberculosis recognition among community health workers and health system segmentation creates obstacles to appropriate care, especially for patients with limited means. As a result, significant diagnostic and treatment delays can occur, increasing the public health burden of tuberculosis. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Thoughts Regarding the Dimensions of Faults at Rainier and Aqueduct Mesas, Nye County, Nevada, Based on Surface and Underground Mapping

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

Drellack, S.L.; Prothro, L.B.; Townsend, M.J.

2011-02-01

The geologic setting and history, along with observations through 50 years of detailed geologic field work, show that large-displacement (i.e., greater than 30 meters of displacement) syn- to post-volcanic faults are rare in the Rainier Mesa area. Faults observed in tunnels and drill holes are mostly tight, with small displacements (most less than 1.5 meters) and small associated damage zones. Faults are much more abundant in the zeolitized tuffs than in the overlying vitric tuffs, and there is little evidence that faults extend downward from the tuff section through the argillic paleocolluvium into pre-Tertiary rocks. The differences in geomechanical characteristicsmore » of the various tuff lithologies at Rainier Mesa suggest that most faults on Rainer Mesa are limited to the zeolitic units sandwiched between the overlying vitric bedded tuffs and the underlying pre-Tertiary units (lower carbonate aquifer–3, lower clastic confining unit–1, and Mesozoic granite confining unit).« less

Lower Genital Tract Trauma in A Tertiary Care Centre in Mid-Western Nepal.

PubMed

Adhikari, A K; Dutta, M; Das, C R

2017-01-01

The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Appropriate surgical intervention can avert morbidity and mortality.

Lead isotope compositions of Late Cretaceous and early Tertiary igneous rocks and sulfide minerals in Arizona: Implications for the sources of plutons and metals in porphyry copper deposits

USGS Publications Warehouse

Bouse, R.M.; Ruiz, J.; Titley, S.R.; Tosdal, R.M.; Wooden, J.L.

1999-01-01

Porphyry copper deposits in Arizona are genetically associated with Late Cretaceous and early Tertiary igneous complexes that consist of older intermediate volcanic rocks and younger intermediate to felsic intrusions. The igneous complexes and their associated porphyry copper deposits were emplaced into an Early Proterozoic basement characterized by different rocks, geologic histories, and isotopic compositions. Lead isotope compositions of the Proterozoic basement rocks define, from northwest to southeast, the Mojave, central Arizona, and southeastern Arizona provinces. Porphyry copper deposits are present in each Pb isotope province. Lead isotope compositions of Late Cretaceous and early Tertiary plutons, together with those of sulfide minerals in porphyry copper deposits and of Proterozoic country rocks, place important constraints on genesis of the magmatic suites and the porphyry copper deposits themselves. The range of age-corrected Pb isotope compositions of plutons in 12 Late Cretaceous and early Tertiary igneous complexes is 206Pb/204Pb = 17.34 to 22.66, 207Pb/204Pb = 15.43 to 15.96, and 208Pb/204Pb = 37.19 to 40.33. These Pb isotope compositions and calculated model Th/U are similar to those of the Proterozoic rocks in which the plutons were emplaced, thereby indicating that Pb in the younger rocks and ore deposits was inherited from the basement rocks and their sources. No Pb isotope differences distinguish Late Cretaceous and early Tertiary igneous complexes that contain large economic porphyry copper deposits from less rich or smaller deposits that have not been considered economic for mining. Lead isotope compositions of Late Cretaceous and early Tertiary plutons and sulfide minerals from 30 metallic mineral districts, furthermore, require that the southeastern Arizona Pb province be divided into two subprovinces. The northern subprovince has generally lower 206Pb/204Pb and higher model Th/U, and the southern subprovince has higher 206Pb/204Pb and lower model Th/U. These Pb isotope differences are inferred to result from differences in their respective post-1.7 Ga magmatic histories. Throughout Arizona, Pb isotope compositions of Late Cretaceous and early Tertiary plutons and associated sulfide minerals are distinct from those of Jurassic plutons and also middle Tertiary igneous rocks and sulfide minerals. These differences most likely reflect changes in tectonic setting and magmatic sources. Within Late Cretaceous and early Tertiary igneous complexes that host economic porphyry copper deposits, there is commonly a decrease in Pb isotope composition from older to younger plutons. This decrease in Pb isotope values with time suggests an increasing involvement of crust with lower U/Pb than average crust in the source(s) of Late Cretaceous and early Tertiary magmas. Lead isotope compositions of the youngest porphyries in the igneous complexes are similar to those in most sulfide minerals within the associated porphyry copper deposit. This Pb isotope similarity argues for a genetic link between them. However, not all Pb in the sulfide minerals in porphyry copper deposits is magmatically derived. Some sulfide minerals, particularly those that are late stage, or distal to the main orebody, or in Proterozoic or Paleozoic rocks, have elevated Pb isotope compositions displaced toward the gross average Pb isotope composition of the local country rocks. The more radiogenic isotopic compositions argue for a contribution of Pb from those rocks at the site of ore deposition. Combining the Pb isotope data with available geochemical, isotopic, and petrologic data suggests derivation of the young porphyry copper-related plutons, most of their Pb, and other metals from a hybridized lower continental crustal source. Because of the likely involvement of subduction-related mantle-derived basaltic magma in the hybridized lower crustal source, an indiscernible mantle contribution is probable in the porphyry magmas. Clearly, in addition

Six-month outcome in unstable angina patients without previous myocardial infarction according to the use of tertiary cardiologic resources. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.

PubMed

Lupón, J; Valle, V; Marrugat, J; Elosua, R; Serés, L; Pavesi, M; Freixa, R; Sanz, G; Masiá, R; Molina, L; Sala, J; Serra, J

1999-12-01

The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes. The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established. A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias. Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p = 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p < 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67). The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.

A novel assay to measure tertiary and quaternary amines in wastewater: An indicator for NDMA wastewater precursors.

PubMed

Woods-Chabane, Gwen C; Glover, Caitlin M; Marti, Erica J; Dickenson, Eric R V

2017-07-01

This study examined the potential of using a novel bulk amine assay as an approximation for the tertiary and quaternary amine load in wastewaters and surface water samples, and this approximation was compared to N-nitrosodimethylamine (NDMA) formation potential using chloramines. An existing colorimetric method was examined and optimized for the detection of amines in environmental water samples. The method consists of liquid-liquid extraction followed by a catalyzed reaction to form a yet-undefined product that is known to be both a strong chromophore and fluorophore. Previous work verified that this reaction was effectively catalyzed by a number of compounds containing tertiary and quaternary amine moieties. Many tertiary and quaternary compounds are also efficient producers of NDMA under chloramination conditions, and a linear correlation was consequently derived from the bulk amine signals vs. NDMA formation potential in various wastewater samples (R 2  = 0.74; n = 24; p-value < 0.05). The results provide evidence that approximately 2% of the tertiary and quaternary amines measured can form NDMA and an estimated 0.01-1.3% of nitrogen in dissolved organic nitrogen originates from these bulk amines. The normalization of NDMA concentration by the amine measurement revealed that ozone effectively destroyed those tertiary and quaternary amine structures more likely to form NDMA in treated wastewater samples. This bulk amine assay illustrates that proxy measurements of tertiary and quaternary amines can be linked to the NDMA formation potential of a given sample, and this approach may prove useful as a characterizing tool for NDMA precursors in wastewater. Copyright © 2017 Elsevier Ltd. All rights reserved.

An assessment on the trustworthiness of engineers in higher tertiary institutions

NASA Astrophysics Data System (ADS)

Ooi Kuan, Tan; Lloyd, Ling; Mou Chuan, Cheng

2017-10-01

In Malaysian higher education history, the evolution from public funded to private funded and now to private non profit oriented model has been taking place since 80s. The evolution also demarcated higher learning institution into academic or research based university. As such, postgraduate studies became increasingly competitive in students intake. The evolution also created doubt to the public in term of the quality of postgraduate education offered by different classifications. This study investigates the gender specific perception and trustworthiness of engineering postgraduate students in private non profit oriented higher tertiary institution. An equally divided gender groups of 118 respondents were chosen for the study. Non-parametric statistics were used and the result showed that there was no difference and no correlation of genders in perception on teaching role and trustworthiness among the future engineers in private non profit oriented higher tertiary institution.

Biostratigraphy of the Cretaceous/Tertiary boundary in the Sirwan Valley (Sulaimani Region, Kurdistan, NE Iraq)

NASA Astrophysics Data System (ADS)

Sharbazheri, Khalid Mahmood; Ghafor, Imad Mahmood; Muhammed, Qahtan Ahmad

2009-10-01

The Cretaceous/Tertiary (K/T) boundary sequence, which crops out in the studied area is located within the High Folded Zone, in the Sirwan Valley, northeastern Iraq. These units mainly consist of flysch and flysch-type successions of thick clastic beds of Tanjero/Kolosh Formations. A detailed lithostratigraphic study is achieved on the outcropping uppermost part of the Upper Cretaceous successions (upper part of Tanjero Formation) and the lowermost part of the Kolosh Formation. On the basis of the identified planktonic foraminiferal assemblages, five biozones are recorded from the uppermost part of Tanjero Formation and four biozones from the lower part of the Kolosh Formation (Lower Paleocene) in the Sirwan section. The biostratigraphic correlations based on planktonic foraminiferal zonations showed a comparison between the biostratigraphic zones established in this study and other equivalents of the commonly used planktonic zonal scheme around the Cretaceous/Tertiary boundary in and outside Iraq.

Real time application of whole genome sequencing for outbreak investigation - What is an achievable turnaround time?

PubMed

McGann, Patrick; Bunin, Jessica L; Snesrud, Erik; Singh, Seema; Maybank, Rosslyn; Ong, Ana C; Kwak, Yoon I; Seronello, Scott; Clifford, Robert J; Hinkle, Mary; Yamada, Stephen; Barnhill, Jason; Lesho, Emil

2016-07-01

Whole genome sequencing (WGS) is increasingly employed in clinical settings, though few assessments of turnaround times (TAT) have been performed in real-time. In this study, WGS was used to investigate an unfolding outbreak of vancomycin resistant Enterococcus faecium (VRE) among 3 patients in the ICU of a tertiary care hospital. Including overnight culturing, a TAT of just 48.5 h for a comprehensive report was achievable using an Illumina Miseq benchtop sequencer. WGS revealed that isolates from patient 2 and 3 differed from that of patient 1 by a single nucleotide polymorphism (SNP), indicating nosocomial transmission. However, the unparalleled resolution provided by WGS suggested that nosocomial transmission involved two separate events from patient 1 to patient 2 and 3, and not a linear transmission suspected by the time line. Rapid TAT's are achievable using WGS in the clinical setting and can provide an unprecedented level of resolution for outbreak investigations. Published by Elsevier Inc.

Epidemiology of Pediatric Convulsive Status Epilepticus With Fever in the Emergency Department: A Cohort Study of 381 Consecutive Cases.

PubMed

Hayakawa, Itaru; Miyama, Sahoko; Inoue, Nobuaki; Sakakibara, Hiroshi; Hataya, Hiroshi; Terakawa, Toshiro

2016-09-01

Pediatric convulsive status epilepticus with fever is common in the emergency setting but leads to severe neurological sequelae in some patients. To explore the epidemiology of convulsive status epilepticus with fever, a retrospective cohort covering all convulsive status epilepticus cases with fever seen in the emergency department of a tertiary care children's hospital were consecutively collected. Of the 381 consecutive cases gathered, 81.6% were due to prolonged febrile seizure, 6.6% to encephalopathy/encephalitis, 0.8% to meningitis, and 7.6% to epilepsy. In addition, seizures were significantly longer in encephalopathy/encephalitis cases than in prolonged febrile seizure cases (log rank test, P < .001). These results provide for the first time the pretest probability of final diagnoses in children with convulsive status epilepticus with fever in the emergency setting, and will help optimize the management of pediatric patients presenting to the emergency department with convulsive status epilepticus with fever. © The Author(s) 2016.

Multidisciplinary Pediatric Obesity Clinic via Telemedicine Within the Los Angeles Metropolitan Area: Lessons Learned.

PubMed

Slusser, Wendy; Whitley, Margaret; Izadpanah, Nilufar; Kim, Sion L; Ponturo, Don

2016-03-01

Telemedicine has been shown to be effective for rural populations, but little is reported on pediatric obesity care via telemedicine in urban settings. This study aims to assess feasibility and acceptability of multidisciplinary pediatric obesity care via telemedicine within the same metropolitan area in terms of information technology, coordination, patient care, and clinical outcomes. All project notes and communications were reviewed to extract key lessons from implementation. Patient and Provider Satisfaction Questionnaires were conducted to assess overall satisfaction; baseline and follow-up information were collected from chart reviews to evaluate clinical outcomes. Based on the questionnaires, 93% of responding patients (n = 28) and 88.3% of referring providers (n = 17) felt satisfied with the appointment. Chart review indicated a trend for decreased or stabilized body mass index and blood pressure (n = 32). Implementation of telemedicine for tertiary multidisciplinary pediatric obesity care in urban settings is both feasible and acceptable to patients and health care providers. © The Author(s) 2015.

Breast Self Examination Practice among Female Students of Tertiary Institutions

ERIC Educational Resources Information Center

Agbonifoh, Julia Adesua

2016-01-01

Against the background of the dangers posed by breast cancer world-wide, and the importance of its early detection and therefore breast self examination (BSE), this study investigated the practice of BSE among female students in tertiary institutions in Edo state. A sample of 723 participants selected through a combination of multi-stage,…

The Equity Imperative in Tertiary Education: Promoting Fairness and Efficiency

ERIC Educational Resources Information Center

Salmi, Jamil; Bassett, Roberta Malee

2014-01-01

While the share of the tertiary education age cohort (19-25) which is being given the opportunity to study has increased worldwide over the past two decades, this does not in fact translate into reduced inequality. For many young people, especially in the developing world, major obstacles such as disparities in terms of gender, minority population…

Small Shifts, Big Changes: Changing the Story for Students with Sensory Processing Sensitivity (SPS)

ERIC Educational Resources Information Center

Cater, Kaaryn

2016-01-01

It is my privilege to work as a tertiary learning advisor (TLA). Through my role I have had the opportunity to form unique relationships with students during individual consultations. This has enabled me to observe student behaviour, and the metacognitive strategies students use to negotiate the myriad challenges of tertiary study. I noticed…

Can Education Add Value to Values? A Study of Law Students

ERIC Educational Resources Information Center

Palermo, Josephine; Evans, Adrian

2004-01-01

In the global market place the value of education takes on many meanings. In transnational education forums it relates to the market's assessment (in dollar terms) of a qualification. But can we measure the value-addedness of tertiary education in existential terms? Can we measure the value that tertiary education provides to the enhancement of…

Changing Destinations: Ideal Attraction and Actual Movement of Cross-Border Tertiary Students from Mainland China

ERIC Educational Resources Information Center

Ghazarian, Peter G.

2014-01-01

Globalization has driven growth in the market for cross-border students. Mainland China, with a burgeoning economy and the largest national population, has become an important source of cross-border students. This study identifies ideal attraction in mainland China to destinations for cross-border tertiary education, as expressed by ideal first…

The Impact of Cooperative Learning on Tertiary EFL Learners' Motivation

ERIC Educational Resources Information Center

Ning, Huiping; Hornby, Garry

2014-01-01

This study was aimed at investigating the impact of cooperative learning on the motivation of tertiary English learners. Participants were from two randomly assigned classes at a university in the north of China. A pre-test-post-test control group design was employed to compare the impact of the cooperative learning approach with that of…

The Adaptation and Validation of the CEQ and the R-SPQ-2F to the Japanese Tertiary Environment

ERIC Educational Resources Information Center

Fryer, Luke K.; Ginns, Paul; Walker, Richard A.; Nakao, Kaori

2012-01-01

Background: Student learning theory (SLT) has established associations between students' approaches to learning and their perceptions of the learning environment. SLT may provide a useful framework for researching student learning within the Japanese tertiary sector. Aims: The study aims to explore and validate the Course Experience Questionnaire…

Word-of-Mouth amongst Students at a New Zealand Tertiary Institution

ERIC Educational Resources Information Center

Warring, Susan

2013-01-01

Purpose: The aim of this case study was to investigate the extent of word-of-mouth influence amongst international students at a New Zealand tertiary institution and to review the literature for a valid and reliable conceptualisation and measurement of word-of-mouth. Design/methodology/approach: Literature suggests that opinion-leading and seeking…

Content and Language Integrated Learning Next in Asia: Evidence of Learners' Achievement in CLIL Education from a Taiwan Tertiary Degree Programme

ERIC Educational Resources Information Center

Yang, Wenhsien

2015-01-01

This study investigates learners' performance in a Taiwanese tertiary content and language integrated learning (CLIL) programme. Learners' English proficiency was measured immediately after entering the programme and before their industrial placement, i.e. after two years. As in previously reported cases, the learners showed a significant…

Graphing in Physics: Processes and Sources of Error in Tertiary Entrance Examinations in Western Australia

ERIC Educational Resources Information Center

Forster, Patricia A.

2004-01-01

Interpretation and construction of graphs are central to the study of physics and to performance in physics. In this paper, I explore the interpretation and construction processes called upon in questions with a graphical component, in Western Australian Physics Tertiary Entrance Examinations. In addition, I list errors made by students as…

The Contribution of Information Acquisition and Management Capacity to Administrators' Decision-Making Effectiveness in Tertiary Institutions in South-Western Nigeria

ERIC Educational Resources Information Center

Fabunmi, Martins; Erwat, Eseza Akiror

2008-01-01

This study investigated through empirical methods the extent to which information acquisition and information management capacity of administrators in tertiary institutions in South-Western Nigeria contributed to their decision-making effectiveness. It adopted the ex post facto survey research design, using the random sampling technique to select…

Predictors of Attrition and Achievement in a Tertiary Bridging Program

ERIC Educational Resources Information Center

Whannell, Robert

2013-01-01

This study examines the attrition and achievement of a sample of 295 students in an on-campus tertiary bridging program at a regional university. A logistic regression analysis using enrolment status, age and the number of absences from scheduled classes at week three of the semester as predictor variables correctly predicted 92.8 percent of…

Using Institutional Research Data on Tertiary Performance to Inform Departmental Advice to Secondary Students

ERIC Educational Resources Information Center

Brogt, Erik; Sampson, Kaylene A.; Comer, Keith; Turnbull, Matthew H; McIntosh, Angus R.

2011-01-01

This article examines the use of institutional research data on tertiary academic success of students in the first-year Biology program at the University of Canterbury in relation to their secondary school performance in English, Mathematics with Statistics, Biology and Chemistry. This study was commissioned by the School of Biological Sciences to…

The effects of health education on knowledge and attitudes to emergency contraception by female students of a tertiary educational institution in Enugu, South East Nigeria.

PubMed

Arinze-Onyia, S U; Onwasigwe, C N; Uzochukwu, B S C; Nwobi, E A; Ndu, A C; Nwobodo, Ed

2010-11-28

This was an intervention study to assess the effects of health education on the knowledge and attitudes to emergency contraception (EC) by female students of University of Nigeria in southeast Nigeria. A structured questionnaire was used to collect data from 337 female students of a tertiary educational institution (150 in the study group and 187 from the control group) who were selected by multistage sampling. Subsequently, health education was conducted only among students in the study institution. Three months after this intervention, its effects were assessed through a survey using the same structured questionnaire employed in the baseline survey. Unlike the pre-intervention results, knowledge of EC was significantly higher among the study group than the controls. Attitudes to EC were also more favourable at the post- intervention survey among the study group. Health education can effectively improve knowledge and attitudes to EC among female students of tertiary institutions and this should be encouraged.

Critical evaluation of the PALM-COEIN classification system among women with abnormal uterine bleeding in low-resource settings.

PubMed

Shubham, Divya; Kawthalkar, Anjali S

2018-05-01

To assess the feasibility of the PALM-COEIN system for the classification of abnormal uterine bleeding (AUB) in low-resource settings and to suggest modifications. A prospective study was conducted among women with AUB who were admitted to the gynecology ward of a tertiary care hospital and research center in central India between November 2014 and October 2016. All patients were managed as per department protocols. The causes of AUB were classified before treatment using the PALM-COEIN system (classification I) and on the basis of the histopathology reports of the hysterectomy specimens (classification II); the results were compared using classification II as the gold standard. The study included 200 women with AUB; hysterectomy was performed in 174 women. Preoperative classification of AUB per the PALM-COEIN system was correct in 130 (65.0%) women. Adenomyosis (evaluated by transvaginal ultrasonography) and endometrial hyperplasia (evaluated by endometrial curettage) were underdiagnosed. The PALM-COEIN classification system helps in deciding the best treatment modality for women with AUB on a case-by-case basis. The incorporation of suggested modifications will further strengthen its utility as a pretreatment classification system in low-resource settings. © 2017 International Federation of Gynecology and Obstetrics.

Mobile Phones as a Potential Vehicle of Infection in a Hospital Setting.

PubMed

Chao Foong, Yi; Green, Mark; Zargari, Ahmad; Siddique, Romana; Tan, Vanessa; Brain, Terry; Ogden, Kathryn

2015-01-01

The objective of this article is to investigate the potential role of mobile phones as a reservoir for bacterial colonization and the risk factors for bacterial colonization in a hospital setting. We screened 226 staff members at a regional Australian hospital (146 doctors and 80 medical students) between January 2013 and March 2014. The main outcomes of interest were the types of microorganisms and the amount of contamination of the mobile phones. This study found a high level of bacterial contamination (n = 168/226, 74%) on the mobile phones of staff members in a tertiary hospital, with similar organisms isolated from the staff member's dominant hand and mobile phones. While most of the isolated organisms were normal skin flora, a small percentage were potentially pathogenic (n = 12/226, 5%). Being a junior medical staff was found to be a risk factor for heavy microbial growth (OR 4.00, 95% CI 1.54, 10.37). Only 31% (70/226) of our participants reported cleaning their phones routinely, and only 21% (47/226) reported using alcohol containing wipes on their phones. This study demonstrates that mobile phones are potentially vehicles for pathogenic bacteria in a hospital setting. Only a minority of our participants reported cleaning their phones routinely. Disinfection guidelines utilizing alcohol wipes should be developed and implemented.

Modeling of beam-induced damage of the LHC tertiary collimators

NASA Astrophysics Data System (ADS)

Quaranta, E.; Bertarelli, A.; Bruce, R.; Carra, F.; Cerutti, F.; Lechner, A.; Redaelli, S.; Skordis, E.; Gradassi, P.

2017-09-01

Modern hadron machines with high beam intensity may suffer from material damage in the case of large beam losses and even beam-intercepting devices, such as collimators, can be harmed. A systematic method to evaluate thresholds of damage owing to the impact of high energy particles is therefore crucial for safe operation and for predicting possible limitations in the overall machine performance. For this, a three-step simulation approach is presented, based on tracking simulations followed by calculations of energy deposited in the impacted material and hydrodynamic simulations to predict the thermomechanical effect of the impact. This approach is applied to metallic collimators at the CERN Large Hadron Collider (LHC), which in standard operation intercept halo protons, but risk to be damaged in the case of extraction kicker malfunction. In particular, tertiary collimators protect the aperture bottlenecks, their settings constrain the reach in β* and hence the achievable luminosity at the LHC experiments. Our calculated damage levels provide a very important input on how close to the beam these collimators can be operated without risk of damage. The results of this approach have been used already to push further the performance of the present machine. The risk of damage is even higher in the upgraded high-luminosity LHC with higher beam intensity, for which we quantify existing margins before equipment damage for the proposed baseline settings.

Cost analysis of an outbreak of Clostridium difficile infection ribotype 027 in a Dutch tertiary care centre.

PubMed

van Beurden, Y H; Bomers, M K; van der Werff, S D; Pompe, E A P M; Spiering, S; Vandenbroucke-Grauls, C M J E; Mulder, C J J

2017-04-01

The economic impact of Clostridium difficile infection (CDI) on the healthcare system is significant. From May 2013 to May 2014, an outbreak of C. difficile ribotype 027 occurred in a Dutch tertiary care hospital, involving 72 patients. The primary aim of this study was to provide insight into the financial burden that this CDI outbreak brought upon this hospital. A retrospective analysis was performed to estimate the costs of a one-year-long C. difficile ribotype 027 outbreak. Medical charts were reviewed for patient data. In addition, all costs associated with the outbreak control measures were collected. The attributable costs of the whole outbreak were estimated to be €1,222,376. The main contributing factor was missed revenue due to increased length of stay of CDI patients and closure of beds to enable contact isolation of CDI patients (36%). A second important cost component was extra surveillance and activities of the Department of Medical Microbiology and Infection Control (25%). To the authors' knowledge, this is the first study to provide insight into the attributable costs of CDI in an outbreak setting, and to delineate the major cost items. It is clear that the economic consequences of CDI are significant. The high costs associated with a CDI outbreak should help to justify the use of additional resources for CDI prevention and control. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Transition from tube feeding to oral feeding: experience in a tertiary care paediatric cardiology unit.

PubMed

Shine, Anne Marie; Finn, Daragh Gerard; Allen, Noeleen; McMahon, Colin J

2018-05-02

Home enteral tube feeding (HETF) is imperative for many infants and children with congenital heart disease (CHD). Tube weaning (TW) facilitates the progression from tube feeding to oral diet. There is limited literature on TW practices, protocols and success for children with CHD that have been tube fed. The objective of this study is to assess the process of weaning HETF in a tertiary referral centre for paediatric CHD. Specifically, we aimed to assess the duration of HETF, duration of TW and the interventions involved. We retrospectively reviewed the medical and dietetic records of all infants and children that were successfully weaned off HETF over a 12-month period from January 2015 to December 2015. There were 30 children included in the study, 9 boys and 21 girls. The diagnoses included 15 septal defects, 8 univentricular diagnosis and other diagnoses in 7 children. The median age at initiation of enteral tube feeding was 45 days (range 2-169). The median duration to wean from enteral tube feeding was 52 days (range 2-359). Number of dietetic consults required for successful TW varied among patients, median 5 (range 2-23). The number of days required for successful TW was associated with age and duration on HETF. Dietetic interventions included discontinuation of nutrient dense feeds, altering feed schedule and reduction of feed volume. Weaning HETF is possible in the outpatient setting. Early and frequent dietetic intervention is recommended to ensure prompt discontinuation of HETF when appropriate.

Travel time and cancer care: an example of the inverse care law?

PubMed

Baird, G; Flynn, R; Baxter, G; Donnelly, M; Lawrence, J

2008-01-01

There is growing evidence that in rural areas cancer mortality is higher and referral occurs later, indicating different patterns of care. In Scotland services to rural areas have been organized through 'managed clinical networks'. In some cases, these organizational networks have been structured so that the referral hospital is not the one nearest to the patient's home. This study set out to discover if access to cancer specialist care in mainland Scotland altered with distance to tertiary care facilities. The aim was to explore the relationship between hospital admission rates, type of hospital and travel time. Retrospective analysis of all registered cancers in Scotland over the three-year period 2000-2002, examining incidence rates and accessibility of care over 3 years, measured by hospital discharge rates (equivalent to admission rates) and mean bed days for cancer patients. The type of hospital to which a cancer patient was admitted and the duration of admission varied with travel distance from a patient's home. All patients travelling more than one hour had lower admission rates to a specialist cancer centre. Those travelling more than 3 hours were not always admitted to the facility nearest their home address and were admitted for significantly fewer days than all other groups. Differences in tertiary cancer care obtained may explain some of the reasons behind late presentation and higher mortality rates. This study provides evidence that the recognized increased cancer mortality in rural patients is indeed compounded by an increased travel burden.

Depressive disorder in patients attending the outpatient department of a tertiary care hospital in Colombo.

PubMed

Anandakumar, D; Ratnatunga, S S; Dayabandara, M; Hanwella, Raveen; de Silva, Varuni A

2016-01-01

Lifetime prevalence of depression varies across countries and different populations. Depression is a common comorbidity of physical illness. Patients with depression are known to present with somatic symptoms. Depression is under-diagnosed in primary care settings. Objectives To estimate the prevalence of depression in patients attending the outpatient department (OPD) of a tertiary care hospital in the Western Province of Sri Lanka. A cross-sectional descriptive study was conducted in the OPD of the National Hospital of Sri Lanka (NHSL). Sample size was 205. Every fifth patient aged between 18 and 60 years who attended the OPD was recruited until the required number was met. Centre for Epidemiologic Studies Depression Scale (CES-D) was used to identify depression. There were 114 (55.6%) females. Mean age was 50 years (SD 13.68).Overall prevalence of depression in the sample was 22.4% (95% CI 16.68-28.20). Prevalence of depression was higher among females 25.4% (95% CI 17.32-33.56) than in males 18.7% (95% CI 10.52- 26.84). Prevalence of severe depression was 15.1% (95% CI 10.18-20.07). Adjusted odds ratios showed that pain related presenting complaints were significantly associated with depression [adjusted OR 1.99 (95% CI 1.01-3.96)]. Prevalence of depression in outpatients is similar to that reported in other parts of the world. None of the patients with depression presented seeking help for depressive symptoms.

Technology-based interventions for tobacco and other drug use in university and college students: a systematic review and meta-analysis.

PubMed

Gulliver, Amelia; Farrer, Louise; Chan, Jade K Y; Tait, Robert J; Bennett, Kylie; Calear, Alison L; Griffiths, Kathleen M

2015-02-24

University students have high levels of tobacco and other drug use, yet they are unlikely to seek traditional care. Technology-based interventions are highly relevant to this population. This paper comprises a systematic review and meta-analysis of published randomized trials of technology-based interventions evaluated in a tertiary (university/college) setting for tobacco and other drug use (excluding alcohol). It extends previous reviews by using a broad definition of technology. PubMed, PsycInfo, and the Cochrane databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n = 627) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial (RCT); (2) the sample was composed of students attending a tertiary (e.g., university, college) institution; (3) the intervention was either delivered by or accessed using a technological device or process (e.g., computer/internet, telephone, mobile short message services [SMS]); (4) the age range or mean of the sample was between 18 and 25 years; and (5) the intervention was designed to alter a drug use outcome relating to tobacco or other drugs (excluding alcohol). A total of 12 papers met inclusion criteria for the current review. The majority of included papers examined tobacco use (n = 9; 75%), two studies targeted marijuana use (17%); and one targeted stress, marijuana, alcohol, and tobacco use. A quantitative meta-analysis was conducted on the tobacco use studies using an abstinence outcome measure (n = 6), demonstrating that the interventions increased the rate of abstinence by 1.5 times that of controls (Risk Ratio [RR] = 1.54; 95% Confidence Interval [CI] = 1.20-1.98). Across all 12 studies, a total of 20 technology-based interventions were reviewed. A range of technology was employed in the interventions, including stand-alone computer programs (n = 10), internet (n = 5), telephone (n = 3), and mobile SMS (n = 2). Although technological interventions have the potential to reduce drug use in tertiary students, very few trials have been conducted, particularly for substances other than tobacco. However, the improvement shown in abstinence from tobacco use has the potential to impact substantially on morbidity and mortality.

Is the Conformational Ensemble of Alzheimer’s Aβ10-40 Peptide Force Field Dependent?

PubMed Central

Siwy, Christopher M.

2017-01-01

By applying REMD simulations we have performed comparative analysis of the conformational ensembles of amino-truncated Aβ10-40 peptide produced with five force fields, which combine four protein parameterizations (CHARMM36, CHARMM22*, CHARMM22/cmap, and OPLS-AA) and two water models (standard and modified TIP3P). Aβ10-40 conformations were analyzed by computing secondary structure, backbone fluctuations, tertiary interactions, and radius of gyration. We have also calculated Aβ10-40 3JHNHα-coupling and RDC constants and compared them with their experimental counterparts obtained for the full-length Aβ1-40 peptide. Our study led us to several conclusions. First, all force fields predict that Aβ adopts unfolded structure dominated by turn and random coil conformations. Second, specific TIP3P water model does not dramatically affect secondary or tertiary Aβ10-40 structure, albeit standard TIP3P model favors slightly more compact states. Third, although the secondary structures observed in CHARMM36 and CHARMM22/cmap simulations are qualitatively similar, their tertiary interactions show little consistency. Fourth, two force fields, OPLS-AA and CHARMM22* have unique features setting them apart from CHARMM36 or CHARMM22/cmap. OPLS-AA reveals moderate β-structure propensity coupled with extensive, but weak long-range tertiary interactions leading to Aβ collapsed conformations. CHARMM22* exhibits moderate helix propensity and generates multiple exceptionally stable long- and short-range interactions. Our investigation suggests that among all force fields CHARMM22* differs the most from CHARMM36. Fifth, the analysis of 3JHNHα-coupling and RDC constants based on CHARMM36 force field with standard TIP3P model led us to an unexpected finding that in silico Aβ10-40 and experimental Aβ1-40 constants are generally in better agreement than these quantities computed and measured for identical peptides, such as Aβ1-40 or Aβ1-42. This observation suggests that the differences in the conformational ensembles of Aβ10-40 and Aβ1-40 are small and the former can be used as proxy of the full-length peptide. Based on this argument, we concluded that CHARMM36 force field with standard TIP3P model produces the most accurate representation of Aβ10-40 conformational ensemble. PMID:28085875

Carrier effects on tertiary nitrifying moving bed biofilm reactor: An examination of performance, biofilm and biologically produced solids.

PubMed

Forrest, Daina; Delatolla, Robert; Kennedy, Kevin

2016-01-01

Increasingly stricter ammonia and nitrogen release regulations with respect to wastewater effluents are creating a need for tertiary treatment systems. The moving bed biofilm reactor (MBBR) is being considered as an upgrade option for an increasing number of wastewater treatment facilities due to its small footprint and ease of operation. Despite the MBBRs creation as a system to remove nitrogen, recent research on MBBR systems showing that the system's performance is directly related to carrier surface area and is irrespective of carrier shape and type has been performed exclusively on chemical oxygen demand (COD) removal systems. Furthermore, the influence of carrier type on the solids produced by MBBR systems has also been exclusively studied for COD removal systems. This work investigates the effects of three specific carrier types on ammonia removal rates, biofilm morphology, along with solids production and settleability of tertiary nitrifying MBBR systems. The study concludes that carrier type has no significant effect on tertiary nitrifying MBBR system performance under steady, moderate loading conditions. The research does however highlight the propensity of greater surface area to volume carriers to become clogged under high loading conditions and that the high surface area carriers investigated in this study required longer adjustment periods to changes in loading after becoming clogged.

Efficient Ligation of the Schistosoma Hammerhead Ribozyme †

PubMed Central

Canny, Marella D.; Jucker, Fiona M.; Pardi, Arthur

2011-01-01

The hammerhead ribozyme from Schistosoma mansoni is the best characterized of the natural hammerhead ribozymes. Biophysical, biochemical, and structural studies have shown that the formation of the loop-loop tertiary interaction between stems I and II alters the global folding, cleavage kinetics, and conformation of the catalytic core of this hammerhead, leading to a ribozyme that is readily cleaved under physiological conditions. This study investigates the ligation kinetics and the internal equilibrium between cleavage and ligation for the Schistosoma hammerhead. Single turnover kinetic studies on a construct where the ribozyme cleaves and ligates substrate(s) in trans showed up to 23% ligation when starting from fully cleaved products. This was achieved by a ~2,000-fold increase in the rate of ligation compared to a minimal hammerhead without the loop-loop tertiary interaction, yielding an internal equilibrium that ranges from 2–3 at physiological Mg2+ ion concentrations (0.1 –1 mM). Thus, the natural Schistosoma hammerhead ribozyme is almost as efficient at ligation as it is at cleavage. The results here are consistent with a model where formation of the loop-loop tertiary interaction leads to a higher population of catalytically active molecules, and where formation of this tertiary interaction has a much larger effect on the ligation than the cleavage activity of the Schistosoma hammerhead ribozyme. PMID:17319693

Transport and fate of microplastic particles in wastewater treatment plants.

PubMed

Carr, Steve A; Liu, Jin; Tesoro, Arnold G

2016-03-15

Municipal wastewater treatment plants (WWTPs) are frequently suspected as significant point sources or conduits of microplastics to the environment. To directly investigate these suspicions, effluent discharges from seven tertiary plants and one secondary plant in Southern California were studied. The study also looked at influent loads, particle size/type, conveyance, and removal at these wastewater treatment facilities. Over 0.189 million liters of effluent at each of the seven tertiary plants were filtered using an assembled stack of sieves with mesh sizes between 400 and 45 μm. Additionally, the surface of 28.4 million liters of final effluent at three tertiary plants was skimmed using a 125 μm filtering assembly. The results suggest that tertiary effluent is not a significant source of microplastics and that these plastic pollutants are effectively removed during the skimming and settling treatment processes. However, at a downstream secondary plant, an average of one micro-particle in every 1.14 thousand liters of final effluent was counted. The majority of microplastics identified in this study had a profile (color, shape, and size) similar to the blue polyethylene particles present in toothpaste formulations. Existing treatment processes were determined to be very effective for removal of microplastic contaminants entering typical municipal WWTPs. Published by Elsevier Ltd.

Small-Island Perceptions of Scholarships: Perspectives from Jamaica

NASA Astrophysics Data System (ADS)

Hyman, T. A.

2017-12-01

The Caribbean has the lowest tertiary enrolment in the Western Hemisphere. This figure currently stands at 10% of the population, instead of a desired 30%. [1] Jamaica specifically, has seen a decline in tertiary education enrolment at major institutions such as the University of Technology, Northern Caribbean University, with the only exception being the University of the West Indies showing a marginal increase of 3.6% in 2016. The inability to cover the cost of tertiary education by citizens is a deterrent - despite government subsidies of up to 80%. Scholarship resources exist in Jamaica, but the challenge is the small number of scholarships granted, in proportion to a large applicant pool. Consequently, only the highest performing students are selected at the expense of other higher performing students. Interestingly though, scholarship resources exist internationally for tertiary studies. In the United States for example, US$100 million funds go unclaimed each year due to a lack of awareness. The European Union (EU) will also invest 80 million Euros in research and innovation from 2014 to 2020, with these funds air marked for partnerships between the EU and the rest of the world. The overall aim of this research is to assess the awareness of Jamaicans ages 17 to 45 years, in terms of their knowledge of these international funds, their perceptions of scholarships as a source of tertiary education financing, and preferences for physical locations of study. [1] UWI Professor Archibald McDonald

Geology and ore deposits of the Casto quadrangle, Idaho

USGS Publications Warehouse

Ross, Clyde P.

1934-01-01

The study of the Casto quadrangle was undertaken as the first item in a project to obtain more thorough knowledge of the general geology of southcentral Idaho on which to base study of the ore deposits of t he region. The quadrangle conta ins fragmentary exposures of Algonkian and Paleozoic sedimentary rocks, extensive deposits of old volcanic strata, presumably Permian, not heretofore recognized in this part of Idaho, and a thick succession of Oligocene(?) lava and pyroclastic rocks. The Idaho batholith and its satellites extend into the quadrangle, and in addition there a re large masses of Tertiary granitic rock, not previously distinguished in Idaho, and many Tertiary dikes, some of which are genetically associated with contact-metamorphic deposits. The area contains injection gneiss of complex origin, largely related to the Idaho batholith but in part resulting from injection by ~he Tertiary granitic rocks under relatively light load. Orogenic movement took place in Algonkian, Paleozoic, and Tertiary time. There is a summit peneplain or par tial peneplain of Tertiary, perhaps Pliocene age, and the erosional history since its elevation has been complex. The ore deposits include lodes and placers. The lodes are related to both the Idaho batholith and the Tert iary intrusive rocks and have yielded gold and copper ore of a total value of about 1,000,000. Placers, largely formed in an interglacial inter val, have yielded about an equal amount. There has been some prospecting but almost no production since 1916.

Psychometric properties of the Trust in Physician Scale in Tamil Nadu, India.

PubMed

Kalsingh, Maria Jusler; Veliah, Geetha; Gopichandran, Vijayaprasad

2017-01-01

Trust in health care is of high intrinsic value. It also leads to positive outcomes such as better treatment adherence and disclosure of sensitive information. Therefore, there is a need to measure trust in health care objectively. To assess the psychometric properties of the Trust in Physician Scale in Tamil Nadu, India. The study was conducted in a private tertiary hospital setting in Tamil Nadu by a cross-sectional survey design. The Trust in Physician Scale and General Trust Scale were administered to 288 participants in the waiting area of a tertiary care hospital in Tamil Nadu. Descriptive statistics, exploratory factor analysis, and Cronbach's alpha statistics were used to assess the validity and reliability of the scale. The respondents were predominantly men from rural areas, older than 35 years of age, and with lesser than 8 years of schooling. The questionnaire had acceptable internal consistency with Cronbach's alpha of 0.707 (95% confidence interval 0.654-0.755). Exploratory factor analysis divided the questionnaire into four domains. Seven items loaded into factor 1 which explained dependability and competence of the physician, two items loaded on factor 2, and one each in factors 3 and 4. The latter four items had very low item to total correlations and hence did not contribute much to the questionnaire. The Trust in Physician questionnaire needs to be modified to accurately measure the domains of trust in the context of the study area. More qualitative studies are required to understand the domains of trust in this cultural and social context.

Hospital workers' perceptions of waste: a qualitative study involving photo-elicitation

PubMed Central

Goff, Sarah L.; Kleppel, Reva; Lindenauer, Peter K.; Rothberg, Michael B.

2015-01-01

Objectives To elicit sources of waste as viewed by hospital workers Design Qualitative study using photo-elicitation, an ethnographic technique for prompting in-depth discussion Setting U.S. academic tertiary care hospital Participants Physicians, nurses, pharmacists, administrative support personnel, administrators and respiratory therapists Methods A purposive sample of personnel at an academic tertiary care hospital was invited to take up to 10 photos of waste. Participants discussed their selections using photos as prompts during in-depth interviews. Transcripts were analyzed in an iterative process using grounded theory; open and axial coding was performed, followed by selective and thematic coding to develop major themes and sub-themes. Results Twenty-one participants (9 women, average number of years in field=19.3) took 159 photos. Major themes included types of waste and recommendations to reduce waste. Types of waste comprised four major categories: Time, Materials, Energy and Talent. Participants emphasized time wastage (50% of photos) over other types of waste such as excess utilization (2.5%). Energy and Talent were novel categories of waste. Recommendations to reduce waste included interventions at the micro-level (e.g. individual/ward), meso-level (e.g. institution) and macro-level (e.g., payor/public policy). Conclusions The waste hospital workers identified differed from previously described waste both in the types of waste described and the emphasis placed on wasted time. The findings of this study represent a possible need for education of hospital workers about known types of waste, an opportunity to assess the impact of novel types of waste described and an opportunity to intervene to reduce the waste identified. PMID:23748192

Medical ethics in the primary care setting.

PubMed

Smith, H L

1987-01-01

Much popular and professional understanding of 'medical ethics' is nowadays located in quandary ethics, exotic life-and-death decision-making, and tertiary care settings. Medical ethics in the primary care setting is concerned with very different matters. Among these are issues having to do with basic self-understandings of health professionals and patients and their fiduciary relationships; with fundamental social, political and economic notions which will and do shape the allocation and distribution of health care resources; with the goals and purposes appropriate to medical interventions of various sorts; and with the care of the whole person rather than the limited attention to a particular illness or disease syndrome. The commitments of primary care medicine challenge in radical ways some cherished claims of modern liberal societies by questioning the limits of autonomous individualism and by affirming the indispensability of social justice.

Evaluation of an ongoing psychoeducational inflammatory bowel disease support group in an adult outpatient setting.

PubMed

McMaster, Kristin; Aguinaldo, Laika; Parekh, Nimisha K

2012-01-01

Previous studies assessing efficacy of support groups for patients with inflammatory bowel disease showed mixed results in terms of attendance and overall effectiveness. In this study, researchers evaluated the use of an ongoing open psychoeducational support group for adult patients with inflammatory bowel disease in an outpatient tertiary setting. The sample consisted of 18 adults who have attended more than 2 meetings of the support group. Topics addressed in the support group include complementary medicine, diet and nutrition, the psychological impact of inflammatory bowel disease, medication and side effects, and insurance/disability. Participants were asked to complete the Client Satisfaction Questionnaire, Multidimensional Support Scale, 11 general demographic questions, and a brief open-ended qualitative questionnaire developed by the researchers. Results demonstrated that participants reported very high satisfaction with the support group and rated the adequacy of peer support from others with inflammatory bowel disease higher than support from family/friends and professionals. A majority of group members reported joining the group for mutual support and education; this expectation was met through the psychoeducational structure of the group. This study demonstrates the potential for success of an ongoing psychoeducational inflammatory bowel disease support group for adult patients and their caregivers.

Mineral resource potential map of the lower San Francisco Wilderness study area and contiguous roadless area, Greenlee County, Arizona and Catron and Grant Counties, New Mexico

USGS Publications Warehouse

Ratte, James C.; Hassemer, Jerry R.; Martin, Ronny A.; Lane, Michael

1982-01-01

The Lower San Francisco Wilderness Study Area consists of a narrow strip 1-2 mi (2-3 km) wide between the rims of the San Francisco River canyon. The wilderness study area has a moderately high potential for geothermal resources, a low to moderate potential for base metal or precious metal resources in middle to upper Tertiary volcanic rocks, essentially no oil, gas, or coal potential, and a largely unassessable potential for metal deposits related to Laramide igneous intrusions in pre-Tertiary or lower Tertiary rocks that underlie the area. The contiguous roadless area, which borders the New Mexico half of the wilderness study area, mainly on the north side of the San Francisco River, has a low to moderate potential for molybdenum or copper deposits related to intrusive igneous rocks in the core of a volcano of dacitic composition at Goat Basin.

The Effect of Using Concept Maps on Student Achievement in Selected Topics in Chemistry at Tertiary Level

ERIC Educational Resources Information Center

Singh, Indra Sen; Moono, Karren

2015-01-01

The performance in chemistry at tertiary level in Zambia has not been as expected. It has therefore been a matter of concern. There has been a continuous focus on exploring new teaching strategies to improve the understanding of this difficult subject. This study investigated the effectiveness of composite use of concept maps and traditional…

Tertiary Education in Colombia: Paving the Way for Reform. A World Bank Country Study.

ERIC Educational Resources Information Center

World Bank, Washington, DC.

A great challenge facing Colombia is how to become an active member of the new global information and knowledge society. The changes required for this transition mean that the role of tertiary education must also shift to add to the traditional tasks of the transmission of knowledge and providing basic research the roles of training adaptable…

Women's Rising Share of Tertiary Enrollment: A Cross-National Analysis

ERIC Educational Resources Information Center

McDaniel, Anne

2014-01-01

In recent decades, a dramatic shift occurred in higher education throughout the world. Women now enroll in and complete more education than men in the majority of countries. Using a lagged cross-sectional design on a dataset of 75 countries from 1990 to 2008, this study examines the predictors of the current gender gap in tertiary enrollment. I…

Actual vs. Ideal Attraction: Trends in the Mobility of Korean International Students

ERIC Educational Resources Information Center

Ghazarian, Peter G.

2014-01-01

In the Republic of Korea (Korea), pressures emerging from the domestic education system seem to drive growing numbers of tertiary students abroad. This trend creates an outward flow of resources and has a number of impacts on Korean society. This study examines trends in the movement of tertiary students out of Korea from 2001 to 2010 and compares…

Information and Communications Technology Use as a Catalyst for the Professional Development: Perceptions of Tertiary Level Faculty

ERIC Educational Resources Information Center

Meiki, Antoine; Nicolas, Maureen; Khairallah, Megan; Adra, Omar

2017-01-01

This study highlights the impact technology can have on the teaching-learning environment to the point of influencing and altering the educational ecosystem. A 5-point Likert scale was designed to elicit tertiary level instructors' attitudes regarding the use of ICT in their professional lives at an institution of higher education in North…

EFL Teachers' Perceptions, Evaluations and Expectations about English Language Courses as EFL in Saudi Universities

ERIC Educational Resources Information Center

Liton, Hussain Ahmed

2013-01-01

The focus of this study is to explore EFL teachers' perceptions, evaluations and expectations about English language courses as EFL in Saudi tertiary level. In other words, this article aims at creating a new avenue for effective EFL teaching-learning curriculum techniques and syllabus in the Saudi tertiary context. Saudi universities offer credit…

English as a Foreign Language Instructors' Induction: Early Practices of Language Teachers Teaching at Tertiary Level

ERIC Educational Resources Information Center

Ozturk, Mustafa; Yildirim, Ali

2012-01-01

This study aimed to investigate the nature of the induction process of English as a foreign language (EFL) teachers teaching at tertiary level through individual interviews. In order to gather intended data, fifteen novice instructors teaching at four different public universities in Ankara were interviewed on a basis of two criteria: (a) having 1…

The Concept of Learning Japanese: Explaining Why Successful Students of Japanese Discontinue Japanese Studies at the Transition to Tertiary Education

ERIC Educational Resources Information Center

Oshima, Ryoko; Harvey, Sharon

2017-01-01

Student attrition and falling tertiary education enrolments afflict languages education across the "inner circle" English speaking world. In the southern hemisphere, in New Zealand and Australia, Japanese has become one of the most successful languages of education. However, numbers of students are now declining. This paper examines why…

Variations in Decision-Making Approach to Tertiary Teaching: A Case Study in Vietnam

ERIC Educational Resources Information Center

Nguyen, Thanh Tien

2016-01-01

Although the question of what to teach and how to teach has received much attention from the literature, little was known about the way in which academics in teaching groups make decision on what and how to teach. This paper reports an analysis of variations in the decision-making approach to tertiary teaching through academics' practices of…

Equity in an Educational Boom: Lessons from the Expansion and Marketisation of Tertiary Schooling in Poland

ERIC Educational Resources Information Center

Herbst, Mikolaj; Rok, Jakub

2014-01-01

This article shows how the probability of enrolment in tertiary schools has evolved for different social groups in Poland during the period of the educational boom. It also analyses how the socio-economic status influences the choices between full-time and part-time studies (the latter being of relatively low quality), and the probability of…

OpenCourseWare, Global Access and the Right to Education: Real Access or Marketing Ploy?

ERIC Educational Resources Information Center

Huijser, Henk; Bedford, Tas; Bull, David

2008-01-01

This paper explores the potential opportunities that OpenCourseWare (OCW) offers in providing wider access to tertiary education, based on the ideal of "the right to education." It first discusses the wider implications of OCW, and its underlying philosophy, before using a case study of a tertiary preparation program (TPP) at the…

Diversification Management at Tertiary Education Level: A Review

ERIC Educational Resources Information Center

Takwate, Kwaji Tizhe

2016-01-01

This paper examines the concept of management of diversification at tertiary education level in view of the growth of national secondary education system which vested high scramble for tertiary education was made in relation to question of access and expansion. This paper examines management of diversification at tertiary education level as a…

A New Synthesis of Tertiary Alkyl N-Arylcarbamates from Isocyanates.

ERIC Educational Resources Information Center

Bailey, William J.; Griffith, James R.

1978-01-01

The method involves the dissolution of a small piece of metallic lithium in a small quantity of tertiary alcohol followed by addition to a mixture of the isocyanate and the tertiary alcohol in ether. This should be useful in organic chemistry laboratory courses for the identification of tertiary alcohols. (Author/BB)