Sample records for study synopses provide

  1. Chronology: MSFC Space Station program, 1982 - present. Major events

    NASA Technical Reports Server (NTRS)

    Whalen, Jessie E. (Compiler); Mckinley, Sarah L. (Compiler); Gates, Thomas G. (Compiler)

    1988-01-01

    The Marshall Space Flight Center (MSFC) maintains an active program to capture historical information and documentation on the MSFC's roles regarding Space Shuttle and Space Station. Marshall History Report 12, called Chronology: MSFC Space Station Program, 1982-Present, is presented. It contains synopses of major events listed according to the dates of their occurrence. Indices follow the synopses and provide additional data concerning the events listed. The Event Index provides a brief listing of all the events without synopses. The Element Index lists the specific elements of the Space Station Program under consideration in the events. The Location Index lists the locations where the events took place. The indices and synopses may be cross-referenced by using dates.

  2. Do Family Physicians Retrieve Synopses of Clinical Research Previously Read as Email Alerts?

    PubMed Central

    Pluye, Pierre; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Bartlett, Gillian; Marlow, Bernard

    2011-01-01

    Background A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. Objectives We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. Methods We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. Results Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. Conclusion In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved. Our findings help us to better understand the effect of push on pull and to improve the integration of research-based information within electronic resources for clinicians. PMID:22130465

  3. Do family physicians retrieve synopses of clinical research previously read as email alerts?

    PubMed

    Grad, Roland; Pluye, Pierre; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Bartlett, Gillian; Marlow, Bernard

    2011-11-30

    A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved. Our findings help us to better understand the effect of push on pull and to improve the integration of research-based information within electronic resources for clinicians.

  4. [Experiences with synopses of clinical guidelines using the example of synopses for Disease Management Programmes (DMP)].

    PubMed

    Siering, Ulrich; Rüther, Alric

    2014-01-01

    Guideline synopses, i.e. the systematic synthesis of clinical practice guidelines, are used as a basis for Disease Management Programmes (DMPs) in Germany. One of the responsibilities of the German Institute for Quality and Efficiency in Health Care (IQWiG) is the preparation of guideline synopses for DMPs. The article describes the experiences with this methodology. For the preparation of guideline synopses, a systematic search for evidence-based guidelines is conducted, and their recommendations are extracted and synthesised. In parallel, the quality of the guidelines is assessed using the AGREE instrument. The need for updating or supplementing a DMP is justified by means of the Grade of Recommendation (GoR) or, alternatively, the Level of Evidence (LoE). Since 2006 IQWiG has synthesised recommendations from 256 evidence-based guidelines in 12 guideline synopses for DMPs. The results are then used by the Federal Joint Committee (G-BA) to update DMPs. Using the example of the 12 synopses, several analyses were conducted. It was determined that a search for guidelines in guideline databases is sufficient and that a search in bibliographic databases can be dispensed with. Furthermore, the analyses showed that a large proportion of recommendations in evidence-based guidelines are not clearly linked to a GoR or LoE. If GoR and LoE are provided, only about 42% of recommendations with a strong GoR also refer to a strong LoE. It was also shown that only 21 % of the analysed guideline providers supplied information on the handling of unpublished data. With consistent average to high values, the assessment of the methodological quality across all of the prepared synopses allows for the conclusion of a basically acceptable guideline quality, but with a need for improvement. A guideline synopsis is an established tool for identifying health care standards as a basis for developing and updating DMPs. Further methodological development, particularly in collaboration with guideline providers, appears to be reasonable. It should be examined whether guideline synopses are suitable not only for guideline and DMP development, but also for other health care issues. Copyright © 2014. Published by Elsevier GmbH.

  5. 14 CFR 1260.9 - Synopses requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... funding opportunities shall be synopsized. Synopses shall be prepared in the NASA Acquisition Internet Service (NAIS), located at: http://prod.nais.nasa.gov/cgi-bin/nais/index.cgi; by using the Electronic Posting System (EPS), and transmitted to http://www.Fedgrants.gov. Synopses shall be electronically posted...

  6. 14 CFR 1260.9 - Synopses requirements.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... funding opportunities shall be synopsized. Synopses shall be prepared in the NASA Acquisition Internet Service (NAIS), located at: http://prod.nais.nasa.gov/cgi-bin/nais/index.cgi; by using the Electronic Posting System (EPS), and transmitted to http://www.Fedgrants.gov. Synopses shall be electronically posted...

  7. 14 CFR § 1260.9 - Synopses requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... funding opportunities shall be synopsized. Synopses shall be prepared in the NASA Acquisition Internet Service (NAIS), located at: http://prod.nais.nasa.gov/cgi-bin/nais/index.cgi; by using the Electronic Posting System (EPS), and transmitted to http://www.Fedgrants.gov. Synopses shall be electronically posted...

  8. 14 CFR 1260.9 - Synopses requirements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... opportunities shall be synopsized. Synopses shall be prepared in the NASA Acquisition Internet Service (NAIS), located at: http://prod.nais.nasa.gov/cgi-bin/nais/index.cgi; by using the Electronic Posting System (EPS), and transmitted to http://www.Fedgrants.gov. Synopses shall be electronically posted to: http://www...

  9. Defense Information Systems Agency and Defense Logistics Agency Information Technology Contracts Awarded Without Competition Were Generally Justified

    DTIC Science & Technology

    2015-07-29

    9 DISA Contracting Personnel Need to Improve When Synopsizing Noncompetitive IT...Conducted__________________________________________________ 30 Appendix F. Synopses Needed Improvements _____________________________________________ 36 iv │ DODIG-2015-152 Contents...exception under FAR 5.202 applies. We discuss this in the “DISA Contracting Personnel Need to Improve When Synopsizing Noncompetitive IT Contracts

  10. A Review of International Telecommunications Industry Issues, Structure, and Regulatory Problems.

    ERIC Educational Resources Information Center

    Cole, Jack E.; And Others

    Industry structure studies prior to 1968 are briefly reviewed, and an overview of industrial and technological developments up to the present is provided through synopses of more recent studies. Areas covered include overseas telephone and record carriers; the creation of the Communications Satellite Corporation; the current regulatory and…

  11. 48 CFR 705.207 - Preparation and transmittal of certain synopses.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... INTERNATIONAL DEVELOPMENT ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Synopsis of Proposed Contract Actions 705.207 Preparation and transmittal of certain synopses. The responsible contracting officer shall...

  12. The identification of clinically important elements within medical journal abstracts: Patient-Population-Problem, Exposure-Intervention, Comparison, Outcome, Duration and Results (PECODR).

    PubMed

    Dawes, Martin; Pluye, Pierre; Shea, Laura; Grad, Roland; Greenberg, Arlene; Nie, Jian-Yun

    2007-01-01

    Information retrieval in primary care is becoming more difficult as the volume of medical information held in electronic databases expands. The lexical structure of this information might permit automatic indexing and improved retrieval. To determine the possibility of identifying the key elements of clinical studies, namely Patient-Population-Problem, Exposure-Intervention, Comparison, Outcome, Duration and Results (PECODR), from abstracts of medical journals. We used a convenience sample of 20 synopses from the journal Evidence-Based Medicine (EBM) and their matching original journal article abstracts obtained from PubMed. Three independent primary care professionals identified PECODR-related extracts of text. Rules were developed to define each PECODR element and the selection process of characters, words, phrases and sentences. From the extracts of text related to PECODR elements, potential lexical patterns that might help identify those elements were proposed and assessed using NVivo software. A total of 835 PECODR-related text extracts containing 41,263 individual text characters were identified from 20 EBM journal synopses. There were 759 extracts in the corresponding PubMed abstracts containing 31,947 characters. PECODR elements were found in nearly all abstracts and synopses with the exception of duration. There was agreement on 86.6% of the extracts from the 20 EBM synopses and 85.0% on the corresponding PubMed abstracts. After consensus this rose to 98.4% and 96.9% respectively. We found potential text patterns in the Comparison, Outcome and Results elements of both EBM synopses and PubMed abstracts. Some phrases and words are used frequently and are specific for these elements in both synopses and abstracts. Results suggest a PECODR-related structure exists in medical abstracts and that there might be lexical patterns specific to these elements. More sophisticated computer-assisted lexical-semantic analysis might refine these results, and pave the way to automating PECODR indexing, and improve information retrieval in primary care.

  13. Behavior Modification for Children with Autistic Tendencies; Study Guide for a Videotaped Series.

    ERIC Educational Resources Information Center

    Ackerman, Arthur; Dirr, Peter J.

    The study guide accompanies a series of 28 videotaped programs designed to provide teachers, teacher aides and parents with an understanding of children with autistic tendencies and of how behavior modification techniques might be used to train such children. Synopses of each program and each program segment and a few questions intended to…

  14. [Graphic synopsis of implementation of German guideline clearing reports in national disease management guidelines].

    PubMed

    Thole, Henning

    2011-01-01

    While methods for the production of guidelines (evidence analysis, assessment, adaptation) have been continually refined throughout the past years, there is a lack of instruments for the production of easily understandable synopses. Definition of a methodological approach to encompass synopses by Spidernet diagrams. Tables of synopses can be generated with distinct information to bring down the main results in one Spidernet diagram. This is possible for both the entire synopsis and parts of it. Guideline comparisons require detailed analyses on the one hand and easily understandable presentations of their results on the other. Guideline synopses can be substantially supported by graphic presentation of the results of synopsis. Graphic synopsis is also helpful in other cases; it may be used, for example, to summarise HTA reports, systematic reviews or guidelines. Copyright © 2011. Published by Elsevier GmbH.

  15. Rowley Revisited: Through an Effective History Lens

    ERIC Educational Resources Information Center

    LaNear, John; Frattura, Elise

    2009-01-01

    Historical synopses of special education litigation in the USA often reflect traditional perspectives. Because these traditional perspectives are commonly referenced by legislators and judges when new legislation is crafted and judicial decisions are handed down, a reliance on these traditional historical synopses may perpetuate a status…

  16. 14 CFR 1260.9 - Synopses requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Service (NAIS), located at: http://prod.nais.nasa.gov/cgi-bin/nais/index.cgi; by using the Electronic Posting System (EPS), and transmitted to http://www.Fedgrants.gov. Synopses shall be electronically posted to: http://www.Fedgrants.gov no later than three business days after release of the full announcement...

  17. Traveling Successfully on the Community College Pathway

    ERIC Educational Resources Information Center

    Johnson, Tracy, Ed.

    2006-01-01

    This cumulative report presents the synopses of the major articles, research notes, and publications from the Transfer and Retention of Urban Community College Students (TRUCCS) project. After a Letter from the Director and sections on the people and origins of TRUCCS, and a synopses, the report contains the following sections: (1) Transfer…

  18. Synopses for Modern Secondary School Mathematics.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France). Directorate for Scientific Affairs.

    The 1959 Royaumont seminar "New Thinking in School Mathematics," having agreed on the need for modernization, recommended that a second group of experts work out detailed synopses of the entire subject matter of secondary school mathematics. This book is the report of the second seminar and contains the Dubrovnik Program which stimulated…

  19. The Legacy of the Space Shuttle Program: Scientific and Engineering Accomplishments

    NASA Technical Reports Server (NTRS)

    Torrez, Jonathan

    2009-01-01

    The goal of this project was to assist in the creation of the appendix for the book being written about the Space Shuttle that is titled The Legacy of the Space Shuttle Program: Scientific and Engineering Accomplishments. The specific responsibility of the intern was the creation of the human health and performance (life sciences) and space biology sections of the appendix. This included examining and finalizing the list of flights with life sciences and space biology experiments flown aboard them, researching the experiments performed, synopsizing each experiment into two sentences, and placing the synopses into an appendix template. Overall, approximately 70 flights had their experiments synopsized and a good method for researching and construction of the template was established this summer.

  20. Rationales for Teaching Young Adult Literature.

    ERIC Educational Resources Information Center

    Reid, Louann, Ed.

    A resource for finding appropriate works of adolescent literature and, when necessary, defending them against challenges, this book presents the recommendations of 25 educators concerning novels, nonfiction works, and short story collections that adolescents enjoy. Contributors provide synopses, sample excerpts, and brief author biographies, along…

  1. In Focus: Alcohol and Alcoholism Audiovisual Guide.

    ERIC Educational Resources Information Center

    National Clearinghouse for Alcohol Information (DHHS), Rockville, MD.

    This guide reviews audiovisual materials currently available on alcohol abuse and alcoholism. An alphabetical index of audiovisual materials is followed by synopses of the indexed materials. Information about the intended audience, price, rental fee, and distributor is included. This guide also provides a list of publications related to media…

  2. CALS Tech Bulletin #3. An Occasional Publication of the Center for Advanced Learning Systems.

    ERIC Educational Resources Information Center

    CSR, Inc., Washington, DC.

    This paper contains brief synopses of recent technical progress/projects in the field of advanced learning systems. This issue contains the following 12 items: (1) "Guest Editorial" (Sylvia Charp) concerning the need to provide better learning experiences for all students; (2) "Steps in Developing an Expert Systems Model," as…

  3. Children's Literature--Passage to the Sea.

    ERIC Educational Resources Information Center

    Bagnall, Norma

    Focusing on books that use the sea as their theme, this booklet provides guidelines for teachers on how to integrate marine-related children's literature into the classroom. The first section of the booklet presents brief synopses of eight sea-related books while the second section contains 39 learning center activities, including knot tying,…

  4. 48 CFR 570.106-1 - Synopsis of lease awards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... officers must synopsize in http://www.FBO.gov awards exceeding $25,000 total contract value that are likely... means where access to the notice of proposed lease action was provided through http://www.FBO.gov; and... than full and open competition must be posted in http://www.FBO.gov. Information exempt from public...

  5. 48 CFR 570.106-1 - Synopsis of lease awards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... officers must synopsize in http://www.FBO.gov awards exceeding $25,000 total contract value that are likely... means where access to the notice of proposed lease action was provided through http://www.FBO.gov; and... than full and open competition must be posted in http://www.FBO.gov. Information exempt from public...

  6. 48 CFR 570.106-1 - Synopsis of lease awards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... officers must synopsize in http://www.FBO.gov awards exceeding $25,000 total contract value that are likely... means where access to the notice of proposed lease action was provided through http://www.FBO.gov; and... than full and open competition must be posted in http://www.FBO.gov. Information exempt from public...

  7. 48 CFR 570.106-1 - Synopsis of lease awards.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... officers must synopsize in http://www.FBO.gov awards exceeding $25,000 total contract value that are likely... means where access to the notice of proposed lease action was provided through http://www.FBO.gov; and... than full and open competition must be posted in http://www.FBO.gov. Information exempt from public...

  8. Guide to Films (16 mm) About Ecology, Adaptation and Pollution.

    ERIC Educational Resources Information Center

    1971

    Synopses of 350 films (16 mm.) on ecology, adaptation of plants and animals to their environment, and environmental pollution are listed alphabetically by title in this guide. It specifies whether the film is black-and-white or color, its running time, and its source. An abbreviated subject index and a directory of sources are also provided. The…

  9. The 1990-1991 project summaries

    NASA Technical Reports Server (NTRS)

    1991-01-01

    The Mechanical Engineering Department at The University of Texas at Austin participated in the NASA/USRA University Advanced Design Program on both an undergraduate and a graduate level during the 1990-91 academic year. The focus of study was on four design projects that fall into one of the following areas: (1) the establishment of a lunar base and (2) mission planet Earth. The design projects were incorporated into already existing design courses and students worked together in groups of three to five. A background of each area of study is provided, along with synopses, conclusions, and recommendations for further study for each design project.

  10. Text Previews and Three Level Study Guides for Content Area Critical Reading.

    ERIC Educational Resources Information Center

    Bean, Thomas W.; Ericson, Bonnie O.

    1989-01-01

    Describes the integration of text previews (teacher-developed synopses of the text) and three-level study guides (encouraging factual, inferential, and problem solving responses). Claims a combination of these constitutes a powerful strategy for content area reading. (RS)

  11. Institutional Research: Coming of Age. General Session Presentations [at the] Annual Forum [of the] Association for Institutional Research (30th, Louisville, Kentucky, May 13-16, 1990).

    ERIC Educational Resources Information Center

    Endo, Jean J., Ed.

    Synopses of six conference presentations are provided in this pamphlet, dealing with the theme of leadership and professional standards in university settings and the influence of social and technological challenges. In "Leadership and Team Building: Key Ingredients to the Institutional Research Role of the Future," Robert L. Taylor…

  12. Exercise, exercise training, and the immune system. A compendium of research (1902-1991)

    NASA Technical Reports Server (NTRS)

    Hardesty, A. J.; Greenleaf, J. E.; Simonson, S.; Hu, A.; Jackson, C. G. R.

    1993-01-01

    This compendium includes abstracts and synopses of clinical observations and of more basic studies involving physiological mechanisms concerning interaction of physical exercise and the human immune system. If the author's abstract or summary was appropriate, it was included. In other cases, a more detailed synopsis of the paper was prepared under the subheadings 'Purpose,' 'Methods,' 'Results,' and 'Conclusions.' Author and subject indices are provided, plus a selected bibliography of related work or those papers received after the volume was being prepared for publication. This volume includes material published from 1902 through 1991.

  13. Sisterhood Surveyed. Proceedings of the Mid-Atlantic Women's Studies Association Conference (West Chester, Pennsylvania, October 1-2, 1982).

    ERIC Educational Resources Information Center

    Sessa, Anne Dzamba, Ed.

    Proceedings of the 1982 conference of the Mid-Atlantic Women's Studies Association are presented. Synopses of sessions include the following topics: iconography of sisterhood, matriarchy, ethnic and cultural critiques, political perspectives, and nontraditional women students. Conference papers and authors are as follows: "Friends for Half a…

  14. Water Metabolism and Fluid Compartment Volumes in Humans at Altitude. A Compendium of Research (1914 - 1996)

    NASA Technical Reports Server (NTRS)

    Chou, J. L.; Stad, N. J.; Gay, E.; West, G. I.; Barnes, P. R.; Greenleaf, J. E.

    1997-01-01

    This compendium includes abstracts and synopses of clinical observations and of more basic studies involving physiological mechanisms concerning interaction of water metabolism and fluid compartment volumes in humans during altitude exposure. If the author's abstract or summary was appropriate, it was included. In other cases a more detailed synopsis of the paper was prepared under the subheadings Purpose, Methods, Results, and Conclusions. Author and subject indices are provided, plus an additional selected bibliography of related work of those papers received after the volume was being prepared for publication. This volume includes material published from 1914 through 1995.

  15. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2015.

    PubMed

    Szostek, Jason H; Wieland, Mark L; Post, Jason A; Sundsted, Karna K; Mauck, Karen F

    2016-08-01

    Identifying new practice-changing articles is challenging. To determine the 2015 practice-changing articles most relevant to outpatient general internal medicine, 3 internists independently reviewed the titles and abstracts of original articles, synopses of single studies and syntheses, and databases of syntheses. For original articles, internal medicine journals with the 7 highest impact factors were reviewed: New England Journal of Medicine, Lancet, Journal of the American Medical Association (JAMA), British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine. For synopses of single studies and syntheses, collections in American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine were reviewed. For databases of synthesis, Evidence Updates and the Cochrane Library were reviewed. More than 100 articles were identified. Criteria for inclusion were as follows: clinical relevance, potential for practice change, and strength of evidence. Clusters of important articles around one topic were considered as a single-candidate series. The 5 authors used a modified Delphi method to reach consensus on inclusion of 7 topics for in-depth appraisal. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Synopses of Selected Papers

    NASA Astrophysics Data System (ADS)

    Curtright, Thomas L.; Fairlie, David B.; Zachos, Cosmas K.

    2014-11-01

    The decisive contributors to the development of the formulation are Hermann Weyl (1885-1955), Eugene Wigner (1902-1995), Hilbrand Groenewold (1910-1996), and Jose Moyal (1910-1998). The bulk of the theory is implicit in Groenewold's and Moyal's seminal papers. But confidence in the autonomy of the formulation accreted slowly and fitfully. As a result, an appraisal of critical milestones cannot avoid subjectivity. Nevertheless, here we provide summaries of a few papers that we believe remedied confusion about the logical structure of the formulation ...

  17. Americans' attitudes toward wolves and wolf reintroduction: An annotated bibliography

    USGS Publications Warehouse

    Browne-Nunez, Christine; Taylor, Jonathan G.

    2002-01-01

    During the period 1974-2000, 50 reports were published in peer-reviewed journals and in theses and dissertations concerning public altitudes and preferences toward wolves and their reinstatement into previously occupied habitat in the continental U.S. This publication provides annotated synopses of these 50 reports, arranged chronologically, but also cross-referenced by authors and by geographic area. In general, Americans favor reinstatement of wolf populations except for those people who perceive them to be a direct threat to their livelihood.

  18. 48 CFR 1005.202 - Exceptions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Synopses of Proposed Contract Actions 1005.202 Exceptions... concerns; (iv) The Procurement Marketing and Access Network (PRO-Net) will be used to identify and solicit...

  19. Concurrent Sessions

    ERIC Educational Resources Information Center

    Australian Science Teachers Journal, 1976

    1976-01-01

    Presents synopses of five papers presented at a conference of the Science Teachers of Australia. Topics include the technology of wine making, integrated science, individualized science instruction, formal operational thinking, and deep ocean drilling. (MLH)

  20. Using Books to Prevent and Treat Adolescent Chemical Dependency.

    ERIC Educational Resources Information Center

    Pardeck, John T.

    1991-01-01

    Presents strategies for using bibliotherapeutic process to prevent and treat adolescent alcohol and drug abuse. Definitions, goals, and principles of bibliotherapy are overviewed. Synopses of several useful books that focus on chemical dependency are presented. (Author)

  1. Distance Education in Higher Education. Inter-Country Study Visit-cum-Mobile Workshop (Sukhothai Thammathirat Open University, Bangkok, Thailand, and Darling Downs Institute of Advanced Education, Toowoomba, Queensland, Australia, September 6-16, 1983).

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and the Pacific.

    The outcome of a study workshop with participants from 11 Asian and Pacific countries, this report is broadly divided into four chapters. The first gives an overview of the philosophical concept and challenges of distance education at the higher education level in the context of this region. The second chapter contains synopses of reports…

  2. SYNOPSES OF FEDERAL DEMONSTRATIONS OF INNOVATIVE REMEDIATION TECHNOLOGIES

    EPA Science Inventory

    This collection of abstracts, compiled by the Federal Remediation Technology Roundtable, describes field demonstrations of innovative technologies to treat hazardous waste. The collection is intended to be an information resource for hazardous waste site project managers for asse...

  3. NOVA.

    ERIC Educational Resources Information Center

    WGBH-TV, Boston, MA.

    News clippings, reviews, and feature articles about the Public Broadcasting System science-adventure series "Nova" are collected here. Included are comments from the New York Times, Washington Post, Christian Science Monitor, and TV Guide. Commentaries are primarily favorable and include synopses of various episodes. (DGC)

  4. Report: FISMA - Fiscal Year 2004 Status of EPA’s Computer Security Program

    EPA Pesticide Factsheets

    Report #2004-S-00007, September 30, 2004. This report synopsizes the results of information technology security work the U.S. Environmental Protection Agency’s Office of Inspector General (OIG) performed during Fiscal Year (FY) 2004.

  5. Recent Developments in the Law.

    ERIC Educational Resources Information Center

    Journal of Law and Education, 1983

    1983-01-01

    An overview of recent court decisions on prayer in public schools is followed by brief synopses of cases in nine areas concerning primary and secondary levels and four areas concerning higher education. Finally, law review articles on federal and state issues are summarized. (MD)

  6. Occupational Standards: International Perspectives.

    ERIC Educational Resources Information Center

    Oliveira, Joao, Ed.

    These nine papers from a conference of the International Research Network for Training and Development focus on occupational classification, standards, and certification. "Introduction" (Joao Oliveria) presents synopses with highlights from the papers. Part I offers an overview of recent developments in the United States in…

  7. 48 CFR 5.205 - Special situations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PUBLICIZING CONTRACT ACTIONS Synopses of Proposed Contract Actions 5.205 Special situations. (a) Research and... interest in potential R&D programs whenever market research does not produce a sufficient number of... subsequent solicitation. Advanced notices must be entitled “Research and Development Sources Sought” and...

  8. 48 CFR 305.202 - Exceptions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... acquisition channels, including the HCA, to Associate DAS for Acquisition requesting an exception to synopsizing. The Associate DAS for Acquisition shall review the request and decide whether an exception is appropriate and reasonable. If it is, the Associate DAS for Acquisition shall take the necessary coordinating...

  9. 10 CFR 436.33 - Procedures and methods for contractor selection.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... for contractor selection. (a) Competitive selection. Competitive selections based on solicitation of... synopsizes the proposed contract action. (2) Each competitive solicitation— (i) Shall request technical and... from those within the competitive range. (b) Unsolicited proposals. Federal agencies may— (1) Consider...

  10. 48 CFR 5.205 - Special situations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... interest in potential R&D programs whenever market research does not produce a sufficient number of... PUBLICIZING CONTRACT ACTIONS Synopses of Proposed Contract Actions 5.205 Special situations. (a) Research and... subsequent solicitation. Advanced notices must be entitled “Research and Development Sources Sought” and...

  11. 48 CFR 705.207 - Preparation and transmittal of certain synopses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... INTERNATIONAL DEVELOPMENT ACQUISITION PLANNING PUBLICIZING CONTRACT ACTIONS Synopsis of Proposed Contract... notify USAID's Office of Small and Disadvantaged Business Utilization (OSDBU) at least seven business days before publicizing a solicitation in the Commerce Business Daily for an acquisition: (a) Which is...

  12. Report to the American Indian People.

    ERIC Educational Resources Information Center

    National Indian Youth Council, Albuquerque, NM.

    Presenting a brief historical profile, program descriptions, synopses of political issues, and a policy statement (1973), this 1975 annual report on the National Indian Youth Council includes: (1) Programs (NIYC/Comprehensive Employment and Training Act manpower development; Investigative Journalism Training Project; Ex-Offender Program; San Juan…

  13. Stephen Hawking's Universe. Teacher's Guide.

    ERIC Educational Resources Information Center

    Thompson, Malcolm H.; Rameau, Jonathan D.

    This program guide is meant to help teachers assist their students in viewing the six-part public television series, "Stephen Hawking's Universe." The guide features program summaries that give background information and brief synopses of the programs; previewing activities that familiarize students with the subject; vocabulary that…

  14. 48 CFR 3405.270 - Notices to perform market surveys.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Notices to perform market surveys. 3405.270 Section 3405.270 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION ACQUISITION REGULATION GENERAL PUBLICIZING CONTRACT ACTIONS Synopses of Proposed Contract Actions 3405.270...

  15. Cells in Space

    NASA Technical Reports Server (NTRS)

    Sibonga, Jean D. (Editor); Mains, Richard C. (Editor); Fast, Thomas N. (Editor); Callahan, Paul X. (Editor); Winget, Charles M. (Editor)

    1989-01-01

    Discussions and presentations addressed three aspects of cell research in space: the suitability of the cell as a subject in microgravity experiments, the requirements for generic flight hardware to support cell research, and the potential for collaboration between academia, industry, and government to develop these studies in space. Synopses are given for the presentations and follow-on discussions at the conference and papers are presented from which the presentations were based. An Executive Summary outlines the recommendations and conclusions generated at the conference.

  16. Beliefs and expectancies in legal decision making: an introduction to the Special Issue

    PubMed Central

    McAuliff, Bradley D.; Bornstein, Brian H.

    2013-01-01

    This introduction describes what the co-editors believe readers can expect in this Special Issue. After beliefs and expectancies are defined, examples of how these constructs influence human thought, feeling, and behavior in legal settings are considered. Brief synopses are provided for the Special Issue papers on beliefs and expectancies regarding alibis, children’s testimony behavior, eyewitness testimony, confessions, sexual assault victims, judges’ decisions in child protection cases, and attorneys’ beliefs about jurors’ perceptions of juvenile offender culpability. Areas for future research are identified, and readers are encouraged to discover new ways that beliefs and expectancies operate in the legal system. PMID:24348006

  17. NAREM Journal. Volume 2, 1979.

    ERIC Educational Resources Information Center

    NAREM Journal, 1979

    1979-01-01

    The issue of the journal of the National Association for Remedial Education in Malaysia contains eight articles (three of which are in English) which discuss the nature of remedial education, causes of learning difficulties, and remedial techniques. Articles in Malay have English synopses. Malay articles are about: a general examination of four…

  18. Proceedings - Management and productivity of western-montane forest soils

    Treesearch

    Alan E. Harvey; Leon F. Neuenschwander

    1991-01-01

    Includes 35 papers and six poster synopses presenting state-of-the-art knowledge on the nature and problems of integrating soils information and expertise into management of inland western forest resources. Papers emphasize regional information, but include data from world literature and previously unpublished material from regional experts.

  19. USAID Worldwide Education and Training Workshop (Arlington, Virginia, August 17-21, 2009)

    ERIC Educational Resources Information Center

    US Agency for International Development, 2009

    2009-01-01

    The 2009 Worldwide Education and Training Workshop brought together over 375 members of the international development community to share best practices in addressing the growing challenges in the field of education for social and economic development. This paper presents synopses of the presentations delivered during the workshop.

  20. Survival Skills. Pre-Apprenticeship Phase 2 Training. Instructors Guide

    ERIC Educational Resources Information Center

    Lane Community Coll., Eugene, OR.

    This instructor's guide contains the 43 Survival Skills modules developed for Pre-Apprenticeship Phase 2 Training. Introductory materials include a description of components of the pre-apprenticeship project, recommendations for module implementation, and synopses of the modules that were developed to prompt social skills development. Each module…

  1. The New Press Guide to Multicultural Resources for Young Readers.

    ERIC Educational Resources Information Center

    Muse, Daphne, Ed.

    This comprehensive guide to multicultural children's literature features over 1,000 critical and detailed book reviews for pre-school, elementary, and middle school students. The reviews in the guide cover a vast range of picture books, biographies, poetry, anthologies, folktales, and young adult novels, and include synopses, suggestions for…

  2. 48 CFR 517.207 - Exercise of options.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Exercise of options. 517... METHODS AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Options 517.207 Exercise of options. Before exercising an option, you must: (a) Synopsize it unless you meet of the following conditions: (1) The option...

  3. 48 CFR 5.207 - Preparation and transmittal of synopses.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Internet at http://www.fedbizopps.gov. (c) General format for “Description.” Prepare a clear and concise...)(i) If the solicitation will include the FAR clause at 52.225-3, Buy American-Free Trade Agreements... more of the items under this acquisition is subject to Free Trade Agreements.” (ii) If the solicitation...

  4. NASA Office of Aeronautics and Space Technology Summer Workshop. Executive summary. [in-space research using the Space Transportation System

    NASA Technical Reports Server (NTRS)

    1975-01-01

    Research and technology investigations are identified in eleven discipline technologies which require or which could significantly benefit from an in-space experiment, systems demonstrations, or component test using the Space Transportation System. Synopses of the eleven technology panels reports are presented.

  5. 48 CFR 1805.303 - Announcement of contract awards. (NASA supplements paragraph (a))

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... awards. (NASA supplements paragraph (a)) 1805.303 Section 1805.303 Federal Acquisition Regulations System... ACTIONS Synopses of Contract Awards 1805.303 Announcement of contract awards. (NASA supplements paragraph (a)) (a)(i) In lieu of the $3.5 million threshold cited in FAR 5.303(a), NASA Headquarters public...

  6. 48 CFR 1805.303 - Announcement of contract awards. (NASA supplements paragraph (a))

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... awards. (NASA supplements paragraph (a)) 1805.303 Section 1805.303 Federal Acquisition Regulations System... ACTIONS Synopses of Contract Awards 1805.303 Announcement of contract awards. (NASA supplements paragraph (a)) (a)(i) In lieu of the $3.5 million threshold cited in FAR 5.303(a), NASA Headquarters public...

  7. 48 CFR 1805.303 - Announcement of contract awards. (NASA supplements paragraph (a))

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... awards. (NASA supplements paragraph (a)) 1805.303 Section 1805.303 Federal Acquisition Regulations System... ACTIONS Synopses of Contract Awards 1805.303 Announcement of contract awards. (NASA supplements paragraph (a)) (a)(i) In lieu of the $3.5 million threshold cited in FAR 5.303(a), NASA Headquarters public...

  8. 78 FR 61185 - Patent and Trademark Office Acquisition Guidelines (PTAG)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-03

    ... USPTO will use the Governmentwide Point of Entry (GPE), as defined in FAR 2.101, to post synopses... procurement guidelines, to publish the acquisition forecast, to post the small business goals, and to communicate upcoming events and items of interest to the vendor community. Part 4--Market Research 4.0 Scope...

  9. Proceedings-symposium on whitebark pine ecosystems: Ecology and management of a high-mountain resource; 1989 March 29-31; Bozeman, MT

    Treesearch

    Wyman C. Schmidt; Kathy J. McDonald

    1990-01-01

    Includes 52 papers and 14 poster synopses that present current knowledge about ecosystems where whitebark pine and associated flora and fauna predominate. This was the first symposium to explore the ecology and management of these ecosystems, which are becoming increasingly important.

  10. 99 Films on Drugs.

    ERIC Educational Resources Information Center

    Weber, David O., Ed.

    This catalog describes and evaluates 16-millimeter films about various aspects of drug use. Among the subjects covered by the 99 films are the composition and effects of different drugs, reasons why people use drugs, life in the drug culture, the problem of law enforcement, and various means of dealing with drug users. Each film is synopsized. Two…

  11. 48 CFR 5.207 - Preparation and transmittal of synopses.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Internet at http://www.fedbizopps.gov. (c) General format for “Description.” Prepare a clear and concise...)(i) If the solicitation will include the FAR clause at 52.225-3, Buy American Act-Free Trade...: “One or more of the items under this acquisition is subject to Free Trade Agreements.” (ii) If the...

  12. 48 CFR 5.207 - Preparation and transmittal of synopses.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Internet at http://www.fedbizopps.gov. (c) General format for “Description.” Prepare a clear and concise...)(i) If the solicitation will include the FAR clause at 52.225-3, Buy American Act-Free Trade...: “One or more of the items under this acquisition is subject to Free Trade Agreements.” (ii) If the...

  13. 48 CFR 5.207 - Preparation and transmittal of synopses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Internet at http://www.fedbizopps.gov. (c) General format for “Description.” Prepare a clear and concise...)(i) If the solicitation will include the FAR clause at 52.225-3, Buy American Act-Free Trade...: “One or more of the items under this acquisition is subject to Free Trade Agreements.” (ii) If the...

  14. 48 CFR 5.207 - Preparation and transmittal of synopses.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Internet at http://www.fedbizopps.gov. (c) General format for “Description.” Prepare a clear and concise...)(i) If the solicitation will include the FAR clause at 52.225-3, Buy American Act-Free Trade...: “One or more of the items under this acquisition is subject to Free Trade Agreements.” (ii) If the...

  15. Musical Chemistry: Integrating Chemistry and Music--A Nine-Part Tutorial for Generating Music from Chemical Processes

    ERIC Educational Resources Information Center

    Kumbar, Mahadev

    2007-01-01

    This paper synopsizes a series of nine tutorials investigating how various chemical processes can be shown to have musical aspects. Both chemistry and music share a common language: mathematics. Interesting music can be created as chemical reactions--mediated by instrumentation and mathematics (e.g., spectrometry and discrete Fourier…

  16. Report to the President: United States National Commission on the International Year of the Child.

    ERIC Educational Resources Information Center

    National Commission on the International Year of the Child, Washington, DC.

    This report to the President overviews the activities of the United States National Commission on the International Year of the Child (IYC), 1979, and makes recommendations for national policy. Part One consists of a brief report of organizing activities of federal agencies and nongovernmental organizations, synopses of local initiatives for…

  17. Advanced Placement® Human Geography: Looking Back and Looking Ahead

    ERIC Educational Resources Information Center

    Lanegran, David A.; Zeigler, Donald J.

    2016-01-01

    Over the past fifteen years, AP Human Geography has grown in numbers and spread to almost every state. This article synopsizes the early history of the subject, summarizes the course and the exam, highlights positive impacts on the discipline of geography, and focuses on the following three issues: teachers who come to the course having majored in…

  18. Handbook of Laws and Regulations Affecting Public Libraries in New York State. Second Edition.

    ERIC Educational Resources Information Center

    Eisner, Joseph, Comp.

    In a looseleaf format which permits easy revision, this handbook synthesizes statutes, opinions, and regulations that affect library operation in New York State. The text consists of excerpts and synopses of statutes and opinions from state agencies and courts. Topics include: (1) library types; (2) establishment and dissolution of libraries; (3)…

  19. Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

    PubMed

    Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Bambrick, Tara; Burnand, Bernard; Mercer, Jay; Marlow, Bernard; Campbell, Craig

    2010-12-01

    The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM. © 2010 Blackwell Publishing Ltd.

  20. Microgravity and Materials Processing Facility study (MMPF): Requirements and Analyses of Commercial Operations (RACO) preliminary data release

    NASA Technical Reports Server (NTRS)

    1988-01-01

    This requirements and analyses of commercial operations (RACO) study data release reflects the current status of research activities of the Microgravity and Materials Processing Facility under Modification No. 21 to NASA/MSFC Contract NAS8-36122. Section 1 includes 65 commercial space processing projects suitable for deployment aboard the Space Station. Section 2 contains reports of the R:BASE (TM) electronic data base being used in the study, synopses of the experiments, and a summary of data on the experimental facilities. Section 3 is a discussion of video and data compression techniques used as well as a mission timeline analysis.

  1. Commission of Professors of Adult Education. Proceedings of the 1986 Annual Conference (Hollywood, Florida, October 20-22, 1986).

    ERIC Educational Resources Information Center

    Lewis, Linda H., Ed.; Niemi, John A., Ed.

    These proceedings of a conference built around the theme of the professionalization of adult and continuing education include the full texts of presentations at the conference General Sessions, papers and synopses of conference workshops and panel presentations, reports from the seven task forces of the Commission of Professors of Adult Education;…

  2. Teaching the Teachers on Building Climatology. (CIB Steering Group S 4, Colloquium, Stockholm, September 4-6, 1972). CIB Proceedings No. 25.

    ERIC Educational Resources Information Center

    National Swedish Inst. for Building Research, Stockholm.

    This publication comprises a collection of papers and synopses of discussions dating from the "Teaching the Teachers in Building Climatology" colloquium which was held under the auspices of the International Council for Building Research (CIB) and the World Meteorological Organization (WMO). The papers deal with the use of various…

  3. Guide to Films (16mm) About the Use of Dangerous Drugs, Narcotics, Alcohol and Tobacco.

    ERIC Educational Resources Information Center

    1971

    About 230 films and 60 filmstrips dealing with drugs, narcotics, alcohol, and tobacco are synopsized. Approximately half the listings deal with alcohol, a quarter concern tobacco, and the rest deal with drugs. For each item, the length, year of release, and source where the film of filmstrip may be obtained is listed. The distributors identified…

  4. Planetary mission summaries. Volume 1: Introduction and overview

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Tabular synopses of twelve missions are presented along with the Mariner Jupiter/Saturn 1977 mission for comparison. Mission definitions considered include: Mars Polar Orbiter; Mars Surface Sample Return; Mars Rover; Marine Jupiter/Uranus 1979 with Uranus Entry Probe; Mariner Jupiter Orbiter; Mariner Mercury Orbiter 1978; Early Mariner Comet Flyby Solar Electric Encke Slow Flyby; Mariner Encke Ballistic Flyby; Solar Electric Encke Rendezvous 1981; Venus Orbital Imaging Radar; Solar Electric Out-of-the-Eliptic Probe 1979. Technical conclusions of mission studies are given in order that these results may interact with the broader questions of scope, pace, and priorities in the planetary exploration program.

  5. Tour of Research Laboratories at the Ford Company

    NASA Astrophysics Data System (ADS)

    Reitz, J. R.

    1981-01-01

    A brief description of the physics programs encountered on the tour of the Ford Motor Company Research Laboratories is provided. A visit to the Research Laboratories of the Ford Motor Company is part of the Conference on Physics in the Automotive Industry. The visit will show a cross-section of the programs in Research Staff which are clearly identified as physics research as well as other areas where physicists have established themselves as dominant or team members in what might traditionally be regarded as the province of engineering R&D. After a brief orientation, the Conference visitors will be divided into tour groups and will visit laboratories involved in combustion research, arc-discharge physics, various spectroscopic applications, metal gauging, energy management, optical display systems and solar energy research. Synopses of the specific tour visits follow.

  6. Pacific Commercial Advertiser: Synopses and Summaries of Dewey's 1899 Lectures on the Life of the Child

    ERIC Educational Resources Information Center

    Educational Perspectives, 2015

    2015-01-01

    In the summer of 1899, [John] Dewey gave two series of talks at Honolulu High School on Tuesday and Friday evenings from 8:00 to 10:00. The first set of five lectures was entitled "The Life of the Child;" the second set, "Movements in Nineteenth Century Thought." The first talk of the lecture series was delivered on the evening…

  7. The Young Child and Music: Contemporary Principles in Child Development and Music Education. Proceedings of the Music in Early Childhood Conference (Provo, Utah, June 28-30, 1984).

    ERIC Educational Resources Information Center

    Boswell, Jacquelyn, Ed.

    Proceedings of the 1984 Music in Early Childhood Conference held at Brigham Young University are presented in this document. Part I contains keynote addresses; Parts II through IV, respectively, consist of reports by research teams, synopses of workshops, and abstracts of research sessions. Keynote speakers addressed a broad scope of issues…

  8. Upgrade and interpersonal skills training at American Airlines

    NASA Technical Reports Server (NTRS)

    Estridge, W. W.; Mansfield, J. L.

    1980-01-01

    Segments of the interpersonal skills training audio visual program are presented. The program was developed to train customer contact personnel with specific emphasis on transactional analysis in customer treatment. Concepts of transactional analysis are summarized in terms of the make up of the personality, identified as the three ego states. These ego states are identified as the parent, the adult, and the child. Synopses of four of the tape programs are given.

  9. Work Now and in the Future--3. Proceedings from the Annual Conference for Business and Industry Representatives, Educators and Others Concerned with the Changing World of Work (3rd, Portland, Oregon, November 5-6, 1986).

    ERIC Educational Resources Information Center

    McClure, Larry; Cotton, Kathleen, Ed.

    These proceedings of a conference, which focused on technology and communications in tomorrow's workplace, include the following: synopses of "Learning for Life: Increasing Awareness of Human Capabilities" and the follow-up session "Multiplying Intelligence: What Do We Know about Learning Styles?" (Dee Dickinson); "From Programmed Instruction to…

  10. Research in computer science

    NASA Technical Reports Server (NTRS)

    Ortega, J. M.

    1985-01-01

    Synopses are given for NASA supported work in computer science at the University of Virginia. Some areas of research include: error seeding as a testing method; knowledge representation for engineering design; analysis of faults in a multi-version software experiment; implementation of a parallel programming environment; two computer graphics systems for visualization of pressure distribution and convective density particles; task decomposition for multiple robot arms; vectorized incomplete conjugate gradient; and iterative methods for solving linear equations on the Flex/32.

  11. Electromagnetic emission experiences using electric propulsion systems: A survey

    NASA Technical Reports Server (NTRS)

    Sovey, James S.; Zana, Lynnette M.; Knowles, Steven C.

    1987-01-01

    As electric propulsion systems become ready to integrate with spacecraft systems, the impact of propulsion system radiated emissions are of significant interest. Radiated emissions from electromagnetic, electrostatic, and electrothermal systems have been characterized and results synopsized from the literature describing 21 space flight programs. Electromagnetic radiated emission results from ground tests and flight experiences are presented with particular attention paid to the performance of spacecraft subsystems and payloads during thruster operations. The impacts to transmission of radio frequency signals through plasma plumes are also reviewed.

  12. Prospects for commercialization of SELV-based in-space operations

    NASA Technical Reports Server (NTRS)

    Katzberg, Stephen J. (Compiler); Garrison, James L., Jr. (Compiler)

    1995-01-01

    A workshop was hosted by the Langley Research Center as a part of an activity to assess the commercialization potential of Small Expendible Launch Vehicle-based in-space operations. Representatives of the space launch insurance industry, industrial consultants, producers of spacecraft, launch vehicle manufacturers, and government researchers constituted the participants. The workshop was broken into four sessions: Customers Small Expendible Launch Systems, Representative Missions, and Synthesis-Government role. This publication contains the presentation material, written synopses of the sessions, and conclusions developed at the workshop.

  13. Investigation of current university research concerning energy conversion and conservation in small single-family dwellings

    NASA Technical Reports Server (NTRS)

    Grossman, G. R.; Roberts, A. S., Jr.

    1975-01-01

    An investigation was made of university research concerning energy conversion and conservation techniques which may be applied in small single-family residences. Information was accumulated through published papers, progress reports, telephone conversations, and personal interviews. A synopsis of each pertinent investigation is given. Finally, a discussion of the synopses is presented and recommendations are made concerning the applicability of concepts for the design and construction of NASA-Langley Research Center's proposed Technology Utilization House in Hampton, Virginia.

  14. Biology Division progress report for period of October 1, 1988--September 30, 1989

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

    Not Available

    1990-02-01

    The Biology Division of the Oak Ridge National Laboratory is one component of the Department of Energy's intramural program in life sciences. With respect to experimental biology, the congressionally mandated mission of this Office is to study adverse health effects of energy production and utilization. Within this stated broad mission, common themes among the research programs of the Biology Division are interactions of animals, cells, and molecules with their respective environments. Investigations focus on genetic and somatic effects of radiation and chemicals. Goals include identification and quantification of these effects, elucidation of pathways by which the effects are expressed, assessmentmore » of risks associated with radiation and chemical exposures, and establishment of strategies for extrapolation of risk data from animals to humans. Concurrent basic studies in genetics, biochemistry, molecular biology, and cell biology illuminate normal life processes as prerequisites to comprehending mutagenic and carcinogenic effects of environmental agents. This Progress Report is intended to provide both broad perspectives of the Division's research programs and synopses of recent achievements. Readers are invited to contact individual principal investigators for more detailed information, including reprints of publications. 120 refs.« less

  15. Women in Academic Medicine Leadership: Has Anything Changed in 25 Years?

    PubMed

    Rochon, Paula A; Davidoff, Frank; Levinson, Wendy

    2016-08-01

    Over the past 25 years, the number of women graduating from medical schools in the United States and Canada has increased dramatically to the point where roughly equal numbers of men and women are graduating each year. Despite this growth, women continue to face challenges in moving into academic leadership positions. In this Commentary, the authors share lessons learned from their own careers relevant to women's careers in academic medicine, including aspects of leadership, recruitment, editorship, promotion, and work-life balance. They provide brief synopses of current literature on the personal and social forces that affect women's participation in academic leadership roles. They are persuaded that a deeper understanding of these realities can help create an environment in academic medicine that is generally more supportive of women's participation, and that specifically encourages women in medicine to take on academic leadership positions.

  16. Federal-State Cooperative Program in Kansas, seminar proceedings, July 1985

    USGS Publications Warehouse

    Huntzinger, T.L.

    1985-01-01

    During the past few years, water-resource management in Kansas has undergone reorientation with the creation of the Kansas Water Authority and the Kansas Water office. New thrusts toward long-term goals based on the Kansas State Water plan demand strong communication and coordination between all water-related agencies within the State. The seminar discussed in this report was an initial step by the Kansas Water Office to assure the continued presence of a technical-coordination process and to provide an opportunity for the U.S. Geological Survey to summarize their technical-informational activities in Kansas for the benefit of State and Federal water agencies with the State. The seminar was held on July 8 and 9, 1985, in Lawrence, Kansas. The agenda included a summary of the data-collection activities and short synopses of projects completed within the past year and those currently underway. The data program discussions described the information obtained at the surface water, groundwater, water quality, and sediment sites in Kansas. Interpretive projects summarized included studies in groundwater modeling, areal hydrologic analysis, regional analysis of floods , low-flow, high-flow, and flow-volume characteristics, water quality of groundwater and lakes, and traveltime and transit-loss analysis. (USGS)

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

    PubMed

    Viereck, Christopher; Boudes, Pol

    2009-07-01

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

  18. NASA and Industry Benefits of ACTS High Speed Network Interoperability Experiments

    NASA Technical Reports Server (NTRS)

    Zernic, M. J.; Beering, D. R.; Brooks, D. E.

    2000-01-01

    This paper provides synopses of the design. implementation, and results of key high data rate communications experiments utilizing the technologies of NASA's Advanced Communications Technology Satellite (ACTS). Specifically, the network protocol and interoperability performance aspects will be highlighted. The objectives of these key experiments will be discussed in their relevant context to NASA missions, as well as, to the comprehensive communications industry. Discussion of the experiment implementation will highlight the technical aspects of hybrid network connectivity, a variety of high-speed interoperability architectures, a variety of network node platforms, protocol layers, internet-based applications, and new work focused on distinguishing between link errors and congestion. In addition, this paper describes the impact of leveraging government-industry partnerships to achieve technical progress and forge synergistic relationships. These relationships will be the key to success as NASA seeks to combine commercially available technology with its own internal technology developments to realize more robust and cost effective communications for space operations.

  19. Designing Flightdeck Procedures: Literature Resources

    NASA Technical Reports Server (NTRS)

    Feldman, Jolene; Barshi, Immanuel; Degani, Asaf; Loukopoulou, Loukia; Mauro, Robert

    2017-01-01

    This technical publication contains the titles, abstracts, summaries, descriptions, and/or annotations of available literature sources on procedure design and development, requirements, and guidance. It is designed to provide users with an easy access to available resources on the topic of procedure design, and with a sense of the contents of these sources. This repository of information is organized into the following publication sources: Research (e.g., journal articles, conference proceedings), Manufacturers' (e.g., operation manuals, newsletters), and Regulatory and/or Government (e.g., advisory circulars, reports). An additional section contains synopses of Accident/Incident Reports involving procedures. This work directly supports a comprehensive memorandum by Barshi, Mauro, Degani, & Loukopoulou (2016) that summarizes the results of a multi-year project, partially funded by the FAA, to develop technical reference materials that support guidance on the process of developing cockpit procedures (see "Designing Flightdeck Procedures" https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20160013263.pdf). An extensive treatment of this topic is presented in a forthcoming book by the same authors.

  20. Applications of the Cambridge Structural Database in organic chemistry and crystal chemistry.

    PubMed

    Allen, Frank H; Motherwell, W D Samuel

    2002-06-01

    The Cambridge Structural Database (CSD) and its associated software systems have formed the basis for more than 800 research applications in structural chemistry, crystallography and the life sciences. Relevant references, dating from the mid-1970s, and brief synopses of these papers are collected in a database, DBUse, which is freely available via the CCDC website. This database has been used to review research applications of the CSD in organic chemistry, including supramolecular applications, and in organic crystal chemistry. The review concentrates on applications that have been published since 1990 and covers a wide range of topics, including structure correlation, conformational analysis, hydrogen bonding and other intermolecular interactions, studies of crystal packing, extended structural motifs, crystal engineering and polymorphism, and crystal structure prediction. Applications of CSD information in studies of crystal structure precision, the determination of crystal structures from powder diffraction data, together with applications in chemical informatics, are also discussed.

  1. Permission Form Synopses to Improve Parents' Understanding of Research: A Randomized Trial

    PubMed Central

    D'Angio, Carl T.; Wang, Hongyue; Hunn, Julianne E.; Pryhuber, Gloria S.; Chess, Patricia R.; Lakshminrusimha, Satyan

    2017-01-01

    Objective We hypothesized that, among parents of potential neonatal research subjects, an accompanying cover sheet added to the permission form (intervention) would increase understanding of the research, when compared to a standard form (control). Study Design This pilot study enrolled parents approached for one of two index studies: one randomized trial and one observational study. A one-page cover sheet described critical study information. Families were randomized 1:1 to receive the cover sheet or not. Objective and subjective understanding and satisfaction were measured. Result Thirty-two parents completed all measures (17 control, 15 intervention). There were no differences in comprehension score (16.8 ± 5.7 v. 16.3 ± 3.5), subjective understanding (median 6.0 v. 6.5), or overall satisfaction with consent (median 7.0 v. 6.5) between control and intervention groups (all p>0.50). Conclusion A simplified permission form cover sheet had no effect on parents' understanding of studies for which their newborns were being recruited. PMID:28358380

  2. Another Look at the "Dismal Science" and Jenner's Experiment.

    PubMed

    Elllis, John A

    2018-03-01

    The follow-up to Jenner's experiment, routine vaccination, has reduced more disease and saved more vertebrate lives than any other iatrogenic procedure by orders of magnitude. The unassailability of that potentially provocative cliché has been ciphered in human medicine, even if it is more difficult in our profession. Most public relations headaches concerning vaccines are a failure to communicate, often resulting in overly great expectations. Even in the throes of a tight appointment schedule remembering and synopsizing (for clients), some details of the dismal science can make practice great again. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Apollo experience report: Communications system flight evaluation and verification

    NASA Technical Reports Server (NTRS)

    Travis, D.; Royston, C. L., Jr.

    1972-01-01

    Flight tests of the synergetic operation of the spacecraft and earth based communications equipment were accomplished during Apollo missions AS-202 through Apollo 12. The primary goals of these tests were to verify that the communications system would adequately support lunar landing missions and to establish the inflight communications system performance characteristics. To attain these goals, a communications system flight verification and evaluation team was established. The concept of the team operations, the evolution of the evaluation processes, synopses of the team activities associated with each mission, and major conclusions and recommendations resulting from the performance evaluation are represented.

  4. Technology transfer in the NASA Ames Advanced Life Support Division

    NASA Technical Reports Server (NTRS)

    Connell, Kathleen; Schlater, Nelson; Bilardo, Vincent; Masson, Paul

    1992-01-01

    This paper summarizes a representative set of technology transfer activities which are currently underway in the Advanced Life Support Division of the Ames Research Center. Five specific NASA-funded research or technology development projects are synopsized that are resulting in transfer of technology in one or more of four main 'arenas:' (1) intra-NASA, (2) intra-Federal, (3) NASA - aerospace industry, and (4) aerospace industry - broader economy. Each project is summarized as a case history, specific issues are identified, and recommendations are formulated based on the lessons learned as a result of each project.

  5. Guidelines for the Design and Conduct of Clinical Studies in Knee Articular Cartilage Repair

    PubMed Central

    Mithoefer, Kai; Saris, Daniel B.F.; Farr, Jack; Kon, Elizaveta; Zaslav, Kenneth; Cole, Brian J.; Ranstam, Jonas; Yao, Jian; Shive, Matthew; Levine, David; Dalemans, Wilfried; Brittberg, Mats

    2011-01-01

    Objective: To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee cartilage repair procedures and products. Design: A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on articular cartilage repair in the knee. Analysis of cartilage repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field. Results: Current literature reflects the methodological limitations of the scientific evidence available for articular cartilage repair. However, clinical trial databases of ongoing trials document a trend suggesting improved study designs and clinical evaluation methodology. Based on the current scientific information and standards of clinical care, detailed methodological recommendations were developed for the statistical study design, patient recruitment, control group considerations, study endpoint definition, documentation of results, use of validated patient-reported outcome instruments, and inclusion and exclusion criteria for the design and conduct of scientifically sound cartilage repair study protocols. A consensus statement among the International Cartilage Repair Society (ICRS) and contributing authors experienced in clinical trial design and implementation was achieved. Conclusions: High-quality clinical research methodology is critical for the optimal evaluation of current and new cartilage repair technologies. In addition to generally applicable principles for orthopedic study design, specific criteria and considerations apply to cartilage repair studies. Systematic application of these criteria and considerations can facilitate study designs that are scientifically rigorous, ethical, practical, and appropriate for the question(s) being addressed in any given cartilage repair research project. PMID:26069574

  6. LDEF materials results for spacecraft applications: Executive summary

    NASA Astrophysics Data System (ADS)

    Whitaker, A. F.; Dooling, D.

    1995-03-01

    To address the challenges of space environmental effects, NASA designed the Long Duration Exposure Facility (LDEF) for an 18-month mission to expose thousands of samples of candidate materials that might be used on a space station or other orbital spacecraft. LDEF was launched in April 1984 and was to have been returned to Earth in 1985. Changes in mission schedules postponed retrieval until January 1990, after 69 months in orbit. Analyses of the samples recovered from LDEF have provided spacecraft designers and managers with the most extensive data base on space materials phenomena. Many LDEF samples were greatly changed by extended space exposure. Among even the most radially altered samples, NASA and its science teams are finding a wealth of surprising conclusions and tantalizing clues about the effects of space on materials. Many were discussed at the first two LDEF results conferences and subsequent professional papers. The LDEF Materials Results for Spacecraft Applications Conference was convened in Huntsville to discuss implications for spacecraft design. Already, paint and thermal blanket selections for space station and other spacecraft have been affected by LDEF data. This volume synopsizes those results.

  7. Assessing information technologies for health.

    PubMed

    Kulikowski, C; Haux, R

    2006-01-01

    To provide an editorial introduction to the 2006 IMIA Yearbook of Medical Informatics with an overview of its contents and contributors. A brief overview of the main theme of 'Assessing Information Technology for Health Care', and an outline of the purposes, readership, contents, new format, and acknowledgment of contributions for the 2006 IMIA Yearbook. Assessing information technology (IT) in biomedicine and health care is emphasized in a number of survey and review articles. Synopses of a selection of best papers for the past 12 months are included, as are original papers on the history of medical informatics by pioneers in the field, and selected research and education programs. Information about IMIA and its constituent societies is given, as well as the authors, reviewers, and advisors to the Yearbook. The 2006 IMIA Yearbook of Medical Informatics highlights as its theme one of the most significant yet difficult aspects of information technology in health: the assessment of IT as part of the complex enterprise of biomedical research and practice. It is being published in a new format with a wide range of original survey and review articles.

  8. LDEF materials results for spacecraft applications: Executive summary

    NASA Technical Reports Server (NTRS)

    Whitaker, A. F. (Compiler); Dooling, D. (Compiler)

    1995-01-01

    To address the challenges of space environmental effects, NASA designed the Long Duration Exposure Facility (LDEF) for an 18-month mission to expose thousands of samples of candidate materials that might be used on a space station or other orbital spacecraft. LDEF was launched in April 1984 and was to have been returned to Earth in 1985. Changes in mission schedules postponed retrieval until January 1990, after 69 months in orbit. Analyses of the samples recovered from LDEF have provided spacecraft designers and managers with the most extensive data base on space materials phenomena. Many LDEF samples were greatly changed by extended space exposure. Among even the most radially altered samples, NASA and its science teams are finding a wealth of surprising conclusions and tantalizing clues about the effects of space on materials. Many were discussed at the first two LDEF results conferences and subsequent professional papers. The LDEF Materials Results for Spacecraft Applications Conference was convened in Huntsville to discuss implications for spacecraft design. Already, paint and thermal blanket selections for space station and other spacecraft have been affected by LDEF data. This volume synopsizes those results.

  9. Comparison of different synthetic 5-min rainfall time series on the results of rainfall runoff simulations in urban drainage modelling

    NASA Astrophysics Data System (ADS)

    Krämer, Stefan; Rohde, Sophia; Schröder, Kai; Belli, Aslan; Maßmann, Stefanie; Schönfeld, Martin; Henkel, Erik; Fuchs, Lothar

    2015-04-01

    The design of urban drainage systems with numerical simulation models requires long, continuous rainfall time series with high temporal resolution. However, suitable observed time series are rare. As a result, usual design concepts often use uncertain or unsuitable rainfall data, which renders them uneconomic or unsustainable. An expedient alternative to observed data is the use of long, synthetic rainfall time series as input for the simulation models. Within the project SYNOPSE, several different methods to generate synthetic rainfall data as input for urban drainage modelling are advanced, tested, and compared. Synthetic rainfall time series of three different precipitation model approaches, - one parametric stochastic model (alternating renewal approach), one non-parametric stochastic model (resampling approach), one downscaling approach from a regional climate model-, are provided for three catchments with different sewer system characteristics in different climate regions in Germany: - Hamburg (northern Germany): maritime climate, mean annual rainfall: 770 mm; combined sewer system length: 1.729 km (City center of Hamburg), storm water sewer system length (Hamburg Harburg): 168 km - Brunswick (Lower Saxony, northern Germany): transitional climate from maritime to continental, mean annual rainfall: 618 mm; sewer system length: 278 km, connected impervious area: 379 ha, height difference: 27 m - Friburg in Brisgau (southern Germany): Central European transitional climate, mean annual rainfall: 908 mm; sewer system length: 794 km, connected impervious area: 1 546 ha, height difference 284 m Hydrodynamic models are set up for each catchment to simulate rainfall runoff processes in the sewer systems. Long term event time series are extracted from the - three different synthetic rainfall time series (comprising up to 600 years continuous rainfall) provided for each catchment and - observed gauge rainfall (reference rainfall) according national hydraulic design standards. The synthetic and reference long term event time series are used as rainfall input for the hydrodynamic sewer models. For comparison of the synthetic rainfall time series against the reference rainfall and against each other the number of - surcharged manholes, - surcharges per manhole, - and the average surcharge volume per manhole are applied as hydraulic performance criteria. The results are discussed and assessed to answer the following questions: - Are the synthetic rainfall approaches suitable to generate high resolution rainfall series and do they produce, - in combination with numerical rainfall runoff models - valid results for design of urban drainage systems? - What are the bounds of uncertainty in the runoff results depending on the synthetic rainfall model and on the climate region? The work is carried out within the SYNOPSE project, funded by the German Federal Ministry of Education and Research (BMBF).

  10. Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals.

    PubMed

    Wasser, Joseph G; Vasilopoulos, Terrie; Zdziarski, Laura Ann; Vincent, Heather K

    2017-02-01

    Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  11. Advanced technology needs for a global change science program: Perspective of the Langley Research Center

    NASA Technical Reports Server (NTRS)

    Rowell, Lawrence F.; Swissler, Thomas J.

    1991-01-01

    The focus of the NASA program in remote sensing is primarily the Earth system science and the monitoring of the Earth global changes. One of NASA's roles is the identification and development of advanced sensing techniques, operational spacecraft, and the many supporting technologies necessary to meet the stringent science requirements. Langley Research Center has identified the elements of its current and proposed advanced technology development program that are relevant to global change science according to three categories: sensors, spacecraft, and information system technologies. These technology proposals are presented as one-page synopses covering scope, objective, approach, readiness timeline, deliverables, and estimated funding. In addition, the global change science requirements and their measurement histories are briefly discussed.

  12. Operating room clinicians' ratings of workload: a vignette simulation study.

    PubMed

    Wallston, Kenneth A; Slagle, Jason M; Speroff, Ted; Nwosu, Sam; Crimin, Kimberly; Feurer, Irene D; Boettcher, Brent; Weinger, Matthew B

    2014-06-01

    Increased clinician workload is associated with medical errors and patient harm. The Quality and Workload Assessment Tool (QWAT) measures anticipated (pre-case) and perceived (post-case) clinical workload during actual surgical procedures using ratings of individual and team case difficulty from every operating room (OR) team member. The purpose of this study was to examine the QWAT ratings of OR clinicians who were not present in the OR but who read vignettes compiled from actual case documentation to assess interrater reliability and agreement with ratings made by clinicians involved in the actual cases. Thirty-six OR clinicians (13 anesthesia providers, 11 surgeons, and 12 nurses) used the QWAT to rate 6 cases varying from easy to moderately difficult based on actual ratings made by clinicians involved with the cases. Cases were presented and rated in random order. Before rating anticipated individual and team difficulty, the raters read prepared clinical vignettes containing case synopses and much of the same written case information that was available to the actual clinicians before the onset of each case. Then, before rating perceived individual and team difficulty, they read part 2 of the vignette consisting of detailed role-specific intraoperative data regarding the anesthetic and surgical course, unusual events, and other relevant contextual factors. Surgeons had higher interrater reliability on the QWAT than did OR nurses or anesthesia providers. For the anticipated individual and team workload ratings, there were no statistically significant differences between the actual ratings and the ratings obtained from the vignettes. There were differences for the 3 provider types in perceived individual workload for the median difficulty cases and in the perceived team workload for the median and more difficult cases. The case difficulty items on the QWAT seem to be sufficiently reliable and valid to be used in other studies of anticipated and perceived clinical workload of surgeons. Perhaps because of the limitations of the clinical documentation shown to anesthesia providers and OR nurses in the current vignette study, more evidence needs to be gathered to demonstrate the criterion-related validity of the QWAT difficulty items for assessing the workload of nonsurgeon OR clinicians.

  13. Status of global virologic surveillance for rubella viruses.

    PubMed

    Abernathy, Emily S; Hübschen, Judith M; Muller, Claude P; Jin, Li; Brown, David; Komase, Katsuhiro; Mori, Yoshio; Xu, Wenbo; Zhu, Zhen; Siqueira, Marilda M; Shulga, Sergey; Tikhonova, Nina; Pattamadilok, Sirima; Incomserb, Patcha; Smit, Sheilagh B; Akoua-Koffi, Chantal; Bwogi, Josephine; Lim, Wilina W L; Woo, Gibson K S; Triki, Hinda; Jee, Youngmee; Mulders, Mick N; de Filippis, Ana Maria Bispo; Ahmed, Hinda; Ramamurty, Nalini; Featherstone, David; Icenogle, Joseph P

    2011-07-01

    The suspected measles case definition captures rubella cases. Therefore, measles surveillance will be improved in the course of the control and eventual elimination of rubella transmission. One aspect of rubella control, virologic surveillance, is reviewed here. A systematic nomenclature for rubella viruses (RVs) based on 13 genotypes has been established and is updated when warranted by increases in information about RVs. From 2005 through 2010, the genotypes of RVs most frequently reported were 1E, 1G, and 2B, and genotypes 1a, 1B, 1C, 1h, 1j, and 2C were less frequently reported. Virologic surveillance can support rubella control and elimination. Synopses of rubella virologic surveillance in various countries, regions, and globally are given, including characterization of viruses from imported cases in a country that has eliminated rubella and studies of endemic viruses circulating in countries without rubella control objectives. Current challenges are discussed. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011.

  14. Approaches to the conservation of coastal wetlands in the Western Hemisphere

    USGS Publications Warehouse

    Bildstein, K.L.; Bancroft, G.T.; Dugan, P.J.; Gordon, D.H.; Erwin, R.M.; Nol, E.; Payne, L.X.; Senner, Stanley E.

    1991-01-01

    Coastal wetlands rank among the most productive and ecologically valuable natural ecosystems on Earth. Unfortunately, they are also some of the most disturbed. Because they are productive and can serve as transportation arteries, coastal wetlands have long attracted human settlement. More than half of the U.S. population currently lives within 80 km of its coasts, and one estimate places 70% of all humanity in the coastal zone. Human impacts to coastal wetlands include physical alteration of hydrological processes; the introduction of toxic materials, nutrients, heat, and exotic species; and the unsustainable harvest of native species. Between 1950 and 1970, coastal wetland losses in the U.S. averaged 8 100 ha/year. In Central and South America, development pressures along the coastal zone rank among the most serious natural resource problems in the region..... Here, we (1) briefly describe coastal wetland avifauna, (2) discuss the threat of global warming on coastal wetlands, (3) use several Western Hemisphere wetlands as site-specific examples of development pressures facing these habitats, and (4) provide synopses of nongovernmental and governmental approaches to wetland conservation. Overall, we provide a socio-economic context for conservation of coastal wetlands in the Western Hemisphere. We suggest that efforts aimed at conserving sites of particular importance for their biological diversity should be pursued within a framework of wise use that addresses the broader issues of human population growth and economic development.

  15. Antenatal Testing – A Reevaluation

    PubMed Central

    Signore, Caroline; Freeman, Roger K.; Spong, Catherine Y.

    2009-01-01

    In August 2007, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health Office of Rare Diseases, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics cosponsored a 2-day workshop to reassess the body of evidence supporting antepartum assessment of fetal well-being, identify key gaps in the evidence, and formulate recommendations for further research. Participants included experts in obstetrics and fetal physiology, and representatives from relevant stakeholder groups and organizations. This article is a summary of the discussions at the workshop, including synopses of oral presentations on the epidemiology of stillbirth and fetal neurological injury, fetal physiology, techniques for antenatal monitoring, and maternal and fetal indications for monitoring. Finally, a synthesis of recommendations for further research compiled from three breakout workgroups is presented. PMID:19300336

  16. Evidence-based management of otitis media: a 5S model approach.

    PubMed

    Wasson, J D; Yung, M W

    2015-02-01

    The 5S model proposes five hierarchical levels (systems, summaries, synopses, syntheses and studies) of pre-appraised evidence to guide evidence-based practice. This review aimed to identify and summarise pre-appraised evidence at the highest available 5S level for the management of different subsets of otitis media: acute otitis media, otitis media with effusion, chronic suppurative otitis media and cholesteatoma in both adults and children. Data sources were pre-appraised evidence resources. Evidence freely available from sources at the highest available level of the 5S model were summarised for this review. System level evidence exists for acute otitis media and otitis media with effusion. Summary level evidence exists for recurrent acute otitis media and medical management of chronic suppurative otitis media. There is an absence of randomised controlled trials to prove the efficacy of surgical management of chronic suppurative otitis media and cholesteatoma. Until randomised controlled trial data are generated, consensus publications on the surgical management of chronic suppurative otitis media and cholesteatoma should be used to guide best practice.

  17. Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2017.

    PubMed

    Wieland, Mark L; Szostek, Jason H; Wingo, Majken T; Post, Jason A; Mauck, Karen F

    2018-02-26

    Clinicians are challenged to identify new practice-changing articles in the medical literature. To identify the practice-changing articles published in 2017 most relevant to outpatient general internal medicine, 5 internists reviewed the following sources: 1) titles and abstracts from internal medicine journals with the 7 highest impact factors, including New England Journal of Medicine, Lancet, Journal of the American Medical Association, British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine; 2) synopses and syntheses of individual studies, including collections in the American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine; 3) databases of synthesis, including Evidence Updates and the Cochrane Library. Inclusion criteria were perceived clinical relevance to outpatient general medicine, potential for practice change, and strength of evidence. This process yielded 140 articles. Clusters of important articles around one topic were considered as a single-candidate series. A modified Delphi method was utilized by the 5 authors to reach consensus on 7 topics to highlight and appraise from the 2017 literature. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Menstrual cycle variation of women's interest in erotica.

    PubMed

    Zillmann, D; Schweitzer, K J; Mundorf, N

    1994-10-01

    Female respondents were given the opportunity to choose feature films for viewing. Choices were made on the basis of synopses and promotional videos. These materials projected (i) a focus on erotic, sexual events, (ii) romantic themes, (iii) action-packed violent drama, and (iv) hilarious comedy. Additionally, respondents evaluated the appeal of the projected films. Respondents' position in the menstrual cycle was then determined, with placement into one of seven 4-day phases. Measured in both choices and evaluations, a postmenstrual surge in erotic interest was evident. Erotic interest was also pronounced prior to and during menses. In contrast, it was at a minimum during the first half of the luteal phase. The choice of romantic films was not appreciably influenced by cycle position. However, in evaluating films with romantic themes, premenstrual women expressed particularly little interest in this genre.

  19. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop.

    PubMed

    Signore, Caroline; Freeman, Roger K; Spong, Catherine Y

    2009-03-01

    In August 2007, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health Office of Rare Diseases, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics cosponsored a 2-day workshop to reassess the body of evidence supporting antepartum assessment of fetal well-being, identify key gaps in the evidence, and formulate recommendations for further research. Participants included experts in obstetrics and fetal physiology and representatives from relevant stakeholder groups and organizations. This article is a summary of the discussions at the workshop, including synopses of oral presentations on the epidemiology of stillbirth and fetal neurological injury, fetal physiology, techniques for antenatal monitoring, and maternal and fetal indications for monitoring. Finally, a synthesis of recommendations for further research compiled from three breakout workgroups is presented.

  20. History of Presolar Grains

    NASA Technical Reports Server (NTRS)

    Bernatowicz, Thomas J.

    2005-01-01

    Papers on the History of Presolar Grains. This has been a very productive period in which much of the laboratory work conducted in the previous year and during this funding cycle were brought to completion. In the last year we have published or submitted for peer review 4 research papers, 4 review papers, and 11 abstracts in research areas supported under this grant. Brief synopses of the results of the research papers are presented, followed by short summaries of the topics discussed in the review papers. Several areas of research are of course being actively pursued, and the appended list of abstracts gives citations to this ongoing work. In a paper submitted to the Astrophysical Journal, the results of an investigation into the physical conditions in the mass outflows of asymptotic giant branch (AGB) carbon stars that are required for the formation of micron-sized presolar graphite grains, with and without previously formed internal crystals of titanium carbide (TIC) are reported.

  1. Editorial highlighting and highly cited papers

    NASA Astrophysics Data System (ADS)

    Antonoyiannakis, Manolis

    Editorial highlighting-the process whereby journal editors select, at the time of publication, a small subset of papers that are ostensibly of higher quality, importance or interest-is by now a widespread practice among major scientific journal publishers. Depending on the venue, and the extent to which editorial resources are invested in the process, highlighted papers appear as News & Views, Research Highlights, Perspectives, Editors' Choice, IOP Select, Editors' Summary, Spotlight on Optics, Editors' Picks, Viewpoints, Synopses, Editors' Suggestions, etc. Here, we look at the relation between highlighted papers and highly influential papers, which we define at two levels: having received enough citations to be among the (i) top few percent of their journal, and (ii) top 1% of all physics papers. Using multiple linear regression and multilevel regression modeling we examine the parameters associated with highly influential papers. We briefly comment on cause and effect relationships between citedness and highlighting of papers.

  2. Great lakes prey fish populations: a cross-basin overview of status and trends based on bottom trawl surveys, 1978-2012

    USGS Publications Warehouse

    Gorman, Owen T.

    2012-01-01

    The assessment of prey fish stocks in the Great Lakes have been conducted annually with bottom trawls since the 1970s by the Great Lakes Science Center, sometimes assisted by partner agencies. These stock assessments provide data on the status and trends of prey fish that are consumed by important commercial and recreational fishes. Although all these annual surveys are conducted using bottom trawls, they differ among the lakes in the proportion of the lake covered, seasonal timing, bottom trawl gear used, and the manner in which the trawl is towed (across or along bottom contours). Because each assessment is unique in one or more important aspects, direct comparison of prey fish catches among lakes is not straightforward. However, all of the assessments produce indices of abundance or biomass that can be standardized to facilitate comparisons of status and trends across all the Great Lakes. In this report, population indices were standardized to the highest value for a time series within each lake for the following principal prey species: cisco (Coregonus artedi), bloater (C. hoyi), rainbow smelt (Osmerus mordax), and alewife (Alosa pseudoharengus). Indices were also provided for round goby (Neogobius melanostomus), an invasive fish that has proliferated throughout the basin over the past 18 years. These standardized indices represent the best available long-term indices of relative abundance for these fishes across all of the Great Lakes. In this report, standardized indices are presented in graphical form along with synopses to provide a short, informal cross-basin summary of the status and trends of principal prey fishes. In keeping with this intent, tables, references, and a detailed discussion were omitted.

  3. Prevalence and proposed mechanisms of chronic low back pain in baseball: part i

    PubMed Central

    Wasser, Joseph G.; Zaremski, Jason L.; Herman, Daniel C.; Vincent, Heather K.

    2017-01-01

    The prevalence of low back pain (LBP) among active baseball players ranges between 3 and 15%. The execution of baseball-specific manoeuvres, such as pitching or batting, may be related to the onset of LBP. These baseball motions are complex and require appropriate activation of the core musculature to produce a well-timed motion with forces minimized at the extremities. The spine, core and back musculature are involved with acceleration and deceleration of rotational motions. This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population. Possible mechanical mechanisms linking baseball play to LBP include aberrant motion, improper timing, high lumbar stress due to mechanical loading and lumbopelvic strength deficits. Potential clinical implications relating to these possible mechanical mechanisms will also be highlighted. The state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions. PMID:28128007

  4. Prevalence and proposed mechanisms of chronic low back pain in baseball: part i.

    PubMed

    Wasser, Joseph G; Zaremski, Jason L; Herman, Daniel C; Vincent, Heather K

    2017-01-01

    The prevalence of low back pain (LBP) among active baseball players ranges between 3 and 15%. The execution of baseball-specific manoeuvres, such as pitching or batting, may be related to the onset of LBP. These baseball motions are complex and require appropriate activation of the core musculature to produce a well-timed motion with forces minimized at the extremities. The spine, core and back musculature are involved with acceleration and deceleration of rotational motions. This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population. Possible mechanical mechanisms linking baseball play to LBP include aberrant motion, improper timing, high lumbar stress due to mechanical loading and lumbopelvic strength deficits. Potential clinical implications relating to these possible mechanical mechanisms will also be highlighted. The state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions.

  5. Assessment and rehabilitation of chronic low back pain in baseball: part II

    PubMed Central

    Wasser, Joseph G.; Zaremski, Jason L.; Herman, Daniel C.; Vincent, Heather K.

    2017-01-01

    Repetitive throwing and hitting motions in baseball place mechanical stresses to the lumbar spine which may cause low back pain (LBP). Pain may be due to vertebral stress reactions or insufficiency fractures, intervertebral disc degeneration or intervertebral disc herniation. Untreated chronic conditions have high potential to lead to a more significant injury such as spondylolysis. Chronic LBP increases the risk for missed playing time, early career termination and lower quality of life after retirement. Proper clinical assessment and prevention/rehabilitation of LBP in this population is thus important for performance, play time and overall long-term quality of life. This narrative review synopsizes the available evidence for assessment and rehabilitation of baseball players with LBP, including the structured rehabilitative techniques and programmes which should be administered to affected players. The state of the evidence suggests that there are deficits in identifying the optimal prevention and rehabilitation prescription components for the variety of LBP-inducing injuries in this athletic population. PMID:28128000

  6. Assessment and rehabilitation of chronic low back pain in baseball: part II.

    PubMed

    Wasser, Joseph G; Zaremski, Jason L; Herman, Daniel C; Vincent, Heather K

    2017-01-01

    Repetitive throwing and hitting motions in baseball place mechanical stresses to the lumbar spine which may cause low back pain (LBP). Pain may be due to vertebral stress reactions or insufficiency fractures, intervertebral disc degeneration or intervertebral disc herniation. Untreated chronic conditions have high potential to lead to a more significant injury such as spondylolysis. Chronic LBP increases the risk for missed playing time, early career termination and lower quality of life after retirement. Proper clinical assessment and prevention/rehabilitation of LBP in this population is thus important for performance, play time and overall long-term quality of life. This narrative review synopsizes the available evidence for assessment and rehabilitation of baseball players with LBP, including the structured rehabilitative techniques and programmes which should be administered to affected players. The state of the evidence suggests that there are deficits in identifying the optimal prevention and rehabilitation prescription components for the variety of LBP-inducing injuries in this athletic population.

  7. Decision-making and problem-solving methods in automation technology

    NASA Technical Reports Server (NTRS)

    Hankins, W. W.; Pennington, J. E.; Barker, L. K.

    1983-01-01

    The state of the art in the automation of decision making and problem solving is reviewed. The information upon which the report is based was derived from literature searches, visits to university and government laboratories performing basic research in the area, and a 1980 Langley Research Center sponsored conferences on the subject. It is the contention of the authors that the technology in this area is being generated by research primarily in the three disciplines of Artificial Intelligence, Control Theory, and Operations Research. Under the assumption that the state of the art in decision making and problem solving is reflected in the problems being solved, specific problems and methods of their solution are often discussed to elucidate particular aspects of the subject. Synopses of the following major topic areas comprise most of the report: (1) detection and recognition; (2) planning; and scheduling; (3) learning; (4) theorem proving; (5) distributed systems; (6) knowledge bases; (7) search; (8) heuristics; and (9) evolutionary programming.

  8. Advanced text and video analytics for proactive decision making

    NASA Astrophysics Data System (ADS)

    Bowman, Elizabeth K.; Turek, Matt; Tunison, Paul; Porter, Reed; Thomas, Steve; Gintautas, Vadas; Shargo, Peter; Lin, Jessica; Li, Qingzhe; Gao, Yifeng; Li, Xiaosheng; Mittu, Ranjeev; Rosé, Carolyn Penstein; Maki, Keith; Bogart, Chris; Choudhari, Samrihdi Shree

    2017-05-01

    Today's warfighters operate in a highly dynamic and uncertain world, and face many competing demands. Asymmetric warfare and the new focus on small, agile forces has altered the framework by which time critical information is digested and acted upon by decision makers. Finding and integrating decision-relevant information is increasingly difficult in data-dense environments. In this new information environment, agile data algorithms, machine learning software, and threat alert mechanisms must be developed to automatically create alerts and drive quick response. Yet these advanced technologies must be balanced with awareness of the underlying context to accurately interpret machine-processed indicators and warnings and recommendations. One promising approach to this challenge brings together information retrieval strategies from text, video, and imagery. In this paper, we describe a technology demonstration that represents two years of tri-service research seeking to meld text and video for enhanced content awareness. The demonstration used multisource data to find an intelligence solution to a problem using a common dataset. Three technology highlights from this effort include 1) Incorporation of external sources of context into imagery normalcy modeling and anomaly detection capabilities, 2) Automated discovery and monitoring of targeted users from social media text, regardless of language, and 3) The concurrent use of text and imagery to characterize behaviour using the concept of kinematic and text motifs to detect novel and anomalous patterns. Our demonstration provided a technology baseline for exploiting heterogeneous data sources to deliver timely and accurate synopses of data that contribute to a dynamic and comprehensive worldview.

  9. Major publications in the critical care pharmacotherapy literature: February 2012 through February 2013.

    PubMed

    Turck, Charles J; Frazee, Erin; Kram, Bridgette; Daley, Mitchell J; Day, Sarah A; Horner, Deanna; Lesch, Christine; Mercer, Jessica M; Plewa, Angela M; Herout, Peter

    2014-01-01

    Recent impactful additions to the professional literature on the role of pharmacotherapy in treating the critically ill are summarized. An unusually large number of updated practice guidelines and other publications with broad critical care pharmacotherapy ramifications appeared in the primary biomedical literature during the designated review period (February 2012-February 2013). Hundreds of relevant articles were evaluated by the Critical Care Pharmacotherapy Literature Update group (CCPLU), a national group of pharmacists who routinely monitor 25 peer-reviewed journals for emerging evidence that pertains to rational medication use in the intensive care unit (ICU) setting. From among those articles, 64 were summarized for dissemination to CCPLU members; the 8 publications deemed to have the greatest utility for critical care practitioners, as determined by CCPLU through a voting process, were selected for inclusion in this review, with preference given to evidence meeting high standards of methodological quality. The summaries presented here include (1) important new recommendations on management of pain, agitation, and delirium in critically ill patients, (2) a comprehensive update of a practice guideline issued in 2008 by the Surviving Sepsis Campaign, (3) novel strategies for the prevention and/or treatment of hyperglycemia in critical care, and (4) reports on clinical trials of promising alternative methods of sedation for use in weaning patients from mechanical ventilation. This review provides synopses of practice guidelines and other recent additions to the professional literature pertaining to rational medication use in the ICU practice setting.

  10. Celluloid devils: a research study of male nurses in feature films.

    PubMed

    Stanley, David

    2012-11-01

    To report a study of how male nurses are portrayed in feature films. It was hypothesized that male nurses are frequently portrayed negatively or stereotypically in the film media, potentially having a negative impact on male nurse recruitment and the public's perception of male nurses. An interpretive, qualitative methodology guided by insights into hegemonic masculinity and structured around a set of collective case studies (films) was used to examine the portrayal of male nurses in feature films made in the Western world from 1900 to 2007. Over 36,000 feature film synopses were reviewed (via CINAHL, ProQuest and relevant movie-specific literature) for the keyword 'nurse' and 'nursing' with an additional search for films from 1900 to 2010 for the word 'male nurse'. Identified films were labelled as 'cases' and analysed collectively to determine key attributes related to men in nursing and explore them for the emergence of concepts and themes related to the image of male nurses in films. A total of 13 relevant cases (feature films) were identified with 12 being made in the USA. Most films portrayed male nurses negatively and in ways opposed to hegemonic masculinity, as effeminate, homosexual, homicidal, corrupt or incompetent. Few film images of male nurses show them in traditional masculine roles or as clinically competent or self-confident professionals.   Feature films predominantly portray male nurses negatively. Given the popularity of feature films, there may be negative effects on recruitment and on the public's perception of male nurses. © 2012 Blackwell Publishing Ltd.

  11. Mineral commodity summaries 2013

    USGS Publications Warehouse

    ,

    2013-01-01

    Each chapter of the 2013 edition of the U.S. Geological Survey (USGS) Mineral Commodity Summaries (MCS) includes information on events, trends, and issues for each mineral commodity as well as discussions and tabular presentations on domestic industry structure, Government programs, tariffs, 5-year salient statistics, and world production and resources. The MCS is the earliest comprehensive source of 2012 mineral production data for the world. More than 90 individual minerals and materials are covered by two-page synopses. For mineral commodities for which there is a Government stockpile, detailed information concerning the stockpile status is included in the two-page synopsis. Abbreviations and units of measure, and definitions of selected terms used in the report, are in Appendix A and Appendix B, respectively. “Appendix C—Reserves and Resources” includes “Part A—Resource/Reserve Classification for Minerals” and “Part B—Sources of Reserves Data.” A directory of USGS minerals information country specialists and their responsibilities is Appendix D. The USGS continually strives to improve the value of its publications to users. Constructive comments and suggestions by readers of the MCS 2013 are welcomed.

  12. Mineral commodity summaries 2014

    USGS Publications Warehouse

    ,

    2014-01-01

    Each chapter of the 2014 edition of the U.S. Geological Survey (USGS) Mineral Commodity Summaries (MCS) includes information on events, trends, and issues for each mineral commodity as well as discussions and tabular presentations on domestic industry structure, Government programs, tariffs, 5-year salient statistics, and world production and resources. The MCS is the earliest comprehensive source of 2013 mineral production data for the world. More than 90 individual minerals and materials are covered by two-page synopses. For mineral commodities for which there is a Government stockpile, detailed information concerning the stockpile status is included in the two-page synopsis. Abbreviations and units of measure, and definitions of selected terms used in the report, are in Appendix A and Appendix B, respectively. “Appendix C—Reserves and Resources” includes “Part A—Resource/Reserve Classification for Minerals” and “Part B—Sources of Reserves Data.” A directory of USGS minerals information country specialists and their responsibilities is Appendix D. The USGS continually strives to improve the value of its publications to users. Constructive comments and suggestions by readers of the MCS 2014 are welcomed.

  13. Deciphering Signaling Pathway Networks to Understand the Molecular Mechanisms of Metformin Action

    PubMed Central

    Sun, Jingchun; Zhao, Min; Jia, Peilin; Wang, Lily; Wu, Yonghui; Iverson, Carissa; Zhou, Yubo; Bowton, Erica; Roden, Dan M.; Denny, Joshua C.; Aldrich, Melinda C.; Xu, Hua; Zhao, Zhongming

    2015-01-01

    A drug exerts its effects typically through a signal transduction cascade, which is non-linear and involves intertwined networks of multiple signaling pathways. Construction of such a signaling pathway network (SPNetwork) can enable identification of novel drug targets and deep understanding of drug action. However, it is challenging to synopsize critical components of these interwoven pathways into one network. To tackle this issue, we developed a novel computational framework, the Drug-specific Signaling Pathway Network (DSPathNet). The DSPathNet amalgamates the prior drug knowledge and drug-induced gene expression via random walk algorithms. Using the drug metformin, we illustrated this framework and obtained one metformin-specific SPNetwork containing 477 nodes and 1,366 edges. To evaluate this network, we performed the gene set enrichment analysis using the disease genes of type 2 diabetes (T2D) and cancer, one T2D genome-wide association study (GWAS) dataset, three cancer GWAS datasets, and one GWAS dataset of cancer patients with T2D on metformin. The results showed that the metformin network was significantly enriched with disease genes for both T2D and cancer, and that the network also included genes that may be associated with metformin-associated cancer survival. Furthermore, from the metformin SPNetwork and common genes to T2D and cancer, we generated a subnetwork to highlight the molecule crosstalk between T2D and cancer. The follow-up network analyses and literature mining revealed that seven genes (CDKN1A, ESR1, MAX, MYC, PPARGC1A, SP1, and STK11) and one novel MYC-centered pathway with CDKN1A, SP1, and STK11 might play important roles in metformin’s antidiabetic and anticancer effects. Some results are supported by previous studies. In summary, our study 1) develops a novel framework to construct drug-specific signal transduction networks; 2) provides insights into the molecular mode of metformin; 3) serves a model for exploring signaling pathways to facilitate understanding of drug action, disease pathogenesis, and identification of drug targets. PMID:26083494

  14. Immunoglobulin replacement therapy: a twenty-year review and current update.

    PubMed

    Saeedian, Monika; Randhawa, Inderpal

    2014-01-01

    The expansion of immunoglobulin replacement to multiple disease entities marks a decade-long advancement in immune therapy. Parallel to its extension, the characteristics and composition of immunoglobulin products have diversified. The aim of this study was to summarize a 20-year comprehensive literature review of currently commercially available immunoglobulin products, particularly examining individual product properties in a comparative format. Data Sources/Study Selections: The literature review was performed using PubMed and Ovid, screening a time span of 2 decades. Both authors reviewed the obtained articles for acceptable quality, and the selection was narrowed down based on criteria for randomized clinical and therapeutic trials. Product-specific characteristics in terms of purification strategy, stabilizers, composition, and viral inactivation were found among the immunoglobulin products investigated. Such differing characteristics manifest in their variable clinical safety and efficacy as assessed by the comparative product analysis. In subgroups of patients, subcutaneous immunoglobulin therapy may be an alternative to intravenous immunoglobulin (IVIG) therapy with an equal efficacy and a lower number of systemic adverse events. Only few comprehensive clinical synopses are available to clearly demonstrate the differences in IVIG products despite the widespread clinical use of the therapy. This review defines significant characteristics of individual immunoglobulin products, noting important differences in product development and application and allowing informed clinical decisions to match a product with patients' risk factors and comorbidity. This balanced approach to gammaglobulin replacement therapy is imperative to produce the highest clinical efficacy and lowest number of adverse events. © 2014 S. Karger AG, Basel.

  15. [Biomedical publications in Spain on debate (II): the on-going 'revolutions' and their application to neurological journals].

    PubMed

    González de Dios, J; Sempere, A P; Aleixandre-Benavent, R

    To debate about the application of on-going 'revolutions' in medical knowledge to Spanish neurological journals in the 21st century. This article reviews the current status of five revolutions in the field of health sciences, in general, and in neurological sciences, in particular: 1) the knowledge revolution: to translate the scientific investigation to the patient, with knowledge needs-driven research agenda with founder commissioning research to answer questions posed by clinicians, managers and patients, and systematic and critical appraisal reviews as the creator of quality improved knowledge; 2) the evidence based medicine revolution: the pyramid information of '4S', with systems (guidelines and computerized decision support systems), synopses (secondary journals), syntheses (systematic reviews and meta-analysis) and studies (original studies published in journals); 3) the web revolution: the possibility of dissemination of biomedical documentation by means of the Internet network are producing changes in the traditional way of conceiving scientific publication; the Internet represents a great advantage for investigation and also for clinical practice, since it permits free, universal access to databases and the interchange of texts, images and videos; 4) the open access revolution: to take full control over all operations related to the process of publish (to create, publish, communicate, distribute, reproduce and transform) with no need of any intermediaries, and to transform fundamental aspects concerning the circulation of knowledge, its use and availability; and 5) the librarian revolution: the project of a Virtual Health Library in Spain as a tool to access and disseminate scientific and technical knowledge on health through the Internet.

  16. Celluloid angels: a research study of nurses in feature films 1900-2007.

    PubMed

    Stanley, David J

    2008-10-01

    This paper is a report of a study examining the influence on how nursing and nurses are portrayed in feature films made between 1900 and 2007, with a nurse as their main or a principle character and a story-line related specifically to nursing. Nurses and the nursing profession are frequently portrayed negatively or stereotypically in the media, with nurses often being portrayed as feminine and caring but not as leaders or professionals capable of autonomous practice. A mixed method approach was used to examine feature films made in the Western world. Over 36,000 feature film synopses were reviewed (via CINAHL, ProQuest and relevant movie-specific literature) for the keywords 'nurse'/'nursing'. Identified films were analysed quantitatively to determine their country of production, genre, plot(s) and other relevant data, and qualitatively to identify the emergence of themes related to the image of nurses/nursing in films. For the period from 1900 to 2007, 280 relevant feature films were identified. Most films were made in the United States of America or United Kingdom, although in recent years films have been increasingly produced in other countries. Early films portrayed nurses as self-sacrificial heroines, sex objects and romantics. More recent films increasingly portray them as strong and self-confident, professionals. Nurse-related films offer a unique insight into the image of nurses and how they have been portrayed. Nurses need to be aware of the impact the film industry has on how nurses and nursing are perceived and represented in feature films.

  17. Report of the first annual airborne weapons training technology review

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

    Snyder, C.E.; Payne, G.B.; Treitler, I.E.

    1990-01-01

    This report documents the First Annual Airborne Weapons Training Technology Review. The Review was held at Oak Ridge Associated Universities from March 29 to 31, 1989. It was an exchange of ideas and information among the members of the network supporting the Naval Air Systems Command's (NAVAIR's) PMA205-11, Program Manager for Ordnance Training. This report describes the briefings and demonstrations presented at the Review, and summarizes the discussion at the informal caucus where significant issues were raised from the first two days' presentations. The report also contains the meeting agenda, a participant list with addresses and telephone numbers, a listmore » of the Department of Defense activities represented, NAVAIR's follow-up communication, and a brief description of Martin Marietta Energy Systems, Inc.'s training technology project support. A broad range of topics related to training systems and training support was covered during the Review. Synopses of the presentations and demonstrations included here cover computer-based and interactive systems, portability of software, reuse of training systems for different weapons, standardization of trainers, instructional systems design, cognitive task analysis, tracking of training resources, and the application of Computer-aided Acquisition and Logistic Support.« less

  18. Overview of drought and hydrologic conditions in the United States and southern Canada, water years 1986-90

    USGS Publications Warehouse

    Holmes, Sandra L.

    1992-01-01

    This report describes the drought and hydrologic conditions in the United States and southern Canada during the 1986-90 water years. This drought, which spread from the Eastern United States, where it was referred to as 'the drought of the century,' through the Midwest to the West Coast, brought to mind the Dust Bowl era of the 1930's. However, generally localized floods were numerous, but only one hurricane (Hugo) was of any consequence to the United States, Puerto Rico, and the Virgin Islands during a coincident period of anomalously low hurricane activity. The drought began in early 1984 as an 'agricultural drought,' which is a precipitation deficiency that results in a lack of soil moisture that is detrimental to agricultural production. This condition did not affect streamflow until about March or April 1986. A 'hydrological drought,' which is far more serious and widespread than an agricultural drought, was apparent from the low streamflow conditions that occurred after April 1986. To illustrate the changing nature of the drought, maps and synopses of monthly hydrologic conditions for the water years 1986-90 are presented.

  19. A management-oriented framework for selecting metrics used to assess habitat- and path-specific quality in spatially structured populations

    USGS Publications Warehouse

    Nicol, Sam; Wiederholt, Ruscena; Diffendorfer, James E.; Mattsson, Brady; Thogmartin, Wayne E.; Semmens, Darius J.; Laura Lopez-Hoffman,; Norris, Ryan

    2016-01-01

    Mobile species with complex spatial dynamics can be difficult to manage because their population distributions vary across space and time, and because the consequences of managing particular habitats are uncertain when evaluated at the level of the entire population. Metrics to assess the importance of habitats and pathways connecting habitats in a network are necessary to guide a variety of management decisions. Given the many metrics developed for spatially structured models, it can be challenging to select the most appropriate one for a particular decision. To guide the management of spatially structured populations, we define three classes of metrics describing habitat and pathway quality based on their data requirements (graph-based, occupancy-based, and demographic-based metrics) and synopsize the ecological literature relating to these classes. Applying the first steps of a formal decision-making approach (problem framing, objectives, and management actions), we assess the utility of metrics for particular types of management decisions. Our framework can help managers with problem framing, choosing metrics of habitat and pathway quality, and to elucidate the data needs for a particular metric. Our goal is to help managers to narrow the range of suitable metrics for a management project, and aid in decision-making to make the best use of limited resources.

  20. Issues in the economic evaluation of influenza vaccination by injection of healthy working adults in the US: a review and decision analysis of ten published studies.

    PubMed

    Hogan, Thomas J

    2012-05-01

    The objective was to review recent economic evaluations of influenza vaccination by injection in the US, assess their evidence, and conclude on their collective findings. The literature was searched for economic evaluations of influenza vaccination injection in healthy working adults in the US published since 1995. Ten evaluations described in nine papers were identified. These were synopsized and their results evaluated, the basic structure of all evaluations was ascertained, and sensitivity of outcomes to changes in parameter values were explored using a decision model. Areas to improve economic evaluations were noted. Eight of nine evaluations with credible economic outcomes were favourable to vaccination, representing a statistically significant result compared with a proportion of 50% that would be expected if vaccination and no vaccination were economically equivalent. Evaluations shared a basic structure, but differed considerably with respect to cost components, assumptions, methods, and parameter estimates. Sensitivity analysis indicated that changes in parameter values within the feasible range, individually or simultaneously, could reverse economic outcomes. Given stated misgivings, the methods of estimating influenza reduction ascribed to vaccination must be researched to confirm that they produce accurate and reliable estimates. Research is also needed to improve estimates of the costs per case of influenza illness and the costs of vaccination. Based on their assumptions, the reviewed papers collectively appear to support the economic benefits of influenza vaccination of healthy adults. Yet the underlying assumptions, methods and parameter estimates themselves warrant further research to confirm they are accurate, reliable and appropriate to economic evaluation purposes.

  1. Comparison of different synthetic 5-min rainfall time series regarding their suitability for urban drainage modelling

    NASA Astrophysics Data System (ADS)

    van der Heijden, Sven; Callau Poduje, Ana; Müller, Hannes; Shehu, Bora; Haberlandt, Uwe; Lorenz, Manuel; Wagner, Sven; Kunstmann, Harald; Müller, Thomas; Mosthaf, Tobias; Bárdossy, András

    2015-04-01

    For the design and operation of urban drainage systems with numerical simulation models, long, continuous precipitation time series with high temporal resolution are necessary. Suitable observed time series are rare. As a result, intelligent design concepts often use uncertain or unsuitable precipitation data, which renders them uneconomic or unsustainable. An expedient alternative to observed data is the use of long, synthetic rainfall time series as input for the simulation models. Within the project SYNOPSE, several different methods to generate synthetic precipitation data for urban drainage modelling are advanced, tested, and compared. The presented study compares four different approaches of precipitation models regarding their ability to reproduce rainfall and runoff characteristics. These include one parametric stochastic model (alternating renewal approach), one non-parametric stochastic model (resampling approach), one downscaling approach from a regional climate model, and one disaggregation approach based on daily precipitation measurements. All four models produce long precipitation time series with a temporal resolution of five minutes. The synthetic time series are first compared to observed rainfall reference time series. Comparison criteria include event based statistics like mean dry spell and wet spell duration, wet spell amount and intensity, long term means of precipitation sum and number of events, and extreme value distributions for different durations. Then they are compared regarding simulated discharge characteristics using an urban hydrological model on a fictitious sewage network. First results show a principal suitability of all rainfall models but with different strengths and weaknesses regarding the different rainfall and runoff characteristics considered.

  2. Positive outcomes influence the rate and time to publication, but not the impact factor of publications of clinical trial results.

    PubMed

    Suñé, Pilar; Suñé, Josep Maria; Montoro, J Bruno

    2013-01-01

    Publication bias may affect the validity of evidence based medical decisions. The aim of this study is to assess whether research outcomes affect the dissemination of clinical trial findings, in terms of rate, time to publication, and impact factor of journal publications. All drug-evaluating clinical trials submitted to and approved by a general hospital ethics committee between 1997 and 2004 were prospectively followed to analyze their fate and publication. Published articles were identified by searching Pubmed and other electronic databases. Clinical study final reports submitted to the ethics committee, final reports synopses available online and meeting abstracts were also considered as sources of study results. Study outcomes were classified as positive (when statistical significance favoring experimental drug was achieved), negative (when no statistical significance was achieved or it favored control drug) and descriptive (for non-controlled studies). Time to publication was defined as time from study closure to publication. A survival analysis was performed using a Cox regression model to analyze time to publication. Journal impact factors of identified publications were recorded. Publication rate was 48·4% (380/785). Study results were identified for 68·9% of all completed clinical trials (541/785). Publication rate was 84·9% (180/212) for studies with results classified as positive and 68·9% (128/186) for studies with results classified as negative (p<0·001). Median time to publication was 2·09 years (IC95 1·61-2·56) for studies with results classified as positive and 3·21 years (IC95 2·69-3·70) for studies with results classified as negative (hazard ratio 1·99 (IC95 1·55-2·55). No differences were found in publication impact factor between positive (median 6·308, interquartile range: 3·141-28·409) and negative result studies (median 8·266, interquartile range: 4·135-17·157). Clinical trials with positive outcomes have significantly higher rates and shorter times to publication than those with negative results. However, no differences have been found in terms of impact factor.

  3. Gabapentin for chronic neuropathic pain and fibromyalgia in adults

    PubMed Central

    Moore, R Andrew; Wiffen, Philip J; Derry, Sheena; McQuay, Henry J

    2014-01-01

    Background This review updates parts of two earlier Cochrane reviews investigating effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage pain, predominantly for chronic neuropathic pain, especially when the pain is lancinating or burning. Objectives To evaluate the analgesic effectiveness and adverse effects of gabapentin for chronic neuropathic pain management. Search methods We identified randomised trials of gabapentin in acute, chronic or cancer pain from MEDLINE, EMBASE, and CENTRAL. We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources. The date of the most recent search was January 2011. Selection criteria Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain with assessment of pain intensity and/or pain relief, using validated scales. Participants were adults aged 18 and over. Data collection and analysis Two review authors independently extracted data. We calculated numbers needed to treat to benefit (NNTs), concentrating on IMM-PACT (Initiative on Methods, Measurement and Pain Assessment in Clinical Trials) definitions of at least moderate and substantial benefit, and to harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. Main results Twenty-nine studies (3571 participants), studied gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 78% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. Using the IMMPACT definition of at least moderate benefit, gabapentin was superior to placebo in 14 studies with 2831 participants, 43% improving with gabapentin and 26% with placebo; the NNT was 5.8 (4.8 to 7.2). Using the IMMPACT definition of substantial benefit, gabapentin was superior to placebo in 13 studies with 2627 participants, 31% improving with gabapentin and 17% with placebo; the NNT was 6.8 (5.6 to 8.7). These estimates of efficacy are more conservative than those reported in a previous review. Data from few studies and participants were available for other painful conditions. Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin can expect to have at least one adverse event (66%), withdraw because of an adverse event (12%), suffer dizziness (21%), somnolence (16%), peripheral oedema (8%), and gait disturbance (9%). Serious adverse events (4%) were no more common than with placebo. There were insufficient data for comparisons with other active treatments. Authors’ conclusions Gabapentin provides pain relief of a high level in about a third of people who take if for painful neuropathic pain. Adverse events are frequent, but mostly tolerable. More conservative estimates of efficacy resulted from using better definitions of efficacy outcome at higher, clinically important, levels, combined with a considerable increase in the numbers of studies and participants available for analysis. PMID:21412914

  4. Gabapentin for chronic neuropathic pain and fibromyalgia in adults.

    PubMed

    Moore, R Andrew; Wiffen, Philip J; Derry, Sheena; McQuay, Henry J

    2011-03-16

    This review updates parts of two earlier Cochrane reviews investigating effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage pain, predominantly for chronic neuropathic pain, especially when the pain is lancinating or burning. To evaluate the analgesic effectiveness and adverse effects of gabapentin for chronic neuropathic pain management. We identified randomised trials of gabapentin in acute, chronic or cancer pain from MEDLINE, EMBASE, and CENTRAL. We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources. The date of the most recent search was January 2011. Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain with assessment of pain intensity and/or pain relief, using validated scales. Participants were adults aged 18 and over. Two review authors independently extracted data. We calculated numbers needed to treat to benefit (NNTs), concentrating on IMMPACT (Initiative on Methods, Measurement and Pain Assessment in Clinical Trials) definitions of at least moderate and substantial benefit, and to harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. Twenty-nine studies (3571 participants), studied gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 78% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. Using the IMMPACT definition of at least moderate benefit, gabapentin was superior to placebo in 14 studies with 2831 participants, 43% improving with gabapentin and 26% with placebo; the NNT was 5.8 (4.8 to 7.2). Using the IMMPACT definition of substantial benefit, gabapentin was superior to placebo in 13 studies with 2627 participants, 31% improving with gabapentin and 17% with placebo; the NNT was 6.8 (5.6 to 8.7). These estimates of efficacy are more conservative than those reported in a previous review. Data from few studies and participants were available for other painful conditions.Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin can expect to have at least one adverse event (66%), withdraw because of an adverse event (12%), suffer dizziness (21%), somnolence (16%), peripheral oedema (8%), and gait disturbance (9%). Serious adverse events (4%) were no more common than with placebo.There were insufficient data for comparisons with other active treatments. Gabapentin provides pain relief of a high level in about a third of people who take if for painful neuropathic pain. Adverse events are frequent, but mostly tolerable. More conservative estimates of efficacy resulted from using better definitions of efficacy outcome at higher, clinically important, levels, combined with a considerable increase in the numbers of studies and participants available for analysis.

  5. Medicine at the crossroads. Part II. Summary of completed project

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

    NONE

    1998-05-01

    Medicine at the crossroads (a.k.a. The Future of Medicine) is an 8-part series of one-hour documentaries which examines the scientific and social forces that have shaped the practice of medicine around the world. The series was developed and produced over a five-year period and in eleven countries. Among the major issues examined in the series are the education of medical practitioners and the communication of medical issues. The series also considers the dilemmas of modern medicine, including the treatment of the elderly and the dying, the myth of the quick fix in the face of chronic and incurable diseases suchmore » as HIV, and the far-reaching implications of genetic treatments. Finally, the series examines the global progress made in medical research and application, as well as the questions remaining to be answered. These include not only scientific treatment, but accessibility and other critical topics affecting the overall success of medical advances. Medicine at the crossroads is a co-production of Thirteen/WNET and BBC-TV in association with Television Espafiola SA (RTVE) and the Australian Broadcasting Corporation. Stefan Moore of Thirteen/WNET and Martin Freeth of BBC-TV are series producers. George Page is executive in charge of medicine at the crossroads. A list of scholarly advisors and a program synopses is attached.« less

  6. Abrupt Impacts of Climate Change: Anticipating Surprises

    NASA Astrophysics Data System (ADS)

    White, James W. C.; Alley, Richard B.; Archer, David E.; Barnosky, Anthony D.; Dunlea, Edward; Foley, Jonathan; Fu, Rong; Holland, Marika M.; Lozier, M. Susan; Schmitt, Johanna; Smith, Laurence C.; Sugihara, George; Thompson, David W. J.; Weaver, Andrew J.; Wofsy, Steven C.

    2014-05-01

    Levels of carbon dioxide and other greenhouse gases in Earth's atmosphere are exceeding levels recorded in the past millions of years, and thus climate is being forced beyond the range of the recent geological era. Lacking concerted action by the world's nations, it is clear that the future climate will be warmer, sea levels will rise, global rainfall patterns will change, and ecosystems will be altered. However, there is still uncertainty about how we will arrive at that future climate state. Although many projections of future climatic conditions have predicted steadily changing conditions giving the impression that communities have time to gradually adapt, the scientific community has been paying increasing attention to the possibility that at least some changes will be abrupt, perhaps crossing a threshold or "tipping point" to change so quickly that there will be little time to react. This presentation will synopsize the new US National Research Council Report, Abrupt Impacts of Climate Change: Anticipating Surprises, highlighting areas of increased and decreased concern, as well as areas of new concern. Emphasis is placed on not only abrupt change in physical climate, but on abrupt changes in human and natural systems that can occur as a result of a slowly changing climate. The report calls for action now on an abrupt change early warning system (ACEWS) if societies are to be resilient to climate change.

  7. Geoengineering properties of potential repository units at Yucca Mountain, southern Nevada

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

    Tillerson, J.R.; Nimick, F.B.

    1984-12-01

    The Nevada Nuclear Waste Storage Investigations (NNWSI) Project is currently evaluating volcanic tuffs at the Yucca Mountain site, located on and adjacent to the Nevada Test Site, for possible use as a host rock for a radioactive waste repository. The behavior of tuff as an engineering material must be understood to design, license, construct, and operate a repository. Geoengineering evaluations and measurements are being made to develop confidence in both the analysis techniques for thermal, mechanical, and hydrothermal effects and the supporting data base of rock properties. The analysis techniques and the data base are currently used for repository design,more » waste package design, and performance assessment analyses. This report documents the data base of geoengineering properties used in the analyses that aided the selection of the waste emplacement horizon and in analyses synopsized in the Environmental Assessment Report prepared for the Yucca Mountain site. The strategy used for the development of the data base relies primarily on data obtained in laboratory tests that are then confirmed in field tests. Average thermal and mechanical properties (and their anticipated variations) are presented. Based upon these data, analyses completed to date, and previous excavation experience in tuff, it is anticipated that existing mining technology can be used to develop stable underground openings and that repository operations can be carried out safely.« less

  8. Measurement realities of current collection in dynamic space plasma environments

    NASA Technical Reports Server (NTRS)

    Szuszczewicz, Edward P.

    1990-01-01

    Theories which describe currents collected by conducting and non-conducting bodies immersed in plasmas have many of their concepts based upon the fundamentals of sheath-potential distributions and charged-particle behavior in superimposed electric and magnetic fields. Those current-collecting bodies (or electrodes) may be Langmuir probes, electric field detectors, aperture plates on ion mass spectrometers and retarding potential analyzers, or spacecraft and their rigid and tethered appendages. Often the models are incomplete in representing the conditions under which the current-voltage characteristics of the electrode and its system are to be measured. In such cases, the experimenter must carefully take into account magnetic field effects and particle anisotropies, perturbations caused by the current collection process itself and contamination on electrode surfaces, the complexities of non-Maxwellian plasma distributions, and the temporal variability of the local plasma density, temperature, composition and fields. This set of variables is by no means all-inclusive, but it represents a collection of circumstances guaranteed to accompany experiments involving energetic particle beams, plasma discharges, chemical releases, wave injection and various events of controlled and uncontrolled spacecraft charging. Here, an attempt is made to synopsize these diagnostic challenges and frame them within a perspective that focuses on the physics under investigation and the requirements on the parameters to be measured. Examples include laboratory and spaceborne applications, with specific interest in dynamic and unstable plasma environments.

  9. The 7 ka pollen record of Akovitika: Key evidence for environmental change and human impact in the SW Peloponnese, Greece

    NASA Astrophysics Data System (ADS)

    Engel, M.; Knipping, M.; Brückner, H.; Kraft, J. C.; Kiderlen, M.

    2009-04-01

    Detailed investigations on the Holocene stratigraphy of the lower Messenian plain (SW Peloponnese, Greece) carried out within the framework of a geoarchaeological study on the Protogeometric Poseidon Sanctuary of Akovitika indicate significant shoreline fluctuations during Holocene times. Sedimentary, geochemical, mineralogical, and microfossil analyses of 18 vibracores document a maximum landward shoreline displacement around 3000 BC. Subsequently, increased sediment loads entering the gulf predominantly at the eastern head overcompensated the decelerating eustatic sea level rise and triggered beach ridge progradation. Synopses of adjacent sediment cores reveal extended wetland formation in the swales between the sand ridges throughout the Holocene. The swamp areas enlarged continuously during the late Holocene marine regression and persisted until the large-scaled implementation of drainage measures in the 20th century. However, the strata representing former wetland environments provide excellently preserved pollen assemblages and enable detailed vegetation reconstruction of certain time windows within the past 7000 years. During early Neolithic times the lower Messenian plain was covered with open vegetation adapted to the seasonal standing water bodies. Deciduous oak forests were abundant but restricted to the surrounding marl terraces while no signs of human impact appear in the pollen record so far. In mid- to late Neolithic times initial modification of the local vegetation composition is evident. The Neogene terraces nearby were still covered with forest, albeit Pinus and evergreen oak gradually started replacing deciduous oak. Anthropogenic influence on the vegetation was moderate although the upper part of the sequence (approx. 3500 BC) contains increasing amounts of settlement indicators. Exceptionally high percentages of Erica and Cistus as well as of charcoal fragments point to extensive burning of woodland and subsequent sustained establishment of a heliophile macchia vegetation. Whether this is man-made or a result of increasing aridity remains uncertain. Agriculture can be excluded for the wet lower Messenian plain in Neolithic times, while it seems possible on the adjacent Neogene marl terraces. The pollen sequence of Submycenaean to Archaic times reflects reduced human impact after the Messenian late Bronze Age population climax. Decreasing amounts of Olea show the abandonment of olive orchards while rising dominance of Phyllirea indicates a temporary re-establishment of high macchia during the cultural decline of the Dark Ages. Higher percentages of Olea in the uppermost sample document a recovering human population in Messenia during Archaic times.

  10. Biological Consequences and Health Risks Of Low-Level Exposure to Ionizing Radiation: Commentary on the Workshop

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

    Feinendegen, Ludwig E.; Brooks, Antone L.; Morgan, William F.

    2011-03-01

    This paper provides an integration and discussion of the information presented at the workshop held from May 2 to 5, 2010, in Richland, WA, adjacent to the Pacific Northwest National Laboratory (PNNL). Consequently, this is commentary and not necessarily a consensus document. This workshop was in honor of Dr. Victor P. Bond in celebration of his numerous contributions to the radiation sciences. Internationally recognized experts in biophysics, experimental radiation biology, epidemiology, and risk assessment were invited to discuss all issues of low-dose risk. This included the physics of track structure and its consequences to dosimetry, primary and secondary responses atmore » the molecular, cellular, and tissue biology levels, epidemiology, definitions of risk, and the practical and regulatory applications of these issues including their biomedical and social consequences. Of major concern was the present state of knowledge about cancer risk and other risks in humans following intentional or accidental exposures to low doses and low dose-rates of ionizing radiation (below about 100 mSv accumulated dose). This includes low dose exposures which occur during radiation therapy in tissues located outside of the irradiated volume. The interdisciplinary approach of this workshop featured discussions rather than formal presentations in ten separate consecutive sessions. Each session was led by chairpersons, listed in the opening of the workshop, which introduced topics, facts and posed relevant questions. The content of each session is given by a brief summary followed by the abstracts from the primary discussants in the session as has been presented in the previous section. This manuscript provides additional review and discussion of the sessions and tracks the topics and issues discussed as follows: • Energy deposition through particle tracks in tissues. • Energy deposition and primary effects in tissues. • Consequences of experimental advances in radiobiology • Non-targeted radiation effects. • System biological considerations. • Propagation of perturbations in the system. • Immediately operating protections. • Delayed stress response protections • Low-dose induced adaptive protections. • Integrated defenses against cancer. • Endogenous versus radiogenic cancer. • The epidemiological dilemma. • Dose-risk functions for different exposure modalities. • Implications for research. • Implications for regulation and protection. A brief summary of the discussions and results on each of these topics and issues is presented in this paper. Additional details of these discussions are provided in the workshop session summaries grouped into topics and followed by applicable abstracts/synopses submitted by the workshop participants.« less

  11. Theory testing in prehistoric North America: fruits of one of the world's great archeological natural laboratories.

    PubMed

    Bingham, Paul M; Souza, Joanne

    2013-01-01

    This paper has several interconnected goals. First and most generally, we will review the project represented by the papers in this dedicated issue and the SAA Symposium (2012) on Social Complexity and the Bow. This project centers on the ever-stronger and broader theory testing now becoming feasible in archeology and anthropology, in this case exploiting the unique natural laboratory represented by what we refer to as the North American Neolithic transitions. Second, we will strive to synopsize the papers in this issue as opportunities to falsify two general theories of the cause of increases in social complexity associated with the North American Neolithic: warfare and social coercion theories.(1) We argue that, though much work remains to be done, the current evidence supports one of the central predictions of both these theories, that the local arrival of elite bow technology was a central driver of local transitions to increased social complexity. This conclusion, if ultimately verified, has profound implications for the possibility of general theories of history. Third, we will argue that several important details of this evidence falsify warfare theory and support (fail to falsify) social coercion theory (the authors' favored perspective). Moreover, several potential falsifications of social coercion theory are amenable to alternative interpretations, leading to new falsifiable predictions. Finally, we discuss how interactions with our colleagues in this project produced new insights into several details of the predictions of social coercion theory, improving our interpretative capacity. Copyright © 2013 Wiley Periodicals, Inc.

  12. Synopsis on Managment Strategies for Neurodegenerative Disorders: Challenges from Bench to Bedside in Successful Drug Discovery and Development.

    PubMed

    Bhat, Sheraz Ahmad; Kamal, Mohammad Amjad; Yarla, Nagendra Sastry; Ashraf, Ghulam Md

    2017-01-01

    The maintenance of health requires successful cell functioning, which in turn depends upon the proper and active conformation of proteins besides other biomolecules. However, occasionally these proteins may misfold and lead to the appearance and progression of protein conformational diseases. These diseases apart from others include several neurodegenerative disorders (NDDs) such as Alzheimer's disease, Parkinson disease, Huntington's disease, multiple sclerosis, amyotrophic lateral sclerosis, and other lesser known diseases. Although much knowledge has been gained, these NDDs still warrant advance research in the elucidation of their mechanisms as well as effective therapeutic interventions and proper management. There is an ever-growing and urgent need to improve the diagnosis and management of NDDs due to their devastating nature, serious social impact and neuropsychiatric symptoms. It is also envisioned that we may be able to encourage, develop, and strengthen the cell defenses against amyloid toxicity and prevent neuronal destruction and consequently neurodegeneration. In this review, the implications of protein misfolding and aggregation in NDDs are discussed along with some of the most recent findings on the curative and beneficial effects of natural molecules such as polyphenols. This paper also reviews the anti-aggregation and protective effects of some organic and peptidic compounds duly supported experimentally, as prospective future therapeutics for NDDs. The synopses presented in this review shall prove helpful in further understanding of the causes, cures and management of lethal NDDs. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  13. Pharmaceutical companies' policies on access to trial data, results, and methods: audit study.

    PubMed

    Goldacre, Ben; Lane, Síle; Mahtani, Kamal R; Heneghan, Carl; Onakpoya, Igho; Bushfield, Ian; Smeeth, Liam

    2017-07-26

    Objectives  To identify the policies of major pharmaceutical companies on transparency of trials, to extract structured data detailing each companies' commitments, and to assess concordance with ethical and professional guidance. Design  Structured audit. Setting  Pharmaceutical companies, worldwide. Participants  42 pharmaceutical companies. Main outcome measures  Companies' commitments on sharing summary results, clinical study reports (CSRs), individual patient data (IPD), and trial registration, for prospective and retrospective trials. Results  Policies were highly variable. Of 23 companies eligible from the top 25 companies by revenue, 21 (91%) committed to register all trials and 22 (96%) committed to share summary results; however, policies commonly lacked timelines for disclosure, and trials on unlicensed medicines and off-label uses were only included in six (26%). 17 companies (74%) committed to share the summary results of past trials. The median start date for this commitment was 2005. 22 companies (96%) had a policy on sharing CSRs, mostly on request: two committed to share only synopses and only two policies included unlicensed treatments. 22 companies (96%) had a policy to share IPD; 14 included phase IV trials (one included trials on unlicensed medicines and off-label uses). Policies in the exploratory group of smaller companies made fewer transparency commitments. Two companies fell short of industry body commitments on registration, three on summary results. Examples of contradictory and ambiguous language were documented and summarised by theme. 23/42 companies (55%) responded to feedback; 7/1806 scored policy elements were revised in light of feedback from companies (0.4%). Several companies committed to changing policy; some made changes immediately. Conclusions  The commitments made by companies to transparency of trials were highly variable. Other than journal submission for all trials within 12 months, all elements of best practice were met by at least one company, showing that these commitments are realistic targets. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Extreme Weather and Climate: Workshop Report

    NASA Technical Reports Server (NTRS)

    Sobel, Adam; Camargo, Suzana; Debucquoy, Wim; Deodatis, George; Gerrard, Michael; Hall, Timothy; Hallman, Robert; Keenan, Jesse; Lall, Upmanu; Levy, Marc; hide

    2016-01-01

    Extreme events are the aspects of climate to which human society is most sensitive. Due to both their severity and their rarity, extreme events can challenge the capacity of physical, social, economic and political infrastructures, turning natural events into human disasters. Yet, because they are low frequency events, the science of extreme events is very challenging. Among the challenges is the difficulty of connecting extreme events to longer-term, large-scale variability and trends in the climate system, including anthropogenic climate change. How can we best quantify the risks posed by extreme weather events, both in the current climate and in the warmer and different climates to come? How can we better predict them? What can we do to reduce the harm done by such events? In response to these questions, the Initiative on Extreme Weather and Climate has been created at Columbia University in New York City (extreme weather.columbia.edu). This Initiative is a University-wide activity focused on understanding the risks to human life, property, infrastructure, communities, institutions, ecosystems, and landscapes from extreme weather events, both in the present and future climates, and on developing solutions to mitigate those risks. In May 2015,the Initiative held its first science workshop, entitled Extreme Weather and Climate: Hazards, Impacts, Actions. The purpose of the workshop was to define the scope of the Initiative and tremendously broad intellectual footprint of the topic indicated by the titles of the presentations (see Table 1). The intent of the workshop was to stimulate thought across disciplinary lines by juxtaposing talks whose subjects differed dramatically. Each session concluded with question and answer panel sessions. Approximately, 150 people were in attendance throughout the day. Below is a brief synopsis of each presentation. The synopses collectively reflect the variety and richness of the emerging extreme event research agenda.

  15. Flood characteristics of urban watersheds in the United States

    USGS Publications Warehouse

    Sauer, Vernon B.; Thomas, W.O.; Stricker, V.A.; Wilson, K.V.

    1983-01-01

    A nationwide study of flood magnitude and frequency in urban areas was made for the purpose of reviewing available literature, compiling an urban flood data base, and developing methods of estimating urban floodflow characteristics in ungaged areas. The literature review contains synopses of 128 recent publications related to urban floodflow. A data base of 269 gaged basins in 56 cities and 31 States, including Hawaii, contains a wide variety of topographic and climatic characteristics, land-use variables, indices of urbanization, and flood-frequency estimates. Three sets of regression equations were developed to estimate flood discharges for ungaged sites for recurrence intervals of 2, 5, 10, 25, 50, 100, and 500 years. Two sets of regression equations are based on seven independent parameters and the third is based on three independent parameters. The only difference in the two sets of seven-parameter equations is the use of basin lag time in one and lake and reservoir storage in the other. Of primary importance in these equations is an independent estimate of the equivalent rural discharge for the ungaged basin. The equations adjust the equivalent rural discharge to an urban condition. The primary adjustment factor, or index of urbanization, is the basin development factor, a measure of the extent of development of the drainage system in the basin. This measure includes evaluations of storm drains (sewers), channel improvements, and curb-and-gutter streets. The basin development factor is statistically very significant and offers a simple and effective way of accounting for drainage development and runoff response in urban areas. Percentage of impervious area is also included in the seven-parameter equations as an additional measure of urbanization and apparently accounts for increased runoff volumes. This factor is not highly significant for large floods, which supports the generally held concept that imperviousness is not a dominant factor when soils become more saturated during large storms. Other parameters in the seven-parameter equations include drainage area size, channel slope, rainfall intensity, lake and reservoir storage, and basin lag time. These factors are all statistically significant and provide logical indices of basin conditions. The three-parameter equations include only the three most significant parameters: rural discharge, basin-development factor, and drainage area size. All three sets of regression equations provide unbiased estimates of urban flood frequency. The seven-parameter regression equations without basin lag time have average standard errors of regression varying from ? 37 percent for the 5-year flood to ? 44 percent for the 100-year flood and ? 49 percent for the 500-year flood. The other two sets of regression equations have similar accuracy. Several tests for bias, sensitivity, and hydrologic consistency are included which support the conclusion that the equations are useful throughout the United States. All estimating equations were developed from data collected on drainage basins where temporary in-channel storage, due to highway embankments, was not significant. Consequently, estimates made with these equations do not account for the reducing effect of this temporary detention storage.

  16. Probiotics for preventing urinary tract infections in adults and children.

    PubMed

    Schwenger, Erin M; Tejani, Aaron M; Loewen, Peter S

    2015-12-23

    Urinary tract infection (UTI) is a common bacterial infection that can lead to significant morbidity including stricture, abscess formation, fistula, bacteraemia, sepsis, pyelonephritis and kidney dysfunction. Mortality rates are reported to be as high as 1% in men and 3% in women due to development of pyelonephritis. Because probiotic therapy is readily available without a prescription, a review of their efficacy in the prevention of UTI may aid consumers in making informed decisions about potential prophylactic therapy. Institutions and caregivers also need evidence-based synopses of current evidence to make informed patient care decisions. Compared to placebo or no therapy, did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality, when used to prevent UTI in susceptible patient populations?Compared to other prophylactic interventions, including drug and non-drug measures (e.g. continuous antibiotic prophylaxis, topical oestrogen, cranberry juice), did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality when used to prevent UTIs in susceptible patient populations? We searched the Cochrane Kidney and Transplant Specialised Register to 21 September 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) of susceptible patients (e.g. past history of UTI) or healthy people in which any strain, formulation, dose or frequency of probiotic was compared to placebo or active comparators were included. All RCTs and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) looking at comparing probiotics to no therapy, placebo, or other prophylactic interventions were included. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes. We included nine studies that involved 735 people in this review. Four studies compared probiotic with placebo, two compared probiotic with no treatment, two compared probiotics with antibiotics in patients with UTI, and one study compared probiotic with placebo in healthy women. All studies aimed to measure differences in rates of recurrent UTI.Our risk of bias assessment found that most studies had small sample sizes and reported insufficient methodological detail to enable robust assessment. Overall, there was a high risk of bias in the included studies which lead to inability to draw firm conclusions and suggesting that any reported treatment effects may be misleading or represent overestimates.We found no significant reduction in the risk of recurrent symptomatic bacterial UTI between patients treated with probiotics and placebo (6 studies, 352 participants: RR 0.82, 95% CI 0.60 to 1.12; I(2) = 23%) with wide confidence intervals, and statistical heterogeneity was low. No significant reduction in the risk of recurrent symptomatic bacterial UTI was found between probiotic and antibiotic treated patients (1 study, 223 participants: RR 1.12, 95% CI 0.95 to 1.33).The most commonly reported adverse effects were diarrhoea, nausea, vomiting, constipation and vaginal symptoms. None of the included studies reported numbers of participants with at least one asymptomatic bacterial UTI, all-cause mortality or those with at least one confirmed case of bacteraemia or fungaemia. Two studies reported study withdrawal due to adverse events and the number of participants who experienced at least one adverse event. One study reported withdrawal occurred in six probiotic participants (5.2%), 15 antibiotic participants (12.2%), while the second study noted one placebo group participant discontinued treatment due to an adverse event. No significant benefit was demonstrated for probiotics compared with placebo or no treatment, but a benefit cannot be ruled out as the data were few, and derived from small studies with poor methodological reporting.There was limited information on harm and mortality with probiotics and no evidence on the impact of probiotics on serious adverse events. Current evidence cannot rule out a reduction or increase in recurrent UTI in women with recurrent UTI who use prophylactic probiotics. There was insufficient evidence from one RCT to comment on the effect of probiotics versus antibiotics.

  17. Proterometra epholkos sp. n. (Digenea: Azygiidae) from Terrapin Creek, Alabama, USA: molecular characterization of life cycle, redescription of Proterometra albacauda, and updated lists of host and geographic locality records for Proterometra spp. in North America.

    PubMed

    Womble, Matthew R; Orélis-Ribeiro, Raphael; Bullard, Stephen A

    2015-02-01

    Proterometra epholkos sp. n. asexually reproduces in the stream dwelling prosobranch, Elimia cf. modesta (Cerithioidea: Pleuroceridae) and infects the buccal cavity epithelium of spotted bass, Micropterus punctulatus (Perciformes: Centrarchidae) in the Coosa River (Terrapin Creek; N33°51'36.56″, W85°31'28.15″; Cleburne County, Alabama, USA). We characterize cercariae and adults of the new species using morphology and molecular sequence data and redescribe its morphologically similar congener Proterometra albacauda based on the holotype and paratype (USNPC Nos. 61229-30). The new species can be distinguished most easily from P. albacauda by the combination of having cercariae with long mamillae (>100μm) that encircle the tail stem anteriorly, that are restricted to 1 lateral column per body margin at midbody, and that are absent from the medial surface of the tail stem as well as by having adults with a partly extracecal uterus, a transverse metraterm occupying the space between the oral sucker and prostatic sac, and a vitellarium that is longer than the ceca and extends anteriad to the level of or beyond the posterior margin of the oral sucker. Sequence data from the ribosomal internal transcribed spacer 2 (ITS2; 251bp) did not reject the notion that the cercariae and adults we collected simultaneously from those infected, sympatric, individual snails and fish in Terrapin Creek were conspecific. Also provided herein for species of Proterometra are (i) taxonomic keys for cercariae and adults based on morphological and behavioral characteristics sourced from the published literature, (ii) updated lists of host records (prosobranchs and fishes) and geographic locality records for Proterometra spp., and (iii) synopses and assessments of the morphological features previously used to differentiate them. Proterometra macrostoma (type species), Proterometra melanophora, and Proterometra hodgesiana are species inquirendae; requiring new collections from type localities and hosts concomitant with neotype designations. P. macrostoma seems a repository for conspicuous, furcocystocercous cercariae shed from freshwater prosobranchs in eastern North American rivers and streams. The specific epithet "pinguis" associated with specimens purportedly infecting Esox lucius and deposited by JF Mueller is a nomen nudum. Proterometra guangzhouensis, Proterometra sillagae, Proterometra brachyuran, and Proterometra lamellorchis are incertae sedis. Significant barriers to characterizing biodiversity and distributions (host range and geographic distribution) of Proterometra spp. comprise a paucity of data on adult morphology, dubious species-level identification or a lack of information regarding prosobranch hosts, lack of molecular data for putative comparisons among fluke 'strains' and species as well as between cercariae and adults, lack of consistency in terminology, and indeterminate homology for key morphological features. Uncertainty about the providence and identity of, or absence of, accessioned museum materials of P. macrostoma, Proterometra catenaria, and P. hodgesiana together represent another fundamental problem. The present study comprises the first description of a new species of Proterometra in nearly 20years, first report of a species of the genus from the Coosa River (Mobile-Tensaw River Basin) and from these host species, and first use of molecular sequence data to elucidate a life cycle for a species of Proterometra. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

    PubMed

    Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

    2017-06-22

    The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta-algorithm illustrates a superordinate process that permanently keeps the entire patient in view. The meta-algorithm represents the back bone of the multimorbidity guideline of the German College of General Practitioners and Family Physicians. This article presents solely the development phase; the meta-algorithm needs to be piloted before it can be implemented. © 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.

  19. Race and Association With Disease Manifestations and Mortality in Scleroderma

    PubMed Central

    Manno, Rebecca L.; Shah, Ami A.; Woods, Adrianne; Le, Elizabeth N.; Boin, Francesco; Hummers, Laura K.; Wigley, Fredrick M.

    2013-01-01

    Abstract Experience suggests that African Americans may express autoimmune disease differently than other racial groups. In the context of systemic sclerosis (scleroderma), we sought to determine whether race was related to a more adverse expression of disease. Between January 1, 1990, and December 31, 2009, a total of 409 African American and 1808 white patients with scleroderma were evaluated at a single university medical center. While the distribution by sex was virtually identical in both groups, at 82% female, African American patients presented to the center at a younger mean age than white patients (47 vs. 53 yr; p < 0.001). Two-thirds of white patients manifested the limited cutaneous subset of disease, whereas the majority of African American patients manifested the diffuse cutaneous subset (p < 0.001). The proportion seropositive for anticentromere antibody was nearly 3-fold greater among white patients, at 34%, compared to African American patients (12%; p < 0.001). Nearly a third of African American (31%) patients had autoantibodies to topoisomerase, compared to 19% of white patients (p = 0.001). Notably, African American patients experienced an increase in prevalence of cardiac (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3–2.2), renal (OR, 1.6; 95% CI, 1.2–2.1), digital ischemia (OR, 1.5; 95% CI, 1.4–2.2), muscle (OR, 1.7; 95% CI, 1.3–2.3), and restrictive lung (OR, 6.9; 95% CI, 5.1–9.4) disease. Overall, 700 (32%) patients died (159 African American; 541 white). The cumulative incidence of mortality at 10 years was 43% among African American patients compared to 35% among white patients (log-rank p = 0.0011). Compared to white patients, African American patients experienced an 80% increase in risk of mortality (relative risk [RR], 1.8; 95% CI, 1.4–2.2), after adjustment for age at disease onset and disease duration. Further adjustment by sex, disease subtype, and scleroderma-specific autoantibody status, and for the socioeconomic measures of educational attainment and health insurance status, diminished these risk estimates (RR, 1.3; 95% CI, 1.0–1.6). The heightened risk of mortality persisted in strata defined by age at disease onset, diffuse cutaneous disease, anticentromere seropositivity, decade of care at the center, and among women. These findings support the notion that race is related to a distinct phenotypic profile in scleroderma, and a more unfavorable prognosis among African Americans, warranting heightened diagnostic evaluation and vigilant care of these patients. Further, we provide a chronologic review of the literature regarding race, organ system involvement, and mortality in scleroderma; we furnish synopses of relevant reports, and summarize findings. PMID:23793108

  20. Race and association with disease manifestations and mortality in scleroderma: a 20-year experience at the Johns Hopkins Scleroderma Center and review of the literature.

    PubMed

    Gelber, Allan C; Manno, Rebecca L; Shah, Ami A; Woods, Adrianne; Le, Elizabeth N; Boin, Francesco; Hummers, Laura K; Wigley, Fredrick M

    2013-07-01

    Experience suggests that African Americans may express autoimmune disease differently than other racial groups. In the context of systemic sclerosis (scleroderma), we sought to determine whether race was related to a more adverse expression of disease. Between January 1, 1990, and December 31, 2009, a total of 409 African American and 1808 white patients with scleroderma were evaluated at a single university medical center. While the distribution by sex was virtually identical in both groups, at 82% female, African American patients presented to the center at a younger mean age than white patients (47 vs. 53 yr; p < 0.001). Two-thirds of white patients manifested the limited cutaneous subset of disease, whereas the majority of African American patients manifested the diffuse cutaneous subset (p < 0.001). The proportion seropositive for anticentromere antibody was nearly 3-fold greater among white patients, at 34%, compared to African American patients (12%; p < 0.001). Nearly a third of African American (31%) patients had autoantibodies to topoisomerase, compared to 19% of white patients (p = 0.001). Notably, African American patients experienced an increase in prevalence of cardiac (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-2.2), renal (OR, 1.6; 95% CI, 1.2-2.1), digital ischemia (OR, 1.5; 95% CI, 1.4-2.2), muscle (OR, 1.7; 95% CI, 1.3-2.3), and restrictive lung (OR, 6.9; 95% CI, 5.1-9.4) disease. Overall, 700 (32%) patients died (159 African American; 541 white). The cumulative incidence of mortality at 10 years was 43% among African American patients compared to 35% among white patients (log-rank p = 0.0011). Compared to white patients, African American patients experienced an 80% increase in risk of mortality (relative risk [RR], 1.8; 95% CI, 1.4-2.2), after adjustment for age at disease onset and disease duration. Further adjustment by sex, disease subtype, and scleroderma-specific autoantibody status, and for the socioeconomic measures of educational attainment and health insurance status, diminished these risk estimates (RR, 1.3; 95% CI, 1.0-1.6). The heightened risk of mortality persisted in strata defined by age at disease onset, diffuse cutaneous disease, anticentromere seropositivity, decade of care at the center, and among women. These findings support the notion that race is related to a distinct phenotypic profile in scleroderma, and a more unfavorable prognosis among African Americans, warranting heightened diagnostic evaluation and vigilant care of these patients. Further, we provide a chronologic review of the literature regarding race, organ system involvement, and mortality in scleroderma; we furnish synopses of relevant reports, and summarize findings.

  1. Connecting the dots: a collaborative USGS-NPS effort to expand the utility of monitoring data

    USGS Publications Warehouse

    Grace, James B.; Schoolmaster, Donald R.; Schweiger, E. William; Mitchell, Brian R.; Miller, Kathryn; Guntenspergen, Glenn R.

    2014-01-01

    The Natural Resource Challenge (National Park Service 1999) was a call to action. It constituted a mandate for monitoring based on the twin premises that (1) natural resources in national parks require active management and stewardship if we are to protect them from gradual degradation, and (2) we cannot protect what we do not understand. The intent of the challenge was embodied in its original description: We must expand existing inventory programs and develop efficient ways to monitor the vital signs of natural systems. We must enlist others in the scientific community to help, and also facilitate their inquiry. Managers must have and apply this information to preserve our natural resources. In this article, we report on ongoing collaborative work between the National Park Service (NPS) and the US Geological Survey (USGS) that seeks to add to our scientific understanding of the ecological processes operating behind vital signs monitoring data. The ultimate goal of this work is to provide insights that can facilitate an understanding of the systems and identify potential opportunities for active stewardship by NPS managers (Bennetts et al. 2007; Mitchell et al. 2014). The bulk of the work thus far has involved Acadia and Rocky Mountain national parks, but there are plans for extending the work to additional parks. Our story stats with work designed to consider ways of assessing the status and condition of natural resources and the potential for historical or ongoing influences of human activities. In the 1990s, the concept of "biotic integrity" began to take hold as an aspiration for developing quantitative indices describing how closely the conditions at a site resemble those found at pristine, unimpacted sites. Quantitative methods for developing indices of biotic integrity (IBIs) and elaborations of that idea (e.g., ecological integrity) have received considerable attention and application of these methods to natural resources has become widespread (Karr 1991; Barbour et al. 1999; Stoddard et al. 2008). Despite widespread use, many questions remain about how metrics are combined to form effective indices and about how to interpret both. Scientists and natural resource specialists within NPS and USGS have joined forces to critique the current analysis methods, with the collaboration involving the Rocky Mountain and Northeast Temperate NPS Inventory and Monitoring (I & M) networks, along with others, and USGS scientists from the National Wetlands Research Center and Patuxent Wildlife Research Center. Funding that initiated the project was from a joint-partnership fund managed by the USGS Ecosystems Program for National Park Monitoring research and the work was focused at Acadia National Park and Rocky Mountain National Park. Here we present synopses of two major issues addressed by the group.

  2. New pathways to physics instruction: Blending a MOOC and in-person discussion to train physics graduate students and postdocs in evidence-based teaching

    NASA Astrophysics Data System (ADS)

    Goldberg, Bennett

    A challenge facing physics education is how to encourage and support the adoption of evidence-based instructional practices that decades of physics education research has shown to be effective. Like many STEM departments, physics departments struggle to overcome the barriers of faculty knowledge, motivation and time; institutional cultures and reward systems; and disciplinary traditions. Research has demonstrated successful transformation of department-level approaches to instruction through local learning communities, in-house expertise, and department administrative support. In this talk, I will discuss how physics and other STEM departments can use a MOOC on evidence-based instruction together with in-person seminar discussions to create a learning community of graduate students and postdocs, and how such communities can affect departmental change in teaching and learning. Four university members of the 21-university network working to prepare future faculty to be both excellent researchers and excellent teachers collaborated on an NSF WIDER project to develop and deliver two massive open online courses (MOOCs) in evidence-based STEM instruction. A key innovation is a new blended mode of delivery where groups of participants engaged with the online content and then meet weekly in local learning communities to discuss content, communicate current experiences, and delve deeper into particular techniques of local interest. The MOOC team supported these so-called MOOC-Centered Learning Communities, or MCLCs, with detailed facilitator guides complete with synopses of online content, learning goals and suggested activities for in-person meetings, as well as virtual MCLC communities for sharing and feedback. In the initial run of the first MOOC, 40 MCLCs were created; in the second run this past fall, more than 80 MCLCs formed. Further, target audiences of STEM graduate students and postdocs completed at a 40-50% rate, indicating the value they place in building their knowledge in evidence-based instruction. We will present data on the impact of being in an MCLC on completion and learning outcomes, as well as data on departmental change in physics supported by MCLCs. Work supported by NSF DUE-1347605.

  3. ARFI-based tissue elasticity quantification and kidney graft dysfunction: first clinical experiences.

    PubMed

    Stock, K F; Klein, B S; Cong, M T Vo; Regenbogen, C; Kemmner, S; Büttner, M; Wagenpfeil, S; Matevossian, E; Renders, L; Heemann, U; Küchle, C

    2011-01-01

    Beyond the medical history, the clinical exam and lab findings, non-invasive ultrasound parameters such as kidney size and Doppler values (e.g. the resistive index) are important tools assisting clinical decision making in the monitoring of renal allografts. The gold standard for the diagnosis of renal allograft dysfunction remains the renal biopsy; while an invasive procedure, the justifiable necessity for this derives from its definitive nature a requirement beyond the synopses of all non-invasive tools. "Acoustic Radiation Force Impulse Imaging"(ARFI)-quantification is a novel ultrasound-based technology measuring tissue elasticity properties. So far experience related to this new method has not been reported in renal transplant follow-up. The purpose of this study was to evaluate changes in ARFI-measurements between clinically stable renal allografts and biopsy-proven transplant dysfunction. We employed "Virtual Touch™ tissue quantification" (Siemens Acuson, S2000) for the quantitative measurement of tissue stiffness in the cortex of transplant kidneys. We performed initial baseline and later disease-evaluative ultrasound examinations in 8 renal transplant patients in a prospective study design. Patients were first examined during stable allograft function with a routine post-transplant renal ultrasound protocol. A second follow-up examination was carried out on subsequent presentation with transplant dysfunction prior to allograft biopsy and histological evaluation. All patiens were examined using ARFI-quantification (15 measurements/kidney). Resistive indices (RI) were calculated using pulsed-wave Doppler ultrasound, and transplant kidney size was measured on B-mode ultrasound images. All biopsies were evaluated histologically by a reference nephropathologist unaware of the results of the ultrasound studies. Histopathological diagnoses were based on biopsy results, taking clinical and laboratory findings into account. Finally we calculated the relative changes in ARFI-quantification, resistive indices and the absolute change of kidney size on a percentage basis at these defined assessment times and compared the results with the final pathologic diagnosis. Histological results enumerated five cases of acute T-cell-mediated rejection, one case of calcineurin inhibitor toxicity and two cases of acute tubular necrosis. Calcineurin inhibitor toxicity and acute tubular necrosis were subsumed as "other pathologies". Mean ARFI-values showed an average increase of more than 15% percent in transplants with histologically proven acute rejection whereas no increase was seen in transplants with other pathologies. Mean RI-values showed no increase either in the diagnostic group of acute rejection, nor in the group with other pathologies. Kidney size showed a mean absolute increase of 0.5 centimetres in allografts with acute rejection, whereas a mean decrease of 0.17 centimetres was seen in the group with other pathologies. As shown before in other studies, RI values and kidney size are of doubtful utility in the evaluation of kidney allograft dysfunction. ARFI-based elasticity measurement shows promise as a complementary non-invasive parameter in follow-on diagnosis of renal allograft rejection.

  4. Great Lakes prey fish populations: a cross-basin overview of status and trends based on bottom trawl surveys, 1978-2013

    USGS Publications Warehouse

    Gorman, Owen T.; Weidel, Brian C.

    2014-01-01

    The assessment of Great Lakes prey fish stocks have been conducted annually with bottom trawls since the 1970s by the Great Lakes Science Center, sometimes assisted by partner agencies. These stock assessments provide data on the status and trends of prey fish that are consumed by important commercial and recreational fishes. Although all these annual surveys are conducted using bottom trawls, they differ among the lakes in the proportion of the lake covered, seasonal timing, trawl gear used, and the manner in which the trawl is towed (across or along bottom contours). Because each assessment is unique, population indices were standardized to the highest value for a time series within each lake for the following prey species: Cisco (Coregonus artedi), Bloater (C. hoyi), Rainbow Smelt (Osmerus mordax), Alewife (Alosa pseudoharengus), and Round Goby (Neogobius melanostomus). In this report, standardized indices are presented in graphical form along with synopses to provide a short, informal cross-basin summary of the status and trends of principal prey fishes. There was basin-wide agreement in the trends of age-1 and older biomass for all prey species, with the highest concordance occurring for coregonids and Rainbow Smelt, and weaker concordance for Alewife. For coregonids, the highest biomass occurred from the mid-1980s to the mid-1990s. Rainbow Smelt biomass declined slowly and erratically during the last quarter century. Alewife biomass was generally higher from the early 1980s through 1990s across the Great Lakes, but since the early 1990s, trends have been divergent across the lakes, though there has been a downward trend in all lakes since 2005. Recently, Lake Huron has shown resurgence in biomass of Bloater, achieving 75% of its maximum record in 2012 due to recruitment of a succession of strong and moderate year classes that appeared in 2005-2011. Also, strong recruitment of the 2010 year class of Alewife has led to a sharp increase in biomass of Alewife in Lake Michigan. In general, trends in year-class strengths were less concordant across the basin and only coregonids showed statistical agreement across the upper Great Lakes. The appearance of strong and moderate year-classes of Bloater in Lake Huron in 2005- 2011 countered the trend of continuing weak year-classes of coregonids in Lakes Michigan and Superior. Not shown in our analysis is the appearance of the 2013 year-class of Bloater in Huron, the largest to date. There was no agreement in cross-basin trends in year-class strengths for Rainbow Smelt and Alewife, although there was agreement between pairs of lakes. Although there was statistical agreement in trends of age-0 and older Round Goby biomass among lakes where this species has successfully invaded (Michigan, Huron, Erie and Ontario), temporal patterns of biomass in each lake were different. Round Goby may be approaching equilibrium in Lake Erie, peaking in Lake Huron, and expanding in Lake Michigan. The trend in Lake Ontario remains unclear. Declining abundance in Lake Erie has corresponded with evidence that Round Goby have become increasingly incorporated into piscivore diets, e.g., Lake Trout, Walleye, Smallmouth Bass, Yellow Perch, and Burbot in Lakes Michigan, Huron, Erie, and Ontario. Round Goby continue to be absent from spring bottom trawl assessments in Lake Superior, but their presence in the harbors and embayments of Duluth and Thunder Bay (U.S. Geological Survey and Ontario Ministry of Natural Resources, unpublished data), suggests that there is potential for future colonization.

  5. Mineral Commodity Summaries 2008

    USGS Publications Warehouse

    ,

    2008-01-01

    Each chapter of the 2008 edition of the U.S. Geological Survey (USGS) Mineral Commodity Summaries (MCS) includes information on events, trends, and issues for each mineral commodity as well as discussions and tabular presentations on domestic industry structure, Government programs, tariffs, 5-year salient statistics, and world production and resources. The MCS is the earliest comprehensive source of 2007 mineral production data for the world. More than 90 individual minerals and materials are covered by two-page synopses. National reserves and reserve base information for most mineral commodities found in this report, including those for the United States, are derived from a variety of sources. The ideal source of such information would be comprehensive evaluations that apply the same criteria to deposits in different geographic areas and report the results by country. In the absence of such evaluations, national reserves and reserve base estimates compiled by countries for selected mineral commodities are a primary source of national reserves and reserve base information. Lacking national assessment information by governments, sources such as academic articles, company reports, common business practice, presentations by company representatives, and trade journal articles, or a combination of these, serve as the basis for national reserves and reserve base information reported in the mineral commodity sections of this publication. A national estimate may be assembled from the following: historically reported reserves and reserve base information carried for years without alteration because no new information is available; historically reported reserves and reserve base reduced by the amount of historical production; and company reported reserves. International minerals availability studies conducted by the U.S. Bureau of Mines, before 1996, and estimates of identified resources by an international collaborative effort (the International Strategic Minerals Inventory) are the basis for some reserves and reserve base estimates. The USGS collects information about the quantity and quality of mineral resources but does not directly measure reserves, and companies or governments do not directly report reserves or reserve base to the USGS. Reassessment of reserves and reserve base is a continuing process and the intensity of this process differs for mineral commodities, countries, and time period. Abbreviations and units of measure, and definitions of selected terms used in the report, are in Appendix A and Appendix B, respectively. A resource/reserve classification for minerals, based on USGS Circular 831 (published with the U.S. Bureau of Mines) is Appendix C, and a directory of USGS minerals information country specialists and their responsibilities is Appendix D. The USGS continually strives to improve the value of its publications to users. Constructive comments and suggestions by readers of the MCS 2008 are welcomed.

  6. Literature and information related to the natural resources of the North Aleutian Basin of Alaska.

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

    Stull, E.A.; Hlohowskyj, I.; LaGory, K. E.

    The North Aleutian Basin Planning Area of the Minerals Management Service (MMS) is a large geographic area with significant natural resources. The Basin includes most of the southeastern part of the Bering Sea Outer Continental Shelf, including all of Bristol Bay. The area supports important habitat for a wide variety of species and globally significant habitat for birds and marine mammals, including several federally listed species. Villages and communities of the Alaska Peninsula and other areas bordering or near the Basin rely on its natural resources (especially commercial and subsistence fishing) for much of their sustenance and livelihood. The offshoremore » area of the North Aleutian Basin is considered to have important hydrocarbon reserves, especially natural gas. In 2006, the MMS released a draft proposed program, 'Outer Continental Shelf Oil and Gas Leasing Program, 2007-2012' and an accompanying draft programmatic environmental impact statement (EIS). The draft proposed program identified two lease sales proposed in the North Aleutian Basin in 2010 and 2012, subject to restrictions. The area proposed for leasing in the Basin was restricted to the Sale 92 Area in the southwestern portion. Additional EISs will be needed to evaluate the potential effects of specific lease actions, exploration activities, and development and production plans in the Basin. A full range of updated multidisciplinary scientific information will be needed to address oceanography, fate and effects of oil spills, marine ecosystems, fish, fisheries, birds, marine mammals, socioeconomics, and subsistence in the Basin. Scientific staff at Argonne National Laboratory were contracted to assist MMS with identifying and prioritizing information needs related to potential future oil and gas leasing and development activities in the North Aleutian Basin. Argonne focused on three related tasks: (1) identify and gather relevant literature published since 1996, (2) synthesize and summarize the literature, and (3) identify and prioritize remaining information needs. To assist in the latter task, MMS convened the North Aleutian Basin Information Status and Research Planning Meeting (the Planning Meeting) in Anchorage, Alaska, from November 28 through December 1, 2006. That meeting and its results are described in 'Proceedings of the North Aleutian Basin Information Status and Research Planning Meeting' (the Planning Meeting report)1. Citations for recent literature (1996-2006) to support an assessment of the impacts of oil and gas development on natural, cultural, and socioeconomic resources in the North Aleutian Basin were entered in a database. The database, a series of Microsoft Excel spreadsheets with links to many of the reference materials, was provided to MMS prior to the Planning Meeting and was made available for participants to use during the meeting. Many types of references were identified and collected from the literature, such as workshop and symposium proceedings, personal web pages, web pages of government and nongovernmental organizations, EISs, books and articles reporting research results, regulatory documents, technical reports, newspaper and newsletter articles, and theses and dissertations. The current report provides (1) a brief overview of the literature; (2) descriptions (in tabular form) of the databased references, including geographic area covered, topic, and species (where relevant); (3) synopses of the contents of the referenced documents and web pages; and (4) a full citation for each reference. At the Planning Meeting, subject matter experts with research experience in the North Aleutian Basin presented overviews of the area's resources, including oceanography, fish and shellfish populations, federal fisheries, commercial fishery economics, community socioeconomics, subsistence, seabirds and shorebirds, waterfowl, seals and sea lions, cetaceans, sea otters, and walruses. These presentations characterized the status of the resource, the current state of knowledge on the topic, and information needs related to an assessment of the effects of oil and gas development. An overview of each presentation and the presentation materials used at the meeting are provided in the Planning Meeting report. The reader should refer to that report as well as to the information presented in the current report for a more complete understanding of each resource.« less

  7. Gabapentin for chronic neuropathic pain and fibromyalgia in adults.

    PubMed

    Moore, R Andrew; Wiffen, Philip J; Derry, Sheena; Toelle, Thomas; Rice, Andrew S C

    2014-04-27

    This review is an update of a review published in 2011, itself a major update of previous reviews published in 2005 and 2000, investigating the effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage chronic neuropathic pain and fibromyalgia. To assess the analgesic efficacy and adverse effects of gabapentin in chronic neuropathic pain and fibromyalgia. We identified randomised trials of gabapentin for chronic neuropathic pain or fibromyalgia by searching the databases MEDLINE (1966 to March 2014), EMBASE (1980 to 2014 week 10), and CENTRAL in The Cochrane Library (Issue 3 of 12, 2014). We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources, and searched Clinicaltrials.gov. Searches were run originally in 2011 and the date of the most recent search was 17 March 2014. Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain or fibromyalgia with assessment of pain intensity, pain relief, or both, using validated scales. Participants were adults. Three review authors independently extracted efficacy and adverse event data, examined issues of study quality, and assessed risk of bias. We performed analysis using three tiers of evidence. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks duration, parallel design), second tier from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison, and third tier from data involving small numbers of participants that were considered very likely to be biased or used outcomes of limited clinical utility, or both.For efficacy, we calculated the number needed to treat to benefit (NNT), concentrating on at least 50% pain intensity reduction, and Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) definitions of at least moderate and substantial benefit. For harm we calculated number needed to treat for harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. We emphasised differences between conditions now defined as neuropathic pain, and other conditions like masticatory pain, complex regional painsyndrome type 1 (CRPS-1), and fibromyalgia. Seven new studies with 1919 participants were added. Another report (147 participants) provided results for a study already included, but which previously had no usable data. A further report (170 participants) used an experimental formulation of intrathecal gabapentin. Thirty-seven studies (5633 participants) studied oral gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 84% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. There was no first tier evidence.Second tier evidence for the outcome of at least 50% pain intensity reduction, considered valuable by patients with chronic pain, showed that gabapentin was significantly better than placebo in postherpetic neuralgia (34% gabapentin versus 21% placebo; NNT 8.0, 95% CI 6.0 to 12) and painful diabetic neuropathy (38% versus 21%, NNT 5.9, 95% CI 4.6 to 8.3). There was insufficient information in other pain conditions to reach any reliable conclusion. There was no obvious difference between standard gabapentin formulations and recently-introduced extended-release or gastro-retentive formulations, or between different doses of gabapentin.Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin could expect to have at least one adverse event (62%), withdraw because of an adverse event (11%), suffer dizziness (19%), somnolence (14%), peripheral oedema (7%), and gait disturbance (9%). Serious adverse events (3%) were no more common than with placebo.There were insufficient data for direct comparisons with other active treatments, and only third tier evidence for other painful conditions. There was no top tier evidence that was unequivocally unbiased. Second tier evidence, with potentially important residual biases, showed that gabapentin at doses of 1200 mg or more was effective for some people with some painful neuropathic pain conditions. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. About 35% achieved this degree of pain relief with gabapentin, compared with 21% for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief. Results might vary between different neuropathic pain conditions, and the amount of evidence for gabapentin in neuropathic pain conditions except postherpetic neuralgia and painful diabetic neuropathy, and in fibromyalgia, is very limited.The levels of efficacy found for gabapentin are consistent with those found for other drug therapies in postherpetic neuralgia and painful diabetic neuropathy.

  8. Liposomal bupivacaine infiltration at the surgical site for the management of postoperative pain.

    PubMed

    Hamilton, Thomas W; Athanassoglou, Vassilis; Mellon, Stephen; Strickland, Louise H; Trivella, Marialena; Murray, David; Pandit, Hemant G

    2017-02-01

    Despite multi-modal analgesic techniques, acute postoperative pain remains an unmet health need, with up to three quarters of people undergoing surgery reporting significant pain. Liposomal bupivacaine is an analgesic consisting of bupivacaine hydrochloride encapsulated within multiple, non-concentric lipid bi-layers offering a novel method of sustained-release analgesia. To assess the analgesic efficacy and adverse effects of liposomal bupivacaine infiltration at the surgical site for the management of postoperative pain. On 13 January 2016 we searched CENTRAL, MEDLINE, MEDLINE In-Process, Embase, ISI Web of Science and reference lists of retrieved articles. We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources, and searched clinical trials databases for ongoing trials. Randomised, double-blind, placebo- or active-controlled clinical trials in people aged 18 years or over undergoing elective surgery, at any surgical site, were included if they compared liposomal bupivacaine infiltration at the surgical site with placebo or other type of analgesia. Two review authors independently considered trials for inclusion, assessed risk of bias, and extracted data. We performed data analysis using standard statistical techniques as described in the Cochrane Handbook for Systematic Reviews of Interventions, using Review Manager 5.3. We planned to perform a meta-analysis and produce a 'Summary of findings' table for each comparison however there were insufficient data to ensure a clinically meaningful answer. As such we have produced two 'Summary of findings' tables in a narrative format. Where possible we assessed the quality of evidence using GRADE. We identified nine studies (10 reports, 1377 participants) that met inclusion criteria. Four Phase II dose-escalating/de-escalating trials, designed to evaluate and demonstrate efficacy and safety, presented pooled data that we could not use. Of the remaining five parallel-arm studies (965 participants), two were placebo controlled and three used bupivacaine hydrochloride local anaesthetic infiltration as a control. Using the Cochrane tool, we judged most studies to be at unclear risk of bias overall; however, two studies were at high risk of selective reporting bias and four studies were at high risk of bias due to size (fewer than 50 participants per treatment arm).Three studies (551 participants) reported the primary outcome cumulative pain intensity over 72 hours following surgery. Compared to placebo, liposomal bupivacaine was associated with a lower cumulative pain score between the end of the operation (0 hours) and 72 hours (one study, very low quality). Compared to bupivacaine hydrochloride, two studies showed no difference for this outcome (very low quality evidence), however due to differences in the surgical population and surgical procedure (breast augmentation versus knee arthroplasty) we did not perform a meta-analysis.No serious adverse events were reported to be associated with the use of liposomal bupivacaine and none of the five studies reported withdrawals due to drug-related adverse events (moderate quality evidence).One study reported a lower mean pain score at 12 hours associated with liposomal bupivacaine compared to bupivacaine hydrochloride, but not at 24, 48 or 72 hours postoperatively (very low quality evidence).Two studies (382 participants) reported a longer time to first postoperative opioid dose compared to placebo (low quality evidence).Two studies (325 participants) reported the total postoperative opioid consumption over the first 72 hours: one study reported a lower cumulative opioid consumption for liposomal bupivacaine compared to placebo (very low quality evidence); one study reported no difference compared to bupivacaine hydrochloride (very low quality evidence).Three studies (492 participants) reported the percentage of participants not requiring postoperative opioids over initial 72 hours following surgery. One of the two studies comparing liposomal bupivacaine to placebo demonstrated a higher number of participants receiving liposomal bupivacaine did not require postoperative opioids (very low quality evidence). The other two studies, one versus placebo and one versus bupivacaine hydrochloride, found no difference in opioid requirement (very low quality evidence). Due to significant heterogeneity between the studies (I 2 = 92%) we did not pool the results.All the included studies reported adverse events within 30 days of surgery, with nausea, constipation and vomiting being the most common. Of the five parallel-arm studies, none performed or reported health economic assessments or patient-reported outcomes other than pain.Using GRADE, the quality of evidence ranged from moderate to very low. The major limitation was the sparseness of data for outcomes of interest. In addition, a number of studies had a high risk of bias resulting in further downgrading. Liposomal bupivacaine at the surgical site does appear to reduce postoperative pain compared to placebo, however, at present the limited evidence does not demonstrate superiority to bupivacaine hydrochloride. There were no reported drug-related serious adverse events and no study withdrawals due to drug-related adverse events. Overall due to the low quality and volume of evidence our confidence in the effect estimate is limited and the true effect may be substantially different from our estimate.

  9. Provider-to-Provider Electronic Communication in the Era of Meaningful Use: A Review of the Evidence

    PubMed Central

    Walsh, Colin; Siegler, Eugenia L; Cheston, Erin; O'Donnell, Heather; Collins, Sarah; Stein, Daniel; Vawdrey, David K.; Stetson, Peter D.

    2014-01-01

    Background Electronic communication between providers occurs daily in clinical practice but has not been well studied. Purpose To assess the impact of provider-to-provider electronic communication tools on communication and healthcare outcomes through literature review. Data sources OVID Medline, Pubmed, Google Scholar, CINAHL, and Academic Search Premier. Study Selection Publication in English language peer-reviewed journals. Studies provided quantitative provider-to-provider communication data, provider satisfaction statistics, or EHR communication data. Data Extraction Literature review. Data Synthesis Two reviewers conducted the title review to determine eligible studies from initial search results. Three reviewers independently reviewed titles, abstracts, and full text (where appropriate) against inclusion and exclusion criteria. Limitations Small number of eligible studies; few described trial design (20%). Homogeneous provider-type (physicians). English-only studies. Conclusions Of twenty-five included studies, all focused on physicians; most were observational (68%). Most (60%) described electronic specialist referral tools. Although overall use has been measured, there were no studies of the effectiveness of intra-EHR messaging. Literature describing the effectiveness of provider-to-provider electronic communications is sparse and narrow in scope. Complex care, such as that envisioned for the Patient Centered Medical Home, necessitates further research. PMID:24101544

  10. Provider responses to patients controlling access to their electronic health records: a prospective cohort study in primary care.

    PubMed

    Tierney, William M; Alpert, Sheri A; Byrket, Amy; Caine, Kelly; Leventhal, Jeremy C; Meslin, Eric M; Schwartz, Peter H

    2015-01-01

    Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data. We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' access to all data (diagnoses, medications, test results, reports, etc.) or only highly sensitive data (sexually transmitted infections, HIV/AIDS, drugs/alcohol, mental or reproductive health). Except for information in free-text reports, we redacted EHR data shown to providers according to patients' preferences. Providers could "break the glass" to display redacted information. We prospectively studied this system in one primary care clinic, noting redactions and when users "broke the glass," and surveyed providers about their experiences and opinions. Eight of nine eligible clinic physicians and all 23 clinic staff participated. All 105 patients who enrolled completed the preference program. Providers did not know which of their patients were enrolled, nor their preferences for accessing their EHRs. During the 6-month prospective study, 92 study patients (88 %) returned 261 times, during which providers viewed their EHRs 126 times (48 %). Providers "broke the glass" 102 times, 92 times for patients not in the study and ten times for six returning study patients, all of whom had restricted EHR access. Providers "broke the glass" for six (14 %) of 43 returning study patients with redacted data vs. zero among 49 study patients without redactions (p = 0.01). Although 54 % of providers agreed that patients should have control over who sees their EHR information, 58 % believed restricting EHR access could harm provider-patient relationships and 71 % felt quality of care would suffer. Patients frequently preferred restricting provider access to their EHRs. Providers infrequently overrode patients' preferences to view hidden data. Providers believed that restricting EHR access would adversely impact patient care. Applying Fair Information Practice principles to EHRs will require balancing patient preferences, providers' needs, and health care quality.

  11. Motivation and challenges for use of malaria rapid diagnostic tests among informal providers in Myanmar: a qualitative study.

    PubMed

    Sudhinaraset, May; Briegleb, Christina; Aung, Moe; Khin, Hnin Su Su; Aung, Tin

    2015-02-06

    Rapid diagnostic tests (RDTs) for malaria enable proper diagnosis and have been shown to reduce overuse of artemisinin combination therapy. Few studies have evaluated the feasibility and use of RDTs in the private sector in Myanmar. The objectives of the study were to: 1) understand the acceptability of using RDTs in the informal sector in Myanmar; 2) examine motivations for use among informal providers; and, 3) highlight decision-making and knowledge of providers for diagnostic testing and treatment. Qualitative interviews were conducted with 30 informal providers. Purposeful sampling was used to enrol study participants in the Mon and Shan State in Myanmar. All interviews were conducted in Burmese, translated into English, and two researchers coded all interviews using Atlas ti. Major themes identified included: 1) informal provider and outlet characteristics, including demographic and background characteristics; 2) the benefits and challenges of using RDTs according to providers; 3) provider experiences with using RDTs, including motivations for using the RDT; 4) adherence to test results, either positive or negative; and, 5) recommendations from informal providers to promote increased use of RDTs in their communities. This study found that introducing RDTs to informal providers in Myanmar was feasible, resulting in improved provider empowerment and patient-provider relationships. Specific challenges included facility infrastructure to use and dispose RDTs and provider knowledge. This varied across the type of informal provider, with itinerant drug vendors more comfortable and knowledgeable about RDTs compared to general retail sellers and medical drug representatives. This study found informal providers in Myanmar found the introduction of RDTs to be highly acceptable. Providers discussed improvement in service quality including provider empowerment and patient-provider relationships. The study also highlighted a number of challenges that informal providers face which may be used for future development of interventions.

  12. The perspective of healthcare providers and patients on health literacy: a systematic review of the quantitative and qualitative studies.

    PubMed

    Rajah, Retha; Ahmad Hassali, Mohamed Azmi; Jou, Lim Ching; Murugiah, Muthu Kumar

    2018-03-01

    Health literacy (HL) is a multifaceted concept, thus understanding the perspective of healthcare providers, patients, and the system is vital. This systematic review examines and synthesises the available studies on HL-related knowledge, attitude, practice, and perceived barriers. CINAHL and Medline (via EBSCOhost), Google Scholar, PubMed, ProQuest, Sage Journals, and Science Direct were searched. Both quantitative and/or qualitative studies in the English language were included. Intervention studies and studies focusing on HL assessment tools and prevalence of low HL were excluded. The risk of biasness reduced with the involvement of two reviewers independently assessing study eligibility and quality. A total of 30 studies were included, which consist of 19 quantitative, 9 qualitative, and 2 mixed-method studies. Out of 17 studies, 13 reported deficiency of HL-related knowledge among healthcare providers and 1 among patients. Three studies showed a positive attitude of healthcare providers towards learning about HL. Another three studies demonstrated patients feel shame exposing their literacy and undergoing HL assessment. Common HL communication techniques reported practiced by healthcare providers were the use of everyday language, teach-back method, and providing patients with reading materials and aids, while time constraint was the most reported HL perceived barriers by both healthcare providers and patients. Significant gaps exists in HL knowledge among healthcare providers and patients that needs immediate intervention. Such as, greater effort placed in creating a health system that provides an opportunity for healthcare providers to learn about HL and patients to access health information with taking consideration of their perceived barriers.

  13. Do Bedside Visual Tools Improve Patient and Caregiver Satisfaction? A Systematic Review of the Literature.

    PubMed

    Goyal, Anupama A; Tur, Komalpreet; Mann, Jason; Townsend, Whitney; Flanders, Scott A; Chopra, Vineet

    2017-11-01

    Although common, the impact of low-cost bedside visual tools, such as whiteboards, on patient care is unclear. To systematically review the literature and assess the influence of bedside visual tools on patient satisfaction. Medline, Embase, SCOPUS, Web of Science, CINAHL, and CENTRAL. Studies of adult or pediatric hospitalized patients reporting physician identification, understanding of provider roles, patient-provider communication, and satisfaction with care from the use of visual tools were included. Outcomes were categorized as positive, negative, or neutral based on survey responses for identification, communication, and satisfaction. Two reviewers screened studies, extracted data, and assessed the risk of study bias. Sixteen studies met the inclusion criteria. Visual tools included whiteboards (n = 4), physician pictures (n = 7), whiteboard and picture (n = 1), electronic medical record-based patient portals (n = 3), and formatted notepads (n = 1). Tools improved patients' identification of providers (13/13 studies). The impact on understanding the providers' roles was largely positive (8/10 studies). Visual tools improved patient-provider communication (4/5 studies) and satisfaction (6/8 studies). In adults, satisfaction varied between positive with the use of whiteboards (2/5 studies) and neutral with pictures (1/5 studies). Satisfaction related to pictures in pediatric patients was either positive (1/3 studies) or neutral (1/3 studies). Differences in tool format (individual pictures vs handouts with pictures of all providers) and study design (randomized vs cohort) may explain variable outcomes. The use of bedside visual tools appears to improve patient recognition of providers and patient-provider communication. Future studies that include better design and outcome assessment are necessary before widespread use can be recommended. © 2017 Society of Hospital Medicine

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

    PubMed Central

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

    2014-01-01

    Objective To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Materials and methods Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Results Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Conclusions Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case. PMID:24872341

  15. Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review.

    PubMed

    Luu, Ngoc-Phuong; Pitts, Samantha; Petty, Brent; Sawyer, Melinda D; Dennison-Himmelfarb, Cheryl; Boonyasai, Romsai Tony; Maruthur, Nisa M

    2016-04-01

    Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.

  16. Impact of provider-patient communication on cancer screening adherence: A systematic review.

    PubMed

    Peterson, Emily B; Ostroff, Jamie S; DuHamel, Katherine N; D'Agostino, Thomas A; Hernandez, Marisol; Canzona, Mollie R; Bylund, Carma L

    2016-12-01

    Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Promoting physical activity and health literacy: study protocol for a longitudinal, mixed methods evaluation of a cross-provider workplace-related intervention in Germany (The AtRisk study).

    PubMed

    Schaller, Andrea; Dejonghe, Lea; Alayli-Goebbels, Adrienne; Biallas, Bianca; Froboese, Ingo

    2016-07-22

    Physical activity and health literacy are topics of utmost importance in the prevention of chronic diseases. The present article describes the study protocol for evaluating a cross-provider workplace-related intervention promoting physical activity and health literacy. The RE-AIM Framework will be the conceptual framework of the AtRisk study. A controlled natural experiment and a qualitative study will be conducted. The cross-provider intervention is based on the cooperation of the German Pension Fund Rhineland and cooperating German Statutory Health Insurances. It combines two components: a behavior-oriented lifestyle intervention and the assignment of a health coach. The single-provider intervention only includes the behavior-oriented lifestyle intervention. The quantitative study (natural experiment) encompasses three measuring points (T0 = start of the behavior-oriented lifestyle intervention (baseline); T1 = end of the behavior-oriented lifestyle intervention (16 weeks); T2 = 6 month follow-up) and will compare the effectiveness of the cross-provider workplace-related intervention compared with the single provider intervention. Participants are employees with health related risk factors. ANCOVA will be used to evaluate the effect of the intervention on the outcome variables leisure time physical (primary outcome) activity and health literacy (secondary outcome). The qualitative study comprises semi-structured interviews, systematic field notes of stakeholder meetings and document analyses. The AtRisk study will contribute towards the claim for cross-provider interventions and workplace-related approaches described in the new Preventive Health Care Act. The results of this study will inform providers, payers and policy makers about the effectiveness of a cross-provider workplace-related lifestyle intervention compared to a single-provider intervention. Beyond, the study will identify challenges for implementing cross-provider preventive interventions. With respect to the sustainability of preventive interventions the AtRisk study will give insight in the expectations and needs on health coaching from the perspective of different stakeholders. DRKS00010693 .

  18. An explorative study of experiences of healthcare providers posing as simulated care receivers in a 'care-ethical' lab.

    PubMed

    Vanlaere, Linus; Timmermann, Madeleine; Stevens, Marleen; Gastmans, Chris

    2012-01-01

    In recent approaches to ethics, the personal involvement of health care providers and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab 'sTimul' was founded in Flanders, Belgium, to provide training that focuses on improving care providers' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at care providers' empathic skills. The present study provides better insight into how experiential learning specifically targets the empathic abilities of care providers. Providing contrasting experiences that affect the care providers' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour.

  19. Using Meta-Analysis to Inform the Design of Subsequent Studies of Diagnostic Test Accuracy

    ERIC Educational Resources Information Center

    Hinchliffe, Sally R.; Crowther, Michael J.; Phillips, Robert S.; Sutton, Alex J.

    2013-01-01

    An individual diagnostic accuracy study rarely provides enough information to make conclusive recommendations about the accuracy of a diagnostic test; particularly when the study is small. Meta-analysis methods provide a way of combining information from multiple studies, reducing uncertainty in the result and hopefully providing substantial…

  20. Anger, provider responses, and pain: prospective analysis of stem cell transplant patients.

    PubMed

    Gerhart, James I; Sanchez Varela, Veronica; Burns, John W; Hobfoll, Stevan E; Fung, Henry C

    2015-03-01

    Patient anger can be challenging for providers, and may hinder the patient-provider relationship. Research on the relationships among patient anger, relationships with health care providers and medical outcomes, however, has been limited to anecdotal accounts and cross-sectional studies. This study examined relationships among patient anger, perceptions of provider positive support and negative interactions, by prospectively studying a sample of stem cell transplant (SCT) patients. A prospective design was used to study patient anger, perceived positive support from providers and perceived negative interactions with providers among 88 SCT patients. Data were obtained upon patient's hospitalization before SCT and at 1, 2, and 3 month follow up periods. Repeated-measures mixed models assessed relationships among study variables. Patient anger was associated with a gradual decline in perceived positive support and higher levels of concurrent perceived negative interactions with providers. Further, a significant lagged relationship was found such that patient anger was associated with increased perceived negative interactions with providers 1 month later. Exploratory analyses revealed that perceived negative interactions were also associated with higher levels of physical distress. Perceived positive support buffered the relationship between patient anger and physical distress, such that anger was not associated significantly with physical distress when perceived provider support was high. Patient anger may contribute to a deterioration of the patient-provider relationship, and contribute to negative medical outcomes including physical distress. The association between patient anger and physical distress may be reduced by supportive providers. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  1. Quality of tuberculosis care in India: a systematic review.

    PubMed

    Satyanarayana, S; Subbaraman, R; Shete, P; Gore, G; Das, J; Cattamanchi, A; Mayer, K; Menzies, D; Harries, A D; Hopewell, P; Pai, M

    2015-07-01

    While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. We searched multiple sources to identify studies (2000-2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India.

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2017-07-01

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

  4. NACUBO Endowment Study, 1995.

    ERIC Educational Resources Information Center

    Cambridge Associates, Inc., Boston, MA.

    This report presents the results of the 1995 study of the performance and management of college and university endowments, based on 394 institutions providing data. A summary abstract provides an overview of performance and investment data; and Part 1 of the study provides a brief commentary covering endowment characteristics, historical…

  5. Lifeline: A Tool for Logistics Professionals

    DTIC Science & Technology

    2017-06-01

    proof of concept study is designed to provide a basic understanding of the Supply Corps community, provide a comparative analysis of the organizational...concept study is designed to provide a basic understanding of the Supply Corps community, provide a comparative analysis of the organizational...APPLICATION) ......................................................................................63  G.  DESIGN

  6. Constructions of provider role identity among African American men: an exploratory study.

    PubMed

    Diemer, Matthew A

    2002-02-01

    This exploratory study examined the identity constructions of African American men using a qualitative research methodology. Seven African American men, ranging in age from 20 to 47 years and whose education levels ranged from a 1st-year university student to a PhD, were interviewed for this study. Central to how all of these men defined themselves was the breadwinner or provider role. Participants emphasized education as "insurance" against discrimination and an awareness of educational and occupational opportunities. For these participants, education was a means of ensuring opportunity, which afforded fulfillment of the provider role. This study supports the work of N. Cazenave (1979, 1981), who demonstrated the salience of the provider role among African American men. The implications of the provider role among African American men for research are also discussed. The data also suggested diversity within the African American male experience. As 1 participant described African American men. "We come like flowers, you know. Some in bouquets, and some wild." By providing constructions of identity that diverge from existing negative stereotypes of African American men, this study attempted to deconstruct those stereotypes. Finally, this study provided a voice to an underrepresented group in the research literature.

  7. Market competition, ownership, payment systems and the performance of health care providers - a panel study among Finnish occupational health services providers.

    PubMed

    Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

    2013-10-01

    Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provider and prices are market determined. The price regulation of public providers was abolished in 1995. We had data on providers from 1992, 1995, 1997, 2000 and 2004. The unbalanced panel consisted of 1145 providers and 4059 observations. Our results show that in more competitive markets providers in general offered a higher share of medical care compared to preventive services. The association between unit prices and revenues and market environment varied according to the provider type. For-profit providers had lower prices and revenues in markets with numerous providers. The public providers in more competitive regions were more sensitive to react to the abolishment of their price regulation by raising their prices. Employer governed providers had weaker association between unit prices or revenues and competition. The market share of for-profit providers was negatively associated with productivity, which was the only sign of market spillovers we found in our study.

  8. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies.

    PubMed

    Rai, Sharan K; Choi, Hyon K; Choi, Sally H J; Townsend, Anne F; Shojania, Kam; De Vera, Mary A

    2018-04-17

    Gout care remains highly suboptimal, contributing to an increased global disease burden. To understand barriers to gout care, our aim was to provide a systematic review and thematic synthesis of qualitative studies worldwide reporting provider and patient perspectives and experiences with management. We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies of provider and patient perspectives on gout management. We used thematic synthesis to combine the included studies and identify key themes across studies. We included 20 studies that reported the experiences and perspectives of 480 gout patients and 120 providers spanning five different countries across three continents. We identified three predominant provider themes: knowledge gaps and management approaches; perceptions and beliefs about gout patients; and system barriers to optimal gout care (e.g. time constraints and a lack of incentives). We also identified four predominant themes among gout patients: limited gout knowledge; interactions with health-care providers; attitudes towards and experiences with taking medication; and practical barriers to long-term medication use. Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.

  9. Perceived improvement in integrated management of childhood illness implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania.

    PubMed

    Mitchell, Marc; Getchell, Maya; Nkaka, Melania; Msellemu, Daniel; Van Esch, Jan; Hedt-Gauthier, Bethany

    2012-01-01

    This study examined health care provider and caretaker perceptions of electronic Integrated Management of Childhood Illness (eIMCI) in diagnosing and treating childhood illnesses. The authors conducted semi-structured interviews among caretakers (n = 20) and health care providers (n = 11) in the Pwani region of Tanzania. This qualitative study was nested within a larger quantitative study measuring impact of eIMCI on provider adherence to IMCI protocols. Caretakers and health care workers involved in the larger study provided their perceptions of eIMCI in comparison with the conventional paper forms. One health care provider from each participating health center participated in qualitative interviews; 20 caretakers were selected from 1 health center involved in the quantitative study. Interviews were conducted in Swahili and lasted 5-10 min each. Providers expressed positive opinions of eIMCI, noting that the personal digital assistants were faster and easier to use than were the paper forms and encouraged adherence to IMCI procedures. Caretakers also held a positive view of eIMCI, noting improved service from providers, more thorough examination of their child, and a perception that providers who used the personal digital assistants were more knowledgeable. Research indicates widespread nonadherence to IMCI guidelines, suggesting improved methods for implementing IMCI are necessary. The authors conclude that eIMCI represents a promising method for improving health care delivery because it improves health care provider and caretaker perception of the clinical encounter. Further investigation into this technology is warranted.

  10. “Are you still driving?” Meta-synthesis of patient preferences for communication with healthcare providers

    PubMed Central

    Betz, Marian E.; Scott, Kenneth; Jones, Jacqueline; DiGuiseppi, Carolyn

    2015-01-01

    Aim To synthesize published qualitative studies to identify older adults’ preferences for communication about driving with healthcare providers. Background Healthcare providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their healthcare providers. Design Qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO and Web of Science) and grey literature. Review Methods 22 published studies representing 518 older adult drivers met the following inclusion criteria: (1) the study was about driving; (2) the study involved older drivers; (3) the study was qualitative (rather than quantitative or mixed methods); and (4) the study contained information on older drivers’ perspectives about communication with healthcare providers. Results We identified five major themes regarding older adults’ communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving. Conclusion Various stakeholders involved in older driver safety should consider older drivers’ perspectives regarding discussions about driving. Healthcare providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course. PMID:26507251

  11. Head Start Impact Study. Technical Report

    ERIC Educational Resources Information Center

    Puma, Michael; Bell, Stephen; Cook, Ronna; Heid, Camilla; Shapiro, Gary; Broene, Pam; Jenkins, Frank; Fletcher, Philip; Quinn, Liz; Friedman, Janet; Ciarico, Janet; Rohacek, Monica; Adams, Gina; Spier, Elizabeth

    2010-01-01

    This Technical Report is designed to provide technical detail to support the analysis and findings presented in the "Head Start Impact Study Final Report" (U.S. Department of Health and Human Services, January 2010). Chapter 1 provides an overview of the Head Start Impact Study and its findings. Chapter 2 provides technical information on the…

  12. Brokering Boundaries: Literacy Change Agents at Work

    ERIC Educational Resources Information Center

    VanDeusen-MacLeod, Elizabeth A.

    2009-01-01

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

  13. Adult Literacy: A Study of Community Based Literacy Programs. Revised and Updated. Volume II: Program Profiles.

    ERIC Educational Resources Information Center

    Association for Community Based Education, Washington, DC.

    This volume accompanies a study of community-based approaches to literacy education for adults. It provides profiles of 26 community-based educational institutions that provided study data. Each profile provides name, address, and telephone number; contact; other project sites; institutional description; mission/purpose; approach; skills…

  14. Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

    PubMed Central

    Asselin, Jodie; Salami, Eniola; Osunlana, Adedayo M.; Ogunleye, Ayodele A.; Cave, Andrew; Johnson, Jeffrey A.; Sharma, Arya M.; Campbell-Scherer, Denise L.

    2017-01-01

    Background: The 5As [Ask, Assess, Advise, Agree, Assist] of Obesity Management Team study was a randomized controlled trial of an intervention that was implemented and evaluated to help primary care providers improve clinical practice for obesity management. This paper presents health care provider perspectives of the impacts of the intervention on individual provider and team practices. Methods: This study reports a thematic network analysis of qualitative data collected during the 5As Team study, which involved 24 chronic disease teams affiliated with family practices in a Primary Care Network in Alberta. Qualitative data from 28 primary care providers (registered nurses/nurse practitioners [n = 14], dietitians [n = 7] and mental health workers [n = 7]) in the intervention arm were collected through semistructured interviews, field notes, practice facilitator diaries and 2 evaluation workshop questionnaires. Results: Providers internalized 5As Team intervention concepts, deepening self-evaluation and changing clinical reasoning around obesity. Providers perceived that this internalization changed the provider-patient relationship positively. The intervention changed relations between providers, increasing interdisciplinary understanding, collaboration and discovery of areas for improvement. This personal and interpersonal evolution effected change to the entire Primary Care Network. Interpretation: The 5As Team intervention had multiple impacts on providers and teams to improve obesity management in primary care. Improved provider confidence and capability is a precondition of developing effective patient interventions. Trial registration: ClinicalTrials.gov, no.: NCT01967797. PMID:28450428

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

    PubMed

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

    2018-01-01

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

  16. Doctors or mid-level providers for abortion.

    PubMed

    Barnard, Sharmani; Kim, Caron; Park, Min Hae; Ngo, Thoai D

    2015-07-27

    The World Health Organization recommends that abortion can be provided at the lowest level of the healthcare system. Training mid-level providers, such as midwives, nurses and other non-physician providers, to conduct first trimester aspiration abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion procedures. To assess the safety and effectiveness of abortion procedures administered by mid-level providers compared to doctors. We searched the CENTRAL Issue 7, MEDLINE and POPLINE databases for comparative studies of doctor and mid-level providers of abortion services. We searched for studies published in any language from January 1980 until 15 August 2014. Randomised controlled trials (RCTs) (clustered or not clustered), prospective cohort studies or observational studies that compared the safety or effectiveness (or both) of any type of first trimester abortion procedure, administered by any type of mid-level provider or doctors, were eligible for inclusion in the review. Two independent review authors screened abstracts for eligibility and double-extracted data from the included studies using a pre-tested form. We meta-analysed primary outcome data using both fixed-effect and random-effects models to obtain pooled risk ratios (RR) with 95% confidence intervals (CIs). We carried out separate analyses by study design (RCT or cohort) and type of abortion procedure (medical versus surgical). Eight studies involving 22,018 participants met our eligibility criteria. Five studies (n = 18,962) assessed the safety and effectiveness of surgical abortion procedures administered by mid-level providers compared to doctors. Three studies (n = 3056) assessed the safety and effectiveness of medical abortion procedures. The surgical abortion studies (one RCT and four cohort studies) were carried out in the United States, India, South Africa and Vietnam. The medical abortion studies (two RCTs and one cohort study) were carried out in India, Sweden and Nepal. The studies included women with gestational ages up to 14 weeks for surgical abortion and nine weeks for medical abortion.Risk of selection bias was considered to be low in the three RCTs, unclear in four observational studies and high in one observational study. Concealment bias was considered to be low in the three RCTs and high in all five observational studies. Although none of the eight studies performed blinding of the participants to the provider type, we considered the performance bias to be low as this is part of the intervention. Detection bias was considered to be high in all eight studies as none of the eight studies preformed blinding of the outcome assessment. Attrition bias was low in seven studies and high in one, with over 20% attrition. We considered six studies to have unclear risk of selective reporting bias as their protocols had not been published. The remaining two studies had published their protocols. Few other sources of bias were found.Based on an analysis of three cohort studies, the risk of surgical abortion failure was significantly higher when provided by mid-level providers than when procedures were administered by doctors (RR 2.25, 95% CI 1.38 to 3.68), however the quality of evidence for this outcome was deemed to be very low. For surgical abortion procedures, we found no significant differences in the risk of complications between mid-level providers and doctors (RR 0.99, 95% CI 0.17 to 5.70 from RCTs; RR 1.38, 95% CI 0.70 to 2.72 from observational studies). When we combined the data for failure and complications for surgical abortion we found no significant differences between mid-level providers and doctors in both the observational study analysis (RR 1.36, 95% CI 0.86 to 2.14) and the RCT analysis (RR 3.07, 95% CI 0.16 to 59.08). The quality of evidence of the outcome for RCT studies was considered to be low and for observational studies very low. For medical abortion procedures the risk of failure was not different for mid-level providers or doctors (RR 0.81, 95% CI 0.48 to 1.36 from RCTs; RR 1.09, 95% CI 0.63 to 1.88 from observational studies). The quality of evidence of this outcome for the RCT analysis was considered to be high, although the quality of evidence of the observational studies was considered to be very low. There were no complications reported in the three medical abortion studies. There was no statistically significant difference in the risk of failure for medical abortions performed by mid-level providers compared with doctors. Observational data indicate that there may be a higher risk of abortion failure for surgical abortion procedures administered by mid-level providers, but the number of studies is small and more robust data from controlled trials are needed. There were no statistically significant differences in the risk of complications for first trimester surgical abortions performed by mid-level providers compared with doctors.

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

    PubMed Central

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

    2014-01-01

    Objective To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care. PMID:25005598

  18. A systematic review of the extent and measurement of healthcare provider racism.

    PubMed

    Paradies, Yin; Truong, Mandy; Priest, Naomi

    2014-02-01

    Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism. This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism. The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study. The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed. Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

  19. Engineering practice variation through provider agreement: a cluster-randomized feasibility trial.

    PubMed

    McCarren, Madeline; Twedt, Elaine L; Mansuri, Faizmohamed M; Nelson, Philip R; Peek, Brian T

    2014-01-01

    Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning clusters (eg, providers) to "favor" a particular drug, with providers retaining autonomy for specific patients. Patient informed consent might be waived, broadening inclusion. However, it is not known if providers will adhere to the assignment or whether institutional review boards will waive consent. We evaluated the feasibility of this trial design. Agreeable providers were randomized to "favor" either hydrochlorothiazide or chlorthalidone when starting patients on thiazide-type therapy for hypertension. The assignment applied when the provider had already decided to start a thiazide, and providers could deviate from the strategy as needed. Prescriptions were aggregated to produce a provider strategy-adherence rate. All four institutional review boards waived documentation of patient consent. Providers (n=18) followed their assigned strategy for most of their new thiazide prescriptions (n=138 patients). In the "favor hydrochlorothiazide" group, there was 99% adherence to that strategy. In the "favor chlorthalidone" group, chlorthalidone comprised 77% of new thiazide starts, up from 1% in the pre-study period. When the assigned strategy was followed, dosing in the recommended range was 48% for hydrochlorothiazide (25-50 mg/day) and 100% for chlorthalidone (12.5-25.0 mg/day). Providers were motivated to participate by a desire to contribute to a comparative effectiveness study. A study promotional mug, provider information letter, and interactions with the site investigator were identified as most helpful in reminding providers of their study drug strategy. Providers prescribed according to an assigned drug-choice strategy most of the time for the purpose of a comparative effectiveness study. This simple design could facilitate research participation and behavior change in non-research clinicians. Waiver of patient consent can broaden the representation of patients, providers, and settings.

  20. Physician Perspectives on Providing Primary Medical Care to Adults with Autism Spectrum Disorders (ASD)

    ERIC Educational Resources Information Center

    Warfield, Marji Erickson; Crossman, Morgan K.; Delahaye, Jennifer; Der Weerd, Emma; Kuhlthau, Karen A.

    2015-01-01

    We conducted in-depth case studies of 10 health care professionals who actively provide primary medical care to adults with autism spectrum disorders. The study sought to understand their experiences in providing this care, the training they had received, the training they lack and their suggestions for encouraging more physicians to provide this…

  1. Social Studies: 1970; Instructional Objectives for Grades 1-8.

    ERIC Educational Resources Information Center

    Catholic School Board, Chicago, IL.

    The objectives of this curriculum guide for teachers are: 1) to provide a unified list of yearly instructional objectives for each social studies classroom; 2) to provide basic standards for measuring pupil progress; and 3) to provide a guide for the continuous development in the social studies. The recommendations for each grade level cover:…

  2. Providing Staff Training and Programming to Support People with Disabilities: An Academic Library Case Study

    ERIC Educational Resources Information Center

    Brannen, Michelle H.; Milewski, Steven; Mack, Thura

    2017-01-01

    This case study explores services academic libraries provide to students with disabilities and the impact these can have on the success and experience of these students. The study focuses on staff training and outreach programming. The authors examine the academic library literature surrounding these topics, provide examples of programming…

  3. Mediating Content Area Learning through the Use of Flip-Flop Study Guides.

    ERIC Educational Resources Information Center

    Chalmers, Lynne

    1995-01-01

    Students with learning disabilities may gain from use of "flip-flop" study guides to gain key vocabulary and concepts. Rather than providing definitions for terms, the student provides terms for definitions and concepts in the study guide. Such guides allow the teacher to focus on particular concepts and provide repetition of information for…

  4. Factors influencing private health providers' technical quality of care for acute respiratory infections among under-five children in rural West Bengal, India.

    PubMed

    Chakraborty, Sarbani; Frick, Kevin

    2002-11-01

    In many developing countries, private health practitioners provide a significant portion of curative care for diseases which are of public health importance. Currently, health sector reform efforts in these countries are fostering increased participation of private providers in the delivery of health services, including those of public health importance. Guaranteeing good technical quality of care is critical to the process. However, little is known about private providers' technical quality of care (disease management practices) and the factors influencing these services. The purpose of this study was to contribute information on this topic. The study was conducted among private providers in rural West Bengal, India and focused on providers' disease management practices for acute respiratory infections (ARI) among under-five children. World Health Organization (WHO) guidelines for ARI case management were used as the expected standard of care. Observations of patient-provider encounters and interviews with the providers and mothers were the main sources of data. The study found that private health providers in rural West Bengal have inadequate technical quality of care. The problem was related both to low levels of performance (limited potential) and inconsistency in performance (within-provider variation). Limited potential for good technical quality for ARI among the providers was related to lack of knowledge (technical incompetence). One of the important factors influencing within-provider variation was patient load. Since rural private providers operate on a fee-for-service payment system, there are incentives related to seeing many patients. The study concluded that to bring about sustainable improvements in private providers' ARI disease management practices, training programs and interventions that improved compliance were necessary.

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

    PubMed

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

    2014-07-08

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

  6. Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.

    PubMed

    Kennedy, C E; Yeh, P T; Johnson, C; Baggaley, R

    2017-12-01

    New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p < 0.001). In Malawi, a pre/post study showed increases in HTS sites and tests after delegation to lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (≥98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.

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

    PubMed

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

    2018-05-22

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

  8. Provider-parent Communication When Discussing Vaccines: A Systematic Review.

    PubMed

    Connors, John T; Slotwinski, Kate L; Hodges, Eric A

    Expert literature on communication practices with vaccine hesitant parents posits that a non-confrontational/participatory discussion with the parent would be the best approach to improve compliance. A prior literature review found limited evidence to recommend any particular face to face intervention other than to incorporate communication about vaccination effectiveness during an encounter. Hence, a systematic review was performed in an attempt to determine the most efficacious communication practices to use with parents with vaccination concerns. Quantitative and qualitative studies written in English that assessed the communication framework/style of the provider-parent interaction and studies where provider communication was listed as an intervention were reviewed. Nine articles were included in the sample. The majority of the studies were descriptive and qualitative in nature with only one randomized controlled trial. Five of the 9 studies utilized a descriptive cross-sectional design. Two main themes included message types recommended or given by the provider and message types that were requested by the parent. Overall, findings showed that there is currently not enough information to definitively state the type of provider-parent communication style that should be employed to affect the parents' vaccination viewpoint. However, recurring themes of trust in the provider and a personalized provider-parent interaction were evident, which promotes a participatory type of interaction. The literature indirectly supports providers engaging with vaccine hesitant parents in a more individualized, participatory format, though higher quality and more rigorous studies that focus specifically on provider-parent communication practices are needed. Published by Elsevier Inc.

  9. E-mail in patient–provider communication: A systematic review

    PubMed Central

    Ye, Jiali; Rust, George; Fry-Johnson, Yvonne; Strothers, Harry

    2014-01-01

    Objective To review systematically the role of e-mails in patient–provider communication in terms of e-mail content, and perspectives of providers and patients on e-mail communication in health care. Methods A systematic review of studies on e-mail communication between patients and health providers in regular health care published from 2000 to 2008. Results A total of 24 studies were included in the review. Among these studies, 21 studies examined e-mail communication between patients and providers, and three studies examined the e-mail communication between parents of patients in pediatric primary care and pediatricians. In the content analyses of e-mail messages, topics well represented were medical information exchange, medical condition or update, medication information, and subspecialty evaluation. A number of personal and institutional features were associated with the likelihood of e-mail use between patients and providers. While benefits of e-mails in enhancing communication were recognized by both patients and providers, concerns about confidentiality and security were also expressed. Conclusion The e-mail is transforming the relationship between patients and providers. The rigorous exploration of pros and cons of electronic interaction in health care settings will help make e-mail communication a more powerful, mutually beneficial health care provision tool. Practice implications It is important to develop an electronic communication system for the clinical practice that can address a range of concerns. More efforts need to be made to educate patients and providers to appropriately and effectively use e-mail for communication. PMID:19914022

  10. Provider communication about HPV vaccination: A systematic review

    PubMed Central

    Gilkey, Melissa B.; McRee, Annie-Laurie

    2016-01-01

    abstract Background. Improving HPV vaccination coverage in the US will require healthcare providers to recommend the vaccine more effectively. To inform quality improvement efforts, we systematically reviewed studies of provider communication about HPV vaccination. Methods. We searched MEDLINE, CINAHL, EMBASE, and POPLINE in August 2015 to identify studies of provider communication about HPV vaccination. Results. We identified 101 qualitative and quantitative studies. Providers less often recommended HPV vaccine if they were uncomfortable discussing sex, perceived parents as hesitant, or believed patients to be low risk. Patients less often received recommendations if they were younger, male, or from racial/ethnic minorities. Despite parents' preference for unambiguous recommendations, providers often sent mixed messages by failing to endorse HPV vaccine strongly, differentiating it from other vaccines, and presenting it as an “optional” vaccine that could be delayed. Conclusion. Interventions are needed to help providers deliver effective recommendations in the complex communication environment surrounding HPV vaccination. PMID:26838681

  11. Turning Electromyography Reports Upside Down: A Pilot Study Surveying Referring Providers

    PubMed Central

    Shenoy, Anant M.; Baquis, Kate G.; Baquis, George D.

    2016-01-01

    Providers are expressing a desire for more efficient ways to retrieve relevant clinical data from the Electronic Health Record. In an effort to improve our Electromyography and Nerve Conduction Study reports, we surveyed referring providers on the effects of having the IMPRESSION at the start of the report. Our survey respondents felt that using this format for an Electromyography and Nerve Conduction Study report significantly improved the quality of the report while saving them time and/or mouse clicks when interpreting the report. Electro diagnosticians might consider using this format for their Electromyography and Nerve Conduction Study reports to improve referring provider satisfaction. PMID:27708744

  12. Are Integrated Plan Providers Associated With Lower Premiums on the Health Insurance Marketplaces?

    PubMed

    La Forgia, Ambar; Maeda, Jared Lane K; Banthin, Jessica S

    2018-04-01

    As the health insurance industry becomes more consolidated, hospitals and health systems have started to enter the insurance business. Insurers are also rapidly acquiring providers. Although these "vertically" integrated plan providers are small players in the insurance market, they are becoming more numerous. The health insurance marketplaces (HIMs) offer a unique setting to study integrated plan providers relative to other insurer types because the HIMs were designed to promote competition. In this descriptive study, the authors compared the premiums of the lowest priced silver plans of integrated plan providers with other insurer types on the 2015 and 2016 HIMs. Integrated plan providers were associated with modestly lower premiums relative to most other insurer types. This study provides early insights into premium competition on the HIMs. Examining integrated plan providers as a separate insurer type has important policy implications because they are a growing segment of the marketplaces and their pricing behavior may influence future premium trends.

  13. Brief Mindfulness Practices for Healthcare Providers - A Systematic Literature Review.

    PubMed

    Gilmartin, Heather; Goyal, Anupama; Hamati, Mary C; Mann, Jason; Saint, Sanjay; Chopra, Vineet

    2017-10-01

    Mindfulness practice, where an individual maintains openness, patience, and acceptance while focusing attention on a situation in a nonjudgmental way, can improve symptoms of anxiety, burnout, and depression. The practice is relevant for health care providers; however, the time commitment is a barrier to practice. For this reason, brief mindfulness interventions (eg, ≤ 4 hours) are being introduced. We systematically reviewed the literature from inception to January 2017 about the effects of brief mindfulness interventions on provider well-being and behavior. Studies that tested a brief mindfulness intervention with hospital providers and measured change in well-being (eg, stress) or behavior (eg, tasks of attention or reduction of clinical or diagnostic errors) were selected for narrative synthesis. Fourteen studies met inclusion criteria; 7 were randomized controlled trials. Nine of 14 studies reported positive changes in levels of stress, anxiety, mindfulness, resiliency, and burnout symptoms. No studies found an effect on provider behavior. Brief mindfulness interventions may be effective in improving provider well-being; however, larger studies are needed to assess an impact on clinical care. Published by Elsevier Inc.

  14. Urban Ecology: Exploring Wildlife in the City.

    ERIC Educational Resources Information Center

    Malcarne, Vanessa

    1982-01-01

    Provides rationale for and examples of nature study activities using school yards, vacant lots, and city parks. Focusing on city wildlife, the interdisciplinary activities provide experiences in observing and investigating. Three duplicating masters (animals on ground, animals overhead, and tree study) are provided. (JN)

  15. Metropolitan transportation management center : a case study : Arizona Trailmaster : providing a safe and efficient travel environment for users

    DOT National Transportation Integrated Search

    1999-10-01

    The following case study provides a snapshot of Arizona's TrailMaster statewide transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross...

  16. Recommendations for designing and conducting veterinary clinical pathology biologic variation studies.

    PubMed

    Freeman, Kathleen P; Baral, Randolph M; Dhand, Navneet K; Nielsen, Søren Saxmose; Jensen, Asger L

    2017-06-01

    The recent creation of a veterinary clinical pathology biologic variation website has highlighted the need to provide recommendations for future studies of biologic variation in animals in order to help standardize and improve the quality of published information and to facilitate review and selection of publications as standard references. The following recommendations are provided in the format and order commonly found in veterinary publications. A checklist is provided to aid in planning, implementing, and evaluating veterinary studies on biologic variation (Appendix S1). These recommendations provide a valuable resource for clinicians, laboratorians, and researchers interested in conducting studies of biologic variation and in determining the quality of studies of biologic variation in veterinary laboratory testing. © 2017 American Society for Veterinary Clinical Pathology.

  17. Family planning providers' perspectives on family planning service delivery in Ibadan and Kaduna, Nigeria: a qualitative study.

    PubMed

    Hebert, Luciana Estelle; Schwandt, Hilary Megan; Boulay, Marc; Skinner, Joanna

    2013-01-01

    In Nigeria, fertility continues to be high and contraceptive prevalence remains low. This study was conducted in order to understand the perceptions of, experiences with and challenges of delivering family planning services in two urban areas of Nigeria from the perspectives of family planning service providers. A qualitative study using 59 in-depth interviews was conducted among family planning providers working in hospitals, primary health centres, clinics, pharmacies and patent medicine vendors in Ibadan and Kaduna, Nigeria. Providers support a mix of individuals and organisations involved in family planning provision, including the government of Nigeria. The Nigerian government's role can take a variety of forms, including providing promotional materials for family planning facilities as well as facilitating training and educational opportunities for providers, since many providers lack basic training in family planning provision. Providers often describe their motivation to provide in terms of the health benefits offered by family planning methods. Few providers engage in any marketing of their services and many providers exclude youth and unmarried individuals from their services. The family planning provider community supports a diverse network of providers, but needs further training and support in order to improve the quality of care and market their services. Adolescents, unmarried individuals and women seeking post-abortion care are vulnerable populations that providers need to be better educated about and trained in how to serve. The perspectives of providers should be considered when designing family planning interventions in urban areas of Nigeria.

  18. Recovery-promoting professional competencies: perspectives of mental health consumers, consumer-providers and providers.

    PubMed

    Russinova, Zlatka; Rogers, E Sally; Ellison, Marsha Langer; Lyass, Asya

    2011-01-01

    The purpose of this study was to empirically validate a set of conceptually derived recovery-promoting competencies from the perspectives of mental health consumers, consumer-providers and providers. A national sample of 603 consumers, 153 consumer-providers and 239 providers completed an anonymous survey via the Internet. The survey evaluated respondents' perceptions about a set of 37 competencies hypothesized to enhance clients' hope and empowerment and inquired about interactions with providers that enhanced clients' recovery process. We used descriptive statistics and ranking to establish the relevance of each competency and generalized linear models and post-hoc tests to examine differences in the consumers', consumer-providers' and providers' assessments of these competencies. Analyses confirmed the recovery relevance of several competencies and their relative importance within each group of study participants. They also revealed that while most competencies tended to have universal significance, others depended more strongly on the client's preferences. Finally, differences in the perceptions of consumers, consumer-providers and providers about the recovery relevance of these competencies were established. The study highlighted the crucial role practitioners play in enhancing recovery from serious mental illnesses through specific strategies and attitudes that acknowledge clients' personhood and foster their hopefulness, empowerment and illness management. It informed the development of a new instrument measuring providers' recovery-promoting competence and provides guidelines for sharpening the recovery focus of a wide range of mental health and rehabilitation services.

  19. Engaging with Quality Improvement Initiatives: A Descriptive Study of Learning in the Complex and Dynamic Context of Everyday Life for Family Child Care Providers

    ERIC Educational Resources Information Center

    Tonyan, Holli A.; Nuttall, Joce; Torres, Jeannette; Bridgewater, Jessie

    2017-01-01

    Research Findings: This article reports on family child care providers' views about their engagement with professional development programs, including providers who were and were not participating in Quality Rating and Improvement Systems in Los Angeles, California. Most providers participating in the study were taking active steps to improve…

  20. Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice.

    PubMed

    Aarons, Gregory A; Sommerfeld, David H; Walrath-Greene, Christine M

    2009-12-31

    The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in community settings.

  1. 2007 Wholesale Power Rate Case Initial Proposal : Wholesale Power Rate Development Study.

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

    United States. Bonneville Power Administration.

    The Wholesale Power Rate Development Study (WPRDS) calculates BPA proposed rates based on information either developed in the WPRDS or supplied by the other studies that comprise the BPA rate proposal. All of these studies, and accompanying documentation, provide the details of computations and assumptions. In general, information about loads and resources is provided by the Load Resource Study (LRS), WP-07-E-BPA-01, and the LRS Documentation, WP-07-E-BPA-01A. Revenue requirements information, as well as the Planned Net Revenues for Risk (PNNR), is provided in the Revenue Requirement Study, WP-07-E-BPA-02, and its accompanying Revenue Requirement Study Documentation, WP-07-E-BPA-02A and WP-07-E-BPA-02B. The Market Pricemore » Forecast Study (MPFS), WP-07-E-BPA-03, and the MPFS Documentation, WP-07-E-BPA-03A, provide the WPRDS with information regarding seasonal and diurnal differentiation of energy rates, as well information regarding monthly market prices for Demand Rates. In addition, this study provides information for the pricing of unbundled power products. The Risk Analysis Study, WP-07-E-BPA-04, and the Risk Analysis Study Documentation, WP-07-E-BPA-04A, provide short-term balancing purchases as well as secondary energy sales and revenue. The Section 7(b)(2) Rate Test Study, WP-07-E-BPA-06, and the Section 7(b)(2) Rate Test Study Documentation, WP-07-E-BPA-06A, implement Section 7(b)(2) of the Northwest Power Act to ensure that BPA preference customers firm power rates applied to their general requirements are no higher than rates calculated using specific assumptions in the Northwest Power Act.« less

  2. Non-legislative interventions for the promotion of cycle helmet wearing by children.

    PubMed

    Owen, Rachel; Kendrick, Denise; Mulvaney, Caroline; Coleman, Tim; Royal, Simon

    2011-11-09

    Helmets reduce bicycle-related head injuries, particularly in single vehicle crashes and those where the head strikes the ground. We aimed to identify non-legislative interventions for promoting helmet use among children, so future interventions can be designed on a firm evidence base. To assess the effectiveness of non-legislative interventions in increasing helmet use among children; to identify possible reasons for differences in effectiveness of interventions; to evaluate effectiveness with respect to social group; to identify adverse consequences of interventions. We searched the following databases: Cochrane Injuries Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO (Ovid); PsycEXTRA (Ovid); CINAHL (EBSCO); ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED); Social Sciences Citation Index (SSCI); Conference Proceedings Citation Index-Science (CPCI-S); and PubMed from inception to April 2009; TRANSPORT to 2007; and manually searched other sources of data. We included RCTs and CBAs. Studies included participants aged 0 to 18 years, described interventions promoting helmet use not requiring enactment of legislation and reported observed helmet wearing, self reported helmet ownership or self reported helmet wearing. Two independent review authors selected studies for inclusion and extracted data. We used random-effects models to estimate pooled odds ratios (ORs) (with 95% confidence interval (CI)). We explored heterogeneity with subgroup analyses. We included 29 studies in the review, 21 of which were included in at least one meta-analysis. Non-legislative interventions increased observed helmet wearing (11 studies: OR 2.08, 95% CI 1.29 to 3.34). The effect was most marked amongst community-based interventions (four studies: OR 4.30, 95% 2.24 to 8.25) and those providing free helmets (two studies: OR 4.35, 95% CI 2.13 to 8.89). Significant effects were also found amongst school-based interventions (eight studies: OR 1.73, CI 95% 1.03 to 2.91), with a smaller effect found for interventions providing education only (three studies: OR 1.43, 95% CI 1.09 to 1.88). No significant effect was found for providing subsidised helmets (seven studies: OR 2.02, 95% CI 0.98 to 4.17). Interventions provided to younger children (aged under 12) may be more effective (five studies: OR 2.50, 95% CI 1.17 to 5.37) than those provided to children of all ages (five studies: OR 1.83, 95% CI 0.98 to 3.42).Interventions were only effective in increasing self reported helmet ownership where they provided free helmets (three studies: OR 11.63, 95% CI 2.14 to 63.16).Interventions were effective in increasing self reported helmet wearing (nine studies: OR 3.27, 95% CI 1.56 to 6.87), including those undertaken in schools (six studies: OR 4.21, 95% CI 1.06 to 16.74), providing free helmets (three studies: OR 7.27, 95% CI 1.28 to 41.44), providing education only (seven studies: OR 1.93, 95% CI 1.03 to 3.63) and in healthcare settings (two studies: OR 2.78, 95% CI 1.38 to 5.61). Non-legislative interventions appear to be effective in increasing observed helmet use, particularly community-based interventions and those providing free helmets. Those set in schools appear to be effective but possibly less so than community-based interventions. Interventions providing education only are less effective than those providing free helmets. There is insufficient evidence to recommend providing subsidised helmets at present. Interventions may be more effective if provided to younger rather than older children. There is evidence that interventions offered in healthcare settings can increase self reported helmet wearing.Further high-quality studies are needed to explore whether non-legislative interventions increase helmet wearing, and particularly the effect of providing subsided as opposed to free helmets, and of providing interventions in healthcare settings as opposed to in schools or communities. Alternative interventions (e.g. those including peer educators, those aimed at developing safety skills including skills in decision making and resisting peer pressure or those aimed at improving self esteem or self efficacy) need developing and testing, particularly for 11 to 18 year olds. The effect of interventions in countries with existing cycle helmet legislation and in low and middle-income countries also requires investigation.

  3. The dilemma of disclosure: patient perspectives on gay and lesbian providers.

    PubMed

    Lee, Rita S; Melhado, Trisha V; Chacko, Karen M; White, Kelly J; Huebschmann, Amy G; Crane, Lori A

    2008-02-01

    Discrimination toward gay and lesbian patients by health care providers has been documented. No study has determined if patient behavior would change when seeing a gay/lesbian provider. The objective of the study was to examine whether a provider's sexual orientation would affect the choice of provider, practice, or preference for a chaperone during genital exams. The design of the study was an anonymous, cross-sectional survey. The participants were a random national sample of persons 18 years or older residing in the USA able to read English. The measurements were self-reported perceptions and chaperone preference based on provider gender and sexual orientation. The response rate was 32% (n = 502). Many respondents indicated they would change providers upon finding out their provider was gay/lesbian (30.4%) or change practices if gay/lesbian providers were employed there (35.4%). Female respondents preferred chaperones most with heterosexual male providers (adjusted odds ratio [OR] 1.50, 95% confidence interval [CI] = 1.15 to 1.95) followed by homosexual male (OR 1.17, 95% CI = 0.93 to 1.47), lesbian (reference), and heterosexual female providers (OR 0.63, 95% CI = 0.51 to 0.77). Male respondents showed an increased preference for chaperones with gay/lesbian providers of either gender (OR 1.52, 95%, CI = 1.22 to 1.90, for gay male provider, [reference] for lesbian provider) than with either heterosexual male (OR 0.36, 95% CI = 0.26 to 0.52) or heterosexual female providers (OR 0.39, 95% CI = 0.29 to 0.54). Patients may change providers, practices, or desire for chaperone based on a provider's gender and sexual orientation. Although the low response rate may limit generalizability, these findings have the potential to impact aspects of practice structure including chaperone use and provider-patient relationships.

  4. The role of genomics in the neonatal ICU.

    PubMed

    Maresso, Karen; Broeckel, Ulrich

    2009-03-01

    Results of both the Human Genome and International HapMap Projects have provided the technology and resources necessary to enable fundamental advances through the study of DNA sequence variation in almost all fields of medicine, including neonatology. Genome-wide association studies are now practical, and the first of these studies are appearing in the literature. This article provides the reader with an overview of the issues in technology and study design relating to genome-wide association studies and summarizes the current state of association studies in neonatal ICU populations with a brief review of the relevant literature. Future recommendations for genomic association studies in neonatal ICU populations are also provided.

  5. Health organizations providing and seeking social support: a Twitter-based content analysis.

    PubMed

    Rui, Jian Raymond; Chen, Yixin; Damiano, Amanda

    2013-09-01

    Providing and seeking social support are important aspects of social exchange. New communication technologies, especially social network sites (SNSs), facilitate the process of support exchange. An increasing number of health organizations are using SNSs. However, how they provide and seek social support via SNSs has yet to garner academic attention. This study examined the types of social support provided and sought by health organizations on Twitter. A content analysis was conducted on 1,500 tweets sent by a random sample of 58 health organizations within 2 months. Findings indicate that providing informational and emotional support, as well as seeking instrumental support, were the main types of social support exchanged by health organizations through Twitter. This study provides a typology for studying social support exchanges by health organizations, and recommends strategies for health organizations regarding the effective use of Twitter.

  6. Patient-provider communication about sexual concerns in cancer: a systematic review.

    PubMed

    Reese, Jennifer Barsky; Sorice, Kristen; Beach, Mary Catherine; Porter, Laura S; Tulsky, James A; Daly, Mary B; Lepore, Stephen J

    2017-04-01

    Cancer survivors' needs around sexual concerns are often unmet. The primary objective of this systematic review was to examine the prevalence of and factors associated with patient-provider communication about sexual concerns in cancer. Using PRISMA guidelines, we searched PubMed/MEDLINE, PsychInfo, and CINAHL databases for peer-reviewed quantitative research papers (2000-2015) in cancer samples. Search terms across three linked categories were used (sexuality, communication, and cancer). The National Comprehensive Cancer Network (NCCN) Sexual Function Guidelines were used as a framework to categorize communication reported in each study. Twenty-nine studies from 10 countries (29 % in USA) were included. Studies assessed patients only (21), providers only (4), and both (4). Communication measures differed across studies and many lacked validity data. When reported by patients or providers, the average prevalence of discussing potential treatment effects on sexual function was 50 (60 % for men and 28 % for women) and 88 %, respectively. As reported by patients or providers, respectively, assessing patients' sexual concerns (10 and 21 %) and offering treatments (22 and 17 %) were measured in fewer studies and were reported less frequently. Both patients and providers (28 and 32 %, respectively) reported a low prevalence of other non-specific communication. Greater prevalence of communication was associated with male patient gender and more years of provider experience. Sexual issues go unaddressed for many cancer survivors, particularly women. Both patient and provider interventions are needed. Enhancing patient-provider communication about sexual concerns through evidence-based interventions could improve patient sexual function and quality of life.

  7. Counsellors' perspectives on the experience of providing HIV counselling in Kenya and Tanzania: the Voluntary HIV-1 Counselling and Testing Efficacy Study.

    PubMed

    Grinstead, O A; van der Straten, A

    2000-10-01

    Demand for HIV counselling services is increasing in developing counties, but there have been few previous studies that describe counsellors' roles and experiences providing HIV-related counselling in developing countries. Such information can be used to better supervise and support counsellors and thereby improve counselling services. As a sub-study of the Voluntary Counseling and Testing Efficacy Study, we conducted focus groups and individual interviews with 11 counsellors and counselling supervisors providing HIV counselling services in Kenya and Tanzania. Counsellors told us that their jobs were both rewarding and stressful. In addition to their obligations in the counselling relationship (providing information, protecting confidentiality and being non-judgemental), they perceived pressure to provide information and be good role models in their communities. Additional stresses were related to external (economic and political) conditions, 'spillover' of HIV issues from their personal lives and providing counselling in a research setting. Counsellor stress might be reduced and their effectiveness and retention improved by (1) allowing work flexibility; (2) providing supportive, non-evaluative supervision; (3) offering alternatives to client behaviour change as the indication of counsellor performance; (4) acknowledging and educating about 'emotional labour' in counselling; (5) providing frequent information updates and intensive training; and (6) encouraging counsellor participation in the development of research protocols.

  8. United States Marine Corps Assault Amphibian Vehicle Egress Study

    DTIC Science & Technology

    2014-06-01

    the best chance of survival. This thesis provides baseline results for future emergency egress studies on the AAV and the new ACV... the best chance of survival. This thesis provides baseline results for future emergency egress studies on the AAV and the new ACV. vi THIS PAGE...significantly, changing the way the AAV sinks and thus the way Marines must egress. To provide a point of reference

  9. 21 CFR 20.106 - Studies and reports prepared by or with funds provided by the Food and Drug Administration.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Categories of Records § 20.106 Studies and reports prepared by or with funds provided by the Food and Drug... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Studies and reports prepared by or with funds provided by the Food and Drug Administration. 20.106 Section 20.106 Food and Drugs FOOD AND DRUG...

  10. Affiliation, joint venture or PSO? Case studies show why provider strategies differ.

    PubMed

    1998-03-01

    Joint venture, affiliation or PSO? Here are three case studies of providers who chose different paths under Medicare risk, plus some key questions you'll want to ask of your own provider organization. Learn from these examples so you'll make the best contracting decisions.

  11. Randomised controlled trial of whether erotic material is required for semen collection: impact of informed consent on outcome.

    PubMed

    Handelsman, D J; Sivananathan, T; Andres, L; Bathur, F; Jayadev, V; Conway, A J

    2013-11-01

    Semen is collected to evaluate male fertility or cryostore sperm preferentially in laboratories but such collection facilities have no standard fit-out. It is widely believed but untested whether providing erotic material (EM) is required to collect semen by masturbation in the unfamiliar environment. To test this assumption, 1520 men (1046 undergoing fertility evaluation, 474 sperm cryostorage, providing 1932 semen collection episodes) consecutively attending the semen laboratory of a major metropolitan teaching hospital for semen analysis were eligible for randomization to be provided or not with printed erotic material EM (X-rated, soft-core magazines) during semen collection. Randomization was performed by providing magazines in the collection rooms (as a variation on non-standard fit-out) on alternate weeks using a schedule concealed from participants. In the pilot study, men were randomized without seeking consent. In the second part of the study, which continued on from the first without interruption, an approved informed consent procedure was added. The primary outcome, the time to collect semen defined as the time from receiving to returning the sample receptacle, was significantly longer (by ~6%, 14.9 ± 0.3 [mean ± standard error of mean] vs. 14.0 ± 0.2 minutes, p = 0.02) among men provided with EM than those randomized to not being provided. There was no significant increase in the failure to collect semen samples (2.6% overall) nor any difference in age, semen volume or sperm concentration, output or motility according to whether EM was provided or not. The significantly longer time to collect was evident in the pilot study and the study overall, but not in the main study where the informed consent procedure was used. This study provides evidence that refutes the assumption that EM needs to be provided for semen collection in a laboratory. It also provides an example of a usually unobservable participation bias influencing study outcome of a randomized controlled trials. © 2013 American Society of Andrology and European Academy of Andrology.

  12. "Are you still driving?" Metasynthesis of patient preferences for communication with health care providers.

    PubMed

    Betz, Marian E; Scott, Kenneth; Jones, Jacqueline; Diguiseppi, Carolyn

    2016-05-18

    The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers. Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers. A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed. Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers. We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving. Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers-and support their family members-through tactful communication about driving safety and mobility transitions during the life course.

  13. Palliative Care Gaps in Providing Psychological Treatment: A Review of the Current State of Research in Multidisciplinary Palliative Care.

    PubMed

    Kozlov, Elissa; Niknejad, Bahar; Reid, M C

    2018-03-01

    Patients with advanced illness often have high rates of psychological symptoms. Many multicomponent palliative care intervention studies have investigated the efficacy of overall symptom reduction; however, little research has focused explicitly on how interventions address psychological symptoms associated with serious illness. The current study reviewed 59 multicomponent palliative care intervention articles and analyzed the mental health components of palliative care interventions and their outcomes in order to better understand the current state of psychological care in palliative care. The majority of articles (69.5%) did not provide any details regarding the psychological component delivered as part of the palliative care intervention. Most (54.2%) studies did not specify which provider on the team was responsible for providing the psychological intervention. Studies varied regarding the type of outcome measure utilized; multi-symptom assessment scales were used in 54.2% of studies, mental health scales were employed in 25.4%, quality of life and distress scales were used in 16.9%, and no psychological scales were reported in 28.8%. Fewer than half the studies (42.4%) documented a change in a psychological outcome. The majority of analyzed studies failed to describe how psychological symptoms were identified and treated, which discipline on the team provided the treatment, and whether psychological symptoms improved as a result of the intervention. Future research evaluating the effects of palliative care interventions on psychological symptoms will benefit from using reliable and valid psychological outcome measures and providing specificity regarding the psychological components of the intervention and who provides it.

  14. Customer-Focused Business Practice Adoption: A Comparison of Private and Public Sector Implementations

    DTIC Science & Technology

    2004-03-01

    Narratives Phenomenologies Ethnographies Grounded Theory Case Studies Mixed Methods Sequential Concurrent Transformative Creswell... ethnographies , grounded theory studies and case studies (Creswell, 2003:18). The methods used in qualitative study provide the framework for...Definition Grounded theory provides a structured

  15. A systematic review of HIV partner counseling and referral services: client and provider attitudes, preferences, practices, and experiences.

    PubMed

    Passin, Warren F; Kim, Angela S; Hutchinson, Angela B; Crepaz, Nicole; Herbst, Jeffrey H; Lyles, Cynthia M

    2006-05-01

    The objectives of this study were to understand client and provider attitudes, experiences, and practices regarding HIV partner notification in the United States and to help identify future research and program needs. The goals of this study were to synthesize the literature reporting client and provider attitudes, experiences, and practices and to identify potential negative effects of HIV partner notification. This study consisted of a systematic qualitative review. Clients were willing to self-notify partners and participate in provider notification, and few reported negative effects. The majority of health care providers were in favor of HIV partner notification; however, they did not consistently refer index clients to HIV partner notification programs. Considering that clients have positive attitudes toward self- and provider referral, local HIV prevention programs need to ensure that all HIV-positive clients are offered partner notification services. Additional research is needed to assess the potential risks of notifying partners and to identify effective techniques to improve client and provider participation.

  16. From Mental Game to Cultural Praxis: A Cultural Studies Model's Implications for the Future of Sport Psychology

    ERIC Educational Resources Information Center

    Ryba, Tatiana V.; Wright, Handel Kashope

    2005-01-01

    This paper explores the implications of a cultural studies as praxis heuristic "model: for transforming sport psychology". It provides a brief introduction to both cultural studies and sport psychology and discusses a cultural studies intersection with sport studies and sport psychology. Cultural studies, it asserts, provides one of several…

  17. Community health center provider ability to identify, treat and account for the social determinants of health: a card study.

    PubMed

    Lewis, Joy H; Whelihan, Kate; Navarro, Isaac; Boyle, Kimberly R

    2016-08-27

    The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America's highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH. Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers' perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors. The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code. An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.

  18. Pharmaceutical companies and healthcare providers: Going beyond the gift - An explorative review.

    PubMed

    Latten, Tom; Westra, Daan; Angeli, Federica; Paulus, Aggie; Struss, Marleen; Ruwaard, Dirk

    2018-01-01

    Interactions between pharmaceutical companies and healthcare providers are increasingly scrutinized by academics, professionals, media, and politicians. Most empirical studies and professional guidelines focus on unilateral donor-recipient types of interaction and overlook, or fail to distinguish between, more reciprocal types of interaction. However, the degree of goal alignment and potential for value creation differs in these two types of interactions. Failing to differentiate between these two forms of interaction between pharmaceutical companies and healthcare providers could thus lead to biased conclusions regarding their desirability. This study reviews the empirical literature regarding the effects of bilateral forms of interactions between pharmaceutical companies and healthcare providers in order to explore their effects. We searched two medical databases (i.e. PubMed and Cochrane Library) and one business database (i.e. EBSCO) for empirical, peer-reviewed articles concerning any type of bilateral interaction between pharmaceutical companies and healthcare providers. We included quantitative articles which were written in English and published between January 1st, 2000 and October 31st, 2016, and where the title or abstract included a combination of synonyms of the following keywords: pharmaceutical companies, healthcare providers, interaction, and effects. Our search results yielded 10 studies which were included in our analysis. These studies focused on either research-oriented interaction or on education-oriented interaction. The included studies reported various outcomes of interaction such as prescribing behavior, ethical dilemmas, and research output. Regardless of the type of interaction, the studies either reported no significant effects or ambivalent outcomes such as affected clinical practice or ethical issues. The effects of bilateral interactions reported in the literature are similar to those reported in studies concerning unilateral interactions. The theoretical notion that bilateral interactions between pharmaceutical companies and healthcare providers have different effects given their increased level of goal alignment thus does not seem to hold. However, most of the empirical studies focus on intermediary, provider-level, outcomes such as altered prescribing behavior. Outcomes at the health system level such as overall costs and quality of care are overlooked. Further research is necessary in order to disentangle various forms of value created by different types of interactions between pharmaceutical companies and healthcare providers.

  19. Peer Support in Full-Service Partnerships: A Multiple Case Study Analysis.

    PubMed

    Siantz, Elizabeth; Henwood, Benjamin; Gilmer, Todd

    2017-07-01

    Peer providers are integral to Full Service Partnerships (FSPs), which are team-based mental health service models. Peer providers use principles of recovery to engage clients, but FSPs can vary in their recovery orientation. Whether and how peer recovery orientation reflects the organizational environments of FSPs is unclear. This qualitative study explored peer provider attitudes towards recovery within the organizational contexts of FSPs where they are employed. Case study analysis was conducted on eight purposively sampled FSPs using qualitative interviews with peer providers and program directors. In two cases, peer recovery attitudes diverged from those of their organizational context. In these cases, peer providers were champions for recovery, and used practice-based strategies to promote client autonomy despite working in settings with lower recovery orientation. Peer providers could be uniquely positioned to promote client autonomy in settings where organizational factors limit consumer choice.

  20. An estimation of the cost per visit of nursing home care services.

    PubMed

    Ryu, Ho-Sihn

    2009-01-01

    Procedures used for analyzing the cost of providing home care nursing services through hospital-based home care agencies (HCAs) was the focus of this study. A cross-sectional descriptive study design was used to analyze the workload and caseload of 36 home care nurses from ten HCAs. In addition, information obtained from a national health insurance database, including 54,639 home care claim cases from a total of 185 HCAs during a 6-month period, were analyzed. The findings provide a foundation for improving the alternative home care billing and reimbursement system by using the actual amount of time invested in providing home care when calculating the cost of providing home care nursing services. Further, this study provides a procedure for calculating nursing service costs by analyzing actual data. The results have great potential for use in nursing service cost analysis methodology, which is an essential step in developing a policy for providing home care.

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

    PubMed

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

    1999-11-01

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

  2. Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation.

    PubMed

    Wollscheid, Sabine; Eriksen, John; Hallvik, Jørgen

    2013-06-01

    This study explores the provision of home care services (home nursing and domiciliary help) for the elderly in Norwegian municipalities with purchaser-provider split model. The study draws on the assumption that flexibility in adjusting services to the care receivers' needs, and cooperation between provider and purchasers are indicators of good quality of care. Data were collected through semi-structured telephone interviews with 22 team leaders of provider units in nine municipalities. Data were collected in 2008-2009. The study has been approved by the Norwegian Social Science Data Services. We identified four different ways of organising home care services under a purchaser-provider split model: Provider empowerment, New Public Management, Vague instructions and undermining the rules. High flexibility in providing care and cooperation with the purchaser unit were identified by the team leaders as characteristics for good care. Our findings suggest that the care providers use individual strategies that allow flexibility and cooperation rather than rigidly abiding to the regulations the purchaser-provider split models implies. Ironically, in provider units where the 'rules were undermined', the informants (team leaders of provider units) seemed to be most satisfied with the quality of home care that they delivered. © 2012 Nordic College of Caring Science.

  3. Engaging healthcare providers to implement HIV pre-exposure prophylaxis.

    PubMed

    Krakower, Douglas; Mayer, Kenneth H

    2012-11-01

    Recent randomized controlled trials have demonstrated that HIV pre-exposure prophylaxis (PrEP) can decrease HIV incidence among several at-risk populations, including men who have sex with men, serodiscordant couples, and heterosexual men and women. As PrEP is a biomedical intervention that requires clinical monitoring and a high level of medication adherence, maximizing the public health effectiveness of PrEP in real-world settings will require the training of a cadre of healthcare providers to prescribe PrEP. Therefore it is critical to understand provider knowledge, practices, and attitudes towards PrEP prescribing, and to develop strategies for engaging and training providers to provide PrEP. Limited numbers of studies have focused on PrEP implementation by healthcare providers. These studies suggest that some providers are knowledgeable about PrEP, but many are not, or express misgivings. Although many clinicians report willingness to provide PrEP, few have prescribed PrEP in clinical practice. Provider comfort and skills in HIV risk assessment are suboptimal, which could limit identification of individuals who are most likely to benefit from PrEP use. Further studies to understand facilitators and barriers to HIV-risk assessment and PrEP prescribing by practicing clinicians are needed. Innovative training strategies and decision-support interventions for providers could optimize PrEP implementation and therefore merit additional research.

  4. 77 FR 9945 - Draft Guidance for Industry on Providing Submissions in Electronic Format-Standardized Study Data...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-21

    ...] Draft Guidance for Industry on Providing Submissions in Electronic Format--Standardized Study Data... Submissions in Electronic Format--Standardized Study Data.'' This draft guidance establishes FDA's recommendation that sponsors and applicants submit nonclinical and clinical study data in a standardized...

  5. Patients' and Health Care Providers' Perception of Stressors in the Intensive Care Units.

    PubMed

    Abuatiq, Alham

    2015-01-01

    The purposes of this study is first, to investigate intensive care patients' perceptions of stressors; second, to investigate the health care provider's perception of what constitutes a stressor from the patient's perspective; and third, to describe how health care providers manage their patients' stressors. This was a mixed-methods study; the quantitative section replicated Cornock's 1998 study of stress in the intensive care unit (ICU), with difference in sampling to include all health care providers in the ICU, in addition to nurses. The qualitative section added information to the current literature by describing how health care providers manage their patient's stressors. This article reports the quantitative findings of this study, as the qualitative section is presented in a separate article. It is important to describe ICU patients' stressful experiences to assess patient's stressors, provide holistic care to eliminate stressors, and provide feedback to health care providers. There is a need to describe the clinical practice related to stress perception and management of stressors in the critical care environment. A mixed-methods comparative descriptive design was used for the quantitative section, and a phenomenological approach guided the qualitative section. Lazarus and Folkman's theory formed the bases for integrating all variables investigated in this study. The sample included 70 ICU patients and 70 ICU health care providers. After consenting to participate in this study, subjects were given a demographic form and a paper-based tool, the Environmental Stressors graphic data form Questionnaire. Questionnaires were filled out by subjects anonymously in the ICU and returned to the researcher in the same setting. Descriptive statistics were analyzed using SPSS data analysis software. The top 3 most stressful items ranked by the patients included "being in pain," followed by "not being able to sleep" and "financial worries"; on the other hand, health care providers perceived "being in pain" followed by "not being able to communicate" and "not being in control of yourself" as the top 3 stressors perceived by their patients. The findings of this study are crucial and may inform nursing assessments and care of the ICU patient. In addition, this information may encourage the ICU staff to manipulate and redesign the ICU environment to be less stressful. Also, the findings of this study guided the development of an ICU stressor control policy.

  6. Stigmatized Attitude of Healthcare Providers: A Barrier for Delivering Health Services to HIV Positive Patients

    PubMed Central

    Zarei, Nooshin; Joulaei, Hassan; Darabi, Elahe; Fararouei, Mohammad

    2015-01-01

    Background: Despite the success of developed countries in preventing the spread of HIV/AIDS, the disease is expanding in developing countries where an unfavorable attitude exists among people, health professionals and employees. This study aimed to assess the stigmatized attitude among health care providers toward people living with HIV (PLWHA). Methods: The study is a cross-sectional survey. The data were gathered using a structured questionnaire. The study sample included 575 health care providers of public and private hospitals in Shiraz. The data were gathered using a structured questionnaire in spring 2014. Data analysis was carried out using the Statistical Package for Social Sciences, version 21. Results: The most dominant attitude of the health care providers toward HIV/AIDS patients was related to fear (42.42%). According to the results of this study, there was a significant relationship between stigmatized attitude of the health care providers and their religious beliefs, society stigmatized attitude, and knowledge of transmission routes. The relationship between social stigmatized attitude of health care providers and their knowledge of transmission routes, with their willingness to provide services to patients is significant, as well (P<0.05). 39.6% and 46.2% of the respondents preferred not to provide services to the prostitutes and homosexual patients. Conclusion: Fear of contamination and social stigmatized attitude are the main impediments to dealing with patients and providing services to them. Hence, it seems that creating an effective knowledge about transmission and correcting the socio-cultural beliefs of health providers are two key strategies to tackle this problem. PMID:26448956

  7. Space transportation booster engine configuration study. Addendum: Design definition document

    NASA Technical Reports Server (NTRS)

    1989-01-01

    Gas generator engine characteristics and results of engine configuration refinements are discussed. Updated component mechanical design, performance, and manufacturing information is provided. The results are also provided of ocean recovery studies and various engine integration tasks. The details are provided of the maintenance plan for the Space Transportation Booster Engine.

  8. HPV vaccination: Population approaches for improving rates.

    PubMed

    Oliver, Kristin; Frawley, Alean; Garland, Elizabeth

    2016-06-02

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

  9. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials.

    PubMed

    Brookman-Frazee, Lauren; Stahmer, Aubyn C

    2018-05-09

    The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.

  10. Patient-provider communications in outpatient clinic settings: a clinic-based evaluation of mobile device and multimedia mediated communications for patient education.

    PubMed

    Schooley, Benjamin; San Nicolas-Rocca, Tonia; Burkhard, Richard

    2015-01-12

    Many studies have provided evidence of the importance of quality provider-patient communications and have suggested improvements to patient understanding by using video-based instruction. The objective of this study was to understand how mobile information technology assisted video and three-dimensional (3D) image instruction, provided by a health care worker, influences two categories of outcome: (1) patient understanding of information about their condition and detailed medical discharge instructions; and (2) patient perceptions and attitudes toward their health care providers, which included physicians, nurses, and staff. We hypothesize that video and 3D image instruction, provided on a mobile, tablet hardware platform, will improve patient understanding about the diagnostic testing, diagnoses, procedures, medications, and health topics provided to them. We also propose that use of the tablet/video combination will result in improved attitudinal evaluation by patients of their providers and the treatment plan. This study evaluated a hospital clinic-based trial (patient N=284) of video and 3D image instruction, provided on a mobile, tablet hardware platform, and its potential to improve patient understanding about the diagnostic testing, diagnoses, procedures, medications, and health topics provided to them. Results showed strong evidence that the system was perceived as helpful for improving patient understanding, and that it improved communication between physicians and patients (P<.001). The advanced age of some patients had no effect on their perceptions of the tablet-based mediation. Physician comments provided useful insights on effective use of such systems in the future. Implications for further development and future research are discussed. This study added to the body of evidence that computer-assisted video instructional systems for patients can improve patient understanding of medical instructions from their health care providers and assist with patient compliance. In addition, such systems can be appealing to both patient and provider.

  11. Patient-Provider Communications in Outpatient Clinic Settings: A Clinic-Based Evaluation of Mobile Device and Multimedia Mediated Communications for Patient Education

    PubMed Central

    Schooley, Benjamin; San Nicolas-Rocca, Tonia

    2015-01-01

    Background Many studies have provided evidence of the importance of quality provider-patient communications and have suggested improvements to patient understanding by using video-based instruction. Objective The objective of this study was to understand how mobile information technology assisted video and three-dimensional (3D) image instruction, provided by a health care worker, influences two categories of outcome: (1) patient understanding of information about their condition and detailed medical discharge instructions; and (2) patient perceptions and attitudes toward their health care providers, which included physicians, nurses, and staff. We hypothesize that video and 3D image instruction, provided on a mobile, tablet hardware platform, will improve patient understanding about the diagnostic testing, diagnoses, procedures, medications, and health topics provided to them. We also propose that use of the tablet/video combination will result in improved attitudinal evaluation by patients of their providers and the treatment plan. Methods This study evaluated a hospital clinic-based trial (patient N=284) of video and 3D image instruction, provided on a mobile, tablet hardware platform, and its potential to improve patient understanding about the diagnostic testing, diagnoses, procedures, medications, and health topics provided to them. Results Results showed strong evidence that the system was perceived as helpful for improving patient understanding, and that it improved communication between physicians and patients (P<.001). The advanced age of some patients had no effect on their perceptions of the tablet-based mediation. Physician comments provided useful insights on effective use of such systems in the future. Implications for further development and future research are discussed. Conclusions This study added to the body of evidence that computer-assisted video instructional systems for patients can improve patient understanding of medical instructions from their health care providers and assist with patient compliance. In addition, such systems can be appealing to both patient and provider. PMID:25583145

  12. Effective Elementary Social Studies.

    ERIC Educational Resources Information Center

    Hoge, John Douglas

    This book advocates providing high-quality K-6 social studies instruction. The text provides practical information on how teachers can conduct high-quality social studies programs in their classrooms. The volume is divided into three parts. Part 1 offers an overview of the formal and informal social studies curriculum, its history, current status,…

  13. World association for the advancement of veterinary parasitology (WAAVP) guideline for testing the efficacy of ectoparasiticides for fish.

    PubMed

    Sommerville, C; Endris, R; Bell, T A; Ogawa, K; Buchmann, K; Sweeney, D

    2016-03-30

    This guideline is intended to assist in the planning and execution of studies designed to assess the efficacy of ectoparasiticides for fish. It is the first ectoparasite-specific guideline to deal with studies set in the aquatic environment and therefore provides details for the maintenance of environmental standards for finfish. Information is included on a range of pre-clinical study designs as well as clinical studies in commercial/production sites, set within a regulatory framework. It provides information on the study animals, their welfare, husbandry and environmental requirements during the study. The most commonly pathogenic ectoparasites are presented with relevant points regarding life history, host challenge and numeric evaluation. Preparation and presentation of both topical and oral test treatments is provided, together with guidance on data collection and analysis. The guideline provides a quality standard or efficacy studies on finfish, which will assist researchers and regulatory authorities worldwide and contribute to the wider objective of harmonisation of procedures.

  14. The National Children's Study: Recruitment Outcomes Using the Provider-Based Recruitment Approach.

    PubMed

    Hale, Daniel E; Wyatt, Sharon B; Buka, Stephen; Cherry, Debra; Cislo, Kendall K; Dudley, Donald J; McElfish, Pearl Anna; Norman, Gwendolyn S; Reynolds, Simone A; Siega-Riz, Anna Maria; Wadlinger, Sandra; Walker, Cheryl K; Robbins, James M

    2016-06-01

    In 2009, the National Children's Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment using a birth-rate probability sample. In 2010, the NCS Program Office launched 3 additional recruitment approaches. We tested whether provider-based recruitment could improve recruitment outcomes compared with household-based recruitment. The NCS aimed to recruit 18- to 49-year-old women who were pregnant or at risk for becoming pregnant who lived in designated geographic segments within primary sampling units, generally counties. Using provider-based recruitment, 10 study centers engaged providers to enroll eligible participants at their practice. Recruitment models used different levels of provider engagement (full, intermediate, information-only). The percentage of eligible women per county ranged from 1.5% to 57.3%. Across the centers, 3371 potential participants were approached for screening, 3459 (92%) were screened and 1479 were eligible (43%). Of those 1181 (80.0%) gave consent and 1008 (94%) were retained until delivery. Recruited participants were generally representative of the county population. Provider-based recruitment was successful in recruiting NCS participants. Challenges included time-intensity of engaging the clinical practices, differential willingness of providers to participate, and necessary reliance on providers for participant identification. The vast majority of practices cooperated to some degree. Recruitment from obstetric practices is an effective means of obtaining a representative sample. Copyright © 2016 by the American Academy of Pediatrics.

  15. Providing information about the consequences of female genital mutilation to healthcare providers caring for women and girls living with female genital mutilation: A systematic review.

    PubMed

    Oringanje, Chioma M; Okoro, Anthony; Nwankwo, Ogonna N; Meremikwu, Martin M

    2017-02-01

    The persistence of female genital mutilation (FGM) in some countries, despite an overall decline in the prevalence of the practice, calls for improvement in the capacity of healthcare workers and institutions to provide optimal care for this population. To determine the impact of providing information on FGM and its consequences to healthcare providers on their attitudes toward FGM, and quality of care and patient satisfaction. The following major databases were searched from inception to August 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, SCOPUS, Web of Science, and ClinicalTrials.gov, without language restrictions. Controlled studies were included based on use of objective measures. Two team members independently screened and collected data. Relative risks and proportions were calculated and evidence assessed using the GRADE (Grade of Recommendation, Assessment, Development and Evaluation) approach. One study was identified. Based on this study there was no evidence to suggest change in healthcare provider outcomes after the intervention. Despite a comprehensive search, only one study of low methodological quality was included. This precludes a definitive conclusion regarding the impact of providing information on FGM to healthcare providers. More research is needed. CRD42015024570. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  16. The National Children’s Study: Recruitment Outcomes Using the Provider-Based Recruitment Approach

    PubMed Central

    Wyatt, Sharon B.; Buka, Stephen; Cherry, Debra; Cislo, Kendall K.; Dudley, Donald J.; McElfish, Pearl Anna; Norman, Gwendolyn S.; Reynolds, Simone A.; Siega-Riz, Anna Maria; Wadlinger, Sandra; Walker, Cheryl K.; Robbins, James M.

    2016-01-01

    OBJECTIVE: In 2009, the National Children’s Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment using a birth-rate probability sample. In 2010, the NCS Program Office launched 3 additional recruitment approaches. We tested whether provider-based recruitment could improve recruitment outcomes compared with household-based recruitment. METHODS: The NCS aimed to recruit 18- to 49-year-old women who were pregnant or at risk for becoming pregnant who lived in designated geographic segments within primary sampling units, generally counties. Using provider-based recruitment, 10 study centers engaged providers to enroll eligible participants at their practice. Recruitment models used different levels of provider engagement (full, intermediate, information-only). RESULTS: The percentage of eligible women per county ranged from 1.5% to 57.3%. Across the centers, 3371 potential participants were approached for screening, 3459 (92%) were screened and 1479 were eligible (43%). Of those 1181 (80.0%) gave consent and 1008 (94%) were retained until delivery. Recruited participants were generally representative of the county population. CONCLUSIONS: Provider-based recruitment was successful in recruiting NCS participants. Challenges included time-intensity of engaging the clinical practices, differential willingness of providers to participate, and necessary reliance on providers for participant identification. The vast majority of practices cooperated to some degree. Recruitment from obstetric practices is an effective means of obtaining a representative sample. PMID:27251870

  17. "On the doctor's orders": A pilot study of the effects of website marketing for medical specialist providers under gatekeeping arrangements.

    PubMed

    Zwier, Sandra

    2017-01-01

    Websites from medical specialist providers are becoming increasingly marketing oriented, but there exists a paucity of empirical research on the effects. This experimental study explored effects of exposure to real websites from medical specialist providers among Dutch adults under physician gatekeeper arrangements. Exposure led to a stronger intention to seek treatment from the specialist provider and motivation to rely on the providers' claims. Weaker to absent effects were found for intention to question the physician gatekeeper's referral and this was chiefly motivated by the belief that "the doctor knows best." Implications for specialist provider marketing under gatekeeping arrangements are discussed.

  18. An analysis of computerization in primary care practices.

    PubMed

    Condon, James V; Smith, Sherry P

    2002-12-01

    To remain profitable, primary care practices, the front-line health care providers, must provide excellent patient care and reduce expenses while providing payers with accurate data. Many primary care practices have turned to computer technology to achieve these goals. This study examined the degree of computerization of primary care providers in the Augusta, Georgia, metropolitan area as well as the level of awareness of the Health Insurance Portability and Accountability Act (HIPAA) by primary care providers and its potential effect on their future computerization plans. The study's findings are presented and discussed as well as a number of recommendations for practice managers.

  19. The Relationship Between Provider Competence, Content Exposure, and Consumer Outcomes in Illness Management and Recovery Programs.

    PubMed

    McGuire, Alan B; White, Dominique A; Bartholomew, Tom; Flanagan, Mindy E; McGrew, John H; Rollins, Angela L; Mueser, Kim T; Salyers, Michelle P

    2017-01-01

    Provider competence may affect the impact of a practice. The current study examined this relationship in sixty-three providers engaging in Illness Management and Recovery with 236 consumers. Improving upon previous research, the present study utilized a psychometrically validated competence measure in the ratings of multiple Illness Management and Recovery sessions from community providers, and mapped outcomes onto the theory underlying the practice. Provider competence was positively associated with illness self-management and adaptive coping. Results also indicated baseline self-management skills and working alliance may affect the relationship between competence and outcomes.

  20. B-70 Aircraft Study. Volume 1

    NASA Technical Reports Server (NTRS)

    Johnson, V. T.

    1972-01-01

    This Phase 2 final report for the B-70 aircraft study contains the data location matrix, which provides a summary of the major cost, schedule, and technical items provided in the report; work breakdown structure; cost definitions; and B-70 program level summary data. The Phase 2 objective was to provide the B-70 aircraft data in accordance with the approved study plan. Several minor modifications to the original plan have been made as the result of the Phase 2 effort.

  1. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.

    PubMed

    Maina, Ivy W; Belton, Tanisha D; Ginzberg, Sara; Singh, Ajit; Johnson, Tiffani J

    2018-02-01

    Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient-provider interaction found that providers with stronger implicit bias demonstrated poorer patient-provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators.

    PubMed

    Chong, Wei Wen; Aslani, Parisa; Chen, Timothy F

    2013-09-01

    Shared decision-making and interprofessional collaboration are important approaches to achieving consumer-centered care. The concept of shared decision-making has been expanded recently to include the interprofessional healthcare team. This study explored healthcare providers' perceptions of barriers and facilitators to both shared decision-making and interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers, including medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Healthcare providers identified several factors as barriers to, and facilitators of shared decision-making that could be categorized into three major themes: factors associated with mental health consumers, factors associated with healthcare providers and factors associated with healthcare service delivery. Consumers' lack of competence to participate was frequently perceived by mental health specialty providers to be a primary barrier to shared decision-making, while information provision on illness and treatment to consumers was cited by healthcare providers from all professions to be an important facilitator of shared decision-making. Whilst healthcare providers perceived interprofessional collaboration to be influenced by healthcare provider, environmental and systemic factors, emphasis of the factors differed among healthcare providers. To facilitate interprofessional collaboration, mental health specialty providers emphasized the importance of improving mental health expertise among general practitioners and community pharmacists, whereas general health providers were of the opinion that information sharing between providers and healthcare settings was the key. The findings of this study suggest that changes may be necessary at several levels (i.e. consumer, provider and environment) to implement effective shared decision-making and interprofessional collaboration in mental healthcare.

  3. A Study of Business Incubators: Models, Best Practices, and Recommendations for NASA and Florida

    NASA Technical Reports Server (NTRS)

    1997-01-01

    This study was conducted to provide NASA-Kennedy Space Center with information and recommendations to support establishing one or more technology-based business incubators In Florida. The study involved assembling information about incubators: why they succeed, why they fail, how they are organized, and what services they provide. Consequently, this study focuses on widely-recognized "best practices," needed to establish successful technology- based business incubators. The findings are used to optimize the design and implementation of one or more technology-based business incubators to be established in Florida. Recommendations reflect both the essential characteristics of successful incubators and the optimal business demographics in Florida. Appendix A provides a fuller description of the objectives of the study. Technology-based business incubators are an increasing catalyst of new business development across the USi Incubators focus on providing entrepreneurs and small start-up firms with a wide array of support services necessary to bring forth new products and processes based on technologies developed in the nation's federal and private laboratories and universities. Appendix B provides extensive discussion of findings relative to technology- based business incubators.

  4. Delta Opioid Pharmacology in Relation to Alcohol Behaviors

    PubMed Central

    Alongkronrusmee, Doungkamol; Chiang, Terrance

    2016-01-01

    Delta opioid receptors (DORs) are heavily involved in alcohol-mediated processes in the brain. In this chapter we provide an overview of studies investigating how alcohol directly impacts DOR pharmacology and of early studies indicating DOR modulation of alcohol behavior. We will offer a brief summary of the different animal species used in alcohol studies investigating DORs followed by a broader overview of the types of alcohol behaviors modulated by DORs. We will highlight a small set of studies investigating the relationship between alcohol and DORs in analgesia. We will then provide an anatomical overview linking DOR expression in specific brain regions to different alcohol behaviors. In this section, we will provide two models that try to explain how endogenous opioids acting at DORs may influence alcohol behaviors. Next, we will provide an overview of studies investigating certain new aspects of DOR pharmacology, including the formation of heteromers and biased signaling. Finally, we provide a short overview of the genetics of the DORs in relation to alcohol use disorders (AUDs) and a short statement on the potential of using DOR-based therapeutics for treatment of AUDs. PMID:27316912

  5. Virtual gaming simulation of a mental health assessment: A usability study.

    PubMed

    Verkuyl, Margaret; Romaniuk, Daria; Mastrilli, Paula

    2018-05-18

    Providing safe and realistic virtual simulations could be an effective way to facilitate the transition from the classroom to clinical practice. As nursing programs begin to include virtual simulations as a learning strategy; it is critical to first assess the technology for ease of use and usefulness. A virtual gaming simulation was developed, and a usability study was conducted to assess its ease of use and usefulness for students and faculty. The Technology Acceptance Model provided the framework for the study, which included expert review and testing by nursing faculty and nursing students. This study highlighted the importance of assessing ease of use and usefulness in a virtual game simulation and provided feedback for the development of an effective virtual gaming simulation. The study participants said the virtual gaming simulation was engaging, realistic and similar to a clinical experience. Participants found the game easy to use and useful. Testing provided the development team with ideas to improve the user interface. The usability methodology provided is a replicable approach to testing virtual experiences before a research study or before implementing virtual experiences into curriculum. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. Provider and Site-Level Determinants of Testosterone Prescribing in the Veterans Healthcare System.

    PubMed

    Jasuja, Guneet K; Bhasin, Shalender; Rose, Adam J; Reisman, Joel I; Hanlon, Joseph T; Miller, Donald R; Morreale, Anthony P; Pogach, Leonard M; Cunningham, Francesca E; Park, Angela; Wiener, Renda S; Gifford, Allen L; Berlowitz, Dan R

    2017-09-01

    Testosterone prescribing rates have increased substantially in the past decade. However, little is known about the context within which such prescriptions occur. We evaluated provider- and site-level determinants of receipt of testosterone and of guideline-concordant testosterone prescribing. This study was cross-sectional in design. This study was conducted at the Veterans Health Administration (VA). Study participants were a national cohort of male patients who had received at least one outpatient prescription within the VA during fiscal year (FY) 2008 to FY 2012. A total of 38,648 providers and 130 stations were associated with these patients. This study measured receipt of testosterone and guideline-concordant testosterone prescribing. Providers ranging in age from 31 to 60 years, with less experience in the VA [all adjusted odds ratio (AOR), <2; P < 0.01] and credentialed as medical doctors in endocrinology (AOR, 3.88; P < 0.01) and urology (AOR, 1.48; P < 0.01) were more likely to prescribe testosterone compared with older providers, providers of longer VA tenure, and primary care providers, respectively. Sites located in the West compared with the Northeast [AOR, 1.75; 95% confidence interval (CI), 1.45-2.11] and care received at a community-based outpatient clinic compared with a medical center (AOR, 1.22; 95% CI, 1.20-1.24) also predicted testosterone use. Although they were more likely to prescribe testosterone, endocrinologists were also more likely to obtain an appropriate workup before prescribing compared with primary care providers (AOR, 2.14; 95% CI, 1.54-2.97). Our results highlight the opportunity to intervene at both the provider and the site levels to improve testosterone prescribing. This study also provides a useful example of how to examine contributions to prescribing variation at different levels of the health care system. Copyright © 2017 Endocrine Society

  7. A Qualitative Study of Providers' Perception of Adherence of Women Living with HIV/AIDS in Puerto Rico

    ERIC Educational Resources Information Center

    Rivero-Mendez, Marta; Dawson-Rose, Carol S.; Solis-Baez, Solymar S.

    2010-01-01

    This study examines healthcare providers' perceptions regarding experiences and factors that contribute to adherent and non-adherent behaviors to HIV treatment among women living with HIV infection in Puerto Rico and describes strategies implemented to improve adherence. Providers' accounts revealed that women with HIV infection are living…

  8. Examining Tasks that Facilitate the Experience of Incubation While Problem-Solving

    ERIC Educational Resources Information Center

    Both, Lilly; Needham, Douglas; Wood, Eileen

    2004-01-01

    The three studies presented here contrasted the problem-solving outcomes of university students when a break was provided or not provided during a problem-solving session. In addition, two studies explored the effect of providing hints (priming) and the placement of hints during the problem-solving session. First, the ability to solve a previously…

  9. Parolees' Physical Closeness to Social Services: A Study of California Parolees

    ERIC Educational Resources Information Center

    Hipp, John R.; Jannetta, Jesse; Shah, Rita; Turner, Susan

    2011-01-01

    This study examines the proximity of service providers to recently released parolees in California over a 2-year period (2005-2006). The addresses of parolee residences and service providers are geocoded, and the number of various types of service providers within 2 miles (3.2 km) of a parolee are measured. "Potential demand" is measured…

  10. The Relationship among Stress, Burnout, and Locus of Control of School Psychologists

    ERIC Educational Resources Information Center

    Reece, Shana J.

    2010-01-01

    The purpose of this study was to determine how stress, burnout, and locus of control are related for school psychologists providing direct services in the Metropolitan Nashville Public School System. This knowledge is essential in providing the needed experience and outlook of working as a school psychologist. The current study provided school…

  11. Flow Boiling Critical Heat Flux in Reduced Gravity

    NASA Technical Reports Server (NTRS)

    Mudawar, Issam; Zhang, Hui; Hasan, Mohammad M.

    2004-01-01

    This study provides systematic method for reducing power consumption in reduced gravity systems by adopting minimum velocity required to provide adequate CHF and preclude detrimental effects of reduced gravity . This study proves it is possible to use existing 1 ge flow boiling and CHF correlations and models to design reduced gravity systems provided minimum velocity criteria are met

  12. Self-Study Guide for Florida VPK Provider Improvement Plan Development

    ERIC Educational Resources Information Center

    Phillips, Beth M.; Mazzeo, Debbie; Smith, Kevin

    2016-01-01

    This Self-Study Guide has been developed to support Florida Voluntary Prekindergarten Providers (VPK) who are required to complete an improvement plan process (i.e., low-performing providers). The guide has sections that can be used during both the process of selecting target areas for an improvement plan and the process of implementing new or…

  13. Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study.

    PubMed

    Yang, Chiang-Hsing; Huang, Yu-Tung A; Hsueh, Ya-Seng A

    2013-02-04

    Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers' Gini coefficients also become close to one another. This study found that NHI's offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan.

  14. Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review.

    PubMed

    Petersen, Inge; Fairall, Lara; Egbe, Catherine O; Bhana, Arvin

    2014-05-01

    To conduct a qualitative systematic review on the use of lay counsellors in South Africa to provide lessons on optimizing their use for psychological and behavioural change counselling for chronic long-term care in scare-resource contexts. A qualitative systematic review of the literature on lay counsellor services in South Africa. Twenty-nine studies met the inclusion criteria. Five randomized control trials and two cohort studies reported that lay counsellors can provide behaviour change counselling with good outcomes. One multi-centre cohort study provided promising evidence of improved anti-retroviral treatment adherence and one non-randomized controlled study provided promising results for counselling for depression. Six studies found low fidelity of lay counsellor-delivered interventions in routine care. Reasons for low fidelity include poor role definition, inconsistent remuneration, lack of standardized training, and poor supervision and logistical support. Within resource-constrained settings, adjunct behaviour change and psychological services provided by lay counsellors can be harnessed to promote chronic care at primary health care level. Optimizing lay counsellor services requires interventions at an organizational level that provide a clear role definition and scope of practice; in-service training and formal supervision; and sensitization of health managers to the importance and logistical requirements of counselling. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  15. Tank car accident data analysis

    DOT National Transportation Integrated Search

    1991-06-01

    This report presents the results of a study of accidents involving railroad tank cars. The study is part of an overall effort to provide improved safety of rail transportation at reduced life-cycle costs. A major goal of the study is to provide a tec...

  16. A Rational-Emotive Approach to Mental Health for College Students: Study 1 and Study 2

    ERIC Educational Resources Information Center

    Kujoth, Richard K.; Topetzes, Nick J.

    1977-01-01

    Further replication using other test instruments and measured variables is suggested, but the results of two studies appear to support the view that providing rational ideas fosters mental health while providing psychodynamic insight does not. (Author)

  17. The tradeoff between centralized and decentralized health services: evidence from rural areas in Mexico.

    PubMed

    Vargas Bustamante, Arturo

    2010-09-01

    This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  18. Lead and uranium group abundances in cosmic rays

    NASA Technical Reports Server (NTRS)

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

    1985-01-01

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

  19. Childcare Providers: Work Stress and Personal Well-Being

    ERIC Educational Resources Information Center

    Faulkner, Monica; Gerstenblatt, Paula; Lee, Ahyoung; Vallejo, Viana; Travis, Dnika

    2016-01-01

    Childcare providers face multiple work-related stressors. Small studies of childcare providers have suggested that providers have high levels of depression compared to the general population. However, unlike other caregiving professions, the research examining childcare providers is sparse, and there is little information to inform practices and…

  20. Culture and social support provision: who gives what and why.

    PubMed

    Chen, Jacqueline M; Kim, Heejung S; Mojaverian, Taraneh; Morling, Beth

    2012-01-01

    The present research examined cultural differences in the type and frequency of support provided as well as the motivations underlying these behaviors. Study 1, an open-ended survey, asked participants about their social interactions in the past 24 hours and found that European Americans reported providing emotion-focused support more frequently than problem-focused support, whereas Japanese exhibited the opposite pattern. Study 2, a closed-ended questionnaire study, found that, in response to the close other's big stressor, European Americans provided more emotion-focused support whereas Japanese provided equivalent amounts of emotion-focused and problem-focused support. In addition, Study 2 examined motivational explanations for these differences. Social support provision was motivated by the goal of closeness and increasing recipient self-esteem among European Americans, but only associated with the motive for closeness among Japanese. These studies illustrate the importance of considering cultural context and its role in determining the meaning and function of various support behaviors.

  1. A Global Meta-Analysis of the Value of Ecosystem Services Provided by Lakes.

    PubMed

    Reynaud, Arnaud; Lanzanova, Denis

    2017-07-01

    This study presents the first meta-analysis on the economic value of ecosystem services delivered by lakes. A worldwide data set of 699 observations drawn from 133 studies combines information reported in primary studies with geospatial data. The meta-analysis explores antagonisms and synergies between ecosystem services. This is the first meta-analysis to incorporate simultaneously external geospatial data and ecosystem service interactions. We first show that it is possible to reliably predict the value of ecosystem services provided by lakes based on their physical and geographic characteristics. Second, we demonstrate that interactions between ecosystem services appear to be significant for explaining lake ecosystem service values. Third, we provide an estimation of the average value of ecosystem services provided by lakes: between 106 and 140 USD$2010 per respondent per year for non-hedonic price studies and between 169 and 403 USD$2010 per property per year for hedonic price studies.

  2. Quality of tuberculosis care in India: a systematic review

    PubMed Central

    Satyanarayana, S.; Subbaraman, R.; Shete, P.; Gore, G.; Das, J.; Cattamanchi, A.; Mayer, K.; Menzies, D.; Harries, A. D.; Hopewell, P.; Pai, M.

    2015-01-01

    SUMMARY BACKGROUND While Indian studies have assessed care providers’ knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS We searched multiple sources to identify studies (2000–2014) on providers’ knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULTS Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India. PMID:26056098

  3. Practical Considerations for Conducting Delphi Studies: The Oracle Enters a New Age.

    ERIC Educational Resources Information Center

    Eggers, Renee M.; Jones, Charles M.

    1998-01-01

    In addition to giving an overview of Delphi methodology and describing the methodology used by the researchers in two Delphi studies, the authors provide information about electronic communication in Delphi studies. Also provided are suggestions that can be used in a Delphi study involving any form of communication. (SLD)

  4. Home Care Providers to the Rescue: A Novel First-Responder Programme

    PubMed Central

    Hansen, Steen M.; Brøndum, Stig; Thomas, Grethe; Rasmussen, Susanne R.; Kvist, Birgitte; Christensen, Anette; Lyng, Charlotte; Lindberg, Jan; Lauritsen, Torsten L. B.; Lippert, Freddy K.; Torp-Pedersen, Christian; Hansen, Poul A.

    2015-01-01

    Aim To describe the implementation of a novel first-responder programme in which home care providers equipped with automated external defibrillators (AEDs) were dispatched in parallel with existing emergency medical services in the event of a suspected out-of-hospital cardiac arrest (OHCA). Methods We evaluated a one-year prospective study that trained home care providers in performing cardiopulmonary resuscitation (CPR) and using an AED in cases of suspected OHCA. Data were collected from cardiac arrest case files, case files from each provider dispatch and a survey among dispatched providers. The study was conducted in a rural district in Denmark. Results Home care providers were dispatched to 28 of the 60 OHCAs that occurred in the study period. In ten cases the providers arrived before the ambulance service and subsequently performed CPR. AED analysis was executed in three cases and shock was delivered in one case. For 26 of the 28 cases, the cardiac arrest occurred in a private home. Ninety-five per cent of the providers who had been dispatched to a cardiac arrest reported feeling prepared for managing the initial resuscitation, including use of AED. Conclusion Home care providers are suited to act as first-responders in predominantly rural and residential districts. Future follow-up will allow further evaluation of home care provider arrivals and patient survival. PMID:26509532

  5. Agenda: EDRN FDA Education Workshop — EDRN Public Portal

    Cancer.gov

    The purpose of this workshop was to open dialogue between FDA staff that provide oversight for review of in vitro diagnostic applications and EDRN scientists currently performing clinical validation studies on cancer biomarkers. Issues related to FDA review of diagnostic tests were presented by FDA personnel. Representatives from EDRN provided details on supporting data of their validation studies and the resources developed within EDRN to facilitate such research for FDA compliance. The agenda provided here provides links to the presentations by each speaker.

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

    PubMed

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

    2017-03-21

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

  7. Rising labor costs, earnings management, and financial performance of health care providers around the world.

    PubMed

    Dong, Gang Nathan

    2015-01-01

    Amid increasing interest in how government regulation and market competition affect the cost and financial sustainability in health care sector, it remains unclear whether health care providers behave similarly to their counterparts in other industries. The goal of this chapter is to study the degree to which health care providers manipulate accruals in periods of financial difficulties caused, in part, by the rising costs of labor. We collected the financial information of health care provider in 43 countries from 1984 to 2013 and conducted a pooled cross-sectional study with country and year fixed-effects. The empirical evidence shows that health care providers with higher wage costs are more likely to smooth their earnings in order to maintain financial sustainability. The finding of this study not only informs regulators that earnings management is pervasive in health care organizations around the world, but also contributes to the studies of financial booktax reporting alignment, given the existing empirical evidence linking earnings management to corporate tax avoidance in this very sector.

  8. Community Mental Health Providers' Beliefs About Addressing Weight Loss Among Youth Clients with Serious Emotional Disturbance and Overweight/Obesity: An Elicitation Study.

    PubMed

    Wykes, Thomas L; Bourassa, Katelynn A; Slosser, Andrea E; McKibbin, Christine L

    2018-02-09

    Youth with Serious Emotional Disturbance (SED) have high rates of overweight/obesity. Factors influencing mental health provider intentions to deliver weight-related advice are unclear. This study used qualitative methodology and Theory of Planned Behavior (TPB) constructs to examine these factors. Community mental health providers serving youth with SED were recruited via convenience sampling and an online provider list. Participants completed an open-ended TPB-based questionnaire online. Content analysis identified thematic beliefs. Twenty-one providers completed the questionnaire. Providers identified behavioral beliefs (e.g., client defensiveness), normative beliefs (e.g., medical professionals), and control beliefs (e.g., limited resources) that impact decisions to provide weight-related advice. Knowledge of factors that may influence providers' delivery of weight-related advice may lead to more effective healthy lifestyle programming for youth with SED.

  9. Nuclear medicine imaging system

    DOEpatents

    Bennett, G.W.; Brill, A.B.; Bizais, Y.J.C.; Rowe, R.W.; Zubal, I.G.

    1983-03-11

    It is an object of this invention to provide a nuclear imaging system having the versatility to do positron annihilation studies, rotating single or opposed camera gamma emission studies, and orthogonal gamma emission studies. It is a further object of this invention to provide an imaging system having the capability for orthogonal dual multipinhole tomography. It is another object of this invention to provide a nuclear imaging system in which all available energy data, as well as patient physiological data, are acquired simultaneously in list mode.

  10. Section 905(B) WRDA 86, Reconnaissance Study of Ecosystem Restoration for the Clinton River and Anchor Bay Watersheds, Macomb County and St. Clair County, Michigan

    DTIC Science & Technology

    2012-07-01

    water quality, potential for growth of invasive species , and fish and wildlife habitat . Clinton River and Anchor Bay Watersheds Reconnaissance...However, the study area provides important habitat for many rare species , with the most abundant being wooded areas. In addition, the study area features...animal life and provide spawning grounds for fish. These areas provide habitat for numerous species , including rare species such as black- crowned

  11. Results of the 1978 NACUBO Comparative Performance Study and Investment Questionnaire.

    ERIC Educational Resources Information Center

    Dresner, Bruce M.

    Information from the 1978 Comparative Performance Study and investment questionnaire conducted by the National Association of College and University Business Officers is presented. One hundred forty-four institutions provided information about 164 investment pools. The Comparative Performance Study provides participating institutions with…

  12. 10 CFR 5.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  13. 10 CFR 5.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  14. 24 CFR 3.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  15. 10 CFR 5.400 - Education programs or activities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  16. 24 CFR 3.400 - Education programs or activities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  17. 24 CFR 3.400 - Education programs or activities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... governments and restricted to members of one sex, that are designed to provide opportunities to study abroad... by a recipient educational institution to study at a foreign institution. A recipient educational... provides, or otherwise makes available, reasonable opportunities for similar studies for members of the...

  18. Pharmaceutical companies and healthcare providers: Going beyond the gift – An explorative review

    PubMed Central

    Westra, Daan; Angeli, Federica; Paulus, Aggie; Struss, Marleen; Ruwaard, Dirk

    2018-01-01

    Introduction Interactions between pharmaceutical companies and healthcare providers are increasingly scrutinized by academics, professionals, media, and politicians. Most empirical studies and professional guidelines focus on unilateral donor-recipient types of interaction and overlook, or fail to distinguish between, more reciprocal types of interaction. However, the degree of goal alignment and potential for value creation differs in these two types of interactions. Failing to differentiate between these two forms of interaction between pharmaceutical companies and healthcare providers could thus lead to biased conclusions regarding their desirability. This study reviews the empirical literature regarding the effects of bilateral forms of interactions between pharmaceutical companies and healthcare providers in order to explore their effects. Material and methods We searched two medical databases (i.e. PubMed and Cochrane Library) and one business database (i.e. EBSCO) for empirical, peer-reviewed articles concerning any type of bilateral interaction between pharmaceutical companies and healthcare providers. We included quantitative articles which were written in English and published between January 1st, 2000 and October 31st, 2016, and where the title or abstract included a combination of synonyms of the following keywords: pharmaceutical companies, healthcare providers, interaction, and effects. Results Our search results yielded 10 studies which were included in our analysis. These studies focused on either research-oriented interaction or on education-oriented interaction. The included studies reported various outcomes of interaction such as prescribing behavior, ethical dilemmas, and research output. Regardless of the type of interaction, the studies either reported no significant effects or ambivalent outcomes such as affected clinical practice or ethical issues. Discussion and conclusion The effects of bilateral interactions reported in the literature are similar to those reported in studies concerning unilateral interactions. The theoretical notion that bilateral interactions between pharmaceutical companies and healthcare providers have different effects given their increased level of goal alignment thus does not seem to hold. However, most of the empirical studies focus on intermediary, provider-level, outcomes such as altered prescribing behavior. Outcomes at the health system level such as overall costs and quality of care are overlooked. Further research is necessary in order to disentangle various forms of value created by different types of interactions between pharmaceutical companies and healthcare providers. PMID:29414998

  19. Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization.

    PubMed Central

    Phillips, K A; Morrison, K R; Andersen, R; Aday, L A

    1998-01-01

    OBJECTIVE: The behavioral model of utilization, developed by Andersen, Aday, and others, is one of the most frequently used frameworks for analyzing the factors that are associated with patient utilization of healthcare services. However, the use of the model for examining the context within which utilization occurs-the role of the environment and provider-related factors-has been largely neglected. OBJECTIVE: To conduct a systematic review and analysis to determine if studies of medical care utilization that have used the behavioral model during the last 20 years have included environmental and provider-related variables and the methods used to analyze these variables. We discuss barriers to the use of these contextual variables and potential solutions. DATA SOURCES: The Social Science Citation Index and Science Citation Index. We included all articles from 1975-1995 that cited any of three key articles on the behavioral model, that included all articles that were empirical analyses and studies of formal medical care utilization, and articles that specifically stated their use of the behavioral model (n = 139). STUDY DESIGN: Design was a systematic literature review. DATA ANALYSIS: We used a structured review process to code articles on whether they included contextual variables: (1) environmental variables (characteristics of the healthcare delivery system, external environment, and community-level enabling factors); and (2) provider-related variables (patient factors that may be influenced by providers and provider characteristics that interact with patient characteristics to influence utilization). We also examined the methods used in studies that included contextual variables. PRINCIPAL FINDINGS: Forty-five percent of the studies included environmental variables and 51 percent included provider-related variables. Few studies examined specific measures of the healthcare system or provider characteristics or used methods other than simple regression analysis with hierarchical entry of variables. Only 14 percent of studies analyzed the context of healthcare by including both environmental and provider-related variables as well as using relevant methods. CONCLUSIONS: By assessing whether and how contextual variables are used, we are able to highlight the contributions made by studies using these approaches, to identify variables and methods that have been relatively underused, and to suggest solutions to barriers in using contextual variables. PMID:9685123

  20. Decision support system of e-book provider selection for library using Simple Additive Weighting

    NASA Astrophysics Data System (ADS)

    Ciptayani, P. I.; Dewi, K. C.

    2018-01-01

    Each library has its own criteria and differences in the importance of each criterion in choosing an e-book provider for them. The large number of providers and the different importance levels of each criterion make the problem of determining the e-book provider to be complex and take a considerable time in decision making. The aim of this study was to implement Decision support system (DSS) to assist the library in selecting the best e-book provider based on their preferences. The way of DSS works is by comparing the importance of each criterion and the condition of each alternative decision. SAW is one of DSS method that is quite simple, fast and widely used. This study used 9 criteria and 18 provider to demonstrate how SAW work in this study. With the DSS, then the decision-making time can be shortened and the calculation results can be more accurate than manual calculations.

  1. Strategies for engaging the private sector in sexual and reproductive health: how effective are they?

    PubMed

    Peters, David H; Mirchandani, Gita G; Hansen, Peter M

    2004-10-01

    The private health sector provides a significant portion of sexual and reproductive health (SRH) services in developing countries. Yet little is known about which strategies for intervening with private providers can improve quality or coverage of services. We conducted a systematic review of the literature through PubMed from 1980 to 2003 to assess the effectiveness of private sector strategies for SRH services in developing countries. The strategies examined were regulating, contracting, financing, franchising, social marketing, training and collaborating. Over 700 studies were examined, though most were descriptive papers, with only 71 meeting our inclusion criteria of having a private sector strategy for one or more SRH services and the measurement of an outcome in the provider or the beneficiary. Nearly all studies (96%) had at least one positive association between SRH and the private sector strategy. About three-quarters of the studies involved training private providers, though combinations of strategies tended to give better results. Maternity services were most commonly addressed (55% of studies), followed by prevention and treatment of sexually transmitted diseases (32%). Using study design to rate the strength of evidence, we found that the evidence about effectiveness of private sector strategies on SRH services is weak. Most studies did not use comparison groups, or they relied on cross-sectional designs. Nearly all studies examined short-term effects, largely measuring changes in providers rather than changes in health status or other effects on beneficiaries. Five studies with more robust designs (randomized controlled trials) demonstrated that contraceptive use could be increased through supporting private providers, and showed cases where the knowledge and practices of private providers could be improved through training, regulation and incentives. Although tools to work with the private sector offer considerable promise, without stronger research designs, key questions regarding their feasibility and impact remain unanswered. Copyright 2004 Oxford University Press

  2. Big Impact on Small Children: Child-Care Providers' Perceptions of Their Role in Early Childhood Healthy Lifestyle Behaviours

    ERIC Educational Resources Information Center

    Sisson, Susan B.; Smith, Chelsea L.; Cheney, Marshall

    2017-01-01

    The purpose of this study is to examine childcare providers' perceptions of their role in child health behaviors and attitudes pertaining to physical activity and nutrition. Part and full-time providers in a childcare center or family childcare home were interviewed (n = 30) in this cross-sectional, qualitative study. Transcripts were digitally…

  3. Together and Alone a Study of Interactions between Toddlers and Childcare Providers during Mealtime in Norwegian Childcare Centres

    ERIC Educational Resources Information Center

    Klette, Trine; Drugli, May Britt; Aandahl, Ann Mari

    2018-01-01

    The study investigated the quality of interactions between childcare providers and toddlers during a lunch in childcare centres. Meals in childcare centres are semi-structured adult-led situations where the children not only eat, but are also provided with opportunities for implicit learning and interactions. Participants were 13 toddlers aged…

  4. Identifying the HIV Testing Beliefs of Healthcare Provider Staff at a University Student Health Center: An Exploratory Study

    ERIC Educational Resources Information Center

    Harris, Cornelia A.

    2012-01-01

    This research project examined the views and perceptions of healthcare provider staff regarding HIV testing and the implementation of HIV testing as a routine part of medical practice in a university student health center at a Historically Black College or University (HBCU). This study further explored whether healthcare provider staff promoted…

  5. Family Child Care Providers' Perspectives regarding Effective Professional Development and Their Role in the Child Care System: A Qualitative Study

    ERIC Educational Resources Information Center

    Lanigan, Jane D.

    2011-01-01

    This study examines family child care providers' perspectives regarding effective professional development and their role in the early learning and care system. Four focus groups were conducted annually for 3 years involving a total of 54 licensed family child care providers. Supportive social relationships emerged as an important dimension of…

  6. Making it work: health care provider perspectives on strategies to increase colorectal cancer screening in federally qualified health centers.

    PubMed

    Gwede, Clement K; Davis, Stacy N; Quinn, Gwendolyn P; Koskan, Alexis M; Ealey, Jamila; Abdulla, Rania; Vadaparampil, Susan T; Elliott, Gloria; Lopez, Diana; Shibata, David; Roetzheim, Richard G; Meade, Cathy D

    2013-12-01

    Colorectal cancer screening (CRCS) rates are low among men and women who seek health care at federally qualified health centers (FQHCs). This study explores health care providers' perspectives about their patient's motivators and impediments to CRCS and receptivity to preparatory education. A mixed methods design consisting of in-depth interviews, focus groups, and a short survey is used in this study. The participants of this study are 17 health care providers practicing in FQHCs in the Tampa Bay area. Test-specific patient impediments and motivations were identified including fear of abnormal findings, importance of offering less invasive fecal occult blood tests, and need for patient-centered test-specific educational materials in clinics. Opportunities to improve provider practices were identified including providers' reliance on patients' report of symptoms as a cue to recommend CRCS and overemphasis of clinic-based guaiac stool tests. This study adds to the literature on CRCS test-specific motivators and impediments. Providers offered unique approaches for motivating patients to follow through with recommended CRCS and were receptive to in-clinic patient education. Findings readily inform the design of educational materials and interventions to increase CRCS in FQHCs.

  7. Impact of the Brain Injury Family Intervention (BIFI) training on rehabilitation providers: A mixed methods study.

    PubMed

    Meixner, Cara; O'Donoghue, Cynthia R; Hart, Vesna

    2017-01-01

    The psychological impact of TBI is vast, leading to adverse effects on survivors and their caregivers. Unhealthy family functioning may be mitigated by therapeutic strategies, particularly interdisciplinary family systems approaches like the well-documented Brain Injury Family Intervention (BIFI). Little is known about the experience of providers who offer such interventions. This mixed methods study aims to demonstrate that a structured three-day training on the BIFI protocol improves providers' knowledge and confidence in working with survivors and families, and that this outcome is sustainable. Participants were 34 providers who participated in an intensive training and completed a web-based survey at four points of time. Quantitative data were analyzed via Wilcoxon signed-rank tests and binomial test of proportions. Qualitative data were analyzed according to rigorous coding procedures. Providers' knowledge of brain injury and their ability to conceptualize treatment models for survivors and their families increased significantly and mostly remain consistent over time. Qualitative data point to additional gains, such as understanding of family systems. Past studies quantify the BIFI as an evidence-based intervention. This study supports the effectiveness of training and serves as first to demonstrate the benefit for providers short- and long-term.

  8. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making.

    PubMed

    Gordon, Bradley D; Bernard, Kyle; Salzman, Josh; Whitebird, Robin R

    2015-12-01

    The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. ED providers are driven to use HIE when they're missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.

  9. Does public reporting influence quality, patient and provider's perspective, market share and disparities? A review.

    PubMed

    Vukovic, Vladimir; Parente, Paolo; Campanella, Paolo; Sulejmani, Adela; Ricciardi, Walter; Specchia, Maria Lucia

    2017-12-01

    Public reporting (PR) of healthcare (HC) provider's quality was proposed as a public health instrument for providing transparency and accountability in HC. Our aim was to assess the impact of PR on five main domains: quality improvement; patient choice, service utilization and market share; provider's perspective; patient experience; and unintended consequences. PubMed, Scopus, ISI WOS, and EconLit databases were searched to identify studies investigating relationships between PR and five main domains, published up to April 1, 2016. Sixty-two papers published between 1988 and 2015 were included. Nineteen studies investigated quality improvement, 19 studies explored the unintended consequences of PR, 10 explored the effects on market share, 10 on patients' choice, 7 evaluated the provider's perspective, 4 economic outcome, 4 service utilization, 2 purchasers' use of PR and 2 studies explored patient experiences. The effect of PR was diverse throughout the studies-mostly positive on: patient experience (100%), quality improvement (63%), patient choice, service utilization and market share (46%); mixed on provider's perspective and economic outcome (27%) and mainly negative on unintended consequences (68%). Our research covering different outcomes and settings reported that PR is associated with changes in HC provider's behavior and can influence market share. Unintended consequences are a concern of PR and should be taken into account when allocating HC resources. The experiences collected in this paper could give a snapshot about the impact of PR on a HC user's perception of the providers' quality of care, helping them to make empowered choices. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  10. 34 CFR 692.1 - What is the Leveraging Educational Assistance Partnership?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (LEAP) Program assists States in providing grants and work-study assistance to eligible students who attend institutions of higher education and have substantial financial need. The work-study assistance is provided through campus-based community service work learning study programs, hereinafter referred to as...

  11. 34 CFR 692.1 - What is the Leveraging Educational Assistance Partnership?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (LEAP) Program assists States in providing grants and work-study assistance to eligible students who attend institutions of higher education and have substantial financial need. The work-study assistance is provided through campus-based community service work learning study programs, hereinafter referred to as...

  12. 34 CFR 692.1 - What is the Leveraging Educational Assistance Partnership?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (LEAP) Program assists States in providing grants and work-study assistance to eligible students who attend institutions of higher education and have substantial financial need. The work-study assistance is provided through campus-based community service work learning study programs, hereinafter referred to as...

  13. 34 CFR 692.1 - What is the Leveraging Educational Assistance Partnership?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (LEAP) Program assists States in providing grants and work-study assistance to eligible students who attend institutions of higher education and have substantial financial need. The work-study assistance is provided through campus-based community service work learning study programs, hereinafter referred to as...

  14. Making a Case for a Blended Approach: The Need for The Design-Based Case Study

    ERIC Educational Resources Information Center

    Deaton, Cynthia C. M.; Malloy, Jacquelynn A.

    2017-01-01

    Design-based case studies address research questions that involve instructional innovations within a bounded system. This blend of case study and design-based research provides a systematic approach to examining instructional innovations that are bounded by perspective, context, and time. Design-based case studies provide a framework for engaging…

  15. Tug fleet and ground operations schedules and controls. Volume 2: part 1

    NASA Technical Reports Server (NTRS)

    1975-01-01

    This Tug Fleet and Ground Operations Schedules and Controls Study addresses both ground operational data and technical requirements that span the Tug planning phase and operations phase. A similar study covering mission operations (by others) provides the complimentary flight operations details. The two studies provide the planning data requirements, resource allocation, and control milestones for supporting the requirements of the STS program. This Tug Fleet and Ground Operations Schedules and Controls Study incorporates the basic ground operations requirements and concepts provided by previous studies with the interrelationships of the planning, IUS transition, and Tug fleet operations phases. The interrelationships of these phases were studied as a system to optimize overall program benefits and minimize operational risk factors.

  16. Hands-On Defibrillation Skills of Pediatric Acute Care Providers During a Simulated Ventricular Fibrillation Cardiac Arrest Scenario

    PubMed Central

    Bhalala, Utpal S.; Balakumar, Niveditha; Zamora, Maria; Appachi, Elumalai

    2018-01-01

    Introduction: Timely defibrillation in ventricular fibrillation cardiac arrest (VFCA) is associated with good outcome. While defibrillation skills of pediatric providers have been reported to be poor, the factors related to poor hands-on defibrillation skills of pediatric providers are largely unknown. The aim of our study was to evaluate delay in individual steps of the defibrillation and human and non-human factors associated with poor hands-on defibrillation skills among pediatric acute care providers during a simulated VFCA scenario. Methods: We conducted a prospective observational study of video evaluation of hands-on defibrillation skills of pediatric providers in a simulated VFCA in our children's hospital. Each provider was asked to use pads followed by paddles to provide 2 J/kg shock to an infant mannequin in VFCA. The hands-on skills were evaluated for struggle with any step of defibrillation, defined a priori as >10 s delay with particular step. The data was analyzed using chi-square test with significant p-value < 0.05. Results: A total of 68 acute care providers were evaluated. Median time to first shock was 97 s (IQR: 60–122.5 s) and did not correlate with provider factors, except previous experience with the defibrillator used in study. The number of providers who struggled (>10 s delay) with each of connecting the pads/paddles to the device, using pads/paddles on the mannequin and using buttons on the machine was 34 (50%), 26 (38%), and 31 (46%), respectively. Conclusions: The defibrillation skills of providers in a tertiary care children's hospital are poor. Both human and machine-related factors are associated with delay in defibrillation. Prior use of the study defibrillator is associated with a significantly shorter time-to-first shock as compared to prior use of any other defibrillator or no prior use of any defibrillator. PMID:29740571

  17. Hands-On Defibrillation Skills of Pediatric Acute Care Providers During a Simulated Ventricular Fibrillation Cardiac Arrest Scenario.

    PubMed

    Bhalala, Utpal S; Balakumar, Niveditha; Zamora, Maria; Appachi, Elumalai

    2018-01-01

    Introduction: Timely defibrillation in ventricular fibrillation cardiac arrest (VFCA) is associated with good outcome. While defibrillation skills of pediatric providers have been reported to be poor, the factors related to poor hands-on defibrillation skills of pediatric providers are largely unknown. The aim of our study was to evaluate delay in individual steps of the defibrillation and human and non-human factors associated with poor hands-on defibrillation skills among pediatric acute care providers during a simulated VFCA scenario. Methods: We conducted a prospective observational study of video evaluation of hands-on defibrillation skills of pediatric providers in a simulated VFCA in our children's hospital. Each provider was asked to use pads followed by paddles to provide 2 J/kg shock to an infant mannequin in VFCA. The hands-on skills were evaluated for struggle with any step of defibrillation, defined a priori as >10 s delay with particular step. The data was analyzed using chi-square test with significant p -value < 0.05. Results: A total of 68 acute care providers were evaluated. Median time to first shock was 97 s (IQR: 60-122.5 s) and did not correlate with provider factors, except previous experience with the defibrillator used in study. The number of providers who struggled (>10 s delay) with each of connecting the pads/paddles to the device, using pads/paddles on the mannequin and using buttons on the machine was 34 (50%), 26 (38%), and 31 (46%), respectively. Conclusions: The defibrillation skills of providers in a tertiary care children's hospital are poor. Both human and machine-related factors are associated with delay in defibrillation. Prior use of the study defibrillator is associated with a significantly shorter time-to-first shock as compared to prior use of any other defibrillator or no prior use of any defibrillator.

  18. Developing a tool to assess motivation among health service providers working with public health system in India.

    PubMed

    Purohit, Bhaskar; Maneskar, Abhishek; Saxena, Deepak

    2016-04-14

    Addressing the shortage of health service providers (doctors and nurses) in rural health centres remains a huge challenge. The lack of motivation of health service providers to serve in rural areas is one of the major reasons for such shortage. While many studies have aimed at analysing the reasons for low motivation, hardly any studies in India have focused on developing valid and reliable tools to measure motivation among health service providers. Hence, the objective of the study was to test and develop a valid and reliable instrument to assess the motivation of health service providers working with the public health system in India and the extent to which the motivation factors included in the study motivate health service providers to perform better at work. The present study adapted an already developed tool on motivation. The reliability and validity of the tool were established using different methods. The first stage of the tool development involved content development and assessment where, after a detailed literature review, a predeveloped tool with 19 items was adapted. However, in light of the literature review and pilot test, the same tool was modified to suit the local context by adding 7 additional items so that the final modified tool comprised of 26 items. A correlation matrix was applied to check the pattern of relationships among the items. The total sample size for the study was 154 health service providers from one Western state in India. To understand the sampling adequacy, the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's test of sphericity were applied and finally factor analysis was carried out to calculate the eigenvalues and to understand the relative impact of factors affecting motivation. A correlation matrix value of 0.017 was obtained narrating multi-co-linearity among the observations. Based on initial factor analysis, 8 out of 26 study factors were excluded from the study components with a cutoff range of less than 0.6. Running the factor analysis again suggested the inclusion of 18 items which were subsequently labelled under the following heads: transparency, goals, security, convenience, benefits, encouragement, adequacy of earnings and further growth and power. There is a great need to develop instruments aimed at assessing the motivation of health service providers. The instrument used in the study has good psychometric properties and may serve as a useful tool to assess motivation among healthcare providers.

  19. Distance Learning Library Services in Ugandan Universities

    ERIC Educational Resources Information Center

    Mayende, Jackline Estomihi Kiwelu; Obura, Constant Okello

    2013-01-01

    The study carried out at Makerere University and Uganda Martyrs University in 2010 aimed at providing strategies for enhanced distance learning library services in terms of convenience and adequacy. The study adopted a cross sectional descriptive survey design. The study revealed services provided in branch libraries in Ugandan universities were…

  20. Social Studies Framework: Kindergarten-Grade 12.

    ERIC Educational Resources Information Center

    Texas Education Agency, Austin.

    This document provides general instructional guidelines for district administrators and teachers in Texas as they attempt to meet the goal of preparing students for citizenship in a democracy. The framework includes the legal requirements for social studies and provides guidelines to school districts in planning social studies programs for grades…

  1. Tracking the Gender Pay Gap: A Case Study

    ERIC Educational Resources Information Center

    Travis, Cheryl B.; Gross, Louis J.; Johnson, Bruce A.

    2009-01-01

    This article provides a short introduction to standard considerations in the formal study of wages and illustrates the use of multiple regression and resampling simulation approaches in a case study of faculty salaries at one university. Multiple regression is especially beneficial where it provides information on strength of association, specific…

  2. [Rural Education Studies.

    ERIC Educational Resources Information Center

    Wright, Betty Atwell

    The Rural Education Studies albums (oversized photographs printed on heavy coated cardboard) are published in a set of 8, each of which has a separate teacher's guide to complement the contents. A comprehensive teacher's guide provides background studies for effective use of the series, as well as providing specific information and key-concepts…

  3. 76 FR 57056 - International Cooperation on Harmonisation of Technical Requirements for Registration of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-15

    ... guidance document is intended to provide study design recommendations that will facilitate the universal... objective of this guidance is to provide study design recommendations that will facilitate the universal... Products; Guidance for Industry on Studies To Evaluate the Metabolism and Residue Kinetics of Veterinary...

  4. 34 CFR 674.9 - Student eligibility.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... professional student at the institution, whether or not engaged in a program of study abroad approved for...) who is pursuing a course of study at an institution of higher education is considered to have no... the support it provides; and (3) Directs the member to pursue the course of study or provides...

  5. 34 CFR 674.9 - Student eligibility.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... professional student at the institution, whether or not engaged in a program of study abroad approved for...) who is pursuing a course of study at an institution of higher education is considered to have no... the support it provides; and (3) Directs the member to pursue the course of study or provides...

  6. 34 CFR 674.9 - Student eligibility.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... professional student at the institution, whether or not engaged in a program of study abroad approved for...) who is pursuing a course of study at an institution of higher education is considered to have no... the support it provides; and (3) Directs the member to pursue the course of study or provides...

  7. 34 CFR 674.9 - Student eligibility.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... professional student at the institution, whether or not engaged in a program of study abroad approved for...) who is pursuing a course of study at an institution of higher education is considered to have no... the support it provides; and (3) Directs the member to pursue the course of study or provides...

  8. 34 CFR 674.9 - Student eligibility.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... professional student at the institution, whether or not engaged in a program of study abroad approved for...) who is pursuing a course of study at an institution of higher education is considered to have no... the support it provides; and (3) Directs the member to pursue the course of study or provides...

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

    PubMed

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

    2017-04-01

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

  10. Trust in technology-mediated collaborative health encounters: constructing trust in passive user interactions with technologies.

    PubMed

    Montague, Enid; Asan, Onur

    2012-01-01

    The present study investigated factors that explain patient trust in health technology and the relationship between patient trust in technology and trust in their care provider. Sociotechnical systems theory states that changes in one part of the system are likely related to other parts of the system. Therefore, attitudes about technologies, like trust, are likely related to other aspects of the system. Contributing to appropriate trust at the technological, interpersonal, and system levels can potentially lead to positive health outcomes. The study described in this manuscript used data collected from 101 patients with a Trust in Medical Technology instrument. The instrument measured patients' trust in (1) their providers, (2) the technology, and (3) how their providers used the technology. Measure 3 was positively associated with measures 1 and 2, while measures 1 and 2 were not positively or negatively associated with one another. These results may indicate that patient assessments of the trustworthiness of care providers and technologies are based on their observations of how providers use technologies. Though patients are not active users of technologies in health care, the results of this study show that their perceptions of how providers use technology are related to their trust in both technology and the care provider. Study findings have implications for how trust is conceptualised and measured in interpersonal relationships and in technologies.

  11. Health care in adults with Down syndrome: a longitudinal cohort study.

    PubMed

    Jensen, K M; Davis, M M

    2013-10-01

    Individuals with Down syndrome increasingly survive into adulthood, yet little is known about their healthcare patterns as adults. Our study sought to characterise patterns of health care among adults with Down syndrome based on whether they had fully transitioned to adult-oriented providers by their inception in this cohort. In this retrospective observational cohort study, healthcare utilisation and annualised patient charges were evaluated in patients with Down syndrome aged 18-45 years who received care in a single academic health centre from 2000 to 2008. Comparisons were made based on patients' provider mix (only adult-focused or 'mixed' child- and adult-focused providers). The cohort included 205 patients with median index age = 28 years; 52% of these adult patients had incompletely transitioned to adult providers and received components of their care from child-focused providers. A higher proportion of these 'mixed' patients were seen exclusively by subspecialty providers (mixed = 81%, adult = 46%, P < 0.001), suggesting a need for higher intensity specialised services. Patients in the mixed provider group incurred higher annualised charges in analyses adjusted for age, mortality, total annualised encounters, and number of subspecialty disciplines accessed. These differences were most pronounced when stratified by whether patients were hospitalised during the study period (e.g., difference in adjusted means between mixed versus adult provider groups: $571 without hospitalisation, $19,061 with hospitalisation). In this unique longitudinal cohort of over 200 adults aged 18-45 years with Down syndrome, over half demonstrated incomplete transition to adult care. Persistent use of child-focused care, often with a subspecialty emphasis, has implications for healthcare charges. Future studies must identify reasons for distinct care patterns, examine their relationship with clinical outcomes, and evaluate which provider types deliver the highest quality care for adults with Down syndrome and a wide variety of comorbidities. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

  12. Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon.

    PubMed

    Saleh, Shadi; Khodor, Rawya; Alameddine, Mohamad; Baroud, Maysa

    2016-11-10

    eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools. A self-administered questionnaire was used to assess participants' socio-demographics, computer use, literacy, and access, and participants' readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane's T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth. Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants' level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy. The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

  13. PERSONAL CHARACTERISTICS OF OLDER PRIMARY CARE PATIENTS WHO PROVIDE A BUCCAL SWAB FOR APOE TESTING AND BANKING OF GENETIC MATERIAL: THE SPECTRUM STUDY

    PubMed Central

    Bogner, Hillary R.; Wittink, Marsha N.; Merz, Jon F.; Straton, Joseph B.; Cronholm, Peter F.; Rabins, Peter V.; Gallo, Joseph J.

    2009-01-01

    OBJECTIVE To determine the personal characteristics and reasons associated with providing a buccal swab for APOE genetic testing in a primary care study. METHODS The study sample consisted of 342 adults aged 65 years and older recruited from primary care settings. RESULTS In all, 88% of patients agreed to provide a DNA sample for APOE genotyping and 78% of persons providing a sample agreed to banking of the DNA. Persons aged 80 years and older and African-Americans were less likely to participate in APOE genotyping. Concern about confidentiality was the most common reason for not wanting to provide a DNA sample or to have DNA banked. CONCLUSION We found stronger relationships between sociodemographic variables of age and ethnicity with participation in genetic testing than we did between level of educational attainment, gender, function, cognition, and affect. PMID:15692195

  14. Conflict and Care

    PubMed Central

    Young, Savannah S.; Lewis, Denise C.; Gilbey, Peter; Eisenman, Arie; Schuster, Richard; Seponski, Desiree M.

    2016-01-01

    Israel has provided immediate healthcare to Syrian children, civilians and fighters since early 2013 despite being in an official state of war with Syria since 1973. We present qualitative findings from a larger mixed-methods phenomenological study to understand how the geopolitical and social history of Israel and Syria influences healthcare providers and Syrian patient caregivers in northern Israel. Theories of humanization and cognitive dissonance guided this study and frame the beliefs and experiences of healthcare providers who treated wounded Syrians in Israeli hospitals. Findings indicate healthcare providers and Syrian caregivers adjusted their beliefs to allow for positive healthcare experiences. Qualitative analysis revealed two major themes: supportive and hindering systemic elements contributing to the healthcare provider-patient-caregiver relationship. Internal psychological developments, contextual factors, and relational processes influenced humanization of the other within the relationship. This study illuminates unique ethical and humanitarian demands relevant for healthcare workers and those with whom they interact. PMID:28508018

  15. Consumer providers' experiences of recovery and concerns as members of a psychiatric multidisciplinary outreach team: A qualitative descriptive study from the Japan Outreach Model Project 2011-2014.

    PubMed

    Kido, Yoshifumi; Kayama, Mami

    2017-01-01

    The objective of this study was to clarify consumer providers (CPs) subjective experiences as members of a psychiatric multidisciplinary outreach team that provided services to individuals with a mental illness living in the community. A qualitative descriptive study was conducted through semi-structured interviews. Participants were clients hired as CPs in the Japanese Outreach Model Project from September 2011 until March 2014. Of the seventeen CPs, nine participated in this study. We looked at the CPs' subjective experiences of fulfillment and difficulty. In the process of providing services, CPs experienced both achievements and concerns. They had a sense of achievement by caring for their clients and they experienced that they themselves were recovering. They were also concerned about having inadequate knowledge and skills to provide psychiatric services to their clients. Further, there were concerns about their dual role on the multidisciplinary team and being support staff while they were still using mental health services themselves. The results show that the activities of CPs included fulfillment, recovery, and dilemmas. Clarifications will likely contribute to an increase in understanding and cooperation between CPs and other professionals with whom they work. Further studies are needed to investigate policies related to mental health consumers who are also providers of mental health services.

  16. Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children.

    PubMed

    Svendsen, Edel Jannecke; Moen, Anne; Pedersen, Reidar; Bjørk, Ida Torunn

    2016-03-01

    The aim of this study was to increase understanding of parent-healthcare provider interaction in situations where newly admitted preschool children resist peripheral vein cannulation. Parent-healthcare provider interaction represents an important context for understanding children's resistance to medical procedures. Knowledge about this interaction can provide a better understanding of how restraint is used and talked about. Symbolic interactionism informed the understanding of interaction. An exploratory, qualitative study was chosen because little is known about these interactions. During 2012-2013, 14 naturalistic peripheral vein cannulation -attempts with six newly hospitalized preschool children were video recorded. Eight parents/relatives, seven physicians and eight nurses participated in this study. The analytical foci of turn-taking and participant structure were used. The results comprised three patterns of interactions. The first pattern, 'parents supported the interaction initiated by healthcare providers', was a response to the children's expressed resistance and they performed firm restraint together. The second pattern, 'parents create distance in interaction with healthcare providers', appeared after failed attempts and had a short time span. Parents stopped following up on the healthcare providers' interaction and their restraint became less firm. In the third pattern, 'healthcare providers reorient in interaction', healthcare providers took over more of the restraint and either helped each other to continue the interaction or they stopped it. Knowledge about the identified patterns of interactions can help healthcare providers to better understand and thereby prepare both parents and themselves for situations with potential use of restraint. © 2015 John Wiley & Sons Ltd.

  17. Public health care providers and market competition: the case of Finnish occupational health services.

    PubMed

    Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

    2011-02-01

    As reforms in publicly funded health systems rely heavily on competition, it is important to know if and how public providers react to competition. In many European countries, it is empirically difficult to study public providers in different markets, but in Finnish occupational health services, both public and private for-profit and non-profit providers co-exist. We studied possible differences in public providers' performance (price, intensity of services, service mix-curative medical services/prevention, productivity and revenues) according to the competitiveness of the market. The Finnish Institute of Occupational Health (FIOH) collected data on clients, services and personnel for 1992, 1995, 1997, 2000 and 2004 from occupational health services (OHS) providers. Employers defray the costs of OHS and apply for reimbursement from the Social Insurance Institution (SII). The SII data was merged with FIOH's questionnaire. The unbalanced panel consisted of about 230 public providers, totalling 1,164 observations. Local markets were constructed from several municipalities based on commuting practices and regional collaboration. Competitiveness of the market was measured by the number of providers and by the Herfindahl index. The effect of competition was studied by ordinary least square regression analysis and panel models. The more competitive the environment was for a public provider the higher were intensity, productivity and the share of medical care. Fixed panel models showed that these differences were not due to differences and changes in the competitiveness of the market. Instead, in more competitive markets public providers had higher unit prices and higher revenues.

  18. Role perceptions of occupational therapists providing support and education for caregivers of persons with dementia.

    PubMed

    Toth-Cohen, S

    2000-01-01

    This pilot study explored occupational therapists' perceptions of their roles as interventionists providing education and support for caregivers of persons with dementia. The intervention was provided in caregivers' homes as part of a larger funded study. Interviews were conducted with four occupational therapists to elicit their reflections on practice and their views on occupational therapy services on the basis of their experiences providing support and education for caregivers in the funded study. Key themes consisted of the contrasts between the therapists' roles in the study and their customary practices and the professional and personal impact of their role in the study. Their recommendations for occupational therapy services emphasized the need to (a) collaborate with patients, families, and other health care staff members to solve problems; (b) acknowledge others as experts; (c) include family perspectives; and (d) fully address the needs of patients and families in their home environments. Providing support and education for caregivers in the community can be a major transition for therapists accustomed to practicing in more traditional settings. Additional research is needed to explore the ways in which specific practice contexts influence delivery of occupational therapy services.

  19. Facilitators of Survivorship Care Among Underserved Breast Cancer Survivors: a Qualitative Study.

    PubMed

    Ustjanauskas, Amy E; Quinn, Gwendolyn P; Pan, Tonya M; Rivera, Maria; Vázquez-Otero, Coralia; Ung, Danielle; Roetzheim, Richard G; Laronga, Christine; Johnson, Kenneth; Norton, Marilyn; Carrizosa, Claudia; Muñoz, Dariana; Goldenstein, Marissa; Nuhaily, Sumayah; Wells, Kristen J

    2017-12-01

    Research investigating facilitators of survivorship care among underserved breast cancer survivors (BCS) is sparse. This study aimed to explore facilitators of survivorship care among underserved BCS within the first 5 years following chemotherapy, radiation, or surgery for breast cancer. In-depth interviews were conducted, using a semi-structured interview guide, with underserved BCS exploring survivorship care experiences. Content analysis of the verbatim transcripts was applied, and results were summarized according to themes related to facilitators of breast cancer survivorship care. Interviews were conducted with 25 BCS. Eight main themes were identified: coordination of care; positive perceptions of health care providers; communication between patient and health care providers; financial and insurance facilitators; information, classes, and programs provided; assistance provided by organizations and health care professionals; transportation facilitators; and job flexibility. This study provides a comprehensive look at facilitators of survivorship care among underserved BCS. BCS endorsed several facilitators of their survivorship care, mainly at the interpersonal, organizational, and societal level. This study adds to the research literature on catalysts of care among underserved BCS. Results from this study are currently being used to inform a patient navigation intervention to facilitate care among this population.

  20. Southern Illinois: Resources, Problems, Opportunities. Report Series No. 85-2. Occasional Paper in Geography No. 7.

    ERIC Educational Resources Information Center

    Christensen, David E.; And Others

    This overview of 34 mostly rural counties in southern Illinois is intended to: (1) provide a mid-1980s look at Southern Illinois and its potentials for those who want to learn about the region; (2) provide the basis for further study of the region's many aspects and potentials; and (3) provide basic overview material for those studying particular…

  1. Promoting Socio-Economic Development: How Mobile Telephony Is an Agent for Creating High-Paying Jobs in Ghana from the Service Providers' Perspective

    ERIC Educational Resources Information Center

    Boateng, Ofori

    2011-01-01

    This exploration study examined solely, mobile telephony (which is an important aspect of ICTs) and how it promotes the creation of high-paying jobs that positively impact socio-economic development in Ghana from the service providers. perspective. This academic study focusing solely on Ghana mobile telephony service providers is the first of its…

  2. Systematic Review of Measles and Rubella Serology Studies.

    PubMed

    Thompson, Kimberly M; Odahowski, Cassie L

    2016-07-01

    Serological tests provide information about individual immunity from historical infection or immunization. Cross-sectional serological studies provide data about the age- and sex-specific immunity levels for individuals in the studied population, and these data can provide a point of comparison for the results of transmission models. In the context of developing an integrated model for measles and rubella transmission, we reviewed the existing measles and rubella literature to identify the results of national serological studies that provided cross-sectional estimates of population immunity at the time of data collection. We systematically searched PubMed, the Science Citation Index, and references we identified from relevant articles published in English. We extracted serological data for comparison to transmission model outputs. For rubella, serological studies of women of child-bearing age provide information about the potential risks of infants born with congenital rubella syndrome. Serological studies also document the loss of maternal antibodies, which occurs at different rates for the different viruses and according to the nature of the induced immunity (i.e., infection or vaccine). The serological evidence remains limited for some areas, with studies from developed countries representing a disproportionate part of the evidence. The collection and review of serological evidence can help program managers identify immunity gaps in the population, which may help them better understand the characteristics of individuals within their populations who may participate in transmission and manage risks. © 2015 Society for Risk Analysis.

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

    PubMed

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

    2011-01-01

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

  4. Using and Joining a Franchised Private Sector Provider Network in Myanmar

    PubMed Central

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

    2011-01-01

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

  5. The Concentration of Opioid Prescriptions by Providers and Patients in the Oregon Medicaid Program

    PubMed Central

    Kim, Hyunjee; Hartung, Daniel; Jacob, Lorie; McCarty, Dennis; McConnell, K. John

    2016-01-01

    Objective This study seeks to understand the distribution of opioid prescribing across providers and patients, and examines how this concentration predicts opioid misuse. Methods Using 2013 Oregon Medicaid claims and National Provider ID registry, this study identified patients who filled at least one opioid prescription and providers who prescribed opioids for those patients (N=61,477 Medicaid patients). This study examined the distribution of opioid prescriptions by provider and patient, the extent to which high-volume opioid use was associated with potential opioid misuse, and how this association changes when patients received opioids from providers in the top decile of morphine equivalents (MEQ) prescribed in 2013. This study used four indicators of opioid misuse: doctor and pharmacy shopping for opioid prescriptions, opioid prescription overlap, and opioid and benzodiazepine prescription overlap. Results Opioid use and prescriptions were heavily concentrated among the top 10% opioid users and prescribers. Those high-volume opioid users and prescribers accounted for 83.2% and 80.8% in MEQ of entire opioids prescribed. Patients’ increasing use of MEQ was associated with most measures of opioid misuse. Patients receiving opioids from high-volume prescribers had a higher probability of opioid prescription overlap and opioid and benzodiazepine prescription overlap, but the increase was significant only among patients who received high doses of opioids and the size of the increase was modest. Conclusions Whereas current policies emphasize reducing opioid prescriptions across all patients and providers, study results suggest potential for policies that focus on high-volume opioid users and prescribers. PMID:26766755

  6. Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review.

    PubMed

    Tomasone, Jennifer R; Brouwers, Melissa C; Vukmirovic, Marija; Grunfeld, Eva; O'Brien, Mary Ann; Urquhart, Robin; Walker, Melanie; Webster, Fiona; Fitch, Margaret

    2016-01-01

    Coordination of patient care between primary care and oncology care providers is vital to care quality and outcomes across the cancer continuum, yet it is known to be challenging. We conducted a systematic review to evaluate current or new models of care and/or interventions aimed at improving coordination between primary care and oncology care providers for patients with adult breast and/or colorectal cancer. MEDLINE, EMBASE, CINAHL, Cochrane Library Database of Systematic Reviews, and the Centre for Reviews and Dissemination were searched for existing English language studies published between January 2000 and 15 May 2015. Systematic reviews, meta-analyses, randomised controlled trials (RCTs) and non-randomised studies were included if they evaluated a specific model/intervention that was designed to improve care coordination between primary care and oncology care providers, for any stage of the cancer continuum, for patients with adult breast and/or colorectal cancer. Two reviewers extracted data and assessed risk of bias. Twenty-two studies (5 systematic reviews, 6 RCTs and 11 non-randomised studies) were included and varied with respect to the targeted phase of the cancer continuum, type of model or intervention tested, and outcome measures. The majority of studies showed no statistically significant changes in any patient, provider or system outcomes. Owing to conceptual and methodological limitations in this field, the review is unable to provide specific conclusions about the most effective or preferred model/intervention to improve care coordination. Imprecise results that lack generalisability and definitiveness provide limited evidence to base the development of future interventions and policies. CRD42015025006.

  7. The Concentration of Opioid Prescriptions by Providers and Among Patients in the Oregon Medicaid Program.

    PubMed

    Kim, Hyunjee; Hartung, Daniel M; Jacob, Reside L; McCarty, Dennis; McConnell, K John

    2016-04-01

    This study examined the distribution of opioid prescribing across providers and patients and the extent to which concentrated distribution predicts opioid misuse. Using 2013 Oregon Medicaid claims and the National Provider Identifier Registry, this study identified patients who filled at least one opioid prescription and providers who prescribed opioids for those patients (N=61,477 Medicaid beneficiaries). This study examined the distribution of opioid prescriptions by provider and patient, the extent to which high-volume opioid use was associated with potential opioid misuse, and how this association changed when patients received opioids from providers in the top decile of morphine-equivalent doses (MEQ) prescribed in 2013. This study used four indicators of opioid misuse: doctor and pharmacy shopping for opioid prescriptions, opioid prescription overlap, and opioid and benzodiazepine prescription overlap. Opioid use and prescriptions were heavily concentrated among the top 10% of opioid users and prescribers. Those high-volume opioid users and prescribers accounted for, respectively, 83.2% and 80.8% in MEQ of entire opioids prescribed. Patients' increasing use of opioids (by MEQ) was associated with most measures of opioid misuse. Patients receiving opioids from high-volume prescribers had a higher probability of opioid prescription overlap and opioid and benzodiazepine prescription overlap compared with other patients, but the difference was significant only among patients who received high doses of opioids, and the size of the difference was modest. Whereas current policies emphasize reducing opioid prescriptions across all patients and providers, study results suggest that focusing policies on high-volume opioid users and prescribers may be more beneficial.

  8. A survey of assistive technology service providers in the USA.

    PubMed

    Arthanat, Sajay; Elsaesser, Linda-Jeanne; Bauer, Stephen

    2017-11-01

    This study investigates perspectives of assistive technology service (ATS) providers regarding their education and training, interdisciplinary standards of practice, use of a common language framework, funding policies, utilization of evidence and outcomes measurement. A survey underpinned by AT legislations and established guidelines for practice was completed by 318 certified AT providers. More than 30% of the providers reported their education and training as inadequate to fulfil four of the seven primary roles of ATS. Nearly 90% of providers expressed awareness of the International Classification of Functioning, Disability and Health (ICF) domains for interdisciplinary communication. However, only 45% felt that they could effectively utilize the ICF in their documentation. About 75% of the providers acknowledged the lack of a recognized standard for the provision of services. Prevailing inadequacies in funding were negatively impacting the quality of ATS, as expressed by 88% of respondents. Translation of evidence to practice was identified as a major challenge by 41% of service providers. Providers were predominantly documenting outcomes through informal interviews (54%) or non-standard instruments (26%). Findings support the need for strengthening professional curriculum, pre-service and in-service training and an established standard to support effective, interdisciplinary AT services and data collection to support public policy decisions. Implications for Rehabilitation This study validates the need to strengthen education and training of AT service providers by enhancing professional curriculum as well as their engagement in pre-service and in-service training activities. This study draws attention to health care funding policies and practices that critically impact the quality of AT services. This study signifies the need for an established interdisciplinary standard among AT professionals to support effective communication, service coordination and outcomes measurement.

  9. The Effect of Plan Type and Comprehensive Medication Reviews on High-Risk Medication Use.

    PubMed

    Almodovar, Armando Silva; Axon, David Rhys; Coleman, Ashley M; Warholak, Terri; Nahata, Milap C

    2018-05-01

    In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers. To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use. This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years. Performance data were downloaded per Medicare contract from the CMS. We matched Medicare insurance provider performance data with the enrollment data of each contract. Mann Whitney U and Spearman rho tests and a hierarchical linear regression model assessed the relationship between provider characteristics, high-risk medication use, and CMR completion rate outcome measures. In 2014, an inverse correlation between CMR completion rate and high-risk medication use was identified among MAPD plan providers. This relationship was further strengthened in 2015. No correlation was detected between the CMR completion rate and high-risk medication use among PDP plan providers in either year. A multivariate regression found an inverse association with high-risk medication use among MAPD plan providers in comparison with PDP plan providers in 2014 (beta = -0.358, P < 0.001) and 2015 (beta = -0.350, P < 0.001), the CMR completion rate in 2015 (beta = -0.221, P < 0.001), and enrollee population size in 2015 (beta = -0.203, P = 0.001). This study found that MAPD plan providers and higher CMR completion rates were associated with lower use of high-risk medications among beneficiaries. No outside funding supported this study. Silva Almodovar reports a fellowship funded by SinfoniaRx, Tucson, Arizona, during the time of this study. The other authors have nothing to disclose.

  10. MRI and unilateral NMR study of reindeer skin tanning processes.

    PubMed

    Zhu, Lizheng; Del Federico, Eleonora; Ilott, Andrew J; Klokkernes, Torunn; Kehlet, Cindie; Jerschow, Alexej

    2015-04-07

    The study of arctic or subarctic indigenous skin clothing material, known for its design and ability to keep the body warm, provides information about the tanning materials and techniques. The study also provides clues about the culture that created it, since tanning processes are often specific to certain indigenous groups. Untreated skin samples and samples treated with willow (Salix sp) bark extract and cod liver oil are compared in this study using both MRI and unilateral NMR techniques. The two types of samples show different proton spatial distributions and different relaxation times, which may also provide information about the tanning technique and aging behavior.

  11. Assessment of the Influence of Demographic and Professional Characteristics on Health Care Providers' Pain Management Decisions Using Virtual Humans.

    PubMed

    Boissoneault, Jeff; Mundt, Jennifer M; Bartley, Emily J; Wandner, Laura D; Hirsh, Adam T; Robinson, Michael E

    2016-05-01

    Disparities in health care associated with patients' gender, race, and age are well documented. Previous studies using virtual human (VH) technology have demonstrated that provider characteristics may play an important role in pain management decisions. However, these studies have largely emphasized group differences. The aims of this study were to examine dentists' and physicians' use of VH characteristics when making clinical judgments (i.e., cue use) and to identify provider characteristics associated with the magnitude of the impact of these cues (β-weights). Providers (N=152; 76 physicians, 76 dentists) viewed video vignettes of VH patients varying in gender (male/female), race (white/black), and age (younger/older). Participants rated VH patients' pain intensity and unpleasantness and then rated their own likelihood of administering non-opioid and opioid analgesics. Compared to physicians, dentists had significantly lower β-weights associated with VH age cues for all ratings (p<0.001; d>0.69). These effects varied by provider race and gender. For pain intensity, professional differences were present only among non-white providers. White providers had greater β-weights than non-white providers for pain unpleasantness but only among men. Provider differences regarding the use of VH age cues in non-opioid analgesic administration were present among all providers except non-white males. These findings highlight the interaction of patient and provider factors in driving clinical decision making. Although profession was related to use of VH age cues in pain-related clinical judgments, this relationship was modified by providers' personal characteristics. Additional research is needed to understand what aspects of professional training or practice may account for differences between physicians and dentists and what forms of continuing education may help to mitigate the disparities.

  12. Provider imposed restrictions to clients’ access to family planning in urban Uttar Pradesh, India: a mixed methods study

    PubMed Central

    2013-01-01

    Background Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients’ access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. Methods Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients’ access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. Results The quantitative findings show that providers restrict clients’ access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients’ education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. Conclusions Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods. PMID:24365015

  13. When the visit to the emergency department is medically nonurgent: provider ideologies and patient advice.

    PubMed

    Guttman, N; Nelson, M S; Zimmerman, D R

    2001-03-01

    It is estimated that more than half of pediatric hospital emergency department (ED) visits are medically nonurgent. Anecdotal impressions suggest that ED providers castigate medically nonurgent visits, yet studies on such visits are scarce. This study explored the perspectives of 26 providers working in the EDs of two urban hospitals regarding medically nonurgent pediatric ED visits and advising parents or guardians on appropriate ED use. Three provider ideologies regarding the appropriateness of medically nonurgent ED use were identified and found to be linked to particular communication strategies that providers employed with ED users: restrictive, pragmatic, and all-inclusive. The analysis resulted in the development of a typology of provider ideological orientations toward ED use, distinguished according to different orientations toward professional dominance.

  14. Understanding Older Adult's Perceptions of Factors that Support Trust in Human and Robot Care Providers.

    PubMed

    Stuck, Rachel E; Rogers, Wendy A

    2017-06-01

    As the population of older adults increase so will the need for care providers, both human and robot. Trust is a key aspect to establish and maintain a successful older adult-care provider relationship. However, due to trust volatility it is essential to understand it within specific contexts. This proposed mixed methods study will explore what dimensions of trust emerge as important within the human-human and human-robot dyads in older adults and care providers. First, this study will help identify key qualities that support trust in a care provider relationship. By understanding what older adults perceive as needing to trust humans and robots for various care tasks, we can begin to provide recommendations based on user expectations for design to support trust.

  15. Peterson's Summer Study Abroad: A Guide to Summer Academic and Language Programs. First Edition.

    ERIC Educational Resources Information Center

    Peterson's Guides, Inc., Princeton, NJ.

    This guide provides descriptions of over 900 summer academic and language study-abroad programs in 80 countries that range from 1-week language study courses to full-summer university programs. An introductory section provides general information on study abroad programs and the use of the guide. The bulk of the guide consists of individual…

  16. Second-Wave White Teacher Identity Studies: A Review of White Teacher Identity Literatures From 2004 through 2014

    ERIC Educational Resources Information Center

    Jupp, James C.; Berry, Theodorea Regina; Lensmire, Timothy J.

    2016-01-01

    In this study of White teacher identity literatures, we historicize, define, and advance second-wave White teacher identity studies in education research and teacher education. First, we provide a discussion of methodology used to conduct this study called the synoptic text. Second, we provide an historical account of White teacher identity…

  17. Abortion Providers' Experiences with Medicaid Abortion Coverage Policies: A Qualitative Multistate Study

    PubMed Central

    Dennis, Amanda; Blanchard, Kelly

    2013-01-01

    Objective To evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers. Data Source From 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states. Study Design In-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment. Data Extraction Data were transcribed verbatim before being coded. Principal Findings In two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates. Conclusions Poor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health. PMID:22742741

  18. Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers.

    PubMed

    Fields, Dail; Pruett, Jana; Roman, Paul M

    2015-01-01

    The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA.

  19. Does Having a Culturally Competent Health Care Provider Affect the Patients' Experience or Satisfaction? A Critically Appraised Topic.

    PubMed

    Brunett, Miranda; Shingles, René Revis

    2018-04-23

    Clinical Scenario: The level of cultural competence of health care providers has been studied. However, limited scholarship has examined whether the cultural competence of the health care provider affects patient satisfaction. Focused Clinical Question: Does cultural competence of health care providers influence patient satisfaction with their experience with their provider? Summary of Key Findings: Having a culturally competent health care provider, or one who a patient perceives as culturally competent, does increase patient satisfaction. Clinical Bottom Line: Cultural competence in health care plays an important role in patients being satisfied with their providers, as well as patients willingly and actively participating in their treatment. Strength of Recommendation: Questions 1 to 5 and 9 of the critical appraisal skills program were answered "yes" for all studies in the critically appraised topic. Thus, the authors strongly support the findings.

  20. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review.

    PubMed

    Mannava, P; Durrant, K; Fisher, J; Chersich, M; Luchters, S

    2015-08-15

    High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care. Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded. Of 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients' attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being. The review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient interactions far outweigh positive ones. The nature of the factors which influence health worker attitudes and behaviours suggests that strengthening health systems, and workforce development, including in communication and counselling skills, are important. Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers.

  1. Accessibility of antiretroviral therapy in Ghana: convenience of access.

    PubMed

    Addo-Atuah, Joyce; Gourley, Dick; Gourley, Greta; White-Means, Shelley I; Womeodu, Robin J; Faris, Richard J; Addo, Nii Akwei

    2012-01-01

    The convenience of accessing antiretroviral therapy (ART) is important for initial access to care and subsequent adherence to ART. We conducted a qualitative study of people living with HIV/AIDS (PLWHA) and ART healthcare providers in Ghana in 2005. The objective of this study was to explore the participants' perceived convenience of accessing ART by PLWHA in Ghana. The convenience of accessing ART was evaluated from the reported travel and waiting times to receive care, the availability, or otherwise, of special considerations, with respect to the waiting time to receive care, for those PLWHA who were in active employment in the formal sector, the frequency of clinic visits before and after initiating ART, and whether the PLWHA saw the same or different providers at each clinic visit (continuity of care). This qualitative study used in-depth interviews based on Yin's case-study research design to collect data from 20 PLWHA and 24 ART healthcare providers as study participants. • Reported travel time to receive ART services ranged from 2 to 12 h for 30% of the PLWHA. • Waiting time to receive care was from 4 to 9 h. • While known government workers, such as teachers, were attended to earlier in some of the centres, this was not a consistent practice in all the four ART centres studied. • The PLWHA corroborated the providers' description of the procedure for initiating and monitoring ART in Ghana. • PLWHA did not see the same provider every time, but they were assured that this did not compromise the continuity of their care. Our study suggests that convenience of accessing ART is important to both PLWHA and ART healthcare providers, but the participants alluded to other factors, including open provider-patient communication, which might explain the PLWHA's understanding of the constraints under which they were receiving care. The current nation-wide coverage of the ART programme in Ghana, however, calls for the replication of this study to identify possible perception changes over time that may need attention. Our study findings can inform interventions to promote access to ART, especially in Africa.

  2. Approaches to health-care provider education and professional development in perinatal depression: a systematic review.

    PubMed

    Legere, Laura E; Wallace, Katherine; Bowen, Angela; McQueen, Karen; Montgomery, Phyllis; Evans, Marilyn

    2017-07-24

    Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression. A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis. Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes. This systematic review reveals a lack of strong research in multi-disciplinary, sector, site, and modal approaches to education and professional development for providers to identify and care for women at risk for, or experiencing, depression. To ensure optimal health outcomes, further research comparing diverse educational and professional development approaches is needed to identify the most effective strategies and consistently meet the needs of health-care providers. A protocol for this systematic review was registered on PROSPERO (Protocol number: CRD42015023701 ), June 21, 2015.

  3. "Neither we are satisfied nor they"-users and provider's perspective: a qualitative study of maternity care in secondary level public health facilities, Uttar Pradesh, India.

    PubMed

    Bhattacharyya, Sanghita; Issac, Anns; Rajbangshi, Preety; Srivastava, Aradhana; Avan, Bilal I

    2015-09-27

    Quality of care provided during childbirth is a critical determinant of preventing maternal mortality and morbidity. In the studies available, quality has been assessed either from the users' perspective or the providers'. The current study tries to bring both perspectives together to identify common key focus areas for quality improvement. This study aims to assess the users' (recently delivered women) and care providers' perceptions of care to understand the common challenges affecting provision of quality maternity care in public health facilities in India. A qualitative design comprising of in-depth interviews of 24 recently delivered women from secondary care facilities and 16 health care providers in Uttar Pradesh, India. The data were analysed thematically to assess users' and providers' perspectives on the common themes. The common challenges experienced regarding provision of care were inadequate physical infrastructure, irregular supply of water, electricity, shortage of medicines, supplies, and gynaecologist and anaesthetist to manage complications, difficulty in maintaining privacy and lack of skill for post-delivery counselling. However, physical access, cleanliness, interpersonal behaviour, information sharing and out-of-pocket expenditure were concerns for only users. Similarly, providers raised poor management of referral cases, shortage of staff, non-functioning of blood bank, lack of incentives for work as their concerns. The study identified the common themes of care from both the perspectives, which have been foundrelevant in terms of challenges identified in many developing countries including India. The study framework identified new themes like management of emergencies in complicated cases, privacy and cost of care which both the group felt is relevant in the context of providing quality care during childbirth in low resource setting. The key challenges identified by both the groups can be prioritized, when developing quality improvement program in the health facilities. The identified components of care can match the supply with the demand for care and make the services truly responsive to user needs. The study highlights infrastructure, human resources, supplies and medicine as priority areas of quality improvement in the facility as perceived by both users and providers, nevertheless the interpersonal aspect of care primarily reported by the users must also not be ignored.

  4. Reiki Is Better Than Placebo and Has Broad Potential as a Complementary Health Therapy

    PubMed Central

    2017-01-01

    This study reviews the available clinical studies of Reiki to determine whether there is evidence for Reiki providing more than just a placebo effect. The available English-language literature of Reiki was reviewed, specifically for peer-reviewed clinical studies with more than 20 participants in the Reiki treatment arm, controlling for a placebo effect. Of the 13 suitable studies, 8 demonstrated Reiki being more effective than placebo, 4 found no difference but had questionable statistical resolving power, and only one provided clear evidence for not providing benefit. Viewed collectively, these studies provide reasonably strong support for Reiki being more effective than placebo. From the information currently available, Reiki is a safe and gentle “complementary” therapy that activates the parasympathetic nervous system to heal body and mind. It has potential for broader use in management of chronic health conditions, and possibly in postoperative recovery. Research is needed to optimize the delivery of Reiki. PMID:28874060

  5. Economic impact of stimulated technological activity. Part 3: Case study, knowledge additions and earth links from space crew systems

    NASA Technical Reports Server (NTRS)

    1971-01-01

    A case study of knowledge contributions from the crew life support aspect of the manned space program is reported. The new information needed to be learned, the solutions developed, and the relation of new knowledge gained to earthly problems were investigated. Illustrations are given in the following categories: supplying atmosphere for spacecraft; providing carbon dioxide removal and recycling; providing contaminant control and removal; maintaining the body's thermal balance; protecting against the space hazards of decompression, radiation, and meteorites; minimizing fire and blast hazards; providing adequate light and conditions for adequate visual performance; providing mobility and work physiology; and providing adequate habitability.

  6. Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: a Delphi study

    PubMed Central

    2013-01-01

    Background The integration of behavioral health services into primary care is increasingly popular, yet fidelity of implementation in this area has been infrequently assessed due to the few measurement tools available. A sentinel indicator of fidelity of implementation is provider adherence, or utilization of prescribed procedures and engagement in model-specific behaviors. This study aimed to develop the first self-report measure of behavioral health provider adherence for co-located, collaborative care, a commonly adopted model of behavioral health service delivery in primary care. Methods A preliminary 56-item measure was developed by the research team to represent critical components of adherence among behavioral health providers. To ensure the content validity of the measure, a modified Delphi study was conducted using a panel of co-located, collaborative care model experts. During three rounds of emailed surveys, panel members provided qualitative feedback regarding item content while rating each item’s relevance for behavioral health provider practice. Items with consensus ratings of 80% or greater were included in the final adherence measure. Results The panel consisted of 25 experts representing the Department of Veterans Affairs, the Department of Defense, and academic and community health centers (total study response rate of 76%). During the Delphi process, two new items were added to the measure, four items were eliminated, and a high level of consensus was achieved on the remaining 54 items. Experts identified 38 items essential for model adherence, six items compatible (although not essential) for model adherence, and 10 items that represented prohibited behaviors. Item content addressed several domains, but primarily focused on behaviors related to employing a time-limited, brief treatment model, the scope of patient concerns addressed, and interventions used by providers. Conclusions This study yielded the first content valid self-report measure of critical components of collaborative care adherence for use by behavioral health providers in primary care. Although additional psychometric evaluation is necessary, this measure may assist implementation researchers in clarifying how provider behaviors contribute to clinical outcomes. This measure may also assist clinical stakeholders in monitoring implementation and identifying ways to support frontline providers in delivering high quality services. PMID:23406425

  7. What Makes or Breaks Provider--Researcher Collaborations in HIV Research? A Mixed Method Analysis of Providers' Willingness to Partner

    ERIC Educational Resources Information Center

    Pinto, Rogerio M.

    2013-01-01

    Research is lacking about what makes or breaks collaboration between researchers and HIV services providers. This study identified factors that influence providers' levels of willingness to collaborate in HIV prevention scientific research. Survey measures were grounded in in-depth interview data and included providers' "willingness to…

  8. Using Attribution Theory to Examine Community Rehabilitation Provider Stigma

    ERIC Educational Resources Information Center

    Strauser, David R.; Ciftci, Ayse; O'Sullivan, Deirdre

    2009-01-01

    This study builds on existing research investigating the stigma-reducing strategies specific to rehabilitation service providers by comparing differences in education levels and degree of contact among rehabilitation service providers. Rehabilitation service providers with master's level and bachelor level education showed significant differences…

  9. 'Just doing the best we can': health care providers' perceptions of barriers to providing care to Marshallese patients in Arkansas.

    PubMed

    McElfish, Pearl A; Chughtai, Almas; Low, Lisa K; Garner, Robert; Purvis, Rachel S

    2018-05-04

    Marshallese migrating to the United States encounter challenges in accessing health care. Previous literature has investigated Marshallese participants' perceptions of the barriers they face in accessing health care. For this study, health care providers managing the care of Marshallese patients were interviewed to understand the providers' perception of barriers that their Marshallese patients encounter. A qualitative research design was utilized to explore health care providers' perceptions of and experiences with the barriers faced by their Marshallese patients when accessing the US health care system. The primary barriers identified were: (1) economic barriers; (2) communication challenges; (3) difficulty understanding and navigating the western health care system; and (4) structural and system barriers. This study provides insight on the barriers Marshallese patients face in accessing health care as well as the barriers providers face in delivering care to Marshallese patients. A better understanding of these barriers can help health care providers and educators to begin initiating improvements in the delivery of care to Marshallese patients.

  10. Studying DNA in the Classroom.

    ERIC Educational Resources Information Center

    Zarins, Silja

    1993-01-01

    Outlines a workshop for teachers that illustrates a method of extracting DNA and provides instructions on how to do some simple work with DNA without sophisticated and expensive equipment. Provides details on viscosity studies and breaking DNA molecules. (DDR)

  11. Parent-provider communication during hospitalization.

    PubMed

    Fisher, Mark J; Broome, Marion E

    2011-02-01

    Parents and health care providers interact and communicate with each other during a child's hospitalization. The purpose of this study was to compare communication experiences of parents, nurses, and physicians. A unique aspect of this study involved combining three individual data sources into a collective unit of study (triad). Triads involved in the care of three children in the inpatient setting of an urban children's hospital served as the sample for this study (n = 10). Participants were asked semistructured questions during face-to-face interviews. Findings included (a) the importance of providing information by health care providers using a caring and inclusive approach, (b) the benefits of establishing interpersonal connections and nurturing relationships, and (c) the identification of specific behaviors in all members of the triad that contribute to and sustain positively perceived communication. Future research directions examining triadic interactions, communication, and relationships among parents, nurses, and physicians are recommended. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Stigmatized by association: challenges for abortion service providers in Ghana.

    PubMed

    Aniteye, Patience; O'Brien, Beverley; Mayhew, Susannah H

    2016-09-10

    Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana. A descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists. Stigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association. Stigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.

  13. Communication about life-sustaining therapy: insights from the Adaptive Leadership Framework

    PubMed Central

    Neglia, Elizabeth; Anderson, Ruth A.; Brandon, Debra; Docherty, Sharron L.

    2014-01-01

    Objective Effective provider and caregiver communication is central to quality care during treatment for life-threatening illnesses. The study aim was to analyze communication patterns between providers and a parent of an infant with a life-threatening disease using the Adaptive Leadership Framework, which is an activity that involves mobilizing others to adapt to a difficult situation. Method A secondary analysis was conducted on one case using 23 interviews with providers and mother of an infant diagnosed with Hurler’s syndrome. The interviews focused on decision-making challenges in regard to the infant’s treatment and were conducted over a 1-year period (pre-transplant, study entry, monthly, after a life-threatening event or substantial change in treatment and at 1-year post enrollment). Content analysis was used to identify and categorize communication patterns using concepts from the Adaptive Leadership Framework. Results Infant illness events and parent-provider caregiving were chronicled across a 1-year trajectory. Despite the life-threatening nature of Hurler’s disease, the parent and providers did not discuss palliative care or end-of-life. The parent sought direction and answers from the providers. The Adaptive Leadership Framework suggested how communication approaches were often mismatched with the needs of the parent. Discussion The results of the study accentuate the need to improve communication between provider and parents about end-of-life for their child. Adaptive Leadership illuminates how providers can influence a parent’s behavior when facing a challenging situation. This study suggests that Adaptive Leadership is a useful framework to guide research about healthcare communication in dealing with challenging issues. PMID:25309745

  14. Studying Intermolecular Forces with a Dual Gas Chromatography and Boiling Point Investigation

    ERIC Educational Resources Information Center

    Cunningham, William Patrick; Xia, Ian; Wickline, Kaitlyn; Huitron, Eric Ivan Garcia; Heo, Jun

    2018-01-01

    A procedure for the study of structural differences and intermolecular attraction between ethanol and 1-butanol based in laboratory work is described. This study provides comparisons of data retrieved from both a determination of boiling point and gas chromatography traces for the mixture. The methodology reported here should provide instructors…

  15. Escher's Tessellations in Understanding Group Theory

    ERIC Educational Resources Information Center

    Konyalioglu, Serpil

    2009-01-01

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

  16. Recycling In The U.S. Pallet Industry: 1993

    Treesearch

    Bruce G. Hansen; Robert Bush; John Punches; Philip A. Araman

    1995-01-01

    This report provides the details of a study which investigated pallet recycling activity in the United States pallet industry (Standard Industrial Classification 2448) during 1993. The study was conducted by the Center for Forest Products Marketing at Virginia Tech and replicates a similar study that investigated pallet recycling during 1992. The report provides the...

  17. 1973 ATLAS Curriculum Guide for Mexican-American and Puerto Rican Studies.

    ERIC Educational Resources Information Center

    Association of Teachers of Latin American Studies, Brooklyn, NY.

    This curriculum guide, developed by the Association of Teachers of Latin American Studies, provides an interdisciplinary, inquiry-oriented approach to Mexican-American and Puerto Rican Studies. Unit one contains a list of cognitive and affective objectives and evaluation suggestions. Units two through six provide content materials and include a…

  18. Methodology for the Study of the Development of Racism.

    ERIC Educational Resources Information Center

    Balch, Philip; Paulsen, Karen

    The dearth and inadequacy of measurement instruments to assess racial attitudes in children of preschool age provided the impetus for an empirical study that examined four types of commonly used racial attitude measurement instruments and, at the same time, provided information on racial attitudes among preschoolers. Subjects of the study were 36…

  19. UPS Hybrid Electric Delivery Van Testing | Transportation Research | NREL

    Science.gov Websites

    conventional diesel vans. Publications The following documents provide detailed information about the study the conventional vans during the on-road portion of the study. The two vehicle groups switched route assignments during the study period to provide a balanced review of the vans on the same routes. During

  20. Providers' assessment of transition readiness among adolescent and young adult kidney transplant recipients.

    PubMed

    Marchak, Jordan Gilleland; Reed-Knight, Bonney; Amaral, Sandra; Mee, Laura; Blount, Ronald L

    2015-12-01

    The Readiness for Transition Questionnaire- provider version (RTQ-Provider) was developed to evaluate adolescent patients' transition readiness and healthcare behaviors from the perspective of the healthcare provider. The RTQ-Provider is a parallel version of the RTQ-Teen and RTQ-Parent completed by patients and parents. This study seeks to evaluate the psychometric properties of the RTQ-Provider and its utility as a clinical transition planning tool. Participants consisted of 49 kidney transplant recipients between the ages of 15 and 21. The RTQ-Provider was completed by the pediatric nephrologist and psychologist from the multidisciplinary healthcare team and compared to RTQ data from teens and parents. The RTQ-Provider demonstrated good-to-excellent internal consistency and interrater reliability. Construct validity was supported through significant predictive relationships between providers' perceptions of transition readiness and older patient age, increased patient healthcare responsibility, and decreased parent involvement in health care. By providing parallel teen, parent, and provider forms, the RTQ has the potential to foster open communication between patients, families, and healthcare team members regarding transition readiness. The study provides initial support for the RTQ-Provider as a clinical tool to assess providers' perceptions of transition readiness; however, future longitudinal research is needed to evaluate predictive validity following patients' transfer to adult care. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Toward an understanding of the neural mechanisms underlying dual-task performance: Contribution of comparative approaches using animal models.

    PubMed

    Watanabe, Kei; Funahashi, Shintaro

    2018-01-01

    The study of dual-task performance in human subjects has received considerable interest in cognitive neuroscience because it can provide detailed insights into the neural mechanisms underlying higher-order cognitive control. Despite many decades of research, our understanding of the neurobiological basis of dual-task performance is still limited, and some critical questions are still under debate. Recently, behavioral and neurophysiological studies of dual-task performance in animals have begun to provide intriguing evidence regarding how dual-task information is processed in the brain. In this review, we first summarize key evidence in neuroimaging and neuropsychological studies in humans and discuss possible reasons for discrepancies across studies. We then provide a comprehensive review of the literature on dual-task studies in animals and provide a novel working hypothesis that may reconcile the divergent results in human studies toward a unified view of the mechanisms underlying dual-task processing. Finally, we propose possible directions for future dual-task experiments in the framework of comparative cognitive neuroscience. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China.

    PubMed

    Du, Zhicheng; Liao, Yu; Chen, Chien-Chou; Hao, Yuantao; Hu, Ruwei

    2015-07-31

    Usual source of care (USC) refers to the provider or place a patient consults when sick or in need of medical advice. No studies have been conducted in China to compare the quality of primary care provided with or without USC. The purpose of this study was to fill this gap in the literature by examining the quality of primary care provided between those having a USC and those without. Results of the study would provide implications for policymakers in terms of improving primary care performance in China, and help guide patients in their health care seeking behaviors. A cross-sectional survey with patients was conducted in Guangdong province of China, using the Chinese validated Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and ten domains of primary care quality for patients with and without USC. Multivariate analyses were used to assess the association between USC and quality of primary care attributes while controlling for sociodemographic and health care characteristics. The study added evidence that having a USC can provide higher quality of primary care to patients than those without a USC. Results of this study showed that the PCAT score associated with those having a USC was significantly higher than those not having a USC. Moreover, the study showed that having a usual provider of care was also independently and significantly associated with patients' satisfaction with care. This study added evidence that in China, patients with a USC reported higher quality of medical care experiences compared with those without a USC. The efforts to improve quality of care should include policies promoting USC.

  3. Private Sector Providers of Basic Skills Training in the Workplace. A Study of the General Training and Basic Skills Responses of Randomly Selected Companies Which Provide Basic Skills Training to Their Employees.

    ERIC Educational Resources Information Center

    Mark, Jorie Lester

    A questionnaire was distributed to 1,305 companies to study the basic skills training provided. Of 62 responses, 41 companies had basic skills training programs. Respondents represented these types of companies: communications and utilities, finance and insurance, manufacturing, wholesalers, retailers, health and hospitals, and mining, and had…

  4. Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study

    PubMed Central

    2013-01-01

    Background Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Methods Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. Results The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers’ Gini coefficients also become close to one another. Conclusions This study found that NHI’s offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan. PMID:23374629

  5. Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature.

    PubMed

    Plourde, Natasha; Brown, Hilary K; Vigod, Simone; Cobigo, Virginie

    2016-01-01

    Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers' training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients' receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.

  6. Characterizing and fostering charity care in the surgeon workforce.

    PubMed

    Wright, D Brad; Scarborough, John E

    2011-07-01

    We sought to determine which demographic and practice characteristics are associated with both a surgeon's willingness to provide any charity care as well as the amount of charity care provided. Although it is known that surgeons tend to provide a greater amount of charity care than other physicians, no studies have attempted to look within the surgeon population to identify which factors lead some surgeons to provide more charity care than others. Using 4 rounds of data from the Community Tracking Study, we employ a 2-part multivariate regression model with fixed effects. A greater amount of charity care is provided by surgeons who are male, practice owners, employed in academic medical centers, or earn a greater proportion of their revenue from Medicaid. Surgeons who work in a group HMO are significantly less likely to provide any charity care. Personal resources (eg, time and money) had a minimal association with charity care provision. Surgeons whose characteristics are associated with a greater propensity for charity care provision as suggested by this study, should be considered as a potential source for building the volunteer workforce.

  7. Exploring Mission Concepts with the JPL Innovation Foundry A-Team

    NASA Technical Reports Server (NTRS)

    Ziemer, John K.; Ervin, Joan; Lang, Jared

    2013-01-01

    The JPL Innovation Foundry has established a new approach for exploring, developing, and evaluating early concepts called the A-Team. The A-Team combines innovative collaborative methods with subject matter expertise and analysis tools to help mature mission concepts. Science, implementation, and programmatic elements are all considered during an A-Team study. Methods are grouped by Concept Maturity Level (CML), from 1 through 3, including idea generation and capture (CML 1), initial feasibility assessment (CML 2), and trade space exploration (CML 3). Methods used for each CML are presented, and the key team roles are described from two points of view: innovative methods and technical expertise. A-Team roles for providing innovative methods include the facilitator, study lead, and assistant study lead. A-Team roles for providing technical expertise include the architect, lead systems engineer, and integration engineer. In addition to these key roles, each A-Team study is uniquely staffed to match the study topic and scope including subject matter experts, scientists, technologists, flight and instrument systems engineers, and program managers as needed. Advanced analysis and collaborative engineering tools (e.g. cost, science traceability, mission design, knowledge capture, study and analysis support infrastructure) are also under development for use in A-Team studies and will be discussed briefly. The A-Team facilities provide a constructive environment for innovative ideas from all aspects of mission formulation to eliminate isolated studies and come together early in the development cycle when they can provide the biggest impact. This paper provides an overview of the A-Team, its study processes, roles, methods, tools and facilities.

  8. Improving client-provider communication: evaluation of a training program for women, infants and children (WIC) professionals in New York state.

    PubMed

    Newes-Adeyi, Gabriella; Helitzer, Deborah L; Roter, Debra; Caulfield, Laura E

    2004-11-01

    Results are presented from evaluation of an intensive 1 day training program to improve the growth monitoring counseling skills of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) providers. The training was framed by the patient-centered approach, and focused on a seven-step technique that emphasized eliciting client perspective on the child's health and negotiating follow-up strategies. Changes in skill were assessed during audiotaped mock counseling sessions with simulated clients. Observed intervention effects were moderate but encouraging for future training programs. After the training, more providers elicited client perspective, and provider level of engagement in negotiating with the client increased. At post-test providers asked more open-ended questions than at pre-test, and provider-to-client talk ratio decreased. Increases in provider total and competence-related satisfaction paralleled improvements in counseling proficiency. Study results suggest that counseling skills of non-physician health providers can change after a 1 day focused training: providers were more client-centered in their discussions. Limitations and implications of the study are discussed.

  9. A traits-based approach for prioritizing species for monitoring and surrogacy selection

    DOE PAGES

    Pracheil, Brenda M.; McManamay, Ryan A.; Bevelhimer, Mark S.; ...

    2016-11-28

    The bar for justifying the use of vertebrate animals for study is being increasingly raised, thus requiring increased rigor for species selection and study design. Although we have power analyses to provide quantitative backing for the numbers of organisms used, quantitative backing for selection of study species is not frequently employed. This can be especially important when measuring the impacts of ecosystem alteration, when study species must be chosen that are both sensitive to the alteration and of sufficient abundance for study. Just as important is providing justification for designation of surrogate species for study, especially when the species ofmore » interest is rare or of conservation concern and selection of an appropriate surrogate can have legal implications. In this study, we use a combination of GIS, a fish traits database and multivariate statistical analyses to quantitatively prioritize species for study and to determine potential study surrogate species. We provide two case studies to illustrate our quantitative, traits-based approach for designating study species and surrogate species. In the first case study, we select broadly representative fish species to understand the effects of turbine passage on adult fishes based on traits that suggest sensitivity to turbine passage. In our second case study, we present a framework for selecting a surrogate species for an endangered species. Lastly, we suggest that our traits-based framework can provide quantitative backing and added justification to selection of study species while expanding the inference space of study results.« less

  10. A traits-based approach for prioritizing species for monitoring and surrogacy selection

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

    Pracheil, Brenda M.; McManamay, Ryan A.; Bevelhimer, Mark S.

    The bar for justifying the use of vertebrate animals for study is being increasingly raised, thus requiring increased rigor for species selection and study design. Although we have power analyses to provide quantitative backing for the numbers of organisms used, quantitative backing for selection of study species is not frequently employed. This can be especially important when measuring the impacts of ecosystem alteration, when study species must be chosen that are both sensitive to the alteration and of sufficient abundance for study. Just as important is providing justification for designation of surrogate species for study, especially when the species ofmore » interest is rare or of conservation concern and selection of an appropriate surrogate can have legal implications. In this study, we use a combination of GIS, a fish traits database and multivariate statistical analyses to quantitatively prioritize species for study and to determine potential study surrogate species. We provide two case studies to illustrate our quantitative, traits-based approach for designating study species and surrogate species. In the first case study, we select broadly representative fish species to understand the effects of turbine passage on adult fishes based on traits that suggest sensitivity to turbine passage. In our second case study, we present a framework for selecting a surrogate species for an endangered species. Lastly, we suggest that our traits-based framework can provide quantitative backing and added justification to selection of study species while expanding the inference space of study results.« less

  11. Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

    PubMed Central

    Khatib, Rasha; Schwalm, Jon-David; Yusuf, Salim; Haynes, R. Brian; McKee, Martin; Khan, Maheer; Nieuwlaat, Robby

    2014-01-01

    Background Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control. PMID:24454721

  12. Void Growth and Coalescence Simulations

    DTIC Science & Technology

    2013-08-01

    distortion and damage, minimum time step, and appropriate material model parameters. Further, a temporal and spatial convergence study was used to...estimate errors, thus, this study helps to provide guidelines for modeling of materials with voids. Finally, we use a Gurson model with Johnson-Cook...spatial convergence study was used to estimate errors, thus, this study helps to provide guidelines for modeling of materials with voids. Finally, we

  13. 43 CFR 404.33 - How much Federal funding can Reclamation provide for the completion of a feasibility study?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... provide for the completion of a feasibility study? 404.33 Section 404.33 Public Lands: Interior... of a feasibility study? In general, Reclamation will be responsible for 50 percent of the cost of a feasibility study conducted under § 404.11(a) or (b). You will be responsible to pay for the remaining 50...

  14. System Operations Studies for Automated Gateway Transit Systems - Detailed Station Model Programmer's Manual.

    DOT National Transportation Integrated Search

    1982-01-01

    The Detailed Station Model (DSM) provides operational and performance measures of alternative station configurations and management policies with respect to vehicle and passenger capabilities. It provides an analytic tool to support tradeoff studies ...

  15. Characteristics of medically disqualified airman applicants in calendar years 1973 and 1974.

    DOT National Transportation Integrated Search

    1976-01-01

    This study provides comprehensive data reflecting pertinent denial rates with respect to the medical and general attributes of those airmen denied medical certification in calendar years 1973 and 1974. The study provides such descriptive epidemiologi...

  16. A Basic Bibliography on Canada for Social Studies Educators.

    ERIC Educational Resources Information Center

    Yocum, Michael J.

    1988-01-01

    Presents a bibliography that provides materials on Canada available to social studies educators. Resources for teachers include teaching strategies, literature guides, and books on acid rain. Student resources include books that provide a perspective on Canadian life. (DB)

  17. Metropolitan transportation management center : a case study : COMPASS : effectively managing traffic and incidents

    DOT National Transportation Integrated Search

    1999-10-01

    The following case study provides a snapshot of the Downsview, Ontario transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting ...

  18. Limited-sampling strategies for anti-infective agents: systematic review.

    PubMed

    Sprague, Denise A; Ensom, Mary H H

    2009-09-01

    Area under the concentration-time curve (AUC) is a pharmacokinetic parameter that represents overall exposure to a drug. For selected anti-infective agents, pharmacokinetic-pharmacodynamic parameters, such as AUC/MIC (where MIC is the minimal inhibitory concentration), have been correlated with outcome in a few studies. A limited-sampling strategy may be used to estimate pharmacokinetic parameters such as AUC, without the frequent, costly, and inconvenient blood sampling that would be required to directly calculate the AUC. To discuss, by means of a systematic review, the strengths, limitations, and clinical implications of published studies involving a limited-sampling strategy for anti-infective agents and to propose improvements in methodology for future studies. The PubMed and EMBASE databases were searched using the terms "anti-infective agents", "limited sampling", "optimal sampling", "sparse sampling", "AUC monitoring", "abbreviated AUC", "abbreviated sampling", and "Bayesian". The reference lists of retrieved articles were searched manually. Included studies were classified according to modified criteria from the US Preventive Services Task Force. Twenty studies met the inclusion criteria. Six of the studies (involving didanosine, zidovudine, nevirapine, ciprofloxacin, efavirenz, and nelfinavir) were classified as providing level I evidence, 4 studies (involving vancomycin, didanosine, lamivudine, and lopinavir-ritonavir) provided level II-1 evidence, 2 studies (involving saquinavir and ceftazidime) provided level II-2 evidence, and 8 studies (involving ciprofloxacin, nelfinavir, vancomycin, ceftazidime, ganciclovir, pyrazinamide, meropenem, and alpha interferon) provided level III evidence. All of the studies providing level I evidence used prospectively collected data and proper validation procedures with separate, randomly selected index and validation groups. However, most of the included studies did not provide an adequate description of the methods or the characteristics of included patients, which limited their generalizability. Many limited-sampling strategies have been developed for anti-infective agents that do not have a clearly established link between AUC and clinical outcomes in humans. Future studies should first determine if there is an association between AUC monitoring and clinical outcomes. Thereafter, it may be worthwhile to prospectively develop and validate a limited-sampling strategy for the particular anti-infective agent in a similar population.

  19. An assessment of Chemical, Biological, Radiologic, Nuclear, and Explosive preparedness among emergency department healthcare providers in an inner city emergency department.

    PubMed

    Kotora, Joseph G

    2015-01-01

    Emergency healthcare providers are required to care for victims of Chemical, Biological, Radiologic, Nuclear, and Explosive (CBRNE) agents. However, US emergency departments are often ill prepared to manage CBRNE casualties. Most providers lack adequate knowledge or experience in the areas of patient decontamination, hospital-specific disaster protocols, interagency familiarization, and available supply of necessary medical equipment and medications. This study evaluated the CBRNE preparedness of physicians, nurses, and midlevel providers in an urban tertiary care emergency department. This retrospective observational survey study used a previously constructed questionnaire instrument. A total of 205 e-mail invitations were sent to 191 eligible providers through an online survey distribution tool (Survey Monkey®). Respondents were enrolled from February 1, 2014 to March 15, 2014. Simple frequencies of correct answers were used to determine the level of preparedness of each group. Cronbach's coefficient α was used to validate the precision of the study instrument. Finally, validity coefficients and analysis of variance ANOVA were used to determine the strength of correlation between demographic variables, as well as the variation between individual responses. Fifty-nine providers responded to the questionnaire (31.14 percent response rate). The overall frequency of correct answers was 66.26 percent, indicating a relatively poor level of CBRNE preparedness. The study instrument lacked precision and reliability (coefficient α 0.4050). Significant correlations were found between the frequency of correct answers and the respondents' gender, practice experience, and previous experience with a CBRNE incident. Significant variance exists between how providers believe casualties should be decontaminated, which drugs should be administered, and the interpretation of facility-specific protocols. Emergency care providers are inadequately prepared to manage CBRNE incidents. Furthermore, a valid and precise instrument capable of measuring preparedness needs to be developed. Standardized educational curriculums that consider healthcare providers' genders, occupations, and experience levels may assist in closing the knowledge gaps between providers and reinforce emergency departments' CBRNE preparedness.

  20. When is a carer's employment at risk? Longitudinal analysis of unpaid care and employment in midlife in England.

    PubMed

    King, Derek; Pickard, Linda

    2013-05-01

    This article examines the thresholds at which provision of unpaid care affects employment in England. Previous research has shown that providing care for 20 or more hours a week has a negative effect on employment. The present article explores the impact of a lower threshold and asks whether provision of care for 10 or more hours a week has a negative effect on employment. The article focuses on women and men aged between 50 and State Pension Age (60 for women, 65 for men). The study uses data from the first four waves of the English Longitudinal Study of Ageing (ELSA), collected in 2002/2003, 2004/2005, 2006/2007 and 2008/2009. Across these waves, there are 17,123 people aged 50-59/64 years, of whom 9% provide unpaid care to an adult. Using logistic regression analysis of the longitudinal data, the study finds that employed women in their fifties who start providing care for <10 hours a week are significantly more likely to remain in employment one wave later than similar women who have not started to provide care. In contrast, employed women in their fifties who start providing care for 10 or more hours a week are significantly less likely to remain in employment one wave later than similar women who have not started to provide care. Employed men aged between 50 and State Pension Age, who provide care for 10 or more hours a week at the beginning of the period have a significantly reduced employment rate one wave later than those who do not provide care. The study therefore suggests that carers' employment may be negatively affected when care is provided at a lower intensity than is generally estimated in England. This has important implications for local authorities, who have a duty to provide services to carers whose employment is at risk. © 2013 Blackwell Publishing Ltd.

  1. What Are the Strength of Recommendations and Methodologic Reporting in Health Economic Studies in Orthopaedic Surgery?

    PubMed

    Makhni, Eric C; Steinhaus, Michael E; Swart, Eric; Bozic, Kevin J

    2015-10-01

    Cost-effectiveness research is an increasingly used tool in evaluating treatments in orthopaedic surgery. Without high-quality primary-source data, the results of a cost-effectiveness study are either unreliable or heavily dependent on sensitivity analyses of the findings from the source studies. However, to our knowledge, the strength of recommendations provided by these studies in orthopaedics has not been studied. We asked: (1) What are the strengths of recommendations in recent orthopaedic cost-effectiveness studies? (2) What are the reasons authors cite for weak recommendations? (3) What are the methodologic reporting practices used by these studies? The titles of all articles published in six different orthopaedic journals from January 1, 2004, through April 1, 2014, were scanned for original health economics studies comparing two different types of treatment or intervention. The full texts of included studies were reviewed to determine the strength of recommendations determined subjectively by our study team, with studies providing equivocal conclusions stemming from a lack or uncertainty surrounding key primary data classified as weak and those with definitive conclusions not lacking in high-quality primary data classified as strong. The reasons underlying a weak designation were noted, and methodologic practices reported in each of the studies were examined using a validated instrument. A total of 79 articles met our prespecified inclusion criteria and were evaluated in depth. Of the articles included, 50 (63%) provided strong recommendations, whereas 29 (37%) provided weak recommendations. Of the 29 studies, clinical outcomes data were cited in 26 references as being insufficient to provide definitive conclusions, whereas cost and utility data were cited in 13 and seven articles, respectively. Methodologic reporting practices varied greatly, with mixed adherence to framing, costs, and results reporting. The framing variables included clearly defined intervention, adequate description of a comparator, study perspective clearly stated, and reported discount rate for future costs and quality-adjusted life years. Reporting costs variables included economic data collected alongside a clinical trial or another primary source and clear statement of the year of monetary units. Finally, results reporting included whether a sensitivity analysis was performed. Given that a considerable portion of orthopaedic cost-effectiveness studies provide weak recommendations and that methodologic reporting practices varied greatly among strong and weak studies, we believe that clinicians should exercise great caution when considering the conclusions of cost-effectiveness studies. Future research could assess the effect of such cost-effectiveness studies in clinical practice, and whether the strength of recommendations of a study's conclusions has any effect on practice patterns. Given the increasing use of cost-effectiveness studies in orthopaedic surgery, understanding the quality of these studies and the reasons that limit the ability of studies to provide more definitive recommendations is critical. Highlighting the heterogeneity of methodologic reporting practices will aid clinicians in interpreting the conclusions of cost-effectiveness studies and improve future research efforts.

  2. Drug and alcohol treatment providers' views about the disease model of addiction and its impact on clinical practice: A systematic review.

    PubMed

    Barnett, Anthony I; Hall, Wayne; Fry, Craig L; Dilkes-Frayne, Ella; Carter, Adrian

    2017-12-14

    Addiction treatment providers' views about the disease model of addiction (DMA), and their contemporary views about the brain disease model of addiction (BDMA), remain an understudied area. We systematically reviewed treatment providers' attitudes about the DMA/BDMA, examined factors associated with positive or negative attitudes and assessed their views on the potential clinical impact of both models. Pubmed, EMBASE, PsycINFO, CINAHL Plus and Sociological Abstracts were systematically searched. Original papers on treatment providers' views about the DMA/BDMA and its clinical impact were included. Studies focussing on tobacco, behavioural addictions or non-Western populations were excluded. The 34 included studies were predominantly quantitative and conducted in the USA. Among mixed findings of treatment providers' support for the DMA, strong validity studies indicated treatment providers supported the disease concept and moral, free-will or social models simultaneously. Support for the DMA was positively associated with treatment providers' age, year of qualification, certification status, religious beliefs, being in recovery and Alcoholics Anonymous attendance. Greater education was negatively associated with DMA support. Treatment providers identified potential positive (e.g. reduced stigma) and negative (e.g. increased sense of helplessness) impacts of the DMA on client behaviour. The review suggests treatment providers may endorse disease and other models while strategically deploying the DMA for presumed therapeutic benefits. Varying DMA support across workforces indicated service users may experience multiple and potentially contradictory explanations of addiction. Future policy development will benefit by considering how treatment providers adopt disease concepts in practice. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  3. Natural history collections as windows on evolutionary processes.

    PubMed

    Holmes, Michael W; Hammond, Talisin T; Wogan, Guinevere O U; Walsh, Rachel E; LaBarbera, Katie; Wommack, Elizabeth A; Martins, Felipe M; Crawford, Jeremy C; Mack, Katya L; Bloch, Luke M; Nachman, Michael W

    2016-02-01

    Natural history collections provide an immense record of biodiversity on Earth. These repositories have traditionally been used to address fundamental questions in biogeography, systematics and conservation. However, they also hold the potential for studying evolution directly. While some of the best direct observations of evolution have come from long-term field studies or from experimental studies in the laboratory, natural history collections are providing new insights into evolutionary change in natural populations. By comparing phenotypic and genotypic changes in populations through time, natural history collections provide a window into evolutionary processes. Recent studies utilizing this approach have revealed some dramatic instances of phenotypic change over short timescales in response to presumably strong selective pressures. In some instances, evolutionary change can be paired with environmental change, providing a context for potential selective forces. Moreover, in a few cases, the genetic basis of phenotypic change is well understood, allowing for insight into adaptive change at multiple levels. These kinds of studies open the door to a wide range of previously intractable questions by enabling the study of evolution through time, analogous to experimental studies in the laboratory, but amenable to a diversity of species over longer timescales in natural populations. © 2016 John Wiley & Sons Ltd.

  4. Natural history collections as windows on evolutionary processes

    PubMed Central

    Holmes, Michael W.; Hammond, Talisin T.; Wogan, Guinevere O.U.; Walsh, Rachel E.; LaBarbera, Katie; Wommack, Elizabeth A.; Martins, Felipe M.; Crawford, Jeremy C.; Mack, Katya L.; Bloch, Luke M.; Nachman, Michael W.

    2016-01-01

    Natural history collections provide an immense record of biodiversity on Earth. These repositories have traditionally been used to address fundamental questions in biogeography, systematics, and conservation. However, they also hold the potential for studying evolution directly. While some of the best direct observations of evolution have come from long-term field studies or from experimental studies in the lab, natural history collections are providing new insights into evolutionary change in natural populations. By comparing phenotypic and genotypic changes in populations through time, natural history collections provide a window into evolutionary processes. Recent studies utilizing this approach have revealed some dramatic instances of phenotypic change over short time scales in response to presumably strong selective pressures. In some instances evolutionary change can be paired with environmental change, providing a context for potential selective forces. Moreover, in a few cases, the genetic basis of phenotypic change is well understood, allowing for insight into adaptive change at multiple levels. These kinds of studies open the door to a wide range of previously intractable questions by enabling the study of evolution through time, analogous to experimental studies in the laboratory, but amenable to a diversity of species over longer timescales in natural populations. PMID:26757135

  5. Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal.

    PubMed

    Devkota, Hridaya Raj; Murray, Emily; Kett, Maria; Groce, Nora

    2017-06-29

    Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider's attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider's attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth. The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes. Mean ATDP score among healthcare providers (78.52; SD = 14.75), was low compared to the normative score of 100 or higher. Nurses/auxiliary nurse midwives obtained the highest mean score (85.59, SD = 13.45), followed by general clinical health workers (Mean score = 82.64, SD 15.10). The lowest score was obtained by Female Community Health Volunteers (FCHV) (Score = 73.75, SD = 13.40) (P < 0.001). Younger providers were more positive compared to older age groups (P < 0.001). Similarly, providers working in urban health facilities compared to those working in rural health facilities, and non-Dalit providers compared to Dalit providers reported more positive attitudes towards disability (P < 0.05). However, there were no significant differences in ATDP mean scores between those who had or had not previously provided services for women with disabilities. The mean score difference between those who received disability training and who did not was also found statistically insignificant (P > 0.05). This may reflect the small number of individuals, who have had training on disability thus far, or the nature or quality of the training currently available. The majority of qualitative interview participants perceived providers to have the negative attitude with poor knowledge, skills and preparation for providing care to persons with disabilities. Few participants perceived the providers as kind, respectful, caring or helpful. Overall, provider's attitude towards disability was found to be negative with poor knowledge and skills about providing services. This may have adversely impact maternal healthcare service utilization by women with disabilities. More organized, effective training for healthcare providers is required through on-going mainstream efforts to develop favorable attitudes towards disability. Further research on this subject is also needed.

  6. The Role of Parent, Provider, and Child Characteristics in Parent-Provider Relationships in Infant and Toddler Classrooms

    ERIC Educational Resources Information Center

    Swartz, Mallary I.; Easterbrooks, M. Ann

    2014-01-01

    Research Findings: This study examined how characteristics of parents, providers, and children contribute to the quality of parent--provider relationships in infant and toddler classrooms. Parents (n = 192) and providers (n = 95) from 14 child care centers in a large metropolitan area participated by completing questionnaires about the nature of…

  7. Concept analysis of safety climate in healthcare providers.

    PubMed

    Lin, Ying-Siou; Lin, Yen-Chun; Lou, Meei-Fang

    2017-06-01

    To report an analysis of the concept of safety climate in healthcare providers. Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care. Concept analysis. The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'. The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers. Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate. More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures. The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients. © 2016 John Wiley & Sons Ltd.

  8. Teaching Health Care Providers To Provide Spiritual Care: A Pilot Study

    PubMed Central

    Trevino, Kelly M.; Cadge, Wendy; Balboni, Michael J.; Thiel, Mary Martha; Fitchett, George; Gallivan, Kathleen; VanderWeele, Tyler; Balboni, Tracy A.

    2015-01-01

    Abstract Background: Health care providers' lack of education on spiritual care is a significant barrier to the integration of spiritual care into health care services. Objective: The study objective was to describe the training program, Clinical Pastoral Education for Healthcare Providers (CPE-HP) and evaluate its impact on providers' spiritual care skills. Methods: Fifty CPE-HP participants completed self-report surveys at baseline and posttraining measuring frequency of and confidence in providing religious/spiritual (R/S) care. Four domains were assessed: (1) ability and (2) frequency of R/S care provision; (3) comfort using religious language; and (4) confidence in providing R/S care. Results: At baseline, participants rated their ability to provide R/S care and comfort with religious language as “fair.” In the previous two weeks, they reported approximately two R/S patient conversations, initiated R/S conversations less than twice, and prayed with patients less than once. Posttraining participants' reported ability to provide spiritual care increased by 33% (p<0.001). Their comfort using religious language improved by 29% (p<0.001), and frequency of R/S care increased 75% (p<0.001). Participants reported having 61% more (p<0.001) R/S conversations and more frequent prayer with patients (95% increase; p<0.001). Confidence in providing spiritual care improved by 36% overall, by 20% (p<0.001) with religiously concordant patients, and by 43% (p<0.001) with religiously discordant patients. Conclusions: This study suggests that CPE-HP is an effective approach for training health care providers in spiritual care. Dissemination of this training may improve integration of spiritual care into health care, thereby strengthening comprehensive patient-centered care. PMID:25871494

  9. Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

    PubMed Central

    Pearson, Amy CS; Moman, Rajat N; Moeschler, Susan M; Eldrige, Jason S; Hooten, W Michael

    2017-01-01

    Introduction Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics. Materials and methods The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman’s rho. Results Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8%) did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1) following an opioid therapy protocol (P=0.001), 2) the perceived ability to identify patients at risk for opioid misuse (P=0.006), and 3) using a consistent practice-based approach to improve their comfort level with prescribing opioids (P<0.001). Provider confidence was negatively correlated with the perception that treating pain patients was a “problem in my practice” (P=0.005). Conclusion In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable competence in managing chronic pain and explore approaches to enhance appropriate levels of confidence in caring for patients with chronic pain. PMID:28652805

  10. Patient and Provider Perceptions of Weight Gain, Physical Activity, and Nutrition Counseling during Pregnancy: A Qualitative Study.

    PubMed

    Whitaker, Kara M; Wilcox, Sara; Liu, Jihong; Blair, Steven N; Pate, Russell R

    2016-01-01

    This study investigated patient and provider perceptions of weight gain, physical activity, and nutrition counseling during prenatal care visits. Individual qualitative interviews were conducted with 30 pregnant women between 20 and 30 weeks gestation (15 African American, 15 White) and 11 prenatal care providers (5 attending physicians, 5 residents, 1 nurse practitioner) in 2014. The majority of patients and providers reported receiving or giving advice on weight gain (87% and 100%, respectively), physical activity (87% and 91%), and nutrition (100% and 91%) during a prenatal visit. Discussion of counseling content was largely consistent between patients and providers. However, counseling was limited and not fully consistent with current weight gain, physical activity, or dietary guidelines during pregnancy. Most patients viewed provider advice positively, but some wanted more detailed information. Providers discussed many barriers to lifestyle counseling, including lack of time, inadequate training, concern about the sensitivity of the topic, lower education or income level of the patient, cultural differences, and lack of patient interest. Providers discussed weight gain, physical activity, and nutrition during prenatal care visits and patients accurately recalled this advice. However, counseling was limited and not fully consistent with guidelines. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  11. [Diabetes and fasting during Ramadan. A observational study among Turkish immigrants in Belgium].

    PubMed

    Peeters, B; Mehuys, E; Van Tongelen, I; Van Bever, E; Bultereys, L; Avonts, D; Yildiz, G; Remon, J P; Boussery, K

    2013-03-01

    To investigate (i) Ramadan participation, (ii) provision of Ramadan related advice by healthcare providers (iii) medication use during Ramadan fasting among Turkish migrants with diabetes in Belgium. This pilot observational study was conducted among a convenience sample of 52 Turkish migrants with diabetes in Belgium. Two questionnaires collected information on socio-demographic characteristics, diabetes related characteristics, current hypoglycaemic medication with dosing regimen, participation in the past Ramadan, reasons for (non)participation, use of hypoglycaemic medication during the past Ramadan, advice from their healthcare providers about fasting during Ramadan and follow up of this advice. Sixteen patients (31%) had fasted during the past Ramadan. Main reason for Ramadan participation was reinforcement of faith (12/15), while the main reason for non participation was having diabetes (34/36). About 56% of the study population had received recommendations from their healthcare provider(s) about fasting and diabetes during Ramadan. The most commonly provided advice was not to participate in Ramadan, followed by modification of drug therapy. Only 3 patients ignored the advice of their healthcare professionals. In addition, only 60% of those who actually fasted received recommendations about intake of diabetes medication during the ramadan. Most fasters continued their medication dose unchanged (87% of OHA users and 80% of the insulin users). This pilot study found a low prevalence of Ramadan fasting among Turkish migrants with diabetes in Belgium. We also found that provision of advice by healthcare providers could be improved. Larger scale studies are warranted to confirm these findings.

  12. Designing Computerized Provider Order Entry Software in Iran: The Nurses' and Physicians' Viewpoints.

    PubMed

    Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Keshtkaran, Ali; Barati, Omid

    2016-09-01

    This study aimed to identify the functional requirements of computerized provider order entry software and design this software in Iran. This study was conducted using review documentation, interview, and focus group discussions in Shiraz University of Medical Sciences, as the medical pole in Iran, in 2013-2015. The study sample consisted of physicians (n = 12) and nurses (n = 2) in the largest hospital in the southern part of Iran and information technology experts (n = 5) in Shiraz University of Medical Sciences. Functional requirements of the computerized provider order entry system were examined in three phases. Finally, the functional requirements were distributed in four levels, and accordingly, the computerized provider order entry software was designed. The software had seven main dimensions: (1) data entry, (2) drug interaction management system, (3) warning system, (4) treatment services, (5) ability to write in software, (6) reporting from all sections of the software, and (7) technical capabilities of the software. The nurses and physicians emphasized quick access to the computerized provider order entry software, order prescription section, and applicability of the software. The software had some items that had not been mentioned in other studies. Ultimately, the software was designed by a company specializing in hospital information systems in Iran. This study was the first specific investigation of computerized provider order entry software design in Iran. Based on the results, it is suggested that this software be implemented in hospitals.

  13. The role of epigenetics in genetic and environmental epidemiology.

    PubMed

    Ladd-Acosta, Christine; Fallin, M Daniele

    2016-02-01

    Epidemiology is the branch of science that investigates the causes and distribution of disease in populations in order to provide preventative measures and promote human health. The fields of genetic and environmental epidemiology primarily seek to identify genetic and environmental risk factors for disease, respectively. Epigenetics is emerging as an important piece of molecular data to include in these studies because it can provide mechanistic insights into genetic and environmental risk factors for disease, identify potential intervention targets, provide biomarkers of exposure, illuminate gene-environment interactions and help localize disease-relevant genomic regions. Here, we describe the importance of including epigenetics in genetic and environmental epidemiology studies, provide a conceptual framework when considering epigenetic data in population-based studies and touch upon the many challenges that lie ahead.

  14. The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model

    PubMed Central

    Bialosky, Joel E; Bishop, Mark D; Price, Don D; Robinson, Michael E; George, Steven Z

    2009-01-01

    Prior studies suggest manual therapy (MT) as effective in the treatment of musculoskeletal pain; however, the mechanisms through which MT exerts its effects are not established. In this paper we present a comprehensive model to direct future studies in MT. This model provides visualization of potential individual mechanisms of MT that the current literature suggests as pertinent and provides a framework for the consideration of the potential interaction between these individual mechanisms. Specifically, this model suggests that a mechanical force from MT initiates a cascade of neurophysiological responses from the peripheral and central nervous system which are then responsible for the clinical outcomes. This model provides clear direction so that future studies may provide appropriate methodology to account for multiple potential pertinent mechanisms. PMID:19027342

  15. "I don't know anything about their culture": the disconnect between allopathic and traditional maternity care providers in rural northern Ghana.

    PubMed

    Hill, Elizabeth; Hess, Rebecca; Aborigo, Raymond; Adongo, Philip; Hodgson, Abraham; Engmann, Cyril; Moyer, Cheryl A

    2014-06-01

    The provision of maternal and neonatal health care in rural northern Ghana is pluralistic, consisting of traditional and allopathic providers. Although women often use these providers interchangeably, important differences exist. This study explored the differences in approaches to maternal and neonatal care provision by these two different types of providers. This research was part of the Stillbirth and Neonatal Death Study (SANDS), conducted in northern Ghana in 2010. Trained field staff of the Navrongo Health Research Centre conducted in-depth interviews with 13 allopathic and 8 traditional providers. Interviews were audio-recorded, transcribed, and analyzed using in vivo coding and discussion amongst the research team. Three overarching themes resulted: 1) many allopathic providers were isolated from the culture of the communities in which they practiced, while traditional providers were much more aware of the local cultural beliefs and practices. 2) Allopathic and traditional healthcare providers have different frameworks for understanding health and disease, with allopathic providers relying heavily on their biomedical knowledge, and traditional providers drawing on their knowledge of natural remedies. 3) All providers agreed that education directed at pregnant women, providers (both allopathic and traditional), and the community at large is needed to improve maternal and neonatal outcomes. Our findings suggest that, among other things, programmatic efforts need to be placed on the cultural education of allopathic providers.

  16. Summary of Epidemiology Studies or Activities Involving Workers at the Savannah River Site or the Surrounding Public: An Update

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

    Brown, K.T.

    2002-10-18

    There have been numerous health studies or related activities over time that have involved workers at the Savannah River Site (SRS) or the surrounding public. While most of these epidemiology studies or activities have been performed by external agencies, it has proved useful to provide interested parties an overall summary of such activities. The first such summary was provided in an October 1998 report. The 1998 summary was updated in a February 2000 report. This report provides an update on the status or findings of epidemiology studies or activities involving SRS workers or the surrounding public, as an update tomore » the previous summaries.« less

  17. 3D-QSAR study and design of 4-hydroxyamino α-pyranone carboxamide analogues as potential anti-HCV agents

    NASA Astrophysics Data System (ADS)

    Li, Wenlian; Xiao, Faqi; Zhou, Mingming; Jiang, Xuejin; Liu, Jun; Si, Hongzong; Xie, Meng; Ma, Xiuting; Duan, Yunbo; Zhai, Honglin

    2016-09-01

    The three dimensional-quantitative structure activity relationship (3D-QSAR) study was performed on a series of 4-hydroxyamino α-pyranone carboxamide analogues using comparative molecular similarity indices analysis (COMSIA). The purpose of the present study was to develop a satisfactory model providing a reliable prediction based on 4-hydroxyamino α-pyranone carboxamide analogues as anti-HCV (hepatitis C virus) inhibitors. The statistical results and the results of validation of this optimum COMSIA model were satisfactory. Furthermore, analysis of the contour maps helped to provide guidelines for finding structural requirement. Therefore, the satisfactory results from this study may provide useful guidelines for drug development of anti-HCV inhibitors.

  18. The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis.

    PubMed

    Salyers, Michelle P; Bonfils, Kelsey A; Luther, Lauren; Firmin, Ruth L; White, Dominique A; Adams, Erin L; Rollins, Angela L

    2017-04-01

    Healthcare provider burnout is considered a factor in quality of care, yet little is known about the consistency and magnitude of this relationship. This meta-analysis examined relationships between provider burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) and the quality (perceived quality, patient satisfaction) and safety of healthcare. Publications were identified through targeted literature searches in Ovid MEDLINE, PsycINFO, Web of Science, CINAHL, and ProQuest Dissertations & Theses through March of 2015. Two coders extracted data to calculate effect sizes and potential moderators. We calculated Pearson's r for all independent relationships between burnout and quality measures, using a random effects model. Data were assessed for potential impact of study rigor, outliers, and publication bias. Eighty-two studies including 210,669 healthcare providers were included. Statistically significant negative relationships emerged between burnout and quality (r = -0.26, 95 % CI [-0.29, -0.23]) and safety (r = -0.23, 95 % CI [-0.28, -0.17]). In both cases, the negative relationship implied that greater burnout among healthcare providers was associated with poorer-quality healthcare and reduced safety for patients. Moderators for the quality relationship included dimension of burnout, unit of analysis, and quality data source. Moderators for the relationship between burnout and safety were safety indicator type, population, and country. Rigor of the study was not a significant moderator. This is the first study to systematically, quantitatively analyze the links between healthcare provider burnout and healthcare quality and safety across disciplines. Provider burnout shows consistent negative relationships with perceived quality (including patient satisfaction), quality indicators, and perceptions of safety. Though the effects are small to medium, the findings highlight the importance of effective burnout interventions for healthcare providers. Moderator analyses suggest contextual factors to consider for future study.

  19. Implementation of the CALM intervention for anxiety disorders: a qualitative study

    PubMed Central

    2012-01-01

    Background Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed? Methods Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes. Results Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS. Conclusions The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial. PMID:22404963

  20. Providers' competencies positively affect personal recovery of involuntarily admitted patients with severe mental illness: A prospective observational study.

    PubMed

    Jas, Ellen; Wieling, Martijn

    2018-03-01

    There is limited research on the patient-provider relationship in inpatient settings. The purpose of this study was to measure the effect of mental healthcare providers' recovery-promoting competencies on personal recovery in involuntarily admitted psychiatric patients with severe mental illness. In all, 127 Dutch patients suffering from a severe mental illness residing in a high-secure psychiatric hospital reported the degree of their personal recovery (translated Questionnaire about Processes of Recovery questionnaire (QPR)) and the degree of mental healthcare providers' recovery-promoting competence (Recovery Promoting Relationship Scale (RPRS)) at two measurement points, 6 months apart. (Mixed-effects) linear regression analysis was used to test the effect of providers' recovery-promoting competence on personal recovery, while controlling for the following confounding variables: age, gender drug/alcohol problems, social relationships, activities of daily living, treatment motivation and medication adherence. Analyses revealed a significant positive effect of providers' recovery-promoting competencies on the degree of personal recovery ( t = 8.4, p < .001) and on the degree of change in personal recovery over time ( ts > 4, p < .001). This study shows that recovery-promoting competencies of mental healthcare providers are positively associated with (a change in) personal recovery of involuntarily admitted patients. Further research is necessary on how to organize recovery-oriented care in inpatient settings and how to enhance providers' competencies in a sustainable way.

  1. Provider Factors and Patient-Reported Healthcare Discrimination in the Diabetes Study of California (DISTANCE)

    PubMed Central

    Lyles, Courtney R.; Karter, Andrew J.; Young, Bessie A.; Spigner, Clarence; Grembowski, David; Schillinger, Dean; Adler, Nancy

    2011-01-01

    Objective We examined provider-level factors and reported discrimination in the healthcare setting. Methods With data from the Diabetes Study of Northern California (DISTANCE)—a race-stratified survey of diabetes patients in Kaiser Permanente Northern California—we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables including racial concordance. Results Subjects (n=12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2% to 8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR=0.09; 95% CI: 0.01–0.67), those rating their provider higher on communication (OR=0.70; 95% CI: 0.66–0.74) were less likely to report discrimination, while those with more visits (OR=1.10; 95% CI: 1.03–1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity. Conclusions Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination. Practice Implications Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment. PMID:21605956

  2. The globalization of pediatric clinical trials.

    PubMed

    Dunne, Julia; Murphy, M Dianne; Rodriguez, William J

    2012-12-01

    To examine the characteristics of pediatric trials conducted under US legislation and to compare results with data from 2002 to 2007. We reviewed all pediatric trials provided to the US Food and Drug Administration in submissions that were approved between September 28, 2007 and December 21, 2010. We extracted data for each trial including age range, therapeutic indication, design, duration, and patient and center enrollment by location. Overall 346 studies on 113 drugs and biologicals enrolled 55 819 pediatric patients. The United States participated in 86% of the studies, providing 71% of the centers and 74% of the patients. Corresponding percentages for non-US countries were 43%, 29%, and 26% respectively. Developing or transition countries participated in 22% of the studies, providing 12% of the centers and 10% of the patients; our earlier analysis found corresponding percentages of 38%, 12%, and 23%. The most common therapeutic areas studied in the latter countries were infectious, neurologic, and pulmonary diseases. Seventy-eight vaccine studies enrolled 147 692 patients. The United States participated in 40% of the studies, providing 39% of the centers and 22% of the patients. Corresponding percentages for non-US countries were 74%, 61%, and 78% respectively. Developing or transition countries participated in 27% of the studies, providing 15% of the centers and 52% of the patients. The United States remains an important location for pediatric trials. Developing country involvement in pediatric drug development is not increasing, although these countries participate significantly in vaccine trials.

  3. Vacation Study Abroad.

    ERIC Educational Resources Information Center

    Howard, Edrice Marguerite, Ed.

    This directory of vacation study-abroad programs provides brief descriptions of the programs offered by institutions around the world. An introductory section describes the organization of the listings (which provide program sponsor and name, location, dates, subjects, credit, eligibility, instruction, highlights, costs, housing, deadline, and…

  4. Metropolitan transportation management center : a case study : Long Island INFORM : identifying incidents and informing travelers

    DOT National Transportation Integrated Search

    1999-10-01

    The following case study provides a snapshot of Long Island's INFORM transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting St...

  5. Titan 4 TPS Replacement Implementation Study

    NASA Technical Reports Server (NTRS)

    Jackson, Charles H.

    1996-01-01

    This final report documents the overall progress of the study. It is a general discussion of the documents reviewed, recommendations, trips taken, findings/observations, and proposed corrective actions. In addition, cost data for the contract is addressed. The normal abstract and executive summary provided with most final reports is also provided as a part of this report. A conclusion section is provided that addresses the relative completeness of the Titan 4 TPSR project and this contract.

  6. Health-Care-Seeking Patterns in the Emerging Private Sector in Burkina Faso: A Population-Based Study of Urban Adult Residents in Ouagadougou

    PubMed Central

    Beogo, Idrissa; Liu, Chieh-Yu; Chou, Yiing-Jenq; Chen, Chuan-Yu; Huang, Nicole

    2014-01-01

    Background The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA). However, people’s health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. Method We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. Results Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP) providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.04–1.28), and non-severe conditions (OR = 1.22, 95% CI = 1.07–1.39). Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP) provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. Conclusion The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers in SSA. PMID:24842536

  7. Health-care-seeking patterns in the emerging private sector in Burkina Faso: a population-based study of urban adult residents in Ouagadougou.

    PubMed

    Beogo, Idrissa; Liu, Chieh-Yu; Chou, Yiing-Jenq; Chen, Chuan-Yu; Huang, Nicole

    2014-01-01

    The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA). However, people's health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP) providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR]  = 1.15, 95% confidence interval [CI] = 1.04-1.28), and non-severe conditions (OR = 1.22, 95% CI = 1.07-1.39). Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP) provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers in SSA.

  8. A Case Study of Gifted Education in Two Oklahoma School Districts

    ERIC Educational Resources Information Center

    Rains, Marcia

    2015-01-01

    The purpose of this study was to investigate and study the importance of educational services mandated for Oklahoma's gifted and talented students with the conclusion being likely able to assist educators in providing gifted service options to meet the needs of gifted learners. Research has shown the need to provide educational services to gifted…

  9. An Evaluation of Past Special Education Programs and Services Provided to Incarcerated Young Offenders

    ERIC Educational Resources Information Center

    Ingalls, Lawrence; Hammond, Helen; Trussell, Robert P.

    2011-01-01

    This study investigated the past special education programs and services provided to children and youth who later became incarcerated. Participants in this study were inmates from a medium security state correctional facility in the southwest region of the United States. All inmates involved in this study were identified as having a disability and…

  10. Information Systems Program Graduates: A Qualitative Case Study of Graduates' Preparation and Job Needs

    ERIC Educational Resources Information Center

    Simon, DeShea A.

    2012-01-01

    This study examined the academic preparation and job skill needs of information systems program graduates from institutions in an Eastern state, from their perspective. A historical review of the literature surrounding IS skill requirements was conducted for this study to provide the changes in IS over the past several decades. Providing a…

  11. Case Study: What Makes a Good Case, Revisited: The Survey Monkey Tells All

    ERIC Educational Resources Information Center

    Herried, Clyde Freeman; Prud'homme-Genereux, Annie; Schiller, Nancy A.; Herreid, Ky F.; Wright, Carolyn

    2016-01-01

    This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. In this month's issue the authors provide a more definitive answer to the "What Makes a Good Case?" question based on a just-completed Survey Monkey survey given to NCCSTS teachers.

  12. Classroom-Based Narrative and Vocabulary Instruction: Results of an Early-Stage, Nonrandomized Comparison Study

    ERIC Educational Resources Information Center

    Gillam, Sandra Laing; Olszewski, Abbie; Fargo, Jamison; Gillam, Ronald B.

    2014-01-01

    Purpose: This nonrandomized feasibility study was designed to provide a preliminary assessment of the impact of a narrative and vocabulary instruction program provided by a speech-language pathologist (SLP) in a regular classroom setting. Method: Forty-three children attending 2 first-grade classrooms participated in the study. Children in each…

  13. Reggio Emilia, Vygotsky, and Family Childcare: Four American Providers Describe Their Pedagogical Practice

    ERIC Educational Resources Information Center

    Freeman, Ramona

    2011-01-01

    This case study considers pedagogical techniques used in family childcare to promote children's learning experiences. Data extracted from an earlier study were used to inform this examination of four family childcare providers' pedagogy. In the current study, I use socio-cultural theory and the Reggio Emilia approach to address the following…

  14. How America Pays for College, 2014: Sallie Mae's National Study of College Students and Parents

    ERIC Educational Resources Information Center

    Sallie Mae, Inc., 2014

    2014-01-01

    Sallie Mae has conducted "How America Pays for College" annually since 2008, providing information about the resources American families invest in an undergraduate college education. This study focuses particularly on the planning and payment behaviors in a given academic year. Now in its seventh year, the study provides a compelling…

  15. Adaptation of Organizational Justice in Sport Scale into Turkish Language: Validity and Reliability Study

    ERIC Educational Resources Information Center

    Sayin, Ayfer; Sahin, Mustafa Yasar

    2017-01-01

    The present study aimed to provide a Turkish adaptation of the Organizational Justice in Sport Scale and perform reliability and validity studies. Answers provided by 260 participants who work as football, male basketball and female basketball coaches in National Collegiate Athletic Association (NCAA) were analysed using the original scale that…

  16. Re-Exploring Game-Assisted Learning Research: The Perspective of Learning Theoretical Bases

    ERIC Educational Resources Information Center

    Wu, Wen-Hsiung; Chiou, Wen-Bin; Kao, Hao-Yun; Hu, Chung-Hsing Alex; Huang, Sih-Han

    2012-01-01

    Previous literature reviews or meta-analysis based studies on game-assisted learning have provided important results, but few studies have considered the importance of learning theory, and coverage of papers after 2007 is scant. This study presents a systematic review of the literature using a meta-analysis approach to provide a more comprehensive…

  17. Academic Year Abroad, 1991-92: An IIE Guide to Study Abroad.

    ERIC Educational Resources Information Center

    Steen, Sara J., Ed.; Battle, Ed, Ed.

    This directory provides information on 1,800 postsecondary study programs that take place in countries other than the United States during the academic year, ranging in length from 1 week to 1 year. An introductory section describes the organization of the listings, which provide program sponsor and name, location, dates, fields of study offered,…

  18. Providing Academic Leadership in Universities in Cross River State, Nigeria: Assessment of Departmental Heads' Effectiveness

    ERIC Educational Resources Information Center

    Akuegwu, Basil A.; Nwi-ue, Felix D.

    2017-01-01

    This study assessed Heads of Departments' effectiveness in providing academic leadership at the departmental level. I research question and 2 hypotheses were formulated to give direction to this investigation. Survey design was adopted for the study. The population of the study comprised 110 Heads of Departments from 2 universities in Cross River…

  19. The Educational Value of Esperanto Study: An American View. Esperanto Documents, Number 31A.

    ERIC Educational Resources Information Center

    Sherwood, Bruce Arne

    The linguistic, communicative, and cultural value of teaching Esperanto is discussed. A major linguistic advantage is that Esperanto study provides an ideal introduction to the study of language. The European root stock provides an important resource for building vocabulary in English and in other European languages. Esperanto has a valuable and…

  20. Grandparents Providing Care to Grandchildren: A Population-Based Study of Continuity and Change

    ERIC Educational Resources Information Center

    Luo, Ye; LaPierre, Tracey A.; Hughes, Mary Elizabeth; Waite, Linda J.

    2012-01-01

    This study examines transitions in grandchild care and the characteristics of grandparents making these transitions, using longitudinal data from a nationally representative sample of 13,626 grandparents in the 1998-2008 Health and Retirement Study. More than 60% of grandparents provided grandchild care over the 10-year period; more than 70% of…

  1. An Experimental Study of Medical Error Explanations: Do Apology, Empathy, Corrective Action, and Compensation Alter Intentions and Attitudes?

    PubMed

    Nazione, Samantha; Pace, Kristin

    2015-01-01

    Medical malpractice lawsuits are a growing problem in the United States, and there is much controversy regarding how to best address this problem. The medical error disclosure framework suggests that apologizing, expressing empathy, engaging in corrective action, and offering compensation after a medical error may improve the provider-patient relationship and ultimately help reduce the number of medical malpractice lawsuits patients bring to medical providers. This study provides an experimental examination of the medical error disclosure framework and its effect on amount of money requested in a lawsuit, negative intentions, attitudes, and anger toward the provider after a medical error. Results suggest empathy may play a large role in providing positive outcomes after a medical error.

  2. The paradoxical politics of provider reempowerment.

    PubMed

    Brown, Lawrence D; Eagan, Elizabeth

    2004-12-01

    The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.

  3. Differentiated protection services with failure probability guarantee for workflow-based applications

    NASA Astrophysics Data System (ADS)

    Zhong, Yaoquan; Guo, Wei; Jin, Yaohui; Sun, Weiqiang; Hu, Weisheng

    2010-12-01

    A cost-effective and service-differentiated provisioning strategy is very desirable to service providers so that they can offer users satisfactory services, while optimizing network resource allocation. Providing differentiated protection services to connections for surviving link failure has been extensively studied in recent years. However, the differentiated protection services for workflow-based applications, which consist of many interdependent tasks, have scarcely been studied. This paper investigates the problem of providing differentiated services for workflow-based applications in optical grid. In this paper, we develop three differentiated protection services provisioning strategies which can provide security level guarantee and network-resource optimization for workflow-based applications. The simulation demonstrates that these heuristic algorithms provide protection cost-effectively while satisfying the applications' failure probability requirements.

  4. The effect of foot orthoses and in-shoe wedges during cycling: a systematic review

    PubMed Central

    2014-01-01

    Background The use of foot orthoses and in-shoe wedges in cycling are largely based on theoretical benefits and anecdotal evidence. This review aimed to systematically collect all published research on this topic, critically evaluate the methods and summarise the findings. Methods Study inclusion criteria were: all empirical studies that evaluated the effects of foot orthoses or in-shoe wedges on cycling; outcome measures that investigated physiological parameters, kinematics and kinetics of the lower limb, and power; and, published in English. Studies were located by data-base searching (Medline, CINAHL, Embase and SPORTDiscus) and hand-searching in February 2014. Selected studies were assessed for methodological quality using a modified Quality Index. Data were synthesised descriptively. Meta-analysis was not performed as the included studies were not sufficiently homogeneous to provide a meaningful summary. Results Six studies were identified as meeting the eligibility criteria. All studies were laboratory-based and used a repeated measures design. The quality of the studies varied, with Quality Index scores ranging from 7 to 10 out of 14. Five studies investigated foot orthoses and one studied in-shoe wedges. Foot orthoses were found to increase contact area in the midfoot, peak pressures under the hallux and were perceived to provide better arch support, compared to a control. With respect to physiological parameters, contrasting findings have been reported regarding the effect foot orthoses have on oxygen consumption. Further, foot orthoses have been shown to not provide effects on lower limb kinematics and perceived comfort. Both foot orthoses and in-shoe wedges have been shown to provide no effect on power. Conclusion In general, there is limited high-quality research on the effects foot orthoses and in-shoe wedges provide during cycling. At present, there is some evidence that during cycling foot orthoses: increase contact area under the foot and increase plantar pressures under the hallux, but provide no gains in power. Based on available evidence, no definitive conclusions can be made about the effects foot orthoses have on lower limb kinematics and oxygen consumption, and the effect in-shoe wedges have on power during cycling. Future well-designed studies on this topic are warranted. PMID:24955129

  5. Evaluating Patient Perspectives of Provider Professionalism on Twitter in an Academic Obstetrics and Gynecology Clinic: Patient Survey.

    PubMed

    Maben-Feaster, Rosalyn E; Stansfield, R Brent; Opipari, AnneMarie; Hammoud, Maya M

    2018-03-12

    One-third of Americans use social media websites as a source of health care information. Twitter, a microblogging site that allows users to place 280-character posts-or tweets-on the Web, is emerging as an important social media platform for health care. However, most guidelines on medical professionalism on social media are based on expert opinion. This study sought to examine if provider Twitter profiles with educational tweets were viewed as more professional than profiles with personal tweets or a mixture of the two, and to determine the impact of provider gender on perceptions of professionalism in an academic obstetrics and gynecology clinic. This study randomized obstetrics and gynecology patients at the University of Michigan Von Voigtlander Clinic to view one of six medical provider Twitter profiles, which differed in provider gender and the nature of tweets. Each participant answered 10 questions about their perception of the provider's professionalism based on the Twitter profile content. The provider profiles with educational tweets alone received higher mean professionalism scores than profiles with personal tweets. Specifically, the female and male provider profiles with exclusively educational tweets had the highest and second highest overall mean professionalism ratings at 4.24 and 3.85, respectively. In addition, the female provider profiles received higher mean professionalism ratings than male provider profiles with the same content. The female profile with mixed content received a mean professionalism rating of 3.38 compared to 3.24 for the male mixed-content profile, and the female profile with only personal content received a mean professionalism rating of 3.68 compared to 2.68 for the exclusively personal male provider profile. This study showed that in our obstetrics and gynecology clinic, patients perceived providers with educational profiles as more professional than those with a mixture of educational and personal tweets or only personal tweets. It also showed that our patient population perceived the female provider with educational tweets to be the most professional. This study will help inform the development of evidence-based guidelines for social media use in medicine as it adds to the growing body of literature examining professionalism and social media. ©Rosalyn E Maben-Feaster, R Brent Stansfield, AnneMarie Opipari, Maya M Hammoud. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.03.2018.

  6. Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

    PubMed Central

    Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Braut, Geir Sverre; Søreide, Eldar

    2016-01-01

    Objective Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. Methods, participants This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR. Setting The study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates. Results Three themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident. Conclusions Lay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers. PMID:27225648

  7. Examination of psychosocial predictors of Chinese hospital pharmacists' intention to provide clinical pharmacy services using the theory of planned behaviour: a cross-sectional questionnaire study

    PubMed Central

    He, Yuan; Yang, Fan; Mu, Dongqin; Xing, Yuan; Li, Xin

    2016-01-01

    Objectives Main study aim was as follows: (1) to explore the usefulness of the theory of planned behaviour (TPB) model in predicting Chinese hospital pharmacists' intention to provide clinical pharmacy services (CPSs), including auxiliary CPSs and core CPSs; (2) to identify the main factors affecting the Chinese hospital pharmacists' intention to provide core CPSs based on TPB quantitatively. Design Cross-sectional questionnaire study. Setting The study was conducted in 22 general hospitals in seven cities located in the eastern and western part of China. Participants 416 hospital pharmacists (292 (70.2%) female) entered and completed the study. Primary and secondary outcome measures Quantitative responses with hospital pharmacists' intention, attitude, subjective norms (SNs) and perceived behavioural control (PBC) over provision of CPSs and their past behaviour (PB)-related CPSs. Results The structural equation model analysis found that attitude (p=0.0079, β=0.12), SN (p=0.038, β=0.10) and the pharmacists' intention to provide auxiliary CPSs (p=0.0001, β=0.63) significantly predicted of their intention to provide core CPSs, accounting for 54.0% of its variance. Attitude (p=0.0001, β=0.35), PBC (p=0.0182, β=0.12) and PB (p=0.0009, β=0.15) are significant predictors of pharmacists' intention, accounting for 21% of the variance in pharmacists' intention to provide auxiliary CPSs. Conclusions The TPB with the addition of PB is a useful framework for predicting pharmacists' intention to provide CPSs in Chinese hospital care context. Strategies to improve hospital pharmacists' intention to provide CPSs should focus on helping the individuals related medical care see the value of CPSs, altering their perception of social pressure towards core CPSs and the removal of obstacles that impede the translation of intentions into behaviour. PMID:27707835

  8. Examination of psychosocial predictors of Chinese hospital pharmacists' intention to provide clinical pharmacy services using the theory of planned behaviour: a cross-sectional questionnaire study.

    PubMed

    He, Yuan; Yang, Fan; Mu, Dongqin; Xing, Yuan; Li, Xin

    2016-10-05

    Main study aim was as follows: (1) to explore the usefulness of the theory of planned behaviour (TPB) model in predicting Chinese hospital pharmacists' intention to provide clinical pharmacy services (CPSs), including auxiliary CPSs and core CPSs; (2) to identify the main factors affecting the Chinese hospital pharmacists' intention to provide core CPSs based on TPB quantitatively. Cross-sectional questionnaire study. The study was conducted in 22 general hospitals in seven cities located in the eastern and western part of China. 416 hospital pharmacists (292 (70.2%) female) entered and completed the study. Quantitative responses with hospital pharmacists' intention, attitude, subjective norms (SNs) and perceived behavioural control (PBC) over provision of CPSs and their past behaviour (PB)-related CPSs. The structural equation model analysis found that attitude (p=0.0079, β=0.12), SN (p=0.038, β=0.10) and the pharmacists' intention to provide auxiliary CPSs (p=0.0001, β=0.63) significantly predicted of their intention to provide core CPSs, accounting for 54.0% of its variance. Attitude (p=0.0001, β=0.35), PBC (p=0.0182, β=0.12) and PB (p=0.0009, β=0.15) are significant predictors of pharmacists' intention, accounting for 21% of the variance in pharmacists' intention to provide auxiliary CPSs. The TPB with the addition of PB is a useful framework for predicting pharmacists' intention to provide CPSs in Chinese hospital care context. Strategies to improve hospital pharmacists' intention to provide CPSs should focus on helping the individuals related medical care see the value of CPSs, altering their perception of social pressure towards core CPSs and the removal of obstacles that impede the translation of intentions into behaviour. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Chinese newspaper coverage of (unproven) stem cell therapies and their providers.

    PubMed

    Ogbogu, Ubaka; Du, Li; Rachul, Christen; Bélanger, Lisa; Caulfield, Timothy

    2013-04-01

    China is a primary destination for stem cell tourism, the phenomenon whereby patients travel abroad to receive unproven stem cell-based treatments that have not been approved in their home countries. Yet, much remains unknown about the state of the stem cell treatment industry in China and about how the Chinese view treatments and providers. Given the media's crucial role in science/health communication and in framing public dialogue, this study sought to examine Chinese newspaper portrayal and perceptions of stem cell treatments and their providers. Based on a content analysis of over 300 newspaper articles, the study revealed that while Chinese newspaper reporting is generally neutral in tone, it is also inaccurate, overly positive, heavily influenced by "interested" treatment providers and focused on the therapeutic uses of stem cells to address the health needs of the local population. The study findings suggest a need to counterbalance providers' influence on media reporting through strategies that encourage media uptake of accurate information about stem cell research and treatments.

  10. Providing Students with Written Feedback on Their Assessment: A Collaborative Self-Study Exploring the Nexus of Research and Practice

    ERIC Educational Resources Information Center

    Pittaway, Sharon; Dowden, Tony

    2014-01-01

    This article is an account of a collaborative self-study of the process of providing written feedback on assessment to our teacher education students. Our five-year study grew out of concerns that written feedback might not always meet the learning needs of our students. The study was informed by on-going analysis of our reading of the relevant…

  11. Knowledge, Attitude and Behavior of Healthcare Providers towards Breast Cancer in Malaysia: a Systematic Review.

    PubMed

    Azeem, Eman; Gillani, Syed Wasif; Siddiqui, Ammar; Shammary H A, Al; Poh, Vinci; Syed Sulaiman, Syed Azhar; Baig, Mirza

    2015-01-01

    Breast cancer is the most common cancer among women in Malaysia. Therefore, it is highly important for the public to be educated on breast cancer and to know the steps to detect it early on. Healthcare providers are in the prime position to provide such education to the public due to their high knowledge regarding health and their roles in healthcare. The present systematic review involved studies conducted in recent years to analyze the knowledge, attitudes and behavior of Malaysian healthcare providers regarding breast cancer, in attempts to obtain an overall picture of how well equipped our healthcare providers are to provide optimal breast cancer education, and to see their perceptions and actual involvement in said education. The systematic review was conducted via a primary search of various databases and journal websites, and a secondary search of references used by eligible studies. Criteria for eligibility included being published from the year 2008 till present, being conducted in Malaysia, and being written in the English language. A total of two studies were eligible for this review. Findings show that Malaysian future and current healthcare providers have moderate knowledge on breast cancer, have a positive towards involvement of breast cancer education, but have poor actual involvement.

  12. The implementation of an AR (augmented reality) approach to support mammographic interpretation training: an initial feasibility study

    NASA Astrophysics Data System (ADS)

    Tang, Qiang; Chen, Yan; Gale, Alastair G.

    2017-03-01

    Appropriate feedback plays an important role in optimising mammographic interpretation training whilst also ensuring good interpretation performance. The traditional keyboard, mouse and workstation technical approach has a critical limitation in providing supplementary image-related information and providing complex feedback in real time. Augmented Reality (AR) provides a possible superior approach in this situation, as feedback can be provided directly overlaying the displayed mammographic images so making a generic approach which can also be vendor neutral. In this study, radiological feedback was dynamically remapped virtually into the real world, using perspective transformation, in order to provide a richer user experience in mammographic interpretation training. This is an initial attempt of an AR approach to dynamically superimpose pre-defined feedback information of a DICOM image on top of a radiologist's view, whilst the radiologist is examining images on a clinical workstation. The study demonstrates the feasibility of the approach, although there are limitations on interactive operations which are due to the hardware used. The results of this fully functional approach provide appropriate feedback/image correspondence in a simulated mammographic interpretation environment. Thus, it is argued that employing AR is a feasible way to provide rich feedback in the delivery of mammographic interpretation training.

  13. Assessment of the structural validity of the domestic violence healthcare providers’ survey questionnaire using a Nigerian sample

    PubMed Central

    John, Ime A; Lawoko, Stephen

    2010-01-01

    Abstract: Background: There has been increased advocacy to involve healthcare providers in the prevention of intimate partner violence (IPV) through screening for it in healthcare. Yet, only one in ten providers screen for IPV, suggesting barriers. Understanding the readiness of healthcare providers to screen for IPV is therefore paramount. The Domestic Violence Healthcare Provider Survey Scales (DVHPSS) is a previously validated, comprehensive scale to study readiness of healthcare providers to screen for IPV. However, an understanding of its usefulness in the Sub-Saharan African context remains elusive. The current study undertook to examine the structural validity of the DVHPSS in Nigeria. Methods: Exploratory factor analysis and Cronbach's Alpha were run to reveal the factorial structure and reliability of the instrument/subscales respectively. Established thresholds were used to determine significant factor loadings and alphas coefficient. Results: A six factor model emerged, with 2 factors similar to the original scale, another two differing slightly and a further two factors resulting from a splitting up of the original combination of victim/provider safety to having distinct victim and provider safety subscales. Conclusions: With slight modifications, the DVHPSS can be use to study IPV screening among Nigerian healthcare professionals. Introducing screening protocols could promote better understanding of crucial questions that were lost in the analysis. PMID:21483202

  14. Optimization of radio telemetry receiving systems: Chapter 5.2

    USGS Publications Warehouse

    Evans, Scott D.; Stevenson, John R.; Adams, Noah S.; Beeman, John W.; Eiler, John H.

    2012-01-01

    Telemetry provides a powerful and flexible tool for studying fish and other aquatic animals, and its use has become increasingly commonplace. However, telemetry is gear intensive and typically requires more specialized knowledge and training than many other field techniques. As with other scientific methods, collecting good data is dependent on an understanding of the underlying principles behind the approach, knowing how to use the equipment and techniques properly, and recognizing what to do with the data collected. This book provides a road map for using telemetry to study aquatic animals, and provides the basic information needed to plan, implement, and conduct a telemetry study under field conditions. Topics include acoustic or radio telemetry study design, tag implantation techniques, radio and acoustic telemetry principles and case studies, and data management and analysis.

  15. A history of telemetry in fishery research: Chapter 2

    USGS Publications Warehouse

    Hockersmith, Eric; Beeman, John W.; Adams, Noah S.; Beeman, John W.; Eiler, John H.

    2012-01-01

    Telemetry provides a powerful and flexible tool for studying fish and other aquatic animals, and its use has become increasingly commonplace. However, telemetry is gear intensive and typically requires more specialized knowledge and training than many other field techniques. As with other scientific methods, collecting good data is dependent on an understanding of the underlying principles behind the approach, knowing how to use the equipment and techniques properly, and recognizing what to do with the data collected. This book provides a road map for using telemetry to study aquatic animals, and provides the basic information needed to plan, implement, and conduct a telemetry study under field conditions. Topics include acoustic or radio telemetry study design, tag implantation techniques, radio and acoustic telemetry principles and case studies, and data management and analysis.

  16. Provider self-disclosure during contraceptive counseling.

    PubMed

    McLean, Merritt; Steinauer, Jody; Schmittdiel, Julie; Chan, Pamela; Dehlendorf, Christine

    2017-02-01

    Provider self-disclosure (PSD) - defined as providers making statements regarding personal information to patients - has not been well characterized in the context of contraceptive counseling. In this study, we describe the incidence, content and context of contraceptive PSD. This mixed methods analysis used data from the Provider-Patient Contraceptive Counseling study, for which 349 family planning patients were recruited from 2009 to 2012 from six clinics in the San Francisco Bay Area. Audio-recordings from their visits were analyzed for the presence or absence of PSD, and those visits with evidence of PSD were analyzed using qualitative methods. The associations of patient and provider demographics and patient satisfaction measures, obtained from survey data, with PSD were analyzed using bivariable and multivariable analyses. Thirty-seven percent of providers showed evidence of PSD during at least one visit, and PSD occurred in 9% of clinic visits. Fifty-four percent of PSD statements were about intrauterine devices. About half of PSD statements occurred prior to the final selection of the contraceptive method and appeared to influence the choice of method. In post-visit surveys, all patients who reported receiving PSD considered it to be appropriate, and patient-reported PSD was not statistically associated with measures of patient satisfaction. This study provides some support for the appropriateness of PSD during family planning encounters, at least as practiced during the sampled visits. Further research could explore whether this counseling strategy has an impact on patients' ability to identify the best contraceptive methods for them. In this study, PSD did not have a demonstrated negative effect on the provider-patient relationship. In almost half of visits, PSD appeared to influence patients' choice of a method; whether this influence is beneficial needs further research. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study

    PubMed Central

    2011-01-01

    Background Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perceptions of the benefits and problems of electronic information exchange in health care and the n-EPR in particular. Methods The study was conducted in three Dutch health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, interviews were conducted with 17 stakeholders working in these organisations. Relevant themes were deduced by means of thematic qualitative analysis. Results Health care providers perceived electronic information exchange to promote the efficiency and quality of care. The problems they perceived in electronic information exchange mainly concerned the confidentiality and safety of information exchange and the reliability and quality of patient data. Many problems perceived by health care providers did not specifically apply to the n-EPR, but to electronic information exchange in general. Conclusions The implementation of the Dutch n-EPR has mainly followed a top-down approach, thereby neglecting the fact that the perceptions and preferences of its users (health care providers) need to be addressed in order to achieve successful implementation. The results of this study provide valuable suggestions about how to promote health care providers' willingness to adopt electronic information exchange, which can be useful for other countries currently implementing an n-EPR. Apart from providing information about the benefits and usefulness of electronic information exchange, efforts should be focused on minimising the problems as perceived by health care providers. The safety and confidentiality of electronic information exchange can be improved by developing tools to evaluate the legitimacy of access to electronic records, by increasing health care providers' awareness of the need to be careful when using patient data, and by measures to limit access to sensitive patient data. Improving health care providers' recording behaviour is important to improve the reliability and quality of electronically exchanged patient data. PMID:21982395

  18. Health information management and perceptions of the quality of care for children with tracheotomy: A qualitative study

    PubMed Central

    2011-01-01

    Background Children with tracheotomy receive health care from an array of providers within various hospital and community health system sectors. Previous studies have highlighted substandard health information exchange between families and these sectors. The aim of this study was to investigate the perceptions and experiences of parents and providers with regard to health information management, care plan development and coordination for children with tracheotomy, and strategies to improve health information management for these children. Methods Individual and group interviews were performed with eight parents and fifteen healthcare (primary and specialty care, nursing, therapist, equipment) providers of children with tracheotomy. The primary tracheotomy-associated diagnoses for the children were neuromuscular impairment (n = 3), airway anomaly (n = 2) and chronic lung disease (n = 3). Two independent reviewers conducted deep reading and line-by-line coding of all transcribed interviews to discover themes associated with the objectives. Results Children with tracheotomy in this study had healthcare providers with poorly defined roles and responsibilities who did not actively communicate with one another. Providers were often unsure where to find documentation relating to a child's tracheotomy equipment settings and home nursing orders, and perceived that these situations contributed to medical errors and delayed equipment needs. Parents created a home record that was shared with multiple providers to track the care that their children received but many considered this a burden better suited to providers. Providers benefited from the parent records, but questioned their accuracy regarding critical tracheotomy care plan information such as ventilator settings. Parents and providers endorsed potential improvement in this environment such as a comprehensive internet-based health record that could be shared among parents and providers, and between various clinical sites. Conclusions Participants described disorganized tracheotomy care and health information mismanagement that could help guide future investigations into the impact of improved health information systems for children with tracheotomy. Strategies with the potential to improve tracheotomy care delivery could include defined roles and responsibilities for tracheotomy providers, and improved organization and parent support for maintenance of home-based tracheotomy records with web-based software applications, personal health record platforms and health record data authentication techniques. PMID:21605385

  19. The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families.

    PubMed

    Wong, Sabrina T; Lynam, M Judith; Khan, Koushambhi B; Scott, Lorine; Loock, Christine

    2012-10-04

    The Responsive Interdisciplinary Child-Community Health Education and Research (RICHER) initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC) model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for 'at risk' children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1) access to health care for children and families with multiple forms of disadvantage and 2) patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach. This was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86) and thematic analyses of patient interview data (n=7) were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment. Respondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider's interpersonal style (e.g., being treated as an equal), was very important. Even after controlling for parents' education and ethnicity, the provider's interpersonal style remained positively associated with parent-reported empowerment (p<0.01). This model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can better meet the health and health care needs of people, especially those who are vulnerable due to multiple intersecting social determinants of health. Positive interpersonal communication from providers can play a key role in facilitating situations where individuals have an opportunity to experience success in managing their and their family's health.

  20. Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments.

    PubMed

    Harrison, Mark; Milbers, Katherine; Hudson, Marie; Bansback, Nick

    2017-05-17

    To review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences. A systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers. Systematic review. We identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers. Discordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare. © 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.

  1. Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study.

    PubMed

    Zwaanswijk, Marieke; Verheij, Robert A; Wiesman, Floris J; Friele, Roland D

    2011-10-07

    Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perceptions of the benefits and problems of electronic information exchange in health care and the n-EPR in particular. The study was conducted in three Dutch health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, interviews were conducted with 17 stakeholders working in these organisations. Relevant themes were deduced by means of thematic qualitative analysis. Health care providers perceived electronic information exchange to promote the efficiency and quality of care. The problems they perceived in electronic information exchange mainly concerned the confidentiality and safety of information exchange and the reliability and quality of patient data. Many problems perceived by health care providers did not specifically apply to the n-EPR, but to electronic information exchange in general. The implementation of the Dutch n-EPR has mainly followed a top-down approach, thereby neglecting the fact that the perceptions and preferences of its users (health care providers) need to be addressed in order to achieve successful implementation. The results of this study provide valuable suggestions about how to promote health care providers' willingness to adopt electronic information exchange, which can be useful for other countries currently implementing an n-EPR. Apart from providing information about the benefits and usefulness of electronic information exchange, efforts should be focused on minimising the problems as perceived by health care providers. The safety and confidentiality of electronic information exchange can be improved by developing tools to evaluate the legitimacy of access to electronic records, by increasing health care providers' awareness of the need to be careful when using patient data, and by measures to limit access to sensitive patient data. Improving health care providers' recording behaviour is important to improve the reliability and quality of electronically exchanged patient data.

  2. Non-technical skills and health care provision in low- and middle-income countries: a systematic review.

    PubMed

    Scott, John; Revera Morales, Dianali; McRitchie, Andrew; Riviello, Robert; Smink, Douglas; Yule, Steven

    2016-04-01

    Health care workers must possess high levels of medical knowledge, technical skills and also non-technical skills (NTS) in order to provide safe, effective and patient-centred care. Although there has been a recent proliferation of NTS assessment and training tools developed in high-income countries, little is known about NTS in low- and middle-income countries (LMICs), which face a variety of provider-level and system-level challenges. The aim of this study was to identify the NTS used by providers in LMICs that have been studied, describe how they are assessed and taught, and explain the contextual factors in LMICs that affect their use. We conducted a systematic literature review in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines for primary research publications from January 1994 to December 2013 on evaluation or teaching of NTS used by health care workers in LMICs using MEDLINE, Embase, CIHHAL and Web of Science. Bibliographies of relevant manuscripts were also hand-searched to identify all potentially eligible manuscripts. We identified 21 manuscripts from 17 LMICs involving eight types of health care providers and trainees. These studies covered five NTS categories: decision making, communication, teamwork, leadership and stress management. The most commonly used methods were questionnaires, interviews and observations, and 43% (n = 9) scored > 10 points using the Medical Education Research Study Quality Instrument. Although many studies highlighted the ways in which overburdened health care systems, lack of provider empowerment and deficiencies in provider training had an impact on providers' use of these NTS, no context-specific assessment or educational tools were identified. There is growing worldwide interest in understanding and teaching critical non-technical skills to health care providers. This review highlights several studies describing a variety of important non-technical skills. However, these skills must be further characterised in order to develop context-specific tools for assessing and teaching NTS that are sensitive to the local challenges that are common across a variety of LMIC contexts. © 2016 John Wiley & Sons Ltd.

  3. Errors in weight estimation in the emergency department: comparing performance by providers and patients.

    PubMed

    Hall, William L; Larkin, Gregory L; Trujillo, Mauricio J; Hinds, Jackie L; Delaney, Kathleen A

    2004-10-01

    To examine biases in weight estimation by Emergency Department (ED) providers and patients, a convenience sample of ED providers (faculty, residents, interns, nurses, medical students, paramedics) and patients was studied. Providers (n = 33), blinded to study hypothesis and patient data, estimated their own weight as well as the weight of 11-20 patients each. An independent sample of patients (n = 95) was used to assess biases in patients' estimation of their own weight. Data are represented as over, under, or within +/- 5 kg, the dose tolerance standard for thrombolytics. Logistic regression analysis revealed that patients are almost nine times more likely to accurately estimate their own weight than providers; yet 22% of patients were unable to estimate their own weight within 5 kg. Of all providers, paramedics were significantly worse estimators of patient weight than other providers. Providers were no better at guessing their own weight than were patients. Though there was no systematic estimate bias by weight, experience level (except paramedic), or gender for providers, those providers under 30 years of age were significantly better estimators of patient weight than older providers. Although patient gender did not create a bias in provider estimation accuracy, providers were more likely to underestimate women's weights than men's. In conclusion, patient self-estimates of weight are significantly better than estimates by providers. Inaccurate estimates by both groups could potentially contribute to medication dosing errors in the ED.

  4. Attributes and perspectives of public providers related to provision of medical abortion at public health facilities in Vietnam: a cross-sectional study in three provinces

    PubMed Central

    Ngo, Thoai D; Free, Caroline; Le, Hoan T; Edwards, Phil; Pham, Kiet HT; Nguyen, Yen BT; Nguyen, Thang H

    2014-01-01

    Background The purpose of this study was to investigate attributes of public service providers associated with the provision of medical abortion in Vietnam. Methods We conducted a cross-sectional study via interviewer-administered questionnaire among abortion providers from public health facilities in Hanoi, Khanh Hoa, and Ho Chi Minh City in Vietnam between August 2011 and January 2012. We recruited abortion providers at all levels of Vietnam’s public health service delivery system. Participants were questioned about their medical abortion provision practices and perspectives regarding abortion methods. Results A total of 905 providers from 62 health facilities were included, comprising 525 (58.0%) from Hanoi, 122 (13.5%) from Khanh Hoa, and 258 (28.5%) from Ho Chi Minh City. The majority of providers were female (96.7%), aged ≥25 years (94%), married (84.4%), and had at least one child (89%); 68.9% of providers offered only manual vacuum aspiration and 31.1% performed both medical abortion and manual vacuum aspiration. Those performing both methods included physicians (74.5%), midwives (21.7%), and nurses (3.9%). Unadjusted analyses showed that female providers (odds ratio 0.1; 95% confidence interval 0.01–0.30) and providers in rural settings (odds ratio 0.3; 95% confidence interval 0.08–0.79) were less likely to provide medical abortion than their counterparts. Obstetricians and gynecologists were more likely to provide medical abortion than providers with nursing/midwifery training (odds ratio 22.2; 95% confidence interval 3.81–129.41). The most frequently cited advantages of medical abortion for providers were that no surgical skills are required (61.7%) and client satisfaction is better (61.0%). Conclusion Provision of medical abortion in Vietnam is lower than provision of manual vacuum aspiration. While the majority of abortion providers are female midwives in Vietnam, medical abortion provision is concentrated in urban settings among physicians. Individuals providing medical abortion found that the method yields high client satisfaction. PMID:25152635

  5. Modeling dispersion of traffic-related pollutants in the NEXUS health study

    EPA Science Inventory

    Dispersion modeling tools have traditionally provided critical information for air quality management decisions, but have been used recently to provide exposure estimates to support health studies. However, these models can be challenging to implement, particularly in near-road s...

  6. Metropolitan transportation management center : a case study : Milwaukee MONITOR : addressing congestion while improving safety and air quality

    DOT National Transportation Integrated Search

    1999-10-01

    The following case study provides a snapshot of Milwaukee's MONITOR transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stu...

  7. Metropolitan transportation management center : a case study : Michigan intelligent transportation system : improving safety and air quality while reducing stress for motorists

    DOT National Transportation Integrated Search

    1999-10-01

    The following case study provides a snapshot of Michigan's Intelligent Transportation Systems transportation management center (MITSC). It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts ...

  8. Metropolitan Transportation Management Center : a case study : Houston TranStar maximizing safety and mobility for the public

    DOT National Transportation Integrated Search

    1999-10-01

    The following case study provides a snapshot of Houston's TranStar transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stud...

  9. John F. Kennedy National Historic Site General Management Plan support : transportation study

    DOT National Transportation Integrated Search

    2010-09-01

    This report provides an overview of transportation and access issues related to the John F. Kennedy National Historic Site and the surrounding area in Brookline, MA. The study defines transportation-related goals for the site and provides support for...

  10. Long-Term Studies of Prescribed Burning in Loblolly Pine Forests of the Southeastern Coastal Plain

    Treesearch

    Thomas A. Waldrop; David H. van Lear; F. Thomas Lloyd; William R. Harms

    1987-01-01

    Prescribed fire provides many benefits in southern pine A study begun in 1946 provides a unique opportunity stands. to observe long-term changes in understory vegetation, soil properties, and overstory tree growth caused by repeated burning.

  11. "Let Me Tell You About My…" Provider Self-Disclosure in the Emergency Department Builds Patient Rapport.

    PubMed

    Zink, Korie L; Perry, Marcia; London, Kory; Floto, Olivia; Bassin, Benjamin; Burkhardt, John; Santen, Sally A

    2017-01-01

    As patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD) of personal information by primary care providers decreased patient rating of the provider communication skills. The objective of this study was to explore the incidence and impact of emergency department (ED) provider self-disclosure on patients' rating of provider communication skills. A survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers' communication skills. We compared patients' ratings of communication measurements between encounters where self-disclosure occurred to those where it did not. Patients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (p<0.05), more positive ratings of provider rapport (p<0.05) and higher satisfaction with provider communication (p<0.05). Patients who noted SD scored their providers' communication skills as "excellent" (63.4%) compared to patients without self-disclosure (47.1%). Patients reported that they would like to hear about their providers' experiences with a similar chief complaint (64.4% of patients), their providers' education (49%), family (33%), personal life (21%) or an injury/ailment unlike their own (18%). Patients responded that providers self-disclose to make patients comfortable/at ease and to build rapport. Provider self-disclosure in the ED is common and is associated with higher ratings of provider communication, rapport, and patient satisfaction.

  12. Facilitating mental health research for patients, clinicians and researchers: a mixed-method study.

    PubMed

    Robotham, D; Waterman, S; Oduola, S; Papoulias, C; Craig, T; Wykes, T

    2016-08-08

    Research registers using Consent for Contact (C4C) can facilitate recruitment into mental health research studies, allowing investigators to contact patients based on clinical records information. We investigated whether such a register was useful for mental health research, seeking the perspectives of patients and research investigators. In 2012, a C4C register was developed in a large secondary mental health provider within the UK; almost 9000 patients have joined. This mixed-method study audited the effectiveness of the register. A 'mystery shopper' exercise was conducted, and patients (n=21) were recruited to ask clinicians about the availability of research opportunities. Structured interviews were conducted with patients (n=52) about their experiences of being on the register. Similar interviews were conducted with 18 investigators from 19 studies, who had attempted to use the register to recruit participants. The impact of C4C on study recruitment, and whether it helped patients learn about research. So far, the register has provided 928 individuals with 1085 research opportunities (in 60% of cases, the individual agreed to participate in the study). Clinicians were willing to link patients to research opportunities, but often lacked information about studies. For patients, the register provided opportunities which they may not otherwise have; 27 of 52 had participated in studies since joining the register (18 participating for the first time). Most investigators used the register to supplement recruitment to their studies, but described problems in prescreening potential participants from a clinical record for complex studies. Although the register helped investigators recruit for studies, and provided patients with research opportunities, clinicians' input is still useful for identifying suitable participants. C4C registers should be adapted to provide clinicians with automatically updated information on local studies allowing them to match patients on their caseload with active studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Facilitating mental health research for patients, clinicians and researchers: a mixed-method study

    PubMed Central

    Robotham, D; Waterman, S; Oduola, S; Papoulias, C; Craig, T; Wykes, T

    2016-01-01

    Objectives Research registers using Consent for Contact (C4C) can facilitate recruitment into mental health research studies, allowing investigators to contact patients based on clinical records information. We investigated whether such a register was useful for mental health research, seeking the perspectives of patients and research investigators. Setting and design In 2012, a C4C register was developed in a large secondary mental health provider within the UK; almost 9000 patients have joined. This mixed-method study audited the effectiveness of the register. Participants A ‘mystery shopper’ exercise was conducted, and patients (n=21) were recruited to ask clinicians about the availability of research opportunities. Structured interviews were conducted with patients (n=52) about their experiences of being on the register. Similar interviews were conducted with 18 investigators from 19 studies, who had attempted to use the register to recruit participants. Outcome measures The impact of C4C on study recruitment, and whether it helped patients learn about research. Results So far, the register has provided 928 individuals with 1085 research opportunities (in 60% of cases, the individual agreed to participate in the study). Clinicians were willing to link patients to research opportunities, but often lacked information about studies. For patients, the register provided opportunities which they may not otherwise have; 27 of 52 had participated in studies since joining the register (18 participating for the first time). Most investigators used the register to supplement recruitment to their studies, but described problems in prescreening potential participants from a clinical record for complex studies. Conclusions Although the register helped investigators recruit for studies, and provided patients with research opportunities, clinicians' input is still useful for identifying suitable participants. C4C registers should be adapted to provide clinicians with automatically updated information on local studies allowing them to match patients on their caseload with active studies. PMID:27503859

  14. Urban college student self-report of hookah use with health care providers.

    PubMed

    Jani, Samir Ranjit; Brown, Darryl; Berhane, Zekarias; Peter, Nadja; Solecki, Susan; Turchi, Renee

    2018-07-01

    This study's purpose was to describe urban college students' communication about hookah with health care providers. Participants included a random sample of undergraduate urban college students and health care providers. Students surveyed determined the epidemiology of hookah use in this population, how many health care providers asked about hookah, and how many students admitted hookah use to a physician. Of 375 students surveyed, 78 (20.8%) had never tried it, 284 (75.7%) had smoked hookah at least once, and 64 students (22.6%) were classified as frequent hookah smokers. Only 15 (4.7%) reported a health care provider asking about hookah during visits, whereas 36 (12.7%) admitted their hookah use to a health care provider. Hookah use was found to be highly prevalent among students in one urban university. This study supports the hypothesis that few health care providers broach the topic with patients. Additional research on health consequences of hookah use, education, and improved screening is warranted.

  15. Physicians, nonphysician healthcare providers, and patients communicating in hepatitis C: an in-office sociolinguistic study.

    PubMed

    Hamilton, Heidi E; Gordon, Cynthia; Nelson, Meaghan; Kerbleski, Marian

    2006-01-01

    In-office conversations about hepatitis C can impact patients' perceptions of outcomes, as well as medication adherence. This study analyzed interactions between physicians, nonphysician healthcare providers (including nurses), and patients with hepatitis C virus infection in order to examine differences based on number and type of providers participating. Gastroenterologists, nonphysician healthcare providers, and patients with hepatitis C virus infection were video- and audio-recorded during regularly scheduled visits. Recordings were transcribed and analyzed using validated sociolinguistic techniques. Thirty-four visits took place with a physician only, 4 with a nonphysician healthcare provider only, and 25 with both providers (9 concurrent and 16 consecutive). Differences among the participant schema included visit length, patient "talk-time," and motivation provided. When providers saw patients consecutively, differing information was sometimes provided. In visits where providers saw the patient concurrently, competing authority between providers and exclusion of the patient through use of medical jargon were obstacles to ideal communication. Differences in hepatitis C-related interactions based on the number and type of participants suggest opportunities for improved communication. In visits with multiple providers, physicians and nurses should attempt to ensure that they (a) avoid supplying differing information, (b) present a "unified front" to avoid competing authority, and (c) minimize the use of medical jargon, which excludes patients from participating in their own healthcare.

  16. Usage Data for Electronic Resources: A Comparison between Locally Collected and Vendor-Provided Statistics.

    ERIC Educational Resources Information Center

    Duy, Joanna; Vaughan, Liwen

    2003-01-01

    Vendor-provided electronic resource usage statistics are not currently standardized across vendors. This study investigates the feasibility of using locally collected data to check the reliability of vendor-provided data. Vendor-provided data were compared with local data collected from North Carolina State University (NCSU) Libraries' Web…

  17. SUS in nuclear medicine in Brazil: analysis and comparison of data provided by Datasus and CNEN*

    PubMed Central

    Pozzo, Lorena; Coura Filho, George; Osso Júnior, João Alberto; Squair, Peterson Lima

    2014-01-01

    Objective To investigate the outpatient access to nuclear medicine procedures by means of the Brazilian Unified Health System (SUS), analyzing the correspondence between data provided by this system and those from Comissão Nacional de Energia Nuclear (CNEN) (National Commission of Nuclear Energy). Materials and Methods Data provided by Datasus regarding number of scintillation chambers, outpatient procedures performed from 2008 to 2012, administrative responsibility for such procedures, type of service providers and outsourced services were retrieved and evaluated. Also, such data were compared with those from institutions certified by CNEN. Results The present study demonstrated that the system still lacks maturity in terms of correct data input, particularly regarding equipment available. It was possible to list the most common procedures and check the growth of the specialty along the study period. Private centers are responsible for most of the procedures covered and reimbursed by SUS. However, many healthcare facilities are not certified by CNEN. Conclusion Datasus provides relevant data for analysis as done in the present study, although some issues still require attention. The present study has quantitatively depicted the Brazilian reality regarding access to nuclear medicine procedures offered by/for SUS. PMID:25741070

  18. Pre- and posttest evaluation of a breast cancer risk assessment program for nurse practitioners.

    PubMed

    Edwards, Quannetta T; Seibert, Diane

    2010-07-01

    Numerous studies have shown that healthcare providers, including nurse practitioners (NPs) fail to provide breast cancer risk assessment (BrCRA) in primary care settings. A potential barrier to the use of BrCRA is insufficient knowledge or training of risk assessment. The purpose of this study was to analyze the outcome of a BrCRA program developed to enhance NPs' knowledge of risk assessment and use of empiric risk assessment models. Thirty-five NPs participated in a before-after (pretest-posttest design) study evaluating the effectiveness of a BrCRA education program conducted at a national NP conference. Demographics, pre/post knowledge, and course satisfaction measures were all examined as a part of this pilot study. Continuing education through the implementation of a BrCRA program significantly increased NPs knowledge in assessing breast cancer risk and the use of empiric risk assessment models. Many healthcare providers, including NPs, are inadequately prepared to assess a woman's risk for breast cancer. Understanding breast cancer risk assessment is essential if NPs are to provide appropriate counseling, management, and referral strategies needed to reduce a woman's risk for developing the disease. Continuing education provides one means to enhance NP's knowledge of BrCRA.

  19. A case study in the use of community-based participatory research in public health nursing.

    PubMed

    Savage, Christine L; Xu, Yin; Lee, Rebecca; Rose, Barbara L; Kappesser, Mary; Anthony, Jean Spann

    2006-01-01

    There is growing demand for research using a community-based participatory (CBPR) approach. CBPR requires that the academic research team actively partner with community members and stakeholders in the entire research process. The community members are full partners with the researchers in relation to the development and implementation of the study, analysis of the data, and dissemination of the findings. The purpose of this article is to review four basic principles of CBPR and provide an example of how these CBPR principles were used in an ethnographic study related to the culture of African American infant health. In the pilot study, CBPR provided the framework for recruitment and retention of participants, ongoing data analysis, and dissemination of findings. Using CBPR provided the researchers an introduction into the selected community. Community members served as key informants about the culture of the community and provided access to potential participants. The community partners contributed to analysis of emerging themes and in the dissemination of findings to the community, stakeholders, and the scientific community. CBPR provides opportunities for community health nurse researchers to conduct research with vulnerable populations and sets the stage for implementing evidenced-based nursing interventions in the community.

  20. SUS in nuclear medicine in Brazil: analysis and comparison of data provided by Datasus and CNEN.

    PubMed

    Pozzo, Lorena; Coura Filho, George; Osso Júnior, João Alberto; Squair, Peterson Lima

    2014-01-01

    To investigate the outpatient access to nuclear medicine procedures by means of the Brazilian Unified Health System (SUS), analyzing the correspondence between data provided by this system and those from Comissão Nacional de Energia Nuclear (CNEN) (National Commission of Nuclear Energy). Data provided by Datasus regarding number of scintillation chambers, outpatient procedures performed from 2008 to 2012, administrative responsibility for such procedures, type of service providers and outsourced services were retrieved and evaluated. Also, such data were compared with those from institutions certified by CNEN. The present study demonstrated that the system still lacks maturity in terms of correct data input, particularly regarding equipment available. It was possible to list the most common procedures and check the growth of the specialty along the study period. Private centers are responsible for most of the procedures covered and reimbursed by SUS. However, many healthcare facilities are not certified by CNEN. Datasus provides relevant data for analysis as done in the present study, although some issues still require attention. The present study has quantitatively depicted the Brazilian reality regarding access to nuclear medicine procedures offered by/for SUS.

  1. Communication strategies and accommodations utilized by health care providers with hearing loss: a pilot study.

    PubMed

    Trotter, Alanna R; Matt, Susan B; Wojnara, Danuta

    2014-03-01

    Poor communication between health care providers and patients may negatively impact patient outcomes, and enhancing communication is one way to improve outcomes. Effective communication is particularly important for health care providers who have hearing loss. The authors found that a systematic survey of the communication strategies and experiences of health care providers with hearing loss had not yet been conducted. In this pilot study, 32 health care professionals with hearing loss were recruited via the Association of Medical Professionals With Hearing Losses and were asked to complete a 28-question survey. Health care providers with hearing loss already employ strategies that all health care providers are encouraged to use in order to enhance patient–provider communication, and survey participants have found the strategies to be effective. The communication techniques and assistive technologies used by individuals with hearing loss seem to be effective: All participants reported feeling able to communicate effectively with patients at least most of the time. More research is needed to determine if use of these communication techniques has similar results for health care providers without hearing loss.

  2. Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan.

    PubMed

    Nishtar, Noureen Aleem; Sami, Neelofar; Alim, Sabina; Pradhan, Nousheen; Hasnain, Farid Ul

    2013-01-05

    In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers' perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi. Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived. Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers' improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area. Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods.

  3. Provider satisfaction in army primary care clinics.

    PubMed

    Byers, V L; Mays, M Z; Mark, D D

    1999-02-01

    The job satisfaction of physicians, nurse practitioners, and physician assistants was assessed during the course of a multicenter study of Army primary care clinics. All providers in nine clinics at three medical centers who were engaged in adult or family care were invited to participate in the study. Questionnaires on job satisfaction and other practice style variables were completed by 26 physicians, 19 nurse practitioners, and 13 physician assistants (46, 76, and 41% of eligible providers, respectively). Analysis revealed a broad range of job satisfaction in the sample. However, average levels of job satisfaction were not significantly different across the three groups of primary care providers. Autonomy and collaboration were significant predictors of job satisfaction. It is clear that changes in health care systems that reduce, or appear to reduce, the primary care provider's autonomy in clinical matters are likely to reduce provider satisfaction as well.

  4. Contraceptive counseling among pediatric primary care providers in Western Pennsylvania: A survey-based study.

    PubMed

    Papas, Beth Ann; Shaikh, Nader; Watson, Katherine; Sucato, Gina S

    2017-01-01

    Data suggest that adolescents in the United States receive inadequate contraceptive counseling. This study sought to determine factors affecting pediatricians' discussion of contraception with adolescent patients, with a specific focus on long-acting reversible contraception-implantable contraception and intrauterine devices. A cross-sectional survey was sent via email to a convenience sample of pediatric residents and pediatric primary care providers in Western Pennsylvania. Self-reported contraceptive counseling and prescribing practices in response to clinical vignettes were assessed. Of potential participants (287), 88 (31%) responded. Younger providers and providers who had received contraceptive training were significantly more likely to discuss long-acting reversible contraception methods. Discussion of contraceptive methods also varied by both the age and the sexual history of the patient. Variation in contraceptive counseling potentially results in missed opportunities to counsel about and provide the most effective contraceptive methods. More uniform, universal provider training might alleviate some of these inconsistencies.

  5. The role of provider-patient communication and trust in online sources in Internet use for health-related activities.

    PubMed

    Hou, Jiran; Shim, Minsun

    2010-01-01

    Provider-patient communication is an important factor influencing patients' satisfaction and health outcomes. This study draws upon the uses and gratification theory to examine how individuals' perception of communication with healthcare providers is associated with their Internet use for health-related activities. Using the data from the 2007 Health Information National Trends Survey (HINTS), we found that as individuals perceived their communication with providers to be less patient-centered, they were more likely to engage in various types of online health activities, such as using websites for healthy lifestyles, searching for healthcare providers, and seeking health information. Trust in online health information was also found to be a significant predictor of online health activities. The results of this study emphasized the important role of provider-patient communication in motivating individuals to turn to the Internet for health purposes.

  6. Advanced transportation system studies, technical area 3. Alternate propulsion subsystem concepts: J-2S restart study

    NASA Astrophysics Data System (ADS)

    Vilja, John; Levack, Daniel

    1993-04-01

    The objectives were to assess what design changes would be required to remit late production of the J-2S engine for use as a large high energy upper stage engine. The study assessed design changes required to perform per the J-2S model specification, manufacturing changes required due to obsolescence or improvements in state-of-the-practice, availability issues for supplier provided items, and provided cost and schedule estimates for this configuration. The confidence that J-2S production could be reinitiated within reasonable costs and schedules was provided. No significant technical issues were identified in either the producibility study or in the review of previous technical data. Areas of potential cost reduction were identified which could be quantified to a greater extent with further manufacturing planning. The proposed schedule can be met with no foreseeable impacts. The results of the study provided the necessary foundation for the detailed manufacturing and test plans and non-recurring and recurring cost estimates that are needed to complete the effort to reinitiate production of the J-2S engine system.

  7. Study protocol: mobile improvement of self-management ability through rural technology (mI SMART).

    PubMed

    Mallow, Jennifer A; Theeke, Laurie A; Long, Dustin M; Whetsel, Tara; Theeke, Elliott; Mallow, Brian K

    2015-01-01

    There are 62 million Americans currently residing in rural areas who are more likely to have multiple chronic conditions and be economically disadvantaged, and in poor health, receive less recommended preventive services and attend fewer visits to health care providers. Recent advances in mobile healthcare (mHealth) offer a promising new approach to solving health disparities and improving chronic illness care. It is now possible and affordable to transmit health information, including values from glucometers, automated blood pressure monitors, and scales, through Bluetooth-enabled devices. Additionally, audio and video communications technologies can allow healthcare providers to conduct many parts of a physical exam remotely from varied settings. These technologies could remove geographical distance as a barrier to care and diminish the access to care issues faced by patients who live rurally. However, currently there is lack of studies that provide evidence of feasibility, acceptability, and effectiveness of mHealth initiatives on improved outcomes of care, a needed step to make the translation to implementation studies in healthcare systems. The purpose of this paper is to present the protocol for the first study of mI SMART (mobile Improvement of Self-Management Ability through Rural Technology), a new integrated mHealth intervention. Our objective is to provide evidence of feasibility and acceptability for the use of mI SMART in an underserved population and establish evidence for the refinement of mI SMART. The proposed study will take place at Milan Puskar Health Right, a free primary care clinic in the state of West Virginia. The clinic provides health care at no cost to uninsured, low income; adults aged 18-64 living in West Virginia. We will enroll 30 participants into this feasibility study with plans of implementing a longitudinal randomized, comparative effectiveness design in the future. Data collection will include tracking of barriers and facilitators to using mI SMART on patient and provider feedback surveys, tracking of patient-provider communications, self-reports from patients on quality of life, adherence, and self-management ability, and capture of health record data on chronic illness measures. We expect that the mI SMART intervention, refined from participant and provider feedback, will be acceptable and feasible. We anticipate high patient-provider satisfaction, enhanced patient-provider communication, and improved health related quality of life, adherence to treatment, and self-management ability. In addition, we hypothesize that patients who use mI SMART will demonstrate improved physical outcomes such as blood glucose, blood pressure, and weight.

  8. Field support activity aerospace manpower transfer to small business enterprises

    NASA Technical Reports Server (NTRS)

    Green, M. K.

    1972-01-01

    This report reiterates the major findings of the original study on the utilization of unemployed aerospace professionals in small businesses, and also provides a definition of three programs which, as a result of this study and other research into this problem, offer great potential in providing for better utilization of the nation's technically trained personal and technology resources. Details of these three programs are provided along with a recommended plan of action for their implementation.

  9. Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011): User's Manual for the ECLS-K:2011 Kindergarten-Fourth Grade Data File and Electronic Codebook, Public Version. NCES 2018-032

    ERIC Educational Resources Information Center

    Tourangeau, Karen; Nord, Christine; Lê, Thanh; Wallner-Allen, Kathleen; Vaden-Kiernan, Nancy; Blaker, Lisa; Najarian, Michelle

    2018-01-01

    This manual provides guidance and documentation for users of the longitudinal kindergarten-fourth grade (K-4) data file of the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011). It mainly provides information specific to the fourth-grade round of data collection. The first chapter provides an overview of the…

  10. EMS Providers and Exception From Informed Consent Research: Benefits, Ethics, and Community Consultation

    PubMed Central

    Ripley, Elizabeth; Ramsey, Cornelia; Prorock-Ernest, Amy; Foco, Rebecca; Luckett, Solomon; Ornato, Joseph P.

    2013-01-01

    As attention to, and motivation for, EMS-related research continues to grow, particularly exception from informed consent (EFIC) research, it is important to understand the thoughts, beliefs, and experiences of EMS providers who are actively engaged in the research. Study Objective We explored the attitudes, beliefs, and experiences of EMS providers regarding their involvement in prehospital emergency research, particularly EFIC research. Method Using a qualitative design, 24 participants were interviewed including Nationally Registered Paramedics and Virginia certified Emergency Medical Technicians employed at Richmond Ambulance Authority, the participating EMS agency. At the time of our interviews, the EMS agency was involved in an exception from informed consent trial. Transcribed interview data were coded and analyzed for themes. Findings were presented back to the EMS agency for validation. Results Overall, there appeared to be support for prehospital emergency research. Participants viewed research as necessary for the advancement of the field of EMS. Improvement in patient care was identified as one of the most important benefits. A number of ethical considerations were identified: individual risk versus public good and consent. EMS providers in our study were open to working with EMS researchers throughout the community consultation and public disclosure process. Conclusions EMS providers in our study value research and are willing to participate in studies. Support for research was balanced with concerns and challenges regarding the role of providers in the research process. PMID:22823963

  11. Child Care Providers' Knowledge About Dental Injury First Aid in Preschool-age Children.

    PubMed

    Sienkiewicz, Kristine L; Rainchuso, Lori; Boyd, Linda D; Giblin, Lori

    2017-06-01

    Purpose: The aim of this study was to assess child care providers' level of knowledge of first aid management and attitudes towards dental injuries among preschool-age children within Fairfield County, Connecticut and Boston, Massachusetts. Methods: This descriptive cross-sectional study used a web-based, validated questionnaire adapted from several studies with permission from authors. A panel of 5 dental experts determined the relevance of the questions and overall content (I-CVI range 0.8-1; S-CVI = 0.95). The 28 question survey included demographics, level of knowledge, attitudes about traumatic dental injuries, emergency management, and 2 case study questions on management of luxation and tooth fracture. Survey data was coded and analyzed for associations and trends using STATA® statistics/data analysis software v. 11.2. Results: A total of 100 child care providers completed the online questionnaire. Eighty-four percent self-reported little to no knowledge about dental injury management. Sixty percent of child care providers agreed that they are responsible for managing dental injuries. Approximately two-thirds of child care providers reported not feeling adequately informed about dental injuries, with 77% expressing interest in receiving more information. Conclusions: The majority of child care providers' do not have the knowledge to perform adequate first aid following a dental injury. Professional development on first aid for dental injuries is recommended among this workforce population. Copyright © 2017 The American Dental Hygienists’ Association.

  12. Associations between psychosocial work factors and provider mental well-being in emergency departments: A systematic review.

    PubMed

    Schneider, Anna; Weigl, Matthias

    2018-01-01

    Emergency departments (ED) are complex and dynamic work environments with various psychosocial work stressors that increase risks for providers' well-being. Yet, no systematic review is available which synthesizes the current research base as well as quantitatively aggregates data on associations between ED work factors and provider well-being outcomes. We aimed at synthesizing the current research base on quantitative associations between psychosocial work factors (classified into patient-/ task-related, organizational, and social factors) and mental well-being of ED providers (classified into positive well-being outcomes, affective symptoms and negative psychological functioning, cognitive-behavioural outcomes, and psychosomatic health complaints). A systematic literature search in eight databases was conducted in December 2017. Original studies were extracted following a stepwise procedure and predefined inclusion criteria. A standardized assessment of methodological quality and risk of bias was conducted for each study with the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. In addition to a systematic compilation of included studies, frequency and strength of quantitative associations were synthesized by means of harvest plots. Subgroup analyses for ED physicians and nurses were conducted. N = 1956 records were retrieved. After removal of duplicates, 1473 records were screened for titles and abstracts. 199 studies were eligible for full-text review. Finally, 39 original studies were included whereof 37 reported cross-sectional surveys. Concerning the methodological quality of included studies, the majority was evaluated as weak to moderate with considerable risk of bias. Most frequently surveyed provider outcomes were affective symptoms (e.g., burnout) and positive well-being outcomes (e.g., job satisfaction). 367 univariate associations and 370 multivariate associations were extracted with the majority being weak to moderate. Strong associations were mostly reported for social and organizational work factors. To the best of our knowledge, this review is the first to provide a quantitative summary of the research base on associations of psychosocial ED work factors and provider well-being. Conclusive results reveal that peer support, well-designed organizational structures, and employee reward systems balance the negative impact of adverse work factors on ED providers' well-being. This review identifies avenues for future research in this field including methodological advances by using quasi-experimental and prospective designs, representative samples, and adequate confounder control. Protocol registration number: PROSPERO 2016 CRD42016037220.

  13. Alternative Programs in Public Secondary Schools in Greater Cleveland: A Descriptive Study. [Summary Report; Detailed Study, Sections 1-9].

    ERIC Educational Resources Information Center

    Wertheim, Sally H.; And Others

    The puposes of the study are: (1) to provide a description of alternative programs within public high schools, (2) to compile a written history of these programs, (3) to provide information necessary to compare innovations in alternative schools within and without public school systems, and (4) to collect and disseminate information about…

  14. Feasibility Analysis For Heating Tribal Buildings with Biomass

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

    Steve Clairmont; Micky Bourdon; Tom Roche

    2009-03-03

    This report provides a feasibility study for the heating of Tribal buildings using woody biomass. The study was conducted for the Confederated Salish and Kootenai Tribes of the Flathead Reservation in western Montana. S&K Holding Company and TP Roche Company completed the study and worked together to provide the final report. This project was funded by the DOE's Tribal Energy Program.

  15. Education Websites and Their Benefits to Potential International Students: A Case Study of Higher Education Service Providers in Malaysia

    ERIC Educational Resources Information Center

    Ooi, Teik Chooi; Ho, Henry Wai Leong; Amri, Siti

    2010-01-01

    This paper looks at criteria on how education service providers' websites could benefit their potential students from overseas. Effective design of education website is important as web users are typically fastidious and want information fast--this serves as the background of this study. The study focuses on three selected education institutions'…

  16. Cascabel prescribed fire long-term watershed study: an opportunity to monitor climate change

    Treesearch

    Gerald Gottfried; Daniel Neary; Peter Ffolliott; Karen Koestner

    2012-01-01

    Experimental watershed studies can provide answers to new challenges facing land managers and society including the impacts of fires and climate change on upstream and regional hydrology. The Cascabel Watersheds long-term prescribed fire study provides a unique opportunity to monitor climate change because of its location in an oak savanna situated between deserts or...

  17. A Study of Teacher Opinions Concerning Selected Free Filmstrips Provided by the American Iron and Steel Institute to Schools Throughout the United States.

    ERIC Educational Resources Information Center

    DuVall, Charles R.; And Others

    This study analyzed teacher assessment of several factors related to selected filmstrips provided to teachers by the American Iron and Steel Institute. Main concerns of the study related to applicability of the filmstrip to instructional programs, assessment of accuracy of information contained, effectiveness of content, effectiveness of…

  18. Word Saliency and Frequency of Academic Words in Textbooks: A Case Study in the "New Standard College English"

    ERIC Educational Resources Information Center

    Liqin, Yan; Xinlu, Gao

    2014-01-01

    Though textbooks are one of the main vocabulary input resources for domestic college students and core contents of learning and testing (Liu, 2013), few empirical studies are done to evaluate learning opportunities provided by textbooks. This empirical study is designed to analyze what learning opportunity is provided in a currently used series of…

  19. "Would You Like to Tidy up Now?" An Analysis of Adult Questioning in the English Foundation Stage

    ERIC Educational Resources Information Center

    Siraj-Blatchford, Iram; Manni, Laura

    2008-01-01

    This study provides an extension of analysis concerned with adult questioning carried out in the Researching Effective Pedagogy in the Early Years (REPEY) study. The REPEY study drew on robust quantitative data provided by the Effective Provision of Pre-School Education (EPPE) project to identify the particular pedagogical strategies being applied…

  20. The Application of a Trade Study Methodology to Determine Which Capabilities to Implement in a Test Facility Data Acquisition System Upgrade

    NASA Technical Reports Server (NTRS)

    McDougal, Kristopher J.

    2008-01-01

    More and more test programs are requiring high frequency measurements. Marshall Space Flight Center s Cold Flow Test Facility has an interest in acquiring such data. The acquisition of this data requires special hardware and capabilities. This document provides a structured trade study approach for determining which additional capabilities of a VXI-based data acquisition system should be utilized to meet the test facility objectives. The paper is focused on the trade study approach detailing and demonstrating the methodology. A case is presented in which a trade study was initially performed to provide a recommendation for the data system capabilities. Implementation details of the recommended alternative are briefly provided as well as the system s performance during a subsequent test program. The paper then addresses revisiting the trade study with modified alternatives and attributes to address issues that arose during the subsequent test program. Although the model does not identify a single best alternative for all sensitivities, the trade study process does provide a much better understanding. This better understanding makes it possible to confidently recommend Alternative 3 as the preferred alternative.

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