Missing texture reconstruction method based on error reduction algorithm using Fourier transform magnitude estimation scheme.

PubMed

Ogawa, Takahiro; Haseyama, Miki

2013-03-01

A missing texture reconstruction method based on an error reduction (ER) algorithm, including a novel estimation scheme of Fourier transform magnitudes is presented in this brief. In our method, Fourier transform magnitude is estimated for a target patch including missing areas, and the missing intensities are estimated by retrieving its phase based on the ER algorithm. Specifically, by monitoring errors converged in the ER algorithm, known patches whose Fourier transform magnitudes are similar to that of the target patch are selected from the target image. In the second approach, the Fourier transform magnitude of the target patch is estimated from those of the selected known patches and their corresponding errors. Consequently, by using the ER algorithm, we can estimate both the Fourier transform magnitudes and phases to reconstruct the missing areas.

Chinese Doctoral Student Socialization in the United States: A Qualitative Study

ERIC Educational Resources Information Center

Li, Wendan; Collins, Christopher S.

2014-01-01

Although international students annually contribute billions of dollars to the US economy, meaningful intercultural interaction between international students, peers, and faculty is often missing at US host campuses. Feelings of isolation, loneliness, and alienation are pervasive among international students at US campuses; these feelings can…

A quality improvement project to tackle under-reporting of hazards by doctors by using an anonymous telephone hotline.

PubMed

Johnson, Sarah

2016-01-01

An anonymous hazard reporting hotline was established for doctors to use on two general medical wards at Weston General Hospital (WGH) in North Somerset in England during an eight day period in July/August 2014. Doctors were encouraged to report hazards and near misses or just start a conversation about a concern. The existing computer based significant event system remained alongside the hotline and was to be used where actual harm had come to a patient. A team of consultants and quality improvement administrators monitored the hotline on a daily basis, categorized the level of risk being reported and ensured, where possible, that action was taken to address the doctors' concerns. The hotline increased reporting rates from two per month to 25 in eight days. The system identified 13 amber (medium risk) and five red (high risk) hazards which would otherwise not have been known about. This author believes these five high risk reports alone make the case for a new, quicker, easier, and anonymous reporting system for doctors at WGH urgent and irrefutable.

Low Target Prevalence Is a Stubborn Source of Errors in Visual Search Tasks

ERIC Educational Resources Information Center

Wolfe, Jeremy M.; Horowitz, Todd S.; Van Wert, Michael J.; Kenner, Naomi M.; Place, Skyler S.; Kibbi, Nour

2007-01-01

In visual search tasks, observers look for targets in displays containing distractors. Likelihood that targets will be missed varies with target prevalence, the frequency with which targets are presented across trials. Miss error rates are much higher at low target prevalence (1%-2%) than at high prevalence (50%). Unfortunately, low prevalence is…

The music of trees: the intergenerative tie between primary care and public health

PubMed Central

Whitehouse, Peter

2016-01-01

Abstract Stories help us frame and understand complex ideas and challenges. Metaphors are particularly powerful linguistic devices that guide and extend our thinking by bridging conceptual domains, for example to consider the brain as a digital computer. Trees are widely used as metaphors for broad concepts like evolution, history, society, and even life itself, i.e. ‘the tree of life’. Tree-like diagrams of roots and branches are used to demonstrate historical and cultural relationships, for example, between different species or different languages. In this paper, we describe a theatrical character called a tree doctor which is a living metaphor. A human being, namely the author, lectures, acts or dances as a tree and offers lessons to Homo Sapiens about ‘holistic’ ideas of health. The character teaches us to not only see the value of our relationships to trees, but the importance of seeing forests as well the individual trees. The metaphorical statement that we should not ‘miss the forest for the trees’ means we should learn to think of health embedded in systems and communities. In medicine, we too often focus on individual molecules, pharmaceuticals, or even patients and miss the bigger picture of public and environmental health. In a time of great ecological system change, the tree doctor points to broad ethical responsibility for each other and future generations of humans and other living creatures. The character embraces arts and particularly music as a powerful way of infusing purpose and improving the qualities of our lives together, especially as we age. The tree doctor knows the value of intergenerational relationships. But it also points to intergenerative innovations across many cultural domains, disciplines and professions. The tree doctor supports primary care and empowers the value of intergenerational relationships, art and music in the recommendations doctors make to patients to improve their health and well-being. PMID:28250826

EEG and Eye Tracking Signatures of Target Encoding during Structured Visual Search

PubMed Central

Brouwer, Anne-Marie; Hogervorst, Maarten A.; Oudejans, Bob; Ries, Anthony J.; Touryan, Jonathan

2017-01-01

EEG and eye tracking variables are potential sources of information about the underlying processes of target detection and storage during visual search. Fixation duration, pupil size and event related potentials (ERPs) locked to the onset of fixation or saccade (saccade-related potentials, SRPs) have been reported to differ dependent on whether a target or a non-target is currently fixated. Here we focus on the question of whether these variables also differ between targets that are subsequently reported (hits) and targets that are not (misses). Observers were asked to scan 15 locations that were consecutively highlighted for 1 s in pseudo-random order. Highlighted locations displayed either a target or a non-target stimulus with two, three or four targets per trial. After scanning, participants indicated which locations had displayed a target. To induce memory encoding failures, participants concurrently performed an aurally presented math task (high load condition). In a low load condition, participants ignored the math task. As expected, more targets were missed in the high compared with the low load condition. For both conditions, eye tracking features distinguished better between hits and misses than between targets and non-targets (with larger pupil size and shorter fixations for missed compared with correctly encoded targets). In contrast, SRP features distinguished better between targets and non-targets than between hits and misses (with average SRPs showing larger P300 waveforms for targets than for non-targets). Single trial classification results were consistent with these averages. This work suggests complementary contributions of eye and EEG measures in potential applications to support search and detect tasks. SRPs may be useful to monitor what objects are relevant to an observer, and eye variables may indicate whether the observer should be reminded of them later. PMID:28559807

Reducing calls missed by the hospital telephone exchange from 26% to less than 10.

PubMed

Bhartia, Saru; Bahlvi, Zorba; Sharma, Irina

2016-01-01

A hospital's telephone exchange is the first point of contact for patients and their attendants to take appointments, to collect healthcare related information and to connect to the hospital in case of emergencies. At Sitaram Bhartia Institute of Science and Research the doctors, patients, and attendants often complained about the inefficiency of the hospital exchange. In February 2012, a doctor raised her concern of calls not being picked up at the exchange with the senior management and a QI project was initiated to tackle the problem. Baseline data showed that about 26% of incoming calls to the hospital during 8am to 8pm were not being picked up. On the basis of the baseline data, call audits, staff interviews, and observations the project team identified the defects. These defects were categorized under four headings - manpower, equipment, processes, and environment. The team proposed several change ideas. Some of these change ideas were implemented immediately. Three proposed change ideas were tested through individual PDSA cycles. The percentage of missed calls dropped from 26% to 18.1% after the first cycle and then to 9.6% and 6.5% after the subsequent cycles which involved testing of two other additional change ideas. These changes were implemented and a benchmark of no more than 10% calls to be missed was set. For nearly three years we have held the gains and have met the benchmark of missing not more than 10% calls coming to the hospital exchange between 8am to 8pm. The contributing factors to the success have been the involvement of frontline workers, an expert and engaged head of department, and senior leadership support.

Targeted social mobilization in a global manhunt.

PubMed

Rutherford, Alex; Cebrian, Manuel; Rahwan, Iyad; Dsouza, Sohan; McInerney, James; Naroditskiy, Victor; Venanzi, Matteo; Jennings, Nicholas R; deLara, J R; Wahlstedt, Eero; Miller, Steven U

2013-01-01

Social mobilization, the ability to mobilize large numbers of people via social networks to achieve highly distributed tasks, has received significant attention in recent times. This growing capability, facilitated by modern communication technology, is highly relevant to endeavors which require the search for individuals that possess rare information or skills, such as finding medical doctors during disasters, or searching for missing people. An open question remains, as to whether in time-critical situations, people are able to recruit in a targeted manner, or whether they resort to so-called blind search, recruiting as many acquaintances as possible via broadcast communication. To explore this question, we examine data from our recent success in the U.S. State Department's Tag Challenge, which required locating and photographing 5 target persons in 5 different cities in the United States and Europe - in under 12 hours - based only on a single mug-shot. We find that people are able to consistently route information in a targeted fashion even under increasing time pressure. We derive an analytical model for social-media fueled global mobilization and use it to quantify the extent to which people were targeting their peers during recruitment. Our model estimates that approximately 1 in 3 messages were of targeted fashion during the most time-sensitive period of the challenge. This is a novel observation at such short temporal scales, and calls for opportunities for devising viral incentive schemes that provide distance or time-sensitive rewards to approach the target geography more rapidly. This observation of '12 hours of separation' between individuals has applications in multiple areas from emergency preparedness, to political mobilization.

'Addressed to you not as a smoker… but as a doctor': doctor-targeted cigarette advertisements in JAMA.

PubMed

Jackler, Robert K; Ayoub, Noel F

2018-07-01

During the mid-20th century tobacco companies placed advertisements in medical journals to entice physicians to smoke their brand and, more importantly, to recommend it to their patients. They have been little studied, in part because advertising sections in medical journals are almost universally discarded before binding. This study aimed to define the themes and techniques used in doctor-targeted tobacco advertisements that appeared in American medical journals in the mid-20th century and determine the motivations and tactics of the tobacco industry in engaging the medical profession in this way. Doctor-targeted tobacco advertisements from JAMA and the New York State Medical Journal appearing between 1936 and 1953 were studied. These were obtained from the New York Academy of Medicine and the UCSF Truth database of tobacco industry documents. Content analysis of advertising slogans and imagery was conducted. Using internal tobacco industry documents, we examined the relationship between tobacco advertisers and medical journals. Among the 519 doctor-targeted advertisements, 13 brands were represented, with two (Philip Morris and Camel) accounting for 84%. Correspondence between tobacco advertisers and medical journal editors reveals the potent influence of revenue to the sponsoring society and personal compensation derived from consulting arrangements. Content analysis of the advertisements revealed much flattery of doctors and arguments professing the harmlessness of the company's brand. Analysis of doctor-targeted tobacco advertisements in American medical journals from 1936 to 1953 suggest that tobacco companies targeted physicians as a potential sales force to assuage the public's fear of health risks and to recruit them as allies against negative publicity. Tobacco companies also appeared to try, through the substantial advertising revenue passed by journals to their parent medical societies, to temper any possible opposition by organized medicine. © 2018 Society for the Study of Addiction.

GSimp: A Gibbs sampler based left-censored missing value imputation approach for metabolomics studies

PubMed Central

Jia, Erik; Chen, Tianlu

2018-01-01

Left-censored missing values commonly exist in targeted metabolomics datasets and can be considered as missing not at random (MNAR). Improper data processing procedures for missing values will cause adverse impacts on subsequent statistical analyses. However, few imputation methods have been developed and applied to the situation of MNAR in the field of metabolomics. Thus, a practical left-censored missing value imputation method is urgently needed. We developed an iterative Gibbs sampler based left-censored missing value imputation approach (GSimp). We compared GSimp with other three imputation methods on two real-world targeted metabolomics datasets and one simulation dataset using our imputation evaluation pipeline. The results show that GSimp outperforms other imputation methods in terms of imputation accuracy, observation distribution, univariate and multivariate analyses, and statistical sensitivity. Additionally, a parallel version of GSimp was developed for dealing with large scale metabolomics datasets. The R code for GSimp, evaluation pipeline, tutorial, real-world and simulated targeted metabolomics datasets are available at: https://github.com/WandeRum/GSimp. PMID:29385130

The Development of Children's Ability to Fill the Gaps in Their Knowledge by Consulting Experts

ERIC Educational Resources Information Center

Aguiar, Naomi R.; Stoess, Caryn J.; Taylor, Marjorie

2012-01-01

This research investigated children's ability to recognize gaps in their knowledge and seek missing information from appropriate informants. In Experiment 1, forty-five 4- and 5-year-olds were adept in assigning questions from 3 domains (medicine, firefighting, and farming) to corresponding experts (doctor, firefighter, or farmer). However, when…

A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke survivors.

PubMed

Hollands, K L; Pelton, T A; van der Veen, S; Alharbi, S; Hollands, M A

2016-01-01

Although there is evidence that stroke survivors have reduced gait adaptability, the underlying mechanisms and the relationship to functional recovery are largely unknown. We explored the relationships between walking adaptability and clinical measures of balance, motor recovery and functional ability in stroke survivors. Stroke survivors (n=42) stepped to targets, on a 6m walkway, placed to elicit step lengthening, shortening and narrowing on paretic and non-paretic sides. The number of targets missed during six walks and target stepping speed was recorded. Fugl-Meyer (FM), Berg Balance Scale (BBS), self-selected walking speed (SWWS) and single support (SS) and step length (SL) symmetry (using GaitRite when not walking to targets) were also assessed. Stepwise multiple-linear regression was used to model the relationships between: total targets missed, number missed with paretic and non-paretic legs, target stepping speed, and each clinical measure. Regression revealed a significant model for each outcome variable that included only one independent variable. Targets missed by the paretic limb, was a significant predictor of FM (F(1,40)=6.54, p=0.014,). Speed of target stepping was a significant predictor of each of BBS (F(1,40)=26.36, p<0.0001), SSWS (F(1,40)=37.00, p<0.0001). No variables were significant predictors of SL or SS asymmetry. Speed of target stepping was significantly predictive of BBS and SSWS and paretic targets missed predicted FM, suggesting that fast target stepping requires good balance and accurate stepping demands good paretic leg function. The relationships between these parameters indicate gait adaptability is a clinically meaningful target for measurement and treatment of functionally adaptive walking ability in stroke survivors. Copyright © 2015 Elsevier B.V. All rights reserved.

Enhancing clinical decisions about care through a pre-consultation sheet that captures patients' views on their health conditions and treatments: A qualitative study in the field of chronic pain.

PubMed

Zanini, Claudia; Maino, Paolo; Möller, Jens Carsten; Gobbi, Claudio; Raimondi, Monika; Rubinelli, Sara

2016-05-01

This study examined whether and how a pre-consultation sheet (PCS) that captures patients' views on their condition and treatments can facilitate doctors in identifying targets for medical advice. A PCS in the form of a list of questions was developed and implemented in chronic pain consultations. Its value was examined through video-recordings and post-consultation interviews with doctors and patients. Doctors reported that the PCS helped them identify topics that required further discussion with patients, unexpected information, patients' expectations on outcomes, and their attitudes and beliefs about treatments. Patients reported that the PCS helped them collect and structure their views, reduced their anxiety regarding the encounter, and created a setting in which they felt heard. The PCS captures patients' views that are valuable in helping doctors identify targets of intervention. It focuses on aspects that matter to patients and that enrich information sharing beyond medical records. Addressing patients' views on health conditions and treatments facilitates doctors and patients in defining targets for intervention. It assists doctors in tailoring their advice and helps patients present their case. A PCS seems to be a feasible and acceptable instrument to support doctors and patients in this information sharing. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Olbers, Heinrich Wilhelm (1758-1840)

NASA Astrophysics Data System (ADS)

Murdin, P.

2000-11-01

Doctor, astronomer, born in Arbergen, Germany, enthusiast for astronomy. He discovered several comets. In 1800 he joined the team of 24 `celestial police', organized by FRANZ VON ZACH, who were to patrol a share of the zodiac looking for the planet missing (according to BODE's law) between Mars and Jupiter. On New Year's Day 1801 PIAZZI discovered Ceres, and, in March 1802, Olbers discovered Pall...

Targeted Social Mobilization in a Global Manhunt

PubMed Central

Dsouza, Sohan; McInerney, James; Naroditskiy, Victor; Venanzi, Matteo; Jennings, Nicholas R.; deLara, J. R.; Wahlstedt, Eero; Miller, Steven U.

2013-01-01

Social mobilization, the ability to mobilize large numbers of people via social networks to achieve highly distributed tasks, has received significant attention in recent times. This growing capability, facilitated by modern communication technology, is highly relevant to endeavors which require the search for individuals that possess rare information or skills, such as finding medical doctors during disasters, or searching for missing people. An open question remains, as to whether in time-critical situations, people are able to recruit in a targeted manner, or whether they resort to so-called blind search, recruiting as many acquaintances as possible via broadcast communication. To explore this question, we examine data from our recent success in the U.S. State Department's Tag Challenge, which required locating and photographing 5 target persons in 5 different cities in the United States and Europe – in under 12 hours – based only on a single mug-shot. We find that people are able to consistently route information in a targeted fashion even under increasing time pressure. We derive an analytical model for social-media fueled global mobilization and use it to quantify the extent to which people were targeting their peers during recruitment. Our model estimates that approximately 1 in 3 messages were of targeted fashion during the most time-sensitive period of the challenge. This is a novel observation at such short temporal scales, and calls for opportunities for devising viral incentive schemes that provide distance or time-sensitive rewards to approach the target geography more rapidly. This observation of ′12 hours of separation' between individuals has applications in multiple areas from emergency preparedness, to political mobilization. PMID:24098660

Low target prevalence is a stubborn source of errors in visual search tasks

PubMed Central

Wolfe, Jeremy M.; Horowitz, Todd S.; Van Wert, Michael J.; Kenner, Naomi M.; Place, Skyler S.; Kibbi, Nour

2009-01-01

In visual search tasks, observers look for targets in displays containing distractors. Likelihood that targets will be missed varies with target prevalence, the frequency with which targets are presented across trials. Miss error rates are much higher at low target prevalence (1–2%) than at high prevalence (50%). Unfortunately, low prevalence is characteristic of important search tasks like airport security and medical screening where miss errors are dangerous. A series of experiments show this prevalence effect is very robust. In signal detection terms, the prevalence effect can be explained as a criterion shift and not a change in sensitivity. Several efforts to induce observers to adopt a better criterion fail. However, a regime of brief retraining periods with high prevalence and full feedback allows observers to hold a good criterion during periods of low prevalence with no feedback. PMID:17999575

Ayurvedic college education, reifying biomedicine and the need for reflexivity.

PubMed

Bode, Maarten; Shankar, Prasan

2017-05-16

The paper analyses the experiences with government sanctioned Ayurvedic college education of 14 young Ayurvedic doctors working at the Integrative Health Centre in Bangalore, India. Unfamiliarity with Ayurvedic logic and Indian natural philosophies, lack of clinical training and the mixing-up of Ayurvedic and biomedical notions are their main complaints. The 14 young Ayurvedic doctors also missed a convincing perspective on how to integrate Ayurvedic logic, modern scientific knowledge and biomedical diagnostics. Ayurvedic state sanctioned education seems to be caught between Ayurveda's natural philosophy of health and the techno-science of biomedicine. The Ayurvedic doctors under scrutiny face the danger of becoming 'half-baked products' when they do not learn to reflect on the tension between Indian traditional knowledge and biomedical learning. The paper argues that the logic of modern science and biomedicine's claim to value-free knowledge captivates Ayurvedic education and research. This hinders Ayurveda's development as a vibrant alterity to biomedicine. What is needed is a critical social science perspective on the construction of medical knowledge and India's hierarchical medical landscape.

Targeted doctors, missing patients: obstetric health services and sectarian conflict in northern Pakistan.

PubMed

Varley, Emma

2010-01-01

The spectre of exclusionary medical service provision, restricted clinic access and physician targeting in sectarian-divided Iraq underscores the crucial and timely need for qualitative research into the inter-relationship between conflict, identity and health. In response, this paper provides a critical ethnography of obstetric service provision and patient access during Shia-Sunni hostilities in Gilgit Town, capital of Pakistan's Northern Areas (2005). I analyse how services were embedded in and constrained by sectarian affiliation in ways that detrimentally impacted Sunni women patients and hospital staff, resulting in profoundly diminished clinic access, reduced physician coverage and a higher observed incidence of maternal morbidity and mortality. The paper first situates obstetric medicine at the interstices of contested sectarian terrain and competing historical projects of sectarian identity. Gilgiti Sunnis' high clinical reliance is argued to be a response to and consequence of, inter-sectarian dissonance and the ascendance of biomedicine during three decades of regional development. In 2005, conflict-incurred service deprivations and the enactment and strategic use of sectarian identity in clinical settings were associated with differential treatment and patient-perceived adverse health outcomes, leading Sunnis to generate alternative sect-specific health services. Obstetric morbidity and mortality during sectarian conflict are analyzed as distinctive manifestations of the wide range of direct harms routinely associated with violence and political strife.

Why do we miss rare targets? Exploring the boundaries of the low prevalence effect

PubMed Central

Rich, Anina N.; Kunar, Melina A.; Van Wert, Michael J.; Hidalgo-Sotelo, Barbara; Horowitz, Todd S.; Wolfe, Jeremy M.

2011-01-01

Observers tend to miss a disproportionate number of targets in visual search tasks with rare targets. This ‘prevalence effect’ may have practical significance since many screening tasks (e.g., airport security, medical screening) are low prevalence searches. It may also shed light on the rules used to terminate search when a target is not found. Here, we use perceptually simple stimuli to explore the sources of this effect. Experiment 1 shows a prevalence effect in inefficient spatial configuration search. Experiment 2 demonstrates this effect occurs even in a highly efficient feature search. However, the two prevalence effects differ. In spatial configuration search, misses seem to result from ending the search prematurely, while in feature search, they seem due to response errors. In Experiment 3, a minimum delay before response eliminated the prevalence effect for feature but not spatial configuration search. In Experiment 4, a target was present on each trial in either two (2AFC) or four (4AFC) orientations. With only two response alternatives, low prevalence produced elevated errors. Providing four response alternatives eliminated this effect. Low target prevalence puts searchers under pressure that tends to increase miss errors. We conclude that the specific source of those errors depends on the nature of the search. PMID:19146299

A critical incident study of general practice trainees in their basic general practice term.

PubMed

Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Benefits and risks of using local anaesthetic for pain relief to allow early return to play in professional football

PubMed Central

Orchard, J

2002-01-01

Objective: To investigate the risks and benefits of the use of local anaesthetic in a descriptive case series from three professional football (rugby league and Australian football) teams. Methods: Cases of local anaesthetic use (both injection and topical routes) and complications over a six year period were recorded. Complications were assessed using clinical presentation and also by recording all cases of surgery, incidences of players missing games or leaving the field through injury, and causes of player retirement. Results: There were 268 injuries for which local anaesthetic was used to allow early return to play. There were 11 minor and six major complications, although none of these were catastrophic or career ending. About 10% of players taking the field did so with the assistance of local anaesthetic. This rate should be considered in isolation and not seen to reflect standard practice by team doctors. Conclusions: The use of local anaesthetic in professional football may reduce the rates of players missing matches through injury, but there is the risk of worsening the injury, which should be fully explained to players. A procedure should only be used when both the doctor and player consider that the benefits outweigh the risks. PMID:12055117

SME filter approach to multiple target tracking with false and missing measurements

NASA Astrophysics Data System (ADS)

Lee, Yong J.; Kamen, Edward W.

1993-10-01

The symmetric measurement equation (SME) filter for track maintenance in multiple target tracking is extended to the general case when there are an arbitrary unknown number of false and missing position measurements in the measurement set at any time point. It is assumed that the number N of targets is known a priori and that the target motions consist of random perturbations of constant-velocity trajectories. The key idea in the paper is to generate a new measurement vector from sums-of-products of the elements of 'feasible' N-element data vectors that pass a thresholding operation in the sums-of-products framework. Via this construction, the data association problem is completely avoided, and in addition, there is no need to identify which target measurements may correspond to false returns or which target measurements may be missing. A computer simulation of SME filter performance is given, including a comparison with the associated filter (a benchmark) and the joint probabilistic data association (JPDA) filter.

Has time come for a re-assessment of spa therapy? The NAIADE survey in Italy

NASA Astrophysics Data System (ADS)

Coccheri, S.; Gasbarrini, G.; Valenti, M.; Nappi, G.; di Orio, F.

2008-01-01

Goal of this study was to investigate whether appropriately applied spa therapy in several indications could be associated with a subsequent fall in the need for costly health services and missed working days due to sick-leave. The Naiade project was a multicenter observational, longitudinal, questionnaire-based study comparing an “entry” inquiry addressed to patients before an entry thermal cycle, and a “return” inquiry after 1 year. Routine statistical methods were used for comparisons. The study was carried out in 297 of the 340 certified Italian spa centers. Inquiries were managed by the spa doctor(s), with the collaboration of family doctors, and when necessary, hospitals, other health services, labour offices and employers. After exclusion of regular customers and of patients with acute disease phases or severe health conditions, 39,943 patients divided into eight diseases subgroups (rheumatic, respiratory, dermatologic, gynaecologic, otorhynologic, urinary, vascular and gastroenteric) underwent entry inquiry and appropriate spa treatment. Patients who returned for treatment after 1 year (“index year”) were 23,680 (59.2%) and received return inquiry. Outcomes considered were: frequency and duration of hospitalisation periods; missed working days; regular use of disease-specific drugs; and resort to “non-spa” rehabilitation therapies. The data collected at return inquiry were compared with those of entry inquiry. All the considered outcomes appeared to be significantly reduced in the index year in seven of the eight disease subgroups in comparison with the previous year. In conclusion, disease-appropriate spa treatments were followed by a reduction in the need of subsequent health interventions in most disease subgroups. The health promoting value of spa treatments should therefore undergo more rigorous assessment with randomised controlled studies.

Age Changes in the Missing-Letter Effect Revisited

ERIC Educational Resources Information Center

Saint-Aubin, J.; Klein, R.M.; Landry, T.

2005-01-01

When participants search for a target letter while reading, they make more omissions if the target letter is embedded in frequent function words than in less frequent content words. Reflecting developmental changes in component language and literacy skills, the size of this effect increases with age. With adults, the missing-letter effect is due…

Missed opportunities for diagnosis of female genital mutilation.

PubMed

Abdulcadir, Jasmine; Dugerdil, Adeline; Boulvain, Michel; Yaron, Michal; Margairaz, Christiane; Irion, Olivier; Petignat, Patrick

2014-06-01

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland. In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification. In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women's characteristics or FGM type) associated with missed diagnosis. Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Using the Behaviour Change Wheel to explore potential strategies for minimising harms from non-recreational prescription medicine sharing.

PubMed

Beyene, Kebede; Aspden, Trudi; Sheridan, Janie

2018-04-05

Non-recreational sharing of prescribed medicines can have positive outcomes under some circumstances, but can also result in negative health outcomes. This paper describes a theoretically underpinned and systematic approach to exploring potential interventions to reduce harm. Individual, semi-structured, face-to-face interviews were conducted with purposively sampled pharmacists (n = 8), doctors (n = 4), nurses (n = 6) and patients (n = 17) from Auckland, New Zealand. Thematic analysis of suggested interventions was undertaken, and these were linked to relevant intervention functions of the Behaviour Change Wheel (BCW). Analysis of previously defined factors influencing sharing were mapped onto the "Capability, Opportunity, Motivation - Behaviour" (COM-B) model of the BCW. COM-B analysis of the factors influencing sharing behaviour revealed: (i) 'Capability'-related factors, such as patient misconceptions about the safety of certain medicines, forgetting to refill or to carry around own medicines, and lack of knowledge about safe disposal of leftover/unused medicines; (ii) 'Opportunity'-related factors included lack of access to health facilities, lack of time to see a doctor, linguistic and cultural barriers, lack of information from healthcare providers about risks of sharing, and having leftover/unused medicines, and (iii) 'Motivation'-related factors included altruism, illness denial, embarrassment about seeing a doctor, not carrying around own medicines, habit, and fear of negative health consequences from missing a few doses of medicines. Five intervention functions of the BCW appear to be the most likely candidates for targeting the factors which relate to medicine sharing. These are education, persuasion, enablement, environmental restructuring and restriction. A variety of personal and external factors which influence sharing behaviours were identified, and the BCW provided a means by which theoretically underpinned interventions to reduce potential harms from this behaviour could be proposed. The findings can help with the design of approaches to reduce harm associated with non-recreational medicine sharing. Copyright © 2018 Elsevier Inc. All rights reserved.

Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours.

PubMed

Brady, Anne-Marie; Byrne, Gobnait; Quirke, Mary Brigid; Lynch, Aine; Ennis, Shauna; Bhangu, Jaspreet; Prendergast, Meabh

2017-11-01

This study aimed to evaluate the nature and type of communication and workflow arrangements between nurses and doctors out-of-hours (OOH). Effective communication and workflow arrangements between nurses and doctors are essential to minimize risk in hospital settings, particularly in the out-of-hour's period. Timely patient flow is a priority for all healthcare organizations and the quality of communication and workflow arrangements influences patient safety. Qualitative descriptive design and data collection methods included focus groups and individual interviews. A 500 bed tertiary referral acute hospital in Ireland. Junior and senior Non-Consultant Hospital Doctors, staff nurses and nurse managers. Both nurses and doctors acknowledged the importance of good interdisciplinary communication and collaborative working, in sustaining effective workflow and enabling a supportive working environment and patient safety. Indeed, issues of safety and missed care OOH were found to be primarily due to difficulties of communication and workflow. Medical workflow OOH is often dependent on cues and communication to/from nursing. However, communication systems and, in particular the bleep system, considered central to the process of communication between doctors and nurses OOH, can contribute to workflow challenges and increased staff stress. It was reported as commonplace for routine work, that should be completed during normal hours, to fall into OOH when resources were most limited, further compounding risk to patient safety. Enhancement of communication strategies between nurses and doctors has the potential to remove barriers to effective decision-making and patient flow. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Subarachnoid haemorrhage guidelines and clinical practice: a cross-sectional study of emergency department consultants' and neurospecialists' views and risk tolerances.

PubMed

Lansley, J; Selai, C; Krishnan, A S; Lobotesis, K; Jäger, H R

2016-09-15

To establish if emergency medicine and neuroscience specialist consultants have different risk tolerances for investigation of suspected spontaneous subarachnoid haemorrhage (SAH), and to establish if their risk-benefit appraisals concur with current guidelines. 4 major neuroscience centres in London. 58 consultants in emergency medicine and neuroscience specialities (neurology, neurosurgery and neuroradiology) participated in an anonymous survey. The primary outcome measure was the highest stated acceptable risk of missing SAH in the neurologically intact patient presenting with sudden onset headache. Secondary outcome measures included agreement with guideline recommendations, risk/benefit appraisal and required performance of diagnostic tests, including lumbar puncture. Emergency department clinicians accepted almost 3 times the risk of a missed SAH diagnosis compared with the neuroscience specialists (2.8% vs 1.1%; p=0.02), were more likely to accept a higher risk of missed diagnosis for the benefit of a non-invasive test (p=0.04) and were more likely to disagree with current published guidelines stipulating the need for LP in all CT-negative cases (p=0.001). Divergence from recognised procedures for SAH investigation is often criticised and attributed to a lack of knowledge of guidelines. This study indicates that divergence from guidelines may be explained by alternative risk-benefit appraisals made by doctors with their patients. Guideline recommendations may gain wider acceptance if they accommodate the requirements of the doctors and patients using them. Further study of clinical risk tolerance may help explain patterns of diagnostic test use and other variations in healthcare delivery. 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/

Differences between patient and physician opinions on adherence to medication for hypertension and diabetes mellitus.

PubMed

Liguori, Yuji; Murase, Katsuhito; Hamamura, Misako

2016-09-01

Non-adherence to prescribed medication presents a barrier to effective treatment. In order to find improved ways of tackling non-adherence, it is important to understand the perspective of both patients and physicians. A web-based survey study was performed to obtain the views and opinions of patients receiving medical treatment for hypertension or diabetes mellitus in Japan, and physicians treating such patients, on adherence to medication. Forty-four percent of both physicians and patients placed great importance on medication adherence, but 11% of patients considered it of low importance. Overall, 85% of patients reported taking their medication correctly. Patients missed a mean of 4.8 or 5.4 daily doses per 30 day prescription based on patient and physician estimates, respectively. Both patients (64%) and physicians (23%) considered the main reason patients forgot to take their medication was that they "inadvertently forgot". Only 1% of physicians said they do not specifically check for residual drugs, but 46% of patients said they do not report missed doses to their doctor. Measures taken by physicians to reduce residual drugs included use of single packs (64%) and reductions in administration frequency (55%); 63% adjusted prescriptions to take account of any remaining drugs. Only 4% of physicians were satisfied with the effectiveness of measures to reduce non-adherence, whereas 59% of patients felt they managed to successfully perform measures to avoid forgetting to take drugs. The study questionnaires were newly developed and did not incorporate validated instruments to assess adherence. Similar proportions of physicians and patients consider medication adherence to be important, but their opinions about measures used to improve adherence differ to some extent. Importantly, almost half of patients do not tell their doctor about missed doses.

Does exam-targeted training help village doctors pass the certified (assistant) physician exam and improve their practical skills? A cross-sectional analysis of village doctors' perspectives in Changzhou in Eastern China.

PubMed

Li, Xiaohong; Shen, Jay J; Yao, Fang; Jiang, Chunxin; Chang, Fengshui; Hao, Fengfeng; Lu, Jun

2018-05-11

Quality of health care needs to be improved in rural China. The Chinese government, based on the 1999 Law on Physicians, started implementing the Rural Doctor Practice Regulation in 2004 to increase the percentage of certified physicians among village doctors. Special exam-targeted training for rural doctors therefore was launched as a national initiative. This study examined these rural doctors' perceptions of whether that training helps them pass the exam and whether it improves their skills. Three counties were selected from the 4 counties in Changzhou City in eastern China, and 844 village doctors were surveyed by a questionnaire in July 2012. Chi-square test and Fisher exact test were used to identify differences of attitudes about the exam and training between the rural doctors and certified (assistant) doctors. Longitudinal annual statistics (1980-2014) of village doctors were further analyzed. Eight hundred and forty-four village doctors were asked to participate, and 837 (99.17%) responded. Only 14.93% of the respondents had received physician (assistant) certification. Only 49.45% of the village doctors thought that the areas tested by the certification exam were closely related to the healthcare needs of rural populations. The majority (86.19%) felt that the training program was "very helpful" or "helpful" for preparing for the exam. More than half the village doctors (61.46%) attended the "weekly school". The village doctors considered the most effective method of learning was "continuous training (40.36%)" . The majority of the rural doctors (89.91%) said they would be willing to participate in the training and 96.87% stated that they could afford to pay up to 2000 yuan for it. The majority of village doctors in Changzhou City perceived that neither the certification exam nor the training for it are closely related to the actual healthcare needs of rural residents. Policies and programs should focus on providing exam-preparation training for selected rural doctors, reducing training expenditures, and utilizing web-based methods. The training focused on rural practice should be provided to all village doctors, even certified physicians. The government should also adjust the local licensing requirements to attract and recruit new village doctors.

Variables associated with seeking information from doctors and the internet after exposure to direct-to-consumer advertisements for prescription medications.

PubMed

Fogel, Joshua; Teichman, Chaim

2014-01-01

This study examines variables associated with seeking information from doctors, the Internet, and a combination of both doctors and Internet after exposure to direct-to-consumer advertisements. Data were analyzed from 462 college students. Younger age, women, and health insurance were associated with greater odds for doctor; women, subjective norms, intentions, and greater time since seen doctor were associated with greater odds for Internet; and African American, Hispanic, subjective norms, intentions, and health insurance were associated with greater odds for both doctor and Internet. Marketers of direct-to-consumer advertisements can use these findings for tailoring and targeting direct-to-consumer advertisements.

The Effects of Target and Missile Characteristics on Theoretical Minimum Miss Distance for a Beam-Rider Guidance System in the Presence of Noise

NASA Technical Reports Server (NTRS)

Stewart, Elwood C.; Druding, Frank; Nishiura, Togo

1959-01-01

A study has been made to determine the relative importance of those factors which place an inherent limitation on the minimum obtainable miss distance for a beam-rider navigation system operating in the presence of glint noise and target evasive maneuver. Target and missile motions are assumed to be coplanar. The factors considered are the missile natural frequencies and damping ratios, missile steady-state acceleration capabilities, target evasive maneuver characteristics, and angular scintillation noise characteristics.

A National Model for Diabetes Prevention and Treatment Program in Civilian and Military Beneficiary Populations (FY07)

DTIC Science & Technology

2013-09-24

examination was performed by one of the investigators (medical doctors) or certified nurse practitioners. Prior to initiating the intervention...3 days before their scheduled appointment. If a patient did not show or cancelled their appointment without rescheduling , the study team...additionally tried to reach them by phone to identify the reason for missing an appointment and to attempt to reschedule another appointment. It was

Post traumatic stress disorder following an electric shock.

PubMed

Premalatha, G D

1994-09-01

Post Traumatic Stress Disorder (PTSD) is still a diagnosis which is frequently missed even by psychiatric professionals. Each doctor needs to maintain a high level of awareness that patients may have experienced trauma; that PTSD can often occur for a variety of common symptoms; and that it may also be at the root of a persisting treatment-resistant depressive or anxiety state. This case demonstrates that occupational accidents may result in this condition.

Slp-76 is a critical determinant of NK-cell mediated recognition of missing-self targets.

PubMed

Lampe, Kristin; Endale, Mehari; Cashman, Siobhan; Fang, Hao; Mattner, Jochen; Hildeman, David; Hoebe, Kasper

2015-07-01

Absence of MHC class I expression is an important mechanism by which NK cells recognize a variety of target cells, yet the pathways underlying "missing-self" recognition, including the involvement of activating receptors, remain poorly understood. Using ethyl-N-nitrosourea mutagenesis in mice, we identified a germline mutant, designated Ace, with a marked defect in NK cell mediated recognition and elimination of "missing-self" targets. The causative mutation was linked to chromosome 11 and identified as a missense mutation (Thr428Ile) in the SH2 domain of Slp-76-a critical adapter molecule downstream of ITAM-containing surface receptors. The Slp-76 Ace mutation behaved as a hypomorphic allele-while no major defects were observed in conventional T-cell development/function, a marked defect in NK cell mediated elimination of β2-microglobulin (β2M) deficient target cells was observed. Further studies revealed Slp-76 to control NK-cell receptor expression and maturation; however, activation of Slp-76(ace/ace) NK cells through ITAM-containing NK-cell receptors or allogeneic/tumor target cells appeared largely unaffected. Imagestream analysis of the NK-β2M(-/-) target cell synapse revealed a specific defect in actin recruitment to the conjugate synapse in Slp-76(ace/ace) NK cells. Overall these studies establish Slp-76 as a critical determinant of NK-cell development and NK cell mediated elimination of missing-self target cells in mice. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Slp-76 is a critical determinant of NK cell-mediated recognition of missing-self targets

PubMed Central

Lampe, Kristin; Endale, Mehari; Cashman, Siobhan; Fang, Hao; Mattner, Jochen; Hildeman, David; Hoebe, Kasper

2015-01-01

Absence of MHC class I expression is an important mechanism by which NK cells recognize a variety of target cells, yet the pathways underlying “missing-self” recognition, including the involvement of activating receptors, remain poorly understood. Using ENU mutagenesis in mice, we identified a germline mutant, designated Ace, with a marked defect in NK cell-mediated recognition and elimination of “missing-self” targets. The causative mutation was linked to chromosome 11 and identified as a missense mutation [Thr428Ile] in the SH2 domain of Slp-76—a critical adapter molecule downstream of ITAM-containing surface receptors. The Slp-76 Ace mutation behaved as a hypomorphic allele—while no major defects were observed in conventional T cell development/function, a marked defect in NK cell-mediated elimination of β2-Microglobulin (β2M)-deficient target cells was observed. Further studies revealed Slp-76 to control NK cell receptor expression and maturation, however, activation of Slp-76ace/ace NK cells through ITAM-containing NK cell receptors or allogeneic/tumor target cells appeared largely unaffected. Imagestream analysis of the NK-β2M−/− target cell synapse, revealed a specific defect in actin recruitment to the conjugate synapse in Slp-76ace/ace NK cells. Overall these studies establish Slp-76 as a critical determinant of NK cell development and NK cell-mediated elimination of missing-self target cells. PMID:25929249

Need for and use of family leave among parents of children with special health care needs.

PubMed

Chung, Paul J; Garfield, Craig F; Elliott, Marc N; Carey, Colleen; Eriksson, Carl; Schuster, Mark A

2007-05-01

Parents of children with special health care needs are especially vulnerable to work-family conflicts that family leave benefits might help resolve. We examined leave-taking among full-time-employed parents of children with special health care needs. We identified all children with special health care needs in 2 large inpatient/outpatient systems in Chicago, Illinois, and Los Angeles, California, and randomly selected 800 per site. From November 2003 to January 2004, we conducted telephone interviews with 1105 (87% of eligible and successfully contacted) parents. Among the sample's 574 full-time-employed parents, we examined whether leave benefits predicted missing any work for child illness, missing >4 weeks for child illness, and ability to miss work whenever their child needed them. Forty-eight percent of full-time-employed parents qualified for federal Family and Medical Leave Act benefits; 30% reported employer-provided leave benefits (not including sick leave/vacation). In the previous year, their children averaged 20 missed school/child care days, 12 doctor/emergency department visits, and 1.7 hospitalizations. Although 81% of parents missed work for child illness, 41% reported not always missing work when their child needed them, and 40% of leave-takers reported returning to work too soon. In multivariate regressions, parents who were eligible for Family and Medical Leave Act benefits and aware of their eligibility had 3.0 times greater odds of missing work for child illness than ineligible parents. Parents with >4 weeks of employer-provided leave benefits had 4.7 times greater odds of missing >4 weeks than parents without benefits. Parents with paid leave benefits had 2.8 times greater odds than other parents of missing work whenever their child needed them. Full-time-employed parents of children with special health care needs experience severe work-family conflicts. Although most have leave benefits, many report unmet need for leave. Access to Family and Medical Leave Act benefits and employer-provided leave may greatly affect leave-taking.

Reasons for the Slow Completion of Masters and Doctoral Degrees by Adult Learners in a South African Township

ERIC Educational Resources Information Center

Motseke, Masilonyana

2016-01-01

The aim of the study was to investigate the reasons why adult learners took longer than required to complete their Master's and Doctoral degrees. A questionnaire and focus group interviews were used to collect data. Twenty adult learners who registered for the Master's and Doctoral degrees at one township campus of a university were targeted, and…

Testing and screening for chlamydia in general practice: a cross-sectional analysis.

PubMed

Thomson, Allison; Morgan, Simon; Henderson, Kim; Tapley, Amanda; Spike, Neil; Scott, John; van Driel, Mieke; Magin, Parker

2014-12-01

Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening. A cross-sectional analysis of data from Registrars Clinical Encounters in Training (ReCEnT), a cohort study of registrars' consultations. Registrars record details of 60 consecutive consultations in each GP-term of training. Outcome factors were chlamydia testing, asymptomatic screening and doctor-initiated screening. Testing occurred in 2.5% of 29,112 consultations (398 registrars) and in 5.8% of patients aged 15-25. Asymptomatic screening comprised 47.5% of chlamydia tests, and 55.6% of screening tests were doctor-initiated. Chlamydia testing was associated with female gender of doctor and patient, younger patient age, and patients new to doctor or practice. Asymptomatic screening was associated with practices where patients incur no fees, and in patients new to doctor or practice. Screening of female patients was more often doctor-initiated. GP registrars screen for chlamydia disproportionately in younger females and new patients. Our findings highlight potential opportunities to improve uptake of screening for chlamydia, including targeted education and training for registrars, campaigns targeting male patients, and addressing financial barriers to accessing screening services. © 2014 Public Health Association of Australia.

The Risks of Missing the 2°C Target and the Risks of Framing the Target As 2°C

NASA Astrophysics Data System (ADS)

Nichols, L. H.

2014-12-01

The publication of IPCC AR5 has made it very clear that we are at risk of missing the 2°C target. It has also made it clear that the risks of missing this target would be very dire. But when read through a precautionary lens, it also illustrates potential risks of framing an appropriate climate target as 2°C. We ought to be doing all we can to limit the extent of climate change as much as possible, and framing our target as limiting warming to 2°C may mask the demandingness and urgency of addressing climate change aggressively and holistically. In this session I will summarize my work on what precaution demands in the face of climate change and discuss how it applies to AR5. I argue for a Catastrophic Precautionary Principle that gives us strong moral reasons to take precautionary measures against threats of catastrophe, such as those posed by climate change. I will explain how the IPCC's discussion of the five reasons for concern about climate change support a strong moral argument that we ought to be taking a much more precautionary approach to climate policy than is currently evidenced by UNFCCC agreements and domestic policies around the world. While AR5 supports the conclusion that we should not risk missing the 2°C target, it also supports reevaluating what our target - and more generally what our comprehensive approach to climate policy - should be. In this way, I will discuss the complex science-ethics-policy nexus and the role of climate science in guiding precautionary global climate policies.

Precision targeting in guided munition using IR sensor and MmW radar

NASA Astrophysics Data System (ADS)

Sreeja, S.; Hablani, H. B.; Arya, H.

2015-10-01

Conventional munitions are not guided with sensors and therefore miss the target, particularly if the target is mobile. The miss distance of these munitions can be decreased by incorporating sensors to detect the target and guide the munition during flight. This paper is concerned with a Precision Guided Munition(PGM) equipped with an infrared sensor and a millimeter wave radar [IR and MmW, for short]. Three-dimensional flight of the munition and its pitch and yaw motion models are developed and simulated. The forward and lateral motion of a target tank on the ground is modeled as two independent second-order Gauss-Markov process. To estimate the target location on the ground and the line-of-sight rate to intercept it an Extended Kalman Filter is composed whose state vector consists of cascaded state vectors of missile dynamics and target dynamics. The line-of-sight angle measurement from the infrared seeker is by centroiding the target image in 40 Hz. The centroid estimation of the images in the focal plane is at a frequency of 10 Hz. Every 10 Hz, centroids of four consecutive images are averaged, yielding a time-averaged centroid, implying some measurement delay. The miss distance achieved by including by image processing delays is 1:45m.

Precision targeting in guided munition using infrared sensor and millimeter wave radar

NASA Astrophysics Data System (ADS)

Sulochana, Sreeja; Hablani, Hari B.; Arya, Hemendra

2016-07-01

Conventional munitions are not guided with sensors and therefore miss the target, particularly if the target is mobile. The miss distance of these munitions can be decreased by incorporating sensors to detect the target and guide the munition during flight. This paper is concerned with a precision guided munition equipped with an infrared (IR) sensor and a millimeter wave radar (MmW). Three-dimensional flight of the munition and its pitch and yaw motion models are developed and simulated. The forward and lateral motion of a target tank on the ground is modeled as two independent second-order Gauss-Markov processes. To estimate the target location on the ground and the line-of-sight (LOS) rate to intercept it, an extended Kalman filter is composed whose state vector consists of cascaded state vectors of missile dynamics and target dynamics. The LOS angle measurement from the IR seeker is by centroiding the target image in 40 Hz. The centroid estimation of the images in the focal plane is at a frequency of 10 Hz. Every 10 Hz, centroids of four consecutive images are averaged, yielding a time-averaged centroid, implying some measurement delay. The miss distance achieved by including image processing delays is 1.45 m.

Unbiased clustering estimation in the presence of missing observations

NASA Astrophysics Data System (ADS)

Bianchi, Davide; Percival, Will J.

2017-11-01

In order to be efficient, spectroscopic galaxy redshift surveys do not obtain redshifts for all galaxies in the population targeted. The missing galaxies are often clustered, commonly leading to a lower proportion of successful observations in dense regions. One example is the close-pair issue for SDSS spectroscopic galaxy surveys, which have a deficit of pairs of observed galaxies with angular separation closer than the hardware limit on placing neighbouring fibres. Spatially clustered missing observations will exist in the next generations of surveys. Various schemes have previously been suggested to mitigate these effects, but none works for all situations. We argue that the solution is to link the missing galaxies to those observed with statistically equivalent clustering properties, and that the best way to do this is to rerun the targeting algorithm, varying the angular position of the observations. Provided that every pair has a non-zero probability of being observed in one realization of the algorithm, then a pair-upweighting scheme linking targets to successful observations, can correct these issues. We present such a scheme, and demonstrate its validity using realizations of an idealized simple survey strategy.

[Civil, criminal and ethical liability of medical doctors].

PubMed

Udelsmann, Artur

2002-01-01

In the last years doctors have been the target of a growing number of civil, criminal law suits, as well as ethical procedures. Medicine is a widely targeted career, not only owing to its inherent risks, but also owing to a mistaken approach of the Judiciary Power about the obligations of medical doctors. Decisions of the Medical Board in ethical procedures have an impact in civil and criminal justice and therefore should be followed closely. The purpose of this review is to provide a wide view from a doctor-lawyer perspective of cases involving civil, criminal liability of anesthesiologists as well as ethical procedures against them, in an effort to make them comprehensible to doctors. After a brief historical introduction civil liability foundations and legal articles are examined. Responsibilities of doctors, hospitals and health insurance providers are discussed separately, as well as reparation mechanisms. Crimes possible to occur during medical practice and respective penalties are described; the direct relationship between crime and civil reparation is demonstrated. The administrative nature of ethical procedure is described, emphasizing that the legal character of its penalties often serve as grounds for civil and criminal justice decisions. Prevention is still the best medicine. Good medical practice and a good medical-patient relationship are still the best ways to minimize lawsuits and their repercussions. Doctors should have some knowledge of juridical mechanisms in lawsuits and ethical procedures, but should not take defense initiatives without prior consultation of an attorney. Civil, criminal and ethical liability of physicians.

The role of non-verbal behaviour in racial disparities in health care: implications and solutions.

PubMed

Levine, Cynthia S; Ambady, Nalini

2013-09-01

People from racial minority backgrounds report less trust in their doctors and have poorer health outcomes. Although these deficiencies have multiple roots, one important set of explanations involves racial bias, which may be non-conscious, on the part of providers, and minority patients' fears that they will be treated in a biased way. Here, we focus on one mechanism by which this bias may be communicated and reinforced: namely, non-verbal behaviour in the doctor-patient interaction. We review 2 lines of research on race and non-verbal behaviour: (i) the ways in which a patient's race can influence a doctor's non-verbal behaviour toward the patient, and (ii) the relative difficulty that doctors can have in accurately understanding the nonverbal communication of non-White patients. Further, we review research on the implications that both lines of work can have for the doctor-patient relationship and the patient's health. The research we review suggests that White doctors interacting with minority group patients are likely to behave and respond in ways that are associated with worse health outcomes. As doctors' disengaged non-verbal behaviour towards minority group patients and lower ability to read minority group patients' non-verbal behaviours may contribute to racial disparities in patients' satisfaction and health outcomes, solutions that target non-verbal behaviour may be effective. A number of strategies for such targeting are discussed. © 2013 John Wiley & Sons Ltd.

Learning needs in clinical biochemistry for doctors in foundation years.

PubMed

Khromova, Victoria; Gray, Trevor A

2008-01-01

Most medical school curricula have reduced the amount of time available for teaching in pathology despite the fact that junior staff in the early stages of their training were responsible for requesting the majority of pathology tests on acutely ill hospital patients. So, the lack of specific training in this area means that test requesting may be poorly performed and the results ill understood by these staff. This paper describes a questionnaire, which was designed to assist laboratory staff providing targeted teaching in this area. Doctors in Foundation year 1 (F1) and Foundation year 2 (F2) in Sheffield teaching hospitals were given a questionnaire to ascertain how confident they were in requesting and interpreting the results of clinical biochemistry tests. The doctors were also asked about which areas of laboratory medicine they would like to be taught. Responses were received from 82 doctors, about half those in F1 and F2. The survey revealed areas where juniors are less confident in requesting tests and interpreting results. Despite lack of confidence in interpreting the result, 18% were confident about requesting tests. Doctors were also unsure of the effects of common problems like haemolysis on the interpretation of results. More than 70% of the doctors requested specific teaching in these areas. Foundation doctors have learning needs in clinical biochemistry, addressing which would assist them in patient care. While better training in medical school may help in future, there are specific needs for those on the wards now that require targeted teaching.

[Adherence of type 2 diabetes patients on insulin analogues application: missed dose, time imprecision and dose reduction. The results of GAPP2TM(Global Attitudes of Physicians and Patient) survey in the Czech Republic].

PubMed

Prázný, Martin

2014-11-01

Irregular insulin dose is one of the main problems associated with insulin therapy in patients with type 2 diabetes; its extent is not known precisely. The aim of survey conducted in the Czech Republic in the international project GAPP2 - Global Attitudes of Patients and Physicians was to determine the incidence and the impact of irregular use of basal insulin analogues in patients with type 2 diabetes, to point out the reasons for these irregularities and to focus on how physicians discuss irregular application of insulin with patients. The project GAPP2 is an international cross-sectional study performed on-line via the Internet using a questionnaire filled by diabetic patients treated with insulin analogues and physicians who treat these patients. The survey was conducted in two steps in 17 countries; the first step included 6 countries and was completed in the beginning of 2012, the second step involved 11 other countries including the Czech Republic with termination in 2014. The survey was designed to obtain the views of patients and physicians on certain aspects of insulin treatment and persistent issues in this field in the real daily practice. Special focus was on the incidence and management of hypoglycaemia as well as on irregularities of insulin application. In the part dedicated to adherence to basal insulin application were observed three types of irregular insulin therapy: missed dose, time imprecision of dose (± 2 hours vs. the prescribed time) and dose reduction in all cases in the past 30 days before completing the questionnaire. In addition, it was investigated the attitude and relation of patients to these issues. The results have shown that irregular insulin dose in the Czech Republic is less frequent than in other countries involved in the GAPP2 research. Nevertheless, approximately one fifth of diabetic patients using insulin analogues in basal-bolus or only basal therapy regimen is related to this problem. The last irregular insulin application was due to missed dose in 13% of cases, time imprecision in 23% and reduction of dose in 61% of cases. The most commonly reported reason was risk reduction of hypoglycaemia and the recommendations of health professionals. Fear of missed dose is present in 40% Czech patients and 35% would feel guilty if their insulin dose is missed (up to 47% in patients with intensified insulin regimen). Only 60% patients are aware of negative impact on their long-term health after missed dose of basal insulin. Questioned doctors have suspected that the patients report lower number of missed doses during regular medical check because one third of patients doesn´t admit missed dose. However, this fact conceded only 11% of patients on basal insulin and 15% of patients on intensified insulin therapy. Quarter of prescribing doctors admit that they usually don´t discuss with patients irregularities in basal insulin treatment. Although, type 2 diabetes patients in the Czech Republic follow prescribed basal insulin therapy scheme more often than patients in other countries participating in the survey GAPP2 , missed dose, time imprecision and reduction of dose is quite common and it deserves more attention from medical side during regular medical check together with appropriate education of patients.

GenomewidePDB 2.0: A Newly Upgraded Versatile Proteogenomic Database for the Chromosome-Centric Human Proteome Project.

PubMed

Jeong, Seul-Ki; Hancock, William S; Paik, Young-Ki

2015-09-04

Since the launch of the Chromosome-centric Human Proteome Project (C-HPP) in 2012, the number of "missing" proteins has fallen to 2932, down from ∼5932 since the number was first counted in 2011. We compared the characteristics of missing proteins with those of already annotated proteins with respect to transcriptional expression pattern and the time periods in which newly identified proteins were annotated. We learned that missing proteins commonly exhibit lower levels of transcriptional expression and less tissue-specific expression compared with already annotated proteins. This makes it more difficult to identify missing proteins as time goes on. One of the C-HPP goals is to identify alternative spliced product of proteins (ASPs), which are usually difficult to find by shot-gun proteomic methods due to their sequence similarities with the representative proteins. To resolve this problem, it may be necessary to use a targeted proteomics approach (e.g., selected and multiple reaction monitoring [S/MRM] assays) and an innovative bioinformatics platform that enables the selection of target peptides for rarely expressed missing proteins or ASPs. Given that the success of efforts to identify missing proteins may rely on more informative public databases, it was necessary to upgrade the available integrative databases. To this end, we attempted to improve the features and utility of GenomewidePDB by integrating transcriptomic information (e.g., alternatively spliced transcripts), annotated peptide information, and an advanced search interface that can find proteins of interest when applying a targeted proteomics strategy. This upgraded version of the database, GenomewidePDB 2.0, may not only expedite identification of the remaining missing proteins but also enhance the exchange of information among the proteome community. GenomewidePDB 2.0 is available publicly at http://genomewidepdb.proteomix.org/.

How to succeed as a junior doctor.

PubMed

Azad, Michael

2016-10-01

The Royal College of Physicians (RCP) organised an inaugural 1-day conference, the aim of which was to look into some of the key issues that junior doctors need to address when beginning their careers. The target audience was medical students but a few foundation doctors were also in attendance. The conference also helped to increase RCP engagement with medical students and foundation doctors. The day was co-chaired by Professor Kate Thomas (vice dean, University of Birmingham) and Dr Andrew Macleod and Dr Kanwaljit Sandhu (RCP regional advisors for the West Midlands). © Royal College of Physicians 2016. All rights reserved.

Napoleon’s Missed Opportunities to Maintain Combat Forces through Medical Innovations and Battling the Hidden Enemy

DTIC Science & Technology

2011-12-07

death due to combat injuries. Many of the doctors to include Larrey relied on the miasma theory to explain the fevers that afflicted the troops. Fever ...mindset came during his early years when he came down with a serious fever but survived with no after effects. Another instance was when Napoleon...through the pain, headaches, and intermittent fever .28 Furthermore, Napoleon thought that those who died of disease were not good enough, not

[Surrogacy, yes or no? Case report].

PubMed

Pektorová, M; Ventruba, P

2015-08-01

Case study of surrogacy which did not come up to client-couple´s expectation. Case report. Department of Gynaecology and Obstetrics, Uherske Hradiste Hospital a. s., Uherske Hradiste. Description of the case, case study. In the Czech Republic, missing legislation when subject matter is surrogacy does not allow to make a complex legal contract. This fact causes legal uncertainty to all participants. Irresponsible approach of doctors, surrogate mother, client-couple, and in the upshot care of disabled child at government expense can be results.

Lonely Skies: Air-to-Air Training for a 5th Generation Fighter Force

DTIC Science & Technology

2015-06-01

Missing Attitude Indicator….…………………14 4 Lt James Doolittle during Blind Flight Test…..……………………...15 5 An Early Link Trainer Cockpit...during visual flight because it deceived pilots about the actual aircraft attitude and acceleration. 1st Lt James Doolittle used Doctor David Meyers...flying pioneer and leader, Doolittle believed that pilots should learn to ignore their physical sense of motion while flying blind and to trust their

Student and faculty perceptions of lecture recording in a doctor of pharmacy curriculum.

PubMed

Maynor, Lena M; Barrickman, Ashleigh Landis; Stamatakis, Mary K; Elliott, David P

2013-10-14

To describe students' and faculty members' perceptions of the impact of lecture recording in a doctor of pharmacy (PharmD) curriculum. Second- and third-year pharmacy students and faculty members completed an anonymous survey instrument regarding their perceptions of lecture recording with 2 classroom lecture capture software programs, Camtasia Studio and Wimba Classroom. Most students (82%) responded that Camtasia was very helpful and almost half (49%) responded that Wimba Classroom was helpful (p<0.001). Forty-six percent of the students reported being more likely to miss a class that was recorded; however, few students (10%) reported using recordings as a substitute for attending class. The most common concern of faculty members was decreased student attendance (27%). Pharmacy students consider lecture recordings beneficial, and they use the recordings primarily to review the lecture. While faculty members reported concerns with decreased attendance, few students reported using recordings as an alternative to class attendance.

Predicting appointment misses in hospitals using data analytics

PubMed Central

Karpagam, Sylvia; Ma, Nang Laik

2017-01-01

Background There is growing attention over the last few years about non-attendance in hospitals and its clinical and economic consequences. There have been several studies documenting the various aspects of non-attendance in hospitals. Project Predicting Appoint Misses (PAM) was started with the intention of being able to predict the type of patients that would not come for appointments after making bookings. Methods Historic hospital appointment data merged with “distance from hospital” variable was used to run Logistic Regression, Support Vector Machine and Recursive Partitioning to decide the contributing variables to missed appointments. Results Variables that are “class”, “time”, “demographics” related have an effect on the target variable, however, prediction models may not perform effectively due to very subtle influence on the target variable. Previously assumed major contributors like “age”, “distance” did not have a major effect on the target variable. Conclusions With the given data it will be very difficult to make any moderate/strong prediction of the Appointment misses. That being said with the help of the cut off we are able to capture all of the “appointment misses” in addition to also capturing the actualized appointments. PMID:28567409

Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia

PubMed Central

Bismark, Marie M; Spittal, Matthew J; Gurrin, Lyle C; Ward, Michael; Studdert, David M

2013-01-01

Objectives (1) To determine the distribution of formal patient complaints across Australia's medical workforce and (2) to identify characteristics of doctors at high risk of incurring recurrent complaints. Methods We assembled a national sample of all 18 907 formal patient complaints filed against doctors with health service ombudsmen (‘Commissions’) in Australia over an 11-year period. We analysed the distribution of complaints among practicing doctors. We then used recurrent-event survival analysis to identify characteristics of doctors at high risk of recurrent complaints, and to estimate each individual doctor's risk of incurring future complaints. Results The distribution of complaints among doctors was highly skewed: 3% of Australia's medical workforce accounted for 49% of complaints and 1% accounted for a quarter of complaints. Short-term risks of recurrence varied significantly among doctors: there was a strong dose-response relationship with number of previous complaints and significant differences by doctor specialty and sex. At the practitioner level, risks varied widely, from doctors with <10% risk of further complaints within 2 years to doctors with >80% risk. Conclusions A small group of doctors accounts for half of all patient complaints lodged with Australian Commissions. It is feasible to predict which doctors are at high risk of incurring more complaints in the near future. Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems. PMID:23576774

Multi-Target Tracking Using an Improved Gaussian Mixture CPHD Filter.

PubMed

Si, Weijian; Wang, Liwei; Qu, Zhiyu

2016-11-23

The cardinalized probability hypothesis density (CPHD) filter is an alternative approximation to the full multi-target Bayesian filter for tracking multiple targets. However, although the joint propagation of the posterior intensity and cardinality distribution in its recursion allows more reliable estimates of the target number than the PHD filter, the CPHD filter suffers from the spooky effect where there exists arbitrary PHD mass shifting in the presence of missed detections. To address this issue in the Gaussian mixture (GM) implementation of the CPHD filter, this paper presents an improved GM-CPHD filter, which incorporates a weight redistribution scheme into the filtering process to modify the updated weights of the Gaussian components when missed detections occur. In addition, an efficient gating strategy that can adaptively adjust the gate sizes according to the number of missed detections of each Gaussian component is also presented to further improve the computational efficiency of the proposed filter. Simulation results demonstrate that the proposed method offers favorable performance in terms of both estimation accuracy and robustness to clutter and detection uncertainty over the existing methods.

Missing Modality Transfer Learning via Latent Low-Rank Constraint.

PubMed

Ding, Zhengming; Shao, Ming; Fu, Yun

2015-11-01

Transfer learning is usually exploited to leverage previously well-learned source domain for evaluating the unknown target domain; however, it may fail if no target data are available in the training stage. This problem arises when the data are multi-modal. For example, the target domain is in one modality, while the source domain is in another. To overcome this, we first borrow an auxiliary database with complete modalities, then consider knowledge transfer across databases and across modalities within databases simultaneously in a unified framework. The contributions are threefold: 1) a latent factor is introduced to uncover the underlying structure of the missing modality from the known data; 2) transfer learning in two directions allows the data alignment between both modalities and databases, giving rise to a very promising recovery; and 3) an efficient solution with theoretical guarantees to the proposed latent low-rank transfer learning algorithm. Comprehensive experiments on multi-modal knowledge transfer with missing target modality verify that our method can successfully inherit knowledge from both auxiliary database and source modality, and therefore significantly improve the recognition performance even when test modality is inaccessible in the training stage.

The Impact of the Nursing Practice Environment on Missed Nursing Care.

PubMed

Hessels, Amanda J; Flynn, Linda; Cimiotti, Jeannie P; Cadmus, Edna; Gershon, Robyn R M

2015-12-01

Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. Nurses missed delivering a significant amount of necessary patient care (10-27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care.

Under conditions of large geometric miss, tumor control probability can be higher for static gantry intensity-modulated radiation therapy compared to volume-modulated arc therapy for prostate cancer.

PubMed

Balderson, Michael; Brown, Derek; Johnson, Patricia; Kirkby, Charles

2016-01-01

The purpose of this work was to compare static gantry intensity-modulated radiation therapy (IMRT) with volume-modulated arc therapy (VMAT) in terms of tumor control probability (TCP) under scenarios involving large geometric misses, i.e., those beyond what are accounted for when margin expansion is determined. Using a planning approach typical for these treatments, a linear-quadratic-based model for TCP was used to compare mean TCP values for a population of patients who experiences a geometric miss (i.e., systematic and random shifts of the clinical target volume within the planning target dose distribution). A Monte Carlo approach was used to account for the different biological sensitivities of a population of patients. Interestingly, for errors consisting of coplanar systematic target volume offsets and three-dimensional random offsets, static gantry IMRT appears to offer an advantage over VMAT in that larger shift errors are tolerated for the same mean TCP. For example, under the conditions simulated, erroneous systematic shifts of 15mm directly between or directly into static gantry IMRT fields result in mean TCP values between 96% and 98%, whereas the same errors on VMAT plans result in mean TCP values between 45% and 74%. Random geometric shifts of the target volume were characterized using normal distributions in each Cartesian dimension. When the standard deviations were doubled from those values assumed in the derivation of the treatment margins, our model showed a 7% drop in mean TCP for the static gantry IMRT plans but a 20% drop in TCP for the VMAT plans. Although adding a margin for error to a clinical target volume is perhaps the best approach to account for expected geometric misses, this work suggests that static gantry IMRT may offer a treatment that is more tolerant to geometric miss errors than VMAT. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Design and implementation of a near-miss reporting system at a large, academic pediatric anesthesia department.

PubMed

Guffey, Patrick; Szolnoki, Judit; Caldwell, James; Polaner, David

2011-07-01

Current incident reporting systems encourage retrospective reporting of morbidity and mortality and have low participation rates. A near miss is an event that did not cause patient harm, but had the potential to. By tracking and analyzing near misses, systems improvements can be targeted appropriately, and future errors may be prevented. An electronic, web based, secure, anonymous reporting system for anesthesiologists was designed and instituted at The Children's Hospital, Denver. This portal was compared to an existing hospital incident reporting system. A total of 150 incidents were reported in the first 3 months of operation, compared to four entered in the same time period 1 year ago. An anesthesia-specific anonymous near-miss reporting system, which eases and facilitates data entry and can prospectively identify processes and practices that place patients at risk, was implemented at a large, academic, freestanding children's hospital. This resulted in a dramatic increase in reported events and provided data to target and drive quality and process improvement. © 2011 Blackwell Publishing Ltd.

Dual practice by doctors working in South and East Asia: a review of its origins, scope and impact, and the options for regulation.

PubMed

Hipgrave, David Barry; Hort, Krishna

2014-09-01

Health professionals often undertake private work whilst also employed by government. Such dual practice (DP) is found in both high-income and lower- and middle-income countries (LMIC) around the world, with varying degrees of tolerance. This review focuses on DP in South and East Asia in the context of the rapidly expanding mixed health systems in this region. Although good data are lacking, health service uptake in South and East Asia is increasing, particularly in the private sector. Appropriately regulated, DP can improve health service access, the range of services offered and doctors' satisfaction. By contrast, weakly regulated DP can negatively affect public health service access, quality, efficiency and equity, as doctors often pursue the balance of public and private work that maximizes their income and other benefits. The environment for regulation of DP is changing rapidly, with improved communications opportunities, increasing literacy and rising civil society, particularly in this region. Currently, the options for regulating DP include (1) those which restrict the opportunities for dual practitioners to prioritize income and other benefits over their responsibility to the public; these require a level of regulatory capacity often missing in LMIC governments; and (2) those which not only tolerate public-sector doctors' private work but also encourage adequate health services for the general public. Growth of the private sector and weak regulation in South and East Asia increases the risk that dual practitioners will ignore the poor. Responsive and decentred regulation of doctors involving professional associations, civil society and other stakeholders is increasingly recommended. Moreover, as governments in LMIC strive for universal health coverage, market and financing opportunities for regulation of DP may arise, particularly involving insurers. This may also help to improve the current imbalance in the urban-rural distribution of doctors. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

"What do you know?"--knowledge among village doctors of lead poisoning in children in rural China.

PubMed

Huang, Ruixue; Ning, Huacheng; Baum, Carl R; Chen, Lei; Hsiao, Allen

2017-11-23

This study evaluates the extent of village doctors' knowledge of lead poisoning in children in rural China and assesses the characteristics associated with possessing accurate knowledge. A cross-sectional, questionnaire-based survey of 297 village doctors in Fenghuang County, Hunan Province, China was conducted. All village doctors were interviewed face-to-face using a "What do you know" test questionnaire focusing on prevention strategies and lead sources in rural children. A total of 287 (96.6%) village doctors completed the survey in full. Most village doctors had an appropriate degree of general knowledge of lead poisoning; however, they had relatively poor knowledge of lead sources and prevention measures. Village doctors with an undergraduate level education scored an average of 2.7 points higher than those who had a junior college level education (p = 0.033). Village doctors with an annual income ≤ 10,000 RMB yuan scored 1.03 points lower than those whose income was >10,001 RMB yuan. Ethnic Han village doctors scored 1.12 points higher, on average, than ethnic Tujia village doctors (p = 0.027). This study identified important gaps in knowledge concerning lead poisoning in children among a rural population of village doctors. There is a clear need for multifaceted interventions that target village doctors to improve their knowledge regarding lead poisoning in children. The "What do you know" questionnaire is a new tool to evaluate lead poisoning knowledge and education projects.

Predicting drug-target interaction for new drugs using enhanced similarity measures and super-target clustering.

PubMed

Shi, Jian-Yu; Yiu, Siu-Ming; Li, Yiming; Leung, Henry C M; Chin, Francis Y L

2015-07-15

Predicting drug-target interaction using computational approaches is an important step in drug discovery and repositioning. To predict whether there will be an interaction between a drug and a target, most existing methods identify similar drugs and targets in the database. The prediction is then made based on the known interactions of these drugs and targets. This idea is promising. However, there are two shortcomings that have not yet been addressed appropriately. Firstly, most of the methods only use 2D chemical structures and protein sequences to measure the similarity of drugs and targets respectively. However, this information may not fully capture the characteristics determining whether a drug will interact with a target. Secondly, there are very few known interactions, i.e. many interactions are "missing" in the database. Existing approaches are biased towards known interactions and have no good solutions to handle possibly missing interactions which affect the accuracy of the prediction. In this paper, we enhance the similarity measures to include non-structural (and non-sequence-based) information and introduce the concept of a "super-target" to handle the problem of possibly missing interactions. Based on evaluations on real data, we show that our similarity measure is better than the existing measures and our approach is able to achieve higher accuracy than the two best existing algorithms, WNN-GIP and KBMF2K. Our approach is available at http://web.hku.hk/∼liym1018/projects/drug/drug.html or http://www.bmlnwpu.org/us/tools/PredictingDTI_S2/METHODS.html. Copyright © 2015 Elsevier Inc. All rights reserved.

A regressive methodology for estimating missing data in rainfall daily time series

NASA Astrophysics Data System (ADS)

Barca, E.; Passarella, G.

2009-04-01

The "presence" of gaps in environmental data time series represents a very common, but extremely critical problem, since it can produce biased results (Rubin, 1976). Missing data plagues almost all surveys. The problem is how to deal with missing data once it has been deemed impossible to recover the actual missing values. Apart from the amount of missing data, another issue which plays an important role in the choice of any recovery approach is the evaluation of "missingness" mechanisms. When data missing is conditioned by some other variable observed in the data set (Schafer, 1997) the mechanism is called MAR (Missing at Random). Otherwise, when the missingness mechanism depends on the actual value of the missing data, it is called NCAR (Not Missing at Random). This last is the most difficult condition to model. In the last decade interest arose in the estimation of missing data by using regression (single imputation). More recently multiple imputation has become also available, which returns a distribution of estimated values (Scheffer, 2002). In this paper an automatic methodology for estimating missing data is presented. In practice, given a gauging station affected by missing data (target station), the methodology checks the randomness of the missing data and classifies the "similarity" between the target station and the other gauging stations spread over the study area. Among different methods useful for defining the similarity degree, whose effectiveness strongly depends on the data distribution, the Spearman correlation coefficient was chosen. Once defined the similarity matrix, a suitable, nonparametric, univariate, and regressive method was applied in order to estimate missing data in the target station: the Theil method (Theil, 1950). Even though the methodology revealed to be rather reliable an improvement of the missing data estimation can be achieved by a generalization. A first possible improvement consists in extending the univariate technique to the multivariate approach. Another approach follows the paradigm of the "multiple imputation" (Rubin, 1987; Rubin, 1988), which consists in using a set of "similar stations" instead than the most similar. This way, a sort of estimation range can be determined allowing the introduction of uncertainty. Finally, time series can be grouped on the basis of monthly rainfall rates defining classes of wetness (i.e.: dry, moderately rainy and rainy), in order to achieve the estimation using homogeneous data subsets. We expect that integrating the methodology with these enhancements will certainly improve its reliability. The methodology was applied to the daily rainfall time series data registered in the Candelaro River Basin (Apulia - South Italy) from 1970 to 2001. REFERENCES D.B., Rubin, 1976. Inference and Missing Data. Biometrika 63 581-592 D.B. Rubin, 1987. Multiple Imputation for Nonresponce in Surveys, New York: John Wiley & Sons, Inc. D.B. Rubin, 1988. An overview of multiple imputation. In Survey Research Section, pp. 79-84, American Statistical Association, 1988. J.L., Schafer, 1997. Analysis of Incomplete Multivariate Data, Chapman & Hall. J., Scheffer, 2002. Dealing with Missing Data. Res. Lett. Inf. Math. Sci. 3, 153-160. Available online at http://www.massey.ac.nz/~wwiims/research/letters/ H. Theil, 1950. A rank-invariant method of linear and polynomial regression analysis. Indicationes Mathematicae, 12, pp.85-91.

Screening of missing proteins in the human liver proteome by improved MRM-approach-based targeted proteomics.

PubMed

Chen, Chen; Liu, Xiaohui; Zheng, Weimin; Zhang, Lei; Yao, Jun; Yang, Pengyuan

2014-04-04

To completely annotate the human genome, the task of identifying and characterizing proteins that currently lack mass spectrometry (MS) evidence is inevitable and urgent. In this study, as the first effort to screen missing proteins in large scale, we developed an approach based on SDS-PAGE followed by liquid chromatography-multiple reaction monitoring (LC-MRM), for screening of those missing proteins with only a single peptide hit in the previous liver proteome data set. Proteins extracted from normal human liver were separated in SDS-PAGE and digested in split gel slice, and the resulting digests were then subjected to LC-schedule MRM analysis. The MRM assays were developed through synthesized crude peptides for target peptides. In total, the expressions of 57 target proteins were confirmed from 185 MRM assays in normal human liver tissues. Among the proved 57 one-hit wonders, 50 proteins are of the minimally redundant set in the PeptideAtlas database, 7 proteins even have none MS-based information previously in various biological processes. We conclude that our SDS-PAGE-MRM workflow can be a powerful approach to screen missing or poorly characterized proteins in different samples and to provide their quantity if detected. The MRM raw data have been uploaded to ISB/SRM Atlas/PASSEL (PXD000648).

M$^3$: A New Muon Missing Momentum Experiment to Probe $$(g-2)_{\\mu}$$ and Dark Matter at Fermilab

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

Kahn, Yonatan; Krnjaic, Gordan; Tran, Nhan

New light, weakly-coupled particles are commonly invoked to address the persistentmore » $$\\sim 4\\sigma$$ anomaly in $$(g-2)_\\mu$$ and serve as mediators between dark and visible matter. If such particles couple predominantly to heavier generations and decay invisibly, much of their best-motivated parameter space is inaccessible with existing experimental techniques. In this paper, we present a new fixed-target, missing-momentum search strategy to probe invisibly decaying particles that couple preferentially to muons. In our setup, a relativistic muon beam impinges on a thick active target. The signal consists of events in which a muon loses a large fraction of its incident momentum inside the target without initiating any detectable electromagnetic or hadronic activity in downstream veto systems. We propose a two-phase experiment, M$^3$ (Muon Missing Momentum), based at Fermilab. Phase 1 with $$\\sim 10^{10}$$ muons on target can test the remaining parameter space for which light invisibly-decaying particles can resolve the $$(g-2)_\\mu$$ anomaly, while Phase 2 with $$\\sim 10^{13}$$ muons on target can test much of the predictive parameter space over which sub-GeV dark matter achieves freeze-out via muon-philic forces, including gauged $$U(1)_{L_\\mu - L_\\tau}$$.« less

The influence of performance-based payment on childhood immunisation coverage.

PubMed

Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

2015-06-01

Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent. The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher. Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule. Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

Balderson, Michael, E-mail: michael.balderson@rmp.uhn.ca; Brown, Derek; Johnson, Patricia

The purpose of this work was to compare static gantry intensity-modulated radiation therapy (IMRT) with volume-modulated arc therapy (VMAT) in terms of tumor control probability (TCP) under scenarios involving large geometric misses, i.e., those beyond what are accounted for when margin expansion is determined. Using a planning approach typical for these treatments, a linear-quadratic–based model for TCP was used to compare mean TCP values for a population of patients who experiences a geometric miss (i.e., systematic and random shifts of the clinical target volume within the planning target dose distribution). A Monte Carlo approach was used to account for themore » different biological sensitivities of a population of patients. Interestingly, for errors consisting of coplanar systematic target volume offsets and three-dimensional random offsets, static gantry IMRT appears to offer an advantage over VMAT in that larger shift errors are tolerated for the same mean TCP. For example, under the conditions simulated, erroneous systematic shifts of 15 mm directly between or directly into static gantry IMRT fields result in mean TCP values between 96% and 98%, whereas the same errors on VMAT plans result in mean TCP values between 45% and 74%. Random geometric shifts of the target volume were characterized using normal distributions in each Cartesian dimension. When the standard deviations were doubled from those values assumed in the derivation of the treatment margins, our model showed a 7% drop in mean TCP for the static gantry IMRT plans but a 20% drop in TCP for the VMAT plans. Although adding a margin for error to a clinical target volume is perhaps the best approach to account for expected geometric misses, this work suggests that static gantry IMRT may offer a treatment that is more tolerant to geometric miss errors than VMAT.« less

The analysis of a generic air-to-air missile simulation model

NASA Technical Reports Server (NTRS)

Kaplan, Joseph A.; Chappell, Alan R.; Mcmanus, John W.

1994-01-01

A generic missile model was developed to evaluate the benefits of using a dynamic missile fly-out simulation system versus a static missile launch envelope system for air-to-air combat simulation. This paper examines the performance of a launch envelope model and a missile fly-out model. The launch envelope model bases its probability of killing the target aircraft on the target aircraft's position at the launch time of the weapon. The benefits gained from a launch envelope model are the simplicity of implementation and the minimal computational overhead required. A missile fly-out model takes into account the physical characteristics of the missile as it simulates the guidance, propulsion, and movement of the missile. The missile's probability of kill is based on the missile miss distance (or the minimum distance between the missile and the target aircraft). The problems associated with this method of modeling are a larger computational overhead, the additional complexity required to determine the missile miss distance, and the additional complexity of determining the reason(s) the missile missed the target. This paper evaluates the two methods and compares the results of running each method on a comprehensive set of test conditions.

'Care Under Pressure': a realist review of interventions to tackle doctors' mental ill-health and its impacts on the clinical workforce and patient care.

PubMed

Carrieri, Daniele; Briscoe, Simon; Jackson, Mark; Mattick, Karen; Papoutsi, Chrysanthi; Pearson, Mark; Wong, Geoffrey

2018-02-02

Mental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their 'productivity' and 'resilience', placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors' well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments. Our project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors' mental ill-health. We will conduct a realist review-a form of theory-driven interpretative systematic review-of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors' mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory. Ethical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues. CRD42017069870. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Expanding Doctoral Education in South Africa: Pipeline or Pipedream?

ERIC Educational Resources Information Center

Herman, Chaya

2011-01-01

The purpose of this paper is to discuss both the status of the PhD in South Africa and the feasibility of the country's aspiration to increase by fivefold the production of PhDs by 2025. Based on the first empirical studies on doctoral education in South Africa, it argues that in order to move towards this target, an expanded and coordinated…

Student and Faculty Perceptions of Lecture Recording in a Doctor of Pharmacy Curriculum

PubMed Central

Barrickman, Ashleigh Landis; Stamatakis, Mary K.; Elliott, David P.

2013-01-01

Objective. To describe students’ and faculty members’ perceptions of the impact of lecture recording in a doctor of pharmacy (PharmD) curriculum. Methods. Second- and third-year pharmacy students and faculty members completed an anonymous survey instrument regarding their perceptions of lecture recording with 2 classroom lecture capture software programs, Camtasia Studio and Wimba Classroom. Results. Most students (82%) responded that Camtasia was very helpful and almost half (49%) responded that Wimba Classroom was helpful (p<0.001). Forty-six percent of the students reported being more likely to miss a class that was recorded; however, few students (10%) reported using recordings as a substitute for attending class. The most common concern of faculty members was decreased student attendance (27%). Conclusion. Pharmacy students consider lecture recordings beneficial, and they use the recordings primarily to review the lecture. While faculty members reported concerns with decreased attendance, few students reported using recordings as an alternative to class attendance. PMID:24159206

Spacecraft intercept guidance using zero effort miss steering

NASA Astrophysics Data System (ADS)

Newman, Brett

The suitability of proportional navigation, or an equivalent zero effort miss formulation, for spacecraft intercepts during midcourse guidance, followed by a ballistic coast to the endgame, is addressed. The problem is formulated in terms of relative motion in a general 3D framework. The proposed guidance law for the commanded thrust vector orientation consists of the sum of two terms: (1) along the line of sight unit direction and (2) along the zero effort miss component perpendicular to the line of sight and proportional to the miss itself and a guidance gain. If the guidance law is to be suitable for longer range targeting applications with significant ballistic coasting after burnout, determination of the zero effort miss must account for the different gravitational accelerations experienced by each vehicle. The proposed miss determination techniques employ approximations for the true differential gravity effect. Theoretical results are applied to a numerical engagement scenario and the resulting performance is evaluated in terms of the miss distances determined from nonlinear simulation.

Cortical motor activity and reorganization following upper-limb amputation and subsequent targeted reinnervation.

PubMed

Chen, Albert; Yao, Jun; Kuiken, Todd; Dewald, Julius P A

2013-01-01

Previous studies have postulated that the amount of brain reorganization following peripheral injuries may be correlated with negative symptoms or consequences. However, it is unknown whether restoring effective limb function may then be associated with further changes in the expression of this reorganization. Recently, targeted reinnervation (TR), a surgical technique that restores a direct neural connection from amputated sensorimotor nerves to new peripheral targets such as muscle, has been successfully applied to upper-limb amputees. It has been shown to be effective in restoring both peripheral motor and sensory functions via the reinnervated nerves as soon as a few months after the surgery. However, it was unclear whether TR could also restore normal cortical motor representations for control of the missing limb. To answer this question, we used high-density electroencephalography (EEG) to localize cortical activity related to cued motor tasks generated by the intact and missing limb. Using a case study of 3 upper-limb amputees, 2 of whom went through pre and post-TR experiments, we present unique quantitative evidence for the re-mapping of motor representations for the missing limb closer to their original locations following TR. This provides evidence that an effective restoration of peripheral function from TR can be linked to the return of more normal cortical expression for the missing limb. Therefore, cortical mapping may be used as a potential guide for monitoring rehabilitation following peripheral injuries.

Visual search for features and conjunctions in development.

PubMed

Lobaugh, N J; Cole, S; Rovet, J F

1998-12-01

Visual search performance was examined in three groups of children 7 to 12 years of age and in young adults. Colour and orientation feature searches and a conjunction search were conducted. Reaction time (RT) showed expected improvements in processing speed with age. Comparisons of RT's on target-present and target-absent trials were consistent with parallel search on the two feature conditions and with serial search in the conjunction condition. The RT results indicated searches for feature and conjunctions were treated similarly for children and adults. However, the youngest children missed more targets at the largest array sizes, most strikingly in conjunction search. Based on an analysis of speed/accuracy trade-offs, we suggest that low target-distractor discriminability leads to an undersampling of array elements, and is responsible for the high number of misses in the youngest children.

Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study.

PubMed

McDonald, Ruth; Harrison, Stephen; Checkland, Kath; Campbell, Stephen M; Roland, Martin

2007-06-30

To explore the impact of financial incentives for quality of care on practice organisation, clinical autonomy, and internal motivation of doctors and nurses working in primary care. Ethnographic case study. Two English general practices. 12 general practitioners, nine nurses, four healthcare assistants, and four administrative staff. Observation of practices over a five month period after the introduction of financial incentives for quality of care introduced in the 2004 general practitioner contract. After the introduction of the quality and outcomes framework there was an increase in the use of templates to collect data on quality of care. New regimens of surveillance were adopted, with clinicians seen as "chasers" or the "chased," depending on their individual responsibility for delivering quality targets. Attitudes towards the contract were largely positive, although discontent was higher in the practice with a more intensive surveillance regimen. Nurses expressed more concern than doctors about changes to their clinical practice but also appreciated being given responsibility for delivering on targets in particular disease areas. Most doctors did not question the quality targets that existed at the time or the implications of the targets for their own clinical autonomy. Implementation of financial incentives for quality of care did not seem to have damaged the internal motivation of the general practitioners studied, although more concern was expressed by nurses.

Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study

PubMed Central

Harrison, Stephen; Checkland, Kath; Campbell, Stephen M; Roland, Martin

2007-01-01

Objective To explore the impact of financial incentives for quality of care on practice organisation, clinical autonomy, and internal motivation of doctors and nurses working in primary care. Design Ethnographic case study. Setting Two English general practices. Participants 12 general practitioners, nine nurses, four healthcare assistants, and four administrative staff. Main outcome measure Observation of practices over a five month period after the introduction of financial incentives for quality of care introduced in the 2004 general practitioner contract. Results After the introduction of the quality and outcomes framework there was an increase in the use of templates to collect data on quality of care. New regimens of surveillance were adopted, with clinicians seen as “chasers” or the “chased,” depending on their individual responsibility for delivering quality targets. Attitudes towards the contract were largely positive, although discontent was higher in the practice with a more intensive surveillance regimen. Nurses expressed more concern than doctors about changes to their clinical practice but also appreciated being given responsibility for delivering on targets in particular disease areas. Most doctors did not question the quality targets that existed at the time or the implications of the targets for their own clinical autonomy. Conclusions Implementation of financial incentives for quality of care did not seem to have damaged the internal motivation of the general practitioners studied, although more concern was expressed by nurses. PMID:17580318

A study of the relationship between resilience, burnout and coping strategies in doctors.

PubMed

McCain, R Scott; McKinley, Nicola; Dempster, Martin; Campbell, W Jeffrey; Kirk, Stephen J

2017-08-09

The aim of this study was to measure resilience, coping and professional quality of life in doctors. A cross-sectional study using an online questionnaire in a single National Health Service trust, including both primary and secondary care doctors. 283 doctors were included. Mean resilience was 68.9, higher than population norms. 100 (37%) doctors had high burnout, 194 (72%) doctors had high secondary traumatic stress and 64 (24%) had low compassion satisfaction. Burnout was positively associated with low resilience, low compassion satisfaction, high secondary traumatic stress and more frequent use of maladaptive coping mechanisms, including self-blame, behavioural disengagement and substance use. Non-clinical issues in the workplace were the main factor perceived to cause low resilience in doctors. Despite high levels of resilience, doctors had high levels of burnout and secondary traumatic stress. Doctors suffering from burnout were more likely to use maladaptive coping mechanisms. As doctors already have high resilience, improving personal resilience further may not offer much benefit to professional quality of life. A national study of professional Quality of Life, Coping And REsilience, which we are proposing to undertake, will for the first time assess the UK and Ireland medical workforce in this regard and guide future targeted interventions to improve professional quality of life. © 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.

BeeDoctor, a versatile MLPA-based diagnostic tool for screening bee viruses.

PubMed

De Smet, Lina; Ravoet, Jorgen; de Miranda, Joachim R; Wenseleers, Tom; Mueller, Matthias Y; Moritz, Robin F A; de Graaf, Dirk C

2012-01-01

The long-term decline of managed honeybee hives in the world has drawn significant attention to the scientific community and bee-keeping industry. A high pathogen load is believed to play a crucial role in this phenomenon, with the bee viruses being key players. Most of the currently characterized honeybee viruses (around twenty) are positive stranded RNA viruses. Techniques based on RNA signatures are widely used to determine the viral load in honeybee colonies. High throughput screening for viral loads necessitates the development of a multiplex polymerase chain reaction approach in which different viruses can be targeted simultaneously. A new multiparameter assay, called "BeeDoctor", was developed based on multiplex-ligation probe dependent amplification (MLPA) technology. This assay detects 10 honeybee viruses in one reaction. "BeeDoctor" is also able to screen selectively for either the positive strand of the targeted RNA bee viruses or the negative strand, which is indicative for active viral replication. Due to its sensitivity and specificity, the MLPA assay is a useful tool for rapid diagnosis, pathogen characterization, and epidemiology of viruses in honeybee populations. "BeeDoctor" was used for screening 363 samples from apiaries located throughout Flanders; the northern half of Belgium. Using the "BeeDoctor", virus infections were detected in almost eighty percent of the colonies, with deformed wing virus by far the most frequently detected virus and multiple virus infections were found in 26 percent of the colonies.

Who benefit from school doctors' health checks: a prospective study of a screening method.

PubMed

Nikander, Kirsi; Kosola, Silja; Kaila, Minna; Hermanson, Elina

2018-06-27

School health services provide an excellent opportunity for the detection and treatment of children at risk of later health problems. However, the optimal use of school doctors' skills and expertise remains unknown. Furthermore, no validated method for screening children for school doctors' assessments exists. The aims of the study are 1) to evaluate the benefits or harm of school doctors' routine health checks in primary school grades 1 and 5 (at ages 7 and 11) and 2) to explore whether some of the school doctors' routine health checks can be omitted using study questionnaires. This is a prospective, multicenter observational study conducted in four urban municipalities in Southern Finland by comparing the need for a school doctor's assessment to the benefit gained from it. We will recruit a random sample of 1050 children from 21 schools from primary school grades 1 and 5. Before the school doctor's health check, parents, nurses and teachers fill a study questionnaire to identify any potential concerns about each child. Doctors, blinded to the questionnaire responses, complete an electronic report after the appointment, including given instructions and follow-up plans. The child, parent, doctor and researchers assess the benefit of the health check. The researchers compare the need for a doctor's appointment to the benefit gained from it. At one year after the health check, we will analyze the implementation of the doctors' interventions and follow-up plans. The study will increase our knowledge of the benefits of school doctors' routine health checks and assess the developed screening method. We hypothesize that targeting the health checks to the children in greatest need would increase the quality of school health services. ClinicalTrials.gov Identifier: NCT03178331 , date of registration June 6 th 2017.

Why are they missing? : Bioinformatics characterization of missing human proteins.

PubMed

Elguoshy, Amr; Magdeldin, Sameh; Xu, Bo; Hirao, Yoshitoshi; Zhang, Ying; Kinoshita, Naohiko; Takisawa, Yusuke; Nameta, Masaaki; Yamamoto, Keiko; El-Refy, Ali; El-Fiky, Fawzy; Yamamoto, Tadashi

2016-10-21

NeXtProt is a web-based protein knowledge platform that supports research on human proteins. NeXtProt (release 2015-04-28) lists 20,060 proteins, among them, 3373 canonical proteins (16.8%) lack credible experimental evidence at protein level (PE2:PE5). Therefore, they are considered as "missing proteins". A comprehensive bioinformatic workflow has been proposed to analyze these "missing" proteins. The aims of current study were to analyze physicochemical properties, existence and distribution of the tryptic cleavage sites, and to pinpoint the signature peptides of the missing proteins. Our findings showed that 23.7% of missing proteins were hydrophobic proteins possessing transmembrane domains (TMD). Also, forty missing entries generate tryptic peptides were either out of mass detection range (>30aa) or mapped to different proteins (<9aa). Additionally, 21% of missing entries didn't generate any unique tryptic peptides. In silico endopeptidase combination strategy increased the possibility of missing proteins identification. Coherently, using both mature protein database and signal peptidome database could be a promising option to identify some missing proteins by targeting their unique N-terminal tryptic peptide from mature protein database and or C-terminus tryptic peptide from signal peptidome database. In conclusion, Identification of missing protein requires additional consideration during sample preparation, extraction, digestion and data analysis to increase its incidence of identification. Copyright © 2016. Published by Elsevier B.V.

Depth inpainting by tensor voting.

PubMed

Kulkarni, Mandar; Rajagopalan, Ambasamudram N

2013-06-01

Depth maps captured by range scanning devices or by using optical cameras often suffer from missing regions due to occlusions, reflectivity, limited scanning area, sensor imperfections, etc. In this paper, we propose a fast and reliable algorithm for depth map inpainting using the tensor voting (TV) framework. For less complex missing regions, local edge and depth information is utilized for synthesizing missing values. The depth variations are modeled by local planes using 3D TV, and missing values are estimated using plane equations. For large and complex missing regions, we collect and evaluate depth estimates from self-similar (training) datasets. We align the depth maps of the training set with the target (defective) depth map and evaluate the goodness of depth estimates among candidate values using 3D TV. We demonstrate the effectiveness of the proposed approaches on real as well as synthetic data.

Input Control Processes in Rapid Serial Visual Presentations: Target Selection and Distractor Inhibition

ERIC Educational Resources Information Center

Olivers, Christian N. L.; Watson, Derrick G.

2006-01-01

The attentional blink refers to the finding that the 2nd of 2 targets embedded in a stream of rapidly presented distractors is often missed. Whereas most theories of the attentional blink focus on limited-capacity processes that occur after target selection, the present work investigates the selection process itself. Identifying a target letter…

The Determinants of Productivity in Medical Testing: Intensity and Allocation of Care*

PubMed Central

Abaluck, Jason; Agha, Leila; Kabrhel, Chris; Raja, Ali; Venkatesh, Arjun

2017-01-01

A large body of research has investigated whether physicians overuse care. There is less evidence on whether, for a fixed level of spending, doctors allocate resources to patients with the highest expected returns. We assess both sources of inefficiency exploiting variation in rates of negative imaging tests for pulmonary embolism. We document enormous across-doctor heterogeneity in testing conditional on patient population, which explains the negative relationship between physicians’ testing rates and test yields. Furthermore, doctors do not target testing to the highest risk patients, reducing test yields by one third. Our calibration suggests misallocation is more costly than overuse. PMID:29104293

A Profile of Mexican American, Puerto Rican, and Other Hispanic STEM Doctorates: 1983 TO 1997

NASA Astrophysics Data System (ADS)

Quintana-Baker, Maricel

This article describes the characteristics of Hispanic U. S. citizens who earned doctoral degrees in science, technology, engineering, and mathematics (STEM) from institutions in the United States between 1983 and 1997. The data on this population •were disaggregated by gender and by Hispanic subgroup (i.e., Mexican American, Puerto Rican and other Hispanic). The profile for this population includes parental education, type of financial assistance during time of study, and level of debt on receipt of doctorate. In addition, this research identified and ranked the doctorate-granting institutions according to the absolute number of STEM doctoral degrees they granted to Hispanics during the 15-year period of the study. The results indicate that there are differences among the Hispanic subgroups in this study. Therefore, it is critical thai future researchers understand that studies that analyze Hispanics as one single homogeneous group produce results that are not truly representative and that research, policy, and programmatic efforts must be targeted accordingly.

Outlier and target detection in aerial hyperspectral imagery: a comparison of traditional and percentage occupancy hit or miss transform techniques

NASA Astrophysics Data System (ADS)

Young, Andrew; Marshall, Stephen; Gray, Alison

2016-05-01

The use of aerial hyperspectral imagery for the purpose of remote sensing is a rapidly growing research area. Currently, targets are generally detected by looking for distinct spectral features of the objects under surveillance. For example, a camouflaged vehicle, deliberately designed to blend into background trees and grass in the visible spectrum, can be revealed using spectral features in the near-infrared spectrum. This work aims to develop improved target detection methods, using a two-stage approach, firstly by development of a physics-based atmospheric correction algorithm to convert radiance into re ectance hyperspectral image data and secondly by use of improved outlier detection techniques. In this paper the use of the Percentage Occupancy Hit or Miss Transform is explored to provide an automated method for target detection in aerial hyperspectral imagery.

Professional attitudes toward incident reporting: can we measure and compare improvements in patient safety culture?

PubMed

Tricarico, Pierfrancesco; Castriotta, Luigi; Battistella, Claudio; Bellomo, Fabrizio; Cattani, Giovanni; Grillone, Lucrezia; Degan, Stefania; De Corti, Daniela; Brusaferro, Silvio

2017-04-01

To establish categories of professionals' attitudes toward incident reporting by analyzing the trends in incident reporting while accounting for general risk indicators. The incident reporting system was evaluated over 6 years. Reporting rates, stratified by year and profession, were estimated using the non-mandatory reported events/full-time equivalent (NM-IR/FTE) rate. Other indicators were collected using the hospital's official database. Staff attitudes toward self-reporting were analyzed. Univariate and multivariable analyses were performed. A 1000-bed Italian academic hospital. Staff of the hospital (over 3200 professionals). None. NM-IT/FTE rates, self-reported rates, patient complaints/praises, work accidents among professionals and 30-day readmissions. The overall reporting rate was 0.44 (95% confidence interval [CI]: 0.42-0.46) among doctors and 0.40 (95% CI: 0.39-0.41) among nurses. Between 2010 and 2015, only the doctors' reporting rate increased significantly (P = 0.04), from 0.29 (95% CI: 0.25-0.34) to 0.67 (95% CI: 0.60-0.73). Patient complaints decreased from 384 to 224 (P < 0.001) and work accidents decreased from 296 to 235 (P = 0.01), while other indicators remained constant. Multivariable logistic regression showed that self-reporting was more likely among nurses than doctors (odds ratio: 1.51; 95% CI: 1.31-1.73) and for severe events than near misses (odds ratio: 1.78; 95% CI: 1.11-2.87). Because the doctors' reporting rates increased during the study period, doctors may be more likely to report adverse events than nurses, although nurses reported more events. Incident reporting trends and other routinely collected risk indicators may be useful to improve our understanding and measurement of patient safety issues. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

From novice to proficient general practitioner: a critical incident study.

PubMed

Sim, M G; Kamien, M; Diamond, M R

1996-09-01

To obtain information about any change in the performance or perceptions of doctors undertaking the Royal Australian College of General Practitioners (RACGP) Training Program, with advancing general practice experience. The critical incident technique' was used, which is a comparative qualitative analysis. It involved interviews at 12 to 18 months after the basic term interview. Eighteen Western Australian doctors, who had been interviewed in 1992, at the end of their first 6 months of general practice training and were now completing their advanced or mentor terms in the RACGP Training Program took part in the study. Doctors reported an average of 4.4 critical incidents in their first interview and 5.0 in their second interview. The major areas of positive change included relationships with patients and other health care professionals, including supervisors; paediatrics and orthopaedics skills; the skills of developing a therapeutic relationship to enhance patient compliance and the ability to manage complex cardiovascular and psychiatric problems without reliance on specialist referral; attitudes of responsibility for and enjoyment of long term care of patients and families; and reduced levels of anxiety over difficult problems. New or continuing areas of difficulty were found in gynaecology; pharmacotherapy and dermatology; the diagnosis of common complaints with uncommon presentations; the skill of managing difficult or angry patients; the organisation for the follow-up of patients with potentially severe disorders; and in managing feelings of guilt over missed diagnoses or poor management. An analysis of commonly occurring positive and negative critical incidents shows that RACGP Training Program doctors develop competence, confidence and reduced levels of performance anxiety with advancing experience. All but one doctor found the Training Program helpful in achieving these proficiencies. However, many ongoing areas of difficulty remain. The Critical Incident method is a useful tool for learning and assessment in a vocational training program.

[The work of medical doctors on psychiatric wards: an analysis of everyday activities].

PubMed

Putzhammer, A; Senft, I; Fleischmann, H; Klein, H E; Schmauss, M; Schreiber, W; Hajak, G

2006-03-01

In Germany, the economic situation of psychiatric hospitals has markedly changed during the last years. Whilst the number of patients has steadily increased, many clinics considerably reduced the number of therapeutic staff due to an increasing lack of financial support. The German psychiatry personnel regulations act defines the number of therapeutic staff required for an adequate psychiatric treatment, but the requirements of this regulations act nowadays are widely missed in most of the German psychiatric hospitals. This severely affects the therapeutic work on psychiatric wards. This study analyses tasks and activities of medical doctors on psychiatric wards and compares the hours spent with various types of activities with the amount of time that should be spent according to the personnel regulations act. Results show that doctors spend much more time with documentation and administrative work than originally intended by the personnel regulations act. They compensate this mainly by a reduction of time spent in direct contact with the patients. In this context, the number of psychotherapy sessions as well as sessions with the patients' relatives has been considerably reduced, whereas the time spent for emergency intervention and basic treatment still corresponds to the calculations according to the personnel regulations act. All in all, the results show that a reduction of therapeutic staff in psychiatric hospitals directly leads to a change in treatment settings with a focus on less individual treatment options.

The 'radiographer-referrer game': image interpretation dynamics in rural practice.

PubMed

Squibb, Kathryn; Smith, Anthony; Dalton, Lisa; Bull, Rosalind M

2016-03-01

Effective interprofessional communication is intrinsic to safe health care. Despite the identified positive impact of collaborative radiographic interpretation between rural radiographers and referrers, communication difficulties still exist. This article describes the strategies that Australian rural radiographers use for communication of their radiographic opinion to the referring doctor. In a two-phase interpretive doctoral study completed in 2012, data were collected from radiographers working in rural New South Wales, Western Australia and Tasmania using a paper based questionnaire followed by in-depth semistructured interviews. Data were analysed thematically in order to identify, analyse and report the emergent themes. The overarching theme was Patient Advocacy, where in the interest of patient care radiographers took measures to ensure that a referring doctor did not miss radiographic abnormalities. Strong interprofessional relationships enabled direct communication pathways. Interprofessional boundaries shaped by historical hierarchical relationships, together with a lack of confidence and educational preparation for radiographic interpretation result in barriers to direct communication pathways. These barriers prompted radiographers to pursue indirect communication pathways, such as side-stepping and hint and hope. A lack of formal communication pathways and educational preparation for this role has resulted in radiographers playing the radiographer-referrer game to overtly or covertly assist referrers in reaching a radiographic diagnosis. The findings from this study may be used to plan interventions for strengthening interprofessional communication pathways and improve quality of healthcare for patients.

Recurrent Neural Networks for Multivariate Time Series with Missing Values.

PubMed

Che, Zhengping; Purushotham, Sanjay; Cho, Kyunghyun; Sontag, David; Liu, Yan

2018-04-17

Multivariate time series data in practical applications, such as health care, geoscience, and biology, are characterized by a variety of missing values. In time series prediction and other related tasks, it has been noted that missing values and their missing patterns are often correlated with the target labels, a.k.a., informative missingness. There is very limited work on exploiting the missing patterns for effective imputation and improving prediction performance. In this paper, we develop novel deep learning models, namely GRU-D, as one of the early attempts. GRU-D is based on Gated Recurrent Unit (GRU), a state-of-the-art recurrent neural network. It takes two representations of missing patterns, i.e., masking and time interval, and effectively incorporates them into a deep model architecture so that it not only captures the long-term temporal dependencies in time series, but also utilizes the missing patterns to achieve better prediction results. Experiments of time series classification tasks on real-world clinical datasets (MIMIC-III, PhysioNet) and synthetic datasets demonstrate that our models achieve state-of-the-art performance and provide useful insights for better understanding and utilization of missing values in time series analysis.

A concordance-based study to assess doctors’ and nurses’ mental models in Internal Medicine

PubMed Central

Chan, K. C. Gary; Muller-Juge, Virginie; Cullati, Stéphane; Hudelson, Patricia; Maître, Fabienne; Vu, Nu V.; Savoldelli, Georges L.; Nendaz, Mathieu R.

2017-01-01

Interprofessional collaboration between doctors and nurses is based on team mental models, in particular for each professional’s roles. Our objective was to identify factors influencing concordance on the expectations of doctors’ and nurses’ roles and responsibilities in an Internal Medicine ward. Using a dataset of 196 doctor-nurse pairs (14x14 = 196), we analyzed choices and prioritized management actions of 14 doctors and 14 nurses in six clinical nurse role scenarios, and in five doctor role scenarios (6 options per scenario). In logistic regression models with a non-nested correlation structure, we evaluated concordance among doctors and nurses, and adjusted for potential confounders (including prior experience in Internal Medicine, acuteness of case and gender). Concordance was associated with number of female professionals (adjusted OR 1.32, 95% CI 1.02 to 1.73), for acute situations (adjusted OR 2.02, 95% CI 1.13 to 3.62), and in doctor role scenarios (adjusted OR 2.19, 95% CI 1.32 to 3.65). Prior experience and country of training were not significant predictors of concordance. In conclusion, our concordance-based approach helped us identify areas of lower concordance in expected doctor-nurse roles and responsibilities, particularly in non-acute situations, which can be targeted by future interprofessional, educational interventions. PMID:28792524

The impact of familiarization strategies on the missing-letter effect.

PubMed

Plamondon, Andréanne; Roy-Charland, Annie; Chamberland, Justin; Quenneville, Joannie; Laforge, Christian

2017-08-01

When reading a text and searching for a target letter, readers make more omissions of the target letter if it is embedded in frequent function words than if it is in rare content words. While word frequency effects are consistently found, few studies have examined the impacts of passage familiarity on the missing-letter effect and studies that have present conflicting evidence. The present study examines the effects of passage familiarity, as well as the impacts of passage familiarization strategy promoting surface or deep encoding, on the missing-letter effect. Participants were familiarized with a passage by retyping a text, replacing all common nouns with synonyms, or generating a text on the same topic as that of the original text, and then completed a letter search task on the familiar passage as well as an unfamiliar passage. In Experiment 1, when both familiar and unfamiliar passages use the same words, results revealed fewer omissions for the retyping and synonyms conditions. However, in Experiment 2, when different words are used in both types of texts, no effect of familiarization strategy was observed. Furthermore, the missing-letter effect is maintained in all conditions, adding support to the robustness of the effect regardless of familiarity with the text.

Gestational weight gain information: seeking and sources among pregnant women.

PubMed

Willcox, Jane C; Campbell, Karen J; McCarthy, Elizabeth A; Lappas, Martha; Ball, Kylie; Crawford, David; Shub, Alexis; Wilkinson, Shelley A

2015-08-07

Promoting healthy gestational weight gain (GWG) is important for preventing obstetric and perinatal morbidity, along with obesity in both mother and child. Provision of GWG guidelines by health professionals predicts women meeting GWG guidelines. Research concerning women's GWG information sources is limited. This study assessed pregnant women's sources of GWG information and how, where and which women seek GWG information. Consecutive women (n = 1032) received a mailed questionnaire after their first antenatal visit to a public maternity hospital in Melbourne, Australia. Recalled provision of GWG guidelines by doctors and midwives, recalled provided GWG goals, and the obtaining of GWG information and information sources were assessed. Participants (n = 368; 35.7% response) averaged 32.5 years of age and 20.8 weeks gestation, with 33.7% speaking a language other than English. One in ten women recalled receiving GWG guidelines from doctors or midwives, of which half were consistent with Institute of Medicine guidelines. More than half the women (55.4%) had actively sought GWG information. Nulliparous (OR 7.07, 95% CI = 3.91-12.81) and obese (OR 1.96, 95% CI = 1.05-3.65) women were more likely to seek information. Underweight (OR 0.29, 95% CI = 0.09-0.97) women and those working part time (OR 0.52, 95% CI = 0.28-0.97) were less likely to seek information. Most frequently reported GWG sources included the internet (82.7%), books (55.4%) and friends (51.5%). The single most important sources were identified as the internet (32.8%), general practitioners (16.9%) and books (14.9%). More than half of women were seeking GWG guidance and were more likely to consult non-clinician sources. The small numbers given GWG targets, and the dominance of non-clinical information sources, reinforces that an important opportunity to provide evidence based advice and guidance in the antenatal care setting is currently being missed.

Shrinkage regression-based methods for microarray missing value imputation.

PubMed

Wang, Hsiuying; Chiu, Chia-Chun; Wu, Yi-Ching; Wu, Wei-Sheng

2013-01-01

Missing values commonly occur in the microarray data, which usually contain more than 5% missing values with up to 90% of genes affected. Inaccurate missing value estimation results in reducing the power of downstream microarray data analyses. Many types of methods have been developed to estimate missing values. Among them, the regression-based methods are very popular and have been shown to perform better than the other types of methods in many testing microarray datasets. To further improve the performances of the regression-based methods, we propose shrinkage regression-based methods. Our methods take the advantage of the correlation structure in the microarray data and select similar genes for the target gene by Pearson correlation coefficients. Besides, our methods incorporate the least squares principle, utilize a shrinkage estimation approach to adjust the coefficients of the regression model, and then use the new coefficients to estimate missing values. Simulation results show that the proposed methods provide more accurate missing value estimation in six testing microarray datasets than the existing regression-based methods do. Imputation of missing values is a very important aspect of microarray data analyses because most of the downstream analyses require a complete dataset. Therefore, exploring accurate and efficient methods for estimating missing values has become an essential issue. Since our proposed shrinkage regression-based methods can provide accurate missing value estimation, they are competitive alternatives to the existing regression-based methods.

Prediction of missing common genes for disease pairs using network based module separation on incomplete human interactome.

PubMed

Akram, Pakeeza; Liao, Li

2017-12-06

Identification of common genes associated with comorbid diseases can be critical in understanding their pathobiological mechanism. This work presents a novel method to predict missing common genes associated with a disease pair. Searching for missing common genes is formulated as an optimization problem to minimize network based module separation from two subgraphs produced by mapping genes associated with disease onto the interactome. Using cross validation on more than 600 disease pairs, our method achieves significantly higher average receiver operating characteristic ROC Score of 0.95 compared to a baseline ROC score 0.60 using randomized data. Missing common genes prediction is aimed to complete gene set associated with comorbid disease for better understanding of biological intervention. It will also be useful for gene targeted therapeutics related to comorbid diseases. This method can be further considered for prediction of missing edges to complete the subgraph associated with disease pair.

Differences in multiple-target visual search performance between non-professional and professional searchers due to decision-making criteria.

PubMed

Biggs, Adam T; Mitroff, Stephen R

2015-11-01

Professional visual searches, such as those conducted by airport security personnel, often demand highly accurate performance. As many factors can hinder accuracy, it is critical to understand the potential influences. Here, we examined how explicit decision-making criteria might affect multiple-target search performance. Non-professional searchers (college undergraduates) and professional searchers (airport security officers) classified trials as 'safe' or 'dangerous', in one of two conditions. Those in the 'one = dangerous' condition classified trials as dangerous if they found one or two targets, and those in the 'one = safe' condition only classified trials as dangerous if they found two targets. The data suggest an important role of context that may be mediated by experience; non-professional searchers were more likely to miss a second target in the one = dangerous condition (i.e., when finding a second found target did not change the classification), whereas professional searchers were more likely to miss a second in the one = safe condition. © 2014 The British Psychological Society.

Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK

PubMed Central

Bevan, Gwyn; Hamblin, Richard

2009-01-01

Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of ‘star rating’, which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries. PMID:19381327

Why are hospital doctors not referring to Consultation-Liaison Psychiatry? - a systemic review.

PubMed

Chen, Kai Yang; Evans, Rebecca; Larkins, Sarah

2016-11-09

Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature. We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included. Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis. This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.

The role of mobile devices in doctor-patient communication: A systematic review and meta-analysis.

PubMed

Kashgary, Abdullah; Alsolaimani, Roaa; Mosli, Mahmoud; Faraj, Samer

2017-09-01

Introduction In the last few years, the use of telecommunication and mobile technology has grown significantly. This has led to a notable increase in the utilization of this telecommunication in healthcare, namely phone calls and text messaging (SMS). However, evaluating its global impact on improving healthcare processes and outcomes demands a more comprehensive assessment. In this study, we focused on the role of mobile devices via phone calls and SMS in patient-doctor communication, and aimed to assess its impact on various health outcomes. Methods Major databases, including MEDLINE, EMBASE, PsycINFO, Global Health, and Cochrane CENTRAL, were searched for clinical trials that investigated mobile-device technology in any facet of doctor-patient communication published between 1990 and April 2015. A meta-analysis was performed where appropriate. Results Sixty-two articles met our inclusion criteria. Of those, 23 articles investigated mobile appointment reminder technologies, 19 investigated medication adherence, 20 investigated disease-control interventions, and two investigated test-result reporting. Patients who received an appointment reminder were 10% less likely to miss an appointment (relative risk [RR] = 1.11, 95% confidence interval [CI] 1.08-1.15). Mobile interventions increased medication adherence by 22% (RR = 1.22, 95% CI 1.09-1.36). Ten of 20 studies examining disease control reported statistically significant reductions in clinically meaningful endpoints. The use of mobile-device interventions improved forced expiratory volume in one second and hemoglobin A1c percentage in meta-analyses. Conclusion The use of mobile-device technologies exerted modest improvements in communication and health outcomes. Further research is needed to determine the true effect of these technologies on doctor-patient communication.

Perceptions of doctors and nurses at a Ugandan hospital regarding the introduction and use of the South African Triage Scale.

PubMed

Mulindwa, Francis; Blitz, Julia

2016-03-29

International Hospital Kampala (IHK) experienced a challenge with how to standardise the triaging and sorting of patients. There was no triage tool to help to prioritise which patients to attend to first, with very sick patient often being missed. To explore whether the introduction of the South African Triage Scale (SATS) was seen as valuable and sustainable by the IHK's outpatient department and emergency unit (OPD and EU) staff. The study used qualitative methods to introduce SATS in the OPD and EU at IHK and to obtain the perceptions of doctors and nurses who had used it for 3-6 months on its applicability and sustainability. Specific questions about challenges faced prior to its introduction, strengths and weaknesses of the triage tool, the impact it had on staff practices, and their recommendations on the continued use of the tool were asked. In-depth interviews were conducted with 4 doctors and 12 nurses. SATS was found to be necessary, applicable and recommended for use in the IHK setting. It improved the sorting of patients, as well as nurse-patient and nurse-doctor communication.The IHK OPD & EU staff attained new skills, with nurses becoming more involved in-patient care. It is possibly also useful in telephone triaging and planning of hospital staffing. Adequate nurse staffing, a computer application for automated coding of patients, and regular training would encourage consistent use and sustainability of SATS. Setting up a hospital committee to review signs and symptoms would increase acceptability and sustainability. SATS is valuable in the IHK setting because it improved overall efficiency of triaging and care, with significantly more strengths than weaknesses.

Antibiotic treatment failure when consulting patients with respiratory tract infections in general practice. A qualitative study to explore Danish general practitioners' perspectives.

PubMed

Bordado Sköld, Margrethe; Aabenhus, Rune; Guassora, Ann Dorrit; Mäkelä, Marjukka

2017-12-01

Prescribing antibiotics for acute respiratory tract infections (RTIs) is common in primary healthcare although most of these infections are of viral origin and antibiotics may not be helpful. Some of these prescriptions will not be associated with a quick recovery, and might be regarded as cases of antibiotic treatment failure (ATF). We studied antibiotic treatment failure in patients with acute RTIs from a general practitioner (GP) perspective, aiming to explore (i) GPs' views of ATF in primary care; (ii) how ATF influences the doctor-patient relationship; and (iii) GPs' understanding of patients' views of ATF. Qualitative study based on semi-structured, recorded interviews of 18 GPs between August and October 2012. The interviews started with discussion of a unique case of acute RTI involving ATF, followed by a more general reflection of the topic. Interviews were analysed using qualitative content analysis. In patients with acute RTIs, GPs proposed and agreed to a medical definition of antibiotic treatment failure but believed patients' views to differ significantly from this medical definition. GPs thought ATF affected their daily work only marginally. GPs used many communicative tools to maintain trust with patients in cases of ATF, but they did not consider such incidents to affect the doctor-patient relationship adversely. These findings suggest a possible communication gap between doctors and patients, partly due to a narrow medical definition of ATF. Studies describing patients' views are still missing. General practitioners' experiences and views on antibiotic treatment failure in acute respiratory infections or its effects on the doctor-patient relationship have not been studied previously.

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia.

PubMed

Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A

2018-01-01

Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia

PubMed Central

Vijay, Aishwarya; Earnshaw, Valerie A.; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M.; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L.

2018-01-01

Abstract Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings. PMID:29227183

A model of service and training: threat assessment on a community college campus.

PubMed

Mrad, David F; Hanigan, Antoni J S; Bateman, Joyce R

2015-02-01

Forensic psychological assessment for targeted violence is a growing area of practice and community need. These threat assessments are particularly challenging on community college campuses given the broad range of students and the limited internal resources. A collaborative model of partnership between a community college and the training clinic of a doctoral program in clinical psychology has been developed and implemented. The model provides needed service to the community college and rich training experiences for doctoral students in psychology. Implementation of similar partnerships in other settings may be limited by the training and experience of doctoral faculty and the openness of behavioral intervention teams to external participants.

Depression in male patients on methadone maintenance therapy.

PubMed

Baharudin, Azlin; Mislan, Noormazita; Ibrahim, Normala; Sidi, Hatta; Nik Jaafar, Nik Ruzyanei

2013-04-01

Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT). A cross-sectional study was conducted involving 108 subjects who attended the Drug Clinic at Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition Axis-I Disorder, Beck Depression Inventory and the 15-item International Index of Erectile Function. The rate of depression was 44.4%. There were significant associations between Malay ethnicity, secondary education level and concurrent illicit cannabis use with depression (P < 0.05). However, there was no significant associations between depression and erectile dysfunction (P = 0.379). Even though depression is common among men on MMT, it is often missed by the treating doctors. It is important to make the treating doctors aware that depression is a serious clinical condition that has a profound impact on the individual and compliance to treatment. Copyright © 2013 Wiley Publishing Asia Pty Ltd.

Representative marketing-oriented study on implants in the Austrian population. I. Level of information, sources of information and need for patient information.

PubMed

Tepper, Gabor; Haas, Robert; Mailath, Georg; Teller, Christoph; Zechner, Werner; Watzak, Georg; Watzek, Georg

2003-10-01

The number of dental implants inserted annually worldwide has been estimated to come close to a million. But the level of information available to patients about realistic, evidence-based treatment options by implants is often enough more than fragmentary, and what is disseminated by the media and the industry does not always reflect evidence-based empirical data. This survey of 1000 adults presented with 18 questions was designed to shed light on several points. These were (1). level of subjective patient information, (2). sources of information and prejudices, (3). future demand for implant treatment and target groups for patient information campaigns, and (4). potential misinformation, information deficits, discrepancies of information and how these come about. Of those questioned, 20% said unprompted that implants were a possibility to replace missing teeth. When prompted, 72% said that they knew about dental implants. Most of those questioned felt poorly informed about the options for replacing missing teeth and many knew less about implants than about other alternatives. The dentist was said to be the desired source of information, but 77% of those questioned reported that their dentists did not practice implant dentistry. More than 79% of those questioned did not know whether their dentist worked with implants. Forty-four percent thought that implants should only be placed by specially trained doctors. Sixty-one percent were of the opinion that dentists who provide implant dentistry were better qualified than their nonimplanting colleagues. Half of those questioned attributed implant failures to allergies and incompatibilities, the other half to poor medical care. Only 29% incriminated poor oral hygiene as a cause of implant failure. Future strategies should be geared to more professional public relations and patient information. Internationally operating qualified implant institutions could contribute much to balance discrepant information.

More Doctors or Better Care?

PubMed Central

Watson, Diane E.; McGrail, Kimberlyn M.

2009-01-01

The Canadian Medical Association's More Doctors, More Care campaign seeks to align physician supply targets with policy decisions elsewhere in the Organisation for Economic Co-operation and Development (OECD). Using OECD data for 19 countries to assess the relationship between physician supply and healthcare outcomes, we have determined that there is no association between avoidable mortality and overall physician supply. Similarly, there is no relationship between avoidable mortality and general practitioners and family physicians per capita, specialists per capita, nurses per capita, doctors and nurses per capita or health expenditures per capita. These findings should move us to recognize that (a) more doctors will not necessarily translate into better healthcare outcomes for Canadians and (b) it is in Canadians' better interests that we instead focus on realizing opportunities to improve access to high-quality care and to ensure that changes in physician turnover do not threaten the current generalist-to-specialist mix. PMID:20676248

A generic discrete-event simulation model for outpatient clinics in a large public hospital.

PubMed

Weerawat, Waressara; Pichitlamken, Juta; Subsombat, Peerapong

2013-01-01

The orthopedic outpatient department (OPD) ward in a large Thai public hospital is modeled using Discrete-Event Stochastic (DES) simulation. Key Performance Indicators (KPIs) are used to measure effects across various clinical operations during different shifts throughout the day. By considering various KPIs such as wait times to see doctors, percentage of patients who can see a doctor within a target time frame, and the time that the last patient completes their doctor consultation, bottlenecks are identified and resource-critical clinics can be prioritized. The simulation model quantifies the chronic, high patient congestion that is prevalent amongst Thai public hospitals with very high patient-to-doctor ratios. Our model can be applied across five different OPD wards by modifying the model parameters. Throughout this work, we show how DES models can be used as decision-support tools for hospital management.

[Intra-moenia: a historical and economical research].

PubMed

Citoni, Guido

2013-01-01

The so called free practice intra-moenia or ALPI (to be performed inside the public premises) is very popular among Italian doctors (quite so among patients). Our work aims to shed light both on true motives of such a success and on the degree of accomplishment of stated targets at its institution. We believe that its success among doctors is due both to the increase in providers' autonomy and to its economic advantages. Freedom of choice for patients is also increased (though just a minority of patients says that they have made recourse to intra-moenia because they wanted to choose the doctor). The reduction of queues, one of the stated targets of ALPI, did not happen (as could be anticipated). Intra-moenia may cause, moreover, induction of demand and defensive medicine. A regression analysis shows that the main explanatory factor of the recourse to ALPI is urgent need for treatment. The work, finally, in noting that there is a lack of sufficient administrative controls on ALPI, concludes that intra-moenia is hopefully a viable institution provided that more checks are done.

Effects of Response Bias and Judgment Framing on Operator Use of an Automated Aid in a Target Detection Task

ERIC Educational Resources Information Center

Rice, Stephen; McCarley, Jason S.

2011-01-01

Automated diagnostic aids prone to false alarms often produce poorer human performance in signal detection tasks than equally reliable miss-prone aids. However, it is not yet clear whether this is attributable to differences in the perceptual salience of the automated aids' misses and false alarms or is the result of inherent differences in…

The role of mirror neurons in language acquisition and evolution.

PubMed

Behme, Christina

2014-04-01

I argue that Cook et al.'s attack of the genetic hypothesis of mirror neurons misses its target because the authors miss the point that genetics may specify how neurons may learn, not what they learn. Paying more attention to recent work linking mirror neurons to language acquisition and evolution would strengthen Cook et al.'s arguments against a rigid genetic hypothesis.

Ambulant Measurements of Physiological Status and Cognitive Performance during Sustained Operations

DTIC Science & Technology

2009-10-01

the target, reaction time, illegal responses, and missed responses were recorded. 2.4 Physiological measurements 2.4.1 Anthropometry ...system (SPi-Elite, GPsports Australia ) was mounted on the soldiers’ backpack. The system measured continuously during the training weeks. Walking or...the percentage missed stimuli were even more alike. 3.3 Physiological measurements 3.3.1 Anthropometry The soldiers who completed the training

Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study.

PubMed Central

Grover, S. A.; Lowensteyn, I.; Esrey, K. L.; Steinert, Y.; Joseph, L.; Abrahamowicz, M.

1995-01-01

OBJECTIVE--To evaluate the ability of doctors in primary care to assess risk patients' risk of coronary heart disease. DESIGN--Questionnaire survey. SETTING--Continuing medical education meetings, Ontario and Quebec, Canada. SUBJECTS--Community based doctors who agreed to enroll in the coronary health assessment study. MAIN OUTCOME MEASURE--Ratings of coronary risk factors and estimates by doctors of relative and absolute coronary risk of two hypothetical patients and the "average" 40 year old Canadian man and 70 year old Canadian woman. RESULTS--253 doctors answered the questionnaire. For 30 year olds the doctors rated cigarette smoking as the most important risk factor and raised serum triglyceride concentrations as the least important; for 70 year old patients they rated diabetes as the most important risk factor and raised serum triglyceride concentrations as the least important. They rated each individual risk factor as significantly less important for 70 year olds than for 30 year olds (all risk factors, P < 0.001). They showed a strong understanding of the relative importance of specific risk factors, and most were confident in their ability to estimate coronary risk. While doctors accurately estimated the relative risk of a specific patient (compared with the average adult) they systematically overestimated the absolute baseline risk of developing coronary disease and the risk reductions associated with specific interventions. CONCLUSIONS--Despite guidelines on targeting patients at high risk of coronary disease accurate assessment of coronary risk remains difficult for many doctors. Additional strategies must be developed to help doctors to assess better their patients' coronary risk. PMID:7728035

Pattern masking: the importance of remote spatial frequencies and their phase alignment.

PubMed

Huang, Pi-Chun; Maehara, Goro; May, Keith A; Hess, Robert F

2012-02-16

To assess the effects of spatial frequency and phase alignment of mask components in pattern masking, target threshold vs. mask contrast (TvC) functions for a sine-wave grating (S) target were measured for five types of mask: a sine-wave grating (S), a square-wave grating (Q), a missing fundamental square-wave grating (M), harmonic complexes consisting of phase-scrambled harmonics of a square wave (Qp), and harmonic complexes consisting of phase-scrambled harmonics of a missing fundamental square wave (Mp). Target and masks had the same fundamental frequency (0.46 cpd) and the target was added in phase with the fundamental frequency component of the mask. Under monocular viewing conditions, the strength of masking depends on phase relationships among mask spatial frequencies far removed from that of the target, at least 3 times the target frequency, only when there are common target and mask spatial frequencies. Under dichoptic viewing conditions, S and Q masks produced similar masking to each other and the phase-scrambled masks (Qp and Mp) produced less masking. The results suggest that pattern masking is spatial frequency broadband in nature and sensitive to the phase alignments of spatial components.

Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings.

PubMed

Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto

2014-01-01

Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

Found and Missed: Failing to Recognize a Search Target despite Moving It

ERIC Educational Resources Information Center

Solman, Grayden J. F.; Cheyne, J. Allan; Smilek, Daniel

2012-01-01

We present results from five search experiments using a novel "unpacking" paradigm in which participants use a mouse to sort through random heaps of distractors to locate the target. We report that during this task participants often fail to recognize the target despite moving it, and despite having looked at the item. Additionally, the missed…

Exoatmospheric intercepts using zero effort miss steering for midcourse guidance

NASA Astrophysics Data System (ADS)

Newman, Brett

The suitability of proportional navigation, or an equivalent zero effort miss formulation, for exatmospheric intercepts during midcourse guidance, followed by a ballistic coast to the endgame, is addressed. The problem is formulated in terms of relative motion in a general, three dimensional framework. The proposed guidance law for the commanded thrust vector orientation consists of the sum of two terms: (1) along the line of sight unit direction and (2) along the zero effort miss component perpendicular to the line of sight and proportional to the miss itself and a guidance gain. If the guidance law is to be suitable for longer range targeting applications with significant ballistic coasting after burnout, determination of the zero effort miss must account for the different gravitational accelerations experienced by each vehicle. The proposed miss determination techniques employ approximations for the true differential gravity effect and thus, are less accurate than a direct numerical propagation of the governing equations, but more accurate than a baseline determination, which assumes equal accelerations for both vehicles. Approximations considered are constant, linear, quadratic, and linearized inverse square models. Theoretical results are applied to a numerical engagement scenario and the resulting performance is evaluated in terms of the miss distances determined from nonlinear simulation.

Students learning from patients: let's get real in medical education.

PubMed

Bleakley, Alan; Bligh, John

2008-03-01

Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient's care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of communication skills and empathy within a broad 'professionalism' framework. Paradoxically, while aiming to strengthen patient-student interactions, this approach tends to refocus on the role modelling of the physician, and opportunities for potentially deep collaborative working relationships between students and patients are missed. A radical overhaul of conventional doctor-led medical education may be necessary, that also challenges the orthodoxies of individualistic student-centred approaches, leading to an authentic patient-centred model that shifts the locus of learning from the relationship between doctor as educator and student to the relationship between patient and student, with expert doctor as resource. Drawing on contemporary poststructuralist theory of text and identity construction, and on innovative models of work-based learning, the potential quality of relationship between student and patient is articulated in terms of collaborative knowledge production, involving close reading with the patient as text, through dialogue. Here, a medical 'education' displaces traditional forms of medical 'training' that typically involve individual information reproduction. Students may, paradoxically, improve clinical acumen through consideration of silences, gaps, and contradictions in patients as texts, rather than treating communication as transparent. Such paradoxical effects have been systematically occluded or denied in traditional medical education.

Medical students' experiences with medical errors: an analysis of medical student essays.

PubMed

Martinez, William; Lo, Bernard

2008-07-01

This study aimed to examine medical students' experiences with medical errors. In 2001 and 2002, 172 fourth-year medical students wrote an anonymous description of a significant medical error they had witnessed or committed during their clinical clerkships. The assignment represented part of a required medical ethics course. We analysed 147 of these essays using thematic content analysis. Many medical students made or observed significant errors. In either situation, some students experienced distress that seemingly went unaddressed. Furthermore, this distress was sometimes severe and persisted after the initial event. Some students also experienced considerable uncertainty as to whether an error had occurred and how to prevent future errors. Many errors may not have been disclosed to patients, and some students who desired to discuss or disclose errors were apparently discouraged from doing so by senior doctors. Some students criticised senior doctors who attempted to hide errors or avoid responsibility. By contrast, students who witnessed senior doctors take responsibility for errors and candidly disclose errors to patients appeared to recognise the importance of honesty and integrity and said they aspired to these standards. There are many missed opportunities to teach students how to respond to and learn from errors. Some faculty members and housestaff may at times respond to errors in ways that appear to contradict professional standards. Medical educators should increase exposure to exemplary responses to errors and help students to learn from and cope with errors.

Emergency supply of doctors by the Mais Médicos (More Doctors) Program and the quality of the structure of primary health care facilities.

PubMed

Giovanella, Ligia; Mendonça, Maria Helena Magalhães de; Fausto, Marcia Cristina Rodrigues; Almeida, Patty Fidelis de; Bousquat, Aylene; Lima, Juliana Gagno; Seidl, Helena; Franco, Cassiano Mendes; Fusaro, Edgard Rodrigues; Almeida, Sueli Zeferino Ferreira

2016-09-01

The health policy context in Brazil has featured a series of measures to improve primary health care (PHC), including a national access and quality improvement program (Programa Nacional de Melhoria do Acesso e Qualidade, PMAQ-AB) and the Mais Médicos Program (More Doctors, PMM) and upgrading PHC centers ('Requalifica UBS'). The paper examines the PMM's placement of doctors, by quality of PHC structure, in an endeavor to identify synergies among the three programs. It reports on a transverse study based on secondary data from PMAQ-AB Cycles 1 and 2, the PMM and 'Requalifica UBS'. The PHC facilities inventoried during PMAQ-AB Cycle 1 were classified, on pre-established typology, into five groups ranked from A (best) to E (failed). They were then compared in terms of PMM personnel allocated and Requalifica UBS proposals. The results point to convergences in investments by the three programs. Incentives targeted predominantly PHC facilities of types B and C, indicating a concentration of efforts on PHC facilities with potential for structural quality improvements. In addition to expanding access, the provision of doctors by the PMM, added to infrastructure upgrades and work process improvements, contributes to addressing high turnover and guaranteeing retention of doctors in PHC.

Evaluation of doctoral nursing programs in Japan by faculty members and their educational and research activities.

PubMed

Arimoto, Azusa; Gregg, Misuzu F; Nagata, Satoko; Miki, Yuko; Murashima, Sachiyo

2012-07-01

Evaluation of doctoral programs in nursing is becoming more important with the rapid increase in the programs in Japan. This study aimed to evaluate doctoral nursing programs by faculty members and to analyze the relationship of the evaluation with educational and research activities of faculty members in Japan. Target settings were all 46 doctoral nursing programs. Eighty-five faculty members from 28 programs answered the questionnaire, which included 17 items for program evaluation, 12 items for faculty evaluation, 9 items for resource evaluation, 3 items for overall evaluations, and educational and research activities. A majority gave low evaluations for sources of funding, the number of faculty members and support staff, and administrative systems. Faculty members who financially supported a greater number of students gave a higher evaluation for extramural funding support, publication, provision of diverse learning experiences, time of supervision, and research infrastructure. The more time a faculty member spent on advising doctoral students, the higher were their evaluations on the supportive learning environment, administrative systems, time of supervision, and timely feedback on students' research. The findings of this study indicate a need for improvement in research infrastructure, funding sources, and human resources to achieve quality nursing doctoral education in Japan. Copyright © 2011 Elsevier Ltd. All rights reserved.

Addressing the unequal geographic distribution of specialist doctors in indonesia: the role of the private sector and effectiveness of current regulations.

PubMed

Meliala, Andreasta; Hort, Krishna; Trisnantoro, Laksono

2013-04-01

As in many countries, the geographic distribution of the health workforce in Indonesia is unequal, with a concentration in urban and more developed areas, and a scarcity in rural and remote areas. There is less information on the distribution of specialist doctors, yet inequalities in their distribution could compromise efforts to achieve universal coverage by 2014. This paper uses data from 2007 and 2008 to describe the geographic distribution of specialist doctors in Indonesia, and to examine two key factors that influence the distribution and are targets of current policies: sources of income for specialist doctors, and specialist doctor engagement in private practice. The data demonstrates large differences in the ratio of specialist doctors to population among the provinces of Indonesia, with higher ratios on the provinces of the islands of Java, and much lower ratios on the more remote provinces in eastern Indonesia. Between 65% and 80% of specialist doctors' income derives from private practice in non-state hospitals or private clinics. Despite regulations limiting practice locations to three, most specialists studied in a provincial capital city were working in more than three locations, with some working in up to 7 locations, and spending only a few hours per week in their government hospital practice. Our study demonstrates that the current regulatory policies and financial incentives have not been effective in addressing the maldistribution of specialist doctors in a context of a growing private sector and predominance of doctors' income from private sources. A broader and more integrated policy approach, including more innovative service delivery strategies for rural and remote areas, is recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.

A survey of pharmaceutical company representative interactions with doctors in Libya

PubMed Central

Alssageer, Mustafa A.; Kowalski, Stefan R.

2012-01-01

Objectives To examine the frequency of pharmaceutical company representative (PCR) interactions with doctors in Libya and review possible associations between these interactions and the personal and practice setting characteristics of doctors. Method An anonymous survey questionnaire was circulated to 1,000 Libyan doctors in selected public and private practice settings in Tripoli, Benghazi and Sebha. Results A questionnaire return rate of 61% (608 returned questionnaires) was achieved. Most respondents (94%) reported that they had been visited by PCRs at least ‘once’ in the last year. Fifty per cent of respondents met with PCRs at least once a month, and 20% at least once a week. The following characteristics were significantly associated with meeting with a representative more than once a week: age, gender (male > female), years of practice, being a specialist (other than an anaesthesiologist) or working in private practice. Ninety-one per cent of doctors reported that they had received at least one kind of relationship gift during the last year. Printed materials (79%), simple gifts (73%) and drug samples (69%) were the most common relationship products given to respondents. Reimbursements or sponsored items were reported by 33% of respondents. Physician specialists were more likely to receive drug samples or sponsored items than residents, general practitioners, anaesthesiologists or surgeons (P<0.01). Participants working in private practice alone or in both sectors were more likely to receive printed materials, simple gifts or free samples from PCRs than doctors working in the public sector (P<0.05). Conclusion Libyan doctors are frequently visited by PCRs. Doctors, working in private practice or specialist practice, are especially targeted by promotional activities. An agreed code of conduct for pharmaceutical promotion in Libya between doctors and PCRs should be created. PMID:23002397

Examining perceptual and conceptual set biases in multiple-target visual search.

PubMed

Biggs, Adam T; Adamo, Stephen H; Dowd, Emma Wu; Mitroff, Stephen R

2015-04-01

Visual search is a common practice conducted countless times every day, and one important aspect of visual search is that multiple targets can appear in a single search array. For example, an X-ray image of airport luggage could contain both a water bottle and a gun. Searchers are more likely to miss additional targets after locating a first target in multiple-target searches, which presents a potential problem: If airport security officers were to find a water bottle, would they then be more likely to miss a gun? One hypothetical cause of multiple-target search errors is that searchers become biased to detect additional targets that are similar to a found target, and therefore become less likely to find additional targets that are dissimilar to the first target. This particular hypothesis has received theoretical, but little empirical, support. In the present study, we tested the bounds of this idea by utilizing "big data" obtained from the mobile application Airport Scanner. Multiple-target search errors were substantially reduced when the two targets were identical, suggesting that the first-found target did indeed create biases during subsequent search. Further analyses delineated the nature of the biases, revealing both a perceptual set bias (i.e., a bias to find additional targets with features similar to those of the first-found target) and a conceptual set bias (i.e., a bias to find additional targets with a conceptual relationship to the first-found target). These biases are discussed in terms of the implications for visual-search theories and applications for professional visual searchers.

Miss-distance indicator for tank main gun systems

NASA Astrophysics Data System (ADS)

Bornstein, Jonathan A.; Hillis, David B.

1994-07-01

The initial development of a passive, automated system to track bullet trajectories near a target to determine the `miss distance,' and the corresponding correction necessary to bring the following round `on target' is discussed. The system consists of a visible wavelength CCD sensor, long focal length optics, and a separate IR sensor to detect the muzzle flash of the firing event; this is coupled to a `PC' based image processing and automatic tracking system designed to follow the projectile trajectory by intelligently comparing frame to frame variation of the projectile tracer image. An error analysis indicates that the device is particularly sensitive to variation of the projectile time of flight to the target, and requires development of algorithms to estimate this value from the 2D images employed by the sensor to monitor the projectile trajectory. Initial results obtained by using a brassboard prototype to track training ammunition are promising.

Using a Treat-to-Target Management Strategy to Improve the Doctor-Patient Relationship in Inflammatory Bowel Disease.

PubMed

Rubin, David T; Krugliak Cleveland, Noa

2015-09-01

The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.

Predictors of missed appointments in patients referred for congenital or pediatric cardiac magnetic resonance.

PubMed

Lu, Jimmy C; Lowery, Ray; Yu, Sunkyung; Ghadimi Mahani, Maryam; Agarwal, Prachi P; Dorfman, Adam L

2017-07-01

Congenital cardiac magnetic resonance is a limited resource because of scanner and physician availability. Missed appointments decrease scheduling efficiency, have financial implications and represent missed care opportunities. To characterize the rate of missed appointments and identify modifiable predictors. This single-center retrospective study included all patients with outpatient congenital or pediatric cardiac MR appointments from Jan. 1, 2014, through Dec. 31, 2015. We identified missed appointments (no-shows or same-day cancellations) from the electronic medical record. We obtained demographic and clinical factors from the medical record and assessed socioeconomic factors by U.S. Census block data by patient ZIP code. Statistically significant variables (P<0.05) were included into a multivariable analysis. Of 795 outpatients (median age 18.5 years, interquartile range 13.4-27.1 years) referred for congenital cardiac MR, a total of 91 patients (11.4%) missed appointments; 28 (3.5%) missed multiple appointments. Reason for missed appointment could be identified in only 38 patients (42%), but of these, 28 (74%) were preventable or could have been identified prior to the appointment. In multivariable analysis, independent predictors of missed appointments were referral by a non-cardiologist (adjusted odds ratio [AOR] 5.8, P=0.0002), referral for research (AOR 3.6, P=0.01), having public insurance (AOR 2.1, P=0.004), and having scheduled cardiac MR from November to April (AOR 1.8, P=0.01). Demographic factors can identify patients at higher risk for missing appointments. These data may inform initiatives to limit missed appointments, such as targeted education of referring providers and patients. Further data are needed to evaluate the efficacy of potential interventions.

Identification and Validation of Human Missing Proteins and Peptides in Public Proteome Databases: Data Mining Strategy.

PubMed

Elguoshy, Amr; Hirao, Yoshitoshi; Xu, Bo; Saito, Suguru; Quadery, Ali F; Yamamoto, Keiko; Mitsui, Toshiaki; Yamamoto, Tadashi

2017-12-01

In an attempt to complete human proteome project (HPP), Chromosome-Centric Human Proteome Project (C-HPP) launched the journey of missing protein (MP) investigation in 2012. However, 2579 and 572 protein entries in the neXtProt (2017-1) are still considered as missing and uncertain proteins, respectively. Thus, in this study, we proposed a pipeline to analyze, identify, and validate human missing and uncertain proteins in open-access transcriptomics and proteomics databases. Analysis of RNA expression pattern for missing proteins in Human protein Atlas showed that 28% of them, such as Olfactory receptor 1I1 ( O60431 ), had no RNA expression, suggesting the necessity to consider uncommon tissues for transcriptomic and proteomic studies. Interestingly, 21% had elevated expression level in a particular tissue (tissue-enriched proteins), indicating the importance of targeting such proteins in their elevated tissues. Additionally, the analysis of RNA expression level for missing proteins showed that 95% had no or low expression level (0-10 transcripts per million), indicating that low abundance is one of the major obstacles facing the detection of missing proteins. Moreover, missing proteins are predicted to generate fewer predicted unique tryptic peptides than the identified proteins. Searching for these predicted unique tryptic peptides that correspond to missing and uncertain proteins in the experimental peptide list of open-access MS-based databases (PA, GPM) resulted in the detection of 402 missing and 19 uncertain proteins with at least two unique peptides (≥9 aa) at <(5 × 10 -4 )% FDR. Finally, matching the native spectra for the experimentally detected peptides with their SRMAtlas synthetic counterparts at three transition sources (QQQ, QTOF, QTRAP) gave us an opportunity to validate 41 missing proteins by ≥2 proteotypic peptides.

Missing links between histones and RNA Pol II arising from SAND?

USDA-ARS?s Scientific Manuscript database

Eukaryotic SAND domain-containing proteins bind DNA and are implicated in direct target gene activation and chromatin-mediated gene regulation. We summarize our recent results demonstrating that the Arabidopsis SAND domain protein ULTRAPETALA1 (ULT1) plays a key role in counteracting target gene rep...

Using administrative claims to identify children with chronic conditions in a statewide immunization registry.

PubMed

Dombkowski, Kevin J; Costello, Lauren; Dong, Shiming; Clark, Sarah J

2014-05-01

To demonstrate the feasibility and utility of using administrative claims data from commercial health plans to establish a high-risk indicator in a statewide immunization registry for enrollees with chronic conditions. Retrospective cohort analysis. Administrative data were used to identify children with 1 or more chronic conditions enrolled in 2 commercial health plans during the 2008-2009 and 2009-2010 influenza seasons and matched with a statewide immunization registry. The proportion of cases that successfully matched and historical health services utilization, including influenza vaccinations and missed opportunities, were assessed. A total of 93% of children with chronic conditions identified through administrative claims were successfully matched with the statewide registry. Less than one-third of children received the seasonal influenza vaccine in either the 2008-2009 (29%) or 2009-2010 (32%) seasons; 30% of children received the H1N1 vaccination in 2009-2010. Most children in the 2008-2009 (63%) and 2009-2010 (63%) seasons had at least 1 missed opportunity for seasonal influenza vaccination. Younger children had the highest percentage of missed opportunities while adolescents had the lowest rate of missed opportunities for vaccination. Conclusions It is feasible to identify children with chronic conditions using administrative data and to link them with a statewide immunization registry. Low influenza vaccination rates and high occurrences of missed opportunities among children with chronic conditions suggest the utility of integrating administrative claims data with statewide registries to support various outreach mechanisms, including physician-focused and parent-targeted reminder/recall, based on target age to improve vaccination rates.

Search for Invisible Decays of Sub-GeV Dark Photons in Missing-Energy Events at the CERN SPS.

PubMed

Banerjee, D; Burtsev, V; Cooke, D; Crivelli, P; Depero, E; Dermenev, A V; Donskov, S V; Dubinin, F; Dusaev, R R; Emmenegger, S; Fabich, A; Frolov, V N; Gardikiotis, A; Gninenko, S N; Hösgen, M; Kachanov, V A; Karneyeu, A E; Ketzer, B; Kirpichnikov, D V; Kirsanov, M M; Kovalenko, S G; Kramarenko, V A; Kravchuk, L V; Krasnikov, N V; Kuleshov, S V; Lyubovitskij, V E; Lysan, V; Matveev, V A; Mikhailov, Yu V; Myalkovskiy, V V; Peshekhonov, V D; Peshekhonov, D V; Petuhov, O; Polyakov, V A; Radics, B; Rubbia, A; Samoylenko, V D; Tikhomirov, V O; Tlisov, D A; Toropin, A N; Trifonov, A Yu; Vasilishin, B; Vasquez Arenas, G; Ulloa, P; Zhukov, K; Zioutas, K

2017-01-06

We report on a direct search for sub-GeV dark photons (A^{'}), which might be produced in the reaction e^{-}Z→e^{-}ZA^{'} via kinetic mixing with photons by 100 GeV electrons incident on an active target in the NA64 experiment at the CERN SPS. The dark photons would decay invisibly into dark matter particles resulting in events with large missing energy. No evidence for such decays was found with 2.75×10^{9} electrons on target. We set new limits on the γ-A^{'} mixing strength and exclude the invisible A^{'} with a mass ≲100  MeV as an explanation of the muon g_{μ}-2 anomaly.

Investigation of Hong Kong doctors' current knowledge, beliefs, attitudes, confidence and practices: implications for the treatment of tobacco dependency.

PubMed

Abdullah, Abu Saleh M; Rahman, A S M Mujibur; Suen, Chau Wai; Wing, Lau Sun; Ling, Lau Wai; Mei, Li Yuen; Tat, Lun Chung; Tai, Mak Nin; Wing, Tsai Nga; Yuen, Wu Tsz; Kwan, Yam H

2006-10-01

Physicians play a crucial role in promoting smoking cessation. However, there are lack of data on Chinese doctors' knowledge, beliefs, attitudes, confidence and usual practices in relation to smoking cessation. Understanding of these indicators is important in the design of any effective intervention program targeting doctors. To assess Chinese doctors' knowledge, beliefs, attitudes, confidence and usual practices in relation to smoking cessation, a mailed questionnaire survey was conducted among 4,000 doctors registered with the Hong Kong Medical Association (HKMA) in 2002. Of the 757 respondents (18.9% response rate), 78% were male, 94% were non-smokers and 50% had received no basic training on smoking cessation. More than half of the doctors did not hold adequate knowledge (53%) or favorable attitudes (55%) towards smoking cessation; 44% were less confident in their smoking cessation skills. About 77% of the doctors obtained information on their patients' smoking status and recorded it in their medical record, and 29% advised all smoking patients to quit. Doctors who gave smoking cessation advice were more likely to be aged above 50 years, with more than 30 years' practice experience, working in the private sector, non- or ex-smokers, with more positive beliefs towards smoking cessation, and with higher confidence in smoking cessation skills (p < 0.001). Different factors associated with establishing and recording smoking status, arranging follow-up sessions, acquiring more knowledge and developing a more favorable attitude and greater confidence on smoking cessation-related matters were also identified. The survey has shown that existing smoking cessation service provision in Hong Kong for patients who smoke is inadequate, and has identified a lack of smoking cessation skills among doctors. Action should be taken to train doctors in smoking cessation skills and encourage them to routinely establish the smoking status of their patients and to advise all smokers to quit smoking.

A qualitative study of GP, nurse and practice manager views on using targeted case-finding to identify patients with COPD in primary care.

PubMed

Summers, Rachael H; Sharmeen, Taniya; Lippiett, Kate; Gillett, Kate; Astles, Carla; Vu, Linh; Stafford-Watson, Mark; Bruton, Anne; Thomas, Mike; Wilkinson, Tom

2017-08-29

'Finding the missing millions' with chronic obstructive pulmonary disease became part of the Department of Health strategy for England in 2010. Targeted case-finding within primary care is one potential pro-active strategy, but currently little is known about the views of healthcare professionals on this approach. In this study, 36 healthcare professionals (12 GPs, 14 nurses, and 10 practice managers) from 34 UK practices participated in semi-structured telephone interviews about targeted case-finding. Interviews followed an interview guide, were audio-recorded, transcribed verbatim, coded and analysed using 'Framework Approach'. Most of those interviewed practiced opportunistic case-finding. The main perceived barriers to wider case-finding programmes were the resource implications associated with running such programmes and identifying more chronic obstructive pulmonary disease patients. Financial incentives, support from specialist clinicians, and comprehensive guidance were viewed as facilitators. While targeted case-finding is conceptually accepted by primary care staff, scepticism surrounding (1) the value of identifying those with mild disease and (2) the availability of effective targeted case-finding methods, may lead some to favour an opportunistic approach. Key concerns were a lack of unequivocal evidence for the relative benefits vs. disadvantages of diagnosing patients earlier, and resource constraints in an already over-burdened system. Barriers to practical implementation of case-finding studies may be addressed with financial, human and educational resources, such as additional staff to undertake searches and perform spirometry tests, and practical and educational support from specialist teams. SUPPORT NEEDED TO IDENTIFY THOSE UNDIAGNOSED: Additional staff and resources would facilitate targeted searches for patients showing symptoms of early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) costs the UK economy billions of pounds each year, yet disparate symptoms mean patients aren't always diagnosed in the early, treatable stages of the disease. Recent guidelines suggest introducing 'targeted case-finding', where symptomatic patients with known risk factors are identified and approached for testing by doctors. Rachael Summers and colleagues at the University of Southampton analyzed the opinions of healthcare professionals on implementing targeted case-finding in primary care. While most of the 36 professionals interviewed agreed that diagnosing COPD earlier had clear benefits, concerns were raised regarding negative patient responses and increased stress for patients, alongside the added strain on already stretched resources. Employing independent staff and enhancing resources may facilitate such a program.

Mining Missing Hyperlinks from Human Navigation Traces: A Case Study of Wikipedia.

PubMed

West, Robert; Paranjape, Ashwin; Leskovec, Jure

Hyperlinks are an essential feature of the World Wide Web. They are especially important for online encyclopedias such as Wikipedia: an article can often only be understood in the context of related articles, and hyperlinks make it easy to explore this context. But important links are often missing, and several methods have been proposed to alleviate this problem by learning a linking model based on the structure of the existing links. Here we propose a novel approach to identifying missing links in Wikipedia. We build on the fact that the ultimate purpose of Wikipedia links is to aid navigation. Rather than merely suggesting new links that are in tune with the structure of existing links, our method finds missing links that would immediately enhance Wikipedia's navigability. We leverage data sets of navigation paths collected through a Wikipedia-based human-computation game in which users must find a short path from a start to a target article by only clicking links encountered along the way. We harness human navigational traces to identify a set of candidates for missing links and then rank these candidates. Experiments show that our procedure identifies missing links of high quality.

Mining Missing Hyperlinks from Human Navigation Traces: A Case Study of Wikipedia

PubMed Central

West, Robert; Paranjape, Ashwin; Leskovec, Jure

2015-01-01

Hyperlinks are an essential feature of the World Wide Web. They are especially important for online encyclopedias such as Wikipedia: an article can often only be understood in the context of related articles, and hyperlinks make it easy to explore this context. But important links are often missing, and several methods have been proposed to alleviate this problem by learning a linking model based on the structure of the existing links. Here we propose a novel approach to identifying missing links in Wikipedia. We build on the fact that the ultimate purpose of Wikipedia links is to aid navigation. Rather than merely suggesting new links that are in tune with the structure of existing links, our method finds missing links that would immediately enhance Wikipedia's navigability. We leverage data sets of navigation paths collected through a Wikipedia-based human-computation game in which users must find a short path from a start to a target article by only clicking links encountered along the way. We harness human navigational traces to identify a set of candidates for missing links and then rank these candidates. Experiments show that our procedure identifies missing links of high quality. PMID:26634229

Effect of missing data on multitask prediction methods.

PubMed

de la Vega de León, Antonio; Chen, Beining; Gillet, Valerie J

2018-05-22

There has been a growing interest in multitask prediction in chemoinformatics, helped by the increasing use of deep neural networks in this field. This technique is applied to multitarget data sets, where compounds have been tested against different targets, with the aim of developing models to predict a profile of biological activities for a given compound. However, multitarget data sets tend to be sparse; i.e., not all compound-target combinations have experimental values. There has been little research on the effect of missing data on the performance of multitask methods. We have used two complete data sets to simulate sparseness by removing data from the training set. Different models to remove the data were compared. These sparse sets were used to train two different multitask methods, deep neural networks and Macau, which is a Bayesian probabilistic matrix factorization technique. Results from both methods were remarkably similar and showed that the performance decrease because of missing data is at first small before accelerating after large amounts of data are removed. This work provides a first approximation to assess how much data is required to produce good performance in multitask prediction exercises.

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

Morin, R

The Medical Physics community lost one of its prominent leaders in April, 2013 with the passing of Donald D. Tolbert, PhD. He received his Doctorate at the University of Kansas followed by post Doctoral training at Florida State University and the University of Wisconsin. He was Chief of Radiation Therapy Medical Physics at the University of Wisconsin Hospital for 7 years before relocating to Honolulu Hawaii, where he founded the consulting group Mid-Pacific Medical Physics. Don was a leader in both the AAPM and the ACR, chairing the Professional Council and the Commission on Medical Physics. He was active onmore » the AAPM Board of Directors and a member of the ACR Board of Chancellors. Dr. Tolbert's approach to the difficult problems of the times was admired and respected by colleagues in Medical Physics, Radiation Oncology, and Diagnostic Radiology. He always rose above the heated political rhetoric and led the discussion to higher ground. His wisdom was continually sought to solve complicated problems. Following retirement, he returned to homes in Kansas and Colorado, devoting his time to writing about coping with diabetes and providing support for Seniors in Beloit Kansas. Don is survived by his wife, Mattie, his 3 children and 5 grandchildren. He will be greatly missed.« less

Review of registration requirements for new part-time doctors in New Zealand, Australia, the United Kingdom, Ireland and Canada.

PubMed

Leitch, Sharon; Dovey, Susan M

2010-12-01

By the time medical students graduate many wish to work part-time while accommodating other lifestyle interests. To review flexibility of medical registration requirements for provisional registrants in New Zealand, Australia, the United Kingdom, Ireland and Canada. Internet-based review of registration bodies of each country, and each state or province in Australia and Canada, supplemented by emails and phone calls seeking clarification of missing or obscure information. Data from 20 regions were examined. Many similarities were found between study countries in their approaches to the registration of new doctors, although there are some regional differences. Most regions (65%) have a provisional registration period of one year. Extending this period was possible in 91% of regions. Part-time options were possible in 75% of regions. All regions required trainees to work in approved practice settings. Only the UK provided comprehensive documentation of their requirements in an accessible format and clearly explaining the options for part-time work. Australia appeared to be more flexible than other countries with respect to part- and full-time work requirements. All countries need to examine their registration requirements to introduce more flexibility wherever possible, as a strategy for addressing workforce shortages.

Failures of Perception in the Low-Prevalence Effect: Evidence From Active and Passive Visual Search

PubMed Central

Hout, Michael C.; Walenchok, Stephen C.; Goldinger, Stephen D.; Wolfe, Jeremy M.

2017-01-01

In visual search, rare targets are missed disproportionately often. This low-prevalence effect (LPE) is a robust problem with demonstrable societal consequences. What is the source of the LPE? Is it a perceptual bias against rare targets or a later process, such as premature search termination or motor response errors? In 4 experiments, we examined the LPE using standard visual search (with eye tracking) and 2 variants of rapid serial visual presentation (RSVP) in which observers made present/absent decisions after sequences ended. In all experiments, observers looked for 2 target categories (teddy bear and butterfly) simultaneously. To minimize simple motor errors, caused by repetitive absent responses, we held overall target prevalence at 50%, with 1 low-prevalence and 1 high-prevalence target type. Across conditions, observers either searched for targets among other real-world objects or searched for specific bears or butterflies among within-category distractors. We report 4 main results: (a) In standard search, high-prevalence targets were found more quickly and accurately than low-prevalence targets. (b) The LPE persisted in RSVP search, even though observers never terminated search on their own. (c) Eye-tracking analyses showed that high-prevalence targets elicited better attentional guidance and faster perceptual decisions. And (d) even when observers looked directly at low-prevalence targets, they often (12%–34% of trials) failed to detect them. These results strongly argue that low-prevalence misses represent failures of perception when early search termination or motor errors are controlled. PMID:25915073

Can we prevent doctors being complicit in torture? Breaking the serpent's egg.

PubMed

O'Connor, Mike

2009-12-01

A significant minority of the tortured prisoners who survive report that a doctor was present during their torture. Yet few medical practitioners are ever criminally prosecuted or even disciplined by their regulatory bodies. Can such gross violations of the Hippocratic Code be so easily ignored or are these doctors carefully shielded from detection and prosecution by a grateful state? Mostly doctors act to vet prisoners for their capacity to withstand the torture or resuscitate them to allow torture and interrogation to continue. However, on occasion, the "healers" may be the actual torturers as happened in Russian psychoprisons in the latter part of the 20th century. This article argues that the de facto immunity which complicit doctors currently appear to enjoy must be stripped away and replaced by effective processes to detect and then prosecute criminal behaviour. This will require widespread reporting of cases and action by international bodies, including non-government organisations. Prevention is clearly preferable and this will require improvements in undergraduate and graduate medical education about international humanitarian and human rights law. There is evidence that many medical faculties pay scant attention to this education and their students graduate with serious flaws in their understanding and attitudes towards human rights. Education should target "doctors at risk" in prisons, armed forces and the police. It should address professional behaviour which tolerates or even protects cultures of abuse. A code of professional conduct would assist "doctors at risk" to resist overtures for them to become complicit in torture, Medical Practice Acts should include statements on respecting human rights when defining good professional conduct. Doctors who become complicit in torture betray their profession. Swift action should be taken to stop such abuses and perpetrators should receive strong disciplinary action from regulatory bodies.

Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data.

PubMed

Kepka, Deanna; Spigarelli, Michael G; Warner, Echo L; Yoneoka, Yukiko; McConnell, Nancy; Balch, Alfred

2016-12-01

Human papillomavirus (HPV) vaccine 3-dose completion rates among adolescent females in the US are low. Missed opportunities impede HPV vaccination coverage. A population-based secondary data analysis of de-identified vaccination and demographic data from the Utah Statewide Immunization Information System (USIIS) was conducted. Records were included from 25,866 females ages 11-26 years at any time during 2008-2012 who received at least one of the following adolescent vaccinations documented in the USIIS: Tdap (Tetanus, Diphtheria, Pertussis), meningococcal, and/or influenza. A missed opportunity for HPV vaccination was defined as a clinical encounter where the patient received at least one adolescent vaccination, but not a HPV vaccine. Of 47,665 eligible visits, there were 20,911 missed opportunities (43.87%). Age group, race/ethnicity, and rurality were significantly associated with missed opportunity (p<0.0001). In a multivariable mixed-effects logistic regression model that included ethnicity, location and age, as fixed effects and subject as a random effect, Hispanics were less likely to have a missed opportunity than whites OR 0.59 (95% CI: 0.52-0.66), small rural more likely to have a missed opportunity than urban youth OR 1.8 (95% CI: 1.5-2.2), and preteens more likely than teens OR 2.4 (95% CI: 2.2-2.7). Missed clinical opportunities are a significant barrier to HPV vaccination among female adolescents. Interventions targeted at providers who serve patient groups with the highest missed opportunities are needed to achieve adequate protection from HPV-associated illnesses. This is one of the first studies to utilize state immunization information system data to assess missed opportunities for HPV vaccination.

Lexical Retrieval of Nouns and Verbs in a Sentence Completion Task

ERIC Educational Resources Information Center

Abel, Alyson D.; Maguire, Mandy J.; Naqvi, Fizza M.; Kim, Angela Y.

2015-01-01

This study explored noun and verb retrieval using a sentence completion task to expand upon previous findings from picture naming tasks. Participants completed sentences missing either a target noun or verb in the final position. Non-target responses were coded for substitution type, imageability and frequency. Like picture naming, nouns and verbs…

Cyclists' Anger As Determinant of Near Misses Involving Different Road Users.

PubMed

Marín Puchades, Víctor; Prati, Gabriele; Rondinella, Gianni; De Angelis, Marco; Fassina, Filippo; Fraboni, Federico; Pietrantoni, Luca

2017-01-01

Road anger constitutes one of the determinant factors related to safety outcomes (e.g., accidents, near misses). Although cyclists are considered vulnerable road users due to their relatively high rate of fatalities in traffic, previous research has solely focused on car drivers, and no study has yet investigated the effect of anger on cyclists' safety outcomes. The present research aims to investigate, for the first time, the effects of cycling anger toward different types of road users on near misses involving such road users and near misses in general. Using a daily diary web-based questionnaire, we collected data about daily trips, bicycle use, near misses experienced, cyclist's anger and demographic information from 254 Spanish cyclists. Poisson regression was used to assess the association of cycling anger with near misses, which is a count variable. No relationship was found between general cycling anger and near misses occurrence. Anger toward specific road users had different effects on the probability of near misses with different road users. Anger toward the interaction with car drivers increased the probability of near misses involving cyclists and pedestrians. Anger toward interaction with pedestrians was associated with higher probability of near misses with pedestrians. Anger toward cyclists exerted no effect on the probability of near misses with any road user (i.e., car drivers, cyclists or pedestrians), whereas anger toward the interactions with the police had a diminishing effect on the occurrence of near misses' involving all types of road users. The present study demonstrated that the effect of road anger on safety outcomes among cyclists is different from that of motorists. Moreover, the target of anger played an important role on safety both for the cyclist and the specific road users. Possible explanations for these differences are based on the difference in status and power with motorists, as well as on the potential displaced aggression produced by the fear of retaliation by motorized vehicle users.

Paradigm Change: Targeting Enemy Leadership in a Complex Environment

DTIC Science & Technology

2011-06-10

hunt Pablo Escobar, Centra Spike needed patience and supporting networks to uncover the puzzle of the Medellin Cartel. Although US and British... Medellin Cartel; who calls the shots? Eventually, Escobar stood out, but he was not the first target. Jose Rodriquez Gacha’s outspoken attitude...Alzate, the hired suicide bomber, flipped the switch and 110 passengers were dead. The Medellin Cartel missed their target, but the intent was loud and

Targeted therapy: questions to ask your doctor

MedlinePlus

... References Garraway LA, Verweij J, Ballman KV. Precision oncology: an overview. J Clin Oncol . 2013;31(15): ... JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap ...

Automation reliability in unmanned aerial vehicle control: a reliance-compliance model of automation dependence in high workload.

PubMed

Dixon, Stephen R; Wickens, Christopher D

2006-01-01

Two experiments were conducted in which participants navigated a simulated unmanned aerial vehicle (UAV) through a series of mission legs while searching for targets and monitoring system parameters. The goal of the study was to highlight the qualitatively different effects of automation false alarms and misses as they relate to operator compliance and reliance, respectively. Background data suggest that automation false alarms cause reduced compliance, whereas misses cause reduced reliance. In two studies, 32 and 24 participants, including some licensed pilots, performed in-lab UAV simulations that presented the visual world and collected dependent measures. Results indicated that with the low-reliability aids, false alarms correlated with poorer performance in the system failure task, whereas misses correlated with poorer performance in the concurrent tasks. Compliance and reliance do appear to be affected by false alarms and misses, respectively, and are relatively independent of each other. Practical implications are that automated aids must be fairly reliable to provide global benefits and that false alarms and misses have qualitatively different effects on performance.

Junior doctors' experiences of personal illness: a qualitative study.

PubMed

Fox, Fiona E; Doran, Natasha J; Rodham, Karen J; Taylor, Gordon J; Harris, Michael F; O'Connor, Michael

2011-12-01

Professional status and working arrangements can inhibit doctors from acknowledging and seeking care for their own ill health. Research identifies that a culture of immunity to illness within the medical profession takes root during training. What happens when trainee doctors become unwell during their formative period of education and training? What support do they receive and how do they perceive that the experience of ill health affects their training trajectory? These research questions were developed by a multidisciplinary team of researchers and health professionals, who adopted a qualitative approach to investigate the experiences of personal illness among trainees in their Foundation Programme (FP) years. Semi-structured interviews were conducted with eight FP trainees from the Severn Deanery in southwest England who had experienced significant illness. Interpretative phenomenological analysis was used to conduct and analyse the interviews, resulting in a comprehensive list of master themes. This paper reports an interpretative analysis of the themes of Support, Illness Experience, Crossing the Line, Medical Culture, Stigma and Disclosure. Ineffective communication within the medical education and employment system underpins many of the difficulties encountered by trainees who are unwell. Coping style plays a key role in predicting how trainees experience support during and after their illness, although this may be influenced by their particular diagnoses. The barriers to disclosure of their illnesses are discussed within the context of mobilising and maintaining support. Concern about the impact of missing training as a result of ill health appears to be significant in the transmitting of an ethos of invulnerability within the medical culture. Suggestions to improve support procedures for trainees who are unwell include the provision of greater flexibility within the rotation system along with independent pastoral support. Promoting the importance of disclosing significant illness as early as possible might go some way towards challenging the culture of invulnerability to illness that prevails among doctors. © Blackwell Publishing Ltd 2011.

Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence.

PubMed

Náfrádi, Lilla; Nakamoto, Kent; Schulz, Peter J

2017-01-01

Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence-the extent to which patients follow the physician's prescription of medication intake-is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence. Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included. High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient's control over the disease management, can provide promising new alternatives. The beneficial effect of patients' high internal and concurrent physician-attributed control beliefs suggests that a so-called "joint empowerment" approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship.

Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence

PubMed Central

2017-01-01

Background Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence. Methods Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included. Findings High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives. Discussion The beneficial effect of patients’ high internal and concurrent physician-attributed control beliefs suggests that a so-called “joint empowerment” approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship. PMID:29040335

The Doktabörse - an innovative online platform for research projects at the medical faculty of the LMU Munich.

PubMed

Nicolai, Leo; Gradel, Maximilian; Antón, Sofia; Pander, Tanja; Kalb, Anke; Köhler, Lisa; Fischer, Martin R; Dimitriadis, Konstantinos; von der Borch, Philip

2017-01-01

Introduction: One of the most important extracurricular aspects of medical studies in Germany is a research thesis completed by most students. This research project often times conveys relevant competencies for the physician's role as scientist. Nevertheless, the choice of the right project remains a challenge. Reasons for this are among others, missing structures for a comprehensive overview of research groups and their respective projects. Description of the project: We developed the online platform Doktabörse as an online marketplace for doctoral research projects. The platform enables authorized researchers to create working groups and upload, deactivate and change research projects within their institute. For interested students, a front end with integrated search function displays these projects in a structured and well-arranged way. In parallel, the Doktabörse provides for a comprehensive overview of research at the medical faculty. We evaluated Researchers' and students' use of the platform. Results: 96,6% of students participating in the evaluation (n=400) were in favor of a centralized research platform at the medical faculty. The platform grew at a steady pace and included 120 research groups in June 2016. The students appreciated the structure and design of the Doktabörse. Two thirds of all uploaded projects matched successfully with doctoral students via the platform and over 94% of researchers stated that they did not need technical assistance with uploading projects and handling the platform. Discussion : The Doktabörse represents an innovative and well accepted platform for doctoral research projects. The platform is perceived positively by researchers and students alike. However, students criticized limited extent and timeliness of offered projects. In addition, the platform serves as databank of research at the medical faculty of the LMU Munich. The future potential of this platform is to provide for an integrated management solution of doctoral thesis projects, possibly beyond the medical field and faculty.

An international sepsis survey: a study of doctors' knowledge and perception about sepsis

PubMed Central

Poeze, Martijn; Ramsay, Graham; Gerlach, Herwig; Rubulotta, Francesca; Levy, Mitchel

2004-01-01

Background To be able to diagnose and treat sepsis better it is important not only to improve the knowledge about definitions and pathophysiology, but also to gain more insight into specialists' perception of, and attitude towards, the current diagnosis and treatment of sepsis. Methods The study was conducted as a prospective, international survey by structured telephone interview. The subjects were intensive care physicians and other specialist physicians caring for intensive care unit (ICU) patients. Results The 1058 physicians who were interviewed (including 529 intensivists) agreed that sepsis is a leading cause of death on the ICU and that the incidence of sepsis is increasing, but that the symptoms of sepsis can easily be misattributed to other conditions. Physicians were concerned that this could lead to under-reporting of sepsis. Two-thirds (67%) were concerned that a common definition is lacking and 83% said it is likely that sepsis is frequently missed. Not more than 17% agreed on any one definition. Conclusion There is a general awareness about the inadequacy of the current definitions of sepsis. Physicians caring for patients with sepsis recognise the difficulty of defining and diagnosing sepsis and are aware that they miss the diagnosis frequently. PMID:15566585

Visual Search of Experts in Medical Image Reading: The Effect of Training, Target Prevalence, and Expert Knowledge

PubMed Central

Nakashima, Ryoichi; Kobayashi, Kazufumi; Maeda, Eriko; Yoshikawa, Takeharu; Yokosawa, Kazuhiko

2013-01-01

The aims of this study are (a) To determine the effect of training on the multiple-target lesion search performance; and (b) To examine the effect of target prevalence on the performance of radiologists and novices. We conducted four sessions of 500 trials in a lesion search on a medical image task in which participants searched for three different target lesions. Participants were 10 radiologists and novices. In each session, the prevalence of the different target lesions varied from low (2%) to high (40%). The sensitivity of novices was higher in the later sessions than in the first session, whereas there were no differences among sessions in radiologists. The improvement on sensitivity of novices was largely due to attenuations of false alarm (FA) errors. In addition, miss rates of the three targets did not differ in data of novices, whereas radiologists produced a higher miss rate for the highest prevalence target lesion (non-serious lesion) than for the other two lesions (serious lesions). The conclusions are (a) The training for the multiple-target lesion search task can be effective to reduce FA errors; and (b) The prevalence effect on lesion search can be attenuated by the multiple-target identification and the knowledge about seriousness of lesions. This suggests that acquired knowledge about normal cases and serious lesions is an important aspect of a radiologists’ skill in searching for medical lesions and their high performance levels. PMID:23576997

Visual search of experts in medical image reading: the effect of training, target prevalence, and expert knowledge.

PubMed

Nakashima, Ryoichi; Kobayashi, Kazufumi; Maeda, Eriko; Yoshikawa, Takeharu; Yokosawa, Kazuhiko

2013-01-01

The aims of this study are (a) To determine the effect of training on the multiple-target lesion search performance; and (b) To examine the effect of target prevalence on the performance of radiologists and novices. We conducted four sessions of 500 trials in a lesion search on a medical image task in which participants searched for three different target lesions. Participants were 10 radiologists and novices. In each session, the prevalence of the different target lesions varied from low (2%) to high (40%). The sensitivity of novices was higher in the later sessions than in the first session, whereas there were no differences among sessions in radiologists. The improvement on sensitivity of novices was largely due to attenuations of false alarm (FA) errors. In addition, miss rates of the three targets did not differ in data of novices, whereas radiologists produced a higher miss rate for the highest prevalence target lesion (non-serious lesion) than for the other two lesions (serious lesions). The conclusions are (a) The training for the multiple-target lesion search task can be effective to reduce FA errors; and (b) The prevalence effect on lesion search can be attenuated by the multiple-target identification and the knowledge about seriousness of lesions. This suggests that acquired knowledge about normal cases and serious lesions is an important aspect of a radiologists' skill in searching for medical lesions and their high performance levels.

Factors influencing the choice of specialty of Australian medical graduates.

PubMed

Harris, Mary G; Gavel, Paul H; Young, Jeannette R

2005-09-19

To identify the relative importance of extrinsic determinants of doctors' choice of specialty. A self-administered postal questionnaire. Australian vocational training programs. 4259 Australian medical graduates registered in September 2002 with one of 16 Australian clinical colleges providing vocational training programs. Choice of specialist vocational training program; extrinsic factors influencing choice of program, and variation by sex, age, marital status and country of birth. In total, 79% of respondents rated "appraisal of own skills and aptitudes" as influential in their choice of specialty followed by "intellectual content of the specialty" (75%). Extrinsic factors rated as most influential were "work culture" (72%), "flexibility of working arrangements" (56%) and "hours of work" (54%). We observed variation across training programs in the importance ascribed to factors influencing choice of specialty, and by sex, age and marital status. Factors of particular importance to women, compared with men, were "appraisal of domestic circumstances" (odds ratio [OR], 1.9), "hours of work" (OR, 1.8) and "opportunity to work flexible hours" (OR, 2.6). Partnered doctors, compared with single doctors, rated "hours of work" and "opportunity to work flexible hours" as more important (OR, 1.3), while "domestic circumstances" was more important to doctors with children than those without children (OR, 1.7). In total, 80% of doctors had chosen their specialty by the end of the third year after graduation. Experience with discipline-based work cultures and working conditions occurs throughout medical school and the early postgraduate years, and most doctors choose their specialty during these years. It follows that interventions to influence doctors' choice of specialty need to target these critical years.

Applying sport psychology to improve clinical performance.

PubMed

Church, Helen R; Rumbold, James L; Sandars, John

2017-12-01

Preparedness for practice has become an international theme within Medical Education: for healthcare systems to maintain their highest clinical standards, junior doctors must "hit the ground running" on beginning work. Despite demonstrating logical, structured assessment and management plans during their undergraduate examinations, many newly qualified doctors report difficulty in translating this theoretical knowledge into the real clinical environment. "Preparedness" must constitute more than the knowledge and skills acquired during medical school. Complexities of the clinical environment overwhelm some junior doctors, who acknowledge that they lack strategies to manage their anxieties, under-confidence and low self-efficacy. If uncontrolled, such negative emotions and behaviors may impede the delivery of time-critical treatment for acutely unwell patients and compound junior doctors' self-doubt, thus impacting future patient encounters. Medical Education often seeks inspiration from other industries for potential solutions to challenges. To address "preparedness for practice," this AMEE Guide highlights sport psychology: elite sportspeople train both physically and psychologically for their discipline. The latter promotes management of negative emotions, distractions and under-confidence, thus optimizing performance despite immense pressures of career-defining moments. Similar techniques might allow junior doctors to optimize patient care, especially within stressful situations. This AMEE Guide introduces the novel conceptual model, PERFORM, which targets the challenges faced by junior doctors on graduation. The model applies pre-performance routines from sport psychology with the self-regulatory processes of metacognition to the clinical context. This model could potentially equip junior doctors, and other healthcare professionals facing similar challenges, with strategies to optimize clinical care under the most difficult circumstances.

Parent health literacy and adherence-related outcomes in children with epilepsy.

PubMed

Paschal, Angelia M; Mitchell, Qshequilla P; Wilroy, Jereme D; Hawley, Suzanne R; Mitchell, Jermaine B

2016-03-01

The relationship between parent health literacy and adherence to treatment in children with epilepsy has not been fully explored. The purpose of this study was to determine whether parent health literacy and other variables predicted factors associated with adherence, such as missed medication doses, missed medical appointments, and seizure frequency, in children with epilepsy between 1 and 12 years old. It was hypothesized that parents with adequate parent health literacy would report fewer missed doses, missed appointments, and seizure occurrences. Using a nonexperimental, cross-sectional study design, interviews were conducted with 146 parents and guardians of children with epilepsy who resided in rural communities. Univariate analyses, including ANOVA, and multiple linear regressions were conducted. Results indicated that parent health literacy was the strongest predictor of two of the adherence-related factors. Higher health literacy scores were associated with fewer missed medication doses and seizure occurrences. However, health literacy was not associated with missed medical appointments. Among other study variables, higher household income was also predictive of fewer missed doses. The study findings suggest that inadequate health literacy among parents may serve as an independent risk factor for adherence-related outcomes among children with epilepsy. Further research, as well as effective, targeted parent health literacy strategies used to improve epilepsy management and care in children, is recommended. Copyright © 2015 Elsevier Inc. All rights reserved.

Use of email for patient communication in student health care: a cross-sectional study

PubMed Central

Castrén, Johanna; Niemi, Marja; Virjo, Irma

2005-01-01

Background Citizens increasingly use email in personal communication. It is not however clear to what extent physicians utilize it for patient communication. Our study was designed to examine physicians' activity in using email and to estimate the proportion of email messages missing from documentation in electronic patient records (EPR). Methods All physicians (n = 76; 48 general practitioners and 28 specialists) at the Finnish Student Health Service received a questionnaire by email, and were asked to print it and keep a daily tally of visits, phone calls and email messages over the study period of one working week (5.5. – 9.5.2003). The response rate was 70%. The data originating from the questionnaire were compared with statistical data from the EPR during the study period. Results The majority (79%, 41/52) of doctors reported using email with patients, averaging 8.6 (range: 0–96) email contacts and a percentage rate of "email / visit" 20% (range: 0–185%) in one working week. Doctors in the capital city region and those doctors who had a positive attitude toward email for patient communication were most active in email use. Up to 73% of email contacts were not documented in the EPR. Conclusion The activity in using email with patients verified among Finnish physicians is compatible with recent study results elsewhere. The notable proportion of un-recorded email messages establishes the need for an electric communication system built into the EPR to improve the quality of patient care and to limit medico-legal risks. PMID:15676077

An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC).

PubMed

Ashraf, Bushra; Tasnim, Nasira; Saaiq, Muhammad; Zaman, Khaleeq-Uz-

2014-11-01

The Surgical Informed Consent (SIC) is a comprehensive process that establishes an information-based agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.

Hunter New England Training (HNET): how to effect culture change in a psychiatry medical workforce.

PubMed

Cohen, Martin; Llewellyn, Anthony; Ditton-Phare, Philippa; Sandhu, Harsimrat; Vamos, Marina

2011-12-01

It is now recognized that education and training are at the core of quality systems in health care. In this paper we discuss the processes and drivers that underpinned the development of high quality education and training programs and placements for all junior doctors. The early identification and development of doctors interested in psychiatry as a career, engagement and co-operation with the broader junior doctor network and the creation of teaching opportunities for trainees that was linked to their stage of development were identified as key to the success of the program. Targeted, high quality education programs and clinical placements coupled with strategic development of workforce has reduced staff turn over, led to the stabilization of the medical workforce and created a culture where learning and supervision are highly valued.

Missing clinical information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care.

PubMed

Burnett, Susan J; Deelchand, Vashist; Franklin, Bryony Dean; Moorthy, Krishna; Vincent, Charles

2011-05-23

In Britain over 39,000 reports were received by the National Patient Safety Agency relating to failures in documentation in 2007 and the UK Health Services Journal estimated in 2008 that over a million hospital outpatient visits each year might take place without the full record available. Despite these high numbers, the impact of missing clinical information has not been investigated for hospital outpatients in the UK.Studies in primary care in the USA have found 13.6% of patient consultations have missing clinical information, with this adversely affecting care in about half of cases, and in Australia 1.8% of medical errors were found to be due to the unavailability of clinical information.Our objectives were to assess the frequency, nature and potential impact on patient care of missing clinical information in NHS hospital outpatients and to assess the principal causes. This is the first study to present such figures for the UK and the first to look at how clinicians respond, including the associated impact on patient care. Prospective descriptive study of missing information reported by surgeons, supplemented by interviews on the causes.Data were collected by surgeons in general, gastrointestinal, colorectal and vascular surgical clinics in three teaching hospitals across the UK for over a thousand outpatient appointments. Fifteen interviews were conducted with those involved in collating clinical information for these clinics.The study had ethics approval (Hammersmith and Queen Charlotte's & Chelsea Research Ethics Committee), reference number (09/H0707/27). Participants involved in the interviews signed a consent form and were offered the opportunity to review and agree the transcript of their interview before analysis. No patients were involved in this research. In 15% of outpatient consultations key items of clinical information were missing. Of these patients, 32% experienced a delay or disruption to their care and 20% had a risk of harm. In over half of cases the doctor relied on the patient for the information, making a clinical decision despite the information being missing in 20% of cases. Hospital mergers, temporary staff and non-integrated IT systems were contributing factors. If these findings are replicated across the NHS then almost 10 million outpatients are seen each year without key clinical information, creating over a million unnecessary appointments, and putting nearly 2 million patients at risk of harm. There is a need for a systematic, regular audit of the prevalence of missing clinical information. Only then will we know the impact on clinical decision making and patient care of new technology, service reorganisations and, crucially given the present financial climate, temporary or reduced staffing levels. Further research is needed to assess the relationship between missing clinical information and diagnostic errors; to examine the issue in primary care; and to consider the patients perspective.

Headache pain of ear, nose, throat, and sinus origin.

PubMed

Waldman, Steven D; Waldman, Corey W; Waldman, Jennifer E

2013-03-01

Pain of the ear, nose, sinuses, and throat is commonly encountered in clinical practice. For the most part, the pathologic process responsible for the patient's symptoms is easily identifiable after the physician performs a targeted history and physical examination. Unfortunately, the nature of this anatomic region makes it possible for the most thorough physician to miss pathologic factors that may ultimately harm the patient. For this reason, the following rules for the treatment of ear, nose, sinus, and throat pain serve both the patient and the clinician well: (1) take a targeted history; (2) perform a careful, targeted physical examination; (3) heed the warning signs of serious disease, such as fever, constitutional symptoms, or weight loss; (4) image early and frequently if the diagnosis remains elusive; (5) perform laboratory tests that help identify "sick from well," such as erythrocyte sedimentation rate, hematology, and blood tests; (6) avoid attributing the patient's pain to idiopathic or psychogenic causes; and (7) always assume that you have missed the diagnosis. Copyright © 2013 Elsevier Inc. All rights reserved.

Receiving care for intimate partner violence in primary care: Barriers and enablers for women participating in the weave randomised controlled trial.

PubMed

O'Doherty, Lorna; Taket, Ann; Valpied, Jodie; Hegarty, Kelsey

2016-07-01

Interventions in health settings for intimate partner violence (IPV) are being increasingly recognised as part of a response to addressing this global public health problem. However, interventions targeting this sensitive social phenomenon are complex and highly susceptible to context. This study aimed to elucidate factors involved in women's uptake of a counselling intervention delivered by family doctors in the weave primary care trial (Victoria, Australia). We analysed associations between women's and doctors' baseline characteristics and uptake of the intervention. We interviewed a random selection of 20 women from an intervention group women to explore cognitions relating to intervention uptake. Interviews were audio-recorded, transcribed, coded in NVivo 10 and analysed using the theory of planned behaviour (TPB). Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended sessions). Favourable doctor communication was strongly associated with attendance. Eight themes emerged, including four sets of beliefs that influenced attitudes to uptake: (i) awareness of the abuse and readiness for help; (ii) weave as an avenue to help; (iii) doctor's communication; and (iv) role in providing care for IPV; and four sets of beliefs regarding women's control over uptake: (v) emotional health, (vi) doctors' time, (vii) managing the disclosure process and (viii) viewing primary care as a safe option. This study has identified factors that can promote the implementation and evaluation of primary care-based IPV interventions, which are relevant across health research settings, for example, ensuring fit between implementation strategies and characteristics of the target group (such as range in readiness for intervention). On practice implications, providers' communication remains a key issue for engaging women. A key message arising from this work concerns the critical role of primary care and health services more broadly in reaching victims of domestic violence, and providing immediate and ongoing support (depending on the healthcare context). Copyright © 2016 Elsevier Ltd. All rights reserved.

‘Care Under Pressure’: a realist review of interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care

PubMed Central

Briscoe, Simon; Jackson, Mark; Mattick, Karen; Papoutsi, Chrysanthi; Pearson, Mark; Wong, Geoffrey

2018-01-01

Introduction Mental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their ‘productivity’ and ‘resilience’, placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors’ well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments. Methods and analysis Our project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors’ mental ill-health. We will conduct a realist review—a form of theory-driven interpretative systematic review—of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors’ mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory. Ethics and dissemination Ethical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues. PROSPERO registration number CRD42017069870. PMID:29420234

CPTAC Investigators Identify Rogue Breast Tumor Proteins That Point To Potential Drug Therapies | Office of Cancer Clinical Proteomics Research

Cancer.gov

For patients with difficult-to-treat cancers, doctors increasingly rely on genomic testing of tumors to identify errors in the DNA that indicate a tumor can be targeted by existing therapies. But this approach overlooks another potential marker — rogue proteins — that may be driving cancer cells and also could be targeted with existing treatments.

Persons with dementia missing in the community: is it wandering or something unique?

PubMed

Rowe, Meredeth A; Vandeveer, Sydney S; Greenblum, Catherine A; List, Cassandra N; Fernandez, Rachael M; Mixson, Natalie E; Ahn, Hyo C

2011-06-05

At some point in the disease process many persons with dementia (PWD) will have a missing incident and be unable to safely return to their care setting. In previous research studies, researchers have begun to question whether this phenomenon should continue to be called wandering since the antecedents and characteristics of a missing incident are dissimilar to accepted definitions of wandering in dementia. The purpose of this study was to confirm previous findings regarding the antecedents and characteristics of missing incidents, understand the differences between those found dead and alive, and compare the characteristics of a missing incident to that of wandering. A retrospective design was used to analyse 325 newspaper reports of PWD missing in the community. The primary antecedent to a missing incident, particularly in community-dwelling PWD, was becoming lost while conducting a normal and permitted activity alone in the community. The other common antecedent was a lapse in supervision with the expectation that the PWD would remain in a safe location but did not. Deaths most commonly occurred in unpopulated areas due to exposure and drowning. Those who died were found closer to the place last seen and took longer to find, but there were no significant differences in gender or age. The key characteristics of a missing incident were: unpredictable, non-repetitive, temporally appropriate but spatially-disordered, and while using multiple means of movement (walking, car, public transportation). Missing incidents occurred without the discernible pattern present in wandering such as lapping or pacing, repetitive and temporally-disordered. This research supports the mounting evidence that the concept of wandering, in its formal sense, and missing incidents are two distinct concepts. It will be important to further develop the concept of missing incidents by identifying the differences and similarities from wandering. This will allow a more targeted assessment and intervention strategy for each problem.

Persons with dementia missing in the community: Is it wandering or something unique?

PubMed Central

2011-01-01

Background At some point in the disease process many persons with dementia (PWD) will have a missing incident and be unable to safely return to their care setting. In previous research studies, researchers have begun to question whether this phenomenon should continue to be called wandering since the antecedents and characteristics of a missing incident are dissimilar to accepted definitions of wandering in dementia. The purpose of this study was to confirm previous findings regarding the antecedents and characteristics of missing incidents, understand the differences between those found dead and alive, and compare the characteristics of a missing incident to that of wandering. Methods A retrospective design was used to analyse 325 newspaper reports of PWD missing in the community. Results The primary antecedent to a missing incident, particularly in community-dwelling PWD, was becoming lost while conducting a normal and permitted activity alone in the community. The other common antecedent was a lapse in supervision with the expectation that the PWD would remain in a safe location but did not. Deaths most commonly occurred in unpopulated areas due to exposure and drowning. Those who died were found closer to the place last seen and took longer to find, but there were no significant differences in gender or age. The key characteristics of a missing incident were: unpredictable, non-repetitive, temporally appropriate but spatially-disordered, and while using multiple means of movement (walking, car, public transportation). Missing incidents occurred without the discernible pattern present in wandering such as lapping or pacing, repetitive and temporally-disordered. Conclusions This research supports the mounting evidence that the concept of wandering, in its formal sense, and missing incidents are two distinct concepts. It will be important to further develop the concept of missing incidents by identifying the differences and similarities from wandering. This will allow a more targeted assessment and intervention strategy for each problem. PMID:21639942

How we developed Doctors Speak Up: an evidence-based language and communication skills open access resource for International Medical Graduates.

PubMed

Woodward-Kron, Robyn; Fraser, Catriona; Pill, John; Flynn, Eleanor

2015-01-01

Some International Medical Graduates (IMGs) need to develop language and communication skills for patient-centred care but have limited opportunities to do so. To develop an evidence-based, language and communication skills web resource for IMG doctors and supervisors, focussing on culturally challenging patient interviews. Forty-eight IMGs participated in four practice OSCEs. We video-recorded the interactions and applied discourse analytic methods to investigate salient language and communication features. The findings from the OSCE workshops showed that many participants demonstrated aspects of patient-centred interviewing but were hindered by limited interactional competence to elicit information and negotiate behaviours as well as a limited repertoire of English grammar, vocabulary, and phonological phrasing for effective interaction. These findings guided the choice of content and pedagogy for the development of the web-based resource Doctors Speak Up. Evaluation and uptake of the Doctors Speak Up website confirm the demand for a resource combining targeted communication skills and language instruction. Over 19 500 users visited the website between March 2012 and November 2013.

Mental health workers. Graduation daze.

PubMed

Lewis, Carol

2003-09-11

PCTs are likely to miss the national target on employment of graduate mental health workers. Pilots are showing success in reducing referrals. Managers must address career progression problems and define roles more clearly.

Effect of UK policy on medical migration: a time series analysis of physician registration data

PubMed Central

2012-01-01

Background Economically developed countries have recruited large numbers of overseas health workers to fill domestic shortages. Recognition of the negative impact this can have on health care in developing countries led the United Kingdom Department of Health to issue a Code of Practice for National Health Service (NHS) employers in 1999 providing ethical guidance on international recruitment. Case reports suggest this guidance had limited influence in the context of other NHS policy priorities. Methods The temporal association between trends in new professional registrations from doctors qualifying overseas and relevant United Kingdom government policy is reported. Government policy documents were identified by a literature review; further information was obtained, when appropriate, through requests made under the Freedom of Information Act. Data on new professional registration of doctors were obtained from the General Medical Council (GMC). Results New United Kingdom professional registrations by doctors trained in Africa and south Asia more than doubled from 3105 in 2001 to 7343 in 2003, as NHS Trusts sought to achieve recruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance to avoid active recruitment of doctors from resource-poor countries. Registration of such doctors declined subsequently, but in response to other government policy initiatives. A fall in registration of South African-trained doctors from 3206 in 2003 to 4 in 2004 followed a Memorandum of Understanding with South Africa signed in 2003. Registrations from India and Pakistan fell from a peak of 4626 in 2004 to 1169 in 2007 following changes in United Kingdom immigration law in 2005 and 2006. Since 2007, registration of new doctors trained outside the European Economic Area has remained relatively stable, but in 2010 the United Kingdom still registered 722 new doctors trained in Africa and 1207 trained in India and Pakistan. Conclusions Ethical guidance was ineffective in preventing mass registration by doctors trained in resource-poor countries between 2001 and 2004 because of competing NHS policy priorities. Changes in United Kingdom immigration laws and bilateral agreements have subsequently reduced new registrations, but about 4000 new doctors a year continue to register who trained in Africa, Asia and less economically developed European countries. PMID:23009665

Effect of UK policy on medical migration: a time series analysis of physician registration data.

PubMed

Blacklock, Claire; Heneghan, Carl; Mant, David; Ward, Alison M

2012-09-25

Economically developed countries have recruited large numbers of overseas health workers to fill domestic shortages. Recognition of the negative impact this can have on health care in developing countries led the United Kingdom Department of Health to issue a Code of Practice for National Health Service (NHS) employers in 1999 providing ethical guidance on international recruitment. Case reports suggest this guidance had limited influence in the context of other NHS policy priorities. The temporal association between trends in new professional registrations from doctors qualifying overseas and relevant United Kingdom government policy is reported. Government policy documents were identified by a literature review; further information was obtained, when appropriate, through requests made under the Freedom of Information Act. Data on new professional registration of doctors were obtained from the General Medical Council (GMC). New United Kingdom professional registrations by doctors trained in Africa and south Asia more than doubled from 3105 in 2001 to 7343 in 2003, as NHS Trusts sought to achieve recruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance to avoid active recruitment of doctors from resource-poor countries. Registration of such doctors declined subsequently, but in response to other government policy initiatives. A fall in registration of South African-trained doctors from 3206 in 2003 to 4 in 2004 followed a Memorandum of Understanding with South Africa signed in 2003. Registrations from India and Pakistan fell from a peak of 4626 in 2004 to 1169 in 2007 following changes in United Kingdom immigration law in 2005 and 2006. Since 2007, registration of new doctors trained outside the European Economic Area has remained relatively stable, but in 2010 the United Kingdom still registered 722 new doctors trained in Africa and 1207 trained in India and Pakistan. Ethical guidance was ineffective in preventing mass registration by doctors trained in resource-poor countries between 2001 and 2004 because of competing NHS policy priorities. Changes in United Kingdom immigration laws and bilateral agreements have subsequently reduced new registrations, but about 4000 new doctors a year continue to register who trained in Africa, Asia and less economically developed European countries.

Which non-technical skills do junior doctors require to prescribe safely? A systematic review.

PubMed

Dearden, Effie; Mellanby, Edward; Cameron, Helen; Harden, Jeni

2015-12-01

Prescribing errors are a major source of avoidable morbidity and mortality. Junior doctors write most in-hospital prescriptions and are the least experienced members of the healthcare team. This puts them at high risk of error and makes them attractive targets for interventions to improve prescription safety. Error analysis has shown a background of complex environments with multiple contributory conditions. Similar conditions in other high risk industries, such as aviation, have led to an increased understanding of so-called human factors and the use of non-technical skills (NTS) training to try to reduce error. To date no research has examined the NTS required for safe prescribing. The aim of this review was to develop a prototype NTS taxonomy for safe prescribing, by junior doctors, in hospital settings. A systematic search identified 14 studies analyzing prescribing behaviours and errors by junior doctors. Framework analysis was used to extract data from the studies and identify behaviours related to categories of NTS that might be relevant to safe and effective prescribing performance by junior doctors. Categories were derived from existing literature and inductively from the data. A prototype taxonomy of relevant categories (situational awareness, decision making, communication and team working, and task management) and elements was constructed. This prototype will form the basis of future work to create a tool that can be used for training and assessment of medical students and junior doctors to reduce prescribing error in the future. © 2015 The British Pharmacological Society.

Successes and challenges in a novel doctoral program in systems agriculture: a case example.

PubMed

Lust, D; Topliff, D; Deotte, R

2010-01-01

A doctoral program in Systems Agriculture was initiated at West Texas A&M University, Canyon, TX, in September, 2003. The stated objective of the program was "..to prepare leaders for the agricultural industry that are trained in a multidisciplinary, research-based curriculum that emphasizes a systems approach to problem solving". The program offers a single doctoral degree in Agriculture and accepts qualified students with a master's or professional degree in agricultural or related disciplines. Courses related to systems methodologies, leadership, agricultural economics, plant and soil science, and animal science are required. Additional program requirements include a systems research project and dissertation, leadership training, and written and oral exams. The program has exceeded enrollment and graduation targets, suggesting interest in this approach to a doctoral degree. Students have entered the program with M.S. backgrounds in education, traditional agricultural disciplines, veterinary medicine, business, and physics. Graduates have gained employment in industry, university teaching and research, government research/administration, and extension. Doctoral student projects in systems agriculture contributed to curriculum changes and to the conceptual framework adopted by a multi-state research group. Designing and teaching courses for students with diverse backgrounds has been challenging. Development of a common understanding of systems agriculture was identified by a third-party program review as an issue for faculty. Development and maintenance of program standards and administrative procedures posed additional challenges. Leadership, administrative support, and timely and continuing program assessment are suggested as necessary components for a nontraditional doctoral program.

Knowledge seeking behaviours of pre interns and early career doctors in Sri Lanka: a cross sectional study.

PubMed

Rodrigo, Chaturaka; Maduranga, Sachith; Withana, Milinda; Fernando, Deepika; Rajapakse, Senaka

2015-10-27

Use of reference sources for medical knowledge has changed dramatically over the last two decades with the introduction of online sources of information. This study analyses the medical knowledge seeking behaviours of pre interns and early career doctors in Sri Lanka. This cross sectional survey with a convenience sample was conducted at two sites targeting two groups; pre-intern doctors graduated from the Faculty of Medicine, University of Colombo and early career doctors following a postgraduate course at the National Hospital of Sri Lanka. The data collection tool was an online self-administered questionnaire (paper based questionnaires used on request) that probed the patterns of using reference sources for medical knowledge. The respondents comprised of 52 pre-interns and 34 early career doctors. A majority (98 %) had internet access. Early career doctors preferred online resources significantly more than the pre-interns. However, the utilization of online resources for evidence synthesis and planning research was unsatisfactory in both groups. A significant proportion (35 %) responded that they had never read a systematic review. Only one person in the entire sample had co-authored a review article. The use of online resources by participants seems to be satisfactory with a majority shifting to reliable online resources as a reference point for medical knowledge. However, a closer look at the usage patterns reveal that online resources that can be used for more innovative tasks such as evidence synthesis are grossly under-utilized.

Estimating missing daily temperature extremes in Jaffna, Sri Lanka

NASA Astrophysics Data System (ADS)

Thevakaran, A.; Sonnadara, D. U. J.

2018-04-01

The accuracy of reconstructing missing daily temperature extremes in the Jaffna climatological station, situated in the northern part of the dry zone of Sri Lanka, is presented. The adopted method utilizes standard departures of daily maximum and minimum temperature values at four neighbouring stations, Mannar, Anuradhapura, Puttalam and Trincomalee to estimate the standard departures of daily maximum and minimum temperatures at the target station, Jaffna. The daily maximum and minimum temperatures from 1966 to 1980 (15 years) were used to test the validity of the method. The accuracy of the estimation is higher for daily maximum temperature compared to daily minimum temperature. About 95% of the estimated daily maximum temperatures are within ±1.5 °C of the observed values. For daily minimum temperature, the percentage is about 92. By calculating the standard deviation of the difference in estimated and observed values, we have shown that the error in estimating the daily maximum and minimum temperatures is ±0.7 and ±0.9 °C, respectively. To obtain the best accuracy when estimating the missing daily temperature extremes, it is important to include Mannar which is the nearest station to the target station, Jaffna. We conclude from the analysis that the method can be applied successfully to reconstruct the missing daily temperature extremes in Jaffna where no data is available due to frequent disruptions caused by civil unrests and hostilities in the region during the period, 1984 to 2000.

The long term economic impact of severe obstetric complications for women and their children in Burkina Faso.

PubMed

Ilboudo, Patrick G C; Russell, Steve; D'Exelle, Ben

2013-01-01

This study investigates the long term economic impact of severe obstetric complications for women and their children in Burkina Faso, focusing on measures of food security, expenditures and related quality of life measures. It uses a hospital based cohort, first visited in 2004/2005 and followed up four years later. This cohort of 1014 women consisted of two main groups of comparison: 677 women who had an uncomplicated delivery and 337 women who experienced a severe obstetric complication which would have almost certainly caused death had they not received hospital care (labelled a "near miss" event). To analyze the impact of such near miss events as well as the possible interaction with the pregnancy outcome, we compared household and individual level indicators between women without a near miss event and women with a near miss event who either had a live birth, a perinatal death or an early pregnancy loss. We used propensity score matching to remove initial selection bias. Although we found limited effects for the whole group of near miss women, the results indicated negative impacts: a) for near miss women with a live birth, on child development and education, on relatively expensive food consumption and on women's quality of life; b) for near miss women with perinatal death, on relatively expensive foods consumption and children's education and c) for near miss women who had an early pregnancy loss, on overall food security. Our results showed that severe obstetric complications have long lasting consequences for different groups of women and their children and highlighted the need for carefully targeted interventions.

Revised Household-Based Microplanning in Polio Supplemental Immunization Activities in Kano State, Nigeria. 2013-2014.

PubMed

Gali, Emmanuel; Mkanda, Pascal; Banda, Richard; Korir, Charles; Bawa, Samuel; Warigon, Charity; Abdullahi, Suleiman; Abba, Bashir; Isiaka, Ayodeji; Yahualashet, Yared G; Touray, Kebba; Chevez, Ana; Tegegne, Sisay G; Nsubuga, Peter; Etsano, Andrew; Shuaib, Faisal; Vaz, Rui G

2016-05-01

Remarkable progress had been made since the launch of the Global Polio Eradication Initiative in 1988. However endemic wild poliovirus transmission in Nigeria, Pakistan, and Afghanistan remains an issue of international concern. Poor microplanning has been identified as a major contributor to the high numbers of chronically missed children. We assessed the contribution of the revised household-based microplanning process implemented in Kano State from September 2013 to April 2014 to the outcomes of subsequent polio supplemental immunization activities using used preselected planning and outcome indicators. There was a 38% increase in the number of settlements enumerated, a 30% reduction in the number of target households, and a 54% reduction in target children. The reported number of children vaccinated and the doses of oral polio vaccine used during subsequent polio supplemental immunization activities showed a decline. Postvaccination lot quality assurance sampling and chronically missed settlement reports also showed a progressive reduction in the number of children and settlements missed. We observed improvement in Kano State's performance based on the selected postcampaign performance evaluation indicators and reliability of baseline demographic estimates after the revised household-based microplanning exercise. © 2016 World Health Organization; licensee Oxford Journals.

Revised Household-Based Microplanning in Polio Supplemental Immunization Activities in Kano State, Nigeria. 2013–2014

PubMed Central

Gali, Emmanuel; Mkanda, Pascal; Banda, Richard; Korir, Charles; Bawa, Samuel; Warigon, Charity; Abdullahi, Suleiman; Abba, Bashir; Isiaka, Ayodeji; Yahualashet, Yared G.; Touray, Kebba; Chevez, Ana; Tegegne, Sisay G.; Nsubuga, Peter; Etsano, Andrew; Shuaib, Faisal; Vaz, Rui G.

2016-01-01

Background. Remarkable progress had been made since the launch of the Global Polio Eradication Initiative in 1988. However endemic wild poliovirus transmission in Nigeria, Pakistan, and Afghanistan remains an issue of international concern. Poor microplanning has been identified as a major contributor to the high numbers of chronically missed children. Methods. We assessed the contribution of the revised household-based microplanning process implemented in Kano State from September 2013 to April 2014 to the outcomes of subsequent polio supplemental immunization activities using used preselected planning and outcome indicators. Results. There was a 38% increase in the number of settlements enumerated, a 30% reduction in the number of target households, and a 54% reduction in target children. The reported number of children vaccinated and the doses of oral polio vaccine used during subsequent polio supplemental immunization activities showed a decline. Postvaccination lot quality assurance sampling and chronically missed settlement reports also showed a progressive reduction in the number of children and settlements missed. Conclusions. We observed improvement in Kano State's performance based on the selected postcampaign performance evaluation indicators and reliability of baseline demographic estimates after the revised household-based microplanning exercise. PMID:26908755

Job satisfaction of village doctors during the new healthcare reforms in China.

PubMed

Zhang, Xiaoyan; Fang, Pengqian

2016-04-01

Objective China launched new healthcare reforms in 2009 and several policies targeted village clinics, which affected village doctors' income, training and duties. The aim of the present study was to assess village doctors' job satisfaction during the reforms and to explore factors affecting job satisfaction. Methods Using a stratified multistage cluster sampling process, 935 village doctors in Jiangxi Province were surveyed with a self-administered questionnaire that collected demographic information and contained a job satisfaction scale and questions regarding their work situation and individual perceptions of the new healthcare reforms. Descriptive analysis, Pearson's Chi-squared test and binary logistic regression were used to identify village doctors' job satisfaction and the factors associated with their job satisfaction. Results Only 12.72% of village doctors were either satisfied or very satisfied with their jobs and the top three items leading to dissatisfaction were pay and the amount of work that had to be done, opportunities for job promotion and work conditions. Marriage, income, intention to leave, satisfaction with learning and training, social status, relationship with patients and satisfaction with the new healthcare reforms were significantly associated with job satisfaction (P<0.05). Conclusions China is facing critical challenges with regard to village doctors because of their low job satisfaction. For future healthcare reforms, policy makers should pay more attention to appropriate remuneration and approaches that incentivise village doctors to achieve the goals of the health reforms. What is known about the topic? Village doctors act as gatekeepers at the bottom tier of the rural health system. However, the policies of the new healthcare reform initiatives in China were centred on improving the quality of care delivered to the rural population and reducing fast-growing medical costs. There have been limited studies on village doctors' reactions to these reforms. What does this paper add? The findings of the present study indicate that in the process of implementing the new healthcare reforms, village doctors' overall job satisfaction is low and most respondents are dissatisfied with the reforms. The factors affecting job satisfaction include income, training, social status, relationship with patients and satisfaction with the reforms. What are the implications for practitioners? Health reform policy makers should ensure village doctors feel appropriately remunerated and are motivated while aiming to reduce the financial burden on patients. The views of stakeholders (i.e. patients and village doctors) should be considered when designing future health reforms.

Lorazepam induces multiple disturbances in selective attention: attentional overload, decrement in target processing efficiency, and shifts in perceptual discrimination and response bias.

PubMed

Michael, George Andrew; Bacon, Elisabeth; Offerlin-Meyer, Isabelle

2007-09-01

There is a general consensus that benzodiazepines affect attentional processes, yet only few studies have tried to investigate these impairments in detail. The purpose of the present study was to investigate the effects of a single dose of Lorazepam on performance in a target cancellation task with important time constraints. We measured correct target detections and correct distractor rejections, misses and false positives. The results show that Lorazepam produces multiple kinds of shifts in performance, which suggests that it impairs multipLe processes: (a) the evolution of performance over time was not the same between the placebo and the Lorazepam groups, with the Lorazepam affecting performance quite early after the beginning of the test. This is suggestive of a depletion of attentional resources during sequential attentional processing; (b) Lorazepam affected differently target and distractor processing, with target detection being the most impaired; (c) misses were more frequent under Lorazepam than under placebo, but no such difference was observed as far as false positives were concerned. Signal detection analyses showed that Lorazepam (d) decreased perceptual discrimination, and (e) reliably increased response bias. Our results bring new insights on the multiple effects of Lorazepam on selective attention which, when combined, may have deleterious effects on human performance.

Audit of annual medical appraisal and revalidation activity across the UK Defence Medical Services 2013-2014.

PubMed

Morris, Louisa E; Withnall, Rdj

2017-02-01

To provide the first annual audit of Defence Medical Services (DMS) medical appraisal and revalidation activity. A questionnaire-based survey of appraisal and revalidation activity within the 2013-2014 appraisal year (1 April 2013 - 1 March 2014) across the Royal Navy (RN), Army, Royal Air Force (RAF) and Ministry of Defence (MOD) and Defence Postgraduate Medical Deanery (DPMD) Designated Bodies (DBs). Mandatory annual medical appraisal of all DMS doctors was introduced in 2002. The General Medical Council (GMC) introduced licences to practise in November 2011. Revalidation went live in December 2012. In the 2013-2014 appraisal year, there were 1379 DMS doctors. The Responsible Officers (ROs) of the RN, Army, RAF, MOD and Defence Postgraduate Medical Deanery (DPMD) provide appraisal and revalidation services for doctors within their DBs. In the 2013-2014 appraisal year, 82% of DMS doctors completed an annual appraisal. ROs provided positive revalidation recommendations for 90% of DMS doctors without the need for additional supporting information. Additional supporting evidence was required for 10% of DMS trained doctors, but ultimately 100% of DMS doctors due revalidation in the 2013-2014 appraisal year received a positive recommendation. To assist DMS compliance with GMC quality assurance requirements, HQ Surgeon General now maintains a central database of appraisal and revalidation data across the five DMS DBs. Appropriately targeted appraiser training and 'revalidation ready top-up' training should be provided to ensure the demand for military appraisers is met, and that DMS appraisers appropriately maintain their skills. MOD now maintains a central live database for ongoing appraisal and revalidation monitoring. 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/.

Satisfaction of village doctors with the township and village health services integration policy in the western minority-inhabited areas of China.

PubMed

Feng, Da; Zhang, Liang; Xiang, Yuan-Xi; Zhang, Dong-Lan; Wang, Ruo-Xi; Tang, Shang-Feng; Fu, Hang; Li, Bo-Yang

2017-02-01

Township and Village Health Services Integration Management (TVHSIM) is an essential form of China's two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China's new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors' satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors' personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels (all P<0.05). Age (P<0.05) and years of practice (P<0.01) were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level (P<0.05) was negatively correlated with Operations Management as well. However, social insurance status (P<0.05) was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors' satisfaction with TVHSIM (P<0.01). In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example.

PubMed

Li, Tongtong; Lei, Trudy; Xie, Zheng; Zhang, Tuohong

2016-02-04

To ensure equity and accessibility of public health care in rural areas, the Chinese central government has launched a series of policies to motivate village doctors to provide basic public health services. Using chronic disease management and prevention as an example, this study aims to identify factors associated with village doctors' basic public health services provision and to formulate targeted interventions in rural China. Data was obtained from a survey of village doctors in three provinces in China in 2014. Using a multistage sampling process, data was collected through the self-administered questionnaire. The data was then analyzed using multilevel logistic regression models. The high-level basic public health services for chronic diseases (BPHS) provision rate was 85.2% among the 1149 village doctors whom were included in the analysis. Among individual level variables, more education, more training opportunities, receiving more public health care subsidy (OR = 3.856, 95 % CI: 1.937-7.678, and OR = 4.027, 95% CI: 1.722-9.420), being under integrated management (OR = 1.978, 95% CI: 1.132-3.458), and being a New Cooperative Medical Scheme insurance program-contracted provider (OR = 2.099, 95% CI: 1.187-3.712) were associated with the higher BPHS provision by village doctors. Among county level factors, Foreign Direct Investment Index showed a significant negative correlation with BPHS provision, while the government funding for BPHS showed no correlation (P > 0.100). Increasing public health care subsidies received by individual village doctors, availability and attendance of training opportunities, and integrated management and NCMS contracting of village clinics are important factors in increasing BPHS provision in rural areas.

Perspectives of Patients, Doctors and Medical Students at a Public University Hospital in Rio de Janeiro Regarding Tuberculosis and Therapeutic Adherence.

PubMed

de Andrade, Elizabeth da Trindade; Hennington, Élida Azevedo; Siqueira, Hélio Ribeiro de; Rolla, Valeria Cavalcanti; Mannarino, Celina

2015-01-01

The World Health Organization (WHO) identifies 8.7 million new cases of tuberculosis (TB) annually around the world. The unfavorable outcomes of TB treatment prevent the achievement of the WHO's cure target. To evaluate existing intersections in the conceptions relative to the knowledge of TB, the experience of the illness and the treatment. Doctors, medical students and patients were selected from a public university in Rio de Janeiro, Brazil, from 2011 to 2013. The data were obtained by semi-structured individual and focus group interviews, participant observation and a field journal. The inclusion of patients was interrupted due to saturation, and the inclusion of doctors and medical students stopped due to exhaustion. The theoretical background included symbolic Interactionism, and the analysis used rounded Theory. The analysis prioritized the actions/interactions axis. Twenty-three patients with pulmonary TB, seven doctors and 15 medical students were included. In the interviews, themes such as stigma, self-segregation, and difficulties in assistance emerged, in addition to defense mechanisms such as denial, rationalization, isolation and other mental mechanisms, including guilt, accountability and concealment of the disease. Aspects related to the assistance strategy, the social support network, bonding with the healthcare staff and the doctor-patient relationship were highlighted as adherence enablers. Doctors and students recommended an expansion of the theoretical and practical instruction on TB during medical students' education. The existence of health programs and policies was mentioned as a potential enabler of adherence. The main concepts identified were the stigma, self-segregation, guilt, responsibility, concealment and emotional repercussions. In relation to the facilitation of therapeutic adherence, the concepts identified were the bonds with healthcare staff, the doctor-patient relationship, assistance and educational health strategies.

Perspectives of Patients, Doctors and Medical Students at a Public University Hospital in Rio de Janeiro Regarding Tuberculosis and Therapeutic Adherence

PubMed Central

de Andrade, Elizabeth da Trindade; Hennington, Élida Azevedo; de Siqueira, Hélio Ribeiro; Rolla, Valeria Cavalcanti; Mannarino, Celina

2015-01-01

Introduction The World Health Organization (WHO) identifies 8.7 million new cases of tuberculosis (TB) annually around the world. The unfavorable outcomes of TB treatment prevent the achievement of the WHO’s cure target. Goal To evaluate existing intersections in the conceptions relative to the knowledge of TB, the experience of the illness and the treatment. Methods Doctors, medical students and patients were selected from a public university in Rio de Janeiro, Brazil, from 2011 to 2013. The data were obtained by semi-structured individual and focus group interviews, participant observation and a field journal. The inclusion of patients was interrupted due to saturation, and the inclusion of doctors and medical students stopped due to exhaustion. The theoretical background included symbolic Interactionism, and the analysis used rounded Theory. The analysis prioritized the actions/interactions axis. Results Twenty-three patients with pulmonary TB, seven doctors and 15 medical students were included. In the interviews, themes such as stigma, self-segregation, and difficulties in assistance emerged, in addition to defense mechanisms such as denial, rationalization, isolation and other mental mechanisms, including guilt, accountability and concealment of the disease. Aspects related to the assistance strategy, the social support network, bonding with the healthcare staff and the doctor-patient relationship were highlighted as adherence enablers. Doctors and students recommended an expansion of the theoretical and practical instruction on TB during medical students’ education. The existence of health programs and policies was mentioned as a potential enabler of adherence. Conclusion The main concepts identified were the stigma, self-segregation, guilt, responsibility, concealment and emotional repercussions. In relation to the facilitation of therapeutic adherence, the concepts identified were the bonds with healthcare staff, the doctor-patient relationship, assistance and educational health strategies. PMID:26360291

Efficacy of communication skills training on colorectal cancer screening by GPs: a cluster randomised controlled trial.

PubMed

Aubin-Auger, I; Laouénan, C; Le Bel, J; Mercier, A; Baruch, D; Lebeau, J P; Youssefian, A; Le Trung, T; Peremans, L; Van Royen, P

2016-01-01

Colorectal cancer (CRC) mass screening has been implemented in France since 2008. Participation rates remain too low. The objective of this study was to test if the implementation of a training course focused on communication skills among general practitioners (GP) would increase the delivery of gaiac faecal occult blood test and CRC screening participation among the target population of each participating GP. A cluster randomised controlled trial was conducted with GP's practice as a cluster unit. GPs from practices in the control group were asked to continue their usual care. GPs of the intervention group received a 4-h educational training, built with previous qualitative data on CRC screening focusing on doctor-patient communication with a follow-up of 7 months for both groups. The primary outcome measure was the patients' participation rate in the target population for each GP. Seventeen GPs (16 practices) in intervention group and 28 GPs (19 practices) in control group participated. The patients' participation rate in the intervention group were 36.7% vs. 24.5% in the control group (P = 0.03). Doctor-patient communication should be developed and appear to be one of the possible targets of improvement patients adherence and participation rate in the target population for CRC mass screening. © 2015 John Wiley & Sons Ltd.

Effects of response bias and judgment framing on operator use of an automated aid in a target detection task.

PubMed

Rice, Stephen; McCarley, Jason S

2011-12-01

Automated diagnostic aids prone to false alarms often produce poorer human performance in signal detection tasks than equally reliable miss-prone aids. However, it is not yet clear whether this is attributable to differences in the perceptual salience of the automated aids' misses and false alarms or is the result of inherent differences in operators' cognitive responses to different forms of automation error. The present experiments therefore examined the effects of automation false alarms and misses on human performance under conditions in which the different forms of error were matched in their perceptual characteristics. Young adult participants performed a simulated baggage x-ray screening task while assisted by an automated diagnostic aid. Judgments from the aid were rendered as text messages presented at the onset of each trial, and every trial was followed by a second text message providing response feedback. Thus, misses and false alarms from the aid were matched for their perceptual salience. Experiment 1 found that even under these conditions, false alarms from the aid produced poorer human performance and engendered lower automation use than misses from the aid. Experiment 2, however, found that the asymmetry between misses and false alarms was reduced when the aid's false alarms were framed as neutral messages rather than explicit misjudgments. Results suggest that automation false alarms and misses differ in their inherent cognitive salience and imply that changes in diagnosis framing may allow designers to encourage better use of imperfectly reliable automated aids.

Incomplete Multisource Transfer Learning.

PubMed

Ding, Zhengming; Shao, Ming; Fu, Yun

2018-02-01

Transfer learning is generally exploited to adapt well-established source knowledge for learning tasks in weakly labeled or unlabeled target domain. Nowadays, it is common to see multiple sources available for knowledge transfer, each of which, however, may not include complete classes information of the target domain. Naively merging multiple sources together would lead to inferior results due to the large divergence among multiple sources. In this paper, we attempt to utilize incomplete multiple sources for effective knowledge transfer to facilitate the learning task in target domain. To this end, we propose an incomplete multisource transfer learning through two directional knowledge transfer, i.e., cross-domain transfer from each source to target, and cross-source transfer. In particular, in cross-domain direction, we deploy latent low-rank transfer learning guided by iterative structure learning to transfer knowledge from each single source to target domain. This practice reinforces to compensate for any missing data in each source by the complete target data. While in cross-source direction, unsupervised manifold regularizer and effective multisource alignment are explored to jointly compensate for missing data from one portion of source to another. In this way, both marginal and conditional distribution discrepancy in two directions would be mitigated. Experimental results on standard cross-domain benchmarks and synthetic data sets demonstrate the effectiveness of our proposed model in knowledge transfer from incomplete multiple sources.

Perceived Cost and Intrinsic Motor Variability Modulate the Speed-Accuracy Trade-Off

PubMed Central

Bertucco, Matteo; Bhanpuri, Nasir H.; Sanger, Terence D.

2015-01-01

Fitts’ Law describes the speed-accuracy trade-off of human movements, and it is an elegant strategy that compensates for random and uncontrollable noise in the motor system. The control strategy during targeted movements may also take into account the rewards or costs of any outcomes that may occur. The aim of this study was to test the hypothesis that movement time in Fitts’ Law emerges not only from the accuracy constraints of the task, but also depends on the perceived cost of error for missing the targets. Subjects were asked to touch targets on an iPad® screen with different costs for missed targets. We manipulated the probability of error by comparing children with dystonia (who are characterized by increased intrinsic motor variability) to typically developing children. The results show a strong effect of the cost of error on the Fitts’ Law relationship characterized by an increase in movement time as cost increased. In addition, we observed a greater sensitivity to increased cost for children with dystonia, and this behavior appears to minimize the average cost. The findings support a proposed mathematical model that explains how movement time in a Fitts-like task is related to perceived risk. PMID:26447874

MA_MISS: Mars Multispectral Imager for Subsurface Studies

NASA Astrophysics Data System (ADS)

De Sanctis, M. C.; Coradini, A.; Ammannito, E.; Boccaccini, A.; Di Iorio, T.; Battistelli, E.; Capanni, A.

2012-04-01

A Drilling system, coupled with an in situ analysis package, is installed on the ExoMars Pasteur Rover to perform in situ investigations up to 2m in the Mars soil. Ma_Miss (Mars Multispectral Imager for Subsurface Studies) is a spectrometer devoted to observe the lateral wall of the borehole generated by the Drilling system. The instrument is fully integrated with the Drill and shares its structure and electronics. For the first time in Mars exploration experiments the water/geochemical environment will be investigated as function of depth in the shallow subsurface. Samples from the subsurface of Martian soil are unaltered by weathering process, oxidation and erosion. Subsurface access can be the key to look for signs of present and past environmental conditions, associated to the possibility for life (water, volatiles and weathering process). The analysis of uncontaminated samples by means of instrumented Drill and in situ observations is the solution for unambiguous interpretation of the original environment that leading to the formation of rocks. Ma_Miss experiment is perfectly suited to perform multispectral imaging of the drilled layers. Ma_Miss is a miniaturized near-infrared imaging spectrometer in the range 0.4-2.2 µm with 20nm spectral sampling. The task of illuminating the borehole wall and collecting the diffused light from the illuminated spot on the target requires a transparent window on the Drill tool, which shall prevent the dust contamination of the optical and mechanical elements inside. Hardness of sapphire is the closest to diamond one, thus avoiding the risk of scratches on its surface. The Sapphire window is cylindrical, and bounded such as to realize a continuous auger profile. Ma_Miss Optical Head performs the double task of illuminating the borehole wall with a spot around 1 mm diameter and of collecting the scattered light coming from a 0.1 mm diameter spot of the target. The signal from the Optical Head to the spectrometer is transferred through the different elements of the Drill by means of fiber optics and an optical rotary joint implemented in the roto-translation group of the Drill. Ma_Miss Optical Head has been tested in the breadboard to capture the diffused light from the observed target and transfer the signal to a laboratory spectrometer for analysis. The Optical Head of Ma_Miss has been tested after integration in ExoMars Drill. The drilling experiment has been carried out in realistic media (tuff, red brick). The test shows good performance of Optical Head illumination capability and of the window cleanliness during the drilling. Illumination spot is focused at the nominal distance of 0.2 mm from the sapphire window. During the ExoMars Pasteur Rover mission, the Ma_Miss experiment will allow collecting valuable data of the drilled stratigraphic column, will document "in-situ" the nature of the samples that will be delivered to the Pasteur Laboratory and will be able to identify hydrated minerals, sedimentary materials and different kind of diagnostic materials of Martian subsurface.

Early career retention of Malawian medical graduates: a retrospective cohort study.

PubMed

Mandeville, Kate L; Ulaya, Godwin; Lagarde, Mylene; Gwesele, Lyson; Dzowela, Titha; Hanson, Kara; Muula, Adamson S

2015-01-01

There have been longstanding concerns over Malawian doctors migrating to high-income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi-squared tests were employed to investigate relationships by graduation year and gender. We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54-2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61-0.86, P < 0.0001). While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

If You Don’t Find It Often, You Often Don’t Find It: Why Some Cancers Are Missed in Breast Cancer Screening

PubMed Central

Evans, Karla K.; Birdwell, Robyn L.; Wolfe, Jeremy M.

2013-01-01

Mammography is an important tool in the early detection of breast cancer. However, the perceptual task is difficult and a significant proportion of cancers are missed. Visual search experiments show that miss (false negative) errors are elevated when targets are rare (low prevalence) but it is unknown if low prevalence is a significant factor under real world, clinical conditions. Here we show that expert mammographers in a real, low-prevalence, clinical setting, miss a much higher percentage of cancers than are missed when the mammographers search for the same cancers under high prevalence conditions. We inserted 50 positive and 50 negative cases into the normal workflow of the breast cancer screening service of an urban hospital over the course of nine months. This rate was slow enough not to markedly raise disease prevalence in the radiologists’ daily practice. Six radiologists subsequently reviewed all 100 cases in a session where the prevalence of disease was 50%. In the clinical setting, participants missed 30% of the cancers. In the high prevalence setting, participants missed just 12% of the same cancers. Under most circumstances, this low prevalence effect is probably adaptive. It is usually wise to be conservative about reporting events with very low base rates (Was that a flying saucer? Probably not.). However, while this response to low prevalence appears to be strongly engrained in human visual search mechanisms, it may not be as adaptive in socially important, low prevalence tasks like medical screening. While the results of any one study must be interpreted cautiously, these data are consistent with the conclusion that this behavioral response to low prevalence could be a substantial contributor to miss errors in breast cancer screening. PMID:23737980

Detection of Missing Proteins Using the PRIDE Database as a Source of Mass Spectrometry Evidence.

PubMed

Garin-Muga, Alba; Odriozola, Leticia; Martínez-Val, Ana; Del Toro, Noemí; Martínez, Rocío; Molina, Manuela; Cantero, Laura; Rivera, Rocío; Garrido, Nicolás; Dominguez, Francisco; Sanchez Del Pino, Manuel M; Vizcaíno, Juan Antonio; Corrales, Fernando J; Segura, Victor

2016-11-04

The current catalogue of the human proteome is not yet complete, as experimental proteomics evidence is still elusive for a group of proteins known as the missing proteins. The Human Proteome Project (HPP) has been successfully using technology and bioinformatic resources to improve the characterization of such challenging proteins. In this manuscript, we propose a pipeline starting with the mining of the PRIDE database to select a group of data sets potentially enriched in missing proteins that are subsequently analyzed for protein identification with a method based on the statistical analysis of proteotypic peptides. Spermatozoa and the HEK293 cell line were found to be a promising source of missing proteins and clearly merit further attention in future studies. After the analysis of the selected samples, we found 342 PSMs, suggesting the presence of 97 missing proteins in human spermatozoa or the HEK293 cell line, while only 36 missing proteins were potentially detected in the retina, frontal cortex, aorta thoracica, or placenta. The functional analysis of the missing proteins detected confirmed their tissue specificity, and the validation of a selected set of peptides using targeted proteomics (SRM/MRM assays) further supports the utility of the proposed pipeline. As illustrative examples, DNAH3 and TEPP in spermatozoa, and UNCX and ATAD3C in HEK293 cells were some of the more robust and remarkable identifications in this study. We provide evidence indicating the relevance to carefully analyze the ever-increasing MS/MS data available from PRIDE and other repositories as sources for missing proteins detection in specific biological matrices as revealed for HEK293 cells.

Detection of Missing Proteins Using the PRIDE Database as a Source of Mass Spectrometry Evidence

PubMed Central

2016-01-01

The current catalogue of the human proteome is not yet complete, as experimental proteomics evidence is still elusive for a group of proteins known as the missing proteins. The Human Proteome Project (HPP) has been successfully using technology and bioinformatic resources to improve the characterization of such challenging proteins. In this manuscript, we propose a pipeline starting with the mining of the PRIDE database to select a group of data sets potentially enriched in missing proteins that are subsequently analyzed for protein identification with a method based on the statistical analysis of proteotypic peptides. Spermatozoa and the HEK293 cell line were found to be a promising source of missing proteins and clearly merit further attention in future studies. After the analysis of the selected samples, we found 342 PSMs, suggesting the presence of 97 missing proteins in human spermatozoa or the HEK293 cell line, while only 36 missing proteins were potentially detected in the retina, frontal cortex, aorta thoracica, or placenta. The functional analysis of the missing proteins detected confirmed their tissue specificity, and the validation of a selected set of peptides using targeted proteomics (SRM/MRM assays) further supports the utility of the proposed pipeline. As illustrative examples, DNAH3 and TEPP in spermatozoa, and UNCX and ATAD3C in HEK293 cells were some of the more robust and remarkable identifications in this study. We provide evidence indicating the relevance to carefully analyze the ever-increasing MS/MS data available from PRIDE and other repositories as sources for missing proteins detection in specific biological matrices as revealed for HEK293 cells. PMID:27581094

Predicting missing values in a home care database using an adaptive uncertainty rule method.

PubMed

Konias, S; Gogou, G; Bamidis, P D; Vlahavas, I; Maglaveras, N

2005-01-01

Contemporary literature illustrates an abundance of adaptive algorithms for mining association rules. However, most literature is unable to deal with the peculiarities, such as missing values and dynamic data creation, that are frequently encountered in fields like medicine. This paper proposes an uncertainty rule method that uses an adaptive threshold for filling missing values in newly added records. A new approach for mining uncertainty rules and filling missing values is proposed, which is in turn particularly suitable for dynamic databases, like the ones used in home care systems. In this study, a new data mining method named FiMV (Filling Missing Values) is illustrated based on the mined uncertainty rules. Uncertainty rules have quite a similar structure to association rules and are extracted by an algorithm proposed in previous work, namely AURG (Adaptive Uncertainty Rule Generation). The main target was to implement an appropriate method for recovering missing values in a dynamic database, where new records are continuously added, without needing to specify any kind of thresholds beforehand. The method was applied to a home care monitoring system database. Randomly, multiple missing values for each record's attributes (rate 5-20% by 5% increments) were introduced in the initial dataset. FiMV demonstrated 100% completion rates with over 90% success in each case, while usual approaches, where all records with missing values are ignored or thresholds are required, experienced significantly reduced completion and success rates. It is concluded that the proposed method is appropriate for the data-cleaning step of the Knowledge Discovery process in databases. The latter, containing much significance for the output efficiency of any data mining technique, can improve the quality of the mined information.

Branch target buffer design and optimization

NASA Technical Reports Server (NTRS)

Perleberg, Chris H.; Smith, Alan J.

1993-01-01

Consideration is given to two major issues in the design of branch target buffers (BTBs), with the goal of achieving maximum performance for a given number of bits allocated to the BTB design. The first issue is BTB management; the second is what information to keep in the BTB. A number of solutions to these problems are reviewed, and various optimizations in the design of BTBs are discussed. Design target miss ratios for BTBs are developed, making it possible to estimate the performance of BTBs for real workloads.

Sugar ingestion and dichotic listening: Increased perceptual capacity is more than motivation.

PubMed

Scheel, Matthew H; Ambrose, Aimee L

2014-01-01

Participants ingested a sugar drink or a sugar-free drink and then engaged in a pair of dichotic listening tasks. Tasks presented category labels then played a series of word pairs, one in the left ear and one in the right. Participants attempted to identify pairs containing a target category member. Target category words were homonyms. For example, arms appeared as a target in the "body parts" category. Nontargets that played along with targets were related to a category-appropriate version of the target (e.g., sleeves), a category-inappropriate version (e.g., weapons), or were unrelated to either version of the target (e.g., plant). Hence, an effect of nontarget type on number of targets missed was evidence that participants processed nontargets for meaning. In the divided attention task, participants monitored both ears. In the focused attention task, participants monitored the left ear. Half the participants in each group had the divided attention task before the focused attention task; the other half had the focused attention task before the divided attention task. We set task lengths to about 12 min so working on the first task would give sufficient time for metabolizing sugar from the drink before the start of the second task. Nontarget word type significantly affected targets missed in both tasks. Drink type affected performance in the divided attention task only after sufficient time for converting sugar into blood glucose. The result supports an energy model for the effect of sugar ingestion on perceptual tasks rather than a motivational model.

The uses of the smartphone for doctors: an empirical study from samsung medical center.

PubMed

Choi, Jong Soo; Yi, Byoungkee; Park, Jong Hwan; Choi, Kyesook; Jung, Jaegon; Park, Seung Woo; Rhee, Poong-Lyul

2011-06-01

In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information, then review the consequences of its use and discuss its future direction. Since 2003 when Samsung Medical Center introduced its first mobile application, a need to develop a new application targeting the latest smartphone technology was identified. To that end, an application named Dr. SMART S was officially launched on December 22nd, 2010. We analyzed the usage data of the application for a month until April 25th, 2011. On average, 170 doctors (13% of the entire body of doctors) logged on 2.4 times per day and that number keeps growing. The number was uniformly distributed across all working hours, with exceptions of heavy accesses around 6-8 AM and 4-6 PM when doctors do their regular rounds to see the patients. The most commonly accessed content was inpatient information, this constituted 78.6% of all accesses, within this 50% was to accesses lab results. Looking at the usage data, we can see the use of Dr. SMART S by doctors is growing in sync with the popularity of smartphones. Since u-Health seem an inevitable future trend, a more rigorous study needs to be conducted on how such mobile applications as Dr. SMART S affect the quality of care and patient safety to derive directions for further improvements.

Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia.

PubMed

Tjoa, Aaron; Kapihya, Margaret; Libetwa, Miriam; Schroder, Kate; Scott, Callie; Lee, Joanne; McCarthy, Elizabeth

2010-06-30

The Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH) strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear. We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Meeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment. Supplemental interventions targeting attrition, graduation and public sector entry rates can help close the gap. HRH modelling can help MOH policy makers determine the relative priority and level of investment needed to expand Zambia's workforce to target staffing levels.

Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia

PubMed Central

2010-01-01

Background The Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH) strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear. Methods We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. Results With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Conclusions Meeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment. Supplemental interventions targeting attrition, graduation and public sector entry rates can help close the gap. HRH modelling can help MOH policy makers determine the relative priority and level of investment needed to expand Zambia's workforce to target staffing levels. PMID:20591143

An empirical investigation into the role of subjective prior probability in searching for potentially missing items

PubMed Central

Fanshawe, T. R.

2015-01-01

There are many examples from the scientific literature of visual search tasks in which the length, scope and success rate of the search have been shown to vary according to the searcher's expectations of whether the search target is likely to be present. This phenomenon has major practical implications, for instance in cancer screening, when the prevalence of the condition is low and the consequences of a missed disease diagnosis are severe. We consider this problem from an empirical Bayesian perspective to explain how the effect of a low prior probability, subjectively assessed by the searcher, might impact on the extent of the search. We show how the searcher's posterior probability that the target is present depends on the prior probability and the proportion of possible target locations already searched, and also consider the implications of imperfect search, when the probability of false-positive and false-negative decisions is non-zero. The theoretical results are applied to two studies of radiologists' visual assessment of pulmonary lesions on chest radiographs. Further application areas in diagnostic medicine and airport security are also discussed. PMID:26587267

DEF: an automated dead-end filling approach based on quasi-endosymbiosis.

PubMed

Liu, Lili; Zhang, Zijun; Sheng, Taotao; Chen, Ming

2017-02-01

Gap filling for the reconstruction of metabolic networks is to restore the connectivity of metabolites via finding high-confidence reactions that could be missed in target organism. Current methods for gap filling either fall into the network topology or have limited capability in finding missing reactions that are indirectly related to dead-end metabolites but of biological importance to the target model. We present an automated dead-end filling (DEF) approach, which is derived from the wisdom of endosymbiosis theory, to fill gaps by finding the most efficient dead-end utilization paths in a constructed quasi-endosymbiosis model. The recalls of reactions and dead ends of DEF reach around 73% and 86%, respectively. This method is capable of finding indirectly dead-end-related reactions with biological importance for the target organism and is applicable to any given metabolic model. In the E. coli iJR904 model, for instance, about 42% of the dead-end metabolites were fixed by our proposed method. DEF is publicly available at http://bis.zju.edu.cn/DEF/. mchen@zju.edu.cn Supplementary data are available at Bioinformatics online.

Medication communication through documentation in medical wards: knowledge and power relations.

PubMed

Liu, Wei; Manias, Elizabeth; Gerdtz, Marie

2014-09-01

Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video-recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision-making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals. © 2013 John Wiley & Sons Ltd.

A case study of teaching social responsibility to doctoral students in the climate sciences.

PubMed

Børsen, Tom; Antia, Avan N; Glessmer, Mirjam Sophia

2013-12-01

The need to make young scientists aware of their social responsibilities is widely acknowledged, although the question of how to actually do it has so far gained limited attention. A 2-day workshop entitled "Prepared for social responsibility?" attended by doctoral students from multiple disciplines in climate science, was targeted at the perceived needs of the participants and employed a format that took them through three stages of ethics education: sensitization, information and empowerment. The workshop aimed at preparing doctoral students to manage ethical dilemmas that emerge when climate science meets the public sphere (e.g., to identify and balance legitimate perspectives on particular types of geo-engineering), and is an example of how to include social responsibility in doctoral education. The paper describes the workshop from the three different perspectives of the authors: the course teacher, the head of the graduate school, and a graduate student. The elements that contributed to the success of the workshop, and thus make it an example to follow, are (1) the involvement of participating students, (2) the introduction of external expertise and role models in climate science, and (3) a workshop design that focused on ethical analyses of examples from the climate sciences.

Formulating treatment recommendation as a logical consequence of the diagnosis in post-surgical oncological visits.

PubMed

Fatigante, Marilena; Alby, Francesca; Zucchermaglio, Cristina; Baruzzo, Mattia

2016-06-01

the article analyzes how a doctor delivers diagnoses and recommends treatment in a set of post-surgical oncological visits. The pattern of activities are explored in two different cases: when all diagnostic information is available, and when information is still missing. The data consist of 12 video-recorded visits of breast cancer patients to a senior oncologist. Conversation analysis is employed to analyze sequences in which the delivery of diagnosis and treatment recommendation unfold. The oncologist formulates the treatment recommendation as a logical consequence deriving from the available diagnostic information. In cases when definitive diagnostic information on the cancer type is missing, the oncologist opts to anticipate hypothetical diagnostic scenarios, and to draw the therapeutic alternatives as logical outcomes envisionable from each of the different scenarios. The communicative practice appears functional to encourage the patients' acceptance of a single treatment option rather than present the patients to and involve them in deliberating over multiple available treatment alternatives. Rather than a normative adoption of existing protocols of communication in cancer care, a better understanding of communication practices in use can help practitioners to reflect upon and make intentional choices about different arrangements for the patient's participation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Considerations on the Sistema Único de Saúde in the twenty-first century: an interview with Lígia Bahia].

PubMed

Bahia, Lígia; Cueto, Marcos; Benchimol, Jaime; Teixeira, Luiz Antonio; Cerqueira, Roberta C

2014-01-01

This interview with Lígia Bahia explores evaluations of the first 25 years of Brazil's Sistema Único de Saúde (SUS) and analyzes the project's progress, impasses, and missteps. Bahia is critical of both tendencies currently found within SUS: the one that sees the system as aimed at equity and the other posing equality as its goal. She criticizes the ambivalence that various spheres of government have displayed in their decisions regarding large corporate groups and private health insurance plans, which conflict with the ideas of SUS. She evaluates the participation of doctors and other healthcare professionals in the system. Lastly, she analyzes the emergence of identity politics, which are missing from the public health reform project, whose emphasis was on equality.

Patient perspectives on online health information and communication with doctors: a qualitative study of patients 50 years old and over.

PubMed

Silver, Michelle Pannor

2015-01-13

As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet. Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet. For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis. Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn't want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor. Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue.

Patient Perspectives on Online Health Information and Communication With Doctors: A Qualitative Study of Patients 50 Years Old and Over

PubMed Central

2015-01-01

Background As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet. Objective Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet. Methods For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis. Results Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn’t want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor. Conclusions Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue. PMID:25586865

The challenges of describing rehabilitation services: A discussion paper.

PubMed

Røe, Cecilie; Kirkevold, Marit; Andelic, Nada; Soberg, Helene L; Sveen, Unni; Bautz-Holter, Erik; Jahnsen, Reidun; van Walsem, Marleen R; Kildal Bragstad, Line; Gabrielsen Hjelle, Ellen; Klevberg, Gunvor; Oretorp, Per; Habberstad, Andreas; Hagfors, Jon; Væhle, Randi; Engen, Grace; Gutenbrunner, Christoph

2018-02-13

To apply the Classification of Service Organization in Rehabilitation (ICSO-R) classification of services to different target groups, include the user perspective, identify missing categories, and propose standardized descriptors for the categories from a Norwegian perspective. Expert-based consensus conferences with user involvement. Health professionals, stakeholders and users. Participants were divided into 5 panels, which applied the ICSO-R to describe the habilitation and rehabilitation services provided to children with cerebral palsy and people with Huntington's disease, acquired brain injuries (traumatic brain injuries and stroke) and painful musculoskeletal conditions. Based on the Problem/Population, Intervention, Comparison, Outcome (PICO) framework, the services were described according to the ICSO-R. Missing categories were identified. The ICSO-R was found to be feasible and applicable for describing a variety of services provided to different target groups in Norway, but the user perspective was lacking, categories were missing, and a need for standardized description of the categories was identified. The present work supports the need to produce an updated version of the ICSO-R and to encourage national and international discussion of the framework. The ICSO-R has the potential to become a tool for the standardized assessment of rehabilitation services. For such purposes, more standardized descriptions of subcategories are necessary.

Suicides by persons reported as missing prior to death: a retrospective cohort study.

PubMed

Sveticic, Jerneja; Too, Lay San; De Leo, Diego

2012-01-01

A first study to compare suicides by missing persons with other suicide cases. Retrospective cohort study for the period 1994-2007. GEOGRAPHICAL LOCATION: Queensland, Australia. 194 suicides by missing persons and 7545 other suicides were identified through the Queensland Suicide Register and the National Coroners Information System. χ(2) statistics and binary logistic regression were used to identify distinct characteristics of suicides by missing persons. Compared with other suicide cases, missing persons significantly more often died by motor vehicle exhaust gas toxicity (23.7% vs 16.4%; χ(2)=7.32, p<0.01), jumping from height (6.7% vs 3.2%; χ(2)=7.08, p<0.01) or drowning (8.2% vs 1.8%; χ(2)=39.53, p<0.01), but less frequently by hanging (29.4% vs 39.9%; χ(2)=8.82, p<0.01). They were most frequently located in natural outdoors locations (58.2% vs 11.1%; χ(2)=388.25, p<0.01). Persons gone missing were less likely to have lived alone at time of death (OR 0.45, 95% CI 0.26 to 0.76), yet more likely to be institutionalised (OR 3.12, 95% CI 1.28 to 7.64). They were less likely to have been physically ill (OR 0.64, 95% CI 0.43 to 0.95) or have a history of problematic consumptions of alcohol (OR 0.52, 95% CI 0.31 to 0.87). In comparison to other suicide cases, missing persons more often communicated their suicidal intent prior to death (OR 1.58, 95% CI 1.13 to 2.22). Suicides by missing persons show several distinct characteristics in comparisons to other suicides. The findings have implications for development of suicide prevention strategies focusing on early identification and interventions targeting this group. In particular, it may offer assistance to police in designing risk assessment procedures and subsequent investigations of missing persons.

Suicides by persons reported as missing prior to death: a retrospective cohort study

PubMed Central

Sveticic, Jerneja; Too, Lay San

2012-01-01

Objective A first study to compare suicides by missing persons with other suicide cases. Design Retrospective cohort study for the period 1994–2007. Geographical location Queensland, Australia. Population 194 suicides by missing persons and 7545 other suicides were identified through the Queensland Suicide Register and the National Coroners Information System. Main outcome measure χ2 statistics and binary logistic regression were used to identify distinct characteristics of suicides by missing persons. Results Compared with other suicide cases, missing persons significantly more often died by motor vehicle exhaust gas toxicity (23.7% vs 16.4%; χ2=7.32, p<0.01), jumping from height (6.7% vs 3.2%; χ2=7.08, p<0.01) or drowning (8.2% vs 1.8%; χ2=39.53, p<0.01), but less frequently by hanging (29.4% vs 39.9%; χ2=8.82, p<0.01). They were most frequently located in natural outdoors locations (58.2% vs 11.1%; χ2=388.25, p<0.01). Persons gone missing were less likely to have lived alone at time of death (OR 0.45, 95% CI 0.26 to 0.76), yet more likely to be institutionalised (OR 3.12, 95% CI 1.28 to 7.64). They were less likely to have been physically ill (OR 0.64, 95% CI 0.43 to 0.95) or have a history of problematic consumptions of alcohol (OR 0.52, 95% CI 0.31 to 0.87). In comparison to other suicide cases, missing persons more often communicated their suicidal intent prior to death (OR 1.58, 95% CI 1.13 to 2.22). Conclusions Suicides by missing persons show several distinct characteristics in comparisons to other suicides. The findings have implications for development of suicide prevention strategies focusing on early identification and interventions targeting this group. In particular, it may offer assistance to police in designing risk assessment procedures and subsequent investigations of missing persons. PMID:22454187

Alternative medicine, worker health, and absenteeism in the United States.

PubMed

Rybczynski, Kate

2017-06-01

Health related absenteeism costs an estimated $153 billion annually in the United States (Witters and Agrawal, 2011). 1 Chronic conditions (major contributors to absenteeism) are often successfully managed by Complementary and Alternative Medicine (CAM). As CAM becomes an increasingly visible component of healthcare, firms may wish to consider whether CAM therapies can help reduce illness-related absenteeism. This paper aims to extend the literature on healthcare utilization and absenteeism by exploring whether CAM treatment is associated with fewer workdays missed due to illness. Using the 2007 National Health Interview Survey (NHIS) and propensity score matching (PSM), this study estimates the relationship between visits to CAM practitioners, health, and illness-related absenteeism. In a sample of 8820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p<0.05), whereas visiting a naturopathic doctor correlates with 2.359 and 2.521 fewer workdays missed for women and men, respectively (both p<0.001). Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health. Estimates suggest that some CAM modalities correlate with lower absenteeism, and many correlate with improved health. Two limitations of this study are worth noting. First, a small proportion of the sample uses CAM, limiting the generalizability of results. Second, if health conscious individuals are more likely to use CAM, then health attitudes may be contributing to lower absenteeism among the treated. Further research is needed to identify a causal relationship between CAM treatment, health, and absenteeism. Copyright © 2016 Elsevier Ltd. All rights reserved.

Improving the care of patients with cystic fibrosis (CF)

PubMed Central

Khan, Ahsan Aftab; Nash, Edward F; Whitehouse, Joanna; Rashid, Rifat

2017-01-01

Background The West Midlands Adult Cystic Fibrosis (CF) Centre based at Birmingham Heartlands Hospital provides care for adults with CF in the West Midlands. People with CF are prone to pulmonary exacerbations, which often require inpatient admission for intravenous antibiotics. We observed that the admission process was efficient during working hours (9:00–17:00, Monday–Friday) when the CF team are routinely available, but out-of-working hours, there were delays in these patients being clerked and receiving their first antibiotic dose. We were concerned that this was resulting in quality and potential safety issues by causing delays in starting treatment and prolonging hospital inpatient stays. We therefore undertook a quality improvement project (QIP) aimed at addressing these issues. An initial survey showed median time to clerk of 5 hours, with 60% of patients missing their first dose of antibiotics and mean length of stay of 16 days. Methods We applied the Plan-Do-Study-Act (PDSA) cycle approach, with the first PDSA cycle involving raising awareness of the issue through education to doctors, nurses and patients. Results This led to a reduction of median time to clerk from 5 to 2 hours with 23% of patients missing their first antibiotic dose and mean length of stay reducing to 14 days. The second cycle involved introducing an admissions checklist and displaying education posters around the hospital, resulting in median time to clerk remaining at 2 hours but only 20% of patients missing their first antibiotic dose and the mean length of stay remaining at 14 days. Conclusion This QIP has improved the out-of-hours admissions process for adults with CF in our centre. We plan to review the longer term effects of the project including sustainability, effects on clinical outcomes and patient satisfaction. PMID:28959778

Missed opportunities for immunization.

PubMed

Verma, J; Sachar, R K; Prakash, V; Jain, G D; Sehgal, R

1990-01-01

A survey conducted in the outpatient departments of Dayanand Medical College and Hospital in Ludhiana, India, found that 13.4% of children aged 0-23 months and 33.0% of pregnant women were not being given due immunization. Maximum advantage, however, should be taken of every contact between health workers and clients to provide all available and required health interventions. 80% immunization coverage could be achieved if all children who are brought to clinics for whatever purpose were screened and immunized if necessary. Missed opportunities occur because immunization is not available on all days; there is no uniform contraindication policy; doctors schedule as they please, with only one or two vaccines given to children who are eligible for more; there is an unwillingness to combine vaccines; weak excuses prevent the administration of vaccines; due antigens are not given on discharge from hospitals following recovery; pregnancy of less than 16 weeks is supposed to be a contraindication to tetanus toxoid; there is vaccinator reluctance to open multi-dose BCG/measles vaccine vials for a small number of children for fear of wasting the vaccine; and vaccines may be out of stock. The following suggestions may help minimize missed opportunities for immunization: review of the immunization schedule to provide optimal protection at the earliest age, review of the policy on contraindications to avoid false contraindications, ensuring that all women and children receive all vaccines for which they are eligible, issuing immunization cards to all women and children and checking them on all subsequent visits, making vaccines available in all clinics, educating health care personnel on these issues, packing vaccines in smaller quantities to avoid wastage, and exploiting all contacts with the people to provide maximum health care interventions.

The Inequality of Climate Change From 1.5 to 2°C of Global Warming

NASA Astrophysics Data System (ADS)

King, Andrew D.; Harrington, Luke J.

2018-05-01

The Paris Agreement aims to keep global warming well below 2°C above preindustrial levels with a preferred ambitious 1.5°C target. Developing countries, especially small island nations, pressed for the 1.5°C target to be adopted, but who will suffer the largest changes in climate if we miss this target? Here we show that exceeding the 1.5°C global warming target would lead to the poorest experiencing the greatest local climate changes. Under these circumstances greater support for climate adaptation to prevent poverty growth would be required.

Can contrast-enhanced ultrasonography improve Zone III REBOA placement for prehospital care?

PubMed

Chaudery, Muzzafer; Clark, James; Morrison, Jonathan J; Wilson, Mark H; Bew, Duncan; Darzi, Ara

2016-01-01

Torso hemorrhage is the primary cause of potentially preventable mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been advocated as an adjunct to bridge patients to definitive hemorrhage control. The primary aim of this study was to assess whether contrast-enhanced ultrasonography can improve the accuracy of REBOA placement in the infrarenal aorta (Zone III). A fluoroscopy-free "enhanced" Zone III REBOA technique was developed using a porcine cadaver model. A "standard" over-the-wire Seldinger technique was used, which was enhanced with the addition of a microbubble contrast medium to inflate the balloon, observed with ultrasonography. Following this, attending- and resident-level physicians were randomized into two groups. They were taught either the enhanced with ultrasonography guidance (Group A) or the standard measuring length of catheter insertion (Group B) technique as part of a human cadaver trauma skills course. Outcomes assessed included time (seconds) from insertion to inflation, accuracy, and missed targets. All results were benchmarked against three endovascular experts. There were 20 participants who performed REBOA with Group A (51 [31]) being significantly faster than Group B (90 [63]) (p = 0.003) and more accurate (p = 0.023) with no missed targets. Group B had five missed targets, the most common error being inflation within Zone II. For Zone III REBOA, contrast-enhanced ultrasonography technique is faster and more accurate than the standard technique. This may have value in time-critical and austere environments. Clinical studies are now required to evaluate this approach further.

Direct imaging search for the "missing link" in giant planet formation

NASA Astrophysics Data System (ADS)

Ngo, Henry; Mawet, Dimitri; Ruane, Garreth; Xuan, Wenhao; Bowler, Brendan; Cook, Therese; Zawol, Zoe

2018-01-01

While transit and radial velocity detection techniques have probed giant planet populations at close separations (within a few au), current direct imaging surveys are finding giant planets at separations of 10s-100s au. Furthermore, these directly imaged planets are very massive, including some with masses above the deuterium burning limit. It is not certain whether these objects represent the high mass end of planet formation scenarios or the low mass end of star formation. We present a direct imaging survey to search for the "missing link" population between the close-in RV and transiting giant planets and the extremely distant directly imaged giant planets (i.e. giant planets between 5-10 au). Finding and characterizing this population allows for comparisons with the formation models of closer-in planets and connects directly imaged planets with closer-in planets in semi-major axis phase space. In addition, microlensing surveys have suggested a large reservoir of giant planets exist in this region. To find these "missing link" giant planets, our survey searches for giant planets around M-stars. The ubiquity of M-stars provide a large number of nearby targets and their L-band contrast with planets allow for sensitivities to smaller planet masses than surveys conducted at shorter wavelengths. Along with careful target selection, we use Keck's L-band vector vortex coronagraph to enable sensitivities of a few Jupiter masses as close as 4 au to their host stars. We present our completed 2-year survey targeting 200 young (10-150 Myr), nearby M-stars and our ongoing work to follow-up over 40 candidate objects.

Beam-target double-spin asymmetry in quasielastic electron scattering off the deuteron with CLAS

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

Mayer, M.; Kuhn, S. E.; Adhikari, K. P.

Background: The deuteron plays a pivotal role in nuclear and hadronic physics, as both the simplest bound multi-nucleon system and as an ``effective neutron target''. Quasi-elastic electron scattering on the deuteron is a benchmark reaction to test our understanding of deuteron structure and the properties and interactions of the two nucleons bound in the deuteron. Purpose: The experimental data presented here test state-of-the-art models of the deuteron and the two-nucleon interaction in the final state after two-body breakup of the deuteron. Focusing on polarization degrees of freedom, we gain information on the limits of the Impulse Approximation (IA) picture andmore » put the interpretation of spin structure measurements with deuterium on a firmer footing. Information on this reaction can also be used to improve the determination of the deuteron polarization through quasi-elastic electron scattering. Method: We measured the beam-target double spin asymmetry (A||) for quasi-elastic electron scattering off the deuteron at several beam energies (1.6-1.7 GeV, 2.5 GeV, 4.2 GeV and 5.6-5.8 GeV), using the CEBAF Large Acceptance Spectrometer (CLAS) at Thomas Jefferson National Accelerator Facility. The deuterons were polarized along (or opposite to) the beam direction. The double spin asymmetries were measured as a function of photon virtuality Q2 (0.13-3.17 (GeV/c)2), missing momentum (pm = 0.0 - 0.5 GeV/c), and the angle between the (inferred) ``spectator'' neutron and the momentum transfer direction (θnq). Results: The results are compared with a recent model that includes Final State Interactions (FSI) using a complete parameterization of nucleon-nucleon scattering, as well as a simplified model using the Plane Wave Impulse Approximation (PWIA). We find overall good agreement with both the PWIA and FSI expectations at low to medium missing momenta (pm ≤ 0.25 GeV/c), including the change of the asymmetry due to the contribution of the deuteron D-state at higher momenta. At the highest missing momenta, our data clearly agree better with the calculations including FSI. Conclusions: Final state interactions seem to play a lesser role for polarization observables in deuteron two-body electro-disintegration than for absolute cross sections. Our data, while limited in statistical power, indicate that PWIA models work reasonably well to understand the asymmetries at lower missing momenta. In turn, this information can be used to extract the product of beam and target polarization (PbPt) from quasi-elastic electron-deuteron scattering, which is useful for measurements of spin observables in electron-neutron inelastic scattering. However, at the highest missing (neutron) momenta, FSI effects become important and must be accounted for.« less

Substance use and adherence among people living with HIV/AIDS receiving cART in Latin America

PubMed Central

De Boni, Raquel B.; Shepherd, Bryan E.; Grinsztejn, Beatriz; Cesar, Carina; Cortés, Claudia; Padgett, Denis; Gotuzzo, Eduardo; Belaunzarán-Zamudio, Pablo F.; Rebeiro, Peter F.; Duda, Stephany N.; McGowan, Catherine C.

2016-01-01

This cross-sectional study describes substance use prevalence and its association with cART adherence among 3343 individuals receiving care at HIV clinics in Argentina, Brazil, Chile, Honduras, Mexico, and Peru. A rapid screening tool evaluated self-reported 7-day recall of alcohol, marijuana, cocaine, heroin, and methamphetamine use, and missed cART doses. Overall, 29.3% individuals reported having ≥ 1 alcoholic drinks, 5.0% reported any illicit drug use and 17.0% reported missed cART doses. In the logistic regression model, compared to no substance use, alcohol use (adjusted odds ratio (AOR)=2.46, 95% confidence interval (CI): 1.99–3.05), illicit drug use (AOR=3.57, 95% CI: 2.02–6.30), and using both alcohol and illicit drugs (AOR=4.98, 95% CI: 3.19–7.79) were associated with missed cART doses. The associations between substance use and likelihood of missing cART doses point to the need of targeting alcohol and illicit drug use to improve adherence among people living with HIV in Latin America. PMID:27091028

An investigation of stigmatizing attitudes towards people living with HIV/AIDS by doctors and nurses in Vientiane, Lao PDR.

PubMed

Vorasane, Savina; Jimba, Masamine; Kikuchi, Kimiyo; Yasuoka, Junko; Nanishi, Keiko; Durham, Jo; Sychareun, Vanphanom

2017-02-10

Despite global efforts, HIV-related stigma continues to negatively impact the health and well-being of people living with HIV/AIDS. Even in healthcare settings, people with HIV/AIDS experience discrimination. Anecdotal evidence suggests that healthcare professionals in the Lao People's Democratic Republic, a lower-middle income country situated in Southeast Asia, stigmatize HIV/AID patients. The purpose of this study was to assess HIV stigmatizing attitudes within Laotian healthcare service providers and examine some of the factors associated with HIV/AIDS-related stigma among doctors and nurses. A structured questionnaire, which included a HIV-related stigma scale consisting of 17 items, was self-completed by 558 healthcare workers from 12 of the 17 hospitals in Vientiane. Five hospitals were excluded because they had less than 10 staff and these staff were not always present. The questionnaire was pre-tested with 40 healthcare workers. Descriptive statistical analysis was performed and comparisons between groups undertaken using chi-square test and t-test. Bivariate and multiple linear regression analyses were carried out to examine the associations between stigmatizing attitudes and independent variables. Out of the 558 participating healthcare workers, 277 (49.7%) were doctors and 281 (50.3%) were nurses. Nearly 50% of doctors and nurses included in the study had high levels of stigmatizing attitudes towards people living with HIV/AIDS. Across the different health professionals included in this study, lower levels of HIV/AIDS knowledge were associated with higher levels of stigmatizing attitudes towards people living with HIV/AIDS. Stigmatizing attitudes, including discrimination at work, fear of AIDS, and prejudice, were lower in healthcare workers with more experience in treating HIV/AIDS patients. This study is the first to report on HIV/AIDS-related stigmatization among healthcare workers in Lao PDR. Stigmatizing attitudes contribute to missed opportunities for prevention, education and treatment, undermining efforts to manage and prevent HIV. Reversing stigmatizing attitudes and practices requires interventions that address affective, cognitive and behavioral aspects of stigma. Alongside this, health professionals need to be enabled to enact universal precautions and prevent occupational transmission of HIV.

Acceptability of physical examination by male doctors in medical care: Taking breast palpation as an example.

PubMed

Wang, Yan-jie; Yang, Jie; Kang, Li-xia; Jia, Zhen; Chen, Dong-ming; Zhang, Ping; Feng, Zhan-chun

2015-10-01

In this study, we conducted an investigation among medical workers, patients and college students concerning their acceptability of breast palpation performed by male doctors (hereinafter referred to as "acceptability", or "the examination", respectively, if not otherwise indicated), to get the information about their acceptability and reasons for accepting or declining the examination among the three population. A questionnaire investigation was conducted in 500 patients with breast diseases, 700 students of medical colleges, and 280 medical workers working in hospitals. The subjects were asked to choose between two options: accept or do not accept (the examination). The subjects were asked to fill out the questionnaire forms on free and anonymous basis and the questionnaire forms were collected on spot, immediately after completion. The questionnaires collected were coded, sorted out and checked. Data of the eligible questionnaires were input into Epidata software and analyzed by SPSS. Upon the establishment of the database, the intra-group data were tested by utilizing χ(2) test. Among 1480 questionnaires, 1293 (90.41%) questionnaires were retrieved. Our results showed that 56.78% of patients reported that they could accept breast palpation by male doctors. About 59.66% of medical staff expressed their acceptance of the examination, but only 35.03% of students said the examination. On the basis of this study, we were led to conclude that the examination is not well accepted by different populations, and therefore, (1) medical professionals and administrators should pay attention to the gender-related ethics in their practice and the feeling of patients should be respected when medical examinations involve private or sensitive body parts; (2) to this end, related departments should be properly staffed with doctors of both sexes, and this is especially true of the departments involving the examination or treatment of private or sensitive body parts; (3) health education should, among other things, include helping female patients to overcome the fear and anxiety in such examinations. This is of great importance since some women may miss the opportunity to get timely diagnosis.

Phonation takes precedence over articulation in development as well as evolution of language.

PubMed

Oller, D Kimbrough

2014-12-01

Early human vocal development is characterized first by emerging control of phonation and later by prosodic and supraglottal articulation. The target article has missed the opportunity to use these facts in the characterization of evolution in language-specific brain mechanisms. Phonation appears to be the initial human-specific brain change for language, and it was presumably a key target of selection in early hominin evolution.

Using Hermeneutic Phenomenology to Investigate How Experienced Practitioners Learn to Communicate Clinical Reasoning

ERIC Educational Resources Information Center

Ajjawi, Rola; Higgs, Joy

2007-01-01

This paper is primarily targeted at doctoral students and other researchers considering using hermeneutic phenomenology as a research strategy. We present interpretive paradigm research designed to investigate how experienced practitioners learn to communicate their clinical reasoning in professional practice. Twelve experienced physiotherapy…

Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review

PubMed Central

Papoutsi, Chrysanthi; Mattick, Karen; Pearson, Mark; Brennan, Nicola; Briscoe, Simon; Wong, Geoff

2017-01-01

Abstract Background Antimicrobial resistance has led to widespread implementation of interventions for appropriate prescribing. However, such interventions are often adopted without an adequate understanding of the challenges facing doctors-in-training as key prescribers. Methods The review followed a realist, theory-driven approach to synthesizing qualitative, quantitative and mixed-methods literature. Consistent with realist review quality standards, articles retrieved from electronic databases were systematically screened and analysed to elicit explanations of antimicrobial prescribing behaviours. These explanations were consolidated into a programme theory drawing on social science and learning theory, and shaped though input from patients and practitioners. Results By synthesizing data from 131 articles, the review highlights the complex social and professional dynamics underlying antimicrobial prescribing decisions of doctors-in-training. The analysis shows how doctors-in-training often operate within challenging contexts (hierarchical relationships, powerful prescribing norms, unclear roles and responsibilities, implicit expectations about knowledge levels, uncertainty about application of knowledge in practice) where they prioritize particular responses (fear of criticism and individual responsibility, managing one’s reputation and position in the team, appearing competent). These complex dynamics explain how and why doctors-in-training decide to: (i) follow senior clinicians’ prescribing habits; (ii) take (or not) into account prescribing aids, advice from other health professionals or patient expectations; and (iii) ask questions or challenge decisions. This increased understanding allows for targeted tailoring, design and implementation of antimicrobial prescribing interventions. Conclusions This review contributes to a better understanding of how antimicrobial prescribing interventions for doctors-in-training can be embedded more successfully in the hierarchical and inter-professional dynamics of different healthcare settings. PMID:28859445

The Uses of the Smartphone for Doctors: An Empirical Study from Samsung Medical Center

PubMed Central

Choi, Jong Soo; Yi, Byoungkee; Park, Jong Hwan; Choi, Kyesook; Jung, Jaegon; Park, Seung Woo

2011-01-01

Objectives In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information, then review the consequences of its use and discuss its future direction. Methods Since 2003 when Samsung Medical Center introduced its first mobile application, a need to develop a new application targeting the latest smartphone technology was identified. To that end, an application named Dr. SMART S was officially launched on December 22nd, 2010. Results We analyzed the usage data of the application for a month until April 25th, 2011. On average, 170 doctors (13% of the entire body of doctors) logged on 2.4 times per day and that number keeps growing. The number was uniformly distributed across all working hours, with exceptions of heavy accesses around 6-8 AM and 4-6 PM when doctors do their regular rounds to see the patients. The most commonly accessed content was inpatient information, this constituted 78.6% of all accesses, within this 50% was to accesses lab results. Conclusions Looking at the usage data, we can see the use of Dr. SMART S by doctors is growing in sync with the popularity of smartphones. Since u-Health seem an inevitable future trend, a more rigorous study needs to be conducted on how such mobile applications as Dr. SMART S affect the quality of care and patient safety to derive directions for further improvements. PMID:21886874

Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments-2015.

PubMed

Feinberg, A; Lopez, P M; Wyka, K; Islam, N; Seidl, L; Drackett, E; Mata, A; Pinzon, J; Baker, M R; Lopez, J; Trinh-Shevrin, C; Shelley, D; Bailey, Z; Maybank, K A; Thorpe, L E

2017-08-01

To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.

Scholarly work products of the doctor of nursing practice: one approach to evaluating scholarship, rigour, impact and quality.

PubMed

Terhaar, Mary F; Sylvia, Martha

2016-01-01

The aim of this investigation was to evaluate, monitor and manage the quality of projects conducted and work produced as evidence of scholarship upon completion of Doctor of Nursing Practice education. The Doctor of Nursing Practice is a relatively new degree which prepares nurses for high impact careers in diverse practice settings around the globe. Considerable variation characterises curricula across schools preparing Doctors of Nursing Practice. Accreditation assures curricula are focused on attainment of the Doctor of Nursing Practice essentials, yet outcomes have not been reported to help educators engage in programme improvement. This work has implications for nursing globally because translating strong evidence into practice is key to improving outcomes in direct care, leadership, management and education. The Doctor of Nursing Practice student learns to accomplish translation through the conduct of projects. Evaluating the rigour and results of these projects is essential to improving the quality, safety and efficacy of translation, improvements in care and overall system performance. A descriptive study was conducted to evaluate the scholarly products of Doctor of Nursing Practice education in one programme across four graduating classes. A total of 80 projects, conducted across the USA and around the globe, are described using a modification of the Uncertainty, Pace, Complexity Model. The per cent of students considered to have produced high quality work in relation to target expectations as well as the per cent that conducted means testing increased over the four study years. Evaluation of scope, complexity and rigour of scholarly work products has driven improvements in the curriculum and informed the work of faculty and advisors. Methods, evaluation and outcomes conformed around a set of expectations for scholarship and rigour have resulted in measurable outcomes, and quality publications have increased over time. © 2015 John Wiley & Sons Ltd.

Medical barriers to emergency contraception: a cross-sectional survey of doctors in North India.

PubMed

Khan, M E; Dixit, Anvita; Bhatnagar, Isha; Brady, Martha

2014-05-01

Some medical doctors in India have publicly expressed opposition to making emergency contraceptive pills (ECPs) easily accessible, even though ECPs are included in the method mix of the Ministry of Health and Family Welfare program and as an over-the-counter (OTC) product. Such opposition affects access to ECPs by influencing policy, procurement, and distribution, besides stigmatizing the ECP user. This study was conducted to assess ECP knowledge, attitudes, and practices of doctors in North India. A cross-sectional survey of 83 doctors who provide ECPs, randomly selected from 3 cities in the state of Uttar Pradesh, was conducted in 2011. The quantitative data were complemented by 19 in-depth interviews with purposively selected senior gynecologists and other opinion leaders. All surveyed physicians cited the correct dose and regimen for ECPs. However, the large majority of those surveyed believed that ECPs work by preventing implantation. (The best evidence currently indicates that ECPs do not work by preventing implantation.) Most doctors also believed incorrectly that ECPs have several contraindications and side effects. They also had strong reservations against OTC provision of ECPs by pharmacists and community health workers (CHWs) and negative attitudes toward ECP users, which serve as serious medical barriers to mainstreaming use of ECPs. Physicians and their professional associations exert a strong influence on the operationalization of national contraceptive policies. Evidence-based advocacy and educational campaigns targeting doctors are needed to address and resolve their reservations about ECPs, particularly about its provision as an OTC product and its distribution by CHWs. Partnerships with medical associations can help reduce doctors' negative attitudes and create a conducive environment for influencing clinical practices. Such changes are needed to increase the availability and use of ECPs as part of a package of a full range of contraceptive method options to prevent unwanted pregnancy among the most vulnerable populations.

Specialties differ in which aspects of doctor communication predict overall physician ratings.

PubMed

Quigley, Denise D; Elliott, Marc N; Farley, Donna O; Burkhart, Q; Skootsky, Samuel A; Hays, Ron D

2014-03-01

Effective doctor communication is critical to positive doctor-patient relationships and predicts better health outcomes. Doctor communication is the strongest predictor of patient ratings of doctors, but the most important aspects of communication may vary by specialty. To determine the importance of five aspects of doctor communication to overall physician ratings by specialty. For each of 28 specialties, we calculated partial correlations of five communication items with a 0-10 overall physician rating, controlling for patient demographics. Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) 12-month Survey data collected 2005-2009 from 58,251 adults at a 534-physician medical group. CG-CAHPS includes a 0 ("Worst physician possible") to 10 ("Best physician possible") overall physician rating. Five doctor communication items assess how often the physician: explains things; listens carefully; gives easy-to-understand instructions; shows respect; and spends enough time. Physician showing respect was the most important aspect of communication for 23/28 specialties, with a mean partial correlation (0.27, ranging from 0.07 to 0.44 across specialties) that accounted for more than four times as much variance in the overall physician rating as any other communication item. Three of five communication items varied significantly across specialties in their associations with the overall rating (p < 0.05). All patients valued respectful treatment; the importance of other aspects of communication varied significantly by specialty. Quality improvement efforts by all specialties should emphasize physicians showing respect to patients, and each specialty should also target other aspects of communication that matter most to their patients. The results have implications for improving provider quality improvement and incentive programs and the reporting of CAHPS data to patients. Specialists make important contributions to coordinated patient care, and thus customized approaches to measurement, reporting, and quality improvement efforts are important.

Academic Culture, Business Culture, and Measuring Achievement Differences: Internal Auditing Views

ERIC Educational Resources Information Center

Roth, Benjamin S.

2012-01-01

This study explored whether university internal audit directors' views of culture and measuring achievement differences between their institutions and a business were related to how they viewed internal auditing priorities and uses. The Carnegie Classification system's 283 Doctorate-granting Universities were the target population.…

Making the Invisible Visible: A Methodological and a Substantive Issue

ERIC Educational Resources Information Center

Dagley, Valerie

2004-01-01

This article discusses the issue of "making the invisible visible" from a methodological and a substantive viewpoint. The ideas emerged from a doctoral research study into individual target setting with middle ability students in an English secondary school. The students involved had been identified by assessments as "average"…

Physical environment as a hospital marketing tool.

PubMed

Baker, J; Lamb, C W

1992-01-01

People use tangible cues to form opinions about intangible products such as health care. This paper examines roles that physical environment tangible cues play in: (1) communicating with patients, doctors and staff members; (2) creating favorable patient attitudes; (3) developing positive service quality perceptions; and (4) market segmentation, targeting, and positioning.

Ma_MISS on ExoMars: Mineralogical Characterization of the Martian Subsurface

NASA Astrophysics Data System (ADS)

De Sanctis, Maria Cristina; Altieri, Francesca; Ammannito, Eleonora; Biondi, David; De Angelis, Simone; Meini, Marco; Mondello, Giuseppe; Novi, Samuele; Paolinetti, Riccardo; Soldani, Massimo; Mugnuolo, Raffaele; Pirrotta, Simone; Vago, Jorge L.; Ma_MISS Team

2017-07-01

The Ma_MISS (Mars Multispectral Imager for Subsurface Studies) experiment is the visible and near infrared (VNIR) miniaturized spectrometer hosted by the drill system of the ExoMars 2020 rover. Ma_MISS will perform IR spectral reflectance investigations in the 0.4-2.2 μm range to characterize the mineralogy of excavated borehole walls at different depths (between 0 and 2 m). The spectral sampling is about 20 nm, whereas the spatial resolution over the target is 120 μm. Making use of the drill's movement, the instrument slit can scan a ring and build up hyperspectral images of a borehole. The main goal of the Ma_MISS instrument is to study the martian subsurface environment. Access to the martian subsurface is crucial to our ability to constrain the nature, timing, and duration of alteration and sedimentation processes on Mars, as well as habitability conditions. Subsurface deposits likely host and preserve H2O ice and hydrated materials that will contribute to our understanding of the H2O geochemical environment (both in the liquid and in the solid state) at the ExoMars 2020 landing site. The Ma_MISS spectral range and sampling capabilities have been carefully selected to allow the study of minerals and ices in situ before the collection of samples. Ma_MISS will be implemented to accomplish the following scientific objectives: (1) determine the composition of subsurface materials, (2) map the distribution of subsurface H2O and volatiles, (3) characterize important optical and physical properties of materials (e.g., grain size), and (4) produce a stratigraphic column that will inform with regard to subsurface geological processes. The Ma_MISS findings will help to refine essential criteria that will aid in our selection of the most interesting subsurface formations from which to collect samples.

[Health behavior change: motivational interviewing].

PubMed

Pócs, Dávid; Hamvai, Csaba; Kelemen, Oguz

2017-08-01

Public health data show that early mortality in Hungary could be prevented by smoking cessation, reduced alcohol consumption, regular exercise, healthy diet and increased adherence. Doctor-patient encounters often highlight these aspects of health behavior. There is evidence that health behavior change is driven by internal motivation rather than external influence. This finding has led to the concept of motivational interview, which is a person-centered, goal-oriented approach to counselling. The doctor asks targeted questions to elicit the patient's motivations, strengths, internal resources, and to focus the interview around these. The quality and quantity of the patient's change talk is related to better outcomes. In addition, the interview allows the patient to express ambivalent feelings and doubts about the change. The doctor should use various communication strategies to resolve this ambivalence. Furthermore, establishing a good doctor-patient relationship is the cornerstone of the motivational interview. An optimal relationship can evoke change talk and reduce the patient's resistance, which can also result in a better outcome. The goal of the motivational interview is to focus on the 'why' to change health behavior rather than the 'how', and to utilize internal motivation instead of persuasion. This is the reason why motivational interview has become a widely-accepted evidence based approach. Orv Hetil. 2017; 158(34): 1331-1337.

Advances in Measuring Culturally Competent Care: A Confirmatory Factor Analysis of CAHPS-CC in a Safety-net Population

PubMed Central

Stern, RJ; Fernandez, A; Jacobs, EA; Neilands, TB; Weech-Maldonado, R; Quan, J; Carle, A; Seligman, HK

2012-01-01

Background Providing culturally competent care shows promise as a mechanism to reduce healthcare inequalities. Until the recent development of the CAHPS Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. Methods We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n=600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings. Results A 7-factor model demonstrated satisfactory fit (χ2(231)=484.34, p<.0001) with significant factor loadings at p<.05. Three domains showed excellent reliability – Doctor Communication- Positive Behaviors (α=.82), Trust (α=.77), and Doctor Communication- Health Promotion (α=.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication- Negative Behaviors (α=.54), Equitable Treatment (α=.69), Doctor Communication- Alternative Medicine (α=.52), and Shared Decision-Making (α=.51). CAHPS-CC domains were positively and significantly correlated with global physician rating. Conclusions Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings. PMID:22895231

Human Factors Research in Aircrew Performance and Training: 1986-1991

DTIC Science & Technology

1992-07-01

significant loss of realism . Seventeen functions could not be performed at all, primarily because of three missing system features: an automated target...traditionally trained aviators. In 1979, Anacapa developed 13 cinematic exercises to provide supplemental training in map interpretation and terrain

Barriers to and facilitators of child influenza vaccine - perspectives from parents, teens, marketing and healthcare professionals.

PubMed

Bhat-Schelbert, Kavitha; Lin, Chyongchiou Jeng; Matambanadzo, Annamore; Hannibal, Kristin; Nowalk, Mary Patricia; Zimmerman, Richard K

2012-03-23

The CDC recommends annual influenza vaccination for all children age 6 months and older, yet vaccination rates remain modest. Effective strategies to improve influenza vaccination for children are needed. Eight focus groups with 91 parents, teens, pediatric healthcare staff and providers, and immunization and marketing experts were conducted, audiotaped, transcribed verbatim, and coded based on grounded theory. Three themes emerged: barriers, facilitators, and strategies. Barriers included fear, misinformation, and mistrust, with exacerbation of these barriers attributed to media messages. Many considered influenza vaccination unnecessary and inconvenient, but would accept vaccination if recipients or other family members were considered high risk, if recommended by their doctor or another trusted person, or if offered or mandated by the school. Access to better information regarding influenza disease burden and vaccine safety and efficacy were notable facilitators, as were prevention of the inconvenience of missing work or important events, and if the child requests to receive the vaccine. Marketing strategies included incentives, jingles, videos, wearable items, strategically-located information sheets or posters, and promotion by informed counselors. Practice-based strategies included staff buy-in, standing orders protocols, vaccination clinics, and educational videos. Teen-specific strategies included message delivery through schools, texting, internet, and social networking sites. To improve influenza vaccination rates for children using practice-based interventions, participants suggested campaigns that provide better information regarding the vaccine, the disease and its implications, and convenient access to vaccination. Strategies targeting adolescents should use web-based social marketing technologies and campaigns based in schools. Copyright © 2012 Elsevier Ltd. All rights reserved.

A compact, efficient, and lightweight laser head for CARLO®: integration, performance, and benefits

NASA Astrophysics Data System (ADS)

Deibel, Waldemar; Schneider, Adrian; Augello, Marcello; Bruno, Alfredo E.; Juergens, Philipp; Cattin, Philippe

2015-09-01

Ever since the first functional lasers were built about 50 years ago, researchers and doctors dream of a medical use for such systems. Today's technology is finally advanced enough to realize these ambitions in a variety of medical fields. There are well-established laser based systems in ophthalmology, dental applications, treatment of kidney stones, and many more. Using lasers presents more than just an alternative to conventional methods for osteotomies. It offers less tissue damage, faster healing times, comparable intervention duration and in consequence improves postoperative treatment of patients. However, there are a few factors that limit routine applications. These technical drawbacks include missing depth control and safe guiding of the laser beam. This paper presents the engineering and integration of a miniaturized laser head for a computer assisted and robot-guided laser osteotome (CARLO®), which can overcome the mentioned drawbacks. The CARLO® device ensures a safe and precise guidance of the laser beam. Such guidance also enables new opportunities and methods, e.g. free geometrical functional cuts, which have the potential to revolutionize bone surgery. The laser head is optimized for beam shaping, target conditioning, working distance, compactness and the integration of all other parts needed, e.g. CCD-cameras for monitoring and referencing, a visible laser for cut simulation, etc. The beam coming out of the laser system is conditioned in shape, energy properties and working distance with an optical arrangement to achieve the desired cutting performance. Here also parameters like optical losses, operating mode, optics materials and long-term stability have are taken into account.

Multi-Source Multi-Target Dictionary Learning for Prediction of Cognitive Decline.

PubMed

Zhang, Jie; Li, Qingyang; Caselli, Richard J; Thompson, Paul M; Ye, Jieping; Wang, Yalin

2017-06-01

Alzheimer's Disease (AD) is the most common type of dementia. Identifying correct biomarkers may determine pre-symptomatic AD subjects and enable early intervention. Recently, Multi-task sparse feature learning has been successfully applied to many computer vision and biomedical informatics researches. It aims to improve the generalization performance by exploiting the shared features among different tasks. However, most of the existing algorithms are formulated as a supervised learning scheme. Its drawback is with either insufficient feature numbers or missing label information. To address these challenges, we formulate an unsupervised framework for multi-task sparse feature learning based on a novel dictionary learning algorithm. To solve the unsupervised learning problem, we propose a two-stage Multi-Source Multi-Target Dictionary Learning (MMDL) algorithm. In stage 1, we propose a multi-source dictionary learning method to utilize the common and individual sparse features in different time slots. In stage 2, supported by a rigorous theoretical analysis, we develop a multi-task learning method to solve the missing label problem. Empirical studies on an N = 3970 longitudinal brain image data set, which involves 2 sources and 5 targets, demonstrate the improved prediction accuracy and speed efficiency of MMDL in comparison with other state-of-the-art algorithms.

Implementation of the Ottawa Ankle Rules by nurses working in an accident and emergency department.

PubMed Central

Salt, P; Clancy, M

1997-01-01

OBJECTIVE: To assess whether accident and emergency (A&E) nurses using the Ottawa Ankle Rules could detect all ankle fractures. DESIGN: Prospective observational study. SETTING: A&E department of a university teaching hospital. SUBJECTS: All patients who presented with ankle injuries who were initially assessed by a nurse taught the Ottawa Ankle Rules. OUTCOME MEASURES: (1) The numbers of patients referred by the nurse for ankle radiography; (2) of these, the number with ankle fractures; (3) of those not sent for radiography initially by the nurse, the number who subsequently had x rays (ordered by the doctor) and had a fracture; (4) of those having no x rays, the number who reattended later. RESULTS: 324 patients were eligible; 238 had x rays at the request of the nurse (73%); 48 of these (20%) were diagnosed as having a fracture. Of those 86 patients not sent for radiography by the nurse, 19 subsequently had x ray examinations at the request of a doctor and no fracture was detected. Of the 67 not sent for radiography, none returned within the subsequent eight weeks. CONCLUSIONS: Nurses can apply the Ottawa Ankle Rules safely without missing acute fractures; that is, of those who were not sent for radiography by nurses, none subsequently reattended the A&E department or the trauma service of the Bristol Royal Infirmary during the following two months. PMID:9413774

St Elsewhere's or St Everywhere's: improving patient throughput in the private hospital sector.

PubMed

Laffey, Jennifer A; Wasson, Moran

2007-01-01

Communication errors have been found to be most common root cause of medical errors by the US-based Agency for Healthcare Research and Quality [1]. Although elective admissions to hospital involves a high volume of important healthcare communications where incorrect, missing or illegible information could result in a serious medical error, there is little published research on the impact of improving pre-admission communication flow between admitting doctors and hospitals. The Sydney Adventist Hospital (the San) is a 341-bed private hospital in Sydney's northern suburbs that provides a comprehensive range of health services. A process improvement program began in early 2005 to streamline preadmission communications. The objectives of this ongoing program are broadly to improve patient safety and to increase operating efficiency. The first major initiative within this program was to implement a standardised method for inpatient booking/referral with over three hundred admitting doctors. Eighteen months on, the hospital has been able to demonstrate a significant shift in the timeliness of patient bookings from specialists' rooms, more comprehensive provision of clinical indicators that can facilitate resource planning in operating theatres and on the wards, and reduction in the ratio of bookings made in areas other than the hospital bookings department. The program continues with focus on improving accuracy of data entry, rationalising patient forms, making more effective use of information received and automation of pre-admission information flows.

Delayed detection of cleft palate: an audit of newborn examination.

PubMed

Habel, A; Elhadi, N; Sommerlad, B; Powell, J

2006-03-01

To identify prevalence of delayed detection of cleft palate, and associated factors that could lead to improved identification at neonatal clinical examination. Audit of hospital notes, parental questionnaire incorporating open ended questions, and telephone questionnaire of junior doctors in the referring hospitals incorporating fixed choice questions. Of 344 cleft palate patients without cleft lip or submucous cleft palate, the day the cleft was detected was recorded in 92%. Delayed detection, after the first day, was 28% overall, distributed as 37% with isolated cleft palate and 23% with syndromic cleft palate. Narrow V shaped clefts were more likely to be delayed in detection compared with broad U shaped clefts, as were soft palate clefts compared with hard palate clefts. Five with isolated cleft palates were not detected until after the first year. Babies born at home were unlikely to be detected on day 1. Symptoms were significantly increased in the delayed detection group for feeding problems and nasal regurgitation. A telephone questionnaire of trainee paediatricians in referring units revealed that digital examination was more commonly practised than visual inspection, and few recalled receiving specific instruction on examination of the palate. Delayed detection of cleft palate was not uncommon, and the features of those more likely to be missed suggested digital examination was related. Trainee doctors and midwives should be instructed to inspect visually using a light and tongue depressor, then digitally if submucous cleft palate is suspected.

Foreign science and engineering doctoral attainment at American universities

NASA Astrophysics Data System (ADS)

Hamilton, Robert V.

This dissertation analyzes the nearly 100,000 foreign students who attained science and engineering (S&E) doctorates in the five fields of physical sciences, life sciences, engineering, mathematics and computer sciences, and social and behavioral sciences at American universities from 1994 to 2005. Two models are presented. In the first model controlling for population, multivariate regression results testing for whether foreign students from higher or lower income nations (181 nations) tended to attain S&E doctorates showed that certain S&E fields tended to be represented by students from higher income nations early in the time period (e.g. 1994 to 1999) but the national income variable explaining foreign S&E doctoral attainment was not statistically significant in four of the fields after the year 2000. Four nations, China, India, South Korea and Taiwan stand out due to their large S&E doctoral student presence at American universities, but virtually all growth in foreign doctoral attainment in four of the S&E fields from 1994 to 2005 came from Chinese students, and this growth was most pronounced after the year 2001. In short, whereas the foreign student populations from South Korea and Taiwan were the outliers in 1994 and as such skewed testing results, they had largely been displaced in 2005 by the increased presence of Chinese students. From the US public policy perspective, to the extent that growth in foreign S&E doctoral attainment is an issue to include its related costs and benefits, the appropriate policy focus should shift more specifically towards the growth in Chinese S&E doctoral attainment. Further, with the exception of China and India, foreign doctoral students from the lowest income nations of the world in all five S&E fields were greatly under represented on American campuses from 1994 to 2005. Testing results from the second model complement the findings in the first model. Whereas the first model tested for the effects of national income on foreign S&E doctoral attainment, the second model tested for changes in foreign S&E doctoral attainment over the time period 1994 to 2005. Specifically, testing results for the second model indicated that changes in S&E doctoral attainment by students from the lower income nations tended to more closely track changes in education-related R&D funding compared to students from higher income nations. These results suggest that to the extent the US government desires to increase foreign doctoral attainment in specific S&E fields, students from lower income nations might have a greater tendency to "chase" education-related R&D dollars in the targeted S&E fields. Finally, testing results for both models indicate that there was variation between the five S&E fields, and that highly-skilled migration patterns in certain S&E fields changed relatively quickly during the time period 1994 to 2005. These results suggest that foreign S&E doctoral attainment should be disaggregated both temporally and by S&E population in order to adequately measure and understand this phenomenon.

TargetSpy: a supervised machine learning approach for microRNA target prediction.

PubMed

Sturm, Martin; Hackenberg, Michael; Langenberger, David; Frishman, Dmitrij

2010-05-28

Virtually all currently available microRNA target site prediction algorithms require the presence of a (conserved) seed match to the 5' end of the microRNA. Recently however, it has been shown that this requirement might be too stringent, leading to a substantial number of missed target sites. We developed TargetSpy, a novel computational approach for predicting target sites regardless of the presence of a seed match. It is based on machine learning and automatic feature selection using a wide spectrum of compositional, structural, and base pairing features covering current biological knowledge. Our model does not rely on evolutionary conservation, which allows the detection of species-specific interactions and makes TargetSpy suitable for analyzing unconserved genomic sequences.In order to allow for an unbiased comparison of TargetSpy to other methods, we classified all algorithms into three groups: I) no seed match requirement, II) seed match requirement, and III) conserved seed match requirement. TargetSpy predictions for classes II and III are generated by appropriate postfiltering. On a human dataset revealing fold-change in protein production for five selected microRNAs our method shows superior performance in all classes. In Drosophila melanogaster not only our class II and III predictions are on par with other algorithms, but notably the class I (no-seed) predictions are just marginally less accurate. We estimate that TargetSpy predicts between 26 and 112 functional target sites without a seed match per microRNA that are missed by all other currently available algorithms. Only a few algorithms can predict target sites without demanding a seed match and TargetSpy demonstrates a substantial improvement in prediction accuracy in that class. Furthermore, when conservation and the presence of a seed match are required, the performance is comparable with state-of-the-art algorithms. TargetSpy was trained on mouse and performs well in human and drosophila, suggesting that it may be applicable to a broad range of species. Moreover, we have demonstrated that the application of machine learning techniques in combination with upcoming deep sequencing data results in a powerful microRNA target site prediction tool http://www.targetspy.org.

TargetSpy: a supervised machine learning approach for microRNA target prediction

PubMed Central

2010-01-01

Background Virtually all currently available microRNA target site prediction algorithms require the presence of a (conserved) seed match to the 5' end of the microRNA. Recently however, it has been shown that this requirement might be too stringent, leading to a substantial number of missed target sites. Results We developed TargetSpy, a novel computational approach for predicting target sites regardless of the presence of a seed match. It is based on machine learning and automatic feature selection using a wide spectrum of compositional, structural, and base pairing features covering current biological knowledge. Our model does not rely on evolutionary conservation, which allows the detection of species-specific interactions and makes TargetSpy suitable for analyzing unconserved genomic sequences. In order to allow for an unbiased comparison of TargetSpy to other methods, we classified all algorithms into three groups: I) no seed match requirement, II) seed match requirement, and III) conserved seed match requirement. TargetSpy predictions for classes II and III are generated by appropriate postfiltering. On a human dataset revealing fold-change in protein production for five selected microRNAs our method shows superior performance in all classes. In Drosophila melanogaster not only our class II and III predictions are on par with other algorithms, but notably the class I (no-seed) predictions are just marginally less accurate. We estimate that TargetSpy predicts between 26 and 112 functional target sites without a seed match per microRNA that are missed by all other currently available algorithms. Conclusion Only a few algorithms can predict target sites without demanding a seed match and TargetSpy demonstrates a substantial improvement in prediction accuracy in that class. Furthermore, when conservation and the presence of a seed match are required, the performance is comparable with state-of-the-art algorithms. TargetSpy was trained on mouse and performs well in human and drosophila, suggesting that it may be applicable to a broad range of species. Moreover, we have demonstrated that the application of machine learning techniques in combination with upcoming deep sequencing data results in a powerful microRNA target site prediction tool http://www.targetspy.org. PMID:20509939

Motion of a ballistic missile angularly misaligned with the flight path upon entering the atmosphere and its effect upon aerodynamic heating, aerodynamic loads, and miss distance

NASA Technical Reports Server (NTRS)

Allen, Julian H

1957-01-01

An analysis is given of the oscillating motion of a ballistic missile which upon entering the atmosphere is angularly misaligned with respect to the flight path. The history of the motion for some example missiles is discussed from the point of view of the effect of the motion on the aerodynamic heating and loading. The miss distance at the target due to misalignment and to small accidental trim angles is treated. The stability problem is also discussed for the case where the missile is tumbling prior to atmospheric entry.

When and why might a Computer Aided Detection (CAD) system interfere with visual search? An eye-tracking study

PubMed Central

Drew, Trafton; Cunningham, Corbin; Wolfe, Jeremy

2012-01-01

Rational and Objectives Computer Aided Detection (CAD) systems are intended to improve performance. This study investigates how CAD might actually interfere with a visual search task. This is a laboratory study with implications for clinical use of CAD. Methods 47 naïve observers in two studies were asked to search for a target, embedded in 1/f2.4 noise while we monitored their eye-movements. For some observers, a CAD system marked 75% of targets and 10% of distractors while other observers completed the study without CAD. In Experiment 1, the CAD system’s primary function was to tell observers where the target might be. In Experiment 2, CAD provided information about target identity. Results In Experiment 1, there was a significant enhancement of observer sensitivity in the presence of CAD (t(22)=4.74, p<.001), but there was also a substantial cost. Targets that were not marked by the CAD system were missed more frequently than equivalent targets in No CAD blocks of the experiment (t(22)=7.02, p<.001). Experiment 2 showed no behavioral benefit from CAD, but also no significant cost on sensitivity to unmarked targets (t(22)=0.6, p=n.s.). Finally, in both experiments, CAD produced reliable changes in eye-movements: CAD observers examined a lower total percentage of the search area than the No CAD observers (Ex 1: t(48)=3.05, p<.005; Ex 2: t(50)=7.31, p<.001). Conclusions CAD signals do not combine with observers’ unaided performance in a straight-forward manner. CAD can engender a sense of certainty that can lead to incomplete search and elevated chances of missing unmarked stimuli. PMID:22958720

Baseline Predictors of Missed Visits in the Look AHEAD Study

PubMed Central

Fitzpatrick, Stephanie L.; Jeffery, Robert; Johnson, Karen C.; Roche, Cathy C.; Van Dorsten, Brent; Gee, Molly; Johnson, Ruby Ann; Charleston, Jeanne; Dotson, Kathy; Walkup, Michael P.; Hill-Briggs, Felicia; Brancati, Frederick L.

2013-01-01

Objective To identify baseline attributes associated with consecutively missed data collection visits during the first 48 months of Look AHEAD—a randomized, controlled trial in 5145 overweight/obese adults with type 2 diabetes designed to determine the long-term health benefits of weight loss achieved by lifestyle change. Design and Methods The analyzed sample consisted of 5016 participants who were alive at month 48 and enrolled at Look AHEAD sites. Demographic, baseline behavior, psychosocial factors, and treatment randomization were included as predictors of missed consecutive visits in proportional hazard models. Results In multivariate Cox proportional hazard models, baseline attributes of participants who missed consecutive visits (n=222) included: younger age ( Hazard Ratio [HR] 1.18 per 5 years younger; 95% Confidence Interval 1.05, 1.30), higher depression score (HR 1.04; 1.01, 1.06), non-married status (HR 1.37; 1.04, 1.82), never self-weighing prior to enrollment (HR 2.01; 1.25, 3.23), and randomization to minimal vs. intensive lifestyle intervention (HR 1.46; 1.11, 1.91). Conclusions Younger age, symptoms of depression, non-married status, never self-weighing, and randomization to minimal intervention were associated with a higher likelihood of missing consecutive data collection visits, even in a high-retention trial like Look AHEAD. Whether modifications to screening or retention efforts targeted to these attributes might enhance long-term retention in behavioral trials requires further investigation. PMID:23996977

General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study

PubMed Central

2013-01-01

Background Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease. Methods A national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user. Results Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79). Conclusion Some of the variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease was associated with practice characteristics. This variation in performance may indicate a potential for quality improvement. PMID:23923987

Feasibility and effectiveness of a low cost campaign on antibiotic prescribing in Italy: community level, controlled, non-randomised trial.

PubMed

Formoso, Giulio; Paltrinieri, Barbara; Marata, Anna Maria; Gagliotti, Carlo; Pan, Angelo; Moro, Maria Luisa; Capelli, Oreste; Magrini, Nicola

2013-09-12

To test the hypothesis that a multifaceted, local public campaign could be feasible and influence antibiotic prescribing for outpatients. Community level, controlled, non-randomised trial. Provinces of Modena and Parma in Emilia-Romagna, northern Italy, November 2011 to February 2012. 1,150,000 residents of Modena and Parma (intervention group) and 3,250,000 residents in provinces in the same region but where no campaign had been implemented (control group). Campaign materials (mainly posters, brochures, and advertisements on local media, plus a newsletter on local antibiotic resistance targeted at doctors and pharmacists). General practitioners and paediatricians in the intervention area participated in designing the campaign messages. Primary outcome was the average change in prescribing rates of antibiotics for outpatient in five months, measured as defined daily doses per 1000 inhabitants/day, using health districts as the unit of analysis. Antibiotic prescribing was reduced in the intervention area compared with control area (-4.3%, 95% confidence interval -7.1% to -1.5%). This result was robust to "sensitivity analysis" modifying the baseline period from two months (main analysis) to one month. A higher decrease was observed for penicillins resistant to β lactamase and a lower decrease for penicillins susceptible to β lactamase, consistent with the content of the newsletter on antibiotic resistance directed at health professionals. The decrease in expenditure on antibiotics was not statistically significant in a district level analysis with a two month baseline period (main analysis), but was statistically significant in sensitivity analyses using either a one month baseline period or a more powered doctor level analysis. Knowledge and attitudes of the target population about the correct use of antibiotics did not differ between the intervention and control areas. A local low cost information campaign targeted at citizens, combined with a newsletter on local antibiotic resistance targeted at doctors and pharmacists, was associated with significantly decreased total rates of antibiotic prescribing but did not affect the population's knowledge and attitudes about antibiotic resistance. ClinicalTrials.gov NCT01604096.

Transverse polarization of Σ+(1189) in photoproduction on a hydrogen target in CLAS

NASA Astrophysics Data System (ADS)

Nepali, C. S.; Amaryan, M.; Adhikari, K. P.; Aghasyan, M.; Anefalos Pereira, S.; Baghdasaryan, H.; Ball, J.; Battaglieri, M.; Batourine, V.; Bedlinskiy, I.; Biselli, A. S.; Bono, J.; Boiarinov, S.; Briscoe, W. J.; Bültmann, S.; Burkert, V. D.; Carman, D. S.; Celentano, A.; Chandavar, S.; Charles, G.; Cole, P. L.; Collins, P.; Contalbrigo, M.; Crede, V.; Dashyan, N.; De Vita, R.; De Sanctis, E.; Deur, A.; Djalali, C.; Doughty, D.; Dupre, R.; Alaoui, A. El; Fassi, L. El; Fedotov, G.; Fegan, S.; Fersch, R.; Fleming, J. A.; Gabrielyan, M. Y.; Gevorgyan, N.; Giovanetti, K. L.; Girod, F. X.; Glazier, D. I.; Goetz, J. T.; Gohn, W.; Golovatch, E.; Gothe, R. W.; Griffioen, K. A.; Guidal, M.; Guler, N.; Hafidi, K.; Hakobyan, H.; Hanretty, C.; Harrison, N.; Heddle, D.; Hicks, K.; Ho, D.; Holtrop, M.; Hyde, C. E.; Ilieva, Y.; Ireland, D. G.; Ishkhanov, B. S.; Isupov, E. L.; Jo, H. S.; Keller, D.; Khandaker, M.; Khetarpal, P.; Kim, A.; Kim, W.; Klein, A.; Klein, F. J.; Koirala, S.; Kubarovsky, V.; Kuhn, S. E.; Kuleshov, S. V.; Kvaltine, N. D.; Lu, H. Y.; MacGregor, I. J. D.; Markov, N.; Mayer, M.; McKinnon, B.; Mineeva, T.; Mirazita, M.; Mokeev, V.; Montgomery, R. A.; Munevar, E.; Munoz Camacho, C.; Nadel-Turonski, P.; Niccolai, S.; Niculescu, G.; Niculescu, I.; Osipenko, M.; Ostrovidov, A. I.; Pappalardo, L. L.; Paremuzyan, R.; Park, K.; Park, S.; Pasyuk, E.; Phelps, E.; Phillips, J. J.; Pisano, S.; Pogorelko, O.; Pozdniakov, S.; Price, J. W.; Procureur, S.; Protopopescu, D.; Puckett, A. J. R.; Raue, B. A.; Rimal, D.; Ripani, M.; Ritchie, B. G.; Rosner, G.; Rossi, P.; Sabatié, F.; Saini, M. S.; Salgado, C.; Schott, D.; Schumacher, R. A.; Seder, E.; Seraydaryan, H.; Sharabian, Y. G.; Smith, G. D.; Sober, D. I.; Sokhan, D.; Stepanyan, S. S.; Stepanyan, S.; Strakovsky, I. I.; Strauch, S.; Taiuti, M.; Tang, W.; Taylor, C. E.; Tian, Ye; Tkachenko, S.; Torayev, B.; Vernarsky, B.; Vlassov, A. V.; Voskanyan, H.; Voutier, E.; Walford, N. K.; Watts, D. P.; Weinstein, L. B.; Weygand, D. P.; Zachariou, N.; Zana, L.; Zhang, J.; Zhao, Z. W.; Zonta, I.

2013-04-01

Experimental results on the Σ+(1189) hyperon transverse polarization in photoproduction on a hydrogen target using the CLAS detector at Jefferson Laboratory are presented. The Σ+(1189) was reconstructed in the exclusive reaction γ+p→KS0+Σ+(1189) via the Σ+→pπ0 decay mode. The KS0 was reconstructed in the invariant mass of two oppositely charged pions with the π0 identified in the missing mass of the detected pπ+π- final state. Experimental data were collected in the photon energy range Eγ=1.0-3.5 GeV (s range 1.66-2.73 GeV). We observe a large negative polarization of up to 95%. As the mechanism of transverse polarization of hyperons produced in unpolarized photoproduction experiments is still not well understood, these results will help to distinguish between different theoretical models on hyperon production and provide valuable information for the searches of missing baryon resonances.

Survey of Antithrombotic Treatment in Rural Patients (>60 years) with Atrial Fibrillation in East China.

PubMed

Wei, Yong; Xu, Juan; Wu, Haiqing; Zhou, Genqing; Chen, Songwen; Wang, Caihong; Shen, Yahong; Yang, Shunhong; Wang, Bin; He, Zheng; Sun, Jianping; Sun, Weidong; Ouyang, Ping; Liu, Shaowen

2018-05-01

The prevalence and antithrombotic treatment of atrial fibrillation (AF) in Chinese rural population is not well known. The aim of this study was to investigate the extent to which antithrombotic treatment was prescribed for rural AF patients >60 years. We identified 828 AF patients from 36734 rural residents >60 years in Shanghai China. Our data indicated the overall prevalence rate of AF was 2.3% in rural population >60 years in East China and 38.9% of AF patients underwent antithrombotic therapy, including warfarin (5.9%), aspirin (29.6%), clopidogrel (2.9%) and aspirin combined with clopidogrel (0.5%). Of enrolled subjects, 98.4% had CHA 2 DS 2 -VASc score ≥1, 72.0% had HAS-BLED score <3 and 59.2% had CHA 2 DS 2 -VASc score ≥2 with HAS-BLED score <3. Missing early detection (34.9%), delay in seeking treatment for asymptomatic AF (25.5%) and doctors's incomplete inform of AF-related risk of stroke to patients (21.7%) were three dominant causes for failing anticoagulant usage. In conclusion, most AF patients were with a high risk of thrombosis and a low risk of bleeding in China, but a large majority of them failed to take anticoagulants mainly for missing an early screening of AF and lack of awareness on AF for both patients and primary care physicians.

Design, Implementation, and Evaluation of a Postgraduate Diploma in Surgical Anatomy

ERIC Educational Resources Information Center

Stringer, Mark D.; Lyall, Patrick

2012-01-01

After careful planning, a postgraduate Diploma in Surgical Anatomy was launched in 2009. This report describes the structure of the program, the challenges encountered in implementing and running the course, and results of evaluations. The qualification is targeted at junior doctors intending to become surgeons or radiologists and aims to equip…

Negotiating Knowledge Contribution to Multiple Discourse Communities: A Doctoral Student of Computer Science Writing for Publication

ERIC Educational Resources Information Center

Li, Yongyan

2006-01-01

Despite the rich literature on disciplinary knowledge construction and multilingual scholars' academic literacy practices, little is known about how novice scholars are engaged in knowledge construction in negotiation with various target discourse communities. In this case study, with a focused analysis of a Chinese computer science doctoral…

Using Hermeneutics as a Qualitative Research Approach in Professional Practice

ERIC Educational Resources Information Center

Paterson, Margo; Higgs, Joy

2005-01-01

This paper is targeted primarily at doctoral students and others considering hermeneutics as a research strategy. Research using hermeneutics was carried out with occupational therapy educators and clinicians in Australia, New Zealand, Canada, and the UK. A total of 53 participants engaged in focus groups and individual interviews over a one-year.…

Beam-target double-spin asymmetry in quasielastic electron scattering off the deuteron with CLAS

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

Mayer, M.; Kuhn, S. E.; Adhikari, K. P.

The deuteron plays a pivotal role in nuclear and hadronic physics, as both the simplest bound multinucleon system and as an effective neutron target. Quasielastic electron scattering on the deuteron is a benchmark reaction to test our understanding of deuteron structure and the properties and interactions of the two nucleons bound in the deuteron. The experimental data presented here can be used to test state-of-the-art models of the deuteron and the two-nucleon interaction in the final state after two-body breakup of the deuteron. Focusing on polarization degrees of freedom, we gain information on spin-momentum correlations in the deuteron ground statemore » (due to the D-state admixture) and on the limits of the impulse approximation (IA) picture as it applies to measurements of spin-dependent observables like spin structure functions for bound nucleons. Information on this reaction can also be used to reduce systematic uncertainties on the determination of neutron form factors or deuteron polarization through quasielastic polarized electron scattering. Furthermore, we measured the beam-target double-spin asymmetry (A ||) for quasielastic electron scattering off the deuteron at several beam energies (1.6–1.7, 2.5, 4.2, and 5.6–5.8GeV), using the CEBAF Large Acceptance Spectrometer (CLAS) at the Thomas Jefferson National Accelerator Facility. The deuterons were polarized along (or opposite to) the beam direction. The double-spin asymmetries were measured as a function of photon virtuality Q 2 (0.13–3.17(GeV/c) 2), missing momentum (p m=0.0–0.5GeV/c), and the angle between the (inferred) spectator neutron and the momentum transfer direction (θ nq). We compare our results with a recent model that includes final-state interactions (FSI) using a complete parametrization of nucleon-nucleon scattering, as well as a simplified model using the plane wave impulse approximation (PWIA). We find overall good agreement with both the PWIA and FSI expectations at low to medium missing momenta (p m≤0.25GeV/c), including the change of the asymmetry due to the contribution of the deuteron D state at higher momenta. At the highest missing momenta, our data clearly agree better with the calculations including FSI. Final-state interactions seem to play a lesser role for polarization observables in deuteron two-body electrodisintegration than for absolute cross sections. Our data, while limited in statistical power, indicate that PWIA models work reasonably well to understand the asymmetries at lower missing momenta. In turn, this information can be used to extract the product of beam and target polarization (P bP t) from quasielastic electron-deuteron scattering, which is useful for measurements of spin observables in electron-neutron inelastic scattering. But, at the highest missing (neutron) momenta, FSI effects become important and must be accounted for.« less

Beam-target double-spin asymmetry in quasielastic electron scattering off the deuteron with CLAS

DOE PAGES

Mayer, M.; Kuhn, S. E.; Adhikari, K. P.; ...

2017-02-24

The deuteron plays a pivotal role in nuclear and hadronic physics, as both the simplest bound multinucleon system and as an effective neutron target. Quasielastic electron scattering on the deuteron is a benchmark reaction to test our understanding of deuteron structure and the properties and interactions of the two nucleons bound in the deuteron. The experimental data presented here can be used to test state-of-the-art models of the deuteron and the two-nucleon interaction in the final state after two-body breakup of the deuteron. Focusing on polarization degrees of freedom, we gain information on spin-momentum correlations in the deuteron ground statemore » (due to the D-state admixture) and on the limits of the impulse approximation (IA) picture as it applies to measurements of spin-dependent observables like spin structure functions for bound nucleons. Information on this reaction can also be used to reduce systematic uncertainties on the determination of neutron form factors or deuteron polarization through quasielastic polarized electron scattering. Furthermore, we measured the beam-target double-spin asymmetry (A ||) for quasielastic electron scattering off the deuteron at several beam energies (1.6–1.7, 2.5, 4.2, and 5.6–5.8GeV), using the CEBAF Large Acceptance Spectrometer (CLAS) at the Thomas Jefferson National Accelerator Facility. The deuterons were polarized along (or opposite to) the beam direction. The double-spin asymmetries were measured as a function of photon virtuality Q 2 (0.13–3.17(GeV/c) 2), missing momentum (p m=0.0–0.5GeV/c), and the angle between the (inferred) spectator neutron and the momentum transfer direction (θ nq). We compare our results with a recent model that includes final-state interactions (FSI) using a complete parametrization of nucleon-nucleon scattering, as well as a simplified model using the plane wave impulse approximation (PWIA). We find overall good agreement with both the PWIA and FSI expectations at low to medium missing momenta (p m≤0.25GeV/c), including the change of the asymmetry due to the contribution of the deuteron D state at higher momenta. At the highest missing momenta, our data clearly agree better with the calculations including FSI. Final-state interactions seem to play a lesser role for polarization observables in deuteron two-body electrodisintegration than for absolute cross sections. Our data, while limited in statistical power, indicate that PWIA models work reasonably well to understand the asymmetries at lower missing momenta. In turn, this information can be used to extract the product of beam and target polarization (P bP t) from quasielastic electron-deuteron scattering, which is useful for measurements of spin observables in electron-neutron inelastic scattering. But, at the highest missing (neutron) momenta, FSI effects become important and must be accounted for.« less

Beam-target double-spin asymmetry in quasielastic electron scattering off the deuteron with CLAS

NASA Astrophysics Data System (ADS)

Mayer, M.; Kuhn, S. E.; Adhikari, K. P.; Akbar, Z.; Anefalos Pereira, S.; Asryan, G.; Avakian, H.; Badui, R. A.; Ball, J.; Baltzell, N. A.; Battaglieri, M.; Bedlinskiy, I.; Biselli, A. S.; Boiarinov, S.; Bosted, P.; Briscoe, W. J.; Brooks, W. K.; Bültmann, S.; Burkert, V. D.; Carman, D. S.; Celentano, A.; Charles, G.; Chetry, T.; Ciullo, G.; Clark, L.; Colaneri, L.; Cole, P. L.; Compton, N.; Contalbrigo, M.; Crede, V.; D'Angelo, A.; Dashyan, N.; De Vita, R.; De Sanctis, E.; Deur, A.; Djalali, C.; Dupre, R.; El Alaoui, A.; El Fassi, L.; Elouadrhiri, L.; Eugenio, P.; Fanchini, E.; Fedotov, G.; Fersch, R.; Filippi, A.; Fleming, J. A.; Forest, T. A.; Ghandilyan, Y.; Gilfoyle, G. P.; Giovanetti, K. L.; Girod, F. X.; Gleason, C.; Gothe, R. W.; Griffioen, K. A.; Guidal, M.; Guler, N.; Guo, L.; Hakobyan, H.; Hanretty, C.; Hattawy, M.; Hicks, K.; Holtrop, M.; Hughes, S. M.; Hyde, C. E.; Ilieva, Y.; Ireland, D. G.; Ishkhanov, B. S.; Isupov, E. L.; Jiang, H.; Keith, C.; Keller, D.; Khachatryan, G.; Khachatryan, M.; Khandaker, M.; Kim, A.; Kim, W.; Klein, A.; Kubarovsky, V.; Lanza, L.; Lenisa, P.; Livingston, K.; MacGregor, I. J. D.; McKinnon, B.; Meekins, D.; Mirazita, M.; Mokeev, V.; Movsisyan, A.; Net, L. A.; Niccolai, S.; Niculescu, G.; Osipenko, M.; Ostrovidov, A. I.; Paremuzyan, R.; Park, K.; Pasyuk, E.; Phelps, W.; Pogorelko, O.; Price, J. W.; Prok, Y.; Puckett, A. J. R.; Ripani, M.; Rizzo, A.; Rosner, G.; Rossi, P.; Sabatié, F.; Schumacher, R. A.; Sharabian, Y. G.; Skorodumina, Iu.; Smith, G. D.; Sokhan, D.; Sparveris, N.; Stankovic, I.; Stepanyan, S.; Strauch, S.; Sytnik, V.; Taiuti, M.; Tian, Ye; Torayev, B.; Ungaro, M.; Voskanyan, H.; Voutier, E.; Walford, N. K.; Weinstein, L. B.; Wood, M. H.; Zachariou, N.; Zhang, J.; Zonta, I.; CLAS Collaboration

2017-02-01

Background: The deuteron plays a pivotal role in nuclear and hadronic physics, as both the simplest bound multinucleon system and as an effective neutron target. Quasielastic electron scattering on the deuteron is a benchmark reaction to test our understanding of deuteron structure and the properties and interactions of the two nucleons bound in the deuteron. Purpose: The experimental data presented here can be used to test state-of-the-art models of the deuteron and the two-nucleon interaction in the final state after two-body breakup of the deuteron. Focusing on polarization degrees of freedom, we gain information on spin-momentum correlations in the deuteron ground state (due to the D -state admixture) and on the limits of the impulse approximation (IA) picture as it applies to measurements of spin-dependent observables like spin structure functions for bound nucleons. Information on this reaction can also be used to reduce systematic uncertainties on the determination of neutron form factors or deuteron polarization through quasielastic polarized electron scattering. Method: We measured the beam-target double-spin asymmetry (A||) for quasielastic electron scattering off the deuteron at several beam energies (1.6 -1.7 , 2.5, 4.2, and 5.6 -5.8 GeV ), using the CEBAF Large Acceptance Spectrometer (CLAS) at the Thomas Jefferson National Accelerator Facility. The deuterons were polarized along (or opposite to) the beam direction. The double-spin asymmetries were measured as a function of photon virtuality Q2(0.13 -3.17 (GeV/c ) 2) , missing momentum (pm=0.0 -0.5 GeV /c ), and the angle between the (inferred) spectator neutron and the momentum transfer direction (θn q). Results: The results are compared with a recent model that includes final-state interactions (FSI) using a complete parametrization of nucleon-nucleon scattering, as well as a simplified model using the plane wave impulse approximation (PWIA). We find overall good agreement with both the PWIA and FSI expectations at low to medium missing momenta (pm≤0.25 GeV /c ), including the change of the asymmetry due to the contribution of the deuteron D state at higher momenta. At the highest missing momenta, our data clearly agree better with the calculations including FSI. Conclusions: Final-state interactions seem to play a lesser role for polarization observables in deuteron two-body electrodisintegration than for absolute cross sections. Our data, while limited in statistical power, indicate that PWIA models work reasonably well to understand the asymmetries at lower missing momenta. In turn, this information can be used to extract the product of beam and target polarization (PbPt ) from quasielastic electron-deuteron scattering, which is useful for measurements of spin observables in electron-neutron inelastic scattering. However, at the highest missing (neutron) momenta, FSI effects become important and must be accounted for.

Sri Lankan doctors' and medical undergraduates' attitudes towards mental illness.

PubMed

Fernando, Sunera Mayanthi; Deane, Frank P; McLeod, Hamish J

2010-07-01

Stigmatizing attitudes towards mental illness can impede help-seeking and adversely affect treatment outcomes, especially if such attitudes are endorsed by medical personnel. In order to help identify targets for anti-stigma interventions, we comprehensively examined negative attitudes towards mental illness displayed by Sri Lankan doctors and medical students and compared these with equivalent UK and other international data. A self-report questionnaire originally developed in the UK was completed by medical students (n = 574) and doctors (n = 74) from a teaching hospital in Colombo. The questions assessed the presence and intensity of stigmatizing attitudes towards patients with schizophrenia, depression, panic disorder, dementia and drug and alcohol addiction. The study revealed higher levels of stigma towards patients with depression, alcohol and drug addiction in this Sri Lankan sample compared to UK data but attitudes towards schizophrenia were less stigmatized in Sri Lanka. Blaming attitudes were consistently high across diagnoses in the Sri Lankan sample. Sri Lankan medical students displayed more negative attitudes than doctors (P < 0.001). Overall stigma was greatest towards patients with drug addiction, followed by, alcohol addiction, schizophrenia, depression, panic disorder and dementia. Sri Lankan doctors and undergraduates endorse stigmatizing attitudes towards mental illnesses and are especially prone to see patients as blameworthy. As such attitudes are likely to affect the engagement of patients in treatment and specific interventions that modify negative attitudes towards people with mental illnesses are needed. Ensuring that medical students have contact with recovered patients in community psychiatry settings may be one way of decreasing stigmatizing attitudes.

Digital Natives Versus Digital Immigrants: Influence of Online Health Information Seeking on the Doctor-Patient Relationship.

PubMed

Haluza, Daniela; Naszay, Marlene; Stockinger, Andreas; Jungwirth, David

2017-11-01

Ubiquitous Internet access currently revolutionizes the way people acquire information by creating a complex, worldwide information network. The impact of Internet use on the doctor-patient relationship is a moving target that varies across sociodemographic strata and nations. To increase scientific knowledge on the patient-Web-physician triangle in Austria, this study reports findings regarding prevailing online health information-seeking behavior and the respective impact on doctor-patient interactions among a nonprobability convenience sample of Internet users. To investigate digital age group-specific influences, we analyzed whether digital natives and digital immigrants differed in their perspectives. The questionnaire-based online survey collected sociodemographic data and online health information-seeking behavior from a sample of 562 respondents (59% females, mean age 37 ± 15 years, 54% digital natives). Most respondents (79%) referred to the Internet to seek health information, making it the most commonly used source for health information, even more prevalent then the doctor. We found similar predictors for using the Internet as a source for health-related information across digital age groups. Thus, the overall generational gap seems to be small among regular Internet users in Austria. However, study participants expressed a rather skeptical attitude toward electronic exchange of health data between health care professionals and patients, as well as toward reliability of online health information. To improve adoption of electronic doctor-patient communication and patient empowerment, public education and awareness programs are required to promote consumer-centered health care provision and patient empowerment.

Suing the doctor: lawsuits by injured workers against the occupational physician.

PubMed

Postol, L P

1989-11-01

Occupational physicians are beginning to learn that they, like other physicians, can be targets for lawsuits. This article attempts to outline the relationship between the workers' compensation system and occupational physicians' personal liability. Consideration is given to potential liability due to malpractice, negligent interference with a workers' contractual relationship with his or her employer, libel and slander, and unauthorized release of information. The requirements of the Occupational Health and Safety Administration for medical examinations and recordkeeping are also highlighted. Finally, the need to clarify the relationship between the doctor, patient/worker, and employer is analyzed. Once the occupational physician recognizes the areas for liability, he or she can take practical steps to minimize his or her exposure.

Department of Defense Financial Management Regulation. Volume 5. Disbursing Policy and Procedures

DTIC Science & Technology

1999-08-01

enable them to recognize fraudulent acts and, thereby, avoid losses. Reports of missing luggage, burglarized automobiles , and unauthorized absence of...for the reward requirement, including the amount needed, will be stated for each request. (e) Lost Aircraft and Lost Target Pilotless Aircraft and

Action against contraceptive implant threatened.

PubMed

Dyer, C

1995-08-19

Norplant provides contraception over a five-year period through the gradual subcutaneous release of the progestogen levonorgestrel. It has been on the US market since 1991 and available in Great Britain since 1993. Already the subject of group legal actions in several US states, Norplant may soon be the target of lawyers in Britain for litigation. The lawyers allege that insertion of the implant under the skin of the upper arm by untrained doctors has led to painful and difficult removals and left women with scarred arms. Moreover, insufficient warning has been given about possible side effects such as mood swings and continuous vaginal bleeding. Hoechst Roussel, marketer of the implant in Britain, however, argues that only doctors trained in Norplant insertion and removal should attempt either procedure. Removal will be problematic only if preceded by a problem insertion. Hoechst Roussel recently advised gynecologists, in writing, not to attempt to extract the implant unless they are trained in the removal technique. By British law, the application of a drug product once approved for general release to general practitioners and family planning doctors cannot be restricted by a pharmaceutical company.

The PEREGRINETM program: using physics and computer simulation to improve radiation therapy for cancer

NASA Astrophysics Data System (ADS)

Hartmann Siantar, Christine L.; Moses, Edward I.

1998-11-01

When using radiation to treat cancer, doctors rely on physics and computer technology to predict where the radiation dose will be deposited in the patient. The accuracy of computerized treatment planning plays a critical role in the ultimate success or failure of the radiation treatment. Inaccurate dose calculations can result in either insufficient radiation for cure, or excessive radiation to nearby healthy tissue, which can reduce the patient's quality of life. This paper describes how advanced physics, computer, and engineering techniques originally developed for nuclear weapons and high-energy physics research are being used to predict radiation dose in cancer patients. Results for radiation therapy planning, achieved in the Lawrence Livermore National Laboratory (LLNL) 0143-0807/19/6/005/img2 program show that these tools can give doctors new insights into their patients' treatments by providing substantially more accurate dose distributions than have been available in the past. It is believed that greater accuracy in radiation therapy treatment planning will save lives by improving doctors' ability to target radiation to the tumour and reduce suffering by reducing the incidence of radiation-induced complications.

Psycho-social Correlates of Condom Use and HIV Testing among MSM Refugees in Beirut, Lebanon.

PubMed

Tohme, Johnny; Egan, James E; Friedman, Mackey R; Stall, Ron

2016-12-01

MSM refugees have to deal with personal challenges and social/structural adversaries based on their refugee status on top of their sexual identity. To better customize interventions beside this population, we explored psycho-social and structural correlates of condom use and HIV testing in Lebanon by surveying and testing 150 participants. 67 % self-identified as gay. 84.6 % reported any unprotected anal intercourse (UAI) with men in the prior 3 months. Those who engaged in UAI, were lest comfortable with a doctor, didn't know where to get free HIV testing, experienced discrimination based on their refugee status and spent more time with their refugee peers, were less inclined to have seen a doctor in the past 12 month or knew where to get free HIV testing. Ever having been HIV tested was associated with being comfortable with medical doctors, knowing where to get HIV testing and spending time with other peer refugees. HIV prevention and testing promotion efforts targeting MSM refugees need to account for structural barriers, while fighting discrimination is crucial for a healthy sexual identity development.

Development of electronic software for the management of trauma patients on the orthopaedic unit.

PubMed

Patel, Vishal P; Raptis, Demitri; Christofi, T; Mathew, Rajeev; Horwitz, M D; Eleftheriou, K; McGovern, Paul D; Youngman, J; Patel, J V; Haddad, F S

2009-04-01

Continuity of patient care is an essential prerequisite for the successful running of a trauma surgery service. This is becoming increasingly difficult because of the new working arrangements of junior doctors. Handover is now central to ensure continuity of care following shift change over. The purpose of this study was to compare the quality of information handed over using the traditional ad hoc method of a handover sheet versus a web-based electronic software programme. It was hoped that through improved quality of handover the new system would have a positive impact on clinical care, risk and time management. Data was prospectively collected and analyzed using the SPSS 14 statistical package. The handover data of 350 patients using a paper-based system was compared to the data of 357 cases using the web-based system. Key data included basic demographic data, responsible surgeon, location of patient, injury site including site, whether fractures were open or closed, concomitant injuries and the treatment plan. A survey was conducted amongst health care providers to assess the impact of the new software. With the introduction of the electronic handover system, patients with missing demographic data reduced from 35.1% to 0.8% (p<0.0001) and missing patient location from 18.6% to 3.6% (p<0.0001). Missing consultant information and missing diagnosis dropped from 12.9% to 2.0% (p<0.0001) and from 11.7% to 0.8% (p<0.0001), respectively. The missing information regarding side and anatomical site of the injury was reduced from 31.4% to 0.8% (p<0.0001) and from 13.7% to 1.1% (p<0.0001), respectively. In 96.6% of paper ad hoc handovers it was not stated whether the injury was 'closed' or 'open', whereas in the electronic group this information was evident in all 357 patients (p<0.0001). A treatment plan was included only in 52.3% of paper handovers compared to 94.7% (p<0.0001) of electronic handovers. A survey revealed 96% of members of the trauma team felt an improvement of handover since the introduction of the software, and 94% of members were satisfied with the software. The findings of our study show that the use of web-based electronic software is effective in facilitating and improving the quality of information passed during handover. Structured software also aids in improving work flow amongst the trauma team. We argue that an improvement in the quality of handover is an improvement in clinical practice.

Entanglement-enhanced Neyman-Pearson target detection using quantum illumination

NASA Astrophysics Data System (ADS)

Zhuang, Quntao; Zhang, Zheshen; Shapiro, Jeffrey H.

2017-08-01

Quantum illumination (QI) provides entanglement-based target detection---in an entanglement-breaking environment---whose performance is significantly better than that of optimum classical-illumination target detection. QI's performance advantage was established in a Bayesian setting with the target presumed equally likely to be absent or present and error probability employed as the performance metric. Radar theory, however, eschews that Bayesian approach, preferring the Neyman-Pearson performance criterion to avoid the difficulties of accurately assigning prior probabilities to target absence and presence and appropriate costs to false-alarm and miss errors. We have recently reported an architecture---based on sum-frequency generation (SFG) and feedforward (FF) processing---for minimum error-probability QI target detection with arbitrary prior probabilities for target absence and presence. In this paper, we use our results for FF-SFG reception to determine the receiver operating characteristic---detection probability versus false-alarm probability---for optimum QI target detection under the Neyman-Pearson criterion.

A cross sectional study on the motivators for Asian women to attend opportunistic mammography screening in a private hospital in Malaysia: the MyMammo study.

PubMed

Hassan, Norhashimah; Ho, Weang Kee; Mariapun, Shivaani; Teo, Soo Hwang

2015-06-12

To date, because of limited budgets and lower incidence of breast cancer, the majority of Asian countries do not have population-based screening programmes, but instead offer opportunistic screening. However, there have been few studies which have assessed the motivators for women attending such programmes and the appropriateness of the programmes in terms of targeting women at risk. We conducted a prospective cross-sectional study of 1,619 women aged 40 to 74 years attending a subsidized opportunistic screening mammogram from October 2011 to October 2013 at a private hospital in Malaysia. Breast cancer risk was estimated using the Gail Model and two-step cluster analysis was used to examine the motivators of attending screening. Although Malaysia comprises 54.5% Malay, 24.5% Chinese and 7.3% Indian, the majority of women in the MyMammo Study were Chinese (70.1%) and 99.2% had a <2% ten-year risk of breast cancer. The most commonly cited barriers were the perception of not being at risk and fear of painful mammography. We found that highly educated women, cited doctors, family and friends as their main motivators. Of those with only secondary school education, their main motivators were doctors. Taken together, our results suggest the women attending opportunistic mammography screening in Asia are at low risk of breast cancer and this poses challenges to cost-effective and equitable strategies for cancer control. We propose that to improve uptake of screening mammography, awareness programmes should target both doctors and members of the public.

A national survey of the effects of fatigue on trainees in anaesthesia in the UK.

PubMed

McClelland, L; Holland, J; Lomas, J-P; Redfern, N; Plunkett, E

2017-09-01

Long daytime and overnight shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. The Working Time Regulations (1998) implemented the European Working Time Directive into UK law, and in August 2009 it was applied to junior doctors, reducing the maximum hours worked from an average of 56 per week to 48. Despite this, there is evidence that problems with inadequate rest and fatigue persist. There is no official guidance regarding provision of a minimum standard of rest facilities for doctors in the National Health Service, and the way in which rest is achieved by trainee anaesthetists during their on-call shift depends on rota staffing and workload. We conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK. We achieved a response rate of 59% (2231/3772 responses), with data from 100% of NHS trusts. Fatigue remains prevalent among junior anaesthetists, with reports that it has effects on physical health (73.6% [95%CI 71.8-75.5]), psychological wellbeing (71.2% [69.2-73.1]) and personal relationships (67.9% [65.9-70.0]). The most problematic factor remains night shift work, with many respondents commenting on the absence of breaks, inadequate rest facilities and 57.0% (55.0-59.1) stating they had experienced an accident or near-miss when travelling home from night shifts. We discuss potential explanations for the results, and present a plan to address the issues raised by this survey, aiming to change the culture around fatigue for the better. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Which doctors and with what problems contact a specialist service for doctors? A cross sectional investigation.

PubMed

Garelick, Antony I; Gross, Samantha R; Richardson, Irene; von der Tann, Matthias; Bland, Julia; Hale, Rob

2007-08-28

In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved. A cross-sectional study including all consecutive self-referred doctors (n = 121, 50% male) presenting in 2002-2004 was conducted. Measures included standardised and bespoke questionnaires both self-report and clinician completed. The multi-dimensional evaluation included: demographics, CORE (CORE-OM, CORE-Workplace and CORE-A) an instrument designed to evaluate the psychological difficulties of patients referred to outpatient services, Brief Symptom Inventory to quantify caseness and formal psychiatric illness, and Maslach Burnout Inventory. The most prevalent presenting problems included depression, anxiety, interpersonal, self-esteem and work-related issues. However, only 9% of the cohort were identified as severely distressed psychiatrically using this measure. In approximately 50% of the sample, problems first presented in the preceding year. About 25% were on sick leave at the time of consultation, while 50% took little or no leave in the prior 12 months. A total of 42% were considered to be at some risk of suicide, with more than 25% considered to have a moderate to severe risk. There were no significant gender differences in type of morbidity, severity or days off sick. Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however, low rates of severe psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases that is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area that requires further investigation in the UK.

[Doctors belonging to the Senegalese Association of Sport Medicine and doping in sports: survey on knowledge and attitudes].

PubMed

Dièye, Amadou Moctar; Diallo, Boubacar; Fall, Assane; Ndiaye, Mamadou; Cissè, Fallou; Faye, Babacar

2005-01-01

Doping in sports is as old as sports, but it grew considerably during the 20th century with the arrival in stadiums during the 1990s of amphetamines and anabolic steroids as well as such peptide hormones as erythropoietin. The international fight against doping took a giant step forward in 1999 with the creation of the world antidoping agency (WADA). This study is part of that fight. It follows an earlier survey of retail pharmacists in Senegal and aims to evaluate the knowledge about doping of doctors belonging to the Senegalese Association of Sports Medicine and to assess their attitude towards this phenomenon. Its goal is to determine how best to involve them in preventive actions. We conducted a survey in 2001 and randomly selected and interviewed 60 of the 92 doctors in the association. The questionnaire focused on three areas: their knowledge of doping, their attitudes to it, and the means of prevention that they proposed. The results showed that only 11 of the 60 doctors knew the definition of doping and 15% of doctors could not cite any family of doping products. They were aware mainly of testosterone and other anabolic steroids (84.3%), then amphetamines and other stimulants (64.7%), and finally peptide hormones (58.8%). The subjects mentioned blood doping and pharmacological manipulations as forbidden methods. They considered that the four groups of drugs most often used by athletes for doping were, in descending order, anabolic steroids, stimulants, peptide hormones and corticoids. Eighty per cent of doctors think that Senegalese athletes use doping products and that the sports most involved are football, wrestling, track and field and basketball. They also think that doping is a form of drug addiction and a public health problem. Eleven doctors (18%) said they had been contacted for information on use of doping products. The interviewees consider that the three best methods of prevention include information about side effects, unannounced urine and blood tests, and sanctions. This work shows that Senegalese athletes may use doping; it contains no direct proofs but many indirect indicators. Success against doping requires preventive activities that should be conducted jointly for trainers, sports federations and doctors of the Senegalese Association of Sports Medicine and then by all of them for athletes, who are the primary targets of any prevention campaign.

Barriers and enablers to the delivery of psychological care in the management of patients with type 2 diabetes mellitus in China: a qualitative study using the theoretical domains framework.

PubMed

Chapman, Anna; Yang, Hui; Thomas, Shane A; Searle, Kendall; Browning, Colette

2016-03-29

China has the largest number of type 2 diabetes mellitus (T2DM) cases globally and individuals with T2DM have an increased risk of developing mental health disorders and functional problems. Despite guidelines recommending that psychological care be delivered in conjunction with standard T2DM care; psychological care is not routinely delivered in China. Community Health Centre (CHC) doctors play a key role in the management of patients with T2DM in China. Understanding the behavioural determinants of CHC doctors in the implementation of psychological care recommendations allows for the design of targeted and culturally appropriate interventions. As such, this study aimed to examine barriers and enablers to the delivery of psychological care to patients with T2DM from the perspective of CHC doctors in China. Two focus groups were conducted with 23 CHC doctors from Shenzhen, China. The discussion guide applied the Theoretical Domains Framework (TDF) that examines current practice and identifies key barriers and enablers perceived to influence practice. Focus groups were conducted with an interpreter, and were digitally recorded and transcribed. Two researchers independently coded transcripts into pre-defined themes using deductive thematic analysis. Barriers and enablers perceived by doctors as being relevant to the delivery of psychological care for patients with T2DM were primarily categorised within eight TDF domains. Key barriers included: CHC doctors' knowledge and skills; time constraints; and absence of financial incentives. Other barriers included: societal perception that treating psychological aspects of health is less important than physical health; lack of opinion leaders; doctors' intentional disregard of psychological care; and doubts regarding the efficacy of psychological care. In contrast, perceived enablers included: training of CHC doctors in psychological skills; identification of afternoon/evening clinic times when recommendations could be implemented; introduction of financial incentives; and the creation of a professional role (e.g. diabetes educator), that could implement psychological care recommendations to patients with T2DM. The utilisation of the TDF allowed for the comprehensive understanding of barriers and enablers to the implementation of psychological care recommendations for patients with T2DM, and consequently, has given direction to future interventions strategies aimed at improving the implementation of such recommendations.

Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review.

PubMed

Clough, Bonnie A; March, Sonja; Chan, Raymond J; Casey, Leanne M; Phillips, Rachel; Ireland, Michael J

2017-07-17

Occupational stress and burnout are highly prevalent among medical doctors and can have adverse effects on patient, doctor, and organisational outcomes. The purpose of the current study was to review and evaluate evidence on psychosocial interventions aimed at reducing occupational stress and burnout among medical doctors. A systematic review was conducted for original research articles reporting on psychosocial interventions targeting occupational stress or burnout among medical doctors, published in the English language, and with data collected at a minimum of two time points. Searches were conducted across five electronic databases, as well as by manual search of Google Scholar. Data was extracted relating to study characteristics and outcomes, quality and rigour, as well as modes of delivery and engagement. Studies were appraised using the Strength of Recommendation Taxonomy (SORT) and Critical Appraisal Skills Programme (CASP). Twenty-three articles were reviewed, which reported on interventions utilising cognitive-behavioural, relaxation, and supportive discussion strategies. Only 12 studies allowed estimation of pre- to post-intervention effects. Cognitive behavioural interventions demonstrated the strongest evidence, particularly for reducing stress. Some evidence was identified to support the efficacy of relaxation-based approaches, but no such evidence was found for the efficacy of discussion-based interventions, such as Balint groups. There was a lack of quality among reviewed studies, with no studies receiving a quality rating of 1, and the overall body of evidence being rated as level B, according to the SORT. Effect sizes were not pooled due to a lack of quality among the study sample. This review found that despite increased scientific attention, the quality of research examining the benefits of psychosocial/behavioural interventions for occupational stress and burnout in medical doctors remains low. Despite this, interventions focused on cognitive and behavioural principles appear to show promise in reducing doctor stress and burnout. Limitations of the current review include a lack of risk of bias assessment or pooling of analyses. Recommendations for improving the quality of research in this area, as well as implications of the current body of evidence are discussed. PROSPERO CRD42016032595.

A mixed methods approach to developing and evaluating oncology trainee education around minimization of adverse events and improved patient quality and safety.

PubMed

Janssen, Anna; Shaw, Tim; Bradbury, Lauren; Moujaber, Tania; Nørrelykke, Anne Mette; Zerillo, Jessica A; LaCasce, Ann; Co, John Patrick T; Robinson, Tracy; Starr, Alison; Harnett, Paul

2016-03-12

Adverse events are a significant quality and safety issue in the hospital setting due to their direct impact on patients. Additionally, such events are often handled by junior doctors due to their direct involvement with patients. As such, it is important for health care organizations to prioritize education and training for junior doctors on identifying adverse events and handling them when they occur. The Cancer Cup Challenge is an educational program focuses on quality improvement and adverse event awareness targeting for junior oncology doctors across three international sites. A mixed methodology was used to develop and evaluate the program. The Qstream spaced learning platform was used to disseminate information to participants, as it has been demonstrated to impact on both knowledge and behavior. Eight short case based scenarios with expert feedback were developed by a multidisciplinary advisory committee containing representatives from the international sites. At the conclusion of the course impact on participant knowledge was evaluated using analysis of the metrics collected by the Qstream platform. Additionally, an online survey and semi-structured interviews were used to evaluate engagement and perceived value by participants. A total of 35 junior doctors registered to undertake the Qstream program, with 31 (88.57 %) successfully completing it. Analysis of the Qstream metrics revealed 76.57 % of cases were answered correctly on first attempt. The post-program survey received 17 responses, with 76.47 % indicating cases for the course were interesting and 82.35 % feeling cases were relevant. Finally, 14 participants consented to participate in semi-structured interviews about the program, with feedback towards the course being generally very positive. Our study demonstrates that an online game is well accepted by junior doctors as a method to increase their quality improvement awareness. Developing effective and sustainable training for doctors is important to ensure positive patient outcomes are maintained in the hospital setting. This is particularly important for junior doctors as they are working closely with patients and learning skills and behaviors, which will influence their practice throughout their careers.

Through the eyes of aspiring scientists: Mexican Americans in pursuit of the PhD

NASA Astrophysics Data System (ADS)

Heimlich, Scott Matthew

This qualitative study expands the current knowledge base behind why undergraduates pursue a doctorate in the life and physical sciences, specifically with regard to Mexican Americans. Hispanics make up approximately 11.7% of the United States population, with Mexican Americans comprising almost two-thirds of this total. In 1998, of the 9,683 doctorates awarded to U.S. citizens and permanent residents in the life (biological) and physical sciences, 75 went to Mexican Americans (54 to males, 21 to females). Mexican Americans are severely underrepresented in U.S. doctoral programs in the life and physical sciences, as well as at earlier points in the U.S. educational system. A key aim of this study was to understand the underrepresentation of this population in science, and listen to Mexican Americans currently pursuing their science doctorate discuss their aspirations and experiences. In depth interviews were conducted with twelve Mexican American doctoral students in the life and physical sciences, all currently attending the same competitive research university in California. A comparison of the backgrounds of these twelve students, along with their impetus for pursuing a graduate education, is presented. In depth portraits that chronicle the experiences of five of these students is also included. This study found that a student's personal drive, career aspirations, enjoyment of science and research in addition to the scientist lifestyle were important variables in the decision to pursue a science doctorate. Involvement in research as an undergraduate was highlighted as a crucial factor in introducing and ultimately exciting students about research careers and graduate school, and many of these students participated in organizations at the undergraduate level, often targeted towards groups underrepresented in the sciences, that promoted scientific research and careers. Members of the educational system, peers, and family all played important roles at various times in supporting these students in their educational and career aspirations. No one factor was found to be essential to the pursuit of the doctorate, and each student's perspective on their experiences was truly unique as they discussed both their struggles and supports, and shared their evolving aspirations toward science.

Wikis for Building Content Knowledge in the Foreign Language Classroom

ERIC Educational Resources Information Center

Pellet, Stephanie H.

2012-01-01

Most pedagogical applications of wikis in foreign language education draw on this collaborative tool to improve (formal) writing skills or to develop target language cultural sensitivity, missing largely on the opportunity to support student-developed L2 content knowledge. Seeking an alternative to traditional teacher-centered approaches, this…

Information Gaps: The Missing Links to Learning.

ERIC Educational Resources Information Center

Adams, Carl R.

Communication takes place when a speaker conveys new information to the listener. In second language teaching, information gaps motivate students to use and learn the target language in order to obtain information. The resulting interactive language use may develop affective bonds among the students. A variety of classroom techniques are available…

Armed to Farm: Developing training programs for military veterans in agriculture

USDA-ARS?s Scientific Manuscript database

Farming offers a viable avenue for returning veterans to transition and reincorporate into society. Farming opportunities for veterans are a natural fit and capitalize on skills that made them successful in the military. However, these opportunities may be missed due to lack of targeted training pr...

Miss-distance indicator for tank main guns

NASA Astrophysics Data System (ADS)

Bornstein, Jonathan A.; Hillis, David B.

1996-06-01

Tank main gun systems must possess extremely high levels of accuracy to perform successfully in battle. Under some circumstances, the first round fired in an engagement may miss the intended target, and it becomes necessary to rapidly correct fire. A breadboard automatic miss-distance indicator system was previously developed to assist in this process. The system, which would be mounted on a 'wingman' tank, consists of a charged-coupled device (CCD) camera and computer-based image-processing system, coupled with a separate infrared sensor to detect muzzle flash. For the system to be successfully employed with current generation tanks, it must be reliable, be relatively low cost, and respond rapidly maintaining current firing rates. Recently, the original indicator system was developed further in an effort to assist in achieving these goals. Efforts have focused primarily upon enhanced image-processing algorithms, both to improve system reliability and to reduce processing requirements. Intelligent application of newly refined trajectory models has permitted examination of reduced areas of interest and enhanced rejection of false alarms, significantly improving system performance.

Advances in measuring culturally competent care: a confirmatory factor analysis of CAHPS-CC in a safety-net population.

PubMed

Stern, Rachel J; Fernandez, Alicia; Jacobs, Elizabeth A; Neilands, Torsten B; Weech-Maldonado, Robert; Quan, Judy; Carle, Adam; Seligman, Hilary K

2012-09-01

Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n=600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings. A 7-factor model demonstrated satisfactory fit (χ²₂₃₁=484.34, P<0.0001) with significant factor loadings at P<0.05. Three domains showed excellent reliability-Doctor Communication-Positive Behaviors (α=0.82), Trust (α=0.77), and Doctor Communication-Health Promotion (α=0.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication-Negative Behaviors (α=0.54), Equitable Treatment (α=0.69), Doctor Communication-Alternative Medicine (α=0.52), and Shared Decision-Making (α=0.51). CAHPS-CC domains were positively and significantly correlated with global physician rating. Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings.

Shadow Scholars and the Rise of the Dissertation Service Industry: Can We Maintain Academic Integrity?

ERIC Educational Resources Information Center

White, Jeffry L.

2016-01-01

Notable interest was generated when Dave Tomar's book, "The Shadow Scholar: How I Made a Living Helping College Kids Cheat," was first published. While ghostwriters and paper mills have long been part of the academic landscape, a far more ominous enterprise has appeared that targets master's and doctoral students seeking assistance with…

Elements of Inclusion: Findings from the Field

ERIC Educational Resources Information Center

McMaster, Christopher

2014-01-01

The Ministry of Education has set the target of 100% of New Zealand schools to be "mostly" inclusive by 2014. But what are the essential elements of inclusion? This paper explores essential core elements that allow inclusion to flourish. Based on an extensive time in the field as part of a year-long doctoral research project, these…

An Analysis of the Information Behaviour of Geography Teachers in a Developing African Country--Lesotho

ERIC Educational Resources Information Center

Bitso, Constance

2012-01-01

Information behaviour studies have the potential to inform the design of effective information services that incorporate the information needs, information-seeking and preferences for information sources of target users; hence a doctoral study was conducted on the information behaviour of geography teachers in Lesotho with the aim of guiding the…

Selecting for a Sustainable Workforce to Meet the Future Healthcare Needs of Rural Communities in Australia

ERIC Educational Resources Information Center

Hay, M.; Mercer, A. M.; Lichtwark, I.; Tran, S.; Hodgson, W. C.; Aretz, H. T.; Armstrong, E. G.; Gorman, D.

2017-01-01

An undersupply of generalists doctors in rural communities globally led to widening participation (WP) initiatives to increase the proportion of rural origin medical students. In 2002 the Australian Government mandated that 25% of commencing Australian medical students be of rural origin. Meeting this target has largely been achieved through…

Mission Design Analysis for the Martian Moon Phobos: Close Flybys, Missed Thrusts, and Other In-Flight Entertainment

NASA Technical Reports Server (NTRS)

Stuart, Jeffrey; McElrath, Tim; Petropoulos, Anastassios

2015-01-01

A robotic mission to the Martian moons Phobos and Deimos would offer a wealth of scientific information and serve as a useful precursor to potential human missions. In this paper, we investigate a prospective mission enabled by solar electric propulsion that would explore Phobos via a series of flybys followed by capture into orbit around the moon. Of particular interest are low-cost options for capture and walkdown to the target science orbits aided by multi-body effects due to the mutual gravitational interaction of Phobos and Mars. We also consider contingency operations in the event of missed thrust or maneuver execution errors.

Doctors on the move: a European case study on the key characteristics of national recertification systems.

PubMed

Sehlbach, Carolin; Govaerts, Marjan J; Mitchell, Sharon; Rohde, Gernot G U; Smeenk, Frank W J M; Driessen, Erik W

2018-04-17

With increased cross-border movement, ensuring safe and high-quality healthcare has gained primacy. The purpose of recertification is to ensure quality of care through periodically attesting doctors' professional proficiency in their field. Professional migration and facilitated cross-border recognition of qualifications, however, make us question the fitness of national policies for safeguarding patient care and the international accountability of doctors. We performed document analyses and conducted 19 semistructured interviews to identify and describe key characteristics and effective components of 10 different European recertification systems, each representing one case (collective case study). We subsequently compared these systems to explore similarities and differences in terms of assessment criteria used to determine process quality. Great variety existed between countries in terms and assessment formats used, targeting cognition, competence and performance (Miller's assessment pyramid). Recertification procedures and requirements also varied significantly, ranging from voluntary participation in professional development modules to the mandatory collection of multiple performance data in a competency-based portfolio. Knowledge assessment was fundamental to recertification in most countries. Another difference concerned the stakeholders involved in the recertification process: while some systems exclusively relied on doctors' self-assessment, others involved multiple stakeholders but rarely included patients in assessment of doctors' professional competence. Differences between systems partly reflected different goals and primary purposes of recertification. Recertification systems differ substantially internationally with regard to the criteria they apply to assess doctors' competence, their aims, requirements, assessment formats and patient involvement. In the light of professional mobility and associated demands for accountability, we recommend that competence assessment includes patients' perspectives, and recertification practices be shared internationally to enhance transparency. This can help facilitate cross-border movement, while guaranteeing high-quality patient care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Knowledge of the Role of Papillomavirus—Related Head and Neck Pathologies among General Practitioners, Otolaryngologists and Trainees. A Survey-Based Study

PubMed Central

Jackowska, Joanna; Bartochowska, Anna; Karlik, Michał; Wichtowski, Mateusz; Tokarski, Maciej; Wierzbicka, Małgorzata

2015-01-01

Objectives The aim of the survey was to introduce knowledge of HPV's role in head and neck pathologies to general physicians (GPs), otorhinolaryngologists (ENTs) and newly graduated doctors, as well as to promote HPV-related diseases prevention. Study Design Cross-sectional study. Methods Self-designed questionnaire was sent to 2100 doctors. A total of 404 doctors, including 144 ENTs, 192 GPs and 68 trainees, responded. Results The majority of ENTs (86.8%) had contact with recurrent respiratory papillomatosis (RRP) and oropharyngeal cancers (OPCs) patients; in contrast, the majority of GPs (55.7%) did not (p = 0.00). The knowledge of HPV aetiology of cervical cancer versus OPCs and RRP was statistically higher. 7% of ENTs, 20% of GPs and 10% of trainees had not heard about HPV in oropharyngeal diseases. Women had greater knowledge than men. Both in the group of GPs and ENTs, 100% of respondents had heard about the impact of vaccination on the reduction of cervical cancer incidence. Only 39.11% of respondents had heard about the possibility of using vaccination against HPV in RRP—ENT doctors significantly more often than GPs and trainees (p = 0.00). Only 28.96% of physicians had heard about the potential value of HPV vaccination in preventing OPCs, including 44.44% of ENT doctors, 23.44% of GPs and 11.76% of trainees (p = 0.00). The doctors from district hospitals showed lower level of knowledge compared with clinicians (p = 0.04). Conclusions The different levels of knowledge and awareness of HPV issues highlight the need for targeted awareness strategies in Poland with implementation of HPV testing and vaccination. The information should be accessible especially to those with lower education levels: ENTs from small, provincial wards, GPs from cities of < 200 000 inhabitants and older physicians. The incorporation of HPV issues into the studies curriculum would be fruitful in terms of improving the knowledge of trainees. PMID:26501885

The doctor-patient relationship, defensive medicine and overprescription in Chinese public hospitals: evidence from a cross-sectional survey in Shenzhen city.

PubMed

He, Alex Jingwei

2014-12-01

Defensive medicine describes physicians' behavioral response to threats from medical malpractice litigation. Previous studies have found widespread practice of defensive medicine that is responsible for the global escalation of health care costs. Defying the traditional explanations, this study, with a case of a Chinese city, reveals that in a country where medical malpractice lawsuits are rare, physicians' self-perceived threats from patients may constitute a major reason for defensive practices. Defensive behaviors in the Chinese context mainly take the form of overprescribing diagnostic tests, procedures and drugs. The existing literature tends to explain this in terms of Chinese doctors' desire to supplement their low incomes. Behind this is a series of misaligned incentives deeply embedded in the Chinese health system. Using a cross-sectional survey of physicians, this study shows that overprescription in Chinese hospitals is driven not only by hard economic incentives, but also by doctors' motive of avoiding disputes with patients. The survey was carried out in Shenzhen City, in December 2013. A sample containing 504 licensed physicians was drawn by random sampling. Descriptive analyses identified significant dissatisfaction with income and workload as well as severe tensions between doctors and patients. Drawing from the literature on defensive medicine, multivariate analysis revealed that physicians' previous experience of medical disputes is significantly associated with defensive behaviors, particularly overprescription. Low income continued to be a critical predictor, reinforcing the target income hypothesis and suggesting the resilience of perverse economic incentives. This study sheds fresh light on China's recent health policy reforms by highlighting the critical impact of the doctor-patient relationship. The effort to contain health care costs must progress on two fronts, mitigating the tensions between doctors and patients while still reforming the remuneration scheme cautiously to enable physicians to respond to right incentives. Copyright © 2014 Elsevier Ltd. All rights reserved.

Degos disease: a new simulator of non-accidental injury.

PubMed

Moss, Celia; Wassmer, Evangeline; Debelle, Geoff; Hackett, Scott; Goodyear, Helen; Malcomson, Roger; Ryder, Clive; Sgouros, Spyros; Shahidullah, Hossain

2009-08-01

Recent high-profile cases have made paediatricians very aware of the serious implications of either missing or wrongly diagnosing non-accidental injury. Subdural fluid collections in non-mobile infants usually represent haemorrhage caused by non-accidental injury. We report a 6-month-old male who presented to the Accident and Emergency Department of Birmingham Heartlands Hospital with bilateral subdural fluid collections and skin ulcers resembling cigarette burns. Non-accidental injury was considered to be the most likely diagnosis. However, while under observation in hospital, the child's neurological condition deteriorated with progressive cerebral infarctions, and serial photographs of the skin lesions showed failure to heal. The revised diagnosis, confirmed histologically, was Degos disease, an extremely rare and often fatal occlusive vasculopathy. The child was treated palliatively and died 8 weeks after presentation. This report informs doctors of a new simulator of non-accidental injury to be considered in infants with otherwise unexplained subdural fluid collections.

Performance assessment of a closed-loop system for diabetes management.

PubMed

Martinez-Millana, A; Fico, G; Fernández-Llatas, C; Traver, V

2015-12-01

Telemedicine systems can play an important role in the management of diabetes, a chronic condition that is increasing worldwide. Evaluations on the consistency of information across these systems and on their performance in a real situation are still missing. This paper presents a remote monitoring system for diabetes management based on physiological sensors, mobile technologies and patient/doctor applications over a service-oriented architecture that has been evaluated in an international trial (83,905 operation records). The proposed system integrates three types of running environments and data engines in a single service-oriented architecture. This feature is used to assess key performance indicators comparing them with other type of architectures. Data sustainability across the applications has been evaluated showing better outcomes for full integrated sensors. At the same time, runtime performance of clients has been assessed spotting no differences regarding the operative environment.

The development of children's ability to fill the gaps in their knowledge by consulting experts.

PubMed

Aguiar, Naomi R; Stoess, Caryn J; Taylor, Marjorie

2012-01-01

This research investigated children's ability to recognize gaps in their knowledge and seek missing information from appropriate informants. In Experiment 1, forty-five 4- and 5-year-olds were adept in assigning questions from 3 domains (medicine, firefighting, and farming) to corresponding experts (doctor, firefighter, or farmer). However, when given the options of answering the same questions themselves or assigning them to an expert (Experiment 2), only 6-year-olds were consistently able to recognize when they did not know answers and then assign test questions correctly. Four- and 5-year-olds tended to overestimate their own knowledge or assign questions to the wrong expert. This result was replicated in Experiment 3, in which 5-year-olds were given incentives for correct answers. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

Respiratory Distress

NASA Technical Reports Server (NTRS)

1976-01-01

The University of Miami School of Medicine asked the Research Triangle Institute for assistance in improvising the negative pressure technique to relieve respiratory distress in infants. Marshall Space Flight Center and Johnson Space Center engineers adapted this idea to the lower-body negative-pressure system seals used during the Skylab missions. Some 20,000 babies succumb to respiratory distress in the U.S. each year, a condition in which lungs progressively lose their ability to oxygenate blood. Both positive and negative pressure techniques have been used - the first to force air into lungs, the second to keep infant's lungs expanded. Negative pressure around chest helps the baby expand his lungs and maintain proper volume of air. If doctors can keep the infant alive for four days, the missing substance in the lungs will usually form in sufficient quantity to permit normal breathing. The Skylab chamber and its leakproof seals were adapted for medical use.

Morbidity ranking of U.S. workers employed in 206 occupations: the National Health Interview Survey (NHIS) 1986-1994.

PubMed

Lee, David J; Fleming, Lora E; Gómez-Marín, Orlando; LeBlanc, William G; Arheart, Kristopher L; Caban, Alberto J; Christ, Sharon L; Chung-Bridges, Katherine; Pitman, Terry

2006-02-01

The objective of this study was to rank U.S. occupations by worker morbidity. From 1986 through 1994, morbidity information was collected on over 410,000 U.S. workers who participated in the National Health Interview Survey, an annual household survey representative of the U.S. civilian noninstitutionalized population. A multivariate adjusted logistic regression morbidity summary score was created for each worker group based on seven indicators: days of restricted activity, bedrest, and missed work in the previous 2 weeks; doctor visits and hospitalizations in the previous 12 months; reported health conditions; and health status. Worker groups reporting the greatest morbidity included social workers, inspectors, postal clerks, psychologists, and grinding machine operators; worker groups reporting the least morbidity included dentists, pilots, physicians, pharmacists, and dietitians. These findings aid in the identification of worker groups that require increased attention for morbidity research and prevention.

Victorian spectacle: Julia Pastrana, the bearded and hairy female.

PubMed

Browne, Janet; Messenger, Sharon

2003-12-01

Julia Pastrana toured Europe in the late 1850s advertising herself as the 'Bearded and hairy Lady' or 'Nonedescript'. She suffered from a rare inherited disorder, not understood until the late 20th century, which manifested itself in facial distortion and considerable facial hair in the male pattern. Doctors, as well as sensation seekers, were very keen to examine her. Her story is unusual, not least because she was mummified after death by her husband-manager and continued to tour as a mounted exhibit for a number of decades. Indirectly, she participated in the evolutionary debate in Britain. In 1857, when she arrived in Britain from America, she was popularly known as the baboon-woman. When Darwin's Origin of Species was published, and evolutionary controversy about ape-ancestry was hot in the air, she was more often likened to the gorilla or orang-utan - as a possible specimen of a missing link.

Factors Associated With Missed and Cancelled Colonoscopy Appointments at Veterans Health Administration Facilities.

PubMed

Partin, Melissa R; Gravely, Amy; Gellad, Ziad F; Nugent, Sean; Burgess, James F; Shaukat, Aasma; Nelson, David B

2016-02-01

Cancelled and missed colonoscopy appointments waste resources, increase colonoscopy delays, and can adversely affect patient outcomes. We examined individual and organizational factors associated with missed and cancelled colonoscopy appointments in Veteran Health Administration facilities. From 69 facilities meeting inclusion criteria, we identified 27,994 patients with colonoscopy appointments scheduled for follow-up, on the basis of positive fecal occult blood test results, between August 16, 2009 and September 30, 2011. We identified factors associated with colonoscopy appointment status (completed, cancelled, or missed) by using hierarchical multinomial regression. Individual factors examined included age, race, sex, marital status, residence, drive time to nearest specialty care facility, limited life expectancy, comorbidities, colonoscopy in the past decade, referring facility type, referral month, and appointment lead time. Organizational factors included facility region, complexity, appointment reminders, scheduling, and prep education practices. Missed appointments were associated with limited life expectancy (odds ratio [OR], 2.74; P = .0004), no personal history of polyps (OR, 2.74; P < .0001), high facility complexity (OR, 2.69; P = .007), dual diagnosis of psychiatric disorders and substance abuse (OR, 1.82; P < .0001), and opt-out scheduling (OR, 1.57; P = .02). Cancelled appointments were associated with age (OR, 1.61; P = .0005 for 85 years or older and OR, 1.44; P < .0001 for 65-84 years old), no history of polyps (OR, 1.51; P < .0001), and opt-out scheduling (OR, 1.26; P = .04). Additional predictors of both outcomes included race, marital status, and lead time. Several factors within Veterans Health Administration clinic control can be targeted to reduce missed and cancelled colonoscopy appointments. Specifically, developing systems to minimize referrals for patients with limited life expectancy could reduce missed appointments, and use of opt-in scheduling and reductions in appointment lead time could improve both outcomes. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Statistical methods for identifying and bounding a UXO target area or minefield

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

McKinstry, Craig A.; Pulsipher, Brent A.; Gilbert, Richard O.

2003-09-18

The sampling unit for minefield or UXO area characterization is typically represented by a geographical block or transect swath that lends itself to characterization by geophysical instrumentation such as mobile sensor arrays. New spatially based statistical survey methods and tools, more appropriate for these unique sampling units have been developed and implemented at PNNL (Visual Sample Plan software, ver. 2.0) with support from the US Department of Defense. Though originally developed to support UXO detection and removal efforts, these tools may also be used in current form or adapted to support demining efforts and aid in the development of newmore » sensors and detection technologies by explicitly incorporating both sampling and detection error in performance assessments. These tools may be used to (1) determine transect designs for detecting and bounding target areas of critical size, shape, and density of detectable items of interest with a specified confidence probability, (2) evaluate the probability that target areas of a specified size, shape and density have not been missed by a systematic or meandering transect survey, and (3) support post-removal verification by calculating the number of transects required to achieve a specified confidence probability that no UXO or mines have been missed.« less

Multi-Source Multi-Target Dictionary Learning for Prediction of Cognitive Decline

PubMed Central

Zhang, Jie; Li, Qingyang; Caselli, Richard J.; Thompson, Paul M.; Ye, Jieping; Wang, Yalin

2017-01-01

Alzheimer’s Disease (AD) is the most common type of dementia. Identifying correct biomarkers may determine pre-symptomatic AD subjects and enable early intervention. Recently, Multi-task sparse feature learning has been successfully applied to many computer vision and biomedical informatics researches. It aims to improve the generalization performance by exploiting the shared features among different tasks. However, most of the existing algorithms are formulated as a supervised learning scheme. Its drawback is with either insufficient feature numbers or missing label information. To address these challenges, we formulate an unsupervised framework for multi-task sparse feature learning based on a novel dictionary learning algorithm. To solve the unsupervised learning problem, we propose a two-stage Multi-Source Multi-Target Dictionary Learning (MMDL) algorithm. In stage 1, we propose a multi-source dictionary learning method to utilize the common and individual sparse features in different time slots. In stage 2, supported by a rigorous theoretical analysis, we develop a multi-task learning method to solve the missing label problem. Empirical studies on an N = 3970 longitudinal brain image data set, which involves 2 sources and 5 targets, demonstrate the improved prediction accuracy and speed efficiency of MMDL in comparison with other state-of-the-art algorithms. PMID:28943731

Inhibitory control differentiates rare target search performance in children.

PubMed

Li, Hongting; Chan, John S Y; Cheung, Sui-Yin; Yan, Jin H

2012-02-01

Age-related differences in rare-target search are primarily explained by the speed-accuracy trade-off, primed responses, or decision making. The goal was to examine how motor inhibition influences visual search. Children pressed a key when a rare target was detected. On no-target trials, children withheld reactions. Response time (RT), hits, misses, correct rejection, and false alarms were measured. Tapping tests assessed motor control. Older children tapped faster, were more sensitive to rare targets (higher d'), and reacted more slowly than younger ones. Girls outperformed boys in search sensitivity but not in RT. Motor speed was closely associated with hit rate and RT. Results suggest that development of inhibitory control plays a key role in visual detection. The potential implications for cognitive-motor development and individual differences are discussed.

The Voice of Chinese Health Consumers: A Text Mining Approach to Web-Based Physician Reviews.

PubMed

Hao, Haijing; Zhang, Kunpeng

2016-05-10

Many Web-based health care platforms allow patients to evaluate physicians by posting open-end textual reviews based on their experiences. These reviews are helpful resources for other patients to choose high-quality doctors, especially in countries like China where no doctor referral systems exist. Analyzing such a large amount of user-generated content to understand the voice of health consumers has attracted much attention from health care providers and health care researchers. The aim of this paper is to automatically extract hidden topics from Web-based physician reviews using text-mining techniques to examine what Chinese patients have said about their doctors and whether these topics differ across various specialties. This knowledge will help health care consumers, providers, and researchers better understand this information. We conducted two-fold analyses on the data collected from the "Good Doctor Online" platform, the largest online health community in China. First, we explored all reviews from 2006-2014 using descriptive statistics. Second, we applied the well-known topic extraction algorithm Latent Dirichlet Allocation to more than 500,000 textual reviews from over 75,000 Chinese doctors across four major specialty areas to understand what Chinese health consumers said online about their doctor visits. On the "Good Doctor Online" platform, 112,873 out of 314,624 doctors had been reviewed at least once by April 11, 2014. Among the 772,979 textual reviews, we chose to focus on four major specialty areas that received the most reviews: Internal Medicine, Surgery, Obstetrics/Gynecology and Pediatrics, and Chinese Traditional Medicine. Among the doctors who received reviews from those four medical specialties, two-thirds of them received more than two reviews and in a few extreme cases, some doctors received more than 500 reviews. Across the four major areas, the most popular topics reviewers found were the experience of finding doctors, doctors' technical skills and bedside manner, general appreciation from patients, and description of various symptoms. To the best of our knowledge, our work is the first study using an automated text-mining approach to analyze a large amount of unstructured textual data of Web-based physician reviews in China. Based on our analysis, we found that Chinese reviewers mainly concentrate on a few popular topics. This is consistent with the goal of Chinese online health platforms and demonstrates the health care focus in China's health care system. Our text-mining approach reveals a new research area on how to use big data to help health care providers, health care administrators, and policy makers hear patient voices, target patient concerns, and improve the quality of care in this age of patient-centered care. Also, on the health care consumer side, our text mining technique helps patients make more informed decisions about which specialists to see without reading thousands of reviews, which is simply not feasible. In addition, our comparison analysis of Web-based physician reviews in China and the United States also indicates some cultural differences.

Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle.

PubMed

Tong, Seng Fah; Low, Wah Yun; Ismail, Shaiful Bahari; Trevena, Lyndal; Willcock, Simon

2011-05-12

Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour. A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview. The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia. The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.

Improving preparedness of medical students and junior doctors to manage patients with diabetes.

PubMed

Kelly, Narcie A A; Brandom, Kevin G; Mattick, Karen L

2015-01-01

New medical graduates are the front-line staff in many hospital settings and manage patients with diabetes frequently. Prescribing is an area of concern for junior doctors, however, with insulin prescribing reported as a particular weakness. This study aimed to produce an educational intervention which aimed to improve preparedness to manage patients with diabetes and evaluate it using a mixed methods approach. An e-resource (http://www.diabetesscenariosforjuniordoctors.co.uk) was created to contain commonplace and authentic diabetes decision-making scenarios. -32 junior doctors (n=20) and year 5 students (n=12) in South West England worked through the scenarios while 'thinking aloud' and then undertook a semistructured interview. Qualitative data were transcribed verbatim and analyzed thematically. Participant confidence to manage patients with diabetes before, immediately after, and 6 weeks after the educational intervention was also measured using a self-rating scale. Participants reported that patients with diabetes were daunting to manage because of the wide array of insulin products, their lack of confidence with chronic disease management and the difficulty of applying theory to practice. The e-resource was described as authentic, practical, and appropriate for the target audience. Junior doctors' self-rated confidence to manage patients with diabetes increased from 4.7 (of 10) before using the e-resource, to 6.4 immediately afterwards, and 6.8 6 weeks later. Medical students' confidence increased from 5.1 before, to 6.4 immediately afterwards, and 6.4 6 weeks later. Providing opportunities to work with authentic scenarios in a safe environment can help to ameliorate junior doctors' lack of confidence to manage patients with diabetes.

Repetition blindness has a perceptual locus: evidence from online processing of targets in RSVP streams

NASA Technical Reports Server (NTRS)

Johnston, James C.; Hochhaus, Larry; Ruthruff, Eric

2002-01-01

Four experiments tested whether repetition blindness (RB; reduced accuracy reporting repetitions of briefly displayed items) is a perceptual or a memory-recall phenomenon. RB was measured in rapid serial visual presentation (RSVP) streams, with the task altered to reduce memory demands. In Experiment 1 only the number of targets (1 vs. 2) was reported, eliminating the need to remember target identities. Experiment 2 segregated repeated and nonrepeated targets into separate blocks to reduce bias against repeated targets. Experiments 3 and 4 required immediate "online" buttonpress responses to targets as they occurred. All 4 experiments showed very strong RB. Furthermore, the online response data showed clearly that the 2nd of the repeated targets is the one missed. The present results show that in the RSVP paradigm, RB occurs online during initial stimulus encoding and decision making. The authors argue that RB is indeed a perceptual phenomenon.

Why Do We Miss Rare Targets? Exploring the Boundaries of the Low Prevalence Effect

DTIC Science & Technology

2008-11-24

effect of prevalence ( F (1,8) = 34.2, p G 0.001, partial eta2 = 0.81), but no effect of set size ( F (1,8) G 1 , n.s.) and no interaction ( F (1,8) G 1 , n.s...Figure 2d; for Prevalence, Target Presence, and all interaction terms, F (1,8) G 1 , n.s.; for Set Size, F (1,8) = 1.7, p 9 0.2). What hints can we get... 1 , n.s.), and no interaction ( F (1,14) G 1 , n.s.). There were insufficient errors on target-absent trials for analysis. An analysis by RT quartile

A prospective study: current problems in radiotherapy for nasopharyngeal carcinoma in yogyakarta, indonesia.

PubMed

Stoker, Sharon D; Wildeman, Maarten A; Fles, Renske; Indrasari, Sagung R; Herdini, Camelia; Wildeman, Pieter L; van Diessen, Judi N A; Tjokronagoro, Maesadji; Tan, I Bing

2014-01-01

Nasopharyngeal carcinoma (NPC) has a high incidence in Indonesia. Previous study in Yogyakarta revealed a complete response of 29% and a median overall survival of less than 2 years. These poor treatment outcome are influenced by the long diagnose-to-treatment interval to radiotherapy (DTI) and the extended overall treatment time of radiotherapy (OTT). This study reveals insight why the OTT and DTI are prolonged. All patients treated with curative intent radiotherapy for NPC between July 2011 until October 2012 were included. During radiotherapy a daily diary was kept, containing information on DTI, missed radiotherapy days, the reason for missing and length of OTT. Sixty-eight patients were included. The median DTI was 106 days (95% CI: 98-170). Fifty-nine patients (87%) finished the treatment. The median OTT for radiotherapy was 57 days (95% CI: 57-65). The main reason for missing days was an inoperative radiotherapy machine (36%). Other reasons were patient's poor condition (21%), public holidays (14%), adjustment of the radiation field (7%), power blackout (3%), inoperative treatment planning system (2%) and patient related reasons (9%). Patient's insurance type was correlated to DTI in disadvantage for poor people. Yogyakarta has a lack of sufficient radiotherapy units which causes a delay of 3-4 months, besides the OTT is extended by 10-12 days. This influences treatment outcome to a great extend. The best solution would be creating sufficient radiotherapy units and better management in health care for poor patients. The growing economy in Indonesia will expectantly in time enable these solutions, but in the meantime solutions are needed. Solutions can consist of radiation outside office hours, better maintenance of the facilities and more effort from patient, doctor and nurse to finish treatment in time. These results are valuable when improving cancer care in low and middle income countries.

Is there just one lesion? The need for whole body skin examination in patients presenting with non-melanocytic skin cancer.

PubMed

Terrill, Patricia Jane; Fairbanks, Sian; Bailey, Michael

2009-10-01

In patients presenting with non-melanoma skin cancer (NMSC) the frequency of concurrently presenting tumours is poorly documented. Whole body skin examination is recommended but in a recent survey of Australian General Practitioners and skin cancer clinics doctors it was infrequently performed. The aim of this study was to examine the incidence of concurrent skin cancer at initial presentation and therefore to examine the need for whole body skin examination for NMSC presentations. One hundred consecutive patients with a referral diagnosis indicative of NMSC were examined. Data was analysed as to the referring doctor's diagnosis, whole body skin examination findings and histology of excised lesions. Epidemiological data was obtained by patient questionnaire. One hundred patients, 41 males and 59 females, with a mean age of 70 years (range 39-91 years) underwent whole body skin examination. Sixty-seven per cent of patients were found to have additional lesions requiring treatment, 46% sin cancers (30 patients basal cell carcinomas, five squamous cell carcinomas, seven basal and squamous cell carcinomas, two lentigo maligna, two adenexal tumours) and 21% solar keratoses. Thirty-four of the additional lesions detected were in areas covered by clothing. Sixty-eight patients had a past history of skin cancer excision. In the Australian patient population, the need for whole body skin examination is essential to avoid missing concurrent lesions. Ongoing surveillance is also essential as these patients have a high risk of developing future NMSC.

The importance of prostate bed tilt during postprostatectomy intensity-modulated radiotherapy

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

Bell, Linda J., E-mail: Linda.Bell1@health.nsw.gov.au; Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales; Cox, Jennifer

2014-10-01

Variations in rectal and bladder filling can create a tilt of the prostate bed, which generates the potential for a geographic miss during postprostatectomy radiotherapy. The aim of this study is to assess the effect that bladder and rectum filling has on planning target volume angle, to determine a method to assess prostate bed tilt leading to potential geographic miss, and to discuss possible implementation issues. The cone-beam computed tomography images (n = 377) of 40 patients who received postprostatectomy radiotherapy with intensity-modulated radiotherapy were reviewed. The amount of tilt in the prostate bed was defined as the angle changemore » between 2 surgical clips, one in the upper prostate bed and another in the lower. A potential geographic miss was defined as movement of any clip of more than 1 cm in any direction or 0.5 cm posteriorly when aligned to bone anatomy. Variations in bladder and rectum size were correlated with the degree of prostate bed tilt, and the rate of potential geographic miss was determined. A possible clinical use of prostate bed tilt was then assessed for different imaging techniques. A tilt of more than 10° was seen in 20.2% of images, which resulted in a 57.9% geographic miss rate of the superior clip. When tilt remained within 10°, there was only a 9% rate of geographic miss. Potential geographic miss of the inferior surgical clip was rare, occurring in only 1.9% of all images reviewed. The most common occurrence when the prostate bed tilt increased by more than 10° was a smaller bladder and larger rectum (6.4% of all images). The most common occurrence when the prostate bed tilt decreased by more than 10° was a larger bladder and smaller rectum (1.3% of all images). Significant prostate bed tilt (>± 10°) occurred in more than 20% of images, creating a 58% rate of geographic miss. Greatest prostate bed tilt occurred when the bladder size increased or reduced by more than 2 cm or the superior rectum size increased by more than 1.5 cm or reduced by more than 1 cm from the planned size. Using prostate bed tilt could be an effective measurement for assessing potential geographic miss on orthogonal images if volumetric imaging is unavailable.« less

Missed hepatitis b/c or syphilis diagnosis among Kurdish, Russian, and Somali origin migrants in Finland: linking a population-based survey to the national infectious disease register.

PubMed

Tiittala, Paula; Ristola, Matti; Liitsola, Kirsi; Ollgren, Jukka; Koponen, Päivikki; Surcel, Heljä-Marja; Hiltunen-Back, Eija; Davidkin, Irja; Kivelä, Pia

2018-03-20

Migrants are considered a key population at risk for sexually transmitted and blood-borne diseases in Europe. Prevalence data to support the design of infectious diseases screening protocols are scarce. We aimed to estimate the prevalence of hepatitis B and C, human immunodefiency virus (HIV) infection and syphilis in specific migrant groups in Finland and to assess risk factors for missed diagnosis. A random sample of 3000 Kurdish, Russian, or Somali origin migrants in Finland was invited to a migrant population-based health interview and examination survey during 2010-2012. Participants in the health examination were offered screening for hepatitis B and C, HIV and syphilis. Notification prevalence in the National Infectious Diseases Register (NIDR) was compared between participants and non-participants to assess non-participation. Missed diagnosis was defined as test-positive case in the survey without previous notification in NIDR. Inverse probability weighting was used to correct for non-participation. Altogether 1000 migrants were screened for infectious diseases. No difference in the notification prevalence among participants and non-participants was observed. Seroprevalence of hepatitis B surface antigen (HBsAg) was 2.3%, hepatitis C antibodies 1.7%, and Treponema pallidum antibodies 1.3%. No cases of HIV were identified. Of all test-positive cases, 61% (34/56) had no previous notification in NIDR. 48% of HBsAg, 62.5% of anti-HCV and 84.6% of anti-Trpa positive cases had been missed. Among the Somali population (n = 261), prevalence of missed hepatitis B diagnosis was 3.0%. Of the 324 Russian migrants, 3.0% had not been previously diagnosed with hepatitis C and 2.4% had a missed syphilis diagnosis. In multivariable regression model missed diagnosis was associated with migrant origin, living alone, poor self-perceived health, daily smoking, and previous diagnosis of another blood-borne infection. More than half of chronic hepatitis and syphilis diagnoses had been missed among migrants in Finland. Undiagnosed hepatitis B among Somali migrants implies post-migration transmission that could be prevented by enhanced screening and vaccinations. Rate of missed diagnoses among Russian migrants supports implementation of targeted hepatitis and syphilis screening upon arrival and also in later health care contacts. Coverage and up-take of current screening among migrants should be evaluated.

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

Williamson, Casey W.; Green, Garrett; Noticewala, Sonal S.

Purpose: Validated models are needed to justify strategies to define planning target volumes (PTVs) for intact cervical cancer used in clinical practice. Our objective was to independently validate a previously published shape model, using data collected prospectively from clinical trials. Methods and Materials: We analyzed 42 patients with intact cervical cancer treated with daily fractionated pelvic intensity modulated radiation therapy and concurrent chemotherapy in one of 2 prospective clinical trials. We collected online cone beam computed tomography (CBCT) scans before each fraction. Clinical target volume (CTV) structures from the planning computed tomography scan were cast onto each CBCT scan aftermore » rigid registration and manually redrawn to account for organ motion and deformation. We applied the 95% isodose cloud from the planning computed tomography scan to each CBCT scan and computed any CTV outside the 95% isodose cloud. The primary aim was to determine the proportion of CTVs that were encompassed within the 95% isodose volume. A 1-sample t test was used to test the hypothesis that the probability of complete coverage was different from 95%. We used mixed-effects logistic regression to assess effects of time and patient variability. Results: The 95% isodose line completely encompassed 92.3% of all CTVs (95% confidence interval, 88.3%-96.4%), not significantly different from the 95% probability anticipated a priori (P=.19). The overall proportion of missed CTVs was small: the grand mean of covered CTVs was 99.9%, and 95.2% of misses were located in the anterior body of the uterus. Time did not affect coverage probability (P=.71). Conclusions: With the clinical implementation of a previously proposed PTV definition strategy based on a shape model for intact cervical cancer, the probability of CTV coverage was high and the volume of CTV missed was low. This PTV expansion strategy is acceptable for clinical trials and practice; however, we recommend daily image guidance to avoid systematic large misses in select patients.« less

Enhancement of tracking performance in electro-optical system based on servo control algorithm

NASA Astrophysics Data System (ADS)

Choi, WooJin; Kim, SungSu; Jung, DaeYoon; Seo, HyoungKyu

2017-10-01

Modern electro-optical surveillance and reconnaissance systems require tracking capability to get exact images of target or to accurately direct the line of sight to target which is moving or still. This leads to the tracking system composed of image based tracking algorithm and servo control algorithm. In this study, we focus on the servo control function to minimize the overshoot in the tracking motion and do not miss the target. The scheme is to limit acceleration and velocity parameters in the tracking controller, depending on the target state information in the image. We implement the proposed techniques by creating a system model of DIRCM and simulate the same environment, validate the performance on the actual equipment.

Health literacy, source of information and impact on adherence to therapy in people living with HIV

PubMed Central

Ernst Dorner, Thomas; Schulte-Hermann, Kathrin; Zanini, Matteo; Leichsenring, Birgit; Stefanek, Wiltrut

2014-01-01

Introduction Adequate information and health literacy (HL) has a high impact on patients understanding on the causes and consequences of many chronic diseases, including HIV, and is a crucial prerequisite to ensure adherence to therapy regimens. Several Austrian patient organizations developed an online survey together with MSD (the so-called “PAB-test”) aimed to evaluate how people living with HIV perceive the level of care in Austria. Materials and Methods An online survey has been developed to assess HL in people living with HIV and to evaluate the impact of HL on therapy adherence. HL was assessed with seven items regarding the self-rated comprehension of HIV related information, which showed a high reliability (Cronbach's alpha=0.876). A low health literacy was defined by reaching a score below the median of 20 points in the related indicator. Results A total of 303 subjects completed the questionnaire. Women slightly had more often a low HL than men (57.1% vs 44.7%, p=0.335). Heterosexual subjects had more often a low HL compared to homosexual ones (58.3% vs 38.1%, p=0.007). Health literacy slightly increased with age (not significant). An increasing education level correlated with higher HL, (66.7%, 46.2%, and 38.9% of persons showed low HL with primary, secondary and tertiary education, respectively, p=0.037). The number of missed appointments with the HIV physician was significantly higher in the low HL population (30.0% vs 14.4%, p=0.002), which also showed to be more prone to interrupt the therapy without consulting a physician (22.4% vs 9.8%, p=0.006). The low HL population, however, did not report of having forgotten the medication intake more often than the one with high HL (33.1% vs 39.1%, p=0.305). The most important source of information is the treating physician, followed by NGOs/patient organizations and the internet (Figure 1). Conclusions There are significant differences in HL between different sub-groups in the HIV community. Low HL is significantly associated with a higher frequency of missed doctor appointments and interruptions of treatment, but does not impact adherence to therapy (self-reported). The identified information providers (medical doctors, NGOs/patient organizations) should be encouraged to contribute towards increased HL in HIV patients. PMID:25394103

'Why don't they ever call?' Expectations of clinicians and pathologists regarding the communication of critical diagnoses in dermatopathology.

PubMed

Korbl, Jasmin Dvorah; Wood, Benjamin Andrew; Harvey, Nathan Tobias

2018-04-01

Certain diagnoses in dermatopathology have significant implications for patient management and on occasion appropriate clinical care may be facilitated by a phone call from the reporting dermatopathologist to the referring doctor. Whether this is appropriate depends on a number of factors. The concept of 'critical diagnoses' is now well established in surgical pathology, having evolved from critical value policies in clinical pathology and haematology. However, only limited attempts have been made to assess perceptions among different clinical groups. We designed a survey to assess the attitudes of pathologists, dermatologists, surgeons and general practitioners as to what circumstances warrant telephone contact in addition to a standard written report, as well as their approaches to routine histology follow-up. The survey was distributed Australia-wide via a combination of specialist colleges, medical forums and collegiate contacts. A total of 262 responses were received, encompassing representations from all of the targeted specialties. Approximately 20% of respondents were aware of adverse outcomes or 'near misses' which they felt had been due in some part to inadequate communication of histopathology results. While most practitioners have formal systems in place to review histopathology reports, this practice is not universal. There were a number clinical situations where there was a discrepancy between the expectations of clinicians and those of pathologists, in particular with regard to a diagnosis of cutaneous melanoma as well as cutaneous lesions which might be associated with inherited cancer syndromes. It is our hope that the results of this study will facilitate discussion between pathologists and referring clinicians at a local level to minimise the potential for miscommunication. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand

PubMed Central

Munir, Kerim; Kanabkaew, Cheeraya; Le Coeur, Sophie

2017-01-01

Background Existing studies have suggested decreased adherence and rebound in mortality in perinatally HIV-infected adolescents receiving antiretroviral therapy (ART) as compared to adults and young children. Methods We used both quantitative and qualitative approaches to identify factors influencing adherence among perinatally infected adolescents in Thailand. We analyzed data from 568 pairs of perinatally infected adolescents (aged 12–19) and their primary caregivers in the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional survey conducted in 2010–2012. We also conducted 12 in-depth interviews in 2014 with infected adolescents or their primary caregivers to elicit experiences of living with long-term ART. Results From the quantitative analysis, a total of 275 (48.4%) adolescents had evidence of suboptimal adherence based on this composite outcome: adolescents self-reported missing doses in the past 7 days, caregiver rating of overall adherence as suboptimal, or latest HIV-RNA viral load ≥1000 copies/ml. In multivariate logistic regression analysis, younger age, having grandparents or extended family members as the primary caregiver, caregiver-assessed poor intellectual ability, having a boy/girlfriend, frequent online chatting, self-reported unhappiness and easiness in asking doctors questions were significantly associated with suboptimal adherence. From the in-depth interviews, tensed relationships with caregivers, forgetfulness due to busy schedules, and fear of disclosing HIV status to others, especially boy/girlfriends, were important contributors to suboptimal adherence. Social and emotional support and counseling from peer group was consistently reported as a strong adherence-promoting factor. Conclusion Our findings highlight unique barriers of ART adherence among the perinatally infected adolescents. Future interventions should be targeted at helping adolescents to improve interpersonal relationships and build adaptive skills in recognizing and addressing challenging situations related to ART taking. PMID:28207891

The preparation of several 1,2,3,4,5-functionalized cyclopentane derivatives

PubMed Central

Kelch, André S; Jones, Peter G; Dix, Ina

2013-01-01

Summary With the goal of eventually synthesizing [5]radialene (3), the still missing member of the parent radialene hydrocarbons, we have prepared the pentaacetates 21 and 31, the pentabromide 29 and the hexabromide 32. In principle these should be convertible by elimination reactions to the desired target molecule. PMID:24062831

78 FR 11888 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-20

..., emergency department visits, school or work days missed, and limitations on activity due to asthma. The AIRS... implementation in 2010 AIRS, and technical assistance provided by NCEH staff, has provided states with uniform... NCEH asthma program (e.g., how many states have asthma interventions targeting schools, how many...

Who is missing the message? Targeting strategies to increase food label use among US adults

USDA-ARS?s Scientific Manuscript database

Objective: To evaluate the associations between sociodemographic and psychosocial characteristics and food label (FL) use in US adults. Design: The 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey for 2,797 US adults were used. High socioeconomic st...

The Ms. Stereotype Revisited: Implicit and Explicit Facets

ERIC Educational Resources Information Center

Malcolmson, Kelly A.; Sinclair, Lisa

2007-01-01

Implicit and explicit stereotypes toward the title Ms. were examined. Participants read a short description of a target person whose title of address varied (Ms., Mrs., Miss, Mr.). They then rated the person on agentic and communal traits and completed an Implicit Association Test. Replicating earlier research (Dion, 1987), at an explicit level,…

Boot Camps for Charter Boards

ERIC Educational Resources Information Center

Kronholz, June

2015-01-01

This article addresses the question of who owns the responsibility when a charter school gets into trouble--when its students aren't learning, or it misses its enrollment targets, or money runs short, or it closes. Upon presenting this question to a director of a charter school, a board member, and a Massachusetts-based education consultant and…

Distance Learning and the Web: Are Advertising Programs Missing the Target?

ERIC Educational Resources Information Center

Falk, Louis K.; Rehman, Sharaf; Foster, Dawn

1999-01-01

Discusses survey results that examined whether distance education programs at universities offering courses in advertising and/or public relations make use of the Internet/Web pages to inform potential students about courses taught via distance education. The survey and list of Association of Education in Journalism and Mass Communication (AEJMC)…

["Medical Emergency Services as Seen by Consumers". Health services research by CATI survey of the community].

PubMed

Rau, Rüdiger; Mensing, Monika; Brand, Helmut

2006-01-15

In the Wesel district (North Rhine-Westphalia), emergency ambulances have been called out with increasing frequency and hospitals report that their emergency departments (ED) are more and more being used outside consultation hours of panel doctors. Therefore, the district health conference put this issue on its agenda. The aim was to obtain data on the following questions: * What do people do when they need medical help outside consultation hours of panel doctors? * Do people know that there is an on-call duty by panel doctors? Do they know how to contact this service? Do people know the Emergency Medical Service and phone number 112 and the new phone number 19222 for Patient Transport Ambulances? The study population was defined as comprising all residents in the district of Wesel between 18 and 87 years of age (approximately 385,000 people). The sample contained 1,089 persons drawn in accordance with the Gabler-Häder method and in a second step the "birthday method" was used. The survey was carried out by the CATI Laboratory (Computer-Assisted Telephone Interviews) at the Institute of Public Health (lögd, Bielefeld, Germany) between February 18 and March 28, 2002. (1) Being asked: "How would you act in case of a non-life-threatening disease outside consultation hours of panel doctors?", 52.6% of the respondents gave at least one correct answer; 48.6 % of all given answers were "correct" (i. e., on-call duty of Statutory Health Insurance [SHI]-accredited physicians), the others were "incorrect", i. e., "I go to the hospital/emergency department" (24.3%) or "I call the phone number 112" (13%). (2) About 80% of respondents said they heard about the on-call duty of SHI physicians. (3) 95.6% of respondents stated they knew the emergency call of the fire department; 86% of these participants were able to name the correct phone number 112. (4) About 4% of the respondents said they knew the nationwide telephone number for patient transports, and 58% of these respondents mentioned the correct number 19222. A) The tiered medical emergency system should be used adequately; this aim could be attained by (1) information of the public about the "24-h" on-call service of panel doctors; information about the fact that the majority of medical conditions can be treated by panel doctors and that in severe cases a professional and quick referral will be done; information about the fact that self-referral to hospitals may reduce or even obstruct professional resources for the treatment of "real" emergency patients. Target groups are men, younger age groups and people with a higher level of education. (2) information of target groups (elderly people) about the emergency call number 112. (3) information of the public about the national phone number 19222 for patient transports. B) Structural measures such as (1) specific on-call services, (2) improvement of the transparency and reach-ability of panel doctors' on-call services.

Who Seeks "Cita Con El Doctor"? Twelve Years of Spanish-Language Radio Program Targeting U.S. Latinos

ERIC Educational Resources Information Center

Ramirez, A. Susana; Graff, Kaitlin; Nelson, David; Galica, Kasia; Leyva, Bryan; Banegas, Mateo; Huerta, Elmer

2015-01-01

Purpose: Spanish-dominant Latinos make up 13% of the U.S. population, and this group is poorer and faces multiple threats to health compared with the general population. Additionally, Spanish speakers face challenges accessing health information that is often not available in Spanish. This study provides a descriptive epidemiology of a unique,…

Image Retrieval Method for Multiscale Objects from Optical Colonoscopy Images

PubMed Central

Sakanashi, Hidenori; Takahashi, Eiichi; Murakawa, Masahiro; Aoki, Hiroshi; Takeuchi, Ken; Suzuki, Yasuo

2017-01-01

Optical colonoscopy is the most common approach to diagnosing bowel diseases through direct colon and rectum inspections. Periodic optical colonoscopy examinations are particularly important for detecting cancers at early stages while still treatable. However, diagnostic accuracy is highly dependent on both the experience and knowledge of the medical doctor. Moreover, it is extremely difficult, even for specialist doctors, to detect the early stages of cancer when obscured by inflammations of the colonic mucosa due to intractable inflammatory bowel diseases, such as ulcerative colitis. Thus, to assist the UC diagnosis, it is necessary to develop a new technology that can retrieve similar cases of diagnostic target image from cases in the past that stored the diagnosed images with various symptoms of colonic mucosa. In order to assist diagnoses with optical colonoscopy, this paper proposes a retrieval method for colonoscopy images that can cope with multiscale objects. The proposed method can retrieve similar colonoscopy images despite varying visible sizes of the target objects. Through three experiments conducted with real clinical colonoscopy images, we demonstrate that the method is able to retrieve objects of any visible size and any location at a high level of accuracy. PMID:28255295

Image Retrieval Method for Multiscale Objects from Optical Colonoscopy Images.

PubMed

Nosato, Hirokazu; Sakanashi, Hidenori; Takahashi, Eiichi; Murakawa, Masahiro; Aoki, Hiroshi; Takeuchi, Ken; Suzuki, Yasuo

2017-01-01

Optical colonoscopy is the most common approach to diagnosing bowel diseases through direct colon and rectum inspections. Periodic optical colonoscopy examinations are particularly important for detecting cancers at early stages while still treatable. However, diagnostic accuracy is highly dependent on both the experience and knowledge of the medical doctor. Moreover, it is extremely difficult, even for specialist doctors, to detect the early stages of cancer when obscured by inflammations of the colonic mucosa due to intractable inflammatory bowel diseases, such as ulcerative colitis. Thus, to assist the UC diagnosis, it is necessary to develop a new technology that can retrieve similar cases of diagnostic target image from cases in the past that stored the diagnosed images with various symptoms of colonic mucosa. In order to assist diagnoses with optical colonoscopy, this paper proposes a retrieval method for colonoscopy images that can cope with multiscale objects. The proposed method can retrieve similar colonoscopy images despite varying visible sizes of the target objects. Through three experiments conducted with real clinical colonoscopy images, we demonstrate that the method is able to retrieve objects of any visible size and any location at a high level of accuracy.

Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions.

PubMed

Ekstrand, Maria L; Ramakrishna, Jayashree; Bharat, Shalini; Heylen, Elsa

2013-11-13

HIV stigma inflicts hardship and suffering on people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. Health professionals are often named by PLHIV as an important source of stigma. This study was designed to examine rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India. This cross-sectional study enrolled 305 doctors, 369 nurses and 346 ward staff in both governmental and non-governmental healthcare settings in Mumbai and Bengaluru, India. The approximately one-hour long interviews focused on knowledge related to HIV transmission, personal and professional experiences with PLHIV, instrumental and symbolic stigma, endorsement of coercive policies, and intent to discriminate in professional and personal situations that involve high and low risk of fluid exposure. High levels of stigma were reported by all groups. This included a willingness to prohibit female PLHIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs "got what they deserved" (50 to 83%). In addition, 89% of doctors, 88% of nurses and 73% of ward staff stated that they would discriminate against PLHIV in professional situations that involved high likelihood of fluid exposure, and 57% doctors, 40% nurses and 71% ward staff stated that they would do so in low-risk situations as well. Significant and modifiable drivers of stigma and discrimination included having less frequent contact with PLHIV, and a greater number of transmission misconceptions, blame, instrumental and symbolic stigma. Participants in all three groups reported high rates of endorsement of coercive measures and intent to discriminate against PLHIV. Stigma and discrimination were associated with multiple modifiable drivers, which are consistent with previous research, and which need to be targeted in future interventions. Stigma reduction intervention programmes targeting healthcare providers in urban India need to address fear of transmission, improve universal precaution skills, and involve PLHIV at all stages of the intervention to reduce symbolic stigma and ensure that relevant patient interaction skills are taught.

Improving the rates of electronic results acknowledgement at a tertiary eye care centre.

PubMed

Phua, Val; Au, Benjamin; Soh, Yu Qiang; Husain, Rahat

2017-01-01

Hundreds of thousands of tests are performed annually in hospitals worldwide. Safety Issues arise when abnormal results are not recognized promptly resulting in delayed treatment and increased morbidity and mortality. As a result Singapore's largest healthcare group, Singhealth introduced an electronic result acknowledgement system. This system was adopted by the Singapore National Eye Centre (SNEC) in February 2016. Baseline measurements show that weekly numbers of unacknowledged results ranged from 193 to 617. The current standards of electronic results acknowledgement posts a significant patient safety hazard. Root cause analysis was performed to identify contributory factors. Pareto principle was then used by the authors to identify the main contributory factors. We employed the rapid cycle improvement Plan-do-study-act (PDSA) strategy to test and evaluate implemented changes. Changes are implemented for 2 weeks and data collected prospectively. The data is analyzed the week after and the following PDSA actions are decided and instituted the following week. 3 PDSA cycles were undertaken in total. The first PDSA cycle focused on raising awareness of the problem at hand, the number of unacknowledged results drastically decreased during the 1 st week of implementation of our PDSA from 617 to 254. The second PDSA cycle targeted the lack of knowledge of doctors involved in the electronic result acknowledgement process. There was a trend downwards near the end of the cycle which continued through the week after. The third PDSA cycle targeted individual doctors and provided individual remedial training. Second line doctors were also equipped to better handle abnormal results. There was significant improvement with the number of unacknowledged abnormal results dropping to <5 a week. Multiple factors were identified to contribute to the low compliance to electronic acknowledgement of results. The role doctors play in the issue at hand was paramount and required careful handling in a professional manner with multiple reminders and emphasis on the importance of acknowledging and acting on the results.A significant improvement in the rates of acknowledgement of abnormal results was demonstrated with clear benefits to patient safety. Interventions can be replicated when implementing similar systems to other areas of healthcare.

Improving the rates of electronic results acknowledgement at a tertiary eye care centre

PubMed Central

Phua, Val; Au, Benjamin; Soh, Yu Qiang; Husain, Rahat

2017-01-01

Background Hundreds of thousands of tests are performed annually in hospitals worldwide. Safety Issues arise when abnormal results are not recognized promptly resulting in delayed treatment and increased morbidity and mortality. As a result Singapore’s largest healthcare group, Singhealth introduced an electronic result acknowledgement system. This system was adopted by the Singapore National Eye Centre (SNEC) in February 2016. Baseline measurements show that weekly numbers of unacknowledged results ranged from 193 to 617. The current standards of electronic results acknowledgement posts a significant patient safety hazard. Methods Root cause analysis was performed to identify contributory factors. Pareto principle was then used by the authors to identify the main contributory factors. We employed the rapid cycle improvement Plan-do-study-act (PDSA) strategy to test and evaluate implemented changes. Changes are implemented for 2 weeks and data collected prospectively. The data is analyzed the week after and the following PDSA actions are decided and instituted the following week. 3 PDSA cycles were undertaken in total. Results The first PDSA cycle focused on raising awareness of the problem at hand, the number of unacknowledged results drastically decreased during the 1stweek of implementation of our PDSA from 617 to 254. The second PDSA cycle targeted the lack of knowledge of doctors involved in the electronic result acknowledgement process. There was a trend downwards near the end of the cycle which continued through the week after. The third PDSA cycle targeted individual doctors and provided individual remedial training. Second line doctors were also equipped to better handle abnormal results. There was significant improvement with the number of unacknowledged abnormal results dropping to <5 a week. Conclusions Multiple factors were identified to contribute to the low compliance to electronic acknowledgement of results. The role doctors play in the issue at hand was paramount and required careful handling in a professional manner with multiple reminders and emphasis on the importance of acknowledging and acting on the results.A significant improvement in the rates of acknowledgement of abnormal results was demonstrated with clear benefits to patient safety. Interventions can be replicated when implementing similar systems to other areas of healthcare. PMID:29450290

[Implementation of a Plan of Patient Safety in Service of Pediatric Surgery. First results].

PubMed

Paredes Esteban, R M; Garrido Pérez, J I; Ruiz Palomino, A; Guerrero Peña, G; Vázquez Rueda, F; Berenguer García, M J; Miñarro Del Moral, R; Tejedor Fernández, M

2015-07-20

In 2014 our department starts to apply the PatientSafety Strategic in Pediatric Surgery. Our aim is to describe the results obtained. For the measurement of adverse events (AE) we used a modification of the Global Trigger Tool of the Institute for Healthcare Improvement. Population analysed: patients undergoing surgery with hospitalization. On a monthly basis, audits of the medical records of 12 patients discharged in the prior week of the assessment were performed. The evaluation team was composed by experienced pediatric surgeon, two staff nurses, and a doctor and nurse from the Quality Department. 95 clinical records and a total of 406 days of hospital stay were reviewed. 31 patients (32.6%) experienced one or more AE. Total AE: 43. The AE/1000 patients/day ratio: 105.9. The most common AE were: vomiting, itching and pain. 28 EA were considerd mild and 3 moderate in severity, according to the classification of the National Coordinating Council for Medication Error Reporting and Prevention. No EA were considered serious or critical. The analysis of prevalence through regular assessments of medical records is an easy method to obtain information about the frequency of occurrence, exact understanding of the AE types and the implementation of corrective measures. The main limitation of this method is that it can miss some of the serious EA and miss the records and analysis of sentinel events that may occur in the period between assessments.

Barriers to ART adherence & follow ups among patients attending ART centres in Maharashtra, India.

PubMed

Joglekar, N; Paranjape, R; Jain, R; Rahane, G; Potdar, R; Reddy, K S; Sahay, S

2011-12-01

Adherence to ART is a patient specific issue influenced by a variety of situations that a patient may encounter, especially in resource-limited settings. A study was conducted to understand factors and influencers of adherence to ART and their follow ups among patients attending ART centres in Maharashtra, India. Between January and March 2009, barriers to ART adherence among 32 patients at three selected ART centres functioning under national ART roll-out programme in Maharashtra, India, were studied using qualitative methods. Consenting patients were interviewed to assess barriers to ART adherence. Constant comparison method was used to identify grounded codes. Patients reported multiple barriers to ART adherence and follow up as (i) Financial barriers where the contributing factors were unemployment, economic dependency, and debt, (ii) social norm of attending family rituals, and fulfilling social obligations emerged as socio-cultural barriers, (iii) patients' belief, attitude and behaviour towards medication and self-perceived stigma were the reasons for sub-optimal adherence, and (iv) long waiting period, doctor-patient relationship and less time devoted in counselling at the center contributed to missed visits. Mainstreaming ART can facilitate access and address 'missed doses' due to travel and migration. A 'morning' and 'evening' ART centre/s hours may reduce work absenteeism and help in time management. Proactive 'adherence probing' and probing on internalized stigma might optimize adherence. Adherence probing to prevent transitioning to suboptimal adherence among patients stable on ART is recommended.

A drug from poison: how the therapeutic effect of arsenic trioxide on acute promyelocytic leukemia was discovered.

PubMed

Rao, Yi; Li, Runhong; Zhang, Daqing

2013-06-01

It is surprising that, while arsenic trioxide (ATO) is now considered as "the single most active agent in patients with acute promyelocytic leukemia (APL)", the most important discoverer remains obscure and his original papers have not been cited by a single English paper. The discovery was made during the Cultural Revolution when most Chinese scientists and doctors struggled to survive. Beginning with recipes from a countryside practitioner that were vague in applicable diseases, Zhang TingDong and colleagues proposed in the 1970s that a single chemical in the recipe is most effective and that its target is APL. More than 20 years of work by Zhang and colleagues eliminated the confusions about whether and how ATO can be used effectively. Other researchers, first in China and then in the West, followed his lead. Retrospective analysis of data from his own group proved that APL was indeed the most sensitive target. Removal of a trace amount of mercury chloride from the recipe by another group in his hospital proved that only ATO was required. Publication of Western replication in 1998 made the therapy widely accepted, though neither Western, nor Chinese authors of English papers on ATO cited Zhang's papers in the 1970s. This article focuses on the early papers of Zhang, but also suggests it worth further work to validate Chinese reports of ATO treatment of other cancers, and infers that some findings published in Chinese journals are of considerable value to patients and that doctors from other countries can benefit from the clinical experience of Chinese doctors with the largest population of patients.

Hepatitis B testing among Vietnamese American men.

PubMed

Taylor, Victoria M; Yasui, Yutaka; Burke, Nancy; Nguyen, Tung; Chen, Anthony; Acorda, Elizabeth; Choe, John H; Jackson, J Carey

2004-01-01

Vietnamese American men are over 10 times more likely to be diagnosed with liver cancer than their white counterparts. This health disparity is attributable to high rates of hepatitis B virus (HBV) infection. Our study objective was to examine factors associated with HBV testing among Vietnamese men. A population-based survey was conducted in Seattle. The questionnaire content was guided by an earlier qualitative study and the Health Behavior Framework. The survey was completed by 345 men (response rate: 80%). About one-third (34%) of the respondents reported they had not been tested for HBV. The following factors were associated (P < 0.01) with previous testing in bivariate comparisons: having a regular source of care and regular provider; knowing that HBV can be spread during childbirth; believing HBV can cause liver cancer; and doctor(s) had recommended testing as well as had asked doctor(s) for testing. Three variables were independently associated with HBV testing in a logistic regression model: regular source of care (OR = 4.5; 95% CI = 2.6-7.9), physician recommendation (OR = 2.3, 95% CI = 1.3-4.0), and knowing HBV can be spread during childbirth (OR = 2.1; 95% CI = 1.2-3.9). Low levels of HBV testing remain a public health problem in some Vietnamese American sub-groups. Health education about HBV transmission may stimulate patients to seek testing. Intervention programs should specifically target Vietnamese men without a regular source of health care and physicians who serve Vietnamese communities.

A missed primary care appointment correlates with a subsequent emergency department visit among children with asthma.

PubMed

McGovern, Colleen Marie; Redmond, Margaret; Arcoleo, Kimberly; Stukus, David R

2017-11-01

Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits. Longitudinal, retrospective review at a children's hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2-18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted. None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ 2 = 64.28, p <.0001). Males were significantly more likely to have an ED visit following a missed PC appointment than females (χ 2 = 34.37, p <.0001). There was a statistically significant interaction of sex × age. Younger children (<12 years) made more visits than older children. The importance of adherence to PC appointments for children with asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs.

Age-Related Differences in Working Memory Performance in A 2-Back Task

PubMed Central

Wild-Wall, Nele; Falkenstein, Michael; Gajewski, Patrick D.

2011-01-01

The present study aimed to elucidate the neuro-cognitive processes underlying age-related differences in working memory. Young and middle-aged participants performed a two-choice task with low and a 2-back task with high working memory load. The P300, an event-related potential reflecting controlled stimulus–response processing in working memory, and the underlying neuronal sources of expected age-related differences were analyzed using sLORETA. Response speed was generally slower for the middle-aged than the young group. Under low working memory load the middle-aged participants traded speed for accuracy. The middle-aged were less efficient in the 2-back task as they responded slower while the error rates did not differ for groups. An age-related decline of the P300 amplitude and characteristic topographical differences were especially evident in the 2-back task. A more detailed analysis of the P300 in non-target trials revealed that amplitudes in the young but not middle-aged group differentiate between correctly detected vs. missed targets in the following trial. For these trials, source analysis revealed higher activation for the young vs. middle-aged group in brain areas which support working memory processes. The relationship between P300 and overt performance was validated by significant correlations. To sum up, under high working memory load the young group showed an increased neuronal activity before a successful detected target, while the middle-aged group showed the same neuronal pattern regardless of whether a subsequent target will be detected or missed. This stable memory trace before detected targets was reflected by a specific activation enhancement in brain areas which orchestrate maintenance, update, storage, and retrieval of information in working memory. PMID:21909328

Targeting safety improvements through identification of incident origination and detection in a near-miss incident learning system.

PubMed

Novak, Avrey; Nyflot, Matthew J; Ermoian, Ralph P; Jordan, Loucille E; Sponseller, Patricia A; Kane, Gabrielle M; Ford, Eric C; Zeng, Jing

2016-05-01

Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically during the documentation of patient positioning and localization of the patient. Incidents were most frequently detected during treatment delivery (30%), and incidents identified at this point also had higher severity scores than other workflow areas (NMRI = 1.6). Incidents identified during on-treatment quality management were also more severe (NMRI = 1.7), and the specific process steps of reviewing portal and CBCT images tended to catch highest-severity incidents. On average, safety barriers caught 46% of all incidents, most frequently at physics chart review, therapist's chart check, and the review of portal images; however, most of the incidents that pass through a particular safety barrier are not designed to be capable of being captured at that barrier. Incident learning systems can be used to assess the most common points of error origination and detection in radiation oncology. This can help tailor safety improvement efforts and target the highest impact portions of the workflow. The most severe near-miss events tend to originate during simulation, with the most severe near-miss events detected at the time of patient treatment. Safety barriers can be improved to allow earlier detection of near-miss events.

Thinking styles and doctors' knowledge and behaviours relating to acute coronary syndromes guidelines

PubMed Central

Sladek, Ruth M; Bond, Malcolm J; Huynh, Luan T; Chew, Derek PB; Phillips, Paddy A

2008-01-01

Background How humans think and make decisions is important in understanding behaviour. Hence an understanding of cognitive processes among physicians may inform our understanding of behaviour in relation to evidence implementation strategies. A personality theory, Cognitive-Experiential Self Theory (CEST) proposes a relationship between different ways of thinking and behaviour, and articulates pathways for behaviour change. However prior to the empirical testing of interventions based on CEST, it is first necessary to demonstrate its suitability among a sample of healthcare workers. Objectives To investigate the relationship between thinking styles and the knowledge and clinical practices of doctors directly involved in the management of acute coronary syndromes. Methods Self-reported doctors' thinking styles (N = 74) were correlated with results from a survey investigating knowledge, attitudes, and clinical practice, and evaluated against recently published acute coronary syndrome clinical guidelines. Results Guideline-discordant practice was associated with an experiential style of thinking. Conversely, guideline-concordant practice was associated with a higher preference for a rational style of reasoning. Conclusion Findings support that while guidelines might be necessary to communicate evidence, other strategies may be necessary to target discordant behaviours. Further research designed to examine the relationships found in the current study is required. PMID:18439250

The development and evaluation of mini-GEMs - short, focused, online e-learning videos in geriatric medicine.

PubMed

Garside, Mark J; Fisher, James M; Blundell, Adrian G; Gordon, Adam L

2018-01-01

Mini Geriatric E-Learning Modules (Mini-GEMs) are short, focused, e-learning videos on geriatric medicine topics, hosted on YouTube, which are targeted at junior doctors working with older people. This study aimed to explore how these resources are accessed and used. The authors analyzed the viewing data from 22 videos published over the first 18 months of the Mini-GEM project. We conducted a focus group of U.K. junior doctors considering their experiences with Mini-GEMS. The Mini-GEMs were viewed 10,291 times over 18 months, equating to 38,435 minutes of total viewing time. The average viewing time for each video was 3.85 minutes. Learners valued the brevity and focused nature of the Mini-GEMs and reported that they watched them in a variety of settings to supplement clinical experiences and consolidate learning. Watching the videos led to an increase in self-reported confidence in managing older patients. Mini-GEMs can effectively disseminate clinical teaching material to a wide audience. The videos are valued by junior doctors due to their accessibility and ease of use.

The Voice of Chinese Health Consumers: A Text Mining Approach to Web-Based Physician Reviews

PubMed Central

Zhang, Kunpeng

2016-01-01

Background Many Web-based health care platforms allow patients to evaluate physicians by posting open-end textual reviews based on their experiences. These reviews are helpful resources for other patients to choose high-quality doctors, especially in countries like China where no doctor referral systems exist. Analyzing such a large amount of user-generated content to understand the voice of health consumers has attracted much attention from health care providers and health care researchers. Objective The aim of this paper is to automatically extract hidden topics from Web-based physician reviews using text-mining techniques to examine what Chinese patients have said about their doctors and whether these topics differ across various specialties. This knowledge will help health care consumers, providers, and researchers better understand this information. Methods We conducted two-fold analyses on the data collected from the “Good Doctor Online” platform, the largest online health community in China. First, we explored all reviews from 2006-2014 using descriptive statistics. Second, we applied the well-known topic extraction algorithm Latent Dirichlet Allocation to more than 500,000 textual reviews from over 75,000 Chinese doctors across four major specialty areas to understand what Chinese health consumers said online about their doctor visits. Results On the “Good Doctor Online” platform, 112,873 out of 314,624 doctors had been reviewed at least once by April 11, 2014. Among the 772,979 textual reviews, we chose to focus on four major specialty areas that received the most reviews: Internal Medicine, Surgery, Obstetrics/Gynecology and Pediatrics, and Chinese Traditional Medicine. Among the doctors who received reviews from those four medical specialties, two-thirds of them received more than two reviews and in a few extreme cases, some doctors received more than 500 reviews. Across the four major areas, the most popular topics reviewers found were the experience of finding doctors, doctors’ technical skills and bedside manner, general appreciation from patients, and description of various symptoms. Conclusions To the best of our knowledge, our work is the first study using an automated text-mining approach to analyze a large amount of unstructured textual data of Web-based physician reviews in China. Based on our analysis, we found that Chinese reviewers mainly concentrate on a few popular topics. This is consistent with the goal of Chinese online health platforms and demonstrates the health care focus in China’s health care system. Our text-mining approach reveals a new research area on how to use big data to help health care providers, health care administrators, and policy makers hear patient voices, target patient concerns, and improve the quality of care in this age of patient-centered care. Also, on the health care consumer side, our text mining technique helps patients make more informed decisions about which specialists to see without reading thousands of reviews, which is simply not feasible. In addition, our comparison analysis of Web-based physician reviews in China and the United States also indicates some cultural differences. PMID:27165558

Bullying and sexual harassment of junior doctors in New South Wales, Australia: rate and reporting outcomes.

PubMed

Llewellyn, Anthony; Karageorge, Aspasia; Nash, Louise; Li, Wenlong; Neuen, Dennis

2018-02-16

Objective The aim of this study was to describe rates of exposure to bullying and sexual harassment in junior doctors in first- or second-year prevocational medical training (PGY1 or PGY2 respectively) positions in New South Wales (NSW) and the Australian Capital Territory (ACT), and to explore the types of actions taken in response. Methods A cross-sectional survey of junior doctors in PGY1 or PGY2 positions was undertaken in 2015 and 2016 (n=374 and 440 respectively). Thematic analysis was undertaken on free-text responses to describe the reporting process and outcomes in more depth. Results The estimated response rate was 17-20%. Results from both surveys followed almost identical trends. Most respondents in 2015 and 2016 reported being bullied (n=203 (54.3%) and 253 (57.5%) respectively), 16-19% reported sexual harassment (n=58 and 82 respectively) and 29% of females reported sexual harassment. Qualitative analysis elucidated reasons for not taking action in response to bullying and harassment, including workplace normalisation of these behaviours, fear of reprisal and lack of knowledge or confidence in the reporting process. For respondents who did take action, most reported ineffective or personally harmful outcomes when reporting to senior colleagues, including being dismissed or blamed, and an intention not to trust the process in the future. Conclusions The findings suggest that interventions targeted at the level of junior doctors to improve the culture of bullying and harassment in medicine are unlikely to be helpful. Different approaches that address the problem in a more systemic way are needed, as is further research about the effectiveness of such interventions. What is known about the topic? Bullying and sexual harassment are common workplace experiences in the medical profession. What does this paper add? Over half the junior doctors in the present study experienced bullying and nearly one-fifth experienced sexual harassment. Junior doctors are reluctant to speak out, not only for fear of reprisal, but also because they do not believe it is worth doing so. What are the implications for practitioners? The data confirm a systemic problem of bullying in NSW. Primarily focusing on interventions with junior doctors (e.g. resilience training) is unlikely to solve the problem. Different and multipronged approaches (e.g. raising awareness in senior colleagues and training bystanders to intervene) should be tried and studied.

Upgraded automotive gas turbine engine design and development program, volume 2

NASA Technical Reports Server (NTRS)

Wagner, C. E. (Editor); Pampreen, R. C. (Editor)

1979-01-01

Results are presented for the design and development of an upgraded engine. The design incorporated technology advancements which resulted from development testing on the Baseline Engine. The final engine performance with all retro-fitted components from the development program showed a value of 91 HP at design speed in contrast to the design value of 104 HP. The design speed SFC was 0.53 versus the goal value of 0.44. The miss in power was primarily due to missing the efficiency targets of small size turbomachinery. Most of the SFC deficit was attributed to missed goals in the heat recovery system relative to regenerator effectiveness and expected values of heat loss. Vehicular fuel consumption, as measured on a chassis dynamometer, for a vehicle inertia weight of 3500 lbs., was 15 MPG for combined urban and highway driving cycles. The baseline engine achieved 8 MPG with a 4500 lb. vehicle. Even though the goal of 18.3 MPG was not achieved with the upgraded engine, there was an improvement in fuel economy of 46% over the baseline engine, for comparable vehicle inertia weight.

1.688 g/cm(3) satellite-related repeats: a missing link to dosage compensation and speciation.

PubMed

Gallach, Miguel

2015-09-01

Despite the important progress that has been made on dosage compensation (DC), a critical link in our understanding of the X chromosome recognition mechanisms is still missing. Recent studies in Drosophila indicate that the missing link could be a family of DNA repeats populating the euchromatin of the X chromosome. In this opinion article, I discuss how these findings add a new fresh twist on the DC problem. In the following sections, I first summarize our understanding of DC in Drosophila and integrate these recent discoveries into our knowledge of the X chromosome recognition problem. Next, I introduce a model according to which, 1.688 g/cm(3) satellite-related (SR) repeats would be the primary recognition elements for the dosage compensation complex. Contrary to the current belief, I suggest that the DC system in Drosophila is not conserved and static, but it is continuously co-evolving with the target SR repeats. The potential role of the SR repeats in hybrid incompatibilities and speciation is also discussed. © 2015 John Wiley & Sons Ltd.

Covariate Selection for Multilevel Models with Missing Data

PubMed Central

Marino, Miguel; Buxton, Orfeu M.; Li, Yi

2017-01-01

Missing covariate data hampers variable selection in multilevel regression settings. Current variable selection techniques for multiply-imputed data commonly address missingness in the predictors through list-wise deletion and stepwise-selection methods which are problematic. Moreover, most variable selection methods are developed for independent linear regression models and do not accommodate multilevel mixed effects regression models with incomplete covariate data. We develop a novel methodology that is able to perform covariate selection across multiply-imputed data for multilevel random effects models when missing data is present. Specifically, we propose to stack the multiply-imputed data sets from a multiple imputation procedure and to apply a group variable selection procedure through group lasso regularization to assess the overall impact of each predictor on the outcome across the imputed data sets. Simulations confirm the advantageous performance of the proposed method compared with the competing methods. We applied the method to reanalyze the Healthy Directions-Small Business cancer prevention study, which evaluated a behavioral intervention program targeting multiple risk-related behaviors in a working-class, multi-ethnic population. PMID:28239457

Exploring What's Missing: What Do Target Absent Trials Reveal about Autism Search Superiority?

ERIC Educational Resources Information Center

Keehn, Brandon; Joseph, Robert M.

2016-01-01

We used eye-tracking to investigate the roles of enhanced discrimination and peripheral selection in superior visual search in autism spectrum disorder (ASD). Children with ASD were faster at visual search than their typically developing peers. However, group differences in performance and eye-movements did not vary with the level of difficulty of…

Automatic Annotation Method on Learners' Opinions in Case Method Discussion

ERIC Educational Resources Information Center

Samejima, Masaki; Hisakane, Daichi; Komoda, Norihisa

2015-01-01

Purpose: The purpose of this paper is to annotate an attribute of a problem, a solution or no annotation on learners' opinions automatically for supporting the learners' discussion without a facilitator. The case method aims at discussing problems and solutions in a target case. However, the learners miss discussing some of problems and solutions.…

Missing the target: DNAk is a dominant epitope in the humoral immune response of channel catfish (Ictalurus punctatus) to Flavobacterium columnare

USDA-ARS?s Scientific Manuscript database

Vaccination remains a viable alternative for bacterial disease protection in fish; however additional work is required to understand the mechanisms of adaptive immunity in the channel catfish. To assess the humoral immune response to Flavobacterium columnare; a group of channel catfish were first im...

MODELING MOLECULAR TARGETS FOR TOXICITY, A COMPUTATIONAL APPROACH TO UNDERSTANDING KEY STEPS IN THE MECHANISMS FOR TOXICITY AND A TOOL FOR PRIORITIZING BIOASSAY REQUIREMENTS

EPA Science Inventory

The Agency frequently encounters situations where it must make decisions about the potential health and environmental effects of chemicals when all of the relevant data is not available. One rational approach to this problem is to estimate the relevant missing information by ext...

Strategic Reading Groups: Guiding Readers in the Middle Grades

ERIC Educational Resources Information Center

Berne, Jennifer; Degener, Sophie C.

2012-01-01

Strategic grouping can transform reading instruction in the middle grades from a hit-or-miss learning experience to a targeted, responsive one. This book features a practical and field-tested model for small-group differentiated reading instruction in Grades 4-8. Jennifer Berne and Sophie C. Degener offer a clear, detailed discussion of how to…

Profiling 976 ToxCast Chemicals across 331 Enzymatic and Receptor Signaling Assays

PubMed Central

2013-01-01

Understanding potential health risks is a significant challenge due to the large numbers of diverse chemicals with poorly characterized exposures and mechanisms of toxicities. The present study analyzes 976 chemicals (including failed pharmaceuticals, alternative plasticizers, food additives, and pesticides) in Phases I and II of the U.S. EPA’s ToxCast project across 331 cell-free enzymatic and ligand-binding high-throughput screening (HTS) assays. Half-maximal activity concentrations (AC50) were identified for 729 chemicals in 256 assays (7,135 chemical–assay pairs). Some of the most commonly affected assays were CYPs (CYP2C9 and CYP2C19), transporters (mitochondrial TSPO, norepinephrine, and dopaminergic), and GPCRs (aminergic). Heavy metals, surfactants, and dithiocarbamate fungicides showed promiscuous but distinctly different patterns of activity, whereas many of the pharmaceutical compounds showed promiscuous activity across GPCRs. Literature analysis confirmed >50% of the activities for the most potent chemical–assay pairs (54) but also revealed 10 missed interactions. Twenty-two chemicals with known estrogenic activity were correctly identified for the majority (77%), missing only the weaker interactions. In many cases, novel findings for previously unreported chemical–target combinations clustered with known chemical–target interactions. Results from this large inventory of chemical–biological interactions can inform read-across methods as well as link potential targets to molecular initiating events in adverse outcome pathways for diverse toxicities. PMID:23611293

A Comparison of Supply and Demand for PETE Professionals in Higher Education in the United States

ERIC Educational Resources Information Center

Boyce, B. Ann; Rikard, G. Linda

2011-01-01

This study examined the supply and demand issues of D-PETE professionals in higher education. The three concerns addressed were: (a) doctoral graduates and their respective job placements in the academic years of 1996-97 through 2008-09, (b) an examination of two targeted academic years (2005-06 and 2008-09) to determine the supply of entry level…

"People at the Heart of Our Processes", a Case Study of How a Nursery School and Children's Centre Promotes Community Cohesion

ERIC Educational Resources Information Center

Duggan Bio, Martine

2017-01-01

This article reports on a doctoral case study of how an English integrated nursery school and children's centre fulfils its legal duty to promote community cohesion. The provocation for the enquiry derives from the author's growing unease over the perceived limitations of a target-driven culture currently pervading English schools. A case is made…

Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

PubMed Central

Hoddinott, Pat; Thomson, Gill; Morgan, Heather; Crossland, Nicola; MacLennan, Graeme; Dykes, Fiona; Stewart, Fiona; Bauld, Linda; Campbell, Marion K

2015-01-01

Objective To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Design Cross-sectional survey and qualitative interviews. Setting Scotland and North West England. Participants Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Methods Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Results Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were ‘moral tensions around acceptability’, ‘need for incentives’, ‘goals’, ‘collective or divisive action’ and ‘monitoring and proof’. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. Conclusions Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required. PMID:26567253

Multiple, targeted deficiencies in selectins reveal a predominant role for P-selectin in leukocyte recruitment

PubMed Central

Robinson, Stephen D.; Frenette, Paul S.; Rayburn, Helen; Cummiskey, Marge; Ullman-Culleré, Mollie; Wagner, Denisa D.; Hynes, Richard O.

1999-01-01

We extend our previous analyses of mice deficient in selectins by describing the generation and comparative phenotype of mice lacking one, two, or three selectins after sequential ablation of the murine genes encoding P-, E-, and L-selectins. All mice deficient in selectins are viable and fertile as homozygotes. However, mice missing both P- and E-selectins (PE−/−), and mice missing all three selectins (ELP−/−) develop mucocutaneous infections that eventually lead to death. Mice deficient in multiple selectins display varying degrees of leukocytosis, resulting in part from alterations in leukocyte rolling and recruitment. PE−/− mice, ELP−/− mice, and mice missing both P- and L-selectins (PL−/−) show drastic reductions in leukocyte rolling and in extravasation of neutrophils in thioglycollate-induced peritonitis. In a separate inflammatory model (ragweed-induced peritoneal eosinophilia), we demonstrate P-selectin to be both necessary and sufficient for the recruitment of eosinophils. The phenotype of mice missing both E- and L-selectins (EL−/−) is less severe than those seen in the other double knockouts. Comparisons among the double knockouts suggest that P-selectin normally cooperates with both E- and L-selectins. Our results indicate a preeminent role for P-selectin in regulating leukocyte behavior in mice. Data from the ELP−/− mice indicate, however, that all three selectins are important to leukocyte homeostasis and efficient neutrophil recruitment. PMID:10500197

Neural reactivity to reward in school-age offspring of depressed mothers.

PubMed

Wiggins, Jillian Lee; Schwartz, Karen T G; Kryza-Lacombe, Maria; Spechler, Philip A; Blankenship, Sarah L; Dougherty, Lea R

2017-05-01

Identifying neural profiles predictive of future psychopathology in at-risk individuals is important to efficiently direct preventive care. Alterations in reward processing may be a risk factor for depression. The current study characterized neural substrates of reward processing in children at low- and high-risk for psychopathology due to maternal depression status. Children with (n=27) and without (n=19) maternal depression (ages 5.9-9.6 years) performed a monetary incentive delay task in which they received rewards, if they successfully hit a target, or no reward regardless of performance, during fMRI acquisition. Multiple dorsal prefrontal, temporal, and striatal regions showed significant Group (high- vs. low-risk)×Performance (hit vs. miss)×Condition (no reward vs. reward) interactions in a whole-brain analysis. All regions exhibited similar patterns, whereby the high-risk group showed blunted activation differences between trials with vs. without rewards when participants hit the target. Moreover, high-risk children showed activation differences between trials with vs. without rewards in the opposite direction, compared to the low-risk group, when they missed the target. This study had a modest sample size, though larger than existing studies. Children with maternal depression are at elevated risk for future psychopathology, yet not all experience clinically significant symptoms; longitudinal research is necessary to fully track the pathway from risk to disorder. Children of depressed mothers exhibited attenuated neural activation differences and activation patterns opposite to children without depressed mothers. Our findings may provide targets for hypothesis-driven preventive interventions and lead to earlier identification of individuals at risk. Copyright © 2017 Elsevier B.V. All rights reserved.

Estimated number of infants detected and missed by critical congenital heart defect screening.

PubMed

Ailes, Elizabeth C; Gilboa, Suzanne M; Honein, Margaret A; Oster, Matthew E

2015-06-01

In 2011, the US Secretary of Health and Human Services recommended universal screening of newborns for critical congenital heart defects (CCHDs), yet few estimates of the number of infants with CCHDs likely to be detected through universal screening exist. Our objective was to estimate the number of infants with nonsyndromic CCHDs in the United States likely to be detected (true positives) and missed (false negatives) through universal newborn CCHD screening. We developed a simulation model based on estimates of birth prevalence, prenatal diagnosis, late detection, and sensitivity of newborn CCHD screening through pulse oximetry to estimate the number of true-positive and false-negative nonsyndromic cases of the 7 primary and 5 secondary CCHD screening targets identified through screening. We estimated that 875 (95% uncertainty interval [UI]: 705-1060) US infants with nonsyndromic CCHDs, including 470 (95% UI: 360-585) infants with primary CCHD screening targets, will be detected annually through newborn CCHD screening. An additional 880 (UI: 700-1080) false-negative screenings, including 280 (95% UI: 195-385) among primary screening targets, are expected. We estimated that similar numbers of CCHDs would be detected under scenarios comparing "lower" (∼19%) and "higher" (∼41%) than current prenatal detection prevalences. A substantial number of nonsyndromic CCHD cases are likely to be detected through universal CCHD screening; however, an equal number of false-negative screenings, primarily among secondary targets of screening, are likely to occur. Future efforts should document the true impact of CCHD screening in practice. Copyright © 2015 by the American Academy of Pediatrics.

SU-E-T-310: Targeting Safety Improvements Through Analysis of Near-Miss Error Detection Points in An Incident Learning Database

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

Novak, A; Nyflot, M; Sponseller, P

2014-06-01

Purpose: Radiation treatment planning involves a complex workflow that can make safety improvement efforts challenging. This study utilizes an incident reporting system to identify detection points of near-miss errors, in order to guide our departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or their patterns. Methods: 1377 incidents were analyzed from a departmental nearmiss error reporting system from 3/2012–10/2013. All incidents were prospectively reviewed weekly by a multi-disciplinary team, and assigned a near-miss severity score ranging from 0–4 reflecting potential harm (no harm to critical). A 98-step consensus workflow was usedmore » to determine origination and detection points of near-miss errors, categorized into 7 major steps (patient assessment/orders, simulation, contouring/treatment planning, pre-treatment plan checks, therapist/on-treatment review, post-treatment checks, and equipment issues). Categories were compared using ANOVA. Results: In the 7-step workflow, 23% of near-miss errors were detected within the same step in the workflow, while an additional 37% were detected by the next step in the workflow, and 23% were detected two steps downstream. Errors detected further from origination were more severe (p<.001; Figure 1). The most common source of near-miss errors was treatment planning/contouring, with 476 near misses (35%). Of those 476, only 72(15%) were found before leaving treatment planning, 213(45%) were found at physics plan checks, and 191(40%) were caught at the therapist pre-treatment chart review or on portal imaging. Errors that passed through physics plan checks and were detected by therapists were more severe than other errors originating in contouring/treatment planning (1.81 vs 1.33, p<0.001). Conclusion: Errors caught by radiation treatment therapists tend to be more severe than errors caught earlier in the workflow, highlighting the importance of safety checks in dosimetry and physics. We are utilizing our findings to improve manual and automated checklists for dosimetry and physics.« less

Hablamos Juntos (Together We Speak): Interpreters, Provider Communication, and Satisfaction with Care

PubMed Central

Morales, Leo S.

2010-01-01

BACKGROUND The Hablamos Juntos—Together We Speak (HJ)—national demonstration project targeted the improvement of language access for Spanish-speaking Latinos in areas with rapidly growing Latino populations. The objective of HJ was to improve doctor-patient communication by increasing access to and quality of interpreter services for Spanish-speaking patients. OBJECTIVE To investigate how access to interpreters for adult Spanish-speaking Latinos is associated with ratings of doctor/office staff communication and satisfaction with care. DESIGN Cross-sectional cohort study. PATIENTS A total of 1,590 Spanish-speaking Latino adults from eight sites across the United States who participated in the outpatient HJ evaluation. MEASUREMENTS We analyzed two multi-item measures of doctor communication (4 items) and office staff helpfulness (2 items), and one global item of satisfaction with care by interpreter use. We performed regression analyses to control for patient sociodemographic characteristics, survey year, and clustering at the site of care. RESULTS Ninety-five percent of participants were born outside the US, 81% were females, and survey response rates ranged from 45% to 85% across sites. In this cohort of Spanish-speaking patients, those who needed and always used interpreters reported better experiences with care than their counterparts who needed but had interpreters unavailable. Patients who always used an interpreter had better adjusted ratings of doctor communication [effect size (ES = 0.51)], office staff helpfulness (ES = 0.37), and satisfaction with care (ES = 0.37) than patients who needed but did not always use an interpreter. Patients who needed and always used interpreters also reported better experiences with care in all three domains measured [doctor communication (ES = 0.30), office staff helpfulness (ES = 0.21), and satisfaction with care (ES = 0.23)] than patients who did not need interpreters. CONCLUSIONS Among adult Spanish-speaking Latinos, interpreter use is independently associated with higher satisfaction with doctor communication, office staff helpfulness, and ambulatory care. Increased attention to the need for effective interpreter services is warranted in areas with rapidly growing Spanish-speaking populations. PMID:20703951

Factors affecting the uptake of new medicines: a systematic literature review.

PubMed

Lublóy, Ágnes

2014-10-20

The successful diffusion of new drugs is crucial for both pharmaceutical companies and patients-and of wider stakeholder concern, including for the funding of healthcare provision. Micro-level characteristics (the socio-demographic and professional characteristics of medical professionals), meso-level characteristics (the prescribing characteristics of doctors, the marketing efforts of pharmaceutical companies, interpersonal communication among doctors, drug attributes, and the characteristics of patients), and macro-level characteristics (government policies) all influence the diffusion of new drugs. This systematic literature review examines the micro- and meso-level characteristics of early prescribers of newly introduced drugs. Understanding the characteristics of early adopters may help to speed up the diffusion process, promote cost-efficient prescribing habits, forecast utilisation, and develop targeted intervention strategies. The PubMed and Scopus electronic databases were chosen for their extensive coverage of the pertinent literature and used to identify 205 potentially relevant studies by means of a four-layered search string. The 35 studies deemed eligible were then synthetized carefully and critically, to extract variables relevant to this review. Early adoption of new drugs is not a personal trait, independent of drug type, but early adopters share both micro- and meso-level characteristics. At prescriber level, doctors' interest in particular therapeutic areas, participation in clinical trials, and volume of prescribing-either in total or within the therapeutic class of the new drug-increase the likelihood of early adoption. The marketing efforts of pharmaceutical companies and doctors' professional and social interactions leading to prescribing contagion are very powerful predictors of new drug uptake. At patient level, doctors with younger patients, patients with higher socioeconomic statuses and/or patients with poorer health statuses are more inclined to prescribe new drugs early. In contrast, the socio-demographic characteristics of prescribers and many practice-related factors play little role in the adoption process. The most powerful predictors of new drug uptake include the doctors' strong scientific commitment, high prescribing volume in total or in within the therapeutic class of the new drug, high exposure to marketing, and intense communication with colleagues.

Linezolid pharmacokinetics in MDR-TB: a systematic review, meta-analysis and Monte Carlo simulation

PubMed Central

Pertinez, Henry; Bonnett, Laura; Hodel, Eva Maria; Dartois, Véronique; Johnson, John L; Caws, Maxine; Bolhuis, Mathieu; Alffenaar, Jan-Willem C; Davies, Geraint; Sloan, Derek J

2018-01-01

Abstract Objectives The oxazolidinone linezolid is an effective component of drug-resistant TB treatment, but its use is limited by toxicity and the optimum dose is uncertain. Current strategies are not informed by clinical pharmacokinetic (PK)/pharmacodynamic (PD) data; we aimed to address this gap. Methods We defined linezolid PK/PD targets for efficacy (fAUC0–24:MIC >119 mg/L/h) and safety (fCmin <1.38 mg/L). We extracted individual-level linezolid PK data from existing studies on TB patients and performed meta-analysis, producing summary estimates of fAUC0–24 and fCmin for published doses. Combining these with a published MIC distribution, we performed Monte Carlo simulations of target attainment. Results The efficacy target was attained in all simulated individuals at 300 mg q12h and 600 mg q12h, but only 20.7% missed the safety target at 300 mg q12h versus 98.5% at 600 mg q12h. Although suggesting 300 mg q12h should be used preferentially, these data were reliant on a single centre. Efficacy and safety targets were missed by 41.0% and 24.2%, respectively, at 300 mg q24h and by 44.6% and 27.5%, respectively, at 600 mg q24h. However, the confounding effect of between-study heterogeneity on target attainment for q24h regimens was considerable. Conclusions Linezolid dosing at 300 mg q12h may retain the efficacy of the 600 mg q12h licensed dosing with improved safety. Data to evaluate commonly used 300 mg q24h and 600 mg q24h doses are limited. Comprehensive, prospectively obtained PK/PD data for linezolid doses in drug-resistant TB treatment are required. PMID:29584861

Examining single- and multiple-process theories of trust in automation.

PubMed

Rice, Stephen

2009-07-01

The author examined the effects of human responses to automation alerts and nonalerts. Previous research has shown that automation false alarms and misses have differential effects on human trust (i.e., automation false alarms tend to affect operator compliance, whereas automation misses tend to affect operator reliance). Participants performed a simulated combat task, whereby they examined aerial photographs for the presence of enemy targets. A diagnostic aid provided a recommendation during each trial. The author manipulated the reliability and response bias of the aid to provide appropriate data for state-trace analyses. The analyses provided strong evidence that only a multiple-process theory of operator trust can explain the effects of automation errors on human dependence behaviors. The author discusses the theoretical and practical implications of this finding.

Experimental Analysis of hFACT Action during Pol II Transcription in vitro

PubMed Central

Hsieh, Fu-Kai; Kulaeva, Olga I.; Studitsky, Vasily M.

2016-01-01

Summary FACT (facilitates chromatin transcription) is a histone chaperone that facilitates transcription through chromatin and promotes histone recovery during transcription. Here, we describe a highly purified experimental system that recapitulates many important properties of transcribed chromatin and the key aspects of hFACT action during this process in vitro. We present the protocols describing how to prepare different forms of nucleosomes, including intact nucleosome, covalently conjugated nucleosome, nucleosome missing one of the two H2A/2B dimers (hexasome) and tetrasome (a nucleosome missing both H2A/2B dimers). These complexes allow analysis of various aspects of FACT’s function. These approaches and other methods described below can also be applied to the study of other chromatin remodelers and chromatin-targeted factors. PMID:25665573

Finding Your Way™: a collaborative approach to increase awareness of missing person events among persons with dementia.

PubMed

Hillier, Loretta M; Harvey, David; Conway, Cathy; Hunt, Jocelyn; Hoffman, Ron

2016-04-01

To describe an innovative community-wide program aimed at increasing awareness of risks of missing person events among persons with dementia targeting various cultural groups and to present preliminary evaluation findings. Review of program records to describe program implementation and a community partner survey. Over 23 months, 386 partnerships were established to implement the program; 941 awareness-raising sessions were conducted reaching 23,495 individuals. There is an upward trend in number of sessions conducted in various languages and attendance. Community partners' (>85%) responded positively to the program and consultation process. This partnership experience demonstrates the effectiveness of a collaborative approach to the development and widespread dissemination of information and resource materials aimed at ensuring the safety of a vulnerable population.

iCHRCloud: Web & Mobile based Child Health Imprints for Smart Healthcare.

PubMed

Singh, Harpreet; Mallaiah, Raghuram; Yadav, Gautam; Verma, Nitin; Sawhney, Ashu; Brahmachari, Samir K

2017-11-29

Reducing child mortality with quality care is the prime-most concern of all nations. Thus in current IT era, our healthcare industry needs to focus on adapting information technology in healthcare services. Barring few preliminary attempts to digitalize basic hospital administrative and clinical functions, even today in India, child health and vaccination records are still maintained as paper-based records. Also, error in manually plotting the parameters in growth charts results in missed opportunities for early detection of growth disorders in children. To address these concerns, we present India's first hospital linked, affordable automated vaccination and real-time child's growth monitoring cloud based application- Integrated Child Health Record cloud (iCHRcloud). This application is based on HL7 protocol enabling integration with hospital's HIS/EMR system. It provides Java (Enterprise Service Bus and Hibernate) based web portal for doctors and mobile application for parents, enhancing doctor-parent engagement. It leverages highchart to automate chart preparation and provides access of data via Push Notification (GCM and APNS) to parents on iOS and Android mobile platforms. iCHRcloud has also been recognized as one of the best innovative solution in three nationwide challenges, 2016 in India. iCHRcloud offers a seamless, secure (256 bit HTTPS) and sustainable solution to reduce child mortality. Detail analysis on preliminary data of 16,490 child health records highlight the diversified need of various demographic regions. Thus, primary lesson would be to implement better validation strategies to fulfill the customize requisites of entire population. This paper presents first glimpse of data and power of the analytics in policy framework.

Medication reconciliation service in Tan Tock Seng Hospital.

PubMed

Yi, Sia Beng; Shan, Janice Chan Pei; Hong, Goh Lay

2013-01-01

Medication reconciliation is integral to every hospital. Approximately 60 percent of all hospital medication errors occur at admission, intra-hospital transfer or discharge. Effectively and consistently performing medication reconciliation at care-interfaces continues to be a challenge. Tan Tock Seng Hospital (TTSH) averages 4,700 admissions monthly. Many patients are elderly (> 65 years old) at risk from poly-pharmacy. As part of a medication safety initiative, pharmacy staff started a medication reconciliation service in 2007, which expanded to include all patients in October 2009. This article aims to describe the TTSH medication reconciliation system and to highlight common medication errors occurring following incomplete medication reconciliation. Where possible, patients admitted into TTSH are seen by pharmacy staff within 24 hours of admission. A form was created to document their medications, which is filed into the case sheets for referencing purposes. Any discrepancies in medicines are brought to doctors' attention. Patients are also counseled about changes to their medications. Errors picked up were captured in an Excel database. The most common medication error was prescribers missing out medications. The second commonest was recording different doses and regimens. The reason was mainly due to doctors transcribing medications inaccurately. This is a descriptive study and no statistical tests were carried out. Data entry was done by different pharmacy staff, and not a dedicated person; hence, data might be under-reported. The findings demonstrate the importance of medication reconciliation on admission. Accurate medication reconciliation can help to reduce transcription errors and improve service quality. The article highlights medication reconciliation's importance and has implications for healthcare professionals in all countries.

Data imputation analysis for Cosmic Rays time series

NASA Astrophysics Data System (ADS)

Fernandes, R. C.; Lucio, P. S.; Fernandez, J. H.

2017-05-01

The occurrence of missing data concerning Galactic Cosmic Rays time series (GCR) is inevitable since loss of data is due to mechanical and human failure or technical problems and different periods of operation of GCR stations. The aim of this study was to perform multiple dataset imputation in order to depict the observational dataset. The study has used the monthly time series of GCR Climax (CLMX) and Roma (ROME) from 1960 to 2004 to simulate scenarios of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80% and 90% of missing data compared to observed ROME series, with 50 replicates. Then, the CLMX station as a proxy for allocation of these scenarios was used. Three different methods for monthly dataset imputation were selected: AMÉLIA II - runs the bootstrap Expectation Maximization algorithm, MICE - runs an algorithm via Multivariate Imputation by Chained Equations and MTSDI - an Expectation Maximization algorithm-based method for imputation of missing values in multivariate normal time series. The synthetic time series compared with the observed ROME series has also been evaluated using several skill measures as such as RMSE, NRMSE, Agreement Index, R, R2, F-test and t-test. The results showed that for CLMX and ROME, the R2 and R statistics were equal to 0.98 and 0.96, respectively. It was observed that increases in the number of gaps generate loss of quality of the time series. Data imputation was more efficient with MTSDI method, with negligible errors and best skill coefficients. The results suggest a limit of about 60% of missing data for imputation, for monthly averages, no more than this. It is noteworthy that CLMX, ROME and KIEL stations present no missing data in the target period. This methodology allowed reconstructing 43 time series.

Clinical Tumor Dimensions May Be Useful to Prevent Geographic Miss in Conventional Radiotherapy of Uterine Cervix Cancer-A Magnetic Resonance Imaging-Based Study

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

Justino, Pitagoras Baskara; Baroni, Ronaldo; Blasbalg, Roberto

2009-06-01

Purpose: To evaluate the risk of geographic miss associated with the classic four-field 'box' irradiation technique and to define the variables that predict this risk. Materials and Methods: The study population consisted of 80 patients with uterine cervix cancer seen between 2001 and 2006. Median age was 55 years (23-82 years), and 72 (90%) presented with squamous cell carcinoma. Most patients (68.7%) presented with locally advanced disease (IIb or more). Magnetic resonance imaging findings from before treatment were compared with findings from simulation of the conventional four-field 'box' technique done with rectal contrast. Study variables included tumor volume; involvement ofmore » vagina, parametrium, bladder, or rectum; posterior displacement of the anterior rectal wall; and tumor anteroposterior diameter (APD). Margins were considered adequate when the target volume (primary tumor extension, whole uterine body, and parametrium) was included within the field limits and were at least 1 cm in width. Results: Field limits were inadequate in 45 (56%) patients: 29 (36%) patients at the anterior and 28 (35%) at the posterior border of the lateral fields. Of these, 12 patients had both anterior and posterior miss, and this risk was observed in all stages of the disease (p = 0.076). Posterior displacement of the anterior rectal wall beyond S2-S3 was significantly correlated with the risk of geographic miss (p = 0.043). Larger tumors (APD 6 cm or above and volume above 50 cm{sup 3}) were also significantly correlated with this risk (p = 0.004 and p = 0.046, respectively). Conclusions: Posterior displacement of the anterior rectal wall, tumor APD, and volume can be used as guidance in evaluating the risk of geographic miss.« less

Solar Sailing Kinetic Energy Interceptor (KEI) Mission for Impacting/Deflecting Near-Earth Asteroids

NASA Technical Reports Server (NTRS)

Wie, Bong

2005-01-01

A solar sailing mission architecture, which requires a t least ten 160-m, 300-kg solar sail spacecraft with a characteristic acceleration of 0.5 mm/sqs, is proposed as a realistic near- term option for mitigating the threat posed by near-Earth asteroids (NEAs). Its mission feasibility is demonstrated for a fictional asteroid mitigation problem created by AIAA. This problem assumes that a 200-m asteroid, designated 2004WR, was detected on July 4, 2004, and that the expected impact will occur on January 14, 2015. The solar sailing phase of the proposed mission for the AIAA asteroid mitigation problem is comprised of the initial cruise phase from 1 AU t o 0.25 AU (1.5 years), the cranking orbit phase (3.5 years), and the retrograde orbit phase (1 year) prior to impacting the target asteroid at its perihelion (0.75 AU from the sun) on January 1, 2012. The proposed mission will require at least ten kinetic energy interceptor (KEI) solar sail spacecraft. Each KEI sailcraft consists of a 160- m, 150-kg solar sail and a 150-kg microsatellite impactor. The impactor is to be separated from a large solar sail prior to impacting the 200-m target asteroid at its perihelion. Each 150-kg microsatellite impactor, with a relative impact velocity of at least 70 km/s, will cause a conservatively estimated AV of 0.3 cm/s in the trajectory of the 200-m target asteroid, due largely to the impulsive effect of material ejected from the newly-formed crater. The deflection caused by a single impactor will increase the Earth-miss-distance by 0.45Re (where Re denotes the Earth radius of 6,378 km). Therefore, at least ten KEI sailcraft will be required for consecutive impacts, but probably without causing fragmentation, to increase the total Earth-miss-distance by 4.5Re. This miss-distance increase of 29,000 km is outside of a typical uncertainty/error of about 10,000 km in predicting the Earth-miss- distance. A conventional Delta I1 2925 launch vehicle is capable of injecting at least two KEI sailcraft into an Earth escaping orbit. A 40-m solar sail is currently being developed by NASA and industries for a possible flight validation experiment within 10 years, and a 160-m solar sail is expected to be available within 20 years.

A tale of two sequences: microRNA-target chimeric reads.

PubMed

Broughton, James P; Pasquinelli, Amy E

2016-04-04

In animals, a functional interaction between a microRNA (miRNA) and its target RNA requires only partial base pairing. The limited number of base pair interactions required for miRNA targeting provides miRNAs with broad regulatory potential and also makes target prediction challenging. Computational approaches to target prediction have focused on identifying miRNA target sites based on known sequence features that are important for canonical targeting and may miss non-canonical targets. Current state-of-the-art experimental approaches, such as CLIP-seq (cross-linking immunoprecipitation with sequencing), PAR-CLIP (photoactivatable-ribonucleoside-enhanced CLIP), and iCLIP (individual-nucleotide resolution CLIP), require inference of which miRNA is bound at each site. Recently, the development of methods to ligate miRNAs to their target RNAs during the preparation of sequencing libraries has provided a new tool for the identification of miRNA target sites. The chimeric, or hybrid, miRNA-target reads that are produced by these methods unambiguously identify the miRNA bound at a specific target site. The information provided by these chimeric reads has revealed extensive non-canonical interactions between miRNAs and their target mRNAs, and identified many novel interactions between miRNAs and noncoding RNAs.

Missing the Target: We Need to Focus on Informal Care Rather than Preschool. Evidence Speaks Reports, Vol 1, #19

ERIC Educational Resources Information Center

Loeb, Susanna

2016-01-01

Despite the widely-recognized benefits of early childhood experiences in formal settings that enrich the social and cognitive environments of children, many children--particularly infants and toddlers--spend their days in unregulated (or very lightly regulated) "informal" childcare settings. Over half of all one- and two-year-olds are…

The Economic and Human Development Costs of Missing the Millennium Development Goal on Gender Equity.

ERIC Educational Resources Information Center

Abu-Ghaida, Dina; Klasen, Stephan

2004-01-01

At the Millennium Summit, the world community pledged to promote gender equality and chose as a specific target the achievement of gender equity in primary and secondary education by the year 2005 in every country of the world. Based on the findings from a growing empirical literature that suggests that gender equity in education promotes economic…

Linking Research and Practice: Effective Strategies for Teaching Vocabulary in the ESL Classroom

ERIC Educational Resources Information Center

Nam, Jihyun

2010-01-01

Vocabulary plays a pivotal role in the ESL classroom. Whereas a considerable amount of research has examined effective ESL vocabulary teaching and learning, missing are studies that provide examples of how to put various research findings into practice: that is, apply them to real texts including target vocabulary items. In order to close the gap…

The Missing Link: Workplace Education in Small Business.

ERIC Educational Resources Information Center

BCEL Newsletter for the Business & Literacy Communities, 1992

1992-01-01

A study sought to determine how and why small businesses invest or do not invest in basic skills instruction for their workers. Data were gathered through a national mail and telephone survey of a random sampling of 11,000 small (50 or fewer employees) and medium-sized (51-400 employees) firms, a targeted mail survey of 4,317 manufacturers, a…

The Impact Agenda and Critical Social Research in Education: Hitting the Target but Missing the Spot?

ERIC Educational Resources Information Center

Laing, Karen; Mazzoli Smith, Laura; Todd, Liz

2018-01-01

This paper considers whether the impact agenda that has developed over the last decade in UK universities is likely to help create the conditions in which critical educational research makes a more visible difference to society. The UK audit of university research quality (the research excellence framework (REF) now includes an assessment of…

Molecular Pathways

PubMed Central

Lok, Benjamin H.; Powell, Simon N.

2012-01-01

The Rad52 protein was largely ignored in humans and other mammals when the mouse knockout revealed a largely “no-effect” phenotype. However, using synthetic lethal approaches to investigate context dependent function, new studies have shown that Rad52 plays a key survival role in cells lacking the function of the BRCA1-BRCA2 pathway of homologous recombination. Biochemical studies also showed significant differences between yeast and human Rad52, in which yeast Rad52 can promote strand invasion of RPA-coated single-stranded DNA in the presence of Rad51, but human Rad52 cannot. This results in the paradox of how is human Rad52 providing Rad51 function: presumably there is something missing in the biochemical assays that exists in-vivo, but the nature of this missing factor is currently unknown. Recent studies have suggested that Rad52 provides back-up Rad51 function for all members of the BRCA1-BRCA2 pathway, suggesting that Rad52 may be a target for therapy in BRCA pathway deficient cancers. Screening for ways to inhibit Rad52 would potentially provide a complementary strategy for targeting BRCA-deficient cancers in addition to PARP inhibitors. PMID:23071261

Factors associated with consultation behaviour for primary symptoms potentially indicating colorectal cancer: A cross-sectional study on response to symptoms

PubMed Central

2012-01-01

Background Little data exists on the factors associated with health care seeking behaviour for primary symptoms of colorectal cancer (CRC). This study aimed to identify individual, provider and psychosocial factors associated with (i) ever seeking medical advice and (ii) seeking early medical advice for primary symptoms of colorectal cancer (CRC). Methods 1592 persons aged 56–88 years randomly selected from the Hunter Community Study (HCS) were sent a questionnaire. Results Males and those who had received screening advice from a doctor were at significantly higher odds of ever seeking medical advice for rectal bleeding. Persons who had private health coverage, consulted a doctor because the ‘symptom was serious’, or who did not wait to consult a doctor for another reason were at significantly higher odds of seeking early medical advice (< 2 weeks). For change in bowel habit, persons with lower income, within the healthy weight range, or who had discussed their family history of CRC irrespective of whether informed of ‘increased risk’ were at significantly higher odds of ever seeking medical advice. Persons frequenting their GP less often and seeing their doctor because the symptom persisted were at significantly higher odds of seeking early medical advice (< 2 weeks). Conclusions The seriousness of symptoms, importance of early detection, and prompt consultation must be articulated in health messages to at-risk persons. This study identified modifiable factors, both individual and provider-related to consultation behaviour. Effective health promotion efforts must heed these factors and target sub-groups less likely to seek early medical advice. PMID:22862960

Stigmatization of patients with HIV/AIDS among doctors and nurses in Belize.

PubMed

Andrewin, Aisha; Chien, Li-Yin

2008-11-01

This study, conducted from August to September 2007, utilized a population-based survey to investigate stigmatizing attitudes and acts of discrimination against HIV/AIDS patients among doctors and nurses working in public hospitals in Belize. A total of 230 subjects (81.0%) completed the survey. The mean age was 36.8 years; 75% were women; 61% were nurses; 74% were Belizean. Stigmatization was greatest for "attitudes of blame/judgment"; disclosing a patient's HIV/AIDS status to colleagues was the most frequent act of discrimination (29%). Formal HIV/AIDS training was significantly associated with less stigmatization for "attitudes towards imposed measures" (p < .01); "attitudes of blame/judgment" (p < 0.05); and testing without consent (p < 0.05). Doctors showed more stigmatization in "attitudes towards imposed measures," conducted HIV tests without consent and disclosed patient status to colleagues more frequently than nurses (p < 0.05) while nurses gave differential care to patients based on HIV status more frequently (p < 0.01) than doctors. Female and religious health care workers (HCWs) were more stigmatizing in their "attitudes of blame/judgment" than male and nonreligious HCWs (p < 0.05). Cuban HCWs were more stigmatizing in their "attitudes toward imposed measures" and were less comfortable dealing with HIV/AIDS patients than their Belizean counterparts (p < 0.01). Older age was associated with less frequent disclosure of patients' HIV status (p < 0.05). HIV/AIDS training that incorporates stigma reduction strategies tailored to the target groups identified is needed. Additionally, we recommend that the effectiveness of national HIV/AIDS policies be investigated.

Spin Stabilized Impulsively Controlled Missile (SSICM)

NASA Astrophysics Data System (ADS)

Crawford, J. I.; Howell, W. M.

1985-12-01

This patent is for the Spin Stabilized Impulsively Controlled Missile (SSICM). SSICM is a missile configuration which employs spin stabilization, nutational motion, and impulsive thrusting, and a body mounted passive or semiactive sensor to achieve very small miss distances against a high speed moving target. SSICM does not contain an autopilot, control surfaces, a control actuation system, nor sensor stabilization gimbals. SSICM spins at a rate sufficient to provide frequency separation between body motions and inertial target motion. Its impulsive thrusters provide near instantaneous changes in lateral velocity, whereas conventional missiles require a significant time delay to achieve lateral acceleration.

Understanding of elder abuse and neglect among health care professionals in Malaysia: An exploratory survey.

PubMed

Ahmed, Ayesha; Choo, Wan-Yuen; Othman, Sajaratulnisah; Hairi, Noran Naqiah; Hairi, Farizah Mohd; Mohd Mydin, Fadzilah Hanum; Illiani Jaafar, Siti Nur

2016-01-01

Elder abuse and neglect (EAN) is a hidden public health challenge for Malaysia. This cross-sectional survey studied the awareness of EAN among 148 doctors and nurses from two neighboring states in Malaysia using a self-administered questionnaire exploring their knowledge, perceptions, practices, and experience concerning EAN. Both doctors and nurses demonstrated poor understanding of signs of EAN and exhibited misperceptions on reporting requirements. Both groups perceived EAN as a national burden and reporting it as their responsibility; but most felt they had not been trained to diagnose it. Many were unsure of procedures and whether their own intervention could be effective. Only four (nurses) of 41 participants who suspected abuse during the past year reported the cases. Targeted education and uniform protocols are mandatory to ensure best practice with regards to EAN. Further research is crucial to extend this inquiry into the broader health care workforce.

ROLE OF INSTITUTIONAL CLIMATE IN FOSTERING DIVERSITY IN BIOMEDICAL RESEARCH WORKFORCE: A CASE STUDY

PubMed Central

Butts, Gary C.; Hurd, Yasmin; Palermo, Ann-Gel S.; Delbrune, Denise; Saran, Suman; Zony, Chati; Krulwich, Terry A.

2012-01-01

This article reviews the barriers to diversity in biomedical research, describes the evolution and efforts to address climate issues to enhance the ability to attract, retain and develop underrepresented minorities (URM) - underrepresented minorities whose underrepresentation is found both in science and medicine, in the graduate school biomedical research doctoral programs (PhD and MD/PhD) at Mount Sinai School of Medicine (MSSM). We also describe the potential beneficial impact of having a climate that supports diversity and inclusion in the biomedical research workforce. MSSM diversity climate efforts are discussed as part of a comprehensive plan to increase diversity in all institutional programs PhD, MD/PhD, MD, and at the residency, post doctoral fellow, and faculty levels. Lessons learned from four decades of targeted programs and activities at MSSM may be of value to other institutions interested in improving diversity in the biomedical science and academic medicine workforce. PMID:22786740

Disease awareness advertising - women's intentions following exposure.

PubMed

Hall, Danika; Jones, Sandra; Iverson, Don

2011-03-01

In Australia, where direct to consumer advertising of prescription medicines is prohibited, pharmaceutical companies can sponsor disease awareness advertising targeting consumers. This study examined the impact of disease awareness advertising exposure on older women's reported behavioural intentions. Women were approached in a shopping centre and randomly assigned mock advertisements for two health conditions. Disease information and sponsors were manipulated. Two hundred and forty-one women responded to 466 advertisements. Almost half reported an intention to ask their doctor for a prescription or referral as a result of seeing the advertisement, but more reported they would talk to their doctor and ask about treatments and tests. Participants were more likely to report an intention to ask for prescriptions if they perceived the health condition to be severe and themselves susceptible or if they had viewed advertisements containing limited information on the disease. Disease awareness advertising may stimulate demand for prescription medicine products. This has serious implications for general practitioners and regulators.

[The role of the occupational physician in disabled return to work].

PubMed

Belotti, L; Molinero, G; Maccarana, G; Mosconi, G

2012-01-01

Workers, former workers or unemployed workers with disabilities of various kinds often come to the Occupational Health Hospital Department (UOOML), requiring a report on their fitness for work that often is generic or not suitable for specific situations: a detailed knowledge of both working and health conditions, mainly disabilities and job items are needed. The UOOML was never directly involved in the proceedings of targeted fitting-up of the disabled people, while some Doctors of the Department of Prevention of ASL have an advisory role participating in the Technical Committee under Law 68 and the 'Disabled Commission'. INAIL (the National Insurance Institute for Occupational Accidents and Diseases), in case of allocation of percentages of disability higher than 33% (necessary requirement for the targeted employment) provides an assessment of the 'residual capacity'. The Company Occupational Physician cooperates and intervenes in the management of the employment of the disabled worker in very different ways and at several stages of the path of integration or reintegration. Considering the prolonged and effective cooperation among the Doctors of the UOOML and the Psysiatrists of our Hospital, we are developing a specific out-patients' department where a report on the fitness for job, as close as possible to the patient/work-task compliance, is provided to the disabled.

Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

PubMed Central

2011-01-01

Background Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour. Methods A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview. Results The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia. Conclusions The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men. PMID:21569395

[Association of Japanese doctors' sleep habits with working environments and lifestyle].

PubMed

Tamura, Yoshiyuki; Chiba, Shigeru

2011-01-01

To clarify the association of Japanese doctors' sleep habits with working environments and lifestyle, a survey was performed using a self-administered questionnaire in February 2002, targeting a population of 2,455 Asahikawa Medical University alumni. A total of 881 subjects completed questionnaires, yielding a response rate of 35.9%. The mean+/-SD sleep duration on workdays was 410.4+/-60.5 minutes, approximately 30 minutes shorter than that of the general Japanese population. The prevalence of subjective insufficient sleep (SIS) on workdays was 64.5%, significantly higher than that in the general Japanese population. The estimated overall prevalences of various sleep problems are as follows: difficulty initiating sleep, 14.7%; difficulty maintaining sleep, 15.3%; poor perceived quality of sleep, 15.6%; waking without feeling refreshed (WWFR), 30.0%; and excessive daytime sleepiness (EDS), 30.8%. SIS had a significant positive association with WWFR and EDS. Doctors' sleeplessness differed depending on their working style. The prevalence of SIS among doctors working at hospitals and clinics with inpatient wards was significantly higher than that among those working in environments without inpatient wards. The prevalence of SIS was significantly associated with the number of working hours, fatigue, and an irregular lifestyle. Habitual exercise did not appear to affect SIS. A multiple logistic regression model revealed that working in hospitals, long working hours (more than 9 hours a day), fatigue, and an irregular lifestyle were independently associated with SIS [OR=2.19 (95% CI=1.29-3.70); OR=1.95 (95% CI=1.37-2.77); OR=1.93 (95% CI=1.38-2.69); OR=3.27 (95% CI=2.21-4.84)]. Sleep duration on holidays was approximately 60 minutes longer than that on workdays, and the prevalence of SIS decreased to 32.3%. These results demonstrate that the prevalence of SIS is higher among doctors working at hospitals and clinics with inpatient wards, who tend to have long working hours and irregular lifestyles.

Effectiveness of a smart phone app on improving immunization of children in rural Sichuan Province, China: study protocol for a paired cluster randomized controlled trial.

PubMed

Chen, Li; Wang, Wei; Du, Xiaozhen; Rao, Xiuqin; van Velthoven, Michelle Helena; Yang, Ruikan; Zhang, Lin; Koepsell, Jeanne Catherine; Li, Ye; Wu, Qiong; Zhang, Yanfeng

2014-03-20

Although good progress has been achieved in expanding immunization of children in China, disparities exist across different provinces. Information gaps both from the service supply and demand sides hinder timely vaccination of children in rural areas. The rapid development of mobile health technology (mHealth) provides unprecedented opportunities for improving health services and reaching underserved populations. However, there is a lack of literature that rigorously evaluates the impact of mHealth interventions on immunization coverage as well as the usability and feasibility of smart phone applications (apps). This study aims to assess the effectiveness of a smart phone-based app (Expanded Program on Immunization app, or EPI app) on improving the coverage of children's immunization. This cluster randomized trial will take place in Xuanhan County, Sichuan Province, China. Functionalities of the app include the following: to make appointments automatically, record and update children's immunization information, generate a list of children who missed their vaccination appointments, and send health education information to village doctors. After pairing, 36 villages will be randomly allocated to the intervention arm (n=18) and control arm (n=18). The village doctors in the intervention arm will use the app while the village doctors in the control arm will record and manage immunization in the usual way in their catchment areas. A household survey will be used at baseline and at endline (8 months of implementation). The primary outcome is full-dose coverage and the secondary outcome is immunization coverage of the five vaccines that are included in the national Expanded Program on Immunization program as well as Hib vaccine, Rotavirus vaccine and Pneumococcal conjugate vaccine. Multidimensional evaluation of the app will also be conducted to assess usability and feasibility. This study is the first to evaluate the effectiveness of a smart phone app for child immunization in rural China. This study will contribute to the knowledge about the usability and feasibility of a smart phone app for managing immunization in rural China and to similar populations in different settings. Chinese Clinical Trials Registry (ChiCTR): ChiCTR-TRC-13003960.

The clinical usefulness of a web-based messaging system between patients with Crohn disease and their physicians.

PubMed

Jeong, Da Eun; Kim, Kyeong Ok; Jang, Byung Ik; Kim, Eun Young; Jung, Jin Tae; Jeon, Seong Woo; Lee, Hyun Seok; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum

2016-06-01

To avoid missing events associated with clinical activity, the authors previously developed a novel, web-based, self-reporting Crohn disease (CD) symptom diary. However, although this diary provided a means of self-checking based on responses to set questions based on Harvey-Bradshaw index scores, it was limited in terms of describing other specific symptoms. Thus, the authors added a space to the questionnaire, which allows patients to send clinicians questions or a description of unpredictable events. The aim of the present study was to assess the clinical usefulness of this messaging system by analyzing patients' messages.The messaging system between patients and their doctors was included in a webpage created for recording patients' symptom diaries (www.cdsd.or.kr). Using this system, patients can send messages easily at any time and doctors can read and respond to these messages immediately using a smart phone or computer. In the present study, the authors retrospectively reviewed 686 messages sent by 152 patients from July 2012 to July 2014 and patient medical records.Mean patient age was 29.0 ± 11.6 years and the male-to-female ratio was 99:53. Most messages regarded symptoms (381 messages, 55.5%), which was followed by self-reports about general condition (195 messages, 28.4%) and questions about treatment (71 messages, 10.3%). With respect to symptoms, abdominal pain was most common (145 cases, 21.1%) followed by hematochezia (36 cases, 5.2%). Problems about medication were the most frequently associated with treatment (65, 91.5%). Patients above 40 years showed a greater tendency to focus on symptoms and treatment (P = 0.025). The doctor answer rate was 56.3% (n = 386), and based on these responses, an early visit was needed in 28 cases (7.3%).Using this web-based messaging system, patients were able to obtain proper advice from their physicians without visiting clinics or searching the Internet, and in addition, 7.3% of messages prompted an early visit. Although longer follow-up is required, this study shows that the devised messaging system provides a clinically relevant communication tool for patients and physicians.

Medicines information provided by pharmaceutical representatives: a comparative study in Australia and Malaysia

PubMed Central

2010-01-01

Background Pharmaceutical representatives provide medicines information on their promoted products to doctors. However, studies have shown that the quality of this information is often low. No study has assessed the medicines information provided by pharmaceutical representatives to doctors in Malaysia and no recent evidence in Australia is present. We aimed to compare the provision of medicines information by pharmaceutical representatives to doctors in Australia and Malaysia. Methods Following a pharmaceutical representative's visit, general practitioners in Australia and Malaysia who had agreed to participate, were asked to fill out a questionnaire on the main product and claims discussed during the encounter. The questionnaire focused on provision of product information including indications, adverse effects, precautions, contraindications and the provision of information on the Pharmaceutical Benefit Scheme (PBS) listings and restrictions (in Australia only). Descriptive statistics were produced. Chi-square analysis and clustered linear regression were used to assess differences in Australia and Malaysia. Results Significantly more approved product information sheets were provided in Malaysia (78%) than in Australia (53%) (P < 0.001). In both countries, general practitioners reported that indications (Australia, 90%, Malaysia, 93%) and dosages (Australia, 76%, Malaysia, 82%) were frequently provided by pharmaceutical representatives. Contraindications, precautions, drug interactions and adverse effects were often omitted in the presentations (range 25% - 41%). General practitioners in Australia and Malaysia indicated that in more than 90% of presentations, pharmaceutical representatives partly or fully answered their questions on contraindications, precautions, drug interactions and adverse effects. More general practitioners in Malaysia (85%) than in Australia (60%) reported that pharmaceutical representatives should have mentioned contraindications, precautions for use, drug interaction or adverse effects spontaneously (P < 0.001). In 48% of the Australian presentations, general practitioners reported the pharmaceutical representatives failed to mention information on PBS listings to general practitioners. Conclusions Information on indications and dosages were usually provided by pharmaceutical representatives in Australia and Malaysia. However, risk and harmful effects of medicines were often missing in their presentations. Effective control of medicines information provided by pharmaceutical representatives is needed. PMID:21118551

Big Bang Day : Afternoon Play - Torchwood: Lost Souls

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

None

2009-10-13

Martha Jones, ex-time traveller and now working as a doctor for a UN task force, has been called to CERN where they're about to activate the Large Hadron Collider. Once activated, the Collider will fire beams of protons together recreating conditions a billionth of a second after the Big Bang - and potentially allowing the human race a greater insight into what the Universe is made of. But so much could go wrong - it could open a gateway to a parallel dimension, or create a black hole - and now voices from the past are calling out to peoplemore » and scientists have started to disappear... Where have the missing scientists gone? What is the secret of the glowing man? What is lurking in the underground tunnel? And do the dead ever really stay dead? Lost Souls is a spin-off from the award-winning BBC Wales TV production Torchwood. It stars John Barrowman, Freema Agyeman, Eve Myles, Gareth David-Lloyd, Lucy Montgomery (of Titty Bang Bang) and Stephen Critchlow.« less

Big Bang Day : Afternoon Play - Torchwood: Lost Souls

ScienceCinema

None

2017-12-09

Martha Jones, ex-time traveller and now working as a doctor for a UN task force, has been called to CERN where they're about to activate the Large Hadron Collider. Once activated, the Collider will fire beams of protons together recreating conditions a billionth of a second after the Big Bang - and potentially allowing the human race a greater insight into what the Universe is made of. But so much could go wrong - it could open a gateway to a parallel dimension, or create a black hole - and now voices from the past are calling out to people and scientists have started to disappear... Where have the missing scientists gone? What is the secret of the glowing man? What is lurking in the underground tunnel? And do the dead ever really stay dead? Lost Souls is a spin-off from the award-winning BBC Wales TV production Torchwood. It stars John Barrowman, Freema Agyeman, Eve Myles, Gareth David-Lloyd, Lucy Montgomery (of Titty Bang Bang) and Stephen Critchlow.

What gets missed when deploying new technologies in A&E?

PubMed

Broome, C; Adams, A

2005-06-01

This paper presents a longitudinal study (over 4 months) of an A&E department where the existing whiteboards were replaced with PC-based computer systems. The study was conducted in two parts - an observation of the physical whiteboard usage and in-depth interviews with all users of both the traditional whiteboard usage and the replacement technology. The research was conducted with the systems manager and all whiteboard users (i.e. nursing management, nurses, doctors, porters, and agency staff) across a spread of time frames. Although the technology supported simple information requirements, complex co-ordination, collaboration, and awareness issues were left unsupported. The important role of a pen-holder (information co-ordinator) was poorly supported by the replacement technology as was the task of annotating information with changing situations and needs. Specific deployment issues are derived from these findings that should guide designers when implementing technology replacements for current physical information formats (e.g. whiteboards, notice boards, shared paper notes).

Organizational structure of the Croatian family practice: a longitudinal study based on routinely collected data.

PubMed

Keglević, Mladenka Vrcić; Balint, Ines; Cvetković, Ivica; Gaćina, Ana

2014-12-01

This study was undertaken with the main aim of determining the trends in the number of family doctors' (FD), gender and educational structure, working status and the number of patients per FD between 1995 and 2013. As the main source of data collection served the Croatian Health Service Yearbooks and Croatian Health Insurance Fund (CHIF) databases on practices and FDs contracting in 2013. Obtained results indicated that the number of contracted FDs increased until 2007, then decreased, and again increased until 2350 in 2013. Average number of patients on FDs list was 1987 in 2012. Less than 50% FDs were specialist in family medicine, 70.3% of them were self-employed with the CHIF contract, and 81% were women. 123 practices planned by the Network did not have contracting FD in 2013. The lack of FDs, the huge number of patients over the standard number, and the location of the missing practices within the rural communities, together make Croatian FM practices less accessible.

Infrared Technology Trends and Implications to Home and Building Energy Use Efficiency

NASA Astrophysics Data System (ADS)

Woolaway, James T.

2008-09-01

It has long been realized that infrared technology would have applicability in improving the energy efficiency of homes and buildings. Walls that are missing or are poorly insulated can be quickly evaluated by looking at the thermal images of these surfaces. Similarly, air infiltration leaks under doors and around windows leave a telltale thermal signature easily seen in the infrared. The ability to view, evaluate and quickly respond to these images has immediate benefits in addressing and correcting situations where these types of losses are occurring. The principle issue that has been limiting the use of infrared technology in these applications has been the lack of availability and accessibility of infrared technology at a cost point suited to this market. The emergence of low cost microbolometer based infrared cameras, not needing sensor cooling, will greatly increase the accessibility and use of infrared technology for House Doctor inspections. The technology cost for this use is projected to be less than 1 per inspection.

Ion beam collimating grid to reduce added defects

DOEpatents

Lindquist, Walter B.; Kearney, Patrick A.

2003-01-01

A collimating grid for an ion source located after the exit grid. The collimating grid collimates the ion beamlets and disallows beam spread and limits the beam divergence during transients and steady state operation. The additional exit or collimating grid prevents beam divergence during turn-on and turn-off and prevents ions from hitting the periphery of the target where there is re-deposited material or from missing the target and hitting the wall of the vessel where there is deposited material, thereby preventing defects from being deposited on a substrate to be coated. Thus, the addition of a collimating grid to an ion source ensures that the ion beam will hit and be confined to a specific target area.

Illusory words: the roles of attention and of top-down constraints in conjoining letters to form words.

PubMed

Treisman, A; Souther, J

1986-02-01

When attention is divided among four briefly exposed syllables, subjects mistakenly detect targets whose letters are present in the display but in the wrong combinations. These illusory conjunctions are somewhat more frequent when the target is a word and when the distractors are nonwords, but the effects of lexical status are small, and no longer reach significance in free report of the same displays. Search performance is further impaired if the nonwords are unpronounceable consonant strings rather than consonant-vowel-consonant strings, but the decrement is due to missed targets rather than to increased conjunction errors. The results are discussed in relation to feature-integration theory and to current models of word perception.

In need of psychiatric help--leave a message after the beep.

PubMed

Bridler, René; Orosz, Ariane; Cattapan, Katja; Stassen, Hans H

2013-01-01

Every day, a substantial proportion of the general population experiences the distressing and frightening signs of an upcoming psychiatric illness. The consequences can be enormous because severe psychiatric disorders typically cause the loss of the ability to work and often mean a long-term burden for both the patients and their families. Even though most developed countries have an exceptionally high density of general practitioners and psychiatrists in private practice, getting a mental health appointment and seeing a doctor is often very difficult for patients with acute psychiatric symptoms. This study aimed at quantifying the time delay involved in seeking medical attendance when psychiatric disorders begin to develop. Two female actors with well-proven experiences of realistically simulating the clinical presentation of depression and psychotic disorders made systematic phone calls to 106 psychiatrists in private practice and 106 general practitioners (GPs) of the Zurich City area. The actors asked for an appointment at the doctor's earliest convenience due to acute psychiatric symptoms. We assessed (1) the number of phone calls it took to reach each doctor; (2) the time it took to book an appointment; (3) the time span between the first phone call and the earliest available appointment, and (4) the possibility of personal contact with a doctor prior to booking the appointment. A total of 383 phone calls were made by the two actors (227 to psychiatrists and 156 to GPs) which resulted in analyzable data from 102 psychiatrist and 106 GP practices. Two thirds (68%) of the phone calls to the psychiatrists in private practice were answered by voice mail, compared to 21% among the GPs. A personal contact was established with 56% of the psychiatrists and 95% of the GPs. On average, 7.3 phone calls were necessary to successfully book an appointment with a psychiatrist. Almost half of the psychiatrists (45.6%) were not accepting new patients so appointments were able to be booked in less than one third of cases (30.4%). The situation was significantly better with GPs (p < 0.002) but depended on clinical diagnosis (p < 0.01). The waiting time to seeing a psychiatrist often far exceeded 7 days. A high density of psychiatrists in private practice does not necessarily improve the long and troublesome circumstances of obtaining a mental health appointment in acute psychiatric situations. Under these circumstances, a considerable proportion of patients might give up prior to seeing a doctor. This has important implications--many patients could miss the potential benefits from timely therapeutic interventions which can significantly modify both the acute and long-term course of the illness. The situation might be improved if psychiatrists and GPs joined forces in the form of group practices or networks as this would readily ensure (1) a rapid mental health triage by assessing and categorizing the urgency of mental health-related problems, and (2) timely therapeutic interventions whenever indicated. Copyright © 2012 S. Karger AG, Basel.

Memory for found targets interferes with subsequent performance in multiple-target visual search.

PubMed

Cain, Matthew S; Mitroff, Stephen R

2013-10-01

Multiple-target visual searches--when more than 1 target can appear in a given search display--are commonplace in radiology, airport security screening, and the military. Whereas 1 target is often found accurately, additional targets are more likely to be missed in multiple-target searches. To better understand this decrement in 2nd-target detection, here we examined 2 potential forms of interference that can arise from finding a 1st target: interference from the perceptual salience of the 1st target (a now highly relevant distractor in a known location) and interference from a newly created memory representation for the 1st target. Here, we found that removing found targets from the display or making them salient and easily segregated color singletons improved subsequent search accuracy. However, replacing found targets with random distractor items did not improve subsequent search accuracy. Removing and highlighting found targets likely reduced both a target's visual salience and its memory load, whereas replacing a target removed its visual salience but not its representation in memory. Collectively, the current experiments suggest that the working memory load of a found target has a larger effect on subsequent search accuracy than does its perceptual salience. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Treatment cost evaluation of extrauterine gravidity: a literature review of medical and surgical treatment costs.

PubMed

Ebner, Florian; Varga, Dominic; Sorg, Friederike; Vorwerk, Elena; Schochter, Fabienne; Janni, Wolfgang; Wöckel, Achim; DeGregorio, Nikolaus

2015-03-01

The diagnosis of extrauterine pregnancy is possible very early giving the patient and doctors treatment options. As the risks and success rate of medical and surgical treatment are similar, the decision is increasingly influenced by cost-effectiveness. The following article systematically reviews the known literature regarding cost, decision criteria and possible follow-up. Literature review of extrauterine gravity in combination with cost in the online National Library of Medicine since 1.1.1997 following the PRISMA recommendations. Six articles were identified in which the cost of the laparoscopic versus medical treatment is reviewed. In five articles, the medical treatment was shown to be more cost effective and in the sixth article the costs were found to be equal. The cost saving varies between 18 and 88% depending on the consideration of direct and indirect costs. If indirect expenses are considered, the total sum increases with treatment failures. Failure rates are given as up to 27% depending on the type of failure (surgical or medical). These rates seem to be linked indirectly with the β-HCG levels. Predictive parameters for the successful medical treatment are missing. The treatment of small extrauterine gravidities in haemodynamically stable patients (defined by HCG levels <1,500 IU/l) is medically successful and cost-effective. With HCG levels between 1,500 IU/l and 3,000 IU/l, the treatment costs are similar. HCG levels >5,000 IU/l favour the surgical treatment as being more cost-effective. A similar cut-off for the sonographic imaging is missing.

Calculation of Lung Cancer Volume of Target Based on Thorax Computed Tomography Images using Active Contour Segmentation Method for Treatment Planning System

NASA Astrophysics Data System (ADS)

Patra Yosandha, Fiet; Adi, Kusworo; Edi Widodo, Catur

2017-06-01

In this research, calculation process of the lung cancer volume of target based on computed tomography (CT) thorax images was done. Volume of the target calculation was done in purpose to treatment planning system in radiotherapy. The calculation of the target volume consists of gross tumor volume (GTV), clinical target volume (CTV), planning target volume (PTV) and organs at risk (OAR). The calculation of the target volume was done by adding the target area on each slices and then multiply the result with the slice thickness. Calculations of area using of digital image processing techniques with active contour segmentation method. This segmentation for contouring to obtain the target volume. The calculation of volume produced on each of the targets is 577.2 cm3 for GTV, 769.9 cm3 for CTV, 877.8 cm3 for PTV, 618.7 cm3 for OAR 1, 1,162 cm3 for OAR 2 right, and 1,597 cm3 for OAR 2 left. These values indicate that the image processing techniques developed can be implemented to calculate the lung cancer target volume based on CT thorax images. This research expected to help doctors and medical physicists in determining and contouring the target volume quickly and precisely.

Contribution of FDOPA PET to radiotherapy planning for advanced glioma

NASA Astrophysics Data System (ADS)

Dowson, Nicholas; Fay, Michael; Thomas, Paul; Jeffree, Rosalind; McDowall, Robert; Winter, Craig; Coulthard, Alan; Smith, Jye; Gal, Yaniv; Bourgeat, Pierrick; Salvado, Olivier; Crozier, Stuart; Rose, Stephen

2014-03-01

Despite radical treatment with surgery, radiotherapy and chemotherapy, advanced gliomas recur within months. Geographic misses in radiotherapy planning may play a role in this seemingly ineluctable recurrence. Planning is typically performed on post-contrast MRIs, which are known to underreport tumour volume relative to FDOPA PET scans. FDOPA PET fused with contrast enhanced MRI has demonstrated greater sensitivity and specificity than MRI alone. One sign of potential misses would be differences between gross target volumes (GTVs) defined using MRI alone and when fused with PET. This work examined whether such a discrepancy may occur. Materials and Methods: For six patients, a 75 minute PET scan using 3,4-dihydroxy-6-18F-fluoro-L-phynel-alanine (18F-FDOPA) was taken within 2 days of gadolinium enhanced MRI scans. In addition to standard radiotherapy planning by an experienced radiotherapy oncologist, a second gross target volume (GTV) was defined by an experienced nuclear medicine specialist for fused PET and MRI, while blinded to the radiotherapy plans. The volumes from standard radiotherapy planning were compared to the PET defined GTV. Results: The comparison indicated radiotherapy planning would change in several cases if FDOPA PET data was available. PET-defined contours were external to 95% prescribed dose for several patients. However, due to the radiotherapy margins, the discrepancies were relatively small in size and all received a dose of 50 Gray or more. Conclusions: Given the limited size of the discrepancies it is uncertain that geographic misses played a major role in patient outcome. Even so, the existence of discrepancies indicates that FDOPA PET could assist in better defining margins when planning radiotherapy for advanced glioma, which could be important for highly conformal radiotherapy plans.

The Moral Injury Symptom Scale-Military Version.

PubMed

Koenig, Harold G; Ames, Donna; Youssef, Nagy A; Oliver, John P; Volk, Fred; Teng, Ellen J; Haynes, Kerry; Erickson, Zachary D; Arnold, Irina; O'Garo, Keisha; Pearce, Michelle

2018-02-01

The purpose of this study was to develop a multi-dimensional measure of moral injury symptoms that can be used as a primary outcome measure in intervention studies that target moral injury (MI) in Veterans and Active Duty Military with PTSD. This was a multi-center study of 427 Veterans and Active Duty Military with PTSD symptoms recruited from VA Medical Centers in Augusta, Los Angeles, Durham, Houston, and San Antonio, and from Liberty University in Lynchburg. Internal reliability of the Moral Injury Symptom Scale-Military Version (MISS-M) was examined along with factor analytic, discriminant, and convergent validity. Participants were randomly split into two equal samples, with exploratory factor analysis conducted in the first sample and confirmatory factor analysis in the second. Test-retest reliability was assessed in a subsample of 64 Veterans. The 45-item MISS-M consists of 10 theoretically grounded subscales assessing guilt, shame, moral concerns, religious struggles, loss of religious faith/hope, loss of meaning/purpose, difficulty forgiving, loss of trust, and self-condemnation. The Cronbach's alpha of the overall scale was .92 and of individual subscales ranged from .56 to .91. The test-retest reliability was .91 for the total scale and ranged from .78 to .90 for subscales. Discriminant validity was demonstrated by relatively weak correlations with other psychosocial, religious, and physical health constructs, and convergent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms. The MISS-M is a reliable and valid multi-dimensional symptom measure of moral injury that can be used in studies targeting MI in Veterans and Active Duty Military with PTSD symptoms and may also be used by clinicians to identify those at risk.

A stories-based interactive DVD intended to help people with hypertension achieve blood pressure control through improved communication with their doctors.

PubMed

Ashton, Carol M; Houston, Thomas K; Williams, Jessica Hillman; Larkin, Damien; Trobaugh, John; Crenshaw, Katie; Wray, Nelda P

2010-05-01

Our goal was to develop an interactive DVD to help African American and Caucasian American adults with hypertension learn how to become better communicators during medical interactions. Material was to be presented in several formats, including patients' narratives (stories). To develop the narratives we recruited members of the target audience and elicited stories and story units in focus groups, interviews, and seminars. Story units were ranked-ordered based on conformance with the theory of planned behavior and narrative qualities and then melded into cohesive stories. The stories were recounted by actors on the DVD. 55 adults (84% women; 93% African American) participated in a focus group, interview, or seminar; transcripts yielded 120 story units. The most highly rated units were woven into 11 stories. The six highest rated stories/actor-storytellers were selected for presentation on the DVD. We achieved our goal of developing an easy-to-use, story-driven product that may teach adults how to talk effectively with their doctors about hypertension. The DVD's effectiveness should be tested in a randomized trial. Behavioral interventions aimed at improving patients' ability to communicate during doctor visits may be useful adjuncts in the achievement of BP goals. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

[Written pharmaceutical advertising--still unreliable?].

PubMed

Gladsø, Kristin Haugen; Garberg, Hedda Rosland; Spigset, Olav; Slørdal, Lars

2014-09-02

Marketing by the pharmaceutical industry affects doctors' prescribing habits. All pharmaceutical advertising received by nine doctors in two GP offices over a period of three months was collected. The advertising material was sorted by compound. For each compound, the advert with the highest number of references was selected. The cited references were obtained, and the claims in the adverts were assessed in terms of their consistency with the source data based on the provisions in the Norwegian regulations on pharmaceuticals. The references were also assessed with regard to the incidence of conflicts of interest among authors. The doctors received a total of 270 shipments of advertising for 46 different compounds. Altogether 95% of the 173 references cited in the 46 selected adverts could be obtained. The adverts contained a total of 156 claims. Of these, 56% were assessed as correct when compared to the source data and as having clinical relevance. Altogether 75% of the journal articles reported relevant conflicts of interest for the authors. About half the claims in the adverts were found to be correct and clinically relevant. These results concur with those from a methodologically identical study based on advertising material collected in 2004. The cited literature was of varying quality and often funded by the pharmaceutical companies. The findings indicate that the target group should be sceptical of this type of marketing.

A fast ellipse extended target PHD filter using box-particle implementation

NASA Astrophysics Data System (ADS)

Zhang, Yongquan; Ji, Hongbing; Hu, Qi

2018-01-01

This paper presents a box-particle implementation of the ellipse extended target probability hypothesis density (ET-PHD) filter, called the ellipse extended target box particle PHD (EET-BP-PHD) filter, where the extended targets are described as a Poisson model developed by Gilholm et al. and the term "box" is here equivalent to the term "interval" used in interval analysis. The proposed EET-BP-PHD filter is capable of dynamically tracking multiple ellipse extended targets and estimating the target states and the number of targets, in the presence of clutter measurements, false alarms and missed detections. To derive the PHD recursion of the EET-BP-PHD filter, a suitable measurement likelihood is defined for a given partitioning cell, and the main implementation steps are presented along with the necessary box approximations and manipulations. The limitations and capabilities of the proposed EET-BP-PHD filter are illustrated by simulation examples. The simulation results show that a box-particle implementation of the ET-PHD filter can avoid the high number of particles and reduce computational burden, compared to a particle implementation of that for extended target tracking.

Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor-patient communication.

PubMed

Kenny, David A; Veldhuijzen, Wemke; Weijden, Trudy van der; Leblanc, Annie; Lockyer, Jocelyn; Légaré, France; Campbell, Craig

2010-03-01

Doctor-patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters. 2009 Elsevier Ltd. All rights reserved.

[Influence of patients' attitude on doctors' satisfaction with the doctor-patient relationship].

PubMed

Xie, Zheng; Qiu, Ze-qi; Zhang, Tuo-hong

2009-04-18

To describe the doctors' satisfaction of the doctor-patient relationship and find out the influencing factors of the patients, gathering evidence to improve the doctor-patient relationship. This study was a cross-sectional study, in which doctors and nurses in 10 hospitals of Beijing, Shandong and Chongqing were surveyed with structured questionnaires and in-depth interviews. The mean score of the doctors' satisfaction of the doctor-patient relationship was 59.97, which was much lower than the patients'. The patients' socio-demographic characteristics, social economic status (SES) and behavior characteristics influence the interaction of the doctors and the patients. The doctors' satisfaction of the doctor-patient relationship was influenced by the patients' trust. The doctors' perspective is helpful to define the tension and the cause of the doctor-patient relationship. The patients' characteristics have important influence on the doctor-patient relationship. It's necessary to take action on the patients to improve the doctor-patient relationship.

Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions

PubMed Central

Ekstrand, Maria L; Ramakrishna, Jayashree; Bharat, Shalini; Heylen, Elsa

2013-01-01

Introduction HIV stigma inflicts hardship and suffering on people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. Health professionals are often named by PLHIV as an important source of stigma. This study was designed to examine rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India. Methods This cross-sectional study enrolled 305 doctors, 369 nurses and 346 ward staff in both governmental and non-governmental healthcare settings in Mumbai and Bengaluru, India. The approximately one-hour long interviews focused on knowledge related to HIV transmission, personal and professional experiences with PLHIV, instrumental and symbolic stigma, endorsement of coercive policies, and intent to discriminate in professional and personal situations that involve high and low risk of fluid exposure. Results High levels of stigma were reported by all groups. This included a willingness to prohibit female PLHIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs “got what they deserved” (50 to 83%). In addition, 89% of doctors, 88% of nurses and 73% of ward staff stated that they would discriminate against PLHIV in professional situations that involved high likelihood of fluid exposure, and 57% doctors, 40% nurses and 71% ward staff stated that they would do so in low-risk situations as well. Significant and modifiable drivers of stigma and discrimination included having less frequent contact with PLHIV, and a greater number of transmission misconceptions, blame, instrumental and symbolic stigma. Participants in all three groups reported high rates of endorsement of coercive measures and intent to discriminate against PLHIV. Stigma and discrimination were associated with multiple modifiable drivers, which are consistent with previous research, and which need to be targeted in future interventions. Conclusions Stigma reduction intervention programmes targeting healthcare providers in urban India need to address fear of transmission, improve universal precaution skills, and involve PLHIV at all stages of the intervention to reduce symbolic stigma and ensure that relevant patient interaction skills are taught. PMID:24242265

Filling gaps in visual motion for target capture

PubMed Central

Bosco, Gianfranco; Delle Monache, Sergio; Gravano, Silvio; Indovina, Iole; La Scaleia, Barbara; Maffei, Vincenzo; Zago, Myrka; Lacquaniti, Francesco

2015-01-01

A remarkable challenge our brain must face constantly when interacting with the environment is represented by ambiguous and, at times, even missing sensory information. This is particularly compelling for visual information, being the main sensory system we rely upon to gather cues about the external world. It is not uncommon, for example, that objects catching our attention may disappear temporarily from view, occluded by visual obstacles in the foreground. Nevertheless, we are often able to keep our gaze on them throughout the occlusion or even catch them on the fly in the face of the transient lack of visual motion information. This implies that the brain can fill the gaps of missing sensory information by extrapolating the object motion through the occlusion. In recent years, much experimental evidence has been accumulated that both perceptual and motor processes exploit visual motion extrapolation mechanisms. Moreover, neurophysiological and neuroimaging studies have identified brain regions potentially involved in the predictive representation of the occluded target motion. Within this framework, ocular pursuit and manual interceptive behavior have proven to be useful experimental models for investigating visual extrapolation mechanisms. Studies in these fields have pointed out that visual motion extrapolation processes depend on manifold information related to short-term memory representations of the target motion before the occlusion, as well as to longer term representations derived from previous experience with the environment. We will review recent oculomotor and manual interception literature to provide up-to-date views on the neurophysiological underpinnings of visual motion extrapolation. PMID:25755637

Filling gaps in visual motion for target capture.

PubMed

Bosco, Gianfranco; Monache, Sergio Delle; Gravano, Silvio; Indovina, Iole; La Scaleia, Barbara; Maffei, Vincenzo; Zago, Myrka; Lacquaniti, Francesco

2015-01-01

A remarkable challenge our brain must face constantly when interacting with the environment is represented by ambiguous and, at times, even missing sensory information. This is particularly compelling for visual information, being the main sensory system we rely upon to gather cues about the external world. It is not uncommon, for example, that objects catching our attention may disappear temporarily from view, occluded by visual obstacles in the foreground. Nevertheless, we are often able to keep our gaze on them throughout the occlusion or even catch them on the fly in the face of the transient lack of visual motion information. This implies that the brain can fill the gaps of missing sensory information by extrapolating the object motion through the occlusion. In recent years, much experimental evidence has been accumulated that both perceptual and motor processes exploit visual motion extrapolation mechanisms. Moreover, neurophysiological and neuroimaging studies have identified brain regions potentially involved in the predictive representation of the occluded target motion. Within this framework, ocular pursuit and manual interceptive behavior have proven to be useful experimental models for investigating visual extrapolation mechanisms. Studies in these fields have pointed out that visual motion extrapolation processes depend on manifold information related to short-term memory representations of the target motion before the occlusion, as well as to longer term representations derived from previous experience with the environment. We will review recent oculomotor and manual interception literature to provide up-to-date views on the neurophysiological underpinnings of visual motion extrapolation.

An assessment of spacecraft target mode selection methods

NASA Astrophysics Data System (ADS)

Mercer, J. F.; Aglietti, G. S.; Remedia, M.; Kiley, A.

2017-11-01

Coupled Loads Analyses (CLAs), using finite element models (FEMs) of the spacecraft and launch vehicle to simulate critical flight events, are performed in order to determine the dynamic loadings that will be experienced by spacecraft during launch. A validation process is carried out on the spacecraft FEM beforehand to ensure that the dynamics of the analytical model sufficiently represent the behavior of the physical hardware. One aspect of concern is the containment of the FEM correlation and update effort to focus on the vibration modes which are most likely to be excited under test and CLA conditions. This study therefore provides new insight into the prioritization of spacecraft FEM modes for correlation to base-shake vibration test data. The work involved example application to large, unique, scientific spacecraft, with modern FEMs comprising over a million degrees of freedom. This comprehensive investigation explores: the modes inherently important to the spacecraft structures, irrespective of excitation; the particular 'critical modes' which produce peak responses to CLA level excitation; an assessment of several traditional target mode selection methods in terms of ability to predict these 'critical modes'; and an indication of the level of correlation these FEM modes achieve compared to corresponding test data. Findings indicate that, although the traditional methods of target mode selection have merit and are able to identify many of the modes of significance to the spacecraft, there are 'critical modes' which may be missed by conventional application of these methods. The use of different thresholds to select potential target modes from these parameters would enable identification of many of these missed modes. Ultimately, some consideration of the expected excitations is required to predict all modes likely to contribute to the response of the spacecraft in operation.

Abnormal Complex Auditory Pattern Analysis in Schizophrenia Reflected in an Absent Missing Stimulus Mismatch Negativity.

PubMed

Salisbury, Dean F; McCathern, Alexis G

2016-11-01

The simple mismatch negativity (MMN) to tones deviating physically (in pitch, loudness, duration, etc.) from repeated standard tones is robustly reduced in schizophrenia. Although generally interpreted to reflect memory or cognitive processes, simple MMN likely contains some activity from non-adapted sensory cells, clouding what process is affected in schizophrenia. Research in healthy participants has demonstrated that MMN can be elicited by deviations from abstract auditory patterns and complex rules that do not cause sensory adaptation. Whether persons with schizophrenia show abnormalities in the complex MMN is unknown. Fourteen schizophrenia participants and 16 matched healthy underwent EEG recording while listening to 400 groups of 6 tones 330 ms apart, separated by 800 ms. Occasional deviant groups were missing the 4th or 6th tone (50 groups each). Healthy participants generated a robust response to a missing but expected tone. The schizophrenia group was significantly impaired in activating the missing stimulus MMN, generating no significant activity at all. Schizophrenia affects the ability of "primitive sensory intelligence" and pre-attentive perceptual mechanisms to form implicit groups in the auditory environment. Importantly, this deficit must relate to abnormalities in abstract complex pattern analysis rather than sensory problems in the disorder. The results indicate a deficit in parsing of the complex auditory scene which likely impacts negatively on successful social navigation in schizophrenia. Knowledge of the location and circuit architecture underlying the true novelty-related MMN and its pathophysiology in schizophrenia will help target future interventions.

Further dissociating the processes involved in recognition memory: an FMRI study.

PubMed

Henson, Richard N A; Hornberger, Michael; Rugg, Michael D

2005-07-01

Based on an event-related potential study by Rugg et al. [Dissociation of the neural correlates of implicit and explicit memory. Nature, 392, 595-598, 1998], we attempted to isolate the hemodynamic correlates of recollection, familiarity, and implicit memory within a single verbal recognition memory task using event-related fMRI. Words were randomly cued for either deep or shallow processing, and then intermixed with new words for yes/no recognition. The number of studied words was such that, whereas most were recognized ("hits"), an appreciable number of shallow-studied words were not ("misses"). Comparison of deep hits versus shallow hits at test revealed activations in regions including the left inferior parietal gyrus. Comparison of shallow hits versus shallow misses revealed activations in regions including the bilateral intraparietal sulci, the left posterior middle frontal gyrus, and the left frontopolar cortex. Comparison of hits versus correct rejections revealed a relative deactivation in an anterior left medial-temporal region (most likely the perirhinal cortex). Comparison of shallow misses versus correct rejections did not reveal response decreases in any regions expected on the basis of previous imaging studies of priming. Given these and previous data, we associate the left inferior parietal activation with recollection, the left anterior medial-temporal deactivation with familiarity, and the intraparietal and prefrontal responses with target detection. The absence of differences between shallow misses and correct rejections means that the hemodynamic correlates of implicit memory remain unclear.

EAPhy: A Flexible Tool for High-throughput Quality Filtering of Exon-alignments and Data Processing for Phylogenetic Methods.

PubMed

Blom, Mozes P K

2015-08-05

Recently developed molecular methods enable geneticists to target and sequence thousands of orthologous loci and infer evolutionary relationships across the tree of life. Large numbers of genetic markers benefit species tree inference but visual inspection of alignment quality, as traditionally conducted, is challenging with thousands of loci. Furthermore, due to the impracticality of repeated visual inspection with alternative filtering criteria, the potential consequences of using datasets with different degrees of missing data remain nominally explored in most empirical phylogenomic studies. In this short communication, I describe a flexible high-throughput pipeline designed to assess alignment quality and filter exonic sequence data for subsequent inference. The stringency criteria for alignment quality and missing data can be adapted based on the expected level of sequence divergence. Each alignment is automatically evaluated based on the stringency criteria specified, significantly reducing the number of alignments that require visual inspection. By developing a rapid method for alignment filtering and quality assessment, the consistency of phylogenetic estimation based on exonic sequence alignments can be further explored across distinct inference methods, while accounting for different degrees of missing data.

Metabolic pathway reconstruction of eugenol to vanillin bioconversion in Aspergillus niger

PubMed Central

Srivastava, Suchita; Luqman, Suaib; Khan, Feroz; Chanotiya, Chandan S; Darokar, Mahendra P

2010-01-01

Identification of missing genes or proteins participating in the metabolic pathways as enzymes are of great interest. One such class of pathway is involved in the eugenol to vanillin bioconversion. Our goal is to develop an integral approach for identifying the topology of a reference or known pathway in other organism. We successfully identify the missing enzymes and then reconstruct the vanillin biosynthetic pathway in Aspergillus niger. The procedure combines enzyme sequence similarity searched through BLAST homology search and orthologs detection through COG & KEGG databases. Conservation of protein domains and motifs was searched through CDD, PFAM & PROSITE databases. Predictions regarding how proteins act in pathway were validated experimentally and also compared with reported data. The bioconversion of vanillin was screened on UV-TLC plates and later confirmed through GC and GC-MS techniques. We applied a procedure for identifying missing enzymes on the basis of conserved functional motifs and later reconstruct the metabolic pathway in target organism. Using the vanillin biosynthetic pathway of Pseudomonas fluorescens as a case study, we indicate how this approach can be used to reconstruct the reference pathway in A. niger and later results were experimentally validated through chromatography and spectroscopy techniques. PMID:20978605

Search for long-lived, massive particles in events with displaced vertices and missing transverse momentum in s = 13 TeV p p collisions with the ATLAS detector

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

Aaboud, M.; Aad, G.; Abbott, B.

A search for long-lived, massive particles predicted by many theories beyond the Standard Model is presented. Here, the search targets final states with large missing transverse momentum and at least one high-mass displaced vertex with five or more tracks, and uses 32.8 fb -1 of √ s = 13 TeV pp collision data collected by the ATLAS detector at the LHC. The observed yield is consistent with the expected background. The results are used to extract 95% C.L. exclusion limits on the production of long-lived gluinos with masses up to 2.37 TeV and lifetimes of O (10 - 2) -more » O (10) ns in a simplified model inspired by split supersymmetry.« less

Search for long-lived, massive particles in events with displaced vertices and missing transverse momentum in s = 13 TeV p p collisions with the ATLAS detector

DOE PAGES

Aaboud, M.; Aad, G.; Abbott, B.; ...

2018-03-28

A search for long-lived, massive particles predicted by many theories beyond the Standard Model is presented. Here, the search targets final states with large missing transverse momentum and at least one high-mass displaced vertex with five or more tracks, and uses 32.8 fb -1 of √ s = 13 TeV pp collision data collected by the ATLAS detector at the LHC. The observed yield is consistent with the expected background. The results are used to extract 95% C.L. exclusion limits on the production of long-lived gluinos with masses up to 2.37 TeV and lifetimes of O (10 - 2) -more » O (10) ns in a simplified model inspired by split supersymmetry.« less

Missing-mass spectroscopy of the 12C(p ,d ) reaction near the η'-meson production threshold

NASA Astrophysics Data System (ADS)

Tanaka, Y. K.; Itahashi, K.; Fujioka, H.; Ayyad, Y.; Benlliure, J.; Brinkmann, K.-T.; Friedrich, S.; Geissel, H.; Gellanki, J.; Guo, C.; Gutz, E.; Haettner, E.; Harakeh, M. N.; Hayano, R. S.; Higashi, Y.; Hirenzaki, S.; Hornung, C.; Igarashi, Y.; Ikeno, N.; Iwasaki, M.; Jido, D.; Kalantar-Nayestanaki, N.; Kanungo, R.; Knöbel, R.; Kurz, N.; Metag, V.; Mukha, I.; Nagae, T.; Nagahiro, H.; Nanova, M.; Nishi, T.; Ong, H. J.; Pietri, S.; Prochazka, A.; Rappold, C.; Reiter, M. P.; Rodríguez-Sánchez, J. L.; Scheidenberger, C.; Simon, H.; Sitar, B.; Strmen, P.; Sun, B.; Suzuki, K.; Szarka, I.; Takechi, M.; Tanihata, I.; Terashima, S.; Watanabe, Y. N.; Weick, H.; Widmann, E.; Winfield, J. S.; Xu, X.; Yamakami, H.; Zhao, J.; η-PRiME/Super-FRS Collaboration

2018-01-01

Excitation-energy spectra of 11C nuclei near the η'-meson production threshold have been measured by missing-mass spectroscopy using the 12C(p ,d ) reaction. A carbon target has been irradiated with a 2.5 GeV proton beam supplied by the synchrotron SIS-18 at GSI to produce η'-meson bound states in 11C nuclei. Deuterons emitted at 0∘ in the reaction have been momentum analyzed by the fragment separator (FRS), used as a high-resolution spectrometer. No distinct structure due to the formation of η'-mesic states is observed although a high statistical sensitivity is achieved in the experimental spectra. Upper limits on the formation cross sections of η'-mesic states are determined, and thereby a constraint imposed on the η'-nucleus interaction is discussed.

Orexin: a Missing Link Between Sleep Disorders and Heart Failure?

PubMed

Pan, Stephen; Cabral, Carolina S; Ashley, Euan A; Perez, Marco V

2017-04-01

Sleep disorders represent a significant comorbidity in the heart failure population, and there is mounting evidence that treatment of sleep disorders such as obstructive sleep apnea can significantly improve cardiac function. However, the link between these two disorders is still not entirely clear. Recently, a novel neurohormonal pathway has been elucidated involving signaling molecules now collectively known as the orexins, which have been implicated in regulating autonomic function during sleep/wake cycles. Further evidence has mounted that orexin signaling is deeply perturbed in the setting of sleep disorders, and furthermore that abnormal orexin signaling may be implicated in the pathology of heart failure. The orexin signaling pathway represents an enticing novel target for both the treatment of sleep disorders as well as heart failure, and may represent one facet of the "missing link" between these two prevalent and often comorbid diseases.

Search for long-lived, massive particles in events with displaced vertices and missing transverse momentum in √{s }=13 TeV p p collisions with the ATLAS detector

NASA Astrophysics Data System (ADS)

Aaboud, M.; Aad, G.; Abbott, B.; Abdinov, O.; Abeloos, B.; Abidi, S. H.; Abouzeid, O. S.; Abraham, N. L.; Abramowicz, H.; Abreu, H.; Abreu, R.; Abulaiti, Y.; Acharya, B. S.; Adachi, S.; Adamczyk, L.; Adelman, J.; Adersberger, M.; Adye, T.; Affolder, A. A.; Agatonovic-Jovin, T.; Agheorghiesei, C.; Aguilar-Saavedra, J. A.; Ahlen, S. P.; Ahmadov, F.; Aielli, G.; Akatsuka, S.; Akerstedt, H.; Åkesson, T. P. A.; Akilli, E.; Akimov, A. V.; Alberghi, G. L.; Albert, J.; Albicocco, P.; Alconada Verzini, M. J.; Alderweireldt, S. C.; Aleksa, M.; Aleksandrov, I. N.; Alexa, C.; Alexander, G.; Alexopoulos, T.; Alhroob, M.; Ali, B.; Aliev, M.; Alimonti, G.; Alison, J.; Alkire, S. P.; Allbrooke, B. M. M.; Allen, B. W.; Allport, P. P.; Aloisio, A.; Alonso, A.; Alonso, F.; Alpigiani, C.; Alshehri, A. A.; Alstaty, M. I.; Alvarez Gonzalez, B.; Álvarez Piqueras, D.; Alviggi, M. G.; Amadio, B. T.; Amaral Coutinho, Y.; Amelung, C.; Amidei, D.; Amor Dos Santos, S. P.; Amorim, A.; Amoroso, S.; Amundsen, G.; Anastopoulos, C.; Ancu, L. S.; Andari, N.; Andeen, T.; Anders, C. F.; Anders, J. K.; Anderson, K. J.; Andreazza, A.; Andrei, V.; Angelidakis, S.; Angelozzi, I.; Angerami, A.; Anisenkov, A. V.; Anjos, N.; Annovi, A.; Antel, C.; Antonelli, M.; Antonov, A.; Antrim, D. J.; Anulli, F.; Aoki, M.; Aperio Bella, L.; Arabidze, G.; Arai, Y.; Araque, J. P.; Araujo Ferraz, V.; Arce, A. T. H.; Ardell, R. E.; Arduh, F. A.; Arguin, J.-F.; Argyropoulos, S.; Arik, M.; Armbruster, A. J.; Armitage, L. J.; Arnaez, O.; Arnold, H.; Arratia, M.; Arslan, O.; Artamonov, A.; Artoni, G.; Artz, S.; Asai, S.; Asbah, N.; Ashkenazi, A.; Asquith, L.; Assamagan, K.; Astalos, R.; Atkinson, M.; Atlay, N. B.; Augsten, K.; Avolio, G.; Axen, B.; Ayoub, M. K.; Azuelos, G.; Baas, A. E.; Baca, M. J.; Bachacou, H.; Bachas, K.; Backes, M.; Backhaus, M.; Bagnaia, P.; Bahmani, M.; Bahrasemani, H.; Baines, J. T.; Bajic, M.; Baker, O. K.; Baldin, E. M.; Balek, P.; Balli, F.; Balunas, W. K.; Banas, E.; Bandyopadhyay, A.; Banerjee, Sw.; Bannoura, A. A. E.; Barak, L.; Barberio, E. L.; Barberis, D.; Barbero, M.; Barillari, T.; Barisits, M.-S.; Barkeloo, J. T.; Barklow, T.; Barlow, N.; Barnes, S. L.; Barnett, B. M.; Barnett, R. M.; Barnovska-Blenessy, Z.; Baroncelli, A.; Barone, G.; Barr, A. J.; Barranco Navarro, L.; Barreiro, F.; Barreiro Guimarães da Costa, J.; Bartoldus, R.; Barton, A. E.; Bartos, P.; Basalaev, A.; Bassalat, A.; Bates, R. L.; Batista, S. J.; Batley, J. R.; Battaglia, M.; Bauce, M.; Bauer, F.; Bawa, H. S.; Beacham, J. B.; Beattie, M. D.; Beau, T.; Beauchemin, P. H.; Bechtle, P.; Beck, H. P.; Beck, H. C.; Becker, K.; Becker, M.; Beckingham, M.; Becot, C.; Beddall, A. J.; Beddall, A.; Bednyakov, V. A.; Bedognetti, M.; Bee, C. P.; Beermann, T. A.; Begalli, M.; Begel, M.; Behr, J. K.; Bell, A. S.; Bella, G.; Bellagamba, L.; Bellerive, A.; Bellomo, M.; Belotskiy, K.; Beltramello, O.; Belyaev, N. L.; Benary, O.; Benchekroun, D.; Bender, M.; Bendtz, K.; Benekos, N.; Benhammou, Y.; Benhar Noccioli, E.; Benitez, J.; Benjamin, D. P.; Benoit, M.; Bensinger, J. R.; Bentvelsen, S.; Beresford, L.; Beretta, M.; Berge, D.; Bergeaas Kuutmann, E.; Berger, N.; Beringer, J.; Berlendis, S.; Bernard, N. R.; Bernardi, G.; Bernius, C.; Bernlochner, F. U.; Berry, T.; Berta, P.; Bertella, C.; Bertoli, G.; Bertolucci, F.; Bertram, I. A.; Bertsche, C.; Bertsche, D.; Besjes, G. J.; Bessidskaia Bylund, O.; Bessner, M.; Besson, N.; Betancourt, C.; Bethani, A.; Bethke, S.; Bevan, A. J.; Beyer, J.; Bianchi, R. M.; Biebel, O.; Biedermann, D.; Bielski, R.; Bierwagen, K.; Biesuz, N. V.; Biglietti, M.; Billoud, T. R. V.; Bilokon, H.; Bindi, M.; Bingul, A.; Bini, C.; Biondi, S.; Bisanz, T.; Bittrich, C.; Bjergaard, D. M.; Black, C. W.; Black, J. E.; Black, K. M.; Blair, R. E.; Blazek, T.; Bloch, I.; Blocker, C.; Blue, A.; Blum, W.; Blumenschein, U.; Blunier, S.; Bobbink, G. J.; Bobrovnikov, V. S.; Bocchetta, S. S.; Bocci, A.; Bock, C.; Boehler, M.; Boerner, D.; Bogavac, D.; Bogdanchikov, A. G.; Bohm, C.; Boisvert, V.; Bokan, P.; Bold, T.; Boldyrev, A. S.; Bolz, A. E.; Bomben, M.; Bona, M.; Boonekamp, M.; Borisov, A.; Borissov, G.; Bortfeldt, J.; Bortoletto, D.; Bortolotto, V.; Boscherini, D.; Bosman, M.; Bossio Sola, J. D.; Boudreau, J.; Bouffard, J.; Bouhova-Thacker, E. V.; Boumediene, D.; Bourdarios, C.; Boutle, S. K.; Boveia, A.; Boyd, J.; Boyko, I. R.; Bracinik, J.; Brandt, A.; Brandt, G.; Brandt, O.; Bratzler, U.; Brau, B.; Brau, J. E.; Breaden Madden, W. D.; Brendlinger, K.; Brennan, A. J.; Brenner, L.; Brenner, R.; Bressler, S.; Briglin, D. L.; Bristow, T. M.; Britton, D.; Britzger, D.; Brochu, F. M.; Brock, I.; Brock, R.; Brooijmans, G.; Brooks, T.; Brooks, W. K.; Brosamer, J.; Brost, E.; Broughton, J. H.; Bruckman de Renstrom, P. A.; Bruncko, D.; Bruni, A.; Bruni, G.; Bruni, L. S.; Brunt, Bh; Bruschi, M.; Bruscino, N.; Bryant, P.; Bryngemark, L.; Buanes, T.; Buat, Q.; Buchholz, P.; Buckley, A. G.; Budagov, I. A.; Buehrer, F.; Bugge, M. K.; Bulekov, O.; Bullock, D.; Burch, T. J.; Burdin, S.; Burgard, C. D.; Burger, A. M.; Burghgrave, B.; Burka, K.; Burke, S.; Burmeister, I.; Burr, J. T. P.; Busato, E.; Büscher, D.; Büscher, V.; Bussey, P.; Butler, J. M.; Buttar, C. M.; Butterworth, J. M.; Butti, P.; Buttinger, W.; Buzatu, A.; Buzykaev, A. R.; Cabrera Urbán, S.; Caforio, D.; Cairo, V. M.; Cakir, O.; Calace, N.; Calafiura, P.; Calandri, A.; Calderini, G.; Calfayan, P.; Callea, G.; Caloba, L. P.; Calvente Lopez, S.; Calvet, D.; Calvet, S.; Calvet, T. P.; Camacho Toro, R.; Camarda, S.; Camarri, P.; Cameron, D.; Caminal Armadans, R.; Camincher, C.; Campana, S.; Campanelli, M.; Camplani, A.; Campoverde, A.; Canale, V.; Cano Bret, M.; Cantero, J.; Cao, T.; Capeans Garrido, M. D. M.; Caprini, I.; Caprini, M.; Capua, M.; Carbone, R. M.; Cardarelli, R.; Cardillo, F.; Carli, I.; Carli, T.; Carlino, G.; Carlson, B. T.; Carminati, L.; Carney, R. M. D.; Caron, S.; Carquin, E.; Carrá, S.; Carrillo-Montoya, G. D.; Carvalho, J.; Casadei, D.; Casado, M. P.; Casolino, M.; Casper, D. W.; Castelijn, R.; Castillo Gimenez, V.; Castro, N. F.; Catinaccio, A.; Catmore, J. R.; Cattai, A.; Caudron, J.; Cavaliere, V.; Cavallaro, E.; Cavalli, D.; Cavalli-Sforza, M.; Cavasinni, V.; Celebi, E.; Ceradini, F.; Cerda Alberich, L.; Cerqueira, A. S.; Cerri, A.; Cerrito, L.; Cerutti, F.; Cervelli, A.; Cetin, S. A.; Chafaq, A.; Chakraborty, D.; Chan, S. K.; Chan, W. S.; Chan, Y. L.; Chang, P.; Chapman, J. D.; Charlton, D. G.; Chau, C. C.; Chavez Barajas, C. A.; Che, S.; Cheatham, S.; Chegwidden, A.; Chekanov, S.; Chekulaev, S. V.; Chelkov, G. A.; Chelstowska, M. A.; Chen, C.; Chen, H.; Chen, J.; Chen, S.; Chen, S.; Chen, X.; Chen, Y.; Cheng, H. C.; Cheng, H. 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M.; Veloso, F.; Veneziano, S.; Ventura, A.; Venturi, M.; Venturi, N.; Venturini, A.; Vercesi, V.; Verducci, M.; Verkerke, W.; Vermeulen, A. T.; Vermeulen, J. C.; Vetterli, M. C.; Viaux Maira, N.; Viazlo, O.; Vichou, I.; Vickey, T.; Vickey Boeriu, O. E.; Viehhauser, G. H. A.; Viel, S.; Vigani, L.; Villa, M.; Villaplana Perez, M.; Vilucchi, E.; Vincter, M. G.; Vinogradov, V. B.; Vishwakarma, A.; Vittori, C.; Vivarelli, I.; Vlachos, S.; Vogel, M.; Vokac, P.; Volpi, G.; von der Schmitt, H.; von Toerne, E.; Vorobel, V.; Vorobev, K.; Vos, M.; Voss, R.; Vossebeld, J. H.; Vranjes, N.; Vranjes Milosavljevic, M.; Vrba, V.; Vreeswijk, M.; Vuillermet, R.; Vukotic, I.; Wagner, P.; Wagner, W.; Wagner-Kuhr, J.; Wahlberg, H.; Wahrmund, S.; Wakabayashi, J.; Walder, J.; Walker, R.; Walkowiak, W.; Wallangen, V.; Wang, C.; Wang, C.; Wang, F.; Wang, H.; Wang, H.; Wang, J.; Wang, J.; Wang, Q.; Wang, R.; Wang, S. M.; Wang, T.; Wang, W.; Wang, W.; Wang, Z.; Wanotayaroj, C.; Warburton, A.; Ward, C. P.; Wardrope, D. R.; Washbrook, A.; Watkins, P. M.; Watson, A. T.; Watson, M. F.; Watts, G.; Watts, S.; Waugh, B. M.; Webb, A. F.; Webb, S.; Weber, M. S.; Weber, S. W.; Weber, S. A.; Webster, J. S.; Weidberg, A. R.; Weinert, B.; Weingarten, J.; Weirich, M.; Weiser, C.; Weits, H.; Wells, P. S.; Wenaus, T.; Wengler, T.; Wenig, S.; Wermes, N.; Werner, M. D.; Werner, P.; Wessels, M.; Weston, T. D.; Whalen, K.; Whallon, N. L.; Wharton, A. M.; White, A. S.; White, A.; White, M. J.; White, R.; Whiteson, D.; Whitmore, B. W.; Wickens, F. J.; Wiedenmann, W.; Wielers, M.; Wiglesworth, C.; Wiik-Fuchs, L. A. M.; Wildauer, A.; Wilk, F.; Wilkens, H. G.; Williams, H. H.; Williams, S.; Willis, C.; Willocq, S.; Wilson, J. A.; Wingerter-Seez, I.; Winkels, E.; Winklmeier, F.; Winston, O. J.; Winter, B. T.; Wittgen, M.; Wobisch, M.; Wolf, T. M. H.; Wolff, R.; Wolter, M. W.; Wolters, H.; Wong, V. W. S.; Worm, S. D.; Wosiek, B. K.; Wotschack, J.; Wozniak, K. W.; Wu, M.; Wu, S. L.; Wu, X.; Wu, Y.; Wyatt, T. R.; Wynne, B. M.; Xella, S.; Xi, Z.; Xia, L.; Xu, D.; Xu, L.; Xu, T.; Yabsley, B.; Yacoob, S.; Yamaguchi, D.; Yamaguchi, Y.; Yamamoto, A.; Yamamoto, S.; Yamanaka, T.; Yamatani, M.; Yamauchi, K.; Yamazaki, Y.; Yan, Z.; Yang, H.; Yang, H.; Yang, Y.; Yang, Z.; Yao, W.-M.; Yap, Y. C.; Yasu, Y.; Yatsenko, E.; Yau Wong, K. H.; Ye, J.; Ye, S.; Yeletskikh, I.; Yigitbasi, E.; Yildirim, E.; Yorita, K.; Yoshihara, K.; Young, C.; Young, C. J. S.; Yu, J.; Yu, J.; Yuen, S. P. Y.; Yusuff, I.; Zabinski, B.; Zacharis, G.; Zaidan, R.; Zaitsev, A. M.; Zakharchuk, N.; Zalieckas, J.; Zaman, A.; Zambito, S.; Zanzi, D.; Zeitnitz, C.; Zemaityte, G.; Zemla, A.; Zeng, J. C.; Zeng, Q.; Zenin, O.; Ženiš, T.; Zerwas, D.; Zhang, D.; Zhang, F.; Zhang, G.; Zhang, H.; Zhang, J.; Zhang, L.; Zhang, L.; Zhang, M.; Zhang, P.; Zhang, R.; Zhang, R.; Zhang, X.; Zhang, Y.; Zhang, Z.; Zhao, X.; Zhao, Y.; Zhao, Z.; Zhemchugov, A.; Zhou, B.; Zhou, C.; Zhou, L.; Zhou, M.; Zhou, M.; Zhou, N.; Zhu, C. G.; Zhu, H.; Zhu, J.; Zhu, Y.; Zhuang, X.; Zhukov, K.; Zibell, A.; Zieminska, D.; Zimine, N. I.; Zimmermann, C.; Zimmermann, S.; Zinonos, Z.; Zinser, M.; Ziolkowski, M.; Živković, L.; Zobernig, G.; Zoccoli, A.; Zou, R.; Zur Nedden, M.; Zwalinski, L.; Atlas Collaboration

2018-03-01

A search for long-lived, massive particles predicted by many theories beyond the Standard Model is presented. The search targets final states with large missing transverse momentum and at least one high-mass displaced vertex with five or more tracks, and uses 32.8 fb-1 of √{s }=13 TeV p p collision data collected by the ATLAS detector at the LHC. The observed yield is consistent with the expected background. The results are used to extract 95% C.L. exclusion limits on the production of long-lived gluinos with masses up to 2.37 TeV and lifetimes of O (10-2)-O (10 ) ns in a simplified model inspired by split supersymmetry.

Distractor Devaluation Effect in the Attentional Blink: Direct Evidence for Distractor Inhibition

ERIC Educational Resources Information Center

Kihara, Ken; Yagi, Yoshihiko; Takeda, Yuji; Kawahara, Jun I.

2011-01-01

When two targets (T1 and T2) are embedded in rapid serial visual presentation (RSVP), T2 is often missed (attentional blink, AB) if T2 follows T1 by less than 500 ms. Some have proposed that inhibition of a distractor following T1 contributes to the AB, but no direct evidence supports this proposal. This study examined distractor inhibition by…

Missing "Links" in Bioinformatics Education: Expanding Students' Conceptions of Bioinformatics Using a Biodiversity Database of Living and Fossil Reef Corals

ERIC Educational Resources Information Center

Nehm, Ross H.; Budd, Ann F.

2006-01-01

NMITA is a reef coral biodiversity database that we use to introduce students to the expansive realm of bioinformatics beyond genetics. We introduce a series of lessons that have students use this database, thereby accessing real data that can be used to test hypotheses about biodiversity and evolution while targeting the "National Science …

Hospitals as budget target. Bush's proposed budget has hospitals crying foul over a 'savings' plan that reduces Medicare, Medicaid funding by $200 billion.

PubMed

Lubell, Jennifer

2008-02-11

President Bush's fiscal 2009 budget proposal comes equipped with $200 billion in Medicare and Medicaid savings. While the Bush administration deems the figure necessary to ensure the programs remain solvent, hospitals are crying foul. Michael Connelly, left, president and CEO of Catholic Healthcare Partners, said Bush's budget proposal "fundamentally missed the point."

Operation Facelift: Cover Makeovers Can Be the Fountain of Youth for Many Titles

ERIC Educational Resources Information Center

Jones, Leigh Ann

2009-01-01

Aging covers and those that miss their mark and lead to sluggish sales are often targeted for makeovers, many times with good results. Up to 75 percent of Viking's books get redesigned, says Assistant Art Director Jim Hoover, because the publisher sees it as a chance to reintroduce a book to the market. Makeovers are considered the fountain of…

A mass assembly of associative mechanisms: a dynamical systems account of natural social interaction.

PubMed

Duran, Nicholas D; Dale, Rick; Richardson, Daniel C

2014-04-01

The target article offers a negative, eliminativist thesis, dissolving the specialness of mirroring processes into a solution of associative mechanisms. We support the authors' project enthusiastically. What they are currently missing, we argue, is a positive, generative thesis about associative learning mechanisms and how they might give way to the complex, multimodal coordination that naturally arises in social interaction.

Fitness and Independence after SCI: Defining Meaningful Change and Thresholds

DTIC Science & Technology

2017-10-01

would you prefer to get this report from a health care provider, like a Doctor or Physical Therapist, or would you prefer to be able to get this...month. Lack of participant transportation and cancellations secondary to health issues are the primary barriers. MIA has over N=200 screen passes. The...3 update: Accrual rates at both centers are below target secondary to participation barriers, primarily transportation and short term health issues

Early Detection of Prostate Cancer with New Nanoparticle Based UltrasoundContrast Agents Targeted to PSMA

DTIC Science & Technology

2017-08-01

biodistribution studies with FMT, ultrasound imaging and ex vivo tissue analysis (months 10-14) 2d. Measure bubble dynamic parameters (months 10-14) 1...doctoral training studying post -transcriptional gene regulation National Institutes of Health-NICHD, Bethesda, MD Postdoctoral Fellow 02/1996 IRTA...and manage these studies . My research career has been hybrid consisting of experience in the biotech industry in addition to my academic position

Particle Beam Tracker for an Accelerating Target.

DTIC Science & Technology

1985-12-01

previous efforts by Captain David Meer in his Doctoral Dissertation and Lieutenants William Zicker and Bill Moose in their Master’s theses. Specifically...detection and position esti- mation in hand, the problem of beam control can now be addressed. In 1983, ILt William Zicker , in his master’s thesis...beam controller. Another problem studied by Zicker was how to limit the size of the * Meer filter, which grows with each new realization on the

Novel Array-Based Target Identification for Synergistic Sensitization of Breast Cancer to Herceptin

DTIC Science & Technology

2010-05-01

Tatsuya Azum, Eileen Adamson, Ryan Alipio, Becky Pio, Frank Jones, Dan Mercola. Chip- on- chip analysis of mechanism of action of HER2 inhibition in...Munawar, Kutbuddin S. Doctor, Michael Birrer, Michael McClelland, Eileen Adamson, Dan Mercola. Egr1 regulates the coordinated expression of numerous...Kemal Korkmaz, Mashide Ohmichi, Eileen Adamson, Michael McClelland, Dan Mercola. Identification of genes bound and regulated by ATF2/c-Jun

A signal detection approach to patient-doctor communication and doctor-shopping behaviour among Japanese patients.

PubMed

Hagihara, Akihito; Tarumi, Kimio; Odamaki, Misato; Nobutomo, Koichi

2005-12-01

As one of the factors related to doctor-shopping behaviour (i.e. consulting multiple doctors with regard to the same illness episode), very little has been revealed about the role of doctor explanation. We examined therefore the association between doctor explanation and doctor-shopping behaviour. The subjects were internist-patient pairs in Japan. Signal detection analysis (SDA) was used for the data analysis. Of the 303 patients, 84 patients engaged in doctor shopping (27.7%). The following results were obtained: (1) of the 19 relevant variables, the 'level of doctor explanation: treatment' was the most significant predictor of doctor-shopping behaviour (P < 0.01), and (2) with regard to their subjective evaluations of the sufficiency of their explanations about treatment or testing, the evaluations of the doctors, rather than those of the patient, were significant predictors of doctor-shopping behaviour. These results imply the following: (1) a patient's inability to understand a doctor's explanation about treatment, which results from a large gap between the perceptions of the patient and those of the doctor, is the most significant predictor of doctor-shopping behaviour, and (2) in the context of favourable patient-doctor interactions, when doctors feel their explanations are insufficient, they may be able to prevent doctor-shopping behaviour by providing relatively thorough explanations about treatment.

University strategy for doctoral training: the Ghent University Doctoral Schools.

PubMed

Bracke, N; Moens, L

2010-01-01

The Doctoral Schools at Ghent University have a three-fold mission: (1) to provide support to doctoral students during their doctoral research, (2) to foster a quality culture in (doctoral) research, (3) to promote the international and social stature and prestige of the doctorate vis-a-vis potential researchers and the potential labour market. The Doctoral Schools offer top-level specialized courses and transferable skills training to doctoral students as part of their doctoral training programme. They establish mechanisms of quality assurance in doctoral research. The Doctoral Schools initialize and support initiatives of internationalization. They also organize information sessions, promotional events and interaction with the labour market, and as such keep a finger on the pulse of external stakeholders.

How Should Genes and Taxa be Sampled for Phylogenomic Analyses with Missing Data? An Empirical Study in Iguanian Lizards.

PubMed

Streicher, Jeffrey W; Schulte, James A; Wiens, John J

2016-01-01

Targeted sequence capture is becoming a widespread tool for generating large phylogenomic data sets to address difficult phylogenetic problems. However, this methodology often generates data sets in which increasing the number of taxa and loci increases amounts of missing data. Thus, a fundamental (but still unresolved) question is whether sampling should be designed to maximize sampling of taxa or genes, or to minimize the inclusion of missing data cells. Here, we explore this question for an ancient, rapid radiation of lizards, the pleurodont iguanians. Pleurodonts include many well-known clades (e.g., anoles, basilisks, iguanas, and spiny lizards) but relationships among families have proven difficult to resolve strongly and consistently using traditional sequencing approaches. We generated up to 4921 ultraconserved elements with sampling strategies including 16, 29, and 44 taxa, from 1179 to approximately 2.4 million characters per matrix and approximately 30% to 60% total missing data. We then compared mean branch support for interfamilial relationships under these 15 different sampling strategies for both concatenated (maximum likelihood) and species tree (NJst) approaches (after showing that mean branch support appears to be related to accuracy). We found that both approaches had the highest support when including loci with up to 50% missing taxa (matrices with ~40-55% missing data overall). Thus, our results show that simply excluding all missing data may be highly problematic as the primary guiding principle for the inclusion or exclusion of taxa and genes. The optimal strategy was somewhat different for each approach, a pattern that has not been shown previously. For concatenated analyses, branch support was maximized when including many taxa (44) but fewer characters (1.1 million). For species-tree analyses, branch support was maximized with minimal taxon sampling (16) but many loci (4789 of 4921). We also show that the choice of these sampling strategies can be critically important for phylogenomic analyses, since some strategies lead to demonstrably incorrect inferences (using the same method) that have strong statistical support. Our preferred estimate provides strong support for most interfamilial relationships in this important but phylogenetically challenging group. © The Author(s) 2015. Published by Oxford University Press, on behalf of the Society of Systematic Biologists. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Linking Proteomic and Transcriptional Data through the Interactome and Epigenome Reveals a Map of Oncogene-induced Signaling

PubMed Central

Huang, Shao-shan Carol; Clarke, David C.; Gosline, Sara J. C.; Labadorf, Adam; Chouinard, Candace R.; Gordon, William; Lauffenburger, Douglas A.; Fraenkel, Ernest

2013-01-01

Cellular signal transduction generally involves cascades of post-translational protein modifications that rapidly catalyze changes in protein-DNA interactions and gene expression. High-throughput measurements are improving our ability to study each of these stages individually, but do not capture the connections between them. Here we present an approach for building a network of physical links among these data that can be used to prioritize targets for pharmacological intervention. Our method recovers the critical missing links between proteomic and transcriptional data by relating changes in chromatin accessibility to changes in expression and then uses these links to connect proteomic and transcriptome data. We applied our approach to integrate epigenomic, phosphoproteomic and transcriptome changes induced by the variant III mutation of the epidermal growth factor receptor (EGFRvIII) in a cell line model of glioblastoma multiforme (GBM). To test the relevance of the network, we used small molecules to target highly connected nodes implicated by the network model that were not detected by the experimental data in isolation and we found that a large fraction of these agents alter cell viability. Among these are two compounds, ICG-001, targeting CREB binding protein (CREBBP), and PKF118–310, targeting β-catenin (CTNNB1), which have not been tested previously for effectiveness against GBM. At the level of transcriptional regulation, we used chromatin immunoprecipitation sequencing (ChIP-Seq) to experimentally determine the genome-wide binding locations of p300, a transcriptional co-regulator highly connected in the network. Analysis of p300 target genes suggested its role in tumorigenesis. We propose that this general method, in which experimental measurements are used as constraints for building regulatory networks from the interactome while taking into account noise and missing data, should be applicable to a wide range of high-throughput datasets. PMID:23408876

Overcoming hurdles in translating visual search research between the lab and the field.

PubMed

Clark, Kait; Cain, Matthew S; Adamo, Stephen H; Mitroff, Stephen R

2012-01-01

Research in visual search can be vital to improving performance in careers such as radiology and airport security screening. In these applied, or "field," searches, accuracy is critical, and misses are potentially fatal; however, despite the importance of performing optimally, radiological and airport security searches are nevertheless flawed. Extensive basic research in visual search has revealed cognitive mechanisms responsible for successful visual search as well as a variety of factors that tend to inhibit or improve performance. Ideally, the knowledge gained from such laboratory-based research could be directly applied to field searches, but several obstacles stand in the way of straightforward translation; the tightly controlled visual searches performed in the lab can be drastically different from field searches. For example, they can differ in terms of the nature of the stimuli, the environment in which the search is taking place, and the experience and characteristics of the searchers themselves. The goal of this chapter is to discuss these differences and how they can present hurdles to translating lab-based research to field-based searches. Specifically, most search tasks in the lab entail searching for only one target per trial, and the targets occur relatively frequently, but field searches may contain an unknown and unlimited number of targets, and the occurrence of targets can be rare. Additionally, participants in lab-based search experiments often perform under neutral conditions and have no formal training or experience in search tasks; conversely, career searchers may be influenced by the motivation to perform well or anxiety about missing a target, and they have undergone formal training and accumulated significant experience searching. This chapter discusses recent work that has investigated the impacts of these differences to determine how each factor can influence search performance. Knowledge gained from the scientific exploration of search can be applied to field searches but only when considering and controlling for the differences between lab and field.

UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender, ethnicity and disability.

PubMed

Lambert, Trevor; Surman, Geraldine; Goldacre, Michael

2014-10-01

To seek doctors' views about the NHS as an employer, our surveys about doctors' career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good 'equal opportunities' employer for women doctors, doctors from ethnic minority groups and doctors with disabilities. Surveys undertaken in the UK by mail and Internet. UK medical graduates in selected graduation years between 1993 and 2012. Respondents were asked to rate their level of agreement with three statements starting 'The NHS is a good equal opportunities employer for…' and ending 'women doctors', 'doctors from ethnic minorities' and 'doctors with disabilities'. Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000-2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities. Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern. © The Royal Society of Medicine.

Missing marine protected area (MPA) targets: How the push for quantity over quality undermines sustainability and social justice.

PubMed

De Santo, Elizabeth M

2013-07-30

International targets for marine protected areas (MPAs) and networks of MPAs set by the World Summit on Sustainable Development and United Nations Convention on Biological Diversity failed to meet their 2012 deadline and have been extended to 2020. Whilst targets play an important role in building momentum for conservation, they are also responsible for the recent designation of several extremely large no-take MPAs, which pose significant long-term monitoring and enforcement challenges. This paper critically examines the effectiveness of MPA targets, focusing on the underlying risks to achieving Millennium Development Goals posed by the global push for quantity versus quality of MPAs. The observations outlined in this paper have repercussions for international protected area politics with respect to (1) the science-policy interface in environmental decision-making, and (2) social justice concerns in global biodiversity conservation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Optogenetic Tools for Subcellular Applications in Neuroscience.

PubMed

Rost, Benjamin R; Schneider-Warme, Franziska; Schmitz, Dietmar; Hegemann, Peter

2017-11-01

The ability to study cellular physiology using photosensitive, genetically encoded molecules has profoundly transformed neuroscience. The modern optogenetic toolbox includes fluorescent sensors to visualize signaling events in living cells and optogenetic actuators enabling manipulation of numerous cellular activities. Most optogenetic tools are not targeted to specific subcellular compartments but are localized with limited discrimination throughout the cell. Therefore, optogenetic activation often does not reflect context-dependent effects of highly localized intracellular signaling events. Subcellular targeting is required to achieve more specific optogenetic readouts and photomanipulation. Here we first provide a detailed overview of the available optogenetic tools with a focus on optogenetic actuators. Second, we review established strategies for targeting these tools to specific subcellular compartments. Finally, we discuss useful tools and targeting strategies that are currently missing from the optogenetics repertoire and provide suggestions for novel subcellular optogenetic applications. Copyright © 2017 Elsevier Inc. All rights reserved.

Why is there variation in the practice of evidence-based medicine in primary care? A qualitative study

PubMed Central

Hisham, Ranita; Ng, Chirk Jenn; Liew, Su May; Hamzah, Nurazira; Ho, Gah Juan

2016-01-01

Objective To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors’ views and experiences. Research design The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach. Participants 37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings. Setting The study was conducted across three primary care settings—an academic primary care practice, private and public health clinics in Klang Valley, Malaysia. Results The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors’ daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors’ practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience. Conclusions Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace ‘EBM culture’ had an important influence on the doctors’ behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care. PMID:26962037

The PRONE score: an algorithm for predicting doctors’ risks of formal patient complaints using routinely collected administrative data

PubMed Central

Spittal, Matthew J; Bismark, Marie M; Studdert, David M

2015-01-01

Background Medicolegal agencies—such as malpractice insurers, medical boards and complaints bodies—are mostly passive regulators; they react to episodes of substandard care, rather than intervening to prevent them. At least part of the explanation for this reactive role lies in the widely recognised difficulty of making robust predictions about medicolegal risk at the individual clinician level. We aimed to develop a simple, reliable scoring system for predicting Australian doctors’ risks of becoming the subject of repeated patient complaints. Methods Using routinely collected administrative data, we constructed a national sample of 13 849 formal complaints against 8424 doctors. The complaints were lodged by patients with state health service commissions in Australia over a 12-year period. We used multivariate logistic regression analysis to identify predictors of subsequent complaints, defined as another complaint occurring within 2 years of an index complaint. Model estimates were then used to derive a simple predictive algorithm, designed for application at the doctor level. Results The PRONE (Predicted Risk Of New Event) score is a 22-point scoring system that indicates a doctor's future complaint risk based on four variables: a doctor's specialty and sex, the number of previous complaints and the time since the last complaint. The PRONE score performed well in predicting subsequent complaints, exhibiting strong validity and reliability and reasonable goodness of fit (c-statistic=0.70). Conclusions The PRONE score appears to be a valid method for assessing individual doctors’ risks of attracting recurrent complaints. Regulators could harness such information to target quality improvement interventions, and prevent substandard care and patient dissatisfaction. The approach we describe should be replicable in other agencies that handle large numbers of patient complaints or malpractice claims. PMID:25855664

The status of bedside teaching in the United Kingdom: the student perspective

PubMed Central

Jones, Patrick; Rai, Bhavan Prasad

2015-01-01

Purpose Bedside teaching holds a strong tradition as a key-learning platform for clinical examination in the basic medical clerkship. There is a growing body of literature expressing concern for its witnessed decline in medical school curricula. However, the views of students toward this patient-centered cornerstone in surgical education remain under-reported. The purpose of this study was to gain a nationwide perspective on bedside teaching according to medical students in the United Kingdom. Materials and methods An adapted Delphi method was employed to formulate the question series as part of a multi-step process including a pilot study, which was used to construct this survey. The target population was medical undergraduates in the United Kingdom and participants were recruited via social media. Outcomes assessed included exposure to bedside teaching, perceived benefits of clinical simulation, and junior doctors as clinical teachers. Barriers to clinical examination were also evaluated. Results Overall, 368 completed surveys were received (completion rate 98.9%). Final year students were significantly more likely to report receiving insufficient bedside teaching (P<0.01). Seventy-eight percent of the study group agreed that clinical simulation is a good learning tool for clinical examination. Seventy percent of students felt junior doctors were as able as senior doctors to teach. Lack of confidence was identified as the commonest barrier to overcome when examining patients and two-thirds of students felt they burdened patients during bedside teaching. Conclusion This prospective study confirms the exposure deficit, which medical students experience in bedside teaching. The junior doctor represents a dynamic clinical teacher in the face of working time directives. Peer learning is a novel solution to such pressures. Work is needed to re-establish the hospital wards as a supportive environment for student learning. PMID:26082672

Risk factors at medical school for later severe depression: a 15-year longitudinal, nationwide study (NORDOC).

PubMed

Støen Grotmol, Kjersti; Gude, Tore; Moum, Torbjørn; Vaglum, Per; Tyssen, Reidar

2013-03-20

Doctors have an increased risk of suicide, and depressive symptoms are prominent among young doctors. We lack prospective studies that identify risk factors to be targeted in medical schools. From 1993 to 2008, graduating medical students (n=631) from all four Norwegian universities participated in the Longitudinal Study of Norwegian Medical Students and Doctors (NORDOC). After their graduating term (T1), they were followed up 1 (T2), 4 (T3), 10 (T4), and 15 (T5) years later with postal surveys. Severe depressive symptoms were measured by the General Health Questionnaire-28 (T1, T2, T3, T4, and T5) and analyzed by generalized estimating equations. At T1 and T5, 13.7% and 7.2%, respectively, of the doctors reported severe depressive symptoms; a significant reduction over time (p=0.001) in both genders (response rates 56-83%). Independent risk factors for future depressive symptoms were: young age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.04-1.2, p=0.003); high neuroticism (OR 3.4, 95% CI 1.5-7.6, p=0.003); high reality weakness (OR 2.3, 95% CI 1.2-4.2, p=0.008); and severe depressive symptoms at T1 (OR 3.6, 95% CI 2.1-6.1, p<0.001). Selection bias and concurrent life and work stress may have influenced the results. In addition to low age, high neuroticism yielded a threefold increased risk over the 15-year follow-up, whereas high reality weakness, which is linked to personality pathology, doubled the risk. These factors are clinically relevant for identification of students at risk. Copyright © 2012 Elsevier B.V. All rights reserved.

Challenges to healthcare reform in China: profit-oriented medical practices, patients' choice of care and guanxi culture in Zhejiang province.

PubMed

Wu, Dan; Lam, Tai Pong; Lam, Kwok Fai; Zhou, Xu Dong; Sun, Kai Sing

2017-11-01

Doctors' profit-oriented practices in public institutions were widespread in China. Two major targets of the healthcare reform launched in 2009 were to curb the profit-making practices in public institutions and to encourage the citizens to use primary care. After 6 years, the status of profit-orientation of public institutions remains unknown. Compared with hospitals, there is no trend of increasing use of primary care. Our study aimed to explore the status of profit-orientation of public institutions and patients' utilization preference. The impacts of guanxi (personal relationship) on patients' utilization of healthcare and doctors' practices were also explored. From September 2014 to September 2015, we conducted focus group and individual interviews, followed by a survey with doctors (n = 1111) in Hangzhou, Zhejiang province. Thematic analysis, independent t-test and Fisher's exact test were conducted to analyse the data. This study found that 36.8% of survey respondents needed to consider making profits for their institutions, especially the hospital specialists. A total of 38.5% and 40.7% thought that their practices led to patients' worries of unnecessary drugs and tests, respectively. Doctors attributed their profit-oriented practices to institutions' agenda setting, poor salary and an organizational bonus system. Their awareness of breaching medical ethics created a guilt feeling and frustration. Nearly 65.0% reported patients' preference for hospital-based care even for minor conditions and 76.2% if the patient was a child. Ineffective gate-keeping mechanism, weak primary care and mistrust in community-based care were major reasons. More specialists than primary care practitioners (41.0 vs 21.5%, P < 0.001) said that patients would use guanxi to gain better services and 64.5% of doctors reported better dedication when patients were somehow connected. In conclusion, profit-orientated practice widely exists in public institutions. Patients generally prefer hospital-based services. Guanxi, which affects both patients' and doctors' practices, is more often used to access hospital-based services. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Continuous time wavelet entropy of auditory evoked potentials.

PubMed

Cek, M Emre; Ozgoren, Murat; Savaci, F Acar

2010-01-01

In this paper, the continuous time wavelet entropy (CTWE) of auditory evoked potentials (AEP) has been characterized by evaluating the relative wavelet energies (RWE) in specified EEG frequency bands. Thus, the rapid variations of CTWE due to the auditory stimulation could be detected in post-stimulus time interval. This approach removes the probability of missing the information hidden in short time intervals. The discrete time and continuous time wavelet based wavelet entropy variations were compared on non-target and target AEP data. It was observed that CTWE can also be an alternative method to analyze entropy as a function of time. 2009 Elsevier Ltd. All rights reserved.

Marketing health promotion: hitting or missing the target in occupational health.

PubMed

Fontana, S A

1993-10-01

1. Occupational health nurses can use marketing strategies to plan, offer, and manage health promotion programs; and to conduct research aimed at better understanding the health needs of workers. 2. By applying a social marketing orientation to health promotion planning, occupational health nurses can tailor programs to fit employees' needs, and deliver health messages that are readily understandable to worker groups. 3. A priority in implementing any occupational health program or service is learning about the needs, desires, and health habits of employees. 4. Greater benefits to employee health may occur by targeting change in structures and systems at the workplace rather than solely focusing on lifestyle issues.

Technical aids for the flexible use of the Leksell stereotactic system.

PubMed

Salcman, M; Bellis, E H; Sewchand, W; Amin, P

1989-06-01

As part of a multimodality therapy program for intracranial tumours, 105 stereotactic and implant procedures have been carried out utilizing the CT-compatible Leksell stereotactic system. In the iridium implant series, 86 catheters have been implanted for an average of 3.6 targets per patient. There have been no deaths or missed targets and only two incidential haemorrhages detected. In order to facilitate the reliability, safety and speed of multiple catheter insertion, several techniques have been developed including: (a) a standardized single-length catheter and flange system; (b) a ceramic catheter for microwave hyperthermia; (c) a mnemonic card for ease of calculation; (d) a radiation shield for nursing; (e) a stereotactic drill and surgical approaches to far lateral and posterior fossa targets. Principles for the use of these technical aids are discussed.

Exploring What’s Missing: What Do Target Absent Trials Reveal About Autism Search Superiority?

PubMed Central

Keehn, Brandon; Joseph, Robert M.

2016-01-01

We used eye-tracking to investigate the roles of enhanced discrimination and peripheral selection in superior visual search in autism spectrum disorder (ASD). Children with ASD were faster at visual search than their typically developing peers. However, group differences in performance and eye-movements did not vary with the level of difficulty of discrimination or selection. Rather, consistent with prior ASD research, group differences were mainly the effect of faster performance on target-absent trials. Eye-tracking revealed a lack of left-visual-field search asymmetry in ASD, which may confer an additional advantage when the target is absent. Lastly, ASD symptomatology was positively associated with search superiority, the mechanisms of which may shed light on the atypical brain organization that underlies social-communicative impairment in ASD. PMID:26762114

Financial Incentives, Targeting, and Utilization of Child Health Services: Experimental Evidence from Zambia.

PubMed

Fink, Günther; Rockers, Peter C

2017-10-01

To address untreated infections in children, routine health checkups have increasingly been incentivized as part of conditional cash transfer programs targeted at the poor. We conducted a field experiment in Zambia to assess the elasticity of demand for checkups as well as the associated health benefits. We find that relatively small incentives induce substantial increases in uptake among non-farming households and households living farther away from clinics, but not among households in the top wealth quintile. These results suggest that small financial incentives may be an efficient way to target poor populations. However, given the weak socioeconomic gradient in infections observed, small incentives will miss a substantial fraction of exposed children. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study.

PubMed

Hoddinott, Pat; Thomson, Gill; Morgan, Heather; Crossland, Nicola; MacLennan, Graeme; Dykes, Fiona; Stewart, Fiona; Bauld, Linda; Campbell, Marion K

2015-11-13

To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Cross-sectional survey and qualitative interviews. Scotland and North West England. Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required. 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/

MISS-Prot: web server for self/non-self discrimination of protein residue networks in parasites; theory and experiments in Fasciola peptides and Anisakis allergens.

PubMed

González-Díaz, Humberto; Muíño, Laura; Anadón, Ana M; Romaris, Fernanda; Prado-Prado, Francisco J; Munteanu, Cristian R; Dorado, Julián; Sierra, Alejandro Pazos; Mezo, Mercedes; González-Warleta, Marta; Gárate, Teresa; Ubeira, Florencio M

2011-06-01

Infections caused by human parasites (HPs) affect the poorest 500 million people worldwide but chemotherapy has become expensive, toxic, and/or less effective due to drug resistance. On the other hand, many 3D structures in Protein Data Bank (PDB) remain without function annotation. We need theoretical models to quickly predict biologically relevant Parasite Self Proteins (PSP), which are expressed differentially in a given parasite and are dissimilar to proteins expressed in other parasites and have a high probability to become new vaccines (unique sequence) or drug targets (unique 3D structure). We present herein a model for PSPs in eight different HPs (Ascaris, Entamoeba, Fasciola, Giardia, Leishmania, Plasmodium, Trypanosoma, and Toxoplasma) with 90% accuracy for 15 341 training and validation cases. The model combines protein residue networks, Markov Chain Models (MCM) and Artificial Neural Networks (ANN). The input parameters are the spectral moments of the Markov transition matrix for electrostatic interactions associated with the protein residue complex network calculated with the MARCH-INSIDE software. We implemented this model in a new web-server called MISS-Prot (MARCH-INSIDE Scores for Self-Proteins). MISS-Prot was programmed using PHP/HTML/Python and MARCH-INSIDE routines and is freely available at: . This server is easy to use by non-experts in Bioinformatics who can carry out automatic online upload and prediction with 3D structures deposited at PDB (mode 1). We can also study outcomes of Peptide Mass Fingerprinting (PMFs) and MS/MS for query proteins with unknown 3D structures (mode 2). We illustrated the use of MISS-Prot in experimental and/or theoretical studies of peptides from Fasciola hepatica cathepsin proteases or present on 10 Anisakis simplex allergens (Ani s 1 to Ani s 10). In doing so, we combined electrophoresis (1DE), MALDI-TOF Mass Spectroscopy, and MASCOT to seek sequences, Molecular Mechanics + Molecular Dynamics (MM/MD) to generate 3D structures and MISS-Prot to predict PSP scores. MISS-Prot also allows the prediction of PSP proteins in 16 additional species including parasite hosts, fungi pathogens, disease transmission vectors, and biotechnologically relevant organisms.

A Survey of Recent Advances in Particle Filters and Remaining Challenges for Multitarget Tracking

PubMed Central

Wang, Xuedong; Sun, Shudong; Corchado, Juan M.

2017-01-01

We review some advances of the particle filtering (PF) algorithm that have been achieved in the last decade in the context of target tracking, with regard to either a single target or multiple targets in the presence of false or missing data. The first part of our review is on remarkable achievements that have been made for the single-target PF from several aspects including importance proposal, computing efficiency, particle degeneracy/impoverishment and constrained/multi-modal systems. The second part of our review is on analyzing the intractable challenges raised within the general multitarget (multi-sensor) tracking due to random target birth and termination, false alarm, misdetection, measurement-to-track (M2T) uncertainty and track uncertainty. The mainstream multitarget PF approaches consist of two main classes, one based on M2T association approaches and the other not such as the finite set statistics-based PF. In either case, significant challenges remain due to unknown tracking scenarios and integrated tracking management. PMID:29168772

How To Talk to Your Doctor (and Get Your Doctor To Talk to You!). An Educational Workshop on Doctor Patient Communication = Como Hablarle a su Doctor (iY que su doctor le hable a usted!). Un seminario educativo sobre la comunicacion entre el doctor y el paciente.

ERIC Educational Resources Information Center

Baylor Coll. of Medicine, Houston, TX.

This workshop, written in both English and Spanish, focuses on improving communication between physician and patient. In the workshop, the trainers will talk about "building bridges" between patient and doctor by understanding the doctor's role and his/her duty to the patient. According to the workshop, a person's doctor should…

Silence That Can Be Dangerous: A Vignette Study to Assess Healthcare Professionals’ Likelihood of Speaking up about Safety Concerns

PubMed Central

Schwappach, David L. B.; Gehring, Katrin

2014-01-01

Purpose To investigate the likelihood of speaking up about patient safety in oncology and to clarify the effect of clinical and situational context factors on the likelihood of voicing concerns. Patients and Methods 1013 nurses and doctors in oncology rated four clinical vignettes describing coworkers’ errors and rule violations in a self-administered factorial survey (65% response rate). Multiple regression analysis was used to model the likelihood of speaking up as outcome of vignette attributes, responder’s evaluations of the situation and personal characteristics. Results Respondents reported a high likelihood of speaking up about patient safety but the variation between and within types of errors and rule violations was substantial. Staff without managerial function provided significantly higher levels of decision difficulty and discomfort to speak up. Based on the information presented in the vignettes, 74%−96% would speak up towards a supervisor failing to check a prescription, 45%−81% would point a coworker to a missed hand disinfection, 82%−94% would speak up towards nurses who violate a safety rule in medication preparation, and 59%−92% would question a doctor violating a safety rule in lumbar puncture. Several vignette attributes predicted the likelihood of speaking up. Perceived potential harm, anticipated discomfort, and decision difficulty were significant predictors of the likelihood of speaking up. Conclusions Clinicians’ willingness to speak up about patient safety is considerably affected by contextual factors. Physicians and nurses without managerial function report substantial discomfort with speaking up. Oncology departments should provide staff with clear guidance and trainings on when and how to voice safety concerns. PMID:25116338

Factors Related to Pertussis and Tetanus Vaccination Status Among Foreign-Born Adults Living in the United States.

PubMed

Sánchez-González, Liliana; Rodriguez-Lainz, Alfonso; O'Halloran, Alissa; Rowhani-Rahbar, Ali; Liang, Jennifer L; Lu, Peng-Jun; Houck, Peter M; Verguet, Stephane; Williams, Walter W

2017-06-01

Pertussis is a common vaccine-preventable disease (VPD) worldwide. Its reported incidence has increased steadily in the United States, where it is endemic. Tetanus is a rare but potentially fatal VPD. Foreign-born adults have lower tetanus-diphtheria-pertussis (Tdap) and tetanus-diphtheria (Td) vaccination coverage than do U.S.-born adults. We studied the association of migration-related, socio-demographic, and access-to-care factors with Tdap and Td vaccination among foreign-born adults living in the United States. The 2012 and 2013 National Health Interview Survey data for foreign-born respondents were analyzed. Multivariable logistic regression was conducted to calculate prevalence ratios and 95% confidence intervals, and to identify variables independently associated with Tdap and Td vaccination among foreign-born adults. Tdap and Td vaccination status was available for 9316 and 12,363 individuals, respectively. Overall vaccination coverage was 9.1% for Tdap and 49.8% for Td. Younger age, higher education, having private health insurance (vs. public insurance or uninsured), having visited a doctor in the previous year, and region of residence were independently associated with Tdap and Td vaccination. Among those reporting a doctor visit, two-thirds had not received Tdap. This study provides further evidence of the need to enhance access to health care and immunization services and reduce missed opportunities for Tdap and Td vaccination for foreign-born adults in the United States. These findings apply to all foreign-born, irrespective of their birthplace, citizenship, language and years of residence in the United States. Addressing vaccination disparities among the foreign-born will help achieve national vaccination goals and protect all communities in the United States.

Frequency of self-reported COPD exacerbation and airflow obstruction in five Latin American cities: the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study.

PubMed

Montes de Oca, Maria; Tálamo, Carlos; Halbert, Ronald J; Perez-Padilla, Rogelio; Lopez, Maria Victorina; Muiño, Adriana; Jardim, José Roberto B; Valdivia, Gonzalo; Pertuzé, Julio; Moreno, Dolores; Menezes, Ana Maria B

2009-07-01

Recurrent exacerbations are common in COPD patients. Limited information exists regarding exacerbation frequency in COPD patients from epidemiologic studies. We examined the frequency of self-reported exacerbations and the factors influencing exacerbation frequency among COPD patients in a population-based study conducted in Latin America. We used a post-bronchodilator FEV(1)/FVC ratio of < 0.70 to define COPD. Exacerbation was self-reported and defined by symptoms (deterioration of breathing symptoms that affected usual daily activities or caused missed work). Spirometry was performed in 5,314 subjects. There were 759 subjects with airflow limitation; of these, 18.2% reported ever having had an exacerbation, 7.9% reported having an exacerbation, and 6.2% reported having an exacerbation requiring at least a doctor visit within the past year. The proportion of individuals with an exacerbation significantly increased by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, from 4.2% in stage 1 to 28.9% in stages 3 and 4. The self-reported exacerbation rate was 0.58 exacerbations per year. The rate of exacerbations requiring at least a doctor visit and length of stay in hospital due to exacerbations also increased as COPD severity progressed. The factors associated with having an exacerbation in the past year were dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and disease severity of GOLD stages 3 and 4. The proportion of individuals with airflow limitation and self-reported exacerbation increases as the disease severity progresses. Dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and more severe obstruction were significantly associated with having an exacerbation in the past year.

Visual Display Principles for C3I System Tasks

DTIC Science & Technology

1993-06-01

early in the design process is now explicitly recognized in military R & D policy as evidenced by the Navy’s HARDMAN and the Army’s MANPRINT programs...information): required sampling rate for each battlefield area, target type, and sensor type, etc.? - Change detections aids - Where is the enemy...increasing load and sophistication for - Automated measurement and operators and decisionmakers scoring (%hits, miss distances, attrition rates , etc

Three-dimensional Radar Imaging of a Building

DTIC Science & Technology

2012-12-01

spotlight configuration and H-V ( cross ) polarization as seen from two different aspect angles. The feature colors correspond to their brightness... cross - ranges but at different heights. This effect may create significant confusion in image interpretation and result in missed target detections...over a range of azimuth angles ( centered at  = 0°) and elevation angles ( centered at 0), creating cross -range and height resolution, while

Studies on Radar Sensor Networks

DTIC Science & Technology

2007-08-08

scheme in which 2-D image was created via adding voltages with the appropriate time offset. Simulation results show that our DCT-based scheme works...using RSNs in terms of the probability of miss detection PMD and the root mean square error (RMSE). Simulation results showed that multi-target detection... Simulation results are presented to evaluate the feasibility and effectiveness of the proposed JMIC algorithm in a query surveillance region. 5 SVD-QR and

On Alternative Formulations for Linearised Miss Distance Analysis

DTIC Science & Technology

2013-05-01

is traditionally employed by analysts as part of the solution process . To gain further insight into the nature of the missile-target engagement...a constant. Thus, following this process , the revised block diagram model for the linearised equations is presented in Figure 13. This model is... process is known as reducing the block to its fundamental closed loop form and has been achieved here using standard block diagram algebra. This

Conservatism is not the missing viewpoint for true diversity.

PubMed

Seibt, Beate; Waldzus, Sven; Schubert, Thomas W; Brito, Rodrigo

2015-01-01

The target article diagnoses a dominance of liberal viewpoints with little evidence, promotes a conservative viewpoint without defining it, and wrongly projects the U.S. liberal-conservative spectrum to the whole field of social psychology. Instead, we propose to anticipate and reduce mixing of theorizing and ideology by using definitions that acknowledge divergence in perspective, and promote representative sampling and observation of the field, as well as dialogical publication.

Emerging technologies for telemedicine.

PubMed

Cao, Minh Duc; Minh, Cao Duc; Shimizu, Shuji; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao

2012-01-01

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions.

What do doctors and nurses think about development of clinical leadership?

PubMed

Lo, David; Till, Alex; McKimm, Judy

2017-09-02

Leadership development for health-care professionals is a priority within the NHS. Training is generally targeted at individual staff groups in isolation, even though contemporary leadership thinking recognizes the benefits of collaborative leadership between different clinical disciplines. Focussing on the attitudes and perceived training needs of undergraduate and qualified medical and nursing professionals, this article highlights the similarities and differences and will help to inform the design of existing and future leadership programmes.

Medical Aspects of Disaster Preparedness and Response: A System Overview of Civil and Military Resources and New Potential

DTIC Science & Technology

2007-01-01

primary care facilities, necessitating the establishment of surge capacity sub-acute treatment in nursing homes, retirement homes, school gymnasiums and...see Figure 1, below) rated by their ability to field, equip and sustain their mixed compliments of doctors, nurses , EMTs PAs, paramedics and support...200-member National Nursing Response Teams (NNRT) (which are primarily targeted to provide mass pre or post incident inoculations) share personnel and

Emerging Technologies for Telemedicine

PubMed Central

Minh, Cao Duc; Antoku, Yasuaki; Torata, Nobuhiro; Kudo, Kuriko; Okamura, Koji; Nakashima, Naoki; Tanaka, Masao

2012-01-01

This paper focuses on new technologies that are practically useful for telemedicine. Three representative systems are introduced: a Digital Video Transport System (DVTS), an H.323 compatible videoconferencing system, and Vidyo. Based on some of our experiences, we highlight the advantages and disadvantages of each technology, and point out technologies that are especially targeted at doctors and technicians, so that those interested in using similar technologies can make appropriate choices and achieve their own goals depending on their specific conditions. PMID:22563284

Radiation-induced genomic instability: Are epigenetic mechanisms the missing link?

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

Aypar, Umut; Morgan, William F.; Baulch, Janet E.

Purpose: This review examines the evidence for the hypothesis that epigenetics are involved in the initiation and perpetuation of radiation-induced genomic instability (RIGI). Conclusion: In addition to the extensively studied targeted effects of radiation, it is now apparent that non-targeted delayed effects such as RIGI are also important post-irradiation outcomes. In RIGI, unirradiated progeny cells display phenotypic changes at delayed times after radiation of the parental cell. RIGI is thought to be important in the process of carcinogenesis, however, the mechanism by which this occurs remains to be elucidated. In the genomically unstable clones developed by Morgan and colleagues, radiation-inducedmore » mutations, double-strand breaks, or changes in mRNA levels alone could not account for the initiation or perpetuation of RIGI. Since changes in the DNA sequence could not fully explain the mechanism of RIGI, inherited epigenetic changes may be involved. Epigenetics are known to play an important role in many cellular processes and epigenetic aberrations can lead to carcinogenesis. Recent studies in the field of radiation biology suggest that the changes in methylation patterns may be involved in RIGI. Together these clues have led us to hypothesize that epigenetics may be the missing link in understanding the mechanism behind RIGI.« less

Adding "Missed" Science to Cassini's Ops Plan

NASA Technical Reports Server (NTRS)

Roy, Mou; Burton, Marcia E.; Edgington, Scott; Pitesky, Jo E.; Steadman, Kimberly B.; Ray, Trina L.; Evans, Mike

2014-01-01

The phenomenal success of the Cassini Mission at Saturn is largely due to flagship instruments, in a target rich environment, for a long period of time, executing almost error free complex mission operations. A smooth transition from cruise operations through the prime science mission and extended science (Equinox) mission culminating in the currently executing Solstice mission has folded in necessary procedural alterations due to improved understanding of the spacecraft, instruments, uplink and planning systems as well as additional science objectives. These have come with the maturation of the mission along with management of workforce reductions. One important set of operational changes has been initiated due to scientific findings highlighting "missed" science opportunities. This is the case for the Titan Meteorology Campaigns and Saturn Storm Watch Campaigns. These observations involve long term monitoring of the atmospheres of Titan and Saturn while the spacecraft and science teams are focused on other high priority targets of opportunity (like Enceladus). Our objective in this paper is to emphasize how a non-invasive strategy to get additional remarkable science was conceived and implemented in a mission with an already well defined operational plan. To illustrate this we will detail Titan Meteorology Campaign and Saturn Storm Watch Campaign integration and implementation strategies as well as the scientific goals and achievements of both.

Targeted Treatment of Yaws With Household Contact Tracing: How Much Do We Miss?

PubMed Central

Dyson, Louise; Marks, Michael; Crook, Oliver M; Sokana, Oliver; Solomon, Anthony W; Bishop, Alex; Mabey, David C W; Hollingsworth, T Déirdre

2018-01-01

Abstract Yaws is a disabling bacterial infection found primarily in warm and humid tropical areas. The World Health Organization strategy mandates an initial round of total community treatment (TCT) with single-dose azithromycin followed either by further TCT or active case-finding and treatment of cases and their contacts (the Morges strategy). We sought to investigate the effectiveness of the Morges strategy. We employed a stochastic household model to study the transmission of infection using data collected from a pre-TCT survey conducted in the Solomon Islands. We used this model to assess the proportion of asymptomatic infections that occurred in households without active cases. This analysis indicated that targeted treatment of cases and their household contacts would miss a large fraction of asymptomatic infections (65%–100%). This fraction was actually higher at lower prevalences. Even assuming that all active cases and their households were successfully treated, our analysis demonstrated that at all prevalences present in the data set, up to 90% of (active and asymptomatic) infections would not be treated under household-based contact tracing. Mapping was undertaken as part of the study “Epidemiology of Yaws in the Solomon Islands and the Impact of a Trachoma Control Programme,” in September–October 2013. PMID:29140407

From receptor binding kinetics to signal transduction; a missing link in predicting in vivo drug-action.

PubMed

Nederpelt, Indira; Kuzikov, Maria; de Witte, Wilbert E A; Schnider, Patrick; Tuijt, Bruno; Gul, Sheraz; IJzerman, Adriaan P; de Lange, Elizabeth C M; Heitman, Laura H

2017-10-26

An important question in drug discovery is how to overcome the significant challenge of high drug attrition rates due to lack of efficacy and safety. A missing link in the understanding of determinants for drug efficacy is the relation between drug-target binding kinetics and signal transduction, particularly in the physiological context of (multiple) endogenous ligands. We hypothesized that the kinetic binding parameters of both drug and endogenous ligand play a crucial role in determining cellular responses, using the NK1 receptor as a model system. We demonstrated that the binding kinetics of both antagonists (DFA and aprepitant) and endogenous agonists (NKA and SP) have significantly different effects on signal transduction profiles, i.e. potency values, in vitro efficacy values and onset rate of signal transduction. The antagonistic effects were most efficacious with slowly dissociating aprepitant and slowly associating NKA while the combination of rapidly dissociating DFA and rapidly associating SP had less significant effects on the signal transduction profiles. These results were consistent throughout different kinetic assays and cellular backgrounds. We conclude that knowledge of the relationship between in vitro drug-target binding kinetics and cellular responses is important to ultimately improve the understanding of drug efficacy in vivo.

Women's opinions of legal requirements for drug testing in prenatal care.

PubMed

Tucker Edmonds, Brownsyne; Mckenzie, Fatima; Austgen, MacKenzie B; Carroll, Aaron E; Meslin, Eric M

2017-07-01

To explore women's attitudes and perceptions regarding legal requirements for prenatal drug testing. Web-based survey of 500 US women (age 18-45) recruited from a market research survey panel. A 24-item questionnaire assessed their opinion of laws requiring doctors to routinely verbal screen and urine drug test patients during pregnancy; recommendations for consequences for positive drug tests during pregnancy; and opinion of laws requiring routine drug testing of newborns. Additional questions asked participants about the influence of such laws on their own care-seeking behaviors. Data were analyzed for associations between participant characteristics and survey responses using Pearson's chi-squared test. The majority of respondents (86%) stated they would support a law requiring verbal screening of all pregnant patients and 73% would support a law requiring universal urine drug testing in pregnancy. Fewer respondents were willing to support laws that required verbal screening or urine drug testing (68% and 61%, respectively) targeting only Medicaid recipients. Twenty-one percent of respondents indicated they would be offended if their doctors asked them about drug use and 14% indicated that mandatory drug testing would discourage prenatal care attendance. Women would be more supportive of policies requiring universal rather than targeted screening and testing for prenatal drug use. However, a noteworthy proportion of women would be discouraged from attending prenatal care - a reminder that drug testing policies may have detrimental effects on maternal child health.

Guideline adherence for pharmacotherapy of chronic systolic heart failure in general practice: a closer look on evidence-based therapy.

PubMed

Peters-Klimm, F; Müller-Tasch, T; Schellberg, D; Remppis, A; Barth, A; Holzapfel, N; Jünger, J; Herzog, W; Szecsenyi, J

2008-04-01

There is robust evidence for effective pharmacotherapy of chronic (systolic) heart failure (CHF) which has led to the creation of guidelines, but many surveys evaluating CHF treatment show an under-utilisation of relevant drugs, while setting and patient population appear to be crucial for adequate appraisal of treatment patterns. To evaluate the guideline adherence (GA) of general practitioners (GPs) in a well-defined patient population with CHF in primary care (PC). A cross-sectional analysis was performed with the data of 167 patients enrolled in 37 GP practices (Germany) with documented left ventricular systolic dysfunction (LVEF: 33.3 +/- 6.9%). GA was assessed as usual (prescribing "yes" or "no"), through evaluation of target dosing, while adjusting for potential clinical contraindications, and through a modified Guideline Adherence Indicator-3 (mGAI-3), which assesses three relevant groups of substances according to New York Heart Association (NYHA) functional class: ACE-Inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone-antagonists (AA). Prescription rates for ACE-I/ARB, BB or both were 80%, 75% and 62%, respectively. The proportion of target doses reached for ACE-I was 16%, for BB only 8%. When adjusted for potential (mainly relative) contraindications (COPD, heart rate <60/min, hypotension, hyperkalaemia and renal dysfunction), the percentage of target doses reached increased to 49% for ACE-I/ARBs and 46% for BB. Application of the mGAI-3 showed moderate to perfect GA for usual assessment, proportion of target dose reached and adjusted in 83%, 16% and 55% of the patients, respectively. In the context of this patient and doctor setting, life-saving treatment was provided above average when assessed by usual criteria. The application of additional criteria showed further room for improvement. Future interventions aiming at optimisation should be tailored to the needs of doctors and patients likewise.

Doctors and romance: not only of interest to Mills and Boon readers.

PubMed

Callister, Paul; Badkar, Juthika; Didham, Robert

2009-06-01

Internationally there is a growing demand for health services. Skilled health workers, including doctors, have a high degree of international mobility and New Zealand (NZ) stands out internationally in terms of the significant flows of doctors in and out of the country. Through changes in training of doctors in NZ and migration flows, there have been major shifts in the composition of the medical workforce in NZ since the mid-1980s. Studies of the changing nature of the medical workforce often focus on gender and migration separately as well as only considering doctors as individuals. The aim of this exploratory study is to examine the living arrangements of doctors, the composition of migrant doctors who are coming to NZ, and to understand the educational and employment status of the partners of doctors. This study is a descriptive analysis primarily using census data from 1986 through to 2006 and immigration data collected by the Department of Labour. Half of the female medical doctors approved for residence through the Skilled/Business stream migrated independently, while for male doctors less than athird came to NZ independently. Male migrant doctors were more likely to be partnered. Census data showed that people with medical backgrounds tend to partner with each other. However, these relationships are changing, as more women become doctors. In 1986 about 14% of male doctors had a nurse or midwife as a partner and nearly 9% had a doctor partner. By 2006 the proportion of partners of male doctors who were also doctors had risen to 16%, higher than the 9% who were nurses. For female doctors the changes are more dramatic. In 1986, 42% of female doctors in relationships had a doctor as a partner. By 2006, female doctors had increased substantially, but the percentage with a doctor partner had dropped to under athird. Well-qualified couples where one or both are doctors, have a greater propensityto live in main urban areas. Through official reports and extensive media coverage, the NZ public is well aware of local and national doctor shortages. There is also awareness, often through personal visits to a GP or hospital, of the significant rise in number of female and of foreign-born doctors. The choices doctors are making in living arrangements need to be taken into account when considering both national and international recruitment of medical staff. Researchers and policy makers may need to consider family migration issues more than they have in the past for doctors as well as for other migrant groups.

[The motivation to become a medical doctor - doctoral students in a formal academic study program compared with those pursuing their doctorate independently].

PubMed

Pfeiffer, M; Dimitriadis, K; Holzer, M; Reincke, M; Fischer, M R

2011-04-01

Weight and quality of medical doctoral theses have been discussed in Germany for years. Doctoral study programs in various graduate schools offer opportunities to improve quality of medical doctoral theses. The purpose of this study was to demonstrate distinctions and differences concerning motivation, choice of subject and the dissertation process between doctoral candidates completing the doctoral seminar for doctoral students in the Ludwig-Maximilians-University (LMU) Munich and doctoral candidates doing their doctorate individually. All 4000 medical students of the LMU obtained an online-questionnaire which was completed by 767 students (19 % response rate). The theoretical framework of this study was based upon the Self-Determination-Theory by Deci and Ryan. Doctoral candidates completing the doctoral study program were more intrinsically motivated than doctoral candidates doing their doctorate individually; no difference was found in their extrinsic motivation. In regard to choice of subject and dissertation process the doctoral students in the seminar were distinguished from the individual group by having chosen a more challenging project. They anticipated a demanding dissertation process including conference participation, publishing of papers, etc. Intrinsic motivation correlates positively with choosing a challenging project and a demanding dissertation process. High intrinsic motivation seems to be very important for autonomous scholarly practice. Our results suggest that doctoral study programs have a positive impact on intrinsic motivation and interest in research. © Georg Thieme Verlag KG Stuttgart · New York.

Computerized reminders for five preventive screening tests: generation of patient-specific letters incorporating physician preferences.

PubMed Central

Murphy, D. J.; Gross, R.; Buchanan, J.

2000-01-01

Compliance with preventive screening tests is inadequate in the United States. We describe a computer based system for generating reminder letters to patients who may have missed their indicated screening tests because they do not visit a provider regularly or missed their tests despite the fact that they do visit a provider. We started with national recommendations and generated a local consensus for test indications. We then used this set of indications and our electronic record to determine test deficiencies in our pilot pool of 3073 patients. The computer generated customized reminder letters targeting several tests. Physicians chose any patients who should not receive letters. The response rate for fecal occult blood (FOB) testing was 33% compared with an 18% historical compliance rate within the same community. FOB reminders generated improved test compliance. Test execution must be considered when commencing a program of screening test reminders. PMID:11079954

Temporally coherent 4D video segmentation for teleconferencing

NASA Astrophysics Data System (ADS)

Ehmann, Jana; Guleryuz, Onur G.

2013-09-01

We develop an algorithm for 4-D (RGB+Depth) video segmentation targeting immersive teleconferencing ap- plications on emerging mobile devices. Our algorithm extracts users from their environments and places them onto virtual backgrounds similar to green-screening. The virtual backgrounds increase immersion and interac- tivity, relieving the users of the system from distractions caused by disparate environments. Commodity depth sensors, while providing useful information for segmentation, result in noisy depth maps with a large number of missing depth values. By combining depth and RGB information, our work signi¯cantly improves the other- wise very coarse segmentation. Further imposing temporal coherence yields compositions where the foregrounds seamlessly blend with the virtual backgrounds with minimal °icker and other artifacts. We achieve said improve- ments by correcting the missing information in depth maps before fast RGB-based segmentation, which operates in conjunction with temporal coherence. Simulation results indicate the e±cacy of the proposed system in video conferencing scenarios.

Measuring progress toward the Millennium Development Goals and the missing millions.

PubMed

Carr-Hill, Roy A

2013-01-01

The 2015 target date for achieving the Millennium Development Goals (MDGs) is fast approaching, but there is very little discussion of the validity of the indicators used to measure progress. In particular, there has been little attention given to the problems that arise when assessments of progress are based on household surveys. These are inappropriate for obtaining information about the poorest of the poor. Typically, they omit by design those not in households because they are homeless; those who are in institutions; and mobile, nomadic or pastoralist populations; and, in practice, household surveys will typically under-represent those in fragile, disjointed or multiple occupancy households; and those in urban slums and insecure areas of a country. Those six subgroups constitute a pretty comprehensive ostensive definition of the "poorest of the poor." Between 300 and 500 million people--mainly in developing countries--will be missed worldwide from the sampling frames of household surveys.

Inference of missing data and chemical model parameters using experimental statistics

NASA Astrophysics Data System (ADS)

Casey, Tiernan; Najm, Habib

2017-11-01

A method for determining the joint parameter density of Arrhenius rate expressions through the inference of missing experimental data is presented. This approach proposes noisy hypothetical data sets from target experiments and accepts those which agree with the reported statistics, in the form of nominal parameter values and their associated uncertainties. The data exploration procedure is formalized using Bayesian inference, employing maximum entropy and approximate Bayesian computation methods to arrive at a joint density on data and parameters. The method is demonstrated in the context of reactions in the H2-O2 system for predictive modeling of combustion systems of interest. Work supported by the US DOE BES CSGB. Sandia National Labs is a multimission lab managed and operated by Nat. Technology and Eng'g Solutions of Sandia, LLC., a wholly owned subsidiary of Honeywell Intl, for the US DOE NCSA under contract DE-NA-0003525.

Do not judge according to appearance: patients' preference of a doctor's face does not influence their assessment of the patient-doctor relationship.

PubMed

Lee, Soon-Ho; Chang, Dong-Seon; Kang, O-Seok; Kim, Hwa-Hyun; Kim, Hackjin; Lee, Hyejung; Park, Hi-Joon; Chae, Younbyoung

2012-12-01

The aim of this study was to investigate whether a patient's preference for a doctor's face is associated with better assessments of relational empathy in the patient-doctor relationship after the first clinical consultation. A total of 110 patients enrolled in a traditional Korean medical clinic participated in the study. Patients' preference for doctors' faces was assessed by a two alternative forced choice (2AFC) task, with 60 different pairs of six different Asian male doctors' faces. One of the six doctors then carried out the initial clinical consultation for these patients. The patient-doctor relationship was assessed using the Consultation and Relational Empathy (CARE) measure. The data of all patients' simulated preferences for a doctor's face and their assessment values of a doctor's relational empathy was compared, and no significant correlation was found between both values (r=-0.024, p>0.809). These findings suggest that the perceived empathy in the patient-doctor relationship is not influenced by the patient's preference for a certain doctor's face. The first impression of a doctor is often determined by his appearance and look. However, whether or not the patient particularly prefers a doctor's face does not seem to matter in developing a good patient-doctor relationship.

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

PubMed

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

2016-11-01

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

Effects of imputation on correlation: implications for analysis of mass spectrometry data from multiple biological matrices.

PubMed

Taylor, Sandra L; Ruhaak, L Renee; Kelly, Karen; Weiss, Robert H; Kim, Kyoungmi

2017-03-01

With expanded access to, and decreased costs of, mass spectrometry, investigators are collecting and analyzing multiple biological matrices from the same subject such as serum, plasma, tissue and urine to enhance biomarker discoveries, understanding of disease processes and identification of therapeutic targets. Commonly, each biological matrix is analyzed separately, but multivariate methods such as MANOVAs that combine information from multiple biological matrices are potentially more powerful. However, mass spectrometric data typically contain large amounts of missing values, and imputation is often used to create complete data sets for analysis. The effects of imputation on multiple biological matrix analyses have not been studied. We investigated the effects of seven imputation methods (half minimum substitution, mean substitution, k-nearest neighbors, local least squares regression, Bayesian principal components analysis, singular value decomposition and random forest), on the within-subject correlation of compounds between biological matrices and its consequences on MANOVA results. Through analysis of three real omics data sets and simulation studies, we found the amount of missing data and imputation method to substantially change the between-matrix correlation structure. The magnitude of the correlations was generally reduced in imputed data sets, and this effect increased with the amount of missing data. Significant results from MANOVA testing also were substantially affected. In particular, the number of false positives increased with the level of missing data for all imputation methods. No one imputation method was universally the best, but the simple substitution methods (Half Minimum and Mean) consistently performed poorly. © The Author 2016. Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Integrated skin flash planning technique for intensity-modulated radiation therapy for vulvar cancer prevents marginal misses and improves superficial dose coverage.

PubMed

Dyer, Brandon A; Jenshus, Abriel; Mayadev, Jyoti S

2018-02-28

Radiation therapy (RT) plays a definitive role in locally advanced vulvar cancer, and in the adjuvant setting with high risk postoperative features after wide local excision. There is significant morbidity associated with traditional, large RT fields using 2D or 3D techniques, and the use of intensity-modulated radiation therapy (IMRT) in vulvar cancer is increasing. However, there remains a paucity of technical information regarding the prevention of a marginal miss during the treatment planning process. The use of an integrated skin flash (ISF) during RT planning can be used to account for anatomic variation, and intra- and interfraction motion seen during treatment. Herein we present the case of a patient with a T1aN0M0, Stage IA vulva cancer to illustrate the progressive vulvar swelling and lymph edema seen during treatment and retrospectively evaluate the dosimetric effects of using an ISF RT plan vs standard RT planning techniques. Standard planning techniques to treat vulvar cancer patients with IMRT do not sufficiently account for the change in patient anatomy and can lead to a marginal miss. ISF is an RT planning technique that can decrease the risk of a marginal miss and the technique is easily implemented during the planning stages of RT treatment. Furthermore, use of an ISF technique can improve vulvar clinical target volume coverage and plan homogeneity. Based on our experience, and this study, a 2-cm ISF is suggested to account for variations in daily clinical setup and changes in patient anatomy during treatment. Published by Elsevier Inc.

The effect of expert knowledge on medical search: medical experts have specialized abilities for detecting serious lesions.

PubMed

Nakashima, Ryoichi; Watanabe, Chisaki; Maeda, Eriko; Yoshikawa, Takeharu; Matsuda, Izuru; Miki, Soichiro; Yokosawa, Kazuhiko

2015-09-01

How does domain-specific knowledge influence the experts' performance in their domain of expertise? Specifically, can visual search experts find, with uniform efficiency, any type of target in their domain of expertise? We examined whether acquired knowledge of target importance influences an expert's visual search performance. In some professional searches (e.g., medical screenings), certain targets are rare; one aim of this study was to examine the extent to which experts miss such targets in their searches. In one experiment, radiologists (medical experts) engaged in a medical lesion search task in which both the importance (i.e., seriousness/gravity) and the prevalence of targets varied. Results showed decreased target detection rates in the low prevalence conditions (i.e., the prevalence effect). Also, experts were better at detecting important (versus unimportant) lesions. Results of an experiment using novices ruled out the possibility that decreased performance with unimportant targets was due to low target noticeability/visibility. Overall, the findings suggest that radiologists do not have a generalized ability to detect any type of lesion; instead, they have acquired a specialized ability to detect only those important lesions relevant for effective medical practices.

Forming maps of targets having multiple reflectors with a biomimetic audible sonar.

PubMed

Kuc, Roman

2018-05-01

A biomimetic audible sonar mimics human echolocation by emitting clicks and sensing echoes binaurally to investigate the limitations in acoustic mapping of 2.5 dimensional targets. A monaural sonar that provides only echo time-of-flight values produces biased maps that lie outside the target surfaces. Reflector bearing estimates derived from the first echoes detected by a binaural sonar are employed to form unbiased maps. Multiple echoes from a target introduce phantom-reflector artifacts into its map because later echoes are produced by reflectors at bearings different from those determined from the first echoes. In addition, overlapping echoes interfere to produce bearing errors. Addressing the causes of these bearing errors motivates a processing approach that employs template matching to extract valid echoes. Interfering echoes can mimic a valid echo and also form PR artifacts. These artifacts are eliminated by recognizing the bearing fluctuations that characterize echo interference. Removing PR artifacts produces a map that resembles the physical target shape to within the resolution capabilities of the sonar. The remaining differences between the target shape and the final map are void artifacts caused by invalid or missing echoes.

Joint passive radar tracking and target classification using radar cross section

NASA Astrophysics Data System (ADS)

Herman, Shawn M.

2004-01-01

We present a recursive Bayesian solution for the problem of joint tracking and classification of airborne targets. In our system, we allow for complications due to multiple targets, false alarms, and missed detections. More importantly, though, we utilize the full benefit of a joint approach by implementing our tracker using an aerodynamically valid flight model that requires aircraft-specific coefficients such as wing area and vehicle mass, which are provided by our classifier. A key feature that bridges the gap between tracking and classification is radar cross section (RCS). By modeling the true deterministic relationship that exists between RCS and target aspect, we are able to gain both valuable class information and an estimate of target orientation. However, the lack of a closed-form relationship between RCS and target aspect prevents us from using the Kalman filter or its variants. Instead, we rely upon a sequential Monte Carlo-based approach known as particle filtering. In addition to allowing us to include RCS as a measurement, the particle filter also simplifies the implementation of our nonlinear non-Gaussian flight model.

Joint passive radar tracking and target classification using radar cross section

NASA Astrophysics Data System (ADS)

Herman, Shawn M.

2003-12-01

We present a recursive Bayesian solution for the problem of joint tracking and classification of airborne targets. In our system, we allow for complications due to multiple targets, false alarms, and missed detections. More importantly, though, we utilize the full benefit of a joint approach by implementing our tracker using an aerodynamically valid flight model that requires aircraft-specific coefficients such as wing area and vehicle mass, which are provided by our classifier. A key feature that bridges the gap between tracking and classification is radar cross section (RCS). By modeling the true deterministic relationship that exists between RCS and target aspect, we are able to gain both valuable class information and an estimate of target orientation. However, the lack of a closed-form relationship between RCS and target aspect prevents us from using the Kalman filter or its variants. Instead, we rely upon a sequential Monte Carlo-based approach known as particle filtering. In addition to allowing us to include RCS as a measurement, the particle filter also simplifies the implementation of our nonlinear non-Gaussian flight model.

Quantifying the impact of expanded age group campaigns for polio eradication.

PubMed

Wagner, Bradley G; Behrend, Matthew R; Klein, Daniel J; Upfill-Brown, Alexander M; Eckhoff, Philip A; Hu, Hao

2014-01-01

A priority of the Global Polio Eradication Initiative (GPEI) 2013-2018 strategic plan is to evaluate the potential impact on polio eradication resulting from expanding one or more Supplementary Immunization Activities (SIAs) to children beyond age five-years in polio endemic countries. It has been hypothesized that such expanded age group (EAG) campaigns could accelerate polio eradication by eliminating immunity gaps in older children that may have resulted from past periods of low vaccination coverage. Using an individual-based mathematical model, we quantified the impact of EAG campaigns in terms of probability of elimination, reduction in polio transmission and age stratified immunity levels. The model was specifically calibrated to seroprevalence data from a polio-endemic region: Zaria, Nigeria. We compared the impact of EAG campaigns, which depend only on age, to more targeted interventions which focus on reaching missed populations. We found that EAG campaigns would not significantly improve prospects for polio eradication; the probability of elimination increased by 8% (from 24% at baseline to 32%) when expanding three annual SIAs to 5-14 year old children and by 18% when expanding all six annual SIAs. In contrast, expanding only two of the annual SIAs to target hard-to-reach populations at modest vaccination coverage-representing less than one tenth of additional vaccinations required for the six SIA EAG scenario-increased the probability of elimination by 55%. Implementation of EAG campaigns in polio endemic regions would not improve prospects for eradication. In endemic areas, vaccination campaigns which do not target missed populations will not benefit polio eradication efforts.

Changing the renewable fuel standard to a renewable material standard: bioethylene case study.

PubMed

Posen, I Daniel; Griffin, W Michael; Matthews, H Scott; Azevedo, Inês L

2015-01-06

The narrow scope of the U.S. renewable fuel standard (RFS2) is a missed opportunity to spur a wider range of biomass use. This is especially relevant as RFS2 targets are being missed due to demand-side limitations for ethanol consumption. This paper examines the greenhouse gas (GHG) implications of a more flexible policy based on RFS2, which includes credits for chemical use of bioethanol (to produce bioethylene). A Monte Carlo simulation is employed to estimate the life-cycle GHG emissions of conventional low-density polyethylene (LDPE), made from natural gas derived ethane (mean: 1.8 kg CO2e/kg LDPE). The life-cycle GHG emissions from bioethanol and bio-LDPE are examined for three biomass feedstocks: U.S. corn (mean: 97g CO2e/MJ and 2.6 kg CO2e/kg LDPE), U.S. switchgrass (mean: -18g CO2e/MJ and -2.9 kg CO2e/kg LDPE), and Brazilian sugar cane (mean: 33g CO2e/MJ and -1.3 kg CO2e/kg LDPE); bioproduct and fossil-product emissions are compared. Results suggest that neither corn product (bioethanol or bio-LDPE) can meet regulatory GHG targets, while switchgrass and sugar cane ethanol and bio-LDPE likely do. For U.S. production, bioethanol achieves slightly greater GHG reductions than bio-LDPE. For imported Brazilian products, bio-LDPE achieves greater GHG reductions than bioethanol. An expanded policy that includes bio-LDPE provides added flexibility without compromising GHG targets.

Follow-up of negative MRI-targeted prostate biopsies: when are we missing cancer?

PubMed

Gold, Samuel A; Hale, Graham R; Bloom, Jonathan B; Smith, Clayton P; Rayn, Kareem N; Valera, Vladimir; Wood, Bradford J; Choyke, Peter L; Turkbey, Baris; Pinto, Peter A

2018-05-21

Multiparametric magnetic resonance imaging (mpMRI) has improved clinicians' ability to detect clinically significant prostate cancer (csPCa). Combining or fusing these images with the real-time imaging of transrectal ultrasound (TRUS) allows urologists to better sample lesions with a targeted biopsy (Tbx) leading to the detection of greater rates of csPCa and decreased rates of low-risk PCa. In this review, we evaluate the technical aspects of the mpMRI-guided Tbx procedure to identify possible sources of error and provide clinical context to a negative Tbx. A literature search was conducted of possible reasons for false-negative TBx. This includes discussion on false-positive mpMRI findings, termed "PCa mimics," that may incorrectly suggest high likelihood of csPCa as well as errors during Tbx resulting in inexact image fusion or biopsy needle placement. Despite the strong negative predictive value associated with Tbx, concerns of missed disease often remain, especially with MR-visible lesions. This raises questions about what to do next after a negative Tbx result. Potential sources of error can arise from each step in the targeted biopsy process ranging from "PCa mimics" or technical errors during mpMRI acquisition to failure to properly register MRI and TRUS images on a fusion biopsy platform to technical or anatomic limits on needle placement accuracy. A better understanding of these potential pitfalls in the mpMRI-guided Tbx procedure will aid interpretation of a negative Tbx, identify areas for improving technical proficiency, and improve both physician understanding of negative Tbx and patient-management options.

Perceived Relevance of Educative Information on Public (Skin) Health: Results of a Representative, Population-Based Telephone Survey.

PubMed

Haluza, Daniela; Schwab, Markus; Simic, Stana; Cervinka, Renate; Moshammer, Hanns

2015-11-09

Individual skin health attitudes are influenced by various factors, including public education campaigns, mass media, family, and friends. Evidence-based, educative information materials assist communication and decision-making in doctor-patient interactions. The present study aims at assessing the prevailing use of skin health information material and sources and their impact on skin health knowledge, motives to tan, and sun protection. We conducted a questionnaire survey among a representative sample of Austrian residents. Print media and television were perceived as the two most relevant sources for skin health information, whereas the source physician was ranked third. Picking the information source physician increased participants' skin health knowledge (p = 0.025) and sun-protective behavior (p < 0.001). The study results highlight the demand for targeted health messages to attain lifestyle changes towards photo-protective habits. Providing resources that encourage pro-active counseling in every-day doctor-patient communication could increase skin health knowledge and sun-protective behavior, and thus, curb the rise in skin cancer incidence rates.