Utilisation of joint movement range in arboreal primates compared with human subjects: an evolutionary frame for primary osteoarthritis.

PubMed Central

Alexander, C J

1994-01-01

OBJECTIVE--To determine whether an arboreal lifestyle required full use of movement ranges underutilised in nine joint groups in humans, because under-utilisation of available movement range may be associated with susceptibility to primary osteoarthritis. METHODS--Utilisation of the nine joint groups was studied in two species of primate exercising in a simulated arboreal environment, using 'focal animal' observation techniques supplemented by telephoto photography and by review of archival material from other sources. Fifteen apes were observed over a total observation period of 20.2 man-hours and 152 films were analysed for utilisation of movement range. RESULTS--With one exception, all the movement ranges reported to be under-utilised in humans were fully utilised by the apes in climbing activities. The exception, metacarpophalangeal extension, was an essential component of the chimpanzee ground progression mode of knuckle walking. CONCLUSIONS--The underused movement range in several human joints is explicable as residual capacity from a semiarboreal lifestyle. If the correlation with primary osteoarthritis is confirmed, it suggests that the disease may reflect a disparity between inherited capacity and current need. The significance of the result lies in its implication that primary osteoarthritis may be preventable. Images PMID:7826133

Utilisation of joint movement range in arboreal primates compared with human subjects: an evolutionary frame for primary osteoarthritis.

PubMed

Alexander, C J

1994-11-01

To determine whether an arboreal lifestyle required full use of movement ranges underutilised in nine joint groups in humans, because under-utilisation of available movement range may be associated with susceptibility to primary osteoarthritis. Utilisation of the nine joint groups was studied in two species of primate exercising in a simulated arboreal environment, using 'focal animal' observation techniques supplemented by telephoto photography and by review of archival material from other sources. Fifteen apes were observed over a total observation period of 20.2 man-hours and 152 films were analysed for utilisation of movement range. With one exception, all the movement ranges reported to be under-utilised in humans were fully utilised by the apes in climbing activities. The exception, metacarpophalangeal extension, was an essential component of the chimpanzee ground progression mode of knuckle walking. The underused movement range in several human joints is explicable as residual capacity from a semiarboreal lifestyle. If the correlation with primary osteoarthritis is confirmed, it suggests that the disease may reflect a disparity between inherited capacity and current need. The significance of the result lies in its implication that primary osteoarthritis may be preventable.

Time utilisation trends of supported employment services by persons with mental disability in South Africa.

PubMed

Van Niekerk, Lana; Coetzee, Zelda; Engelbrecht, Madri; Hajwani, Zerina; Terreblanche, Santie

2015-01-01

This paper reports on the second phase of a two-phased study that was undertaken to determine the feasibility of supported employment (SE) as a strategy with which to facilitate the employment of persons with disability in competitive work contexts. The study population comprised people with mental disabilities receiving SE in the Western Cape Province, South Africa. To describe the components of SE utilised by persons with mental disability (i.e. psychiatric or intellectual disability) in terms of type and time utilisation patterns over 12 months. Criterion sampling, a form of purposive sampling, was used to identify 29 study participants - 19 with intellectual disability and 10 with psychiatric disability. Data collection commenced for each participant when a work placement had been identified and preparation for such ensued. Data was collected prospectively for a period of 12 months. SE service components utilised by participants were captured using a data capture sheet that was developed for this purpose. Time utilisation indicated a steep downwards trend for both cohorts. The decrease in utilisation of SE service components over a period of one year was more pronounced in the psychiatric disability (PD) cohort, who utilized almost half the total SE services in the first month. SE services can be considered as a viable option for return to work in resource-constrained environments. Providers of SE services will need to modify approaches in order to meet contextual realities.

DISCOURS QUI RÉSISTENT À L’OBJECTIVATION : QUE PEUT-ON EN TIRER POUR L’ÉVALUATION?

PubMed Central

Brousselle, Astrid

2013-01-01

Résumé L’évaluateur doit porter attention aux distorsions qu’il contribue à créer lorsqu’il utilise l’entrevue comme méthode de collecte de données. L’évaluation est un exercice politique qui, placé dans un contexte politique, peut favoriser l’émergence de discours de résistance à l’objectivation. À partir des entrevues que nous avons effectuées lors de l’évaluation du processus d’implantation de l’initiative ONUSIDA d’accès aux médicaments au Chili, nous illustrons différentes tactiques que les acteurs utilisent et qui peuvent soit attirer la sympathie de l’évaluateur, soit faire obstacle à son besoin d’information. Nous présentons une méthode d’analyse que l’évaluateur peut utiliser pour redonner du sens aux discours de résistance. PMID:23997421

Correlation between carotid bifurcation calcium burden on non-enhanced CT and percentage stenosis, as confirmed by digital subtraction angiography

PubMed Central

Sarikaya, B; Lohman, B; Mckinney, A M; Gadani, S; Irfan, M; Lucato, L

2012-01-01

Objectives Previous evidence supports a direct relationship between the calcium burden (volume) on post-contrast CT with the percent internal carotid artery (ICA) stenosis at the carotid bifurcation. We sought to further investigate this relationship by comparing non-enhanced CT (NECT) and digital subtraction angiography (DSA). Methods 50 patients (aged 41–82 years) were retrospectively identified who had undergone cervical NECT and DSA. A 64-multidetector array CT (MDCT) scanner was utilised and the images reviewed using preset window widths/levels (30/300) optimised to calcium, with the volumes measured via three-dimensional reconstructive software. Stenosis measurements were performed on DSA and luminal diameter stenoses >40% were considered “significant”. Volume thresholds of 0.01, 0.03, 0.06, 0.09 and 0.12 cm3 were utilised and Pearson'S correlation coefficient (r) was calculated to correlate the calcium volume with percent stenosis. Results Of 100 carotid bifurcations, 88 were available and of these 7 were significantly stenotic. The NECT calcium volume moderately correlated with percent stenosis on DSA r=0.53 (p<0.01). A moderate–strong correlation was found between the square root of calcium volume on NECT with percent stenosis on DSA (r=0.60, p<0.01). Via a receiver operating characteristic curve, 0.06 cm3 was determined to be the best threshold (sensitivity 100%, specificity 90.1%, negative predictive value 100% and positive predictive value 46.7%) for detecting significant stenoses. Conclusion This preliminary investigation confirms a correlation between carotid bifurcation calcium volume and percent ICA stenosis and is promising for the optimal threshold for stenosis detection. Future studies could utilise calcium volumes to create a “score” that could predict high grade stenosis. PMID:21896662

An interval-valued 2-tuple linguistic group decision-making model based on the Choquet integral operator

NASA Astrophysics Data System (ADS)

Liu, Bingsheng; Fu, Meiqing; Zhang, Shuibo; Xue, Bin; Zhou, Qi; Zhang, Shiruo

2018-01-01

The Choquet integral (IL) operator is an effective approach for handling interdependence among decision attributes in complex decision-making problems. However, the fuzzy measures of attributes and attribute sets required by IL are difficult to achieve directly, which limits the application of IL. This paper proposes a new method for determining fuzzy measures of attributes by extending Marichal's concept of entropy for fuzzy measure. To well represent the assessment information, interval-valued 2-tuple linguistic context is utilised to represent information. Then, we propose a Choquet integral operator in an interval-valued 2-tuple linguistic environment, which can effectively handle the correlation between attributes. In addition, we apply these methods to solve multi-attribute group decision-making problems. The feasibility and validity of the proposed operator is demonstrated by comparisons with other models in illustrative example part.

Sampling and sensitivity analyses tools (SaSAT) for computational modelling

PubMed Central

Hoare, Alexander; Regan, David G; Wilson, David P

2008-01-01

SaSAT (Sampling and Sensitivity Analysis Tools) is a user-friendly software package for applying uncertainty and sensitivity analyses to mathematical and computational models of arbitrary complexity and context. The toolbox is built in Matlab®, a numerical mathematical software package, and utilises algorithms contained in the Matlab® Statistics Toolbox. However, Matlab® is not required to use SaSAT as the software package is provided as an executable file with all the necessary supplementary files. The SaSAT package is also designed to work seamlessly with Microsoft Excel but no functionality is forfeited if that software is not available. A comprehensive suite of tools is provided to enable the following tasks to be easily performed: efficient and equitable sampling of parameter space by various methodologies; calculation of correlation coefficients; regression analysis; factor prioritisation; and graphical output of results, including response surfaces, tornado plots, and scatterplots. Use of SaSAT is exemplified by application to a simple epidemic model. To our knowledge, a number of the methods available in SaSAT for performing sensitivity analyses have not previously been used in epidemiological modelling and their usefulness in this context is demonstrated. PMID:18304361

Caregiver perceptions of mental health problems and treatment utilisation in siblings of children with mental health problems.

PubMed

Ma, Nylanda; Furber, Gareth; Roberts, Rachel; Winefield, Helen

2016-01-01

Siblings of children with mental health problems (MHPs) have been found to have higher rates of psychopathology and impaired psychosocial functioning compared to control children. It is not yet known how these siblings are managed within the clinical service context (e.g., are they assessed for mental health problems? Do they receive appropriate psychological treatment?). The following brief report describes a pilot study which aimed to explore (a) the rate of caregiver-identified MHPs in siblings and (b) the proportion of siblings receiving psychiatric or psychosocial treatment or support (i.e., treatment utilisation). Eighty-five caregivers of children receiving treatment at CAMHS were interviewed about the mental health and treatment utilisation of their siblings. The findings revealed a high rate of caregiver-identified MHPs in siblings (34.1%) and a high rate of treatment utilisation (85.7%). The findings suggest that, for the vast majority, when siblings of children with MHPs are identified by their caregivers as having MHPs, they are receiving some kind of support and treatment. Implications for mental health service costs are discussed and recommendations for future research are outlined.

Student-Teachers' Strategies in Classroom Interaction in the Context of the Teaching Practicum

ERIC Educational Resources Information Center

Heikonen, Lauri; Toom, Auli; Pyhältö, Kirsi; Pietarinen, Janne; Soini, Tiina

2017-01-01

Strategies student-teachers employ in classroom interaction with pupils during teaching practice periods are surprisingly understudied, considering that the teaching practicum provides a central arena for student-teachers learning to become teachers. This study investigates the primary strategies student-teachers utilised in classroom interaction…

Setting the Context for Using Complexity Theory in Evaluation: Boundaries, Governance and Utilisation

ERIC Educational Resources Information Center

Walton, Mat

2016-01-01

Recent literature has usefully explored the application of complexity theory to evaluation. However, there is little discussion of the contextual conditions in applying complexity theory. Drawing upon a single complexity-consistent public health programme evaluation and subsequent policy decisions, this paper considers how programme framing and…

Here's Another Nice Mess: Using Video in Reflective Dialogue Research Method

ERIC Educational Resources Information Center

Hepplewhite, K.

2014-01-01

This account discusses "reflective dialogues", a process utilising video to re-examine in-action decision-making with theatre practitioners who operate in community contexts. The reflexive discussions combine with observation, text and digital documentation to offer a sometimes "messy" (from Schön 1987) dynamic to the research…

Resilience Strategies for New Teachers in High-Needs Areas

ERIC Educational Resources Information Center

Castro, Antonio J.; Kelly, John; Shih, Minyi

2010-01-01

This qualitative study investigates strategies of resilience exhibited by fifteen novice teachers employed in high-needs areas, such as in urban and rural contexts and in special education. Findings indicated that teachers utilised a variety of strategies, including help-seeking, problem-solving, managing difficult relationships, and seeking…

Tilling the Soil of the European Higher Education Area

ERIC Educational Resources Information Center

Burnett, John

2007-01-01

The Bologna Process presents both opportunities and challenges for teachers in the European area. As tensions surface between different forms of national legislation, accreditation and quality assurance, projects need to be developed that model ways of resolving problems within a European context. Utilising their links and network of contacts…

A Bricolage Exploration in "Genkan" Space: "Tengu" and Adjunct TEFL in the Japanese University Context

ERIC Educational Resources Information Center

Whitsed, Craig; Wright, Peter

2016-01-01

This paper reports on research focusing on a group of adjunct teachers of English employed in Japanese universities. Grounded in interpretive epistemology foregrounding constructionist traditions, this research employed bricolage as way of inquiring into, then representing, these teacher's experiences utilising multi-perspectival,…

Rebraiding Photovoice: Methodological Métissage at the Cultural Interface

ERIC Educational Resources Information Center

Higgins, Marc

2014-01-01

Photovoice, the most prevalent participatory visual research methodology utilised within social science research, has begun making its way into Indigenous contexts in light of its critical and pedagogical potential. However, this potential is not always actualised as the assumptions that undergird photovoice are often the same ones that…

Demand and utilisation of labour analgesia service by Nigerian women.

PubMed

Imarengiaye, C O; Ande, A B A

2006-02-01

This study sought to determine the clinical correlates of the demand and utilisation of labour analgesia resources by Nigerian women in labour. All consenting women were interviewed on arrival at the Unit and while in labour. Biodata, options for relief of labour pain, request for analgesia, method of analgesia, VAS score and cervical score at time of request for analgesia were obtained. A total of 288 women in labour were studied. Of these, 108 (37.5%) patients were aware that the pain of labour can be relieved but only 26.0% had prenatal information on labour analgesia. However, 85.1% of the patients would want their pain of labour relieved. A total of 112 (38.9%) did receive analgesia during labour. Cervical dilatation of <4 cm at presentation to the Unit and nulliparity were likely factors for pain treatment during labour (p = 0.001, chi2 test). There is poor utilisation of labour analgesia services. Improved antenatal information on labour analgesia may boost the utilisation of these resources by Nigerian women in labour.

Sustainability indicator system and policy processes in Malaysia: a framework for utilisation and learning.

PubMed

Hezri, A A

2004-12-01

Formulation of effective sustainability indicators for national assessment demands a comprehensive understanding of the utilisation, diffusion and dissemination of information in policy processes. To illustrate the dynamic of sustainability assessment within the context of policy processes, this paper uses a case study of national sustainability indicators development in Malaysia. Subsequently, this paper ascribes the limited achievement of national sustainability assessment in Malaysia to four types of constraints: meta-policy issues; technical capacities; communication concerns; and the inherent knowledge gaps within the indicator developer community vis-a-vis their theoretical limitations. It is proposed that such constraints will be encountered in many countries. Drawing from the literature on public policy, this paper outlines a framework for investigating indicator behaviour within policy processes based on well-established concepts such as knowledge utilisation and policy learning. I conclude this paper by elaborating on the corresponding future challenges that must be addressed before effective integration of sustainability indicators within policy systems can occur.

'If you feel that nobody wants you you'll withdraw into your own': Gypsies/Travellers, networks and healthcare utilisation.

PubMed

Smith, David; Ruston, Annmarie

2013-11-01

Gypsies and Travellers are the unhealthiest group in British society, suffering from higher levels of physical and mental illness, lower life expectancy and with low levels of healthcare utilisation. They also continue to experience the highest level of prejudice and discrimination in society. While studies indicate that social networks play an important role in shaping health beliefs and the response to symptoms, evidence on the influence of networks on health is unclear and contradictory. This article draws on social network theory and research into the relation between discrimination and health to critically examine how networks mediate between collective experiences of racism and health-related behavior. Qualitative interviews with 39 adult Gypsies and Travellers were conducted in the South-East of England to explore the wider structural and institutional context and the influence those contexts play in shaping health beliefs and decisions whether to access formal health services. The findings indicate that the influence networks play in shaping health behaviour is dependent on the particular social context of the group and its status in relation to wider social structures, making generalization problematic. © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Measuring change in health care equity using small-area administrative data - evidence from the English NHS 2001-2008.

PubMed

Cookson, Richard; Laudicella, Mauro; Donni, Paolo Li

2012-10-01

This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement. Copyright © 2012 Elsevier Ltd. All rights reserved.

Stroke patients’ utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation

PubMed Central

2014-01-01

Background Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Methods Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Results Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. Conclusions Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery. PMID:24903401

Stroke patients' utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation.

PubMed

Parker, Jack; Mawson, Susan; Mountain, Gail; Nasr, Nasrin; Zheng, Huiru

2014-06-05

Evidence indicates that post-stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner.Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, 'what works for whom and in what circumstances and respects?' Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms. Findings suggest that the theory-driven mechanisms underpinning the utilisation of feedback from computer-based technology for home-based upper-limb post-stroke rehabilitation are dependent on key elements of computer feedback and the personal and environmental context. The identification of these elements may therefore inform the development of technology; therapy education and the subsequent adoption of technology and a self-management paradigm; long-term self-managed rehabilitation; and importantly, improvements in the physical and psychosocial aspects of recovery.

Method paper--distance and travel time to casualty clinics in Norway based on crowdsourced postcode coordinates: a comparison with other methods.

PubMed

Raknes, Guttorm; Hunskaar, Steinar

2014-01-01

We describe a method that uses crowdsourced postcode coordinates and Google maps to estimate average distance and travel time for inhabitants of a municipality to a casualty clinic in Norway. The new method was compared with methods based on population centroids, median distance and town hall location, and we used it to examine how distance affects the utilisation of out-of-hours primary care services. At short distances our method showed good correlation with mean travel time and distance. The utilisation of out-of-hours services correlated with postcode based distances similar to previous research. The results show that our method is a reliable and useful tool for estimating average travel distances and travel times.

A Framework for Designing Effective Professional Development: Science Teachers' Perspectives in a Context of Reform

ERIC Educational Resources Information Center

EL-Deghaidy, Heba; Mansour, Nasser; Aldahmash, Abdulwali; Alshamrani, Saeed

2015-01-01

This paper explores science teachers' experiences, views, and preferences of what constitutes effective teacher professional development. The research method utilised both quantitative and qualitative analyses. The former was used with responses from closed-ended questions while responses to an open-ended question were analysed qualitatively. The…

Aural Classification and Temporal Robustness

DTIC Science & Technology

2010-11-01

Canada – Atlantique ; novembre 2010. Contexte : Le présent projet vise le développement d’un classificateur robuste qui utilise des...10 4.2.2.2 Discriminant score . . . . . . . . . . . . . . . . . . . 11 4.2.3 Principal component analysis . . . . . . . . . . . . . . . . . . . 13 ...allows class separation. . . . . . . . . . . . 13 Figure 7: Hypothetical clutter and target pdfs and posterior probabilties shown as surfaces

Committed, Face-Value, Hybrid or Mutual Adaptation? The Experiences of International Students in Australian Higher Education

ERIC Educational Resources Information Center

Tran, Ly Thi

2011-01-01

This paper explores the adaptation patterns of international Chinese and Vietnamese students in relation to academic writing practices in a higher education context. The study utilises a trans-disciplinary framework for interpreting students' and lecturers' practices within institutional structures. This framework has been developed by infusing a…

Entrepreneurship and Innovation: Setting an Agenda for Greater Discipline Contextualisation

ERIC Educational Resources Information Center

Maritz, Alex; Donovan, Jerome

2015-01-01

Purpose: The purpose of this paper is to explore the synergies, similarities and differences between entrepreneurship and innovation education and training programs, with the aim of challenging the context of such programs. Design/methodology/approach: This study utilises an extensive review of extant literature in the fields of innovation,…

A Cross-Cultural Exploration of 'Wild' in Wilderness Therapy: Canada, Norway and Australia

ERIC Educational Resources Information Center

Harper, Nevin J.; Gabrielsen, Leiv E.; Carpenter, Cathryn

2018-01-01

This paper addresses pluralistic understandings of wilderness in the context of wilderness therapy (WT). The term wilderness perpetuates a modern worldview of place that beyond 'civilisation' exists an environment defined by risk, fear and an unpredictable nature. WT utilises outdoor travel and living practices during therapeutic intervention and…

Neighborhood deprivation and small-for-gestaional-age term births among non-Hispanic whites and non-Hispanic blacks in the United States

EPA Science Inventory

Residential context has received increased attention as a possible contributing factor to race/ethnic and socio-economic disparities in birth outcomes in the United States. Utilising vital statistics birth record data, this study examined the association between neighbourhood dep...

Transition, Inclusion and Partnership: Child-, Parent- and Professional-Led Approaches in a European Research Project

ERIC Educational Resources Information Center

Davis, John M.; Ravenscroft, John; Bizas, Nik

2015-01-01

This paper utilises qualitative and quantitative findings from the Facilitating Inclusive Education and Supporting the Transition Agenda (FIESTA) project that carried out a survey of professionals and focus groups/interviews with parents and children to understand the context of transition, inclusion and collaborative working. The paper contrasts…

Differences in social support of caregivers living with partners suffering from COPD or dementia.

PubMed

Nordtug, Bente; Krokstad, Steinar; Sletvold, Olav; Holen, Are

2013-05-01

Future patients with chronic diseases will probably remain longer in their homes. To enable family caregivers to meet these challenges, public services and informal support are essential. This study compared social support between home-dwelling caregivers of partners with chronic obstructive pulmonary disease or dementia. A cross-sectional study of 206 caregivers. Professional aid was quantified by the services utilised. Informal support from family and friends was rated by the number of helping persons and the degree of social withdrawal. The Medical Outcomes Study Social Support Survey Form captured perceived social support. For both diseases, increased severity correlated with more utilisation of professional aid. The chronic obstructive pulmonary disease group perceived more social support, reported less social withdrawal and higher numbers of helping persons. Ill partners' aggressive behaviour reduced perceived support. The use of professional aid was negatively associated with the ill partner's level of self-care, and positively correlated with social withdrawal. Professional aid was more utilised by the dementia group and by men. Differences in caregivers' needs for social support were related to their partner's disease. Counteracting social withdrawal, considering type of illness and gender differences may increase the quality of informal care. © 2011 Blackwell Publishing Ltd.

Towards MRI microarrays.

PubMed

Hall, Andrew; Mundell, Victoria J; Blanco-Andujar, Cristina; Bencsik, Martin; McHale, Glen; Newton, Michael I; Cave, Gareth W V

2010-04-14

Superparamagnetic iron oxide nanometre scale particles have been utilised as contrast agents to image staked target binding oligonucleotide arrays using MRI to correlate the signal intensity and T(2)* relaxation times in different NMR fluids.

Measuring the benefits of using market based approaches to provide water and sanitation in humanitarian contexts.

PubMed

Martin-Simpson, S; Parkinson, J; Katsou, E

2018-06-15

The use of cash transfers and market based programming (CT/MBP) to increase the efficiency and effectiveness of emergency responses is gaining prominence in the humanitarian sector. However, there is a lack of existing indicators and methodologies to monitor activities designed to strengthen water and sanitation (WaSH) markets. Gender and vulnerability markers to measure the impact of such activities on different stakeholders is also missing. This study identifies parameters to monitor, evaluate and determine the added value of utilising CT/MBP to achieve WaSH objectives in humanitarian response. The results of the work revealed that CT/MBP can be used to support household, community and market level interventions to effectively reduce transmission of faeco-oral diseases. Efficiency, effectiveness, sustainability, appropriateness and equity were identified as useful parameters which correlated to widely accepted frameworks against which to evaluate humanitarian action. The parameters were found to be directly applicable to the case of increasing demand and supply of point of use water treatment technology for a) disaster resilience activities, and b) post-crisis response. The need for peer review of the parameters and indicators and pilot measurement in humanitarian contexts was recognised. Copyright © 2017 Elsevier Ltd. All rights reserved.

Estimating mutual information using B-spline functions – an improved similarity measure for analysing gene expression data

PubMed Central

Daub, Carsten O; Steuer, Ralf; Selbig, Joachim; Kloska, Sebastian

2004-01-01

Background The information theoretic concept of mutual information provides a general framework to evaluate dependencies between variables. In the context of the clustering of genes with similar patterns of expression it has been suggested as a general quantity of similarity to extend commonly used linear measures. Since mutual information is defined in terms of discrete variables, its application to continuous data requires the use of binning procedures, which can lead to significant numerical errors for datasets of small or moderate size. Results In this work, we propose a method for the numerical estimation of mutual information from continuous data. We investigate the characteristic properties arising from the application of our algorithm and show that our approach outperforms commonly used algorithms: The significance, as a measure of the power of distinction from random correlation, is significantly increased. This concept is subsequently illustrated on two large-scale gene expression datasets and the results are compared to those obtained using other similarity measures. A C++ source code of our algorithm is available for non-commercial use from kloska@scienion.de upon request. Conclusion The utilisation of mutual information as similarity measure enables the detection of non-linear correlations in gene expression datasets. Frequently applied linear correlation measures, which are often used on an ad-hoc basis without further justification, are thereby extended. PMID:15339346

Analysis of healthcare financing, supply and utilisation trends in the new EU countries.

PubMed

Ruseski, Jane E

2006-01-01

The EU expanded in 2004 to include eight transition countries, i.e. Central and Eastern European (CEE) and newly independent states of the former Soviet Union, and two other CEE countries are scheduled to join the EU in 2007. Each of these countries has undertaken substantial healthcare reform efforts over the past 15 years. The paths of healthcare reform are diverse for a number of reasons including differences in initial economic, political and structural conditions. The objective of this article is to evaluate the process and preliminary outcomes of healthcare reform in the new EU and candidate countries by analysing trends in aggregate financing, supply and utilisation indicators using data drawn from the WHO Health for All database. The analysis is done in the context of an analytical framework built around common healthcare reform themes. The key reform measures examined include implementing social insurance systems, implementing payment systems that promote efficiency, and removal of excess capacity. The trend analysis highlights the importance of the economic, political and social context in driving the direction and pace of healthcare reform. For example, the transition to social insurance systems was smoother in countries with stronger economies and political commitment to reform. Policies aimed at improving the efficiency of the healthcare system, reducing utilisation and reducing excess capacity were met with some success in all of the countries. However, the reform effort continues as the countries are still addressing the initial challenges of insufficient funding, informal payments, excess capacity and inefficiencies in the provision of healthcare.

Intersectionality and Reflexivity in Gender Research: Disruptions, Tracing Lines and Shooting Arrows

ERIC Educational Resources Information Center

Locke, Kirsten

2015-01-01

This paper utilises the conceptual lens of intersectionality to explore gendered academic career trajectory in the context of one participant's challenge to a normative reading of the link between her private life and its relation to a "successful" academic career. The paper then charts the recalibrations that needed to take place to…

The Client Company Marginally Utilises the Knowledge of Highly Skilled Temporary Staff

ERIC Educational Resources Information Center

Augustsson, Gunnar

2016-01-01

This study is based on the presumption that there is often an underuse of temporary staff in client companies (CC) with highly skilled professionals. The study combines theories of the flexible organisation and a sociocultural perspective on learning within the framework of an inter-organisational context. The data are based partly on 17…

Examining Curriculum Related Progress Using a Context-Based Test Instrument--A Comparison of Estonian Grade 10 and 11 Students

ERIC Educational Resources Information Center

Soobard, R.; Rannikmae, M.

2015-01-01

This study was undertaken to investigate the progress in operational scientific literacy skills through demonstrating cognition associated with undertaking scientific processes. Scientific literacy is taken here to mean utilising science knowledge and skills, particularly with relevance to creative problem solving and making reasoned decisions in…

Shaping Children's Artwork in English Primary Classes: Insights from Teacher-Child Interaction during Art Activities

ERIC Educational Resources Information Center

Hallam, Jenny; Gupta, Mani Das; Lee, Helen

2011-01-01

This paper utilises a Vygotskian framework to examine the ways in which teachers shape the creation of children's artwork in educational contexts. Reflexive ethnography and a bottom up approach to discourse analysis are used to analyse a range of qualitative data including photographs, observational notes and audio recordings collected from a Year…

Networking and Managers' Career Success in the Malaysian Public Sector: The Moderating Effect of Managerial Level

ERIC Educational Resources Information Center

Rasdi, Roziah Mohd; Garavan, Thomas N.; Ismail, Maimunah

2012-01-01

Purpose: The purpose of this paper is to investigate how managerial level moderates the relationships between networking behaviours and career success (objective and subjective) in the context of a public sector organisation in Malaysia. Design/methodology/approach: The study utilised a cross-sectional design and investigated these relationships…

Realistic Real World Contexts: Model Eliciting Activities

ERIC Educational Resources Information Center

Doruk, Bekir Kürsat

2016-01-01

Researchers have proposed a variety of methods to make a connection between real life and mathematics so that it can be learned in a practical way and enable people to utilise mathematics in their daily lives. Model-eliciting activities (MEAs) were developed to fulfil this need and are very capable of serving this purpose. The reason MEAs are so…

Social Networking and the Social and Emotional Wellbeing of Adolescents in Australia

ERIC Educational Resources Information Center

Bourgeois, Amanda; Bower, Julie; Carroll, Annemaree

2014-01-01

Technology and social networking tools and sites are changing the way young people build and maintain their social connections with others (Boyd & Ellison, 2008). This study utilised a new measure, The Self in a Social Context, Virtual Connectedness subscale (SSC-VC subscale), to examine the effects of social networking tools and sites on…

Multilingual Literacies in Transnational Digitally Mediated Contexts: An Exploratory Study of Immigrant Teens in the United States

ERIC Educational Resources Information Center

Lam, Wan Shun Eva; Rosario-Ramos, Enid

2009-01-01

This study explores the literacy practices that are involved in transnational social and information networking among youths of immigrant backgrounds in the United States. In particular, it investigates the ways in which young migrants of diverse national origins in the United States are utilising digital media to organise social relationships…

Open and Anonymous Peer Review in a Digital Online Environment Compared in Academic Writing Context

ERIC Educational Resources Information Center

Razi, Salim

2016-01-01

This study compares the impact of "open" and "anonymous" peer feedback as an adjunct to teacher-mediated feedback in a digital online environment utilising data gathered on an academic writing course at a Turkish university. Students were divided into two groups with similar writing proficiencies. Students peer reviewed papers…

Farm Education and the Value of Learning in an Authentic Learning Environment

ERIC Educational Resources Information Center

Smeds, Pia; Jeronen, Eila; Kurppa, Sirpa

2015-01-01

Farm education is a newly emerging field of research that utilises authentic learning environments, environments that combine a subject of academic study with its real-world surroundings, actors, and activities--in this case, the practical context of a farm. The aim of the study was to investigate the effects of various learning environments…

Undergraduate Student Peer Mentoring in a Multi-Faculty, Multi-Campus University Context

ERIC Educational Resources Information Center

Townsend, Robert A.; Delves, Melinda; Kidd, Tracy; Figg, Bev

2011-01-01

This article explores research that utilised a mapping strategy to investigate the elements of peer mentoring and peer tutoring programs across a multi-campus Australian university. Peer mentoring, peer tutoring and peer learning activities at the multi-campus university are occurring in a manner that may be considered ad-hoc which does not…

Active and Passive Technology Integration: A Novel Approach for Managing Technology's Influence on Learning Experiences in Context-Aware Learning Spaces

ERIC Educational Resources Information Center

Laine, Teemu H.; Nygren, Eeva

2016-01-01

Technology integration is the process of overcoming different barriers that hinder efficient utilisation of learning technologies. The authors divide technology integration into two components based on technology's role in the integration process. In active integration, the technology integrates learning resources into a learning space, making it…

What does 'access to health care' mean?

PubMed

Gulliford, Martin; Figueroa-Munoz, Jose; Morgan, Myfanwy; Hughes, David; Gibson, Barry; Beech, Roger; Hudson, Meryl

2002-07-01

Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration. Copyright The Royal Society of Medicine Press Ltd 2002.

A marketing strategy for a nursing college.

PubMed

Pryde, M; Muller, M

1995-08-01

The objective of this study is to explore and describe a marketing strategy for a nursing college. An explorative and descriptive research design, within the context of a nursing college and affiliated hospitals, was followed. A literature study of marketing models was undertaken and the Delphi-method was utilised to determine the contribution of marketing staff and the possible content of a marketing strategy for a nursing college. The results were utilised to describe guidelines for such a strategy, consisting of marketers/marketing agents, target market, product, price, promotional activities, place and market research. Recommendations include the planning, implementation and evaluation of strategy, inservice training for potential marketing agents, inclusion of marketing as part of the formal education of tutors and nurse managers, as well as an impact study of the scholar as the main consumer.

An efficient sensitivity analysis method for modified geometry of Macpherson suspension based on Pearson correlation coefficient

NASA Astrophysics Data System (ADS)

Shojaeefard, Mohammad Hasan; Khalkhali, Abolfazl; Yarmohammadisatri, Sadegh

2017-06-01

The main purpose of this paper is to propose a new method for designing Macpherson suspension, based on the Sobol indices in terms of Pearson correlation which determines the importance of each member on the behaviour of vehicle suspension. The formulation of dynamic analysis of Macpherson suspension system is developed using the suspension members as the modified links in order to achieve the desired kinematic behaviour. The mechanical system is replaced with an equivalent constrained links and then kinematic laws are utilised to obtain a new modified geometry of Macpherson suspension. The equivalent mechanism of Macpherson suspension increased the speed of analysis and reduced its complexity. The ADAMS/CAR software is utilised to simulate a full vehicle, Renault Logan car, in order to analyse the accuracy of modified geometry model. An experimental 4-poster test rig is considered for validating both ADAMS/CAR simulation and analytical geometry model. Pearson correlation coefficient is applied to analyse the sensitivity of each suspension member according to vehicle objective functions such as sprung mass acceleration, etc. Besides this matter, the estimation of Pearson correlation coefficient between variables is analysed in this method. It is understood that the Pearson correlation coefficient is an efficient method for analysing the vehicle suspension which leads to a better design of Macpherson suspension system.

Drug-related stigma and access to care among people who inject drugs in Vietnam.

PubMed

Lan, Chiao-Wen; Lin, Chunqing; Thanh, Duong Cong; Li, Li

2018-03-01

There are considerable challenges faced by people with a history of injecting drug use (PWID) in Vietnam, including drug-related stigma and lack of access to healthcare. Seeking and utilising healthcare, as well as harm reduction programs for PWID, are often hampered by drug-related stigma. This study aimed to examine the impacts of drug-related stigma on access to care and utilisation of harm reduction programs among PWID in Vietnam. A cross-sectional study was conducted in two provinces in Vietnam, Phú Thọ and Vinh Phúc. The study participants completed the survey by using Audio Computer-Assisted Self-Interview between late 2014 and early 2015. Linear multiple regression models and logistic regression models were used to assess the relationship among drug-related stigma, access to care and utilisation of harm reduction programs, including methadone maintenance treatment (MMT) and needle exchange programs (NEP). A total of 900 PWID participated in this study. Drug-related stigma was significantly associated with lower level of access to care, but not with utilisation of MMT or NEP. Older age was positively associated with higher levels of access to care. Levels of education were positively correlated with access to care, as well as utilisation of MMT and NEP. This study underscores the need for future interventions to reduce drug-related stigma in society and in health-care settings to improve PWID's utilisation of care services. Special attention should be paid to younger PWID and those with lower levels of education. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Numerical Modelling of Coherent Broadband Pulses for Seismic Exploration

DTIC Science & Technology

2011-11-01

236 ; Recherche et développement pour la défense Canada – Atlantique ; novembre 2011. Contexte : En exploration sismique marine, on utilise...4 Discussion of Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Annex A: Details of the scattering matrix R...attenuation. The results are shown after multiplication by 1.E6 . . . . . . . . . . . 13 viii DRDC Atlantic TM 2011-236 Figure 11: The Ricker wavelet (blue) and

User Experience Design of History Game: An Analysis Review and Evaluation Study for Malaysia Context

ERIC Educational Resources Information Center

Wong, Seng Yue; Ghavifekr, Simin

2018-01-01

User experience (UX) and user interface design of an educational game are important in enhancing and sustaining the utilisation of Game Based Learning (GBL) in learning history. Thus, this article provides a detailed literature review on history learning problems, as well as previous studies on user experience in game design. Future studies on…

Optimal Use of Hyperbaric Oxygen Therapy in Military Medical Setting (Utilisation optimale de loxygnothrapie hyperbare dans le contexte militaire)

DTIC Science & Technology

2016-02-01

cardiac rhythm abnormalities [115]. The central nervous system is particularly sensitive to the toxic effects of CO poisoning. While petechial hemorrhage...low grade fever , bronzing of the skin, bullae formation, obtunded sensation [164]. A.10.1.1 Benefit of HBO There are only a few studies as to the

Selecting an E-(Text)Book: Evaluation Criteria

ERIC Educational Resources Information Center

Marczak, Mariusz

2013-01-01

This paper aims to propose a repository of pre-use evaluation criteria for language teachers who wish to introduce e-books or e-textbooks to their own teaching practices. By selectively using a set of such criteria, they will be able to evaluate to what extent a given e-book/e-textbook lends itself to utilisation within their own teaching context.…

Teachers' Experiences of Engagement with and in Educational Research: What Can Be Learned from Teachers' Views?

ERIC Educational Resources Information Center

Leat, David; Reid, Anna; Lofthouse, Rachel

2015-01-01

In this paper, we explore what is known about teachers' engagement in and with educational research with a special emphasis on teachers' voice evoking their experience of participating in research. This will draw upon international contexts in order to suggest ways of utilising the benefits of research in practice. Our review is framed around five…

Proximity with under Two-Year-Olds in Early Childhood Education: A Silent Pedagogical Encounter

ERIC Educational Resources Information Center

White, Elizabeth Jayne; Redder, Bridgette

2015-01-01

Using mixed methods to analyse the experience of a 4-month-old and a 10-month-old infant in a high-quality New Zealand education and care setting, this paper utilises dialogic methodology to foreground the importance of key teacher proximity to infant relationships with adults, peers and artefacts in a group context. Quantitative findings…

Motivation and Ability: Which Students Use Online Learning and What Influence Does it Have On Their Achievement?

ERIC Educational Resources Information Center

Hoskins, Sherria L.; van Hooff, Johanna C.

2005-01-01

There has been much recent research examining online learning in universities, but two questions seem to have been largely overlooked in this context: (1) Which students voluntarily utilise web-based learning; and (2) Does this use influence their academic achievement? The current study aimed to determine whether the approaches to studying,…

Promoting Access and Enhancing Education Opportunities? The Case of "No-Fees Schools" in South Africa

ERIC Educational Resources Information Center

Ahmed, R.; Sayed, Yusuf

2009-01-01

Public financing of education in the developing world context combines public and private funds, and the utilisation of fees is seen as a way of complementing state resources. In South Africa the new government in 1994 permitted schools to charge fees, a policy that has provoked much controversy. While different aspects of this policy have been…

Raising Aspirations and Widening Participation: An Evaluation of Aimhigher in Herefordshire and Worcestershire

ERIC Educational Resources Information Center

Miller, Judy; Smith, Catherine

2011-01-01

Set in the context of a falling budget, the purpose of this study was to investigate how the impact of Aimhigher funds could be maximised in Herefordshire and Worcestershire schools. A case study approach using phenomenological methods was used to examine three key areas: How are funds distributed and utilised by schools and colleges? How are…

"Heidegger and Joe:" Revisiting the "Thing" in the Context of a Student's Experience of an Online Community

ERIC Educational Resources Information Center

Naughton, Christopher

2012-01-01

In many countries it has become commonplace for students at school to undertake their own composing in the classroom. At the same time students often develop their own creative musical interests outside school hours. This paper looks at how teachers might re-evaluate students' self-initiated compositional activity. By utilising Martin Heidegger's…

Theorising "Sacred" Space in Educational Contexts: A Case Study of Three English Midlands Sixth Form Colleges

ERIC Educational Resources Information Center

Parker, Stephen G.

2009-01-01

Sixth Form Colleges (along with the general Further Education sector) in England and Wales have of late begun to appoint new chaplains and to set aside space for quiet, prayer and reflection. This article explores this phenomenon as exhibited by three colleges in the English Midlands, utilising spatial theory and the sociology of…

Incremental Impact of Time on Students' Use of E-Learning via Facebook

ERIC Educational Resources Information Center

Moghavvemi, Sedigheh; Salarzadeh Janatabadi, Hashem

2018-01-01

The majority of studies utilised the cross-sectional method to measure students' intention to learn and investigate their corresponding learning behaviours. Only a few studies have measured the process of change in students' learning behaviour in the context of time. The main purpose of this study is to determine the effects of using a Facebook…

Examining construct validity of a new naturalistic observational assessment of hand skills for preschool- and school-age children.

PubMed

Chien, Chi-Wen; Brown, Ted; McDonald, Rachael

2012-04-01

The Assessment of Children's Hand Skills is a new assessment that utilises a naturalistic observational method to capture children's real-life hand skill performance when engaged at various types of daily activities in everyday living contexts. The Assessment of Children's Hand Skills is designed for use with 2- to 12-year-old children with a range of disabilities or health conditions. The study aimed to investigate construct validity of the Assessment of Children's Hand Skills in Australian children. Rasch analysis was used to examine internal construct validity of the Assessment of Children's Hand Skills in a mixed sample of 53 children with disabilities (including autism spectrum disorder, developmental/genetic disorders and physical disabilities) and 85 typically developing children. External construct validity was examined by correlating with three questionnaires evaluating daily living skills and hand skills. Rasch goodness-of-fit analysis suggested that all 22 activity items and 19 of 20 hand skill items in the Assessment of Children's Hand Skills measured a single construct. The Assessment of Children's Hand Skills items were placed in a clinically meaningful hierarchy from easy to hard, and the difficulty range of the items also matched the majority of children with disabilities and typically developing preschool-aged children. Moderate to high correlations (0.59 ≤ Spearman's ρ coefficients ≤ 0.89, P < 0.01) were found with the assessments of daily living and fine motor skills. This study provided preliminary evidence supporting the construct validity of the Assessment of Children's Hand Skills for its clinical application in assessing children's real-life hand skill performance in Australian contexts. © 2012 The Authors Australian Occupational Therapy Journal © 2012 Occupational Therapy Australia.

L’utilisation d’objets comme outils: un développement continu

PubMed Central

Kahrs, Björn Alexander; Lockman, Jeffrey J.

2014-01-01

Le débat autour des origines développementales de la capacité humaine à utiliser des outils de manière souple reste ouvert. Alors que l’approche dominante se focalise sur un changement qualitatif cognitif vers la fin de la première année, la théorie perception-action fournit des indices importants sur la manière dont les comportements exploratoires plus précoces des nourrissons jettent les bases pour l’émergence de cette capacité. En particulier, nous nous intéressons à la manière dont les tentatives des nourrissons de mettre en rapport les objets et les surfaces leur permettent d’apprendre comment les objets peuvent servir d’extension de la main et fournissent l’occasion d’exercer des actions qui seront recrutées plus tard pour l’utilisation d’outils. Dans ce contexte, nous discutons des études comportementales et cinématiques portant sur la manipulation d’objets, qui montrent que les nourrissons font interagir les objets et les surfaces avec discernement et que leur contrôle de la frappe (banging) augmente au cours de leur première année. En conclusion, une perspective perception-action suggère que l’utilisation d’outils émerge de manière plus continue au cours du développement que ce qui a été traditionnellement envisagé. PMID:24511151

Safety and Efficacy of Warfarin Therapy in Remote Communities of the Top End of Northern Australia.

PubMed

Dennis, Jahde; Majoni, William; Tinsley, Jeffrey; Kangaharan, Nadarajah

2017-12-01

Warfarin remains a widely used anticoagulant but application in the remote context is not well documented. This study aimed to assess in more detail whether warfarin is being utilised effectively in Australia's most isolated and remote areas. Retrospective cohort analysis of 2013 captured international normalised ratio (INR) results from people engaged in long term warfarin usage within a number of remote Northern Australian communities. Assessment of monitoring, effectiveness of dosing and complication rates was undertaken. A cohort of 167 patients was established. On average, warfarin was utilised within therapeutic range 52% of the time. Monitoring frequency averaged 16 days. Major bleeding and thrombo-embolism occurred at rates of 5.8 and 4.1 per 100 patient years respectively. Therapeutic utilisation of warfarin in this setting is close to accepted rates but has room for improvement. Monitoring was acceptable and complication rates were not disproportionately high. This study indicates that warfarin is being used with reasonable safety and efficacy in remote regions, but further research is needed. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

How Singapore Teachers in a Pioneer "School of the Future" Context "Deal with" the Process of Integrating Information and Communication Technology into the School Curriculum

ERIC Educational Resources Information Center

Lim, Melvyn H.

2015-01-01

The aim of this research was to understand and develop theory concerning how teachers in a pioneer "School of the Future" in Singapore deal with information and communication technology (ICT) integration, utilising grounded theory methods, within the interpretivist paradigm. Findings revealed that teachers tended not to make radical…

Utilising Podcasts for Learning and Teaching: A Review and Ways Forward for E-Learning Cultures

ERIC Educational Resources Information Center

Kidd, Warren

2012-01-01

This article explores the usefulness of podcasts as a pedagogic tool.1 It situates the adoption of podcasts for learning and teaching within the context of a brief history of e-Learning itself and briefly reviews the suggestion that e-Learning and social media suit the construction of a new learner--the digital native. While treating much of the…

The Impact of Fostering Relationships through Music within a Special School Classroom for Students with Autism Spectrum Disorder: An Action Research Study

ERIC Educational Resources Information Center

McFerran, Katrina Skewes; Thompson, Grace; Bolger, Lucy

2016-01-01

Music therapists have been working in special education contexts for many decades, utilising research and case studies to inform practice. Growing interest in the link between the creative arts and well-being has led music therapists to consider what aspects of their knowledge others could feasibly appropriate in the school system. An action…

Social Learning among Organic Farmers and the Application of the Communities of Practice Framework

ERIC Educational Resources Information Center

Morgan, Selyf Lloyd

2011-01-01

The paper examines social learning processes among organic farmers and explores the application of the Community of Practice (CoP) model in this context. The analysis employed utilises an approach based on the CoP model, and considers how, or whether, this approach may be useful to understand social learning among farmers. The CoP model is applied…

The Rise of Risk Management in the Universities: A New Way to Understand Quality in University Management

ERIC Educational Resources Information Center

Yokoyama, Keiko

2018-01-01

This study aims to identify how uncertainty and insecurity in the post-2008 period have reshaped risk management in the university systems. The study scrutinises internal control in the contexts of the English university system and the State University of New York (SUNY) system. It utilises the concept of 'risk' by exploring 'risk society' theses.…

Do Runner Beans Really Make You Run Fast? Young Children Learning About Science-Related Food Concepts in Informal Settings

NASA Astrophysics Data System (ADS)

Cumming, Jenny

2003-08-01

Early years practitioners acknowledge that much learning takes place in a family context. Science educators, in particular, recognise the importance of children's prior knowledge, both as a foundation on which to build and as a possible source of misconceptions. However, little work has been done to discover what young children learn outside school. This study utilised parent diaries and questionnaires to elucidate the experiences of children aged four to seven which might contribute to their knowledge about the origin of food and its destiny after being eaten. The findings indicate that children learn more scientifically correct information with friends and family than teachers might realise. Awareness of children's informal knowledge can assist teachers when planning activities. As well as this, children's prior knowledge can be utilised in classroom discourse to promote understanding.

Community/hospital indicators in South African public sector mental health services.

PubMed

Lund, Crick; Flisher, Alan J

2003-12-01

The need to balance resources between community and hospital-based mental health services in the post-deinstitutionalisation era has been well-documented. However, few indicators have been developed to monitor the relationship between community and hospital services, in either developed or developing countries. There is a particular need for such indicators in the South African context, with its history of inequitable services based in custodial institutions under apartheid, and a new policy that proposes the development of more equitable community-based care. Indicators are needed to measure the distribution of resources and the relative utilisation of community and hospital-based services during the reform process. These indicators are potentially useful for assessing the implementation of policy objectives over time. To develop and document community/hospital indicators in public sector mental health services in South Africa. A questionnaire was distributed to provincial mental health coordinators requesting numbers of full-time equivalent (FTE) staff who provide mental health care at all service levels, annual patient admissions to hospitals and annual patient attendances at ambulatory care facilities. The information was supplemented by consultations with mental health coordinators in each of the 9 provinces. Population data were obtained from preliminary findings of the 1996 census. The community/hospital indicator measuring staff distribution was defined as the ratio of staff employed in community settings to all staff, expressed as a percentage. The community/hospital indicator measuring patient service utilisation was defined as the ratio of the annual ambulatory care attendance rate per 100,000 population to the sum of this rate and the annual hospital admission rate per 100,000 population, expressed as a percentage. Of psychiatric public sector staff, 25% are located in community settings in South Africa (provincial range: 11-70%). If hospital outpatient services are included in the definition of ' 'hospital' ', this figure is reduced to 17% (provincial range: 3-56%). In terms of service utilisation, 66% of patient contacts with mental health services occur through ambulatory care services in South Africa (provincial range: 44-93%). Community/hospital staff distribution indicates an overemphasis on centralised hospital-based care in most provinces and inadequate hospital care in certain provinces. Patterns of patient service utilisation indicate an over-reliance on central hospital-based services and substantial unmet need. The findings draw attention to problems in information systems for mental health care in South Africa. The community/hospital indicators developed for this study form a useful measure for assessing the implementation of mental health policy over time. For the South African context, the community/hospital indicators are a measure of the extent of resource redistribution from hospital to community services and changing patterns of service utilisation over time. Currently, patterns of resource distribution and service utilisation are inconsistent with government policy. Further research is needed into the development of mental health information systems, refining service indicators and improving methodologies for assessing the implementation of mental health policies in service delivery.

Cluster analysis reveals subclinical subgroups with shared autistic and schizotypal traits.

PubMed

Ford, Talitha C; Apputhurai, Pragalathan; Meyer, Denny; Crewther, David P

2018-07-01

Autism and schizophrenia spectrum research is typically based on coarse diagnostic classification, which overlooks individual variation within clinical groups. This method limits the identification of underlying cognitive, genetic and neural correlates of specific symptom dimensions. This study, therefore, aimed to identify homogenous subclinical subgroups of specific autistic and schizotypal traits dimensions, that may be utilised to establish more effective diagnostic and treatment practices. Latent profile analysis of subscale scores derived from an autism-schizotypy questionnaire, completed by 1678 subclinical adults aged 18-40 years (1250 females), identified a local optimum of eight population clusters: High, Moderate and Low Psychosocial Difficulties; High, Moderate and Low Autism-Schizotypy; High Psychosis-Proneness; and Moderate Schizotypy. These subgroups represent the convergent and discriminant dimensions of autism and schizotypy in the subclinical population, and highlight the importance of examining subgroups of specific symptom characteristics across these spectra in order to identify the underlying genetic and neural correlates that can be utilised to advance diagnostic and treatment practices. Copyright © 2018 Elsevier B.V. All rights reserved.

Digital Traces of Behaviour Within Addiction: Response to Griffiths (2017).

PubMed

Ellis, David A; Kaye, Linda K; Wilcockson, Thomas D W; Ryding, Francesca C

2018-01-01

Griffiths' (2017) response to the recent commentary piece by Ryding and Kaye (2017) on "Internet Addiction: A conceptual minefield" provided a useful critique and extension of some key issues. We take this opportunity to further build upon on one of these issues to provide some further insight into how the field of "internet addiction" (IA) or technological addictions more generally, may benefit from capitalising on behavioural data. As such, this response extends Griffiths' (2007) points surrounding the efficacy of behavioural data previously used in studies on problematic gambling, to consider its merit for future research on IA or associated topics such as Internet Gaming Disorder (IGD) or "Smartphone addiction". Within this, we highlight the challenges associated with utilising behavioural data but provide some practical solutions which may support researchers and practitioners in this field. These recent developments could, in turn, advance our understanding and potentially validate such concepts by establishing behavioural correlates, conditions and contexts. Indeed, corroborating behavioural metrics alongside self-report measures presents a key opportunity if scholars and practitioners are to move the field forward.

A multimode electromechanical parametric resonator array

PubMed Central

Mahboob, I.; Mounaix, M.; Nishiguchi, K.; Fujiwara, A.; Yamaguchi, H.

2014-01-01

Electromechanical resonators have emerged as a versatile platform in which detectors with unprecedented sensitivities and quantum mechanics in a macroscopic context can be developed. These schemes invariably utilise a single resonator but increasingly the concept of an array of electromechanical resonators is promising a wealth of new possibilities. In spite of this, experimental realisations of such arrays have remained scarce due to the formidable challenges involved in their fabrication. In a variation to this approach, we identify 75 harmonic vibration modes in a single electromechanical resonator of which 7 can also be parametrically excited. The parametrically resonating modes exhibit vibrations with only 2 oscillation phases which are used to build a binary information array. We exploit this array to execute a mechanical byte memory, a shift-register and a controlled-NOT gate thus vividly illustrating the availability and functionality of an electromechanical resonator array by simply utilising higher order vibration modes. PMID:24658349

Disability and the Family in South Wales Coalfield Society, c.1920–1939

PubMed Central

Curtis, Ben; Thompson, Steven

2017-01-01

This article utilises the south Wales coalfield in the interwar period as a case study to illustrate the applicability of two sociological theories – family systems theory and the social ecology of the family – to impairment in the past. It demonstrates that a theoretically-informed approach can help to situate impairment in its particular contexts, most especially the family and the community, and give a better sense of the lived experience of disability. It also demonstrates the complexity of the experience of disability as the family and economic circumstances of each impaired individual varied and led to different forms of care-giving or the utilisation of different sources of support. The article also sheds further light on the ubiquity of disability as many families included a number of individuals with different impairments and this too had consequences for experiences and coping strategies. PMID:28706465

Characteristics of coal mine ventilation air flows.

PubMed

Su, Shi; Chen, Hongwei; Teakle, Philip; Xue, Sheng

2008-01-01

Coal mine methane (CMM) is not only a greenhouse gas but also a wasted energy resource if not utilised. Underground coal mining is by far the most important source of fugitive methane emissions, and approximately 70% of all coal mining related methane is emitted to the atmosphere through mine ventilation air. Therefore, research and development on mine methane mitigation and utilisation now focuses on methane emitted from underground coal mines, in particular ventilation air methane (VAM) capture and utilisation. To date, most work has focused on the oxidation of very low concentration methane. These processes may be classified based on their combustion kinetic mechanisms into thermal oxidation and catalytic oxidation. VAM mitigation/utilisation technologies are generally divided into two basic categories: ancillary uses and principal uses. However, it is possible that the characteristics of ventilation air flows, for example the variations in methane concentration and the presence of certain compounds, which have not been reported so far, could make some potential VAM mitigation and utilisation technologies unfeasible if they cannot cope with the characteristics of mine site ventilation air flows. Therefore, it is important to understand the characteristics of mine ventilation air flows. Moreover, dust, hydrogen sulphide, sulphur dioxide, and other possible compounds emitted through mine ventilation air into the atmosphere are also pollutants. Therefore, this paper presents mine-site experimental results on the characteristics of mine ventilation air flows, including methane concentration and its variations, dust loadings, particle size, mineral matter of the dust, and other compounds in the ventilation air flows. The paper also discusses possible correlations between ventilation air characteristics and underground mining activities.

A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises.

PubMed

Singh, Neha S; Aryasinghe, Sarindi; Smith, James; Khosla, Rajat; Say, Lale; Blanchet, Karl

2018-01-01

Women and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries. We searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach. Of the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers. Despite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations.

Determinants of skilled birth attendants for delivery in Nepal.

PubMed

Baral, Y R; Lyons, K; Skinner, J; van Teijlingen, E R

2010-01-01

This review is to explore the factors affecting the uptake of skilled birth attendants for delivery and the issues associated with women's role and choices of maternal health care service for delivery in Nepal. Literature was reviewed across the globe and discussed in a Nepalese context. Delivery by Skilled Birth Attendance serves as an indicator of progress towards reducing maternal mortality worldwide, the fifth Millennium Development Goal. Nepal has committed to reducing its maternal mortality by 75% by 2015 through ensuring accessibility to the availability and utilisation of skilled care at every birth. The literature suggests that several socio-economic, cultural and religious factors play a significant role in the use of Skilled Birth Attendance for delivery in Nepal. Availability of transportation and distance to the health facility; poor infrastructure and lack of services; availability and accessibility of the services; cost and convenience; staff shortages and attitudes; gender inequality; status of women in society; women's involvement in decision making; and women's autonomy and place of residence are significant contributing factors for uptake of Skilled Birth Attendance for delivery in Nepal. The review found more quantitative research studies exploring the determinants of utilisation of the maternal health services during pregnancy in Nepal than qualitative studies. Findings of quantitative research show that different social demographic, economic, socio-cultural and religious factors are responsible for the utilisation of maternal health services but very few studies discussed how and why these factors are responsible for utilisation of skilled birth attendants in pregnancy. It is suggested that there is need for more qualitative research to explore the women's role and choice regarding use of skilled birth attendants services and to find out how and why these factors are responsible for utilisation of skilled birth attendants for delivery. Qualitative research will help further exploration of the issues and contribute to improvement of maternal health services.

A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises

PubMed Central

Aryasinghe, Sarindi; Smith, James; Khosla, Rajat; Say, Lale; Blanchet, Karl

2018-01-01

Introduction Women and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries. Methods We searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach. Results Of the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers. Conclusions Despite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations. PMID:29736272

Reflective topical autobiography: an under utilised interpretive research method in nursing.

PubMed

Johnstone, M J

1999-01-01

Reflective topical autobiography (an autobiographical method) belongs to the genre of testimonial research and is located within the postpositivist interpretive research paradigm. Despite the (reflective) topical autobiographical method enjoying a 'rebirth' in recent years and being utilised by a range of researchers in the human and literary disciplines, it remains largely unknown and under utilised in nursing research domains. In this article it is proposed that reflective topical autobiography is an important research method in its own right, and one which promises to make a substantive contribution to the overall project of advancing nursing inquiry and knowledge. This is particularly so where nursing research shares in the affirming projects of interpretive research generally and the relatively new sociology of the emotions in particular apropos: (i) increasing understanding of subjectivity and making subjective experiences more visible and intelligible, (ii) the search for meaning and increasing understanding of the commonality of existential human experience, and (iii) decentring the detached observer and his/her privileging the objectivist illusion in the hierarchy of research discourses, paving the way for the admission of multiple realities and interpretations of lived experience. In this article, a coherent reflective topical autobiographical research method is advanced for use in nursing education and research contexts.

Revisualising 'porn': how young adults' consumption of sexually explicit Internet movies can inform approaches to Canadian sexual health promotion.

PubMed

Hare, Kathleen A; Gahagan, Jacqueline; Jackson, Lois; Steenbeek, Audrey

2015-01-01

The Internet offers an invaluable opportunity to re-imagine ideas, constructs and disciplines to create innovative sexual health promotion interventions. To gain insight into what young adults (aged 19-28) may be seeking in online sexual resources and approaches, this study explored how young people perceived their sexual health to be influenced by their consumption of the highly utilised sexual medium of Sexually Explicit Internet Movies [SEIM]. Employing an exploratory, qualitative methodology, data were collected through semi-structured interviews with 12 urban, heterosexual young adults, who self-identified as having consumed SEIM for a period of at least one year. All interviews were audiotaped with permission, transcribed verbatim and the data were analysed to identify emergent thematic concepts. Participants described utilising SEIM as an all-inclusive sexual forum to learn more about the positive aspects of sexual health, in a context that they viewed as being devoid of alternatives. Young adults' perceptions of the utility of SEIM suggest that it would be beneficial to create novel, sex-positive online sexual health interventions. Further exploration is clearly warranted on how Internet resources that are related to sexual health, such as SEIM, can be utilised to facilitate innovative approaches to online sexual health promotion.

Use of simulated patients to develop communication skills in nursing education: An integrative review.

PubMed

MacLean, Sharon; Kelly, Michelle; Geddes, Fiona; Della, Phillip

2017-01-01

Registered nurses are expected to communicate effectively with patients. To improve on this skill education programmes in both hospital and tertiary settings are increasingly turning to simulation modalities when training undergraduate and registered nurses. The roles simulated patients (SPs) assume can vary according to training purposes and approach. The first aim is to analyse how SPs are used in nursing education to develop communication skills. The second aim is to evaluate the evidence that is available to support the efficacy of using SPs for training nurses in communication skills and finally to review the SP recruitment and training procedure. An Integrative review. A search was conducted on CINAHL, Psych-info, PubMed, Google Scholar, Scopus, Ovid, Medline, and ProQuest databases. Keywords and inclusion/exclusion criteria were determined and applied to the search strategy. The integrative review included Nineteen studies from 2006-2016. Critical Appraisal Skills Program (CASP) method of evaluation was utilised. Emergent themes were extracted with similar and divergent perspectives. Analysis identified seven clinical contexts for communication skills training (CST) and two SP roles from the eighteen studies. SPs were either directly involved in the teaching of communication (active role) or used in the evaluation of the effectiveness of a communication skills program (passive role). A majority of studies utilised faculty-designed measurement instruments. The evidence presented in the 19 articles indicates that the use of SPs to teach nurse-patient communication skills targets more challenging clinical interactions. Engaging SPs in both CST program facilitation and course evaluation provides nurse educators with a strong foundation to develop further pedagogical and research capacity. Expanding the utilisation of SPs to augment nurses' communication skills and ability to engage with patients in a broader range of clinical contexts with increased methodological rigor is recommended. Copyright © 2016 Elsevier Ltd. All rights reserved.

Recent applications of THERMUS

NASA Astrophysics Data System (ADS)

Wheaton, S.; Hauer, M.

2011-12-01

Some of the most recent applications of the statistical-thermal model package, THERMUS, are reviewed. These applications focus on fluctuation and correlation observables in an ideal particle and anti-particle gas in limited momentum space segments, as well as in a hadron resonance gas. In the case of the latter, a Monte Carlo event generator, utilising THERMUS functionality and assuming thermal production of hadrons, is discussed. The system under consideration is sampled grand canonically in the Boltzmann approximation. A re-weighting scheme is then introduced to account for conservation of charges (baryon number, strangeness, electric charge) and energy and momentum, effectively allowing for extrapolation of grand canonical results to the micro canonical limit. The approach utilised in this and other applications suggests improvements to existing THERMUS calculations.

Good phonetic errors in poor spellers are associated with right-handedness and possible weak utilisation of visuospatial abilities.

PubMed

Eglinton, Elizabeth; Annett, Marian

2008-06-01

Poor spellers in normal schools, who were not poor readers, were studied for handedness, visuospatial and other cognitive abilities in order to explore contrasts between poor spellers with and without good phonology. It was predicted by the right shift (RS) theory of handedness and cerebral dominance that those with good phonology would have strong bias to dextrality and relative weakness of the right hemisphere, while those without good phonology would have reduced bias to dextrality and relative weakness of the left hemisphere. Poor spellers with good phonetic equivalent spelling errors (GFEs) included fewer left-handers (2.4%) than poor spellers without GFEs (24.4%). Differences for hand skill were as predicted. Tests of visuospatial processing found no differences between the groups in levels of ability, but there was a marked difference in pattern of correlations between visuospatial test scores and homophonic word discrimination. Whereas good spellers (GS) and poor spellers without GFEs showed positive correlations between word discrimination and visuospatial ability, there were no significant correlations for poor spellers with GFEs. The differences for handedness and possibly for the utilisation of visuospatial skills suggest that surface dyslexics differ from phonological dyslexics in cerebral specialisation and perhaps in the quality of inter-hemispheric relations.

The relationship between momentary emotions and well-being across European Americans, Hispanic Americans, and Asian Americans.

PubMed

Choi, Eunsoo; Chentsova-Dutton, Yulia E

2017-09-01

Cultural differences in the emphasis on positive and negative emotions suggest that the impact of these emotions on well-being may differ across cultural contexts. The present study utilised a momentary sampling method to capture average momentary emotional experiences. We found that for participants from cultural contexts that foster positive emotions (European Americans and Hispanic Americans), average momentary positive emotions predicted well-being better than average momentary negative emotions. In contrast, average momentary negative emotions were more strongly associated with well-being measures for Asian Americans, the group from a cultural context that emphasises monitoring of negative emotions. Furthermore, we found that acculturation to American culture moderated the association between average momentary positive emotions and well-being for Asian Americans. These findings suggest the importance of culture in studying the impact of daily emotional experiences on well-being.

Concepts, Diagnosis and the History of Medicine: Historicising Ian Hacking and Munchausen Syndrome.

PubMed

Millard, Chris

2017-08-01

Concepts used by historians are as historical as the diagnoses or categories that are studied. The example of Munchausen syndrome (deceptive presentation of illness in order to adopt the 'sick role') is used to explore this. Like most psychiatric diagnoses, Munchausen syndrome is not thought applicable across time by social historians of medicine. It is historically specific, drawing upon twentieth-century anthropology and sociology to explain motivation through desire for the 'sick role'. Ian Hacking's concepts of 'making up people' and 'looping effects' are regularly utilised outside of the context in which they are formed. However, this context is precisely the same anthropological and sociological insight used to explain Munchausen syndrome. It remains correct to resist the projection of Munchausen syndrome into the past. However, it seems inconsistent to use Hacking's concepts to describe identity formation before the twentieth century as they are given meaning by an identical context.

Technology-enhanced teacher development in rural Bangladesh: A critical realist evaluation of the context.

PubMed

Jamil, Md Golam

2018-08-01

This study arose in response to the complexity of implementing technology-enhanced learning for teacher development in a developing country. Bangladesh is a country with growing technological capacity including mobile phone network coverage, yet it faces vast challenges of utilising these facilities in the education sector. As educational change and technological innovation do not happen in a vacuum, the researcher used a critical realist approach to understand the layers of the rural Bangladesh context where technology-enhanced learning will take place. Findings have been drawn from survey data (n = 207) and a series of six focus group sessions with the same six stakeholders, informing future technology-enhanced teacher development programmes. The implications of the study are to suggest principles for pedagogical change and a methodological approach which attends to context. Copyright © 2018 Elsevier Ltd. All rights reserved.

Counting the costs: Comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South Africa

PubMed Central

2001-01-01

Background In South Africa, where health care resources are limited, it is important to ensure that drugs provision and use is rational. The Essential Drug List includes depot medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NET-EN) as injectable progestagen-only contraceptives (IPCs), and both products are extensively used. Objectives and Methods Utilisation patterns of the injectable contraceptive products DMPA and NET-EN are compared in the context of current knowledge of the safety and efficacy of these agents. Utilisation patterns were analysed by means of a Pareto (ABC) analysis of IPCs issued from 4 South African provincial pharmaceutical depots over 3 financial years. A case study from rural KwaZulu-Natal, South Africa, is used to examine utilisation patterns and self-reported side effects experienced by 187 women using IPCs. Results IPCs accounted for a substantial share of total state expenditure on drugs. While more DMPA than NET-EN was issued, NET-EN distribution from 2 depots increased over the 3-year period. Since DMPA was cheaper, if all NET-EN clients in the 1999/2000 financial year (annualised) had used DMPA, the 4 depots could have saved 4.95 million South African Rands on product acquisition costs alone. The KZN case study showed slightly more NET-EN (54%) than DMPA (46%) use; no significant differences in self-reported side effects; and that younger women were more likely to use NET-EN than DMPA (p = 0.0001). Conclusions Providing IPCs on the basis of age is not appropriate or cost effective. Rational use of these products should include consideration of the cost of prescribing one over another. PMID:11401729

Using the Kaleidoscope Career Model to Examine Generational Differences in Work Attitudes

ERIC Educational Resources Information Center

Sullivan, Sherry E.; Forret, Monica L.; Carraher, Shawn M.; Mainiero, Lisa A.

2009-01-01

Purpose: The purpose of this paper is to examine, utilising the Kaleidoscope Career Model, whether members of the Baby Boom generation and Generation X differ in their needs for authenticity, balance, and challenge. Design/methodology/approach: Survey data were obtained from 982 professionals located across the USA. Correlations, t-tests, and…

Infant carrying methods: Correlates and associated musculoskeletal disorders among nursing mothers in Nigeria.

PubMed

Ojukwu, Chidiebele Petronilla; Anyanwu, Godson Emeka; Anekwu, Emelie Morris; Chukwu, Sylvester Caesar; Fab-Agbo, Chukwubuikem

2017-10-01

Infant carrying is an integral part of the mothering occupation. Paucity of data exists on its correlates and associated musculoskeletal injuries. In this study, factors and musculoskeletal injuries associated with infant carrying were investigated in 227 nursing mothers, using a structured questionnaire. 77.1% utilised the back infant carrying methods (ICM). Maternal comfort was the major factor influencing participants' (37.4%) choices of ICMs. Infant's age (p = .000) and transportation means (p = .045) were significantly associated with ICMs. Low back pain (82.8%) and upper back pain (74.9%) were the most reported musculoskeletal discomforts associated with ICMs, especially among women who utilised back ICM. Back ICM is predominantly used by nursing mothers. Impact statement Infant carrying has been associated with increased energy cost and biomechanical changes. Currently, there is a paucity of data on infant carrying-related musculoskeletal injuries. In this study, investigating factors and musculoskeletal injuries associated with infant carrying, the results showed that back infant carrying method is predominantly used by nursing mothers. Age of the infant and mothers' means of transportation were determinant factors of infant carrying methods. Among the several reported infant carrying-related musculoskeletal disorders, low back and upper back pain were the most prevalent, especially among women who utilised the back infant carrying method. There is need for women's health specialists to introduce appropriate ergonomic training and interventions on infant carrying tasks in order to improve maternal musculoskeletal health during the childbearing years and beyond. Further experimental studies on the effects of various infant carrying methods on the musculoskeletal system are recommended.

Measuring and decomposing socioeconomic inequality in healthcare delivery: A microsimulation approach with application to the Palestinian conflict-affected fragile setting.

PubMed

Abu-Zaineh, Mohammad; Mataria, Awad; Moatti, Jean-Paul; Ventelou, Bruno

2011-01-01

Socioeconomic-related inequalities in healthcare delivery have been extensively studied in developed countries, using standard linear models of decomposition. This paper seeks to assess equity in healthcare delivery in the particular context of the occupied Palestinian territory: the West Bank and the Gaza Strip, using a new method of decomposition based on microsimulations. Besides avoiding the 'unavoidable price' of linearity restriction that is imposed by the standard methods of decomposition, the microsimulation-based decomposition enables to circumvent the potentially contentious role of heterogeneity in behaviours and to better disentangle the various sources driving inequality in healthcare utilisation. Results suggest that the worse-off do have a disproportinately greater need for all levels of care. However with the exception of primary-level, utilisation of all levels of care appears to be significantly higher for the better-off. The microsimulation method has made it possible to identify the contributions of factors driving such pro-rich patterns. While much of the inequality in utilisation appears to be caused by the prevailing socioeconomic inequalities, detailed analysis attributes a non-trivial part (circa 30% of inequalities) to heterogeneity in healthcare-seeking behaviours across socioeconomic groups of the population. Several policy recommendations for improving equity in healthcare delivery in the occupied Palestinian territory are proposed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Operationalisation of the construct of access to dental care: a position paper and proposed conceptual definitions.

PubMed

Harris, R V

2013-06-01

'Access' is a term readily used in a political and policy context, but one which has not leant itself to measurement of progress towards policy goals or comparisons between health systems. Like 'quality', 'access' is a multi-dimensional construct, but currently often remains a vague and abstract concept which is difficult to translate into something specific, concrete and therefore measureable. The paper describes previous work and identifies a need for a greater consensus and conceptual clarity in the selection of metrics for dental access. The construct of dental access is described as involving the concepts of 1: opportunity for access; 2, realised access (utilisation); 3, equity and 4, outcomes. Proposed conceptual definitions are given and a case made for measuring 'initial utilisation' separately from 'continued utilisation', reflecting modern approaches which distinguish 'entry access' (gaining entry to the dental care system), from the process of gaining access to higher levels of care. Using a distinction between 'entry access' and 'effective access' allows a choice of whether to restrict measurement to mainly supply side considerations, or alternatively to extend the measurement to include whether there is equity in the proportion of patients who are able obtain effective needed interventions. A development of conceptual definitions of dental access could facilitate measurement of progress towards policy goals and operationalisation of the construct.

The Australian Racism, Acceptance, and Cultural-Ethnocentrism Scale (RACES): item response theory findings.

PubMed

Grigg, Kaine; Manderson, Lenore

2016-03-17

Racism and associated discrimination are pervasive and persistent challenges with multiple cumulative deleterious effects contributing to inequities in various health outcomes. Globally, research over the past decade has shown consistent associations between racism and negative health concerns. Such research confirms that race endures as one of the strongest predictors of poor health. Due to the lack of validated Australian measures of racist attitudes, RACES (Racism, Acceptance, and Cultural-Ethnocentrism Scale) was developed. Here, we examine RACES' psychometric properties, including the latent structure, utilising Item Response Theory (IRT). Unidimensional and Multidimensional Rating Scale Model (RSM) Rasch analyses were utilised with 296 Victorian primary school students and 182 adolescents and 220 adults from the Australian community. RACES was demonstrated to be a robust 24-item three-dimensional scale of Accepting Attitudes (12 items), Racist Attitudes (8 items), and Ethnocentric Attitudes (4 items). RSM Rasch analyses provide strong support for the instrument as a robust measure of racist attitudes in the Australian context, and for the overall factorial and construct validity of RACES across primary school children, adolescents, and adults. RACES provides a reliable and valid measure that can be utilised across the lifespan to evaluate attitudes towards all racial, ethnic, cultural, and religious groups. A core function of RACES is to assess the effectiveness of interventions to reduce community levels of racism and in turn inequities in health outcomes within Australia.

Comparison of common lignin methods and modifications on forage and lignocellulosic biomass materials.

PubMed

Goff, Ben M; Murphy, Patrick T; Moore, Kenneth J

2012-03-15

A variety of methods have been developed for estimating lignin concentration within plant materials. The objective of this study was to compare the lignin concentrations produced by six methods on a diverse population of forage and biomass materials and to examine the relationship between these concentrations and the portions of these materials that are available for utilisation by livestock or for ethanol conversion. Several methods produced lignin concentrations that were highly correlated with the digestibility of the forages, but there were few relationships between these methods and the available carbohydrate of the biomass materials. The use of Na₂SO₃ during preparation of residues for hydrolysis resulted in reduced lignin concentrations and decreased correlation with digestibility of forage materials, particularly the warm-season grasses. There were several methods that were well suited for predicting the digestible portion of forage materials, with the acid detergent lignin and Klason lignin method giving the highest correlation across the three types of forage. The continued use of Na₂SO₃ during preparation of Van Soest fibres needs to be evaluated owing to its ability to reduce lignin concentrations and effectiveness in predicting the utilisation of feedstuffs and feedstocks. Because there was little correlation between the lignin concentration and the biomass materials, there is a need to examine alternative or develop new methods to estimate lignin concentrations that may be used to predict the availability of carbohydrates for ethanol conversion. Copyright © 2011 Society of Chemical Industry.

Pleasure: An under-utilised 'P' in social marketing for healthy eating.

PubMed

Pettigrew, Simone

2016-09-01

The escalating obesity crisis has resulted in a wide range of efforts to develop more effective prevention approaches. This review article explores the potential for the concept of food pleasure to take centre stage in social marketing programs that aim to encourage healthy eating. Literature relating to food motivations is reviewed and the various strategic phases involved in developing social marketing programs are outlined in the context of incorporating a food pleasure focus. Copyright © 2015 Elsevier Ltd. All rights reserved.

Fascination and Isolation: A Grounded Theory Exploration of Unusual Sensory Experiences in Adults with Asperger Syndrome

ERIC Educational Resources Information Center

Smith, Richard S.; Sharp, Jonathan

2013-01-01

Unusual sensory experiences are commonly seen in people with Asperger syndrome (AS). They correlate with functional impairments and cause distress. The current study investigates how these experiences have affected nine adults with AS's lives, as well as the coping strategies utilised. Semi-structured interviews were conducted using Instant…

A national appraisal of haemodialysis vascular access provision in Scotland.

PubMed

Oliver, Scott W; Campbell, Jacqueline; Kingsmore, David B; Kasthuri, Ram; Metcalfe, Wendy; Traynor, Jamie P; Fischbacher-Smith, Denis; Jardine, Alan G; Thomson, Peter C

2017-03-21

Published registry data demonstrate longstanding variation in the utilisation of different vascular access (VA) modalities between Scottish renal units; this may reflect different clinical processes between centres. A comprehensive appraisal was undertaken to understand the processes underpinning VA creation and maintenance across Scotland. A mixed methods approach was utilised. Fifty-two semi-structured interviews were conducted with patients and clinicians in all ten, adult and paediatric, Scottish renal units. Interview transcripts were subjected to thematic analysis. Clinical activity data were prospectively collected for six weeks, and correlated with registry data. VA accounts for a large clinical workload. There was significant inter-centre variation in the utilisation of different VA modalities, and patients described frustrating, dissatisfying experiences. VA creation and maintenance pathways functioned best when nephrologists, surgeons and radiologists were co-located on the same campus with close multi-disciplinary working, protected clinical time, and proactive VA maintenance. No unit routinely measured or discussed procedure outcomes or strategic aspects of their service. Varied clinical outcomes reflected varied clinical processes. Optimised clinical pathways, staff education and measurement of clinical outcomes may improve VA service quality and facilitate safer, more effective, patient-centred care.

Contextual modulation of pain sensitivity utilising virtual environments

PubMed Central

Smith, Ashley; Carlow, Klancy; Biddulph, Tara; Murray, Brooke; Paton, Melissa; Harvie, Daniel S

2017-01-01

Background: Investigating psychological mechanisms that modulate pain, such as those that might be accessed by manipulation of context, is of great interest to researchers seeking to better understand and treat pain. The aim of this study was to better understand the interaction between pain sensitivity, and contexts with inherent emotional and social salience – by exploiting modern immersive virtual reality (VR) technology. Methods: A within-subjects, randomised, double-blinded, repeated measures (RM) design was used. In total, 25 healthy participants were exposed to neutral, pleasant, threatening, socially positive and socially negative contexts, using an Oculus Rift DK2. Pressure pain thresholds (PPTs) were recorded in each context, as well as prior to and following the procedure. We also investigated whether trait anxiety and pain catastrophisation interacted with the relationship between the different contexts and pain. Results: Pressure pain sensitivity was not modulated by context (p = 0.48). Anxiety and pain catastrophisation were not significantly associated with PPTs, nor did they interact with the relationship between context and PPTs. Conclusion: Contrary to our hypothesis, socially and emotionally salient contexts did not influence pain thresholds. In light of other research, we suggest that pain outcomes might only be tenable to manipulation by contextual cues if they specifically manipulate the meaning of the pain-eliciting stimulus, rather than manipulate psychological state generally – as per the current study. Future research might exploit immersive VR technology to better explore the link between noxious stimuli and contexts that directly alter its threat value. PMID:28491299

Utilisation de lignes directrices dans le cadre de l’implantation de cabinets automatisés décentralisés en établissement de santé

PubMed Central

Brisseau, Lionel; Bussières, Jean-François; Lebel, Denis; Atkinson, Suzanne; Robinette, Louise; Fortin, Sylvie; Lemay, Michel

2011-01-01

RÉSUMÉ Contexte : Il existe peu de données sur les conséquences de l’utilisation des cabinets automatisés décentralisés (CAD) en établissements de santé. Méthode : Il s’agit d’une étude descriptive de la conformité des pratiques par rapport à des lignes directrices publiées dans le cadre de l’implantation de CAD. L’objectif principal de l’étude est d’évaluer la conformité globale et celle de chaque processus du circuit du médicament. L’étude se déroule au sein du Centre hospitalier universitaire (CHU) Sainte-Justine, un établissement mère–enfant de 500 lits. À partir des lignes directrices portant sur l’utilisation sécuritaire des CAD de l’Institute for Safe Medication Practice (aux États-Unis) (2008) et de son outil d’autoévaluation (2009), nous avons évalué la conformité de la pratique à 30 jours et à 120 jours après l’implantation. Résultats : Nous avons procédé de novembre 2009 à avril 2010 à l’implantation de sept stations de CAD au sein du CHU Sainte-Justine. Le profil de conformité est passé de 66 % à 74 % de janvier à avril 2010. Pour chaque processus relatif à l’utilisation sécuritaire des CAD, nous présentons une brève description des critères ainsi que les éléments de non-conformité liés à la technologie ou aux aspects organisationnels. Pour chaque élément de non-conformité, nous avons déterminé les actions requises auprès du fabricant afin de modifier l’équipement (c. à .d. aspects technologiques) et auprès de l’établissement afin de modifier les modalités d’utilisation (aspects organisationnels) en précisant le ou les processus impliqués. Conclusion : Cette étude décrit la conformité des pratiques au CHU Sainte-Justine par rapport à des lignes directrices publiées par l’Institute for Safe Medication Practices. L’utilisation de lignes directrices dans le cadre de l’implantation de cabinets automatisés décentralisés en établissement peut aider à guider les actions tant sur le plan technologique qu’organisationnel. PMID:22479039

Comorbid Diabetes and Depression among Older Adults - Prevalence, Correlates, Disability and Healthcare Utilisation.

PubMed

Subramaniam, Mythily; Abdin, Edimansyah; Vaingankar, Janhavi A; Picco, Louisa; Seow, Esmond; Chua, Boon Yiang; Ng, Li Ling; Mahendran, Rathi; Chua, Hong Choon; Heng, Derrick Mk; Chong, Siow Ann

2017-03-01

The objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation. Data for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM. DM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed. Given the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.

Evaluating the use of Social Impact Assessment in the context of agricultural development projects in Iran

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

Ahmadvand, Mostafa, E-mail: ahmadvand_2000@yahoo.co; Karami, Ezatollah, E-mail: ekarami@shirazu.ac.i; Zamani, Gholam Hossein, E-mail: zamani@shirazu.ac.i

2009-11-15

The utilisation of Social Impact Assessment (SIA) in Iran is analysed in terms of its policy context and its application in practice. Five case studies where SIA was employed in conjunction with Environmental Impact Assessments (EIA) for agricultural development projects are evaluated. In addition, the performance of the policy context is assessed. This research revealed that there are legal and institutional constraints to the effective functioning of SIA in Iran, and that there are deficiencies in the operating guidelines. There were serious problems associated with the way SIA was undertaken in all five case studies. Recommendations to improve the policymore » framework for the conduct of SIA are made. The recommendations advocate for a higher profile of SIA within legislation, for social issues to have greater emphasis in official guidelines for the conduct of EIA and SIA, and for a range of measures to increase the professionalism of SIA practice.« less

Concepts, Diagnosis and the History of Medicine: Historicising Ian Hacking and Munchausen Syndrome

PubMed Central

Millard, Chris

2017-01-01

Summary Concepts used by historians are as historical as the diagnoses or categories that are studied. The example of Munchausen syndrome (deceptive presentation of illness in order to adopt the ‘sick role’) is used to explore this. Like most psychiatric diagnoses, Munchausen syndrome is not thought applicable across time by social historians of medicine. It is historically specific, drawing upon twentieth-century anthropology and sociology to explain motivation through desire for the ‘sick role’. Ian Hacking’s concepts of ‘making up people’ and ‘looping effects’ are regularly utilised outside of the context in which they are formed. However, this context is precisely the same anthropological and sociological insight used to explain Munchausen syndrome. It remains correct to resist the projection of Munchausen syndrome into the past. However, it seems inconsistent to use Hacking’s concepts to describe identity formation before the twentieth century as they are given meaning by an identical context. PMID:29713120

Why did an effective Dutch complex psycho-social intervention for people with dementia not work in the German healthcare context? Lessons learnt from a process evaluation alongside a multicentre RCT.

PubMed

Voigt-Radloff, Sebastian; Graff, Maud; Leonhart, Rainer; Hüll, Michael; Rikkert, Marcel Olde; Vernooij-Dassen, Myrra

2011-08-09

Background The positive effects of the Dutch Community Occupational Therapy in Dementia programme on patients' daily functioning were not found in a multicentre randomised controlled trial (RCT) in Germany. Objectives To evaluate possible effect modification on the primary outcome within the German RCT with regard to (1) participant characteristics, (2) treatment performance and (3) healthcare service utilisation; and (4) to compare the design and primary outcome between the German and the original Dutch study. Methods (1) The impact of participant baseline data on the primary outcome was analysed in exploratory ANCOVA and regression analyses. (2) Therapists completed questionnaires on context and performance problems. The main problems were identified by a qualitative content analysis and focus-group discussion. Associations of the primary outcome with scores of participant adherence and treatment performance were evaluated by regression analysis. (3) Utilisation rates of healthcare services were controlled for significant group differences. (4) Differences in the Dutch and German study design were identified, and the primary outcome was contrasted at the item level. Results (1) Participant characteristics could not explain more than 5% of outcome variance. (2) The treatment performance of some active intervention components was poor but not significantly associated with the primary outcome. (3) There were no significant group differences in the utilisation of healthcare resources. (4) In contrast to the Dutch waiting-control group, the active intervention in the German control group may have reduced group differences in the current RCT. The German patients demonstrated a higher independence at baseline and less improvement in instrumental activities of daily living. Conclusion The differences in outcome may be explained by a more active control treatment, partially poor experimental treatment and less room for improvement in the German sample. Future cross-national transfers should be prepared by pilot studies assessing the applicability of the intervention and patient needs specific to the target country. Trial registration International Clinical Trials Registry Platform, DRKS00000053.

Footing the bill: the introduction of Medicare Benefits Schedule rebates for podiatry services in Australia.

PubMed

Short, Anthony J

2009-12-07

The introduction of Medicare Benefits Schedule items for allied health professionals in 2004 was a pivotal event in the public funding of non-medical primary care services. This commentary seeks to provide supplementary discussion of the article by Menz (Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004-2008 Journal of Foot and Ankle Research 2009, 2:30), by placing these findings within the context of the podiatry profession, clinical decision making and the broader health workforce and government policy.

Embodied masculinity and androgen deprivation therapy.

PubMed

Oliffe, John

2006-05-01

This paper describes the findings from an ethnographic study of 16 Anglo-Australian men treated with androgen deprivation therapy (ADT) for advanced prostate cancer. Utilising a social constructionist gendered analysis, participants' experiences, particularly in relation to embodied masculinity, are described in the context of reduced testosterone that accompany ADT. The findings indicated that participants reformulated many ideals of hegemonic masculinity in response to functional body changes. However, hegemonic masculinity strongly influenced participants' philosophical resolve to "fight" prostate cancer. The findings are considered in broader ongoing debates about essentialist sex and the social construction of gender.

Depression and anxiety among elderly earthquake survivors in China.

PubMed

Liang, Ying

2017-12-01

This study investigated depression and anxiety among Chinese elderly earthquake survivors, addressing relevant correlations. We sampled one earthquake-prone city, utilising the Geriatric Depression Scale and Beck Anxiety Inventory. In addition, explorative factor analysis and structural equation model methods were used. Results indicated elderly earthquake survivors exhibited symptoms of moderate depression and anxiety; depression and anxiety are highly positively correlated. The overlap between these two psychological problems may be due to subjective fear and motoric dimensions; subjective fear and motoric dimensions of Beck Anxiety Inventory are more strongly related to Geriatric Depression Scale domains. The two scales exhibit high reliability and validity.

Field Trial Data Analysis and Testing (FiTAT) Tool

DTIC Science & Technology

2011-10-01

amplitude/phase pour chaque antenne du réseau) contenu dans les données acquises pourrait être faite par FiTAT et utilisé dans PAASoM pour déterminer...identity matrix, k is the loop gain, φ is the correlation matrix of the incident signals and T = [1 0 . . . 0]T . The length of vector T is equal to the

Alteration of Multiple Leukocyte Gene Expression Networks is Linked with Magnetic Resonance Markers of Prognosis After Acute ST-Elevation Myocardial Infarction.

PubMed

Teren, A; Kirsten, H; Beutner, F; Scholz, M; Holdt, L M; Teupser, D; Gutberlet, M; Thiery, J; Schuler, G; Eitel, I

2017-02-03

Prognostic relevant pathways of leukocyte involvement in human myocardial ischemic-reperfusion injury are largely unknown. We enrolled 136 patients with ST-elevation myocardial infarction (STEMI) after primary angioplasty within 12 h after onset of symptoms. Following reperfusion, whole blood was collected within a median time interval of 20 h (interquartile range: 15-25 h) for genome-wide gene expression analysis. Subsequent CMR scans were performed using a standard protocol to determine infarct size (IS), area at risk (AAR), myocardial salvage index (MSI) and the extent of late microvascular obstruction (lateMO). We found 398 genes associated with lateMO and two genes with IS. Neither AAR, nor MSI showed significant correlations with gene expression. Genes correlating with lateMO were strongly related to several canonical pathways, including positive regulation of T-cell activation (p = 3.44 × 10 -5 ), and regulation of inflammatory response (p = 1.86 × 10 -3 ). Network analysis of multiple gene expression alterations associated with larger lateMO identified the following functional consequences: facilitated utilisation and decreased concentration of free fatty acid, repressed cell differentiation, enhanced phagocyte movement, increased cell death, vascular disease and compensatory vasculogenesis. In conclusion, the extent of lateMO after acute, reperfused STEMI correlated with altered activation of multiple genes related to fatty acid utilisation, lymphocyte differentiation, phagocyte mobilisation, cell survival, and vascular dysfunction.

Utilisation of rheumatology care services in Germany: the case of physical therapy and self-help groups.

PubMed

Thieme, Holm; Borgetto, Bernhard

2012-01-01

Physical Therapy (PT) and self-help groups (SHG) are important components of health care in rheumatic diseases. The utilisation of PT and SHG by patients with rheumatic diseases may be influenced by several factors. The aim of this study is to summarize the evidence on PT and SHG utilisation of patients with rheumatic diseases in Germany. We systematically searched the MEDLINE-database for studies that evaluated the utilisation and factors that possibly influence the utilisation of PT and SHG. Eight studies were found for PT-utilisation and one for SHG-utilisation. Between 25 and 59 percent of patients with rheumatic diseases received PT services. Several individual and contextual factors that may influence the utilisation could be identified. In conclusion, evidence exists for wide variations in the utilisation of PT services and an underuse of such services among patients with rheumatic diseases in Germany. By contrast, little evidence exists on the utilisation of SHG.

Univariate and multivariate spatial models of health facility utilisation for childhood fevers in an area on the coast of Kenya.

PubMed

Ouma, Paul O; Agutu, Nathan O; Snow, Robert W; Noor, Abdisalan M

2017-09-18

Precise quantification of health service utilisation is important for the estimation of disease burden and allocation of health resources. Current approaches to mapping health facility utilisation rely on spatial accessibility alone as the predictor. However, other spatially varying social, demographic and economic factors may affect the use of health services. The exclusion of these factors can lead to the inaccurate estimation of health facility utilisation. Here, we compare the accuracy of a univariate spatial model, developed only from estimated travel time, to a multivariate model that also includes relevant social, demographic and economic factors. A theoretical surface of travel time to the nearest public health facility was developed. These were assigned to each child reported to have had fever in the Kenya demographic and health survey of 2014 (KDHS 2014). The relationship of child treatment seeking for fever with travel time, household and individual factors from the KDHS2014 were determined using multilevel mixed modelling. Bayesian information criterion (BIC) and likelihood ratio test (LRT) tests were carried out to measure how selected factors improve parsimony and goodness of fit of the time model. Using the mixed model, a univariate spatial model of health facility utilisation was fitted using travel time as the predictor. The mixed model was also used to compute a multivariate spatial model of utilisation, using travel time and modelled surfaces of selected household and individual factors as predictors. The univariate and multivariate spatial models were then compared using the receiver operating area under the curve (AUC) and a percent correct prediction (PCP) test. The best fitting multivariate model had travel time, household wealth index and number of children in household as the predictors. These factors reduced BIC of the time model from 4008 to 2959, a change which was confirmed by the LRT test. Although there was a high correlation of the two modelled probability surfaces (Adj R 2  = 88%), the multivariate model had better AUC compared to the univariate model; 0.83 versus 0.73 and PCP 0.61 versus 0.45 values. Our study shows that a model that uses travel time, as well as household and individual-level socio-demographic factors, results in a more accurate estimation of use of health facilities for the treatment of childhood fever, compared to one that relies on only travel time.

The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden

PubMed Central

Beckman, Anders; Hakansson, Anders; Rastam, Lennart; Lithman, Thor; Merlo, Juan

2006-01-01

Background People of low socioeconomic status have worse health and a higher probability of being granted a disability pension than people of high socioeconomic status. It is also known that public and private general physicians and public and private specialists have varying practices for issuing sick leave certificates (which, if longstanding, may become the basis of disability pensions). However, few studies have investigated the influence of a patient's country of birth in this context. Methods We used multilevel logistic regression analysis with individuals (first level) nested within countries of birth (second level). We analysed the entire population between the ages of 40 and 64 years (n = 80 212) in the city of Malmo, Sweden, in 2003, and identified 73% of that population who had visited a physician at least once during that year. We studied the associations between individuals and country of birth socioeconomic characteristics, as well as individual utilisation of different kinds of physicians in relation to having been granted a disability pension. Results Living alone (ORwomen = 1.72, 95% CI: 1.62–1.82; ORmen = 2.64, 95% CI: 2.46–2.83) and having limited educational achievement (ORwomen = 2.14, 95% CI: 2.00–2.29; ORmen = 2.12, 95% CI: 1.98–2.28) were positively associated with having a disability pension. Utilisation of public specialists was associated with a higher probability (ORwomen = 2.11, 95% CI: 1.98–2.25; ORmen = 2.16, 95% CI: 2.01–2.32) and utilisation of private GPs with a lower probability (ORmen = 0.76, 95% CI: 0.69–0.83) of having a disability pension. However, these associations differed by countries of birth. Over and above individual socioeconomic status, men from middle income countries had a higher probability of having a disability pension (ORmen = 1.61, 95% CI: 1.06–2.44). Conclusion The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation. PMID:16542459

Utilisation of the healthcare system for authentic early experience placements.

PubMed

Hays, Richard B

2013-01-01

Authentic early experience in clinical contexts adds interest and relevance to basic medical education, and is regarded positively by both learners and teachers. However, with the recent expansion of medical education, the healthcare system appears close to reaching its capacity for student supervision. This study explores the utilisation of the healthcare system for early clinical placements. A secondary analysis was conducted of data from the Medical Schools Outcomes Database, collected from the 2010 annual questionnaire, focusing on the timing, duration and location of clinical placements during 2009 within the first half of basic medical education programs in Australia. Data was received for 67% of Australian medical students, reporting a total of 16 812 early clinical placements that occupied 97 319 days of supervised time in a wide variety of hospital, general practice and Indigenous health contexts, both urban and rural, across the Australian healthcare system. These early placements occupied about 16% of total clinical placement time for all students in all training years during 2009. The majority of these placements were for only a few hours or days; exceptions were longitudinal placements in regional and rural communities at a minority of schools. Early clinical placements may pose significant resource costs for placement providers, particularly supervision time and expertise. As medical education expands and the teaching capacity of the Australian healthcare system appears to reach its limits, it may be necessary to allocate placements according to their specific learning outcomes, prioritise more acute settings for more senior students, and increase capacity in less acute health and social care settings.

Socioeconomic profile and nutritional status of children in rubber smallholdings.

PubMed

Marjan, Zamaliah Mohd; Kandiah, Mirnalini; Lin, Khor Geok; Siong, Tee E

2002-01-01

This paper will present the socioeconomic profile and nutritional status of children aged 1-6 years in the rubber smallholdings of Peninsula Malaysia. A total of 323 households were involved in this study. The sociodemographic data were obtained through interviews with heads of households using a set of questionnaires. Anthropometric measurements were taken from 506 children aged 1-6 years from these households. The weight and height of the children were compared with the reference values of the National Center for Health Statistics (NCHS) and the nutritional status was classified based on the recommendations of WHO. The average age of the fathers was 39.9+/-8.6 years and 34.4+/-7.0 years for the mothers. The mean household size was 6.67+/-2.27. The majority (49.7%) of the heads of households received 4-6 years of formal education and 7.9% received no formal education. Based on the monthly per capita income, 24.0% were found to be in the hardcore poor category, 38.3% fall into the poor category and 37.7% in the above poverty income group. The prevalence of stunting and underweight among children between the ages of 1-6 years were highest among children from the hardcore poor, followed by the poor category and above the poverty line income group. Wasting was present in all income groups, with a prevalence of 4.2% found among the hardcore poor, 9.4% among the poor group and 8.4% in the above poverty income group. The Pearson Product Moment Correlation showed significant relationships between household total income and height-for-age (r = 0.131, P = 0.05) and weight-for-age (r = 0.127, P = 0.05). There were also significant correlations between monthly per capita income with height-for-age (r = 0.16, P < 0.01) and weight-for-age (r = 0.13, P < 0.05). The acreage of land utilised was correlated with height-for-age (r = 0.11, P < 0.05), weight-for-age (r = 0.17, P < 0.05) and weight-for-height (r = 0.16, P < 0.05). However, stepwise multiple regression analysis indicated that the predictor of height-for-age was monthly per capita income (R2 = 0.03, P < 0.01) and acreage of land utilised was a predictor for weight-for-age (R2 = 0.03, P < 0.01) and weight-for-height (R2 = 0.01, P < 0.01). Because income and acreage of land utilised have been shown to be associated with nutritional status, it is recommended that intervention programs that focus on generation of income and diversification of land utilisation should be undertaken. A multidiscipline approach involving the family, community and government agencies should be applied to any type of intervention program.

Inequalities in health and health service utilisation among reproductive age women in St. Petersburg, Russia: a cross-sectional study.

PubMed

Dubikaytis, Tatiana; Larivaara, Meri; Kuznetsova, Olga; Hemminki, Elina

2010-11-11

Russian society has faced dramatic changes in terms of social stratification since the collapse of the Soviet Union. During this time, extensive reforms have taken place in the organisation of health services, including the development of the private sector. Previous studies in Russia have shown a wide gap in mortality between socioeconomic groups. There are just a few studies on health service utilisation in post-Soviet Russia and data on inequality of health service use are limited. The aim of the present study was to analyse health (self-rated health and self-reported chronic diseases) and health care utilisation patterns by socioeconomic status (SES) among reproductive age women in St. Petersburg. The questionnaire survey was conducted in 2004 (n = 1147), with a response rate of 67%. Education and income were used as dimensions of SES. The association between SES and health and use of health services was assessed by logistic regression, adjusting for age. As expected low SES was associated with poor self-rated health (education: OR = 1.48; personal income: OR = 1.42: family income: OR = 2.31). University education was associated with use of a wider range of outpatient medical services and increased use of the following examinations: Pap smear (age-adjusted OR = 2.06), gynaecological examinations (age-adjusted OR = 1.62) and mammography among older (more than 40 years) women (age-adjusted OR = 1.98). Personal income had similar correlations, but family income was related only to the use of mammography among older women. Our study suggests a considerable inequality in health and utilisation of preventive health service among reproductive age women. Therefore, further studies are needed to identify barriers to health promotion resources.

Assessing the combined effects of urbanisation and climate change on the river water quality in an integrated urban wastewater system in the UK.

PubMed

Astaraie-Imani, Maryam; Kapelan, Zoran; Fu, Guangtao; Butler, David

2012-12-15

Climate change and urbanisation are key factors affecting the future of water quality and quantity in urbanised catchments and are associated with significant uncertainty. The work reported in this paper is an evaluation of the combined and relative impacts of climate change and urbanisation on the receiving water quality in the context of an Integrated Urban Wastewater System (IUWS) in the UK. The impacts of intervening system operational control parameters are also investigated. Impact is determined by a detailed modelling study using both local and global sensitivity analysis methods together with correlation analysis. The results obtained from the case-study analysed clearly demonstrate that climate change combined with increasing urbanisation is likely to lead to worsening river water quality in terms of both frequency and magnitude of breaching threshold dissolved oxygen and ammonium concentrations. The results obtained also reveal the key climate change and urbanisation parameters that have the largest negative impact as well as the most responsive IUWS operational control parameters including major dependencies between all these parameters. This information can be further utilised to adapt future IUWS operation and/or design which, in turn, should make these systems more resilient to future climate and urbanisation changes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Modelling parasite aggregation: disentangling statistical and ecological approaches.

PubMed

Yakob, Laith; Soares Magalhães, Ricardo J; Gray, Darren J; Milinovich, Gabriel; Wardrop, Nicola; Dunning, Rebecca; Barendregt, Jan; Bieri, Franziska; Williams, Gail M; Clements, Archie C A

2014-05-01

The overdispersion in macroparasite infection intensity among host populations is commonly simulated using a constant negative binomial aggregation parameter. We describe an alternative to utilising the negative binomial approach and demonstrate important disparities in intervention efficacy projections that can come about from opting for pattern-fitting models that are not process-explicit. We present model output in the context of the epidemiology and control of soil-transmitted helminths due to the significant public health burden imposed by these parasites, but our methods are applicable to other infections with demonstrable aggregation in parasite numbers among hosts. Copyright © 2014. Published by Elsevier Ltd.

Reconnaissance invariante d'objets 3-D et correlation SONG

NASA Astrophysics Data System (ADS)

Roy, Sebastien

Cette these propose des solutions a deux problemes de la reconnaissance automatique de formes: la reconnaissance invariante d'objets tridimensionnels a partir d'images d'intensite et la reconnaissance robuste a la presence de bruit disjoint. Un systeme utilisant le balayage angulaire des images et un classificateur par trajectoires d'espace des caracteristiques permet d'obtenir la reconnaissance invariante d'objets tridimensionnels. La reconnaissance robuste a la presence de bruit disjoint est realisee au moyen de la correlation SONG. Nous avons realise la reconnaissance invariante aux translations, rotations et changements d'echelle d'objets tridimensionnels a partir d'images d'intensite segmentees. Nous utilisons le balayage angulaire et un classificateur a trajectoires d'espace des caracteris tiques. Afin d'obtenir l'invariance aux translations, le centre de balayage angulaire coincide avec le centre geometrique de l'image. Le balayage angulaire produit un vecteur de caracteristiques invariant aux changements d'echelle de l'image et il transforme en translations du signal les rotations autour d'un axe parallele a la ligne de visee. Le classificateur par trajectoires d'espace des caracteristiques represente une rotation autour d'un axe perpendiculaire a la ligne de visee par une courbe dans l'espace. La classification se fait par la mesure de la distance du vecteur de caracteristiques de l'image a reconnaitre aux trajectoires stockees dans l'espace. Nos resultats numeriques montrent un taux de classement atteignant 98% sur une banque d'images composee de 5 vehicules militaires. La correlation non-lineaire generalisee en tranches orthogonales (SONG) traite independamment les niveaux de gris presents dans une image. Elle somme les correlations lineaires des images binaires ayant le meme niveau de gris. Cette correlation est equivalente a compter le nombre de pixels situes aux memes positions relatives et ayant les memes intensites sur deux images. Nous presentons une realisation opto-electronique de la correlation SONG. Cette realisation utilise le correlateur a transformees conjointes. Les resultats des experiences numeriques et optiques montrent que le bruit disjoint ne nuit pas a la correlation SONG.

The effect of context on student engagement in engineering

NASA Astrophysics Data System (ADS)

Patterson, Eann A.; Campbell, Patricia B.; Busch-Vishniac, Ilene; Guillaume, Darrell W.

2011-06-01

The self-belief, motivation, tendency to procrastinate and learning styles of engineering students are discussed. It is proposed that engineering has developed an idiom and a learning approach that favours the dominant client, i.e. men, while simultaneously undermining the self-efficacy and motivation of women. Thematic coherence and teaching within a context that is familiar to students have been shown previously to be effective approaches for engaging students and are extended here to utilise the common experiences of all students to initiate the learning cycle. These approaches are combined with a template for teaching that uses the 5Es (Engage, Explore, Explain, Elaborate and Evaluate) in order to render the fundamentals of engineering more accessible to all students. This methodology can be introduced by individual instructors, who will be rewarded by students who are more engaged, more motivated and more likely to give a higher rating to the instructor and the course.

Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries.

PubMed

de Jongh, T E; Gurol-Urganci, I; Allen, E; Jiayue Zhu, N; Atun, R

2016-03-01

Antenatal care (ANC) represents a delivery platform for a broad range of health services; however, these opportunities are insufficiently utilised. This review explores key barriers and enablers for successful integration of health s"ervices with ANC in different contexts. Data from peer-reviewed and grey literature were organised using the SURE checklist. We identified 46 reports focusing on integration of HIV, tuberculosis, malaria, syphilis or nutrition services with ANC from Asia, Africa and the Pacific. Perspectives of service users and providers, social and political factors, and health system characteristics (such as resource availability and organisational structures) affected ease of integration. Health system factors, context and stakeholders must be considered for integrated antenatal care services. © 2016 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Exploring leadership in the context of dentistry in the UK.

PubMed

Willcocks, Stephen George

2016-05-03

Purpose The purpose of this paper is to explore selective leadership approaches in the context of dentistry in the UK. Design/methodology/approach This is a conceptual paper utilising published sources from relevant literature about leadership theory and practice and the policy background to dentistry in the UK. Findings This paper suggests that there is merit in identifying and applying an eclectic mix of leadership theory to the case of dentistry. It offers insight into individual aspects of the leadership role for dentists and applies this to the dental context. It also contrasts these individual approaches with shared leadership and suggests this may also be relevant to dentistry. It highlights the fact that leadership will be of growing concern for dentistry in the light of recent policy changes. Research limitations/implications This paper points out that there are developmental implications depending on the particular approach taken. It argues that leadership development will become increasingly important in dentistry in the UK. Originality/value This paper addresses a topic that has so far received limited attention in the literature.

Spanish nurses' attitudes towards research and perceived barriers and facilitators of research utilisation: a comparative survey of nurses with and without experience as principal investigators.

PubMed

Moreno-Casbas, Teresa; Fuentelsaz-Gallego, Carmen; de Miguel, Angel Gil; González-María, Esther; Clarke, Sean P

2011-07-01

To examine attitudes towards research and perceived barriers and facilitators of research utilisation in clinical practice in a broad cross-section of Spanish nurses. Nurses' attitudes towards research are critical in determining whether study findings are used to improve practice. Cross-sectional comparative survey in Hospitals, Primary Care Centres and University-affiliated schools of nursing. Surveys were completed by 917 nurses: 69 who received funding from the Spanish national agency (1998-2004) and a nationally representative sample of 848 nurses who did not have the same research experience (the Comparison group). Two instruments (BARRIERS and Attitudes towards nursing research) were translated and culturally adapted for use in Spain. A descriptive analysis of demographic and practice characteristics was performed. Total scale scores, as well as subscale scores, were computed and compared across the two groups using one-way analysis of variance (anova) and multivariate analysis of variance (manova) with post hoc tests. Pearson product-moment correlation coefficients were computed between the total tool scores and subscales measuring barriers and attitudes in both groups. The investigators differed from other nurses on several demographic and work characteristics (more males, older age and more likely to work a fixed day shift schedule). On the whole, investigators showed more favourable attitudes but perceived several elements as posing greater barriers to research utilisation than the Comparison groups. Across all respondents, issues related to the quality of research were rated as the greatest barriers to research utilisation, followed by organisational barriers, barriers involving the communication of findings and finally, those related to nurses' values, awareness and skills. Very similar profiles of perceptions and attitudes regarding research were found in these samples of Spanish nurses relative to those from other countries in earlier reports. Nurses who had experience conducting research demonstrated more favourable research-related attitudes and perceived barriers differently than those without such experience. Understanding different organisational and experience perspectives is important to identify challenges and opportunities to ensure research utilisation in clinical practice. © 2011 Blackwell Publishing Ltd.

Utilisation of antihyperglycaemic drugs in ten European countries: different developments and different levels.

PubMed

Melander, A; Folino-Gallo, P; Walley, T; Schwabe, U; Groop, P-H; Klaukka, T; Vallano, A; Laporte, J-R; Gallego, M R; Schiappa, M; Røder, M; Kampmann, J P; de Swaef, A; Aberg, M; Månsson, N-O; Lindblad, U

2006-09-01

The aim of this study was to compare developments in the utilisation of antihyperglycaemic drugs (AHGDs) in ten European countries. Data on the yearly utilisation of insulin and oral AHGDs were collected from public registers in Denmark, Finland, Norway, Sweden, Belgium, England, Germany, Italy, Portugal and Spain, and were expressed as defined daily doses per 1,000 inhabitants per day. Total AGHD utilisation increased everywhere, but at different rates and levels. Insulin utilisation doubled in England and Germany, but hardly changed in Belgium, Portugal or Italy. Sulfonylurea utilisation doubled in Spain, England and Denmark but was reduced in Germany and Sweden. Metformin utilisation increased greatly everywhere. There were two- to three-fold differences in AHGD utilisation even between neighbouring countries. In Finland, there were more users of both insulin (+120%) and oral AHGDs (+80%) than in Denmark, and the daily oral AHGD doses were higher. In Denmark and Sweden, AHGD utilisation was equal in subjects aged <45 years, but in those >or=45 years of age, both insulin and oral AHGD utilisation were twice as high in Sweden. The ubiquitous increase in AHGD utilisation, particularly metformin, seems logical, considering the increasing prevalence of type 2 diabetes and the results of the UK Prospective Diabetes Study. However, the large differences even between neighbouring countries are more difficult to explain, and suggest different habits and attitudes in terms of screening and management of type 2 diabetes.

Vocal correlates of emotional reactivity within and across contexts in domestic pigs (Sus scrofa).

PubMed

Leliveld, Lisette M C; Düpjan, Sandra; Tuchscherer, Armin; Puppe, Birger

2017-11-01

Vocalizations have long been recognized to encode information about an individual's emotional state and, as such, have contributed to the study of emotions in animals. However, the potential of vocalizations to also encode information about an individual's emotional reactivity has received much less attention. In this study, we aimed to test whether the vocalizations of domestic pigs contain correlates of emotional reactivity that are consistent between different contexts. We recorded vocalizations of 120 young female pigs in an experimental arena in two consecutive recording contexts, social isolation and an encounter with a familiar human. Simultaneously, we measured their heart rate and behaviour to determine their emotional reactivity in the same context (within-context). In addition, we aimed to determine the subjects' emotional reactivity in other contexts (across-context) by measuring their behaviour in four common tests of emotional reactivity, the human approach test, the open door test, the open field test and the novel object test. Using a cluster analysis, we identified four different call types. Significant inter-context correlations were found for all call types, suggesting that pig vocalizations are consistent within an individual across contexts. The call rate and the proportions of the individual call types were found to correlate significantly with indices of emotional reactivity both within and across contexts. Thereby, we found more significant correlations to indices of emotional reactivity within context (behavioural and physiological response during recording) compared to across context (behavioural response in the four emotional reactivity tests). The consistency of the vocal correlates to emotional reactivity between the different contexts depended on the call type. While we found moderate evidence that the high grunt is indicative of more active, more explorative and less fearful individuals both within as well as across contexts, the other call types provided less consistent results. Thus, it seems that some call types are better suited to provide information on a caller's emotional reactivity than others, and further research is needed to clarify the underlying influential factors. Copyright © 2017 Elsevier Inc. All rights reserved.

The presentation of depression in the British Army.

PubMed

Finnegan, Alan; Finnegan, Sara; Thomas, Mike; Deahl, Martin; Simpson, Robin G; Ashford, Robert

2014-01-01

The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder. To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel. Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners. Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation. Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Men's Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Limitation of egg production in Calanus finmarchicus in the field: A stoichiometric analysis

NASA Astrophysics Data System (ADS)

Mayor, Daniel J.; Anderson, Thomas R.; Pond, David W.; Irigoien, Xabier

2009-11-01

The egg production of marine copepods correlates with a range of variables, including the availability of organic carbon (C), nitrogen (N) and the polyunsaturated fatty acids (PUFAs) 20:5( n-3) (EPA) and 22:6( n-3) (DHA). However, an understanding of which substrates limit egg production in the natural environment has yet to be reached. The quantities of C, N, EPA and DHA ingested, derived from parental biomass, and invested in eggs by female Calanus finmarchicus during a 5-day incubation experiment were examined using stoichiometric theory to determine which substrate was limiting. The majority of each substrate was derived from parental biomass, and therefore the existing stoichiometric theory is developed to include this route of supply. The females were essentially devoid of lipid reserves, as evidenced by the lack of the storage fatty acids 20:1( n-9) and 22:1( n-11), and carbon limitation was predicted under most of the scenarios examined. Nitrogen limitation was only apparent when carbon and nitrogen utilisation efficiencies were assumed to be high (0.5) and low (0.4) respectively. PUFAs were assumed to be utilised with high efficiency (0.9), and were never predicted to limit production. This work highlights the need for a more detailed understanding of the maintenance requirements that marine copepods have for C, N, EPA, and DHA and hence the efficiencies with these substrates can be utilised for growth.

C1qTNF-related protein 1 improve insulin resistance by reducing phosphorylation of serine 1101 in insulin receptor substrate 1.

PubMed

Xin, Yaping; Zhang, Dongming; Fu, Yanqin; Wang, Chongxian; Li, Qingju; Tian, Chenguang; Zhang, Suhe; Lyu, Xiaodong

2017-08-30

C1qTNF-related protein 1 (CTRP1) is independently associated with type 2 diabetes. However, the relationship between CTRP1 and insulin resistance is still not established. This study aimed to explore the role of CTRP1 under the situation of insulin resistance in adipose tissue. Plasma CTRP1 level was investigated in type 2 diabetic subjects (n = 35) and non-diabetic subjects (n = 35). The relationship between CTRP1 and phosphorylation of multi insulin receptor substrate 1 (IRS-1) serine (Ser) sites was further explored. Our data showed that Plasma CTRP1 was higher and negative correlation with insulin resistance in diabetic subjects (r = -0.283, p = 0.018). Glucose utilisation test revealed that the glucose utilisation rate of mature adipocytes was improved by CTRP1 in the presence of insulin. CTRP1 was not only related to IRS-1 protein, but also negatively correlated with IRS-1 Ser1101 phosphorylation (r = -0.398, p = 0.031). Furthermore, Phosphorylation levels of IRS-1 Ser1101 were significantly lower after incubation with 40 ng/mL CTRP1 in mature adipocytes than those with no intervention (p < 0.05). There was no significant correlation between CTRP1 and other IRS-1 serine sites (Ser302, Ser307, Ser612, Ser636/639, and Ser789). Collectively, our results suggested that CTRP1 might improve insulin resistance by reducing the phosphorylation of IRS-1 Ser1101, induced in the situation of insulin resistance as a feedback adipokine.

Big Data: the challenge for small research groups in the era of cancer genomics

PubMed Central

Noor, Aisyah Mohd; Holmberg, Lars; Gillett, Cheryl; Grigoriadis, Anita

2015-01-01

In the past decade, cancer research has seen an increasing trend towards high-throughput techniques and translational approaches. The increasing availability of assays that utilise smaller quantities of source material and produce higher volumes of data output have resulted in the necessity for data storage solutions beyond those previously used. Multifactorial data, both large in sample size and heterogeneous in context, needs to be integrated in a standardised, cost-effective and secure manner. This requires technical solutions and administrative support not normally financially accounted for in small- to moderate-sized research groups. In this review, we highlight the Big Data challenges faced by translational research groups in the precision medicine era; an era in which the genomes of over 75 000 patients will be sequenced by the National Health Service over the next 3 years to advance healthcare. In particular, we have looked at three main themes of data management in relation to cancer research, namely (1) cancer ontology management, (2) IT infrastructures that have been developed to support data management and (3) the unique ethical challenges introduced by utilising Big Data in research. PMID:26492224

The Extent of Consumer Product Involvement in Paediatric Injuries

PubMed Central

Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten

2016-01-01

A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases. PMID:27399744

The Extent of Consumer Product Involvement in Paediatric Injuries.

PubMed

Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten

2016-07-07

A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.

Age-related changes in the three-way correlation between anterior hippocampus volume, whole-brain patterns of encoding activity and subsequent context retrieval.

PubMed

Maillet, David; Rajah, M Natasha

2011-10-28

Age-related declines in memory for context have been linked to volume loss in the hippocampal head (HH) with age. However, it remains unclear how this volumetric decline correlates with age-related changes in whole-brain activity during context encoding, and subsequent context retrieval. In the current study we examine this. We collected functional magnetic resonance imaging data in young and older adults during the encoding of item, spatial context and temporal context. HH volume and subsequent retrieval performance was measured in all participants. In young adults only there was a positive three-way correlation between larger HH volumes, better memory retrieval, and increased activity in right hippocampus, right ventrolateral prefrontal cortex (VLPFC) and midline brain regions during episodic encoding. In contrast, older adults exhibited a positive three-way association between HH volume, generalized activity in bilateral hippocampus and dorsolateral PFC across all encoding tasks, and subsequent spatial context retrieval. Young adults also engaged this network, but only during the most difficult temporal context encoding task and activity in this network correlated with subsequent temporal context retrieval. We conclude that age-related volumetric reductions in HH disrupted the structure-function association between the hippocampus and activity in the first general encoding network recruited by young adults. Instead, older adults recruited those brain regions young adults only engaged for the most difficult temporal task, at lower difficulty levels. This altered pattern of association correlated with spatial context retrieval in older adults, but was not sufficient to maintain context memory abilities overall. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

Self-reports of trauma and dissociation: An examination of context effects.

PubMed

Lemons, Peter; Lynn, Steven Jay

2016-08-01

To examine context effects in moderating the link between self-reported trauma and dissociation in undergraduate samples, we administered these measures either in the same or different experimental contexts. Trauma History Screen/THS (Carlson et al., 2011)-Dissociative Experiences Scale/DES-II (Bernstein & Putnam, 1986) correlations revealed a context effect (greater correlations in same test context), although multiple regression analyses did not confirm this finding. A context effect was supported in DES-Taxon scores using multiple regression for the THS but not the Modified Posttraumatic Stress Scale (MPSS-SR; Falsetti, Resnick, Resick, & Kilpatrick, 1993), an effect confirmed with correlation comparisons. Ethnicity influenced the association between measures of trauma and dissociation. Overall, the relation between measures of trauma and dissociation was small to medium, although high correlations were observed between the DES depersonalization/derealization subscale and the Multiscale Dissociation Inventory (Briere, Weathers, & Runtz, 2005) depersonalization and derealization subscales, supporting the construct validity of these measures. Copyright © 2016 Elsevier Inc. All rights reserved.

The Pliocene Model Intercomparison Project - Phase 2

NASA Astrophysics Data System (ADS)

Haywood, Alan; Dowsett, Harry; Dolan, Aisling; Rowley, David; Abe-Ouchi, Ayako; Otto-Bliesner, Bette; Chandler, Mark; Hunter, Stephen; Lunt, Daniel; Pound, Matthew; Salzmann, Ulrich

2016-04-01

The Pliocene Model Intercomparison Project (PlioMIP) is a co-ordinated international climate modelling initiative to study and understand climate and environments of the Late Pliocene, and their potential relevance in the context of future climate change. PlioMIP examines the consistency of model predictions in simulating Pliocene climate, and their ability to reproduce climate signals preserved by geological climate archives. Here we provide a description of the aim and objectives of the next phase of the model intercomparison project (PlioMIP Phase 2), and we present the experimental design and boundary conditions that will be utilised for climate model experiments in Phase 2. Following on from PlioMIP Phase 1, Phase 2 will continue to be a mechanism for sampling structural uncertainty within climate models. However, Phase 1 demonstrated the requirement to better understand boundary condition uncertainties as well as uncertainty in the methodologies used for data-model comparison. Therefore, our strategy for Phase 2 is to utilise state-of-the-art boundary conditions that have emerged over the last 5 years. These include a new palaeogeographic reconstruction, detailing ocean bathymetry and land/ice surface topography. The ice surface topography is built upon the lessons learned from offline ice sheet modelling studies. Land surface cover has been enhanced by recent additions of Pliocene soils and lakes. Atmospheric reconstructions of palaeo-CO2 are emerging on orbital timescales and these are also incorporated into PlioMIP Phase 2. New records of surface and sea surface temperature change are being produced that will be more temporally consistent with the boundary conditions and forcings used within models. Finally we have designed a suite of prioritized experiments that tackle issues surrounding the basic understanding of the Pliocene and its relevance in the context of future climate change in a discrete way.

Effect of a 'diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities.

PubMed

Lafort, Yves; Greener, Letitia; Lessitala, Faustino; Chabeda, Sophie; Greener, Ross; Beksinska, Mags; Gichangi, Peter; Griffin, Sally; Smit, Jenni A; Chersich, Matthew; Delva, Wim

2018-05-12

To enhance uptake of sexual and reproductive health (SRH) services by female sex workers (FSWs), we conducted an implementation study in which we piloted and tested context-specific 'diagonal' interventions, combining vertical, targeted interventions with horizontally improved access to the general health services, in three cities in sub-Saharan Africa. We collected indicators of SRH service uptake through face-to-face interviews with approximately 400 FSWs, pre- and post-intervention, in Durban, South Africa; Tete, Mozambique; and Mombasa, Kenya, recruited by respondent-driven sampling. Changes in uptake were tested for their statistical significance using multivariate logistic regression models. In all cities, overall uptake of services increased. Having used all services for contraception, STI care, HIV testing, HIV care, cervical cancer screening and sexual violence, if needed, increased from 12.5% to 41.5% in Durban, 25.0% to 40.1% in Tete and 44.9% to 69.1% in Mombasa. Across cities, the effect was greatest in having been tested for HIV in the past six months which increased from 40.9% to 83.2% in Durban, 56.0% to 76.6% in Tete and 70.9% to 87.6% in Mombasa. In Tete and Mombasa, rise in SRH service use was almost entirely due to a greater uptake of targeted services. Only in Durban was there additionally an increase in the utilisation of general health services. SRH service utilisation improved in the short-term in three different sub-Saharan African contexts, primarily through vertical, targeted components. The long-term effectiveness of diagonal approaches, in particular on the use of general, horizontal health services, needs further investigation. © 2018 John Wiley & Sons Ltd.

Gender and the utilisation of health services in the Ashanti Region, Ghana.

PubMed

Buor, Daniel

2004-09-01

The survey seeks to structure a model for gender-based health services utilisation for the Ashanti Region of Ghana, and in addition, recommend intervention measures to ensure gender equity in the utilisation of health services. A sample size of 650 covered over 3108 houses, and the main research instruments were the questionnaire and formal interview. A multiple regression model is used for the analysis of the relationship between the complex independent variables and utilisation by gender. Results show that although females have a greater need for health services than males, they do not utilise health services as much. Secondly, whereas quality of service, health status, service cost and education have greater effect on male utilisation than females, distance and income have higher impact on female utilisation. It is recommended that, to ensure equity in health care utilisation, females be empowered through increased access to formal education and sustainable income opportunities. The introduction of a national health insurance scheme is also recommended to ensure adequate access by both sexes.

An analysis of partial efficiencies of energy utilisation of different macronutrients by barramundi (Lates calcarifer) shows that starch restricts protein utilisation in carnivorous fish.

PubMed

Glencross, Brett D; Blyth, David; Bourne, Nicholas; Cheers, Susan; Irvin, Simon; Wade, Nicholas M

2017-02-01

This study examined the effect of including different dietary proportions of starch, protein and lipid, in diets balanced for digestible energy, on the utilisation efficiencies of dietary energy by barramundi (Lates calcarifer). Each diet was fed at one of three ration levels (satiety, 80 % of initial satiety and 60 % of initial satiety) for a 42-d period. Fish performance measures (weight gain, feed intake and feed conversion ratio) were all affected by dietary energy source. The efficiency of energy utilisation was significantly reduced in fish fed the starch diet relative to the other diets, but there were no significant effects between the other macronutrients. This reduction in efficiency of utilisation was derived from a multifactorial change in both protein and lipid utilisation. The rate of protein utilisation deteriorated as the amount of starch included in the diet increased. Lipid utilisation was most dramatically affected by inclusion levels of lipid in the diet, with diets low in lipid producing component lipid utilisation rates well above 1·3, which indicates substantial lipid synthesis from other energy sources. However, the energetic cost of lipid gain was as low as 0·65 kJ per kJ of lipid deposited, indicating that barramundi very efficiently store energy in the form of lipid, particularly from dietary starch energy. This study defines how the utilisation efficiency of dietary digestible energy by barramundi is influenced by the macronutrient source providing that energy, and that the inclusion of starch causes problems with protein utilisation in this species.

Ingenierie de nanoparticules plasmoniques robustes pour la generation de bulles par laser en vue d'applications biomedicales

NASA Astrophysics Data System (ADS)

Lachaine, Remi

Les chirurgiens generent des bulles dans le corps humain a l'aide d'irradiation laser depuis plusieurs decennies. Ils utilisent ces bulles comme de petits scalpels, leur permettant de faire des incisions precises et localisees. Une des applications de cet outil chirurgical est la perforation cellulaire. Au lieu d'utiliser une aiguille pour perforer la membrane des cellules, il est possible de focaliser des impulsions laser en surface d'une cellule, formant un plasma au point focal du laser et generant une bulle qui perfore la membrane cellulaire. Toutefois, ce procede est assez lent et la perforation massive de cellules in-vivo n'est pas envisageable. Pour accelerer le processus, il est possible d'utiliser des nanoparticules plasmoniques. Ces dernieres agissent comme des nano-antennes qui permettent de concentrer la lumiere sur une echelle nanometrique. La possibilite d'irradier un grand nombre de nanoparticules simultanement a donne un nouvel elan a la generation de bulle comme outil de perforation cellulaire. L'utilisation de nanoparticules dans un contexte biomedical comporte toutefois certains risques. En particulier, la fragmentation de nanoparticules peut augmenter la toxicite du traitement. Dans un cas ideal, il est preferable d'utiliser des nanoparticules qui ne sont pas endommagees par l'irradiation laser. Cette these a pour but de developper une methode d'ingenierie de nanoparticules robustes permettant la generation efficace de bulles a des fins biomedicales. Il est tout d'abord demontre experimentalement que la formation de plasma est bel et bien le mecanisme physique principal menant a la generation de bulles lors de l'irradiation infrarouge (longueur d'onde de 800 nm) et ultrarapide (temps d'impulsion entre 45 fs et 1 ps) de nanoparticules d'or de 100 nm. Pour realiser cette demonstration, une methode pompe-sonde de detection de bulles d'environ 1 mum a ete elaboree. Cette methode a permis de mettre en evidence une difference de taille de 18% entre les bulles generees avec une irradiation de polarisation lineaire par rapport a une polarisation circulaire lorsque la duree d'impulsion etait inferieure a la picoseconde. Pour des impulsions plus longues, il est montre que les tailles de bulles sont independantes de la polarisation des impulsions incidentes. Ce comportement particulier est en accord avec les predictions theoriques qui incluent la formation non-lineaire de plasma et ne peut pas etre explique en considerant uniquement l'absorption des particules. Ensuite, une methode de conception de nanoparticules robustes pour la generation de bulles est elaboree. Cette methode se base sur les proprietes optiques des nanostructures.

The choice and preference for public-private health care among urban residents in China: evidence from a discrete choice experiment.

PubMed

Tang, Chengxiang; Xu, Judy; Zhang, Meng

2016-10-18

Public health care dominated the services provision in China before 1980s. However, the number of private health care providers in China has been increasing since then. The growth of private hospitals escalated after a market-oriented reform was implemented in 2001. Through an experimental approach, this study aims to a better understanding of the dynamic change in preference of health care utilisation among the residents in urban China. Based on a discrete choice experiment (DCE) from a random sample of respondents in urban China, the study evaluated preference over health care attributes affecting individuals' choice for the utilisation of hospital health care. The marginal willingness-to-pay for five health care attributes was estimated, including public/private provision of health care, by analysing mixed logit and latent class models. The results indicated a significantly negative marginal willingness-to-pay for private health care, which was interpreted as representing people's previous interactions with the health care system. The latent class model further suggested preference heterogeneity across our sample. We found that Hukou type, a typical indicator of socioeconomic background, was significantly related to respondents' preference for health care utilisation. Permanent urban residents (urban Hukou) valued private health care less; in contrast rural migrants (rural Hukou) were more likely to be indifferent between public/private provision. Urban residents in China showed a high disposition to obtain health care from the public providers of health care. Our results have implications in the context of the Chinese government attempts to expand the private health care sector in the short term. Policy makers need to consider residents' preference for health care in health policy development as the preference can only change in the long term.

Genuine quantum correlations in quantum many-body systems: a review of recent progress

NASA Astrophysics Data System (ADS)

De Chiara, Gabriele; Sanpera, Anna

2018-07-01

Quantum information theory has considerably helped in the understanding of quantum many-body systems. The role of quantum correlations and in particular, bipartite entanglement, has become crucial to characterise, classify and simulate quantum many body systems. Furthermore, the scaling of entanglement has inspired modifications to numerical techniques for the simulation of many-body systems leading to the, now established, area of tensor networks. However, the notions and methods brought by quantum information do not end with bipartite entanglement. There are other forms of correlations embedded in the ground, excited and thermal states of quantum many-body systems that also need to be explored and might be utilised as potential resources for quantum technologies. The aim of this work is to review the most recent developments regarding correlations in quantum many-body systems focussing on multipartite entanglement, quantum nonlocality, quantum discord, mutual information but also other non classical measures of correlations based on quantum coherence. Moreover, we also discuss applications of quantum metrology in quantum many-body systems.

Increasing Specificity of Correlate Research: Exploring Correlates of Children’s Lunchtime and After-School Physical Activity

PubMed Central

Stanley, Rebecca M.; Ridley, Kate; Olds, Timothy S.; Dollman, James

2014-01-01

Background The lunchtime and after-school contexts are critical windows in a school day for children to be physically active. While numerous studies have investigated correlates of children’s habitual physical activity, few have explored correlates of physical activity occurring at lunchtime and after-school from a social-ecological perspective. Exploring correlates that influence physical activity occurring in specific contexts can potentially improve the prediction and understanding of physical activity. Using a context-specific approach, this study investigated correlates of children’s lunchtime and after-school physical activity. Methods Cross-sectional data were collected from 423 South Australian children aged 10.0–13.9 years (200 boys; 223 girls) attending 10 different schools. Lunchtime and after-school physical activity was assessed using accelerometers. Correlates were assessed using purposely developed context-specific questionnaires. Correlated Component Regression analysis was conducted to derive correlates of context-specific physical activity and determine the variance explained by prediction equations. Results The model of boys’ lunchtime physical activity contained 6 correlates and explained 25% of the variance. For girls, the model explained 17% variance from 9 correlates. Enjoyment of walking during lunchtime was the strongest correlate for both boys and girls. Boys’ and girls’ after-school physical activity models explained 20% variance from 14 correlates and 7% variance from the single item correlate, “I do an organised sport or activity after-school because it gets you fit”, respectively. Conclusions Increasing specificity of correlate research has enabled the identification of unique features of, and a more in-depth interpretation of, lunchtime and after-school physical activity behaviour and is a potential strategy for advancing the physical activity correlate research field. The findings of this study could be used to inform and tailor gender-specific public health messages and interventions for promoting lunchtime and after-school physical activity in children. PMID:24809440

Utilisation of cancer screening services by disabled women in Chile

PubMed Central

Rotarou, Elena S.

2017-01-01

Background Research has shown that women with disabilities face additional challenges in accessing and using healthcare services compared to non-disabled women. However, relatively little is known about the utilisation of cancer screening services for women with disabilities. This study addresses this gap by examining the utilisation of the Papanicolaou test and mammography for disabled women in Chile. Methods We used cross-sectional data, taken from a 2015 nationally-representative survey. Initially, we employed logistic regressions to test for differences in utilisation rates for the Papanicolaou test (66,281 observations) and the mammogram (35,294 observations) between disabled and non-disabled women. Next, logistic regressions were used to investigate the demographic, socioeconomic, and health-related factors affecting utilisation rates for cancer screening services for disabled women (sample sizes: 5,823 observations for the Papanicolaou test and 5,731 observations for the mammogram). Results Disabled women were less likely to undergo screening tests than non-disabled women. For the Papanicolaou test and mammography, the multivariable regression models showed that living in rural areas, having higher education, being affiliated with a private health insurance company, giving a good health self-assessment score, and being under medical treatment for other illnesses were associated with higher utilisation rates. On the other hand, being single, inactive with regard to employment, and having a better income were linked with lower utilisation. While utilisation rates for both disabled and non-disabled women have increased since 2006, the utilisation disparity has slightly increased. Conclusions This study shows the influence of various factors in the utilisation rates of preventive cancer screening services for disabled women. To develop effective initiatives targeting inequalities in the utilisation of cancer screening tests, it is important to move beyond an exclusively single-disease approach and acknowledge the complexity of the patient population. PMID:28459874

Utilisation of cancer screening services by disabled women in Chile.

PubMed

Sakellariou, Dikaios; Rotarou, Elena S

2017-01-01

Research has shown that women with disabilities face additional challenges in accessing and using healthcare services compared to non-disabled women. However, relatively little is known about the utilisation of cancer screening services for women with disabilities. This study addresses this gap by examining the utilisation of the Papanicolaou test and mammography for disabled women in Chile. We used cross-sectional data, taken from a 2015 nationally-representative survey. Initially, we employed logistic regressions to test for differences in utilisation rates for the Papanicolaou test (66,281 observations) and the mammogram (35,294 observations) between disabled and non-disabled women. Next, logistic regressions were used to investigate the demographic, socioeconomic, and health-related factors affecting utilisation rates for cancer screening services for disabled women (sample sizes: 5,823 observations for the Papanicolaou test and 5,731 observations for the mammogram). Disabled women were less likely to undergo screening tests than non-disabled women. For the Papanicolaou test and mammography, the multivariable regression models showed that living in rural areas, having higher education, being affiliated with a private health insurance company, giving a good health self-assessment score, and being under medical treatment for other illnesses were associated with higher utilisation rates. On the other hand, being single, inactive with regard to employment, and having a better income were linked with lower utilisation. While utilisation rates for both disabled and non-disabled women have increased since 2006, the utilisation disparity has slightly increased. This study shows the influence of various factors in the utilisation rates of preventive cancer screening services for disabled women. To develop effective initiatives targeting inequalities in the utilisation of cancer screening tests, it is important to move beyond an exclusively single-disease approach and acknowledge the complexity of the patient population.

Trends, determinants and inequities of 4+ ANC utilisation in Bangladesh.

PubMed

Rahman, Aminur; Nisha, Monjura Khatun; Begum, Tahmina; Ahmed, Sayem; Alam, Nurul; Anwar, Iqbal

2017-01-13

The objectives of this study are to document the trend on utilisation of four or more (4 + ) antenatal care (ANC) over the last 22 years period and to explore the determinants and inequity of 4 + ANC utilisation as reported by the last two Bangladesh Demographic and Health surveys (BDHS) (2011 and 2014). The data related to ANC have been extracted from the BDHS data set which is available online as an open source. STATA 13 software was used for organising and analysing the data. The outcome variable considered for this study was utilisation of 4 + ANC. Trends of 4 + ANC were measured in percentage and predictors for 4 + ANC were measured through bivariate and multivariable analysis. The concentration index was estimated for assessing inequity in 4 + ANC utilisation. Utilisation of 4 + ANC has increased by about 26% between the year 1994 and 2014. Higher level of education, residing in urban region and richest wealth quintile were found to be significant predictors. The utilisation of 4 + ANC has decreased with increasing parity and maternal age. The inequity indices showed consistent inequities in 4 + ANC utilisation, and such inequities were increased between 2011 and 2014. In Bangladesh, the utilisation of any ANC rose steadily between 1994 and 2014, but progress in terms of 4 + ANC utilisation was much slower as the expectation was to achieve the national set target (50%: 4 + ANC utilisation) by 2016. Socio-economic inequities were observed in groups that failed to attend a 4 + ANC visit. Policymakers should pay special attention to increase the 4 + ANC coverage where this study can facilitate to identify the target groups whom need to be intervened on priority basis.

Secreted primary human malignant mesothelioma exosome signature reflects oncogenic cargo

PubMed Central

Greening, David W.; Ji, Hong; Chen, Maoshan; Robinson, Bruce W. S.; Dick, Ian M.; Creaney, Jenette; Simpson, Richard J.

2016-01-01

Malignant mesothelioma (MM) is a highly-aggressive heterogeneous malignancy, typically diagnosed at advanced stage. An important area of mesothelioma biology and progression is understanding intercellular communication and the contribution of the secretome. Exosomes are secreted extracellular vesicles shown to shuttle cellular cargo and direct intercellular communication in the tumour microenvironment, facilitate immunoregulation and metastasis. In this study, quantitative proteomics was used to investigate MM-derived exosomes from distinct human models and identify select cargo protein networks associated with angiogenesis, metastasis, and immunoregulation. Utilising bioinformatics pathway/network analyses, and correlation with previous studies on tumour exosomes, we defined a select mesothelioma exosomal signature (mEXOS, 570 proteins) enriched in tumour antigens and various cancer-specific signalling (HPGD/ENO1/OSMR) and secreted modulators (FN1/ITLN1/MAMDC2/PDGFD/GBP1). Notably, such circulating cargo offers unique insights into mesothelioma progression and tumour microenvironment reprogramming. Functionally, we demonstrate that oncogenic exosomes facilitate the migratory capacity of fibroblast/endothelial cells, supporting the systematic model of MM progression associated with vascular remodelling and angiogenesis. We provide biophysical and proteomic characterisation of exosomes, define a unique oncogenic signature (mEXOS), and demonstrate the regulatory capacity of exosomes in cell migration/tube formation assays. These findings contribute to understanding tumour-stromal crosstalk in the context of MM, and potential new diagnostic and therapeutic extracellular targets. PMID:27605433

Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis.

PubMed

Lee, John Tayu; Hamid, Fozia; Pati, Sanghamitra; Atun, Rifat; Millett, Christopher

2015-01-01

The burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Secondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007-2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models. The prevalence of multimorbidity in the adult population varied from 3.9% in Ghana to 33.6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0.56, 95% CI = 0.46, 0.66), a higher likelihood of being hospitalised in India (AOR = 1.59, 95% CI = 1.45, 1.75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88.3% for outpatient, 55.9% for inpatient visit in China) in most countries. Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.

The removal of pharmaceuticals, personal care products, endocrine disruptors and illicit drugs during wastewater treatment and its impact on the quality of receiving waters.

PubMed

Kasprzyk-Hordern, Barbara; Dinsdale, Richard M; Guwy, Alan J

2009-02-01

A 5-month monitoring program was undertaken in South Wales in the UK to determine the fate of 55 pharmaceuticals, personal care products, endocrine disruptors and illicit drugs (PPCPs) in two contrasting wastewater plants utilising two different wastewater treatment technologies: activated sludge and trickling filter beds. The impact of treated wastewater effluent on the quality of receiving waters was also assessed. PPCPs were found to be present at high loads reaching 10kgday(-1) in the raw sewage. Concentrations of PPCPs in raw sewage were found to correlate with their usage/consumption patterns in Wales and their metabolism. The efficiency of the removal of PPCPs was found to be strongly dependent on the technology implemented in the wastewater treatment plant (WWTP). In general, the WWTP utilising trickling filter beds resulted in, on average, less than 70% removal of all 55 PPCPs studied, while the WWTP utilising activated sludge treatment gave a much higher removal efficiency of over 85%. The monitoring programme revealed that treated wastewater effluents were the main contributors to PPCPs concentrations (up to 3kg of PPCPsday(-1)) in the rivers studied. Bearing in mind that in the cases examined here the WWTP effluents were also major contributors to rivers' flows (dilution factor for the studied rivers did not exceed 23 times) the effect of WWTP effluent on the quality of river water is significant and cannot be underestimated.

Diversifying and correlational selection on behavior toward conspecific and heterospecific competitors in brook stickleback (Culaea inconstans)

PubMed Central

Peiman, Kathryn S; Robinson, Beren W

2012-01-01

Behaviors toward heterospecifics and conspecifics may be correlated because of shared mechanisms of expression in both social contexts (nonadaptive covariation) or because correlational selection favors adaptive covariation. We evaluated these hypotheses by comparing behavior toward conspecifics and heterospecifics in brook stickleback (Culaea inconstans) from three populations sympatric with and three allopatric from a competitor, the ninespine stickleback (Pungitius pungitius). Behavioral traits were classified into three multivariate components: overt aggression, sociability, and activity. The correlation of behavior between social contexts for both overt aggression and activity varied among populations in a way unrelated to sympatry with ninespine stickleback, while mean aggression was reduced in sympatry. Correlations in allopatric populations suggest that overt aggression and activity may genetically covary between social contexts for nonadaptive reasons. Sociability was rarely correlated in allopatry but was consistently correlated in sympatry despite reduced mean sociability, suggesting that correlational selection may favor a sociability syndrome in brook stickleback when they coexist with ninespine stickleback. Thus, interspecific competition may impose diversifying selection on behavior among populations, although the causes of correlated behavior toward conspecifics and heterospecifics and whether it can evolve in one social context independent of the other may depend on the type of behavior. PMID:23139874

Arbuscular mycorrhizal fungi make a complex contribution to soil aggregation

NASA Astrophysics Data System (ADS)

McGee, Peter; Daynes, Cathal; Damien, Field

2013-04-01

Soil aggregates contain solid and fluid components. Aggregates develop as a consequence of the organic materials, plants and hyphae of arbuscular mycorrhizal (AM) fungi acting on the solid phase. Various correlative studies indicate hyphae of AM fungi enmesh soil particles, but their impact on the pore space is poorly understood. Hyphae may penetrate between particles, remove water from interstitial spaces, and otherwise re-arrange the solid phase. Thus we might predict that AM fungi also change the pore architecture of aggregates. Direct observations of pore architecture of soil, such as by computer-aided tomography (CT), is difficult. The refractive natures of solid and biological material are similar. The plant-available water in various treatments allows us to infer changes in pore architecture. Our experimental studies indicate AM fungi have a complex role in the formation and development of aggregates. Soils formed from compost and coarse subsoil materials were planted with mycorrhizal or non-mycorrhizal seedlings and the resultant soils compared after 6 or 14 months in separate experiments. As well as enmeshing particles, AM fungi were associated with the development of a complex pore space and greater pore volume. Even though AM fungi add organic matter to soil, the modification of pore space is not correlated with organic carbon. In a separate study, we visualised hyphae of AM fungi in a coarse material using CT. In this study, hyphae appeared to grow close to the surfaces of particles with limited ramification across the pore spaces. Hyphae of AM fungi appear to utilise soil moisture for their growth and development of mycelium. The strong correlation between moisture and hyphae has profound implications for soil aggregation, plant utilisation of soil water, and the distribution of water as water availability declines.

Identifying factors associated with fast food consumption among adolescents in Beijing China using a theory-based approach.

PubMed

Ma, R; Castellanos, D C; Bachman, J

2016-07-01

China is in the midst of the nutrition transition with increasing rates of obesity and dietary changes. One contributor is the increase in fast food chains within the country. The purpose of this study was to develop a theory-based instrument that explores influencing factors of fast food consumption in adolescents residing in Beijing, China. Cross-sectional study. Value expectancy and theory of planned behaviour were utilised to explore influencing factors of fast food consumption in the target population. There were 201 Chinese adolescents between the ages of 12 and 18. Cronbach's alpha correlation coefficients were used to examine internal reliability of the theory-based questionnaire. Bivariate correlations and a MANOVA were utilised to determine the relationship between theory-based constructs, body mass index (BMI)-for-age and fast food intake frequency as well as to determine differences in theory-based scores among fast food consumption frequency groupings. The theory-based questionnaire showed good reliability. Furthermore, there was a significant difference in the theory-based subcategory scores between fast food frequency groups. A significant positive correlation was observed between times per week fast food was consumed and each theory-based subscale score. Using BMI-for-age of 176 participants, 81% were normal weight and 19% were considered overweight or obese. Results showed consumption of fast food to be on average 1.50 ± 1.33 per week. The relationship between BMI-for-age and times per week fast food was consumed was not significant. As the nutrition transition continues and fast food chains expand, it is important to explore factors effecting fast food consumption in China. Interventions targeting influencing factors can be developed to encourage healthy dietary choice in the midst of this transition. Copyright © 2016. Published by Elsevier Ltd.

Healthcare experiences of gender diverse Australians: a mixed-methods, self-report survey.

PubMed

Riggs, Damien W; Coleman, Katrina; Due, Clemence

2014-03-06

To date the healthcare experiences of gender diverse Australians have received little attention. Previous international research indicates a range of both negative and positive healthcare experiences amongst this diverse population, with negative experiences being those most frequently reported. An online survey was designed to examine the healthcare experiences of gender diverse Australians. The survey included Likert scales asking participants to rate their mental and physical health, and their experiences with psychiatrists, general practitioners and surgeons (in terms of perceived comfort, discrimination and information provision). Open-ended questions provided the opportunity for participants to further elaborate on their experiences. Data were collected between June 2012 and July 2013. Quantitative data analysis was conducted utilising SPSS 17.0, including ANCOVAs and correlations to examine the relationships between variables. Qualitative data were coded by the authors in terms of negative or positive responses and the validity of ratings were assessed utilising Cohen's kappa. 110 people assigned male at birth (MAAB) and 78 people assigned female at birth (FAAB) completed two separate surveys. All identified as gender diverse as defined in this paper. 70% of participants had accessed a psychiatrist. Participants MAAB rated their experiences with psychiatrists more highly than participants FAAB. 80% of participants had accessed a general practitioner. Comfort with, and respect from, general practitioners were both positively correlated with mental health, whilst discrimination was negatively correlated with mental health. 42.5% of participants had undertaken sex-affirming surgery. Those who had such surgery reported higher levels of physical and mental health than those who had not undertaken surgery. Participants MAAB reported more positive experiences of surgery than did participants FAAB. Findings highlight the need for increased education of medical practitioners in regards to engaging with gender diverse clients.

Feature extraction of performance variables in elite half-pipe snowboarding using body mounted inertial sensors

NASA Astrophysics Data System (ADS)

Harding, J. W.; Small, J. W.; James, D. A.

2007-12-01

Recent analysis of elite-level half-pipe snowboard competition has revealed a number of sport specific key performance variables (KPV's) that correlate well to score. Information on these variables is difficult to acquire and analyse, relying on collection and labour intensive manual post processing of video data. This paper presents the use of inertial sensors as a user-friendly alternative and subsequently implements signal processing routines to ultimately provide automated, sport specific feedback to coaches and athletes. The author has recently shown that the key performance variables (KPV's) of total air-time (TAT) and average degree of rotation (ADR) achieved during elite half-pipe snowboarding competition show strong correlation with an athlete's subjectively judged score. Utilising Micro-Electrochemical System (MEMS) sensors (tri-axial accelerometers) this paper demonstrates that air-time (AT) achieved during half-pipe snowboarding can be detected and calculated accurately using basic signal processing techniques. Characterisation of the variations in aerial acrobatic manoeuvres and the associated calculation of exact degree of rotation (DR) achieved is a likely extension of this research. The technique developed used a two-pass method to detect locations of half-pipe snowboard runs using power density in the frequency domain and subsequently utilises a threshold based search algorithm in the time domain to calculate air-times associated with individual aerial acrobatic manoeuvres. This technique correctly identified the air-times of 100 percent of aerial acrobatic manoeuvres within each half-pipe snowboarding run (n = 92 aerial acrobatic manoeuvres from 4 subjects) and displayed a very strong correlation with a video based reference standard for air-time calculation (r = 0.78 +/- 0.08; p value < 0.0001; SEE = 0.08 ×/÷ 1.16; mean bias = -0.03 +/- 0.02s) (value +/- or ×/÷ 95% CL).

Outpatient echocardiography in the evaluation of innocent murmurs in children: utilisation benchmarking.

PubMed

Frias, Patricio A; Oster, Matthew; Daley, Patricia A; Boris, Jeffrey R

2016-03-01

We sought to benchmark the utilisation of echocardiography in the outpatient evaluation of heart murmurs by evaluating two large paediatric cardiology centres. Although criteria exist for appropriate use of echocardiography, there are no benchmarking data demonstrating its utilisation. We performed a retrospective cohort study of outpatients aged between 0 and 18 years at the Sibley Heart Center Cardiology and the Children's Hospital of Philadelphia Division of Cardiology, given a sole diagnosis of "innocent murmur" from 1 July, 2007 to 31 October, 2010. Using internal claims data, we compared the utilisation of echocardiography according to centre, patient age, and physician years of service. Of 23,114 eligible patients (Sibley Heart Center Cardiology: 12,815, Children's Hospital of Philadelphia Division of Cardiology: 10,299), 43.1% (Sibley Heart Center Cardiology: 45.2%, Children's Hospital of Philadelphia Division of Cardiology: 40.4%; p1-5 years had the lowest utilisation (32.7%). In two large paediatric cardiology practices, the overall utilisation of echocardiography by physicians with a sole diagnosis of innocent murmur was similar. There was significant and similar variability in utilisation by provider at both centres. Although these data serve as initial benchmarking, the variability in utilisation highlights the importance of appropriate use criteria.

Hierarchical Higher Order Crf for the Classification of Airborne LIDAR Point Clouds in Urban Areas

NASA Astrophysics Data System (ADS)

Niemeyer, J.; Rottensteiner, F.; Soergel, U.; Heipke, C.

2016-06-01

We propose a novel hierarchical approach for the classification of airborne 3D lidar points. Spatial and semantic context is incorporated via a two-layer Conditional Random Field (CRF). The first layer operates on a point level and utilises higher order cliques. Segments are generated from the labelling obtained in this way. They are the entities of the second layer, which incorporates larger scale context. The classification result of the segments is introduced as an energy term for the next iteration of the point-based layer. This framework iterates and mutually propagates context to improve the classification results. Potentially wrong decisions can be revised at later stages. The output is a labelled point cloud as well as segments roughly corresponding to object instances. Moreover, we present two new contextual features for the segment classification: the distance and the orientation of a segment with respect to the closest road. It is shown that the classification benefits from these features. In our experiments the hierarchical framework improve the overall accuracies by 2.3% on a point-based level and by 3.0% on a segment-based level, respectively, compared to a purely point-based classification.

Correlates of the Ability to Use Context Clues in Reading.

ERIC Educational Resources Information Center

Dulin, Kenneth L.

Results of two studies of the ability to use specific context clues and possible academic correlates of this ability are reported. In the first study, a five-form data-gathering instrument, using categories of context clues derived from Artley, Betts, and McCullough, was administered to 315 tenth-grade students in Seattle, Washington. Simulated…

Geographic region, socioeconomic position and the utilisation of primary total joint replacement for hip or knee osteoarthritis across western Victoria: a cross-sectional multilevel study of the Australian Orthopaedic Association National Joint Replacement Registry.

PubMed

Brennan-Olsen, Sharon; Vogrin, Sara; Holloway, Kara L; Page, Richard S; Sajjad, Muhammad A; Kotowicz, Mark A; Livingston, Patricia M; Khasraw, Mustafa; Hakkennes, Sharon; Dunning, Trish L; Brumby, Susan; Pedler, Daryl; Sutherland, Alasdair; Venkatesh, Svetha; Williams, Lana J; Duque, Gustavo; Pasco, Julie A

2017-11-06

Compared to urban residents, those in rural/regional areas often experience inequitable healthcare from specialist service providers. Independent of small between-area differences in utilisation, socially advantaged groups had the greatest uptake of joint replacement. These data suggest low correlation between 'need' vs. 'uptake' of surgery in rural/regional areas. Compared to urban residents, those in rural and regional areas often experience inequitable healthcare from specialist service providers, often due to geographical issues. We investigated associations between socioeconomic position (SEP), region of residence and utilisation of primary total knee replacement (TKR) and/or total hip replacement (THR) for osteoarthritis. As part of the Ageing, Chronic Disease and Injury study, we extracted data from the Australian Orthopaedic Association National Joint Replacement Registry (2011-2013) for adults that utilised primary TKR (n = 4179; 56% female) and/or THR (n = 3120; 54% female). Residential addresses were matched with the Australian Bureau of Statistics (ABS) 2011 census data: region of residence was defined according to local government areas (LGAs), and area-level SEP (quintiles) defined using an ABS-derived composite index. The ABS-determined control population (n = 591,265; 51% female) excluded individuals identified as cases. We performed multilevel logistic regression modelling using a stratified two-stage cluster design. TKR was higher for those aged 70-79 years (AOR 1.4 95%CI 1.3-1.5; referent = 60-69 years) and in the most advantaged SEP quintile (AOR 2.1, 95%CI 1.8-2.3; referent = SEP quintile 3); results were similar for THR (70-79 years = AOR 1.7, 95%CI 1.5-1.8; SEP quintile 5 = AOR 2.5, 95%CI 2.2-2.8). Total variances contributed by the variance in LGAs were 2% (SD random effects ± 0.28) and 3% (SD ± 0.32), respectively. Independent of small between-LGA differences in utilisation, and in contrast to the expected greater prevalence of osteoarthritis in disadvantaged populations, we report greater TKR and THR in more advantaged groups. Further research should investigate whether more advantaged populations may be over-serviced.

Integrated nuclear data utilisation system for innovative reactors.

PubMed

Yamano, N; Hasegawa, A; Kato, K; Igashira, M

2005-01-01

A five-year research and development project on an integrated nuclear data utilisation system was initiated in 2002, for developing innovative nuclear energy systems such as accelerator-driven systems. The integrated nuclear data utilisation system will be constructed as a modular code system, which consists of two sub-systems: the nuclear data search and plotting sub-system, and the nuclear data processing and utilisation sub-system. The system will be operated with a graphical user interface in order to enable easy utilisation through the Internet by both nuclear design engineers and nuclear data evaluators. This paper presents an overview of the integrated nuclear data utilisation system, describes the development of a prototype system to examine the operability of the user interface and discusses specifications of the two sub-systems.

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes.

PubMed

Moran, Anna M; Coyle, Julia; Pope, Rod; Boxall, Dianne; Nancarrow, Susan A; Young, Jennifer

2014-02-13

To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts. This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts. This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme. Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts.

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes

PubMed Central

2014-01-01

Objective To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts. Design This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts. Results This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme. Conclusion Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts. PMID:24521004

Negative expectations interfere with the analgesic effect of safety cues on pain perception by priming the cortical representation of pain in the midcingulate cortex

PubMed Central

Almarzouki, Abeer F.; Brown, Christopher A.; Brown, Richard J.; Leung, Matthew H. K.; Jones, Anthony K. P.

2017-01-01

It is well known that the efficacy of treatment effects, including those of placebos, is heavily dependent on positive expectations regarding treatment outcomes. For example, positive expectations about pain treatments are essential for pain reduction. Such positive expectations not only depend on the properties of the treatment itself, but also on the context in which the treatment is presented. However, it is not clear how the preceding threat of pain will bias positive expectancy effects. One hypothesis is that threatening contexts trigger fearful and catastrophic thinking, reducing the pain-relieving effects of positive expectancy. In this study, we investigated the disruptive influence of threatening contexts on positive expectancy effects while 41 healthy volunteers experienced laser-induced heat pain. A threatening context was induced using pain-threatening cues that preceded the induction of positive expectancies via subsequent pain-safety cues. We also utilised electroencephalography (EEG) to investigate potential neural mechanisms underlying these effects. Lastly, we used the Fear of Pain Questionnaire to address whether the disruptive effect of negative contexts on cued pain relief was related to the degree of fear of pain. As predicted, participants responded less to pain-safety cues (i.e., experienced more pain) when these were preceded by pain-threatening cues. In this threatening context, an enhancement of the N2 component of the laser-evoked potential was detected, which was more pronounced in fearful individuals. This effect was localised to the midcingulate cortex, an area thought to integrate negative affect with pain experience to enable adaptive behaviour in aversive situations. These results suggest that threatening contexts disrupt the effect of pain relief cues via an aversive priming mechanism that enhances neural responses in the early stages of sensory processing. PMID:28665973

A Statistical Model for Estimation of Fish Density Including Correlation in Size, Space, Time and between Species from Research Survey Data

PubMed Central

Bastardie, Francois

2014-01-01

Trawl survey data with high spatial and seasonal coverage were analysed using a variant of the Log Gaussian Cox Process (LGCP) statistical model to estimate unbiased relative fish densities. The model estimates correlations between observations according to time, space, and fish size and includes zero observations and over-dispersion. The model utilises the fact the correlation between numbers of fish caught increases when the distance in space and time between the fish decreases, and the correlation between size groups in a haul increases when the difference in size decreases. Here the model is extended in two ways. Instead of assuming a natural scale size correlation, the model is further developed to allow for a transformed length scale. Furthermore, in the present application, the spatial- and size-dependent correlation between species was included. For cod (Gadus morhua) and whiting (Merlangius merlangus), a common structured size correlation was fitted, and a separable structure between the time and space-size correlation was found for each species, whereas more complex structures were required to describe the correlation between species (and space-size). The within-species time correlation is strong, whereas the correlations between the species are weaker over time but strong within the year. PMID:24911631

Neural correlates of deception in social contexts in normally developing children

PubMed Central

Yokota, Susumu; Taki, Yasuyuki; Hashizume, Hiroshi; Sassa, Yuko; Thyreau, Benjamin; Tanaka, Mari; Kawashima, Ryuta

2013-01-01

Deception is related to the ability to inhibit prepotent responses and to engage in mental tasks such as anticipating responses and inferring what another person knows, especially in social contexts. However, the neural correlates of deception processing, which requires mentalizing, remain unclear. Using functional magnetic resonance imaging (fMRI), we examined the neural correlates of deception, including mentalization, in social contexts in normally developing children. Healthy right-handed children (aged 8–9 years) were scanned while performing interactive games involving deception. The games varied along two dimensions: the type of reply (deception and truth) and the type of context (social and less social). Participants were instructed to deceive a witch and to tell the truth to a girl. Under the social-context conditions, participants were asked to consider what they inferred about protagonists' preferences from their facial expressions when responding to questions. Under the less-social-context conditions, participants did not need to consider others' preferences. We found a significantly greater response in the right precuneus under the social-context than under less-social-context conditions. Additionally, we found marginally greater activation in the right inferior parietal lobule (IPL) under the deception than under the truth condition. These results suggest that deception in a social context requires not only inhibition of prepotent responses but also engagement in mentalizing processes. This study provides the first evidence of the neural correlates of the mentalizing processes involved in deception in normally developing children. PMID:23730281

Computer Security Issues in Online Banking: An Assessment from the Context of Usable Security

NASA Astrophysics Data System (ADS)

Mahmadi, FN; Zaaba, ZF; Osman, A.

2016-11-01

Today's online banking is a convenient mode of finance management. Despite the ease of doing online banking, there are people that still sceptical in utilizing it due to perception and its security. This paper highlights the subject of online banking security in Malaysia, especially from the perspective of the end-users. The study is done by assessing human computer interaction, usability and security. An online survey utilising 137 participants was previously conducted to gain preliminary insights on security issues of online banking in Malaysia. Following from those results, 37 participants were interviewed to gauge deeper understanding about end-users perception on online banking within the context of usable security. The results suggested that most of the end-users are continuingly experiencing significant difficulties especially in relation to the technical terminologies, security features and other technical issues. Although the security features are provided to provide a shield or protection, users are still incapable to cope with the technical aspects of such implementation.

Neural correlates of context-independent and context-dependent self-knowledge.

PubMed

Martial, Charlotte; Stawarczyk, David; D'Argembeau, Arnaud

2018-05-25

The self-concept consists of both a general (context-independent) self-representation and a set of context-dependent selves that represent personal attributes in particular contexts (e.g., as a student, as a daughter). To date, however, neuroimaging studies have focused on general self-representations, such that little is known about the neural correlates of context-dependent self-knowledge. The present study aimed at investigating this issue by examining the neural correlates of both kinds of self-knowledge. Participants judged the extent to which trait adjectives described their own personality or the personality of a close friend, either in a specific context (i.e., as a student) or in general. We found that both kinds of self-judgments were associated with common activation in the medial prefrontal cortex (MPFC), as compared to judgments about others. Interestingly, however, there were also notable differences between self-judgments, with context-independent judgments being associated with higher activity in the MPFC, whereas context-dependent judgments were associated with greater activation in posterior brain regions (i.e., the posterior cingulate/retrosplenial cortex). These findings show that context-independent and context-dependent self-referential judgments recruit both common and distinct brain regions, thereby supporting the view that the self-concept is a multi-dimensional knowledge structure that includes a general self-representation and a set of context-specific selves. Copyright © 2018 Elsevier Inc. All rights reserved.

RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates.

PubMed

Mountain, David; Keijzers, Gerben; Chu, Kevin; Joseph, Anthony; Read, Catherine; Blecher, Gabriel; Furyk, Jeremy; Bharat, Chrianna; Velusamy, Karthik; Munro, Andrew; Baker, Kylie; Kinnear, Frances; Mukherjee, Ahses; Watkins, Gina; Buntine, Paul; Livesay, Georgia; Fatovich, Daniel

2016-01-01

Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4-10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America. To describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation. A retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation. Fourteen radiology departments (15 ED) provided 7077 CTPA data (94% ≥64-slice CT); PE were reported in 1028 (yield 14.6% (95%CI 13.8-15.4%; range 9.3-25.3%; site variation p <0.0001) with four sites significantly below and one above the 15.3% target. Admissions, CTPA usage, PE diagnosis rates and size of PE were uncorrelated with yield. Large PE (≥lobar) were 55% (CI: 52.1-58.2%) and SSPE 8.8% (CI: 7.1-10.5%) of positive scans. CTPA usage (0.2-1.5% adult attendances) was correlated (p<0.006) with PE diagnosis but not SSPE: large PE proportions. We found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5-3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE.

[Migration and rehabilitation of mental diseases -- perspectives and limitations in the reporting of official data of service providers].

PubMed

Rommel, A

2005-04-01

Health and social monitoring are important foundations of political decision making. In order to make statements about populations and subgroups different sources of information are generally used. The potential contribution which aggregated official health data of service providers can make is discussed in the exemplary context of the utilisation of medical rehabilitation of mental diseases. Age specific rates and age standardised ratios show a significantly increased utilisation of services for depression and somatoform disorders amongst women in general and the migrant population in particular. It is demonstrated that the interpretation of such results raises new research questions rather than providing explanations that could prove to be conducive for practical measures. In a methodological discussion it is stated that the reason for this has to be seen in the fact that important structures of action within the care system are concealed by the specific method of collecting and processing official health data. Nevertheless, conceivable interpretations are given regarding the psycho-social living conditions of large parts of the migrant population as well as their difficulties in the interaction with the medical system. This enables the formulation of a hypothetical framework for further research which could help to clarify statistical phenomena found in the official data of service providers.

'We usually just start dancing our Indian dances': urban American Indian (AI) female youths' negotiation of identity, health and the body.

PubMed

Jette, Shannon; Roberts, Erica Blue

2016-03-01

In this article, we utilise qualitative research techniques to explore how 14 urban American Indian (AI) females (aged 11-17) living in the state of Maryland discursively construct and experience health and the body, as well as how/if traditional culture shapes their understandings. In doing so, we address a significant gap in the knowledge base concerning the health beliefs of urban AI youth, and build upon research utilising a decolonising approach. Using a two-step process of thematic analysis and poststructuralist discourse analysis, we arrived at three key findings: (1) while youths are taught (and learn) mainstream lessons about health and bodily norms (mostly at school), they negotiate these lessons in complex and at times contradictory ways; (2) they do not view their AI status as conferring more or less risk upon them or their community; and (3) AI identity appears to be fluid in nature, becoming more salient, even a resource, in certain situations. We conclude with a discussion of the importance of spaces within the urban context in shaping youths' embodied subjectivities, and in particular, contrast the space of the school with that of the urban AI community centre. © 2015 Foundation for the Sociology of Health & Illness.

A systematic review of the technology-based assessment of visual perception and exploration behaviour in association football.

PubMed

McGuckian, Thomas B; Cole, Michael H; Pepping, Gert-Jan

2018-04-01

To visually perceive opportunities for action, athletes rely on the movements of their eyes, head and body to explore their surrounding environment. To date, the specific types of technology and their efficacy for assessing the exploration behaviours of association footballers have not been systematically reviewed. This review aimed to synthesise the visual perception and exploration behaviours of footballers according to the task constraints, action requirements of the experimental task, and level of expertise of the athlete, in the context of the technology used to quantify the visual perception and exploration behaviours of footballers. A systematic search for papers that included keywords related to football, technology, and visual perception was conducted. All 38 included articles utilised eye-movement registration technology to quantify visual perception and exploration behaviour. The experimental domain appears to influence the visual perception behaviour of footballers, however no studies investigated exploration behaviours of footballers in open-play situations. Studies rarely utilised representative stimulus presentation or action requirements. To fully understand the visual perception requirements of athletes, it is recommended that future research seek to validate alternate technologies that are capable of investigating the eye, head and body movements associated with the exploration behaviours of footballers during representative open-play situations.

Floodwater utilisation values of wetland services - a case study in Northeastern China

NASA Astrophysics Data System (ADS)

Lü, S. B.; Xu, S. G.; Feng, F.

2012-02-01

Water plays a significant role in wetlands. Floodwater utilisation in wetlands brings a wide range of wetland services, from goods production and water regulation to animal protection and aesthetics related to water supply in wetlands. In this study, the floodwater utilisation values of wetland services were estimated within the Momoge wetland and Xianghai wetland in western Jilin province of northeastern China. From 2003 to 2008, the floodwater diverted from the Nenjiang and Tao'er River is 381 million m3, which translates into a monetary value of approximately 1.35 billion RMB in 2008 (RMB: Chinese Currency, RMB 6.80 = US 1), and the ratio of economic value, eco-environmental value, and social value is 1:12:2. Besides the monetary value of the water itself, excessive floodwater utilisation may bring losses to wetlands; the threshold floodwater utilisation volumes in wetlands are discussed. Floodwater utilisation can alleviate water shortages in wetlands, and the evaluation of floodwater utilisation in wetland services in monetary terms is a guide for the effective use of the floodwater resources and for the conservation of wetlands.

Determining the dimensions of essential medical coverage required by military body armour plates utilising Computed Tomography.

PubMed

Breeze, J; Lewis, E A; Fryer, R

2016-09-01

Military body armour is designed to prevent the penetration of ballistic projectiles into the most vulnerable structures within the thorax and abdomen. Currently the OSPREY and VIRTUS body armour systems issued to United Kingdom (UK) Armed Forces personnel are provided with a single size front and rear ceramic plate regardless of the individual's body dimensions. Currently limited information exists to determine whether these plates overprotect some members of the military population, and no method exists to accurately size plates to an individual. Computed Tomography (CT) scans of 120 male Caucasian UK Armed Forces personnel were analysed to measure the dimensions of internal thoraco-abdominal anatomical structures that had been defined as requiring essential medical coverage. The boundaries of these structures were related to three potential anthropometric landmarks on the skin surface and statistical analysis was undertaken to validate the results. The range of heights of each individual used in this study was comparable to previous anthropometric surveys, confirming that a representative sample had been used. The vertical dimension of essential medical coverage demonstrated good correlation to torso height (suprasternal notch to iliac crest) but not to stature (r(2)=0.53 versus 0.04). Horizontal coverage did not correlate to either measure of height. Surface landmarks utilised in this study were proven to be reliable surrogate markers for the boundaries of the underlying anatomical structures potentially requiring essential protection by a plate. Providing a range of plate sizes, particularly multiple heights, should optimise the medical coverage and thus effectiveness of body armour for UK Armed Forces personnel. The results of this work provide evidence that a single width of plate if chosen correctly will provide the essential medical coverage for the entire military population, whilst recognising that it still could overprotect the smallest individuals. With regards to anthropometric measurements; it is recommended, based on this work, that torso height is used instead of stature for sizing body armour. Coverage assessments should now be undertaken for side protection as well as for other non-Caucasian populations and females, with anthropometric surveys utilising the three landmarks recommended in this study. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Accuracy verification of magnetic resonance imaging (MRI) technology for lower-limb prosthetic research: utilising animal soft tissue specimen and common socket casting materials.

PubMed

Safari, Mohammad Reza; Rowe, Philip; Buis, Arjan

2012-01-01

Lower limb prosthetic socket shape and volume consistency can be quantified using MRI technology. Additionally, MRI images of the residual limb could be used as an input data for CAD-CAM technology and finite element studies. However, the accuracy of MRI when socket casting materials are used has to be defined. A number of six, 46 mm thick, cross-sections of an animal leg were used. Three specimens were wrapped with Plaster of Paris (POP) and the other three with commercially available silicone interface liner. Data was obtained by utilising MRI technology and then the segmented images compared to corresponding calliper measurement, photographic imaging, and water suspension techniques. The MRI measurement results were strongly correlated with actual diameter, surface area, and volume measurements. The results show that the selected scanning parameters and the semiautomatic segmentation method are adequate enough, considering the limit of clinical meaningful shape and volume fluctuation, for residual limb volume and the cross-sectional surface area measurements.

Accuracy Verification of Magnetic Resonance Imaging (MRI) Technology for Lower-Limb Prosthetic Research: Utilising Animal Soft Tissue Specimen and Common Socket Casting Materials

PubMed Central

Safari, Mohammad Reza; Rowe, Philip; Buis, Arjan

2012-01-01

Lower limb prosthetic socket shape and volume consistency can be quantified using MRI technology. Additionally, MRI images of the residual limb could be used as an input data for CAD-CAM technology and finite element studies. However, the accuracy of MRI when socket casting materials are used has to be defined. A number of six, 46 mm thick, cross-sections of an animal leg were used. Three specimens were wrapped with Plaster of Paris (POP) and the other three with commercially available silicone interface liner. Data was obtained by utilising MRI technology and then the segmented images compared to corresponding calliper measurement, photographic imaging, and water suspension techniques. The MRI measurement results were strongly correlated with actual diameter, surface area, and volume measurements. The results show that the selected scanning parameters and the semiautomatic segmentation method are adequate enough, considering the limit of clinical meaningful shape and volume fluctuation, for residual limb volume and the cross-sectional surface area measurements. PMID:22619599

Evolution of microorganisms in thermophilic-dry anaerobic digestion.

PubMed

Montero, B; Garcia-Morales, J L; Sales, D; Solera, R

2008-05-01

Microbial population dynamics were studied during the start-up and stabilization periods in thermophilic-dry anaerobic digestion at lab-scale. The experimental protocol was defined to quantify Eubacteria and Archaea using Fluorescent in situ hybridization (FISH) in a continuously stirred tank reactor (CSTR), without recycling solids. The reactor was subjected to a programme of steady-state operation over a range of the retention times from 40 to 25 days, with an organic loading rate between 4.42 and 7.50 kg volatile solid/m3/day. Changes in microbial concentrations were linked to traditional performance parameters such as biogas production and VS removal. The relations of Eubacteria:Archaea and H2-utilising methanogens:acetate-utilising methanogens were 88:12 and 11:1, respectively, during start-up stage. Hydrogenotrophic methanogens, although important in the initial phase of the reactor start-up, were displaced by acetoclastic methanogens at steady-state, thus their relation were 7:32, respectively. The methane yield coefficient, the methane content in the biogas and VS removal were stabilized around 0.30 LCH4/gCOD, 50% and 80%, respectively. Methanogenic population correlated well with performance measurements.

The impact of user fees on access to health services in low- and middle-income countries.

PubMed

Lagarde, Mylene; Palmer, Natasha

2011-04-13

Following an international push for financing reforms, many low- and middle-income countries introduced user fees to raise additional revenue for health systems. User fees are charges levied at the point of use and are supposed to help reduce 'frivolous' consumption of health services, increase quality of services available and, as a result, increase utilisation of services. To assess the effectiveness of introducing, removing or changing user fees to improve access to care in low-and middle-income countries We searched 25 international databases, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group's Trials Register, CENTRAL, MEDLINE and EMBASE. We also searched the websites and online resources of international agencies, organisations and universities to find relevant grey literature. We conducted the original searches between November 2005 and April 2006 and the updated search in CENTRAL (DVD-ROM 2011, Issue 1); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (January 25, 2011); MEDLINE, Ovid (1948 to January Week 2 2011); EMBASE, Ovid (1980 to 2011 Week 03) and EconLit, CSA Illumina (1969 - present) on the 26th of January 2011. We included randomised controlled trials, interrupted time-series studies and controlled before-and-after studies that reported an objective measure of at least one of the following outcomes: healthcare utilisation, health expenditures, or health outcomes. We re-analysed studies with longitudinal data. We computed price elasticities of demand for health services in controlled before-and-after studies as a standardised measure. Due to the diversity of contexts and outcome measures, we did not perform meta-analysis. Instead, we undertook a narrative summary of evidence. We included 16 studies out of the 243 identified. Most of the included studies showed methodological weaknesses that hamper the strength and reliability of their findings. When fees were introduced or increased, we found the use of health services decreased significantly in most studies. Two studies found increases in health service use when quality improvements were introduced at the same time as user fees. However, these studies have a high risk of bias. We found no evidence of effects on health outcomes or health expenditure. The review suggests that reducing or removing user fees increases the utilisation of certain healthcare services. However, emerging evidence suggests that such a change may have unintended consequences on utilisation of preventive services and service quality. The review also found that introducing or increasing fees can have a negative impact on health services utilisation, although some evidence suggests that when implemented with quality improvements these interventions could be beneficial. Most of the included studies suffered from important methodological weaknesses. More rigorous research is needed to inform debates on the desirability and effects of user fees.

The role of government policy in service development in a New Zealand statutory mental health service: implications for policy planning and development.

PubMed

Stanley-Clarke, Nicky; Sanders, Jackie; Munford, Robyn

2014-12-01

To explore the relationship between government policy and service development in a New Zealand statutory mental health provider, Living Well. An organisational case study utilising multiple research techniques including qualitative interviews, analysis of business and strategic documents and observation of meetings. Staff understood and acknowledged the importance of government policy, but there were challenges in its implementation. Within New Zealand's statutory mental health services staff struggled to know how to implement government policy as part of service development; rather, operational concerns, patient need, local context and service demands drove the service development process. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Modelling and validation of electromechanical shock absorbers

NASA Astrophysics Data System (ADS)

Tonoli, Andrea; Amati, Nicola; Girardello Detoni, Joaquim; Galluzzi, Renato; Gasparin, Enrico

2013-08-01

Electromechanical vehicle suspension systems represent a promising substitute to conventional hydraulic solutions. However, the design of electromechanical devices that are able to supply high damping forces without exceeding geometric dimension and mass constraints is a difficult task. All these challenges meet in off-road vehicle suspension systems, where the power density of the dampers is a crucial parameter. In this context, the present paper outlines a particular shock absorber configuration where a suitable electric machine and a transmission mechanism are utilised to meet off-road vehicle requirements. A dynamic model is used to represent the device. Subsequently, experimental tests are performed on an actual prototype to verify the functionality of the damper and validate the proposed model.

Genuine quantum correlations in quantum many-body systems: a review of recent progress.

PubMed

De Chiara, Gabriele; Sanpera, Anna

2018-04-19

Quantum information theory has considerably helped in the understanding of quantum many-body systems. The role of quantum correlations and in particular, bipartite entanglement, has become crucial to characterise, classify and simulate quantum many body systems. Furthermore, the scaling of entanglement has inspired modifications to numerical techniques for the simulation of many-body systems leading to the, now established, area of tensor networks. However, the notions and methods brought by quantum information do not end with bipartite entanglement. There are other forms of correlations embedded in the ground, excited and thermal states of quantum many-body systems that also need to be explored and might be utilised as potential resources for quantum technologies. The aim of this work is to review the most recent developments regarding correlations in quantum many-body systems focussing on multipartite entanglement, quantum nonlocality, quantum discord, mutual information but also other non classical measures of correlations based on quantum coherence. Moreover, we also discuss applications of quantum metrology in quantum many-body systems. © 2018 IOP Publishing Ltd.

Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review

PubMed Central

Hone, Thomas; Lee, John Tayu; Majeed, Azeem; Conteh, Lesong; Millett, Christopher

2017-01-01

Abstract Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients. PMID:28453713

The utilisation of health research in policy-making: concepts, examples and methods of assessment

PubMed Central

Hanney, Stephen R; Gonzalez-Block, Miguel A; Buxton, Martin J; Kogan, Maurice

2003-01-01

The importance of health research utilisation in policy-making, and of understanding the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions. The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation. Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation. Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis. Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies. PMID:12646071

Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia

PubMed Central

2012-01-01

Background Allocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system. Methods A standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country. Findings Substantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population, particularly numbers of births, infants and children and also key diseases with high cost/prevalence and variation, most notably the level of malnutrition. The approach to resource allocation was implemented using existing data sources and permitted the rapid construction of a needs based formula that is highly specific to the package mandated across the country. Refinement could focus more on resources required to finance demand side costs and expansion of the service package to include priority non-communicable services. PMID:22931536

Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia.

PubMed

Ensor, Tim; Firdaus, Hafidz; Dunlop, David; Manu, Alex; Mukti, Ali Ghufron; Ayu Puspandari, Diah; von Roenne, Franz; Indradjaya, Stephanus; Suseno, Untung; Vaughan, Patrick

2012-08-29

Allocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system. A standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country. Substantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population, particularly numbers of births, infants and children and also key diseases with high cost/prevalence and variation, most notably the level of malnutrition. The approach to resource allocation was implemented using existing data sources and permitted the rapid construction of a needs based formula that is highly specific to the package mandated across the country. Refinement could focus more on resources required to finance demand side costs and expansion of the service package to include priority non-communicable services.

Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study

PubMed Central

Kohno, Ayako; Nik Farid, Nik Daliana; Musa, Ghazali; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-01-01

Objective While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. Design We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. Setting We interviewed participants at Japan Clubs and their offices. Participants 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. Results We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. Conclusions The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia. PMID:27006344

Quantification of uncertainty in aerosol optical thickness retrieval arising from aerosol microphysical model and other sources, applied to Ozone Monitoring Instrument (OMI) measurements

NASA Astrophysics Data System (ADS)

Määttä, A.; Laine, M.; Tamminen, J.; Veefkind, J. P.

2014-05-01

Satellite instruments are nowadays successfully utilised for measuring atmospheric aerosol in many applications as well as in research. Therefore, there is a growing need for rigorous error characterisation of the measurements. Here, we introduce a methodology for quantifying the uncertainty in the retrieval of aerosol optical thickness (AOT). In particular, we concentrate on two aspects: uncertainty due to aerosol microphysical model selection and uncertainty due to imperfect forward modelling. We apply the introduced methodology for aerosol optical thickness retrieval of the Ozone Monitoring Instrument (OMI) on board NASA's Earth Observing System (EOS) Aura satellite, launched in 2004. We apply statistical methodologies that improve the uncertainty estimates of the aerosol optical thickness retrieval by propagating aerosol microphysical model selection and forward model error more realistically. For the microphysical model selection problem, we utilise Bayesian model selection and model averaging methods. Gaussian processes are utilised to characterise the smooth systematic discrepancies between the measured and modelled reflectances (i.e. residuals). The spectral correlation is composed empirically by exploring a set of residuals. The operational OMI multi-wavelength aerosol retrieval algorithm OMAERO is used for cloud-free, over-land pixels of the OMI instrument with the additional Bayesian model selection and model discrepancy techniques introduced here. The method and improved uncertainty characterisation is demonstrated by several examples with different aerosol properties: weakly absorbing aerosols, forest fires over Greece and Russia, and Sahara desert dust. The statistical methodology presented is general; it is not restricted to this particular satellite retrieval application.

A lesbian, gay, bisexual and transgender dedicated inpatient psychiatric unit in rural New England: a descriptive analysis in demographics, service utilisation and needs.

PubMed

Klotzbaugh, Ralph; Glover, Eileen

2016-12-01

To develop an understanding of lesbian-, gay-, bisexual-, transgender-specific mental health and substance abuse needs in rural populations and to improve data about sexual orientation and gender identity. Existing literature on mental health needs for lesbian, gay, bisexual and transgender populations has continued to reveal higher levels of need. Research has also demonstrated that few mental health providers have expertise or comfort in treating lesbian, gay, bisexual and transgender clients. Descriptive correlational study. A sample (n = 456) of patient records admitted to a rural lesbian, gay, bisexual and transgender inpatient psychiatric clinic over 12 months were examined using descriptive statistics. Patient zip code information was used to determine the levels of rurality. Chi-square analysis was used to determine relationships between sexual orientation, rural/urban distinctions and concomitant drug use. Unexpectedly, those who identified as heterosexual were significantly more likely to concomitantly abuse alcohol and heroin than those who identified as lesbian, gay, bisexual and transgender. Patients residing in small or isolated rural areas were more likely to abuse alcohol or synthetics than those residing in urban or micropolitan areas. Results of this study concerning substance abuse among lesbian, gay, bisexual and transgender individuals are not reflective of prior studies. LGBT patients did not demonstrate a higher proportion of substance abuse compared with those identifying as heterosexual. Increased substance abuse among those from rural isolated areas does support prior studies. The context of gathering demographic information on sexual orientation was thought by staff to increase the number of those identifying as heterosexual. Context in which sensitive questions are asked may affect the accuracy of demographic data. Lack of information regarding patients' sexual orientation or gender identity may impact perceived need for culturally competent care. Results suggest the need for efforts to provide training for mental health specialists in rural areas to provide sensitive care. © 2016 John Wiley & Sons Ltd.

Bone volume fraction and structural parameters for estimation of mechanical stiffness and failure load of human cancellous bone samples; in-vitro comparison of ultrasound transit time spectroscopy and X-ray μCT.

PubMed

Alomari, Ali Hamed; Wille, Marie-Luise; Langton, Christian M

2018-02-01

Conventional mechanical testing is the 'gold standard' for assessing the stiffness (N mm -1 ) and strength (MPa) of bone, although it is not applicable in-vivo since it is inherently invasive and destructive. The mechanical integrity of a bone is determined by its quantity and quality; being related primarily to bone density and structure respectively. Several non-destructive, non-invasive, in-vivo techniques have been developed and clinically implemented to estimate bone density, both areal (dual-energy X-ray absorptiometry (DXA)) and volumetric (quantitative computed tomography (QCT)). Quantitative ultrasound (QUS) parameters of velocity and attenuation are dependent upon both bone quantity and bone quality, although it has not been possible to date to transpose one particular QUS parameter into separate estimates of quantity and quality. It has recently been shown that ultrasound transit time spectroscopy (UTTS) may provide an accurate estimate of bone density and hence quantity. We hypothesised that UTTS also has the potential to provide an estimate of bone structure and hence quality. In this in-vitro study, 16 human femoral bone samples were tested utilising three techniques; UTTS, micro computed tomography (μCT), and mechanical testing. UTTS was utilised to estimate bone volume fraction (BV/TV) and two novel structural parameters, inter-quartile range of the derived transit time (UTTS-IQR) and the transit time of maximum proportion of sonic-rays (TTMP). μCT was utilised to derive BV/TV along with several bone structure parameters. A destructive mechanical test was utilised to measure the stiffness and strength (failure load) of the bone samples. BV/TV was calculated from the derived transit time spectrum (TTS); the correlation coefficient (R 2 ) with μCT-BV/TV was 0.885. For predicting mechanical stiffness and strength, BV/TV derived by both μCT and UTTS provided the strongest correlation with mechanical stiffness (R 2 =0.567 and 0.618 respectively) and mechanical strength (R 2 =0.747 and 0.736 respectively). When respective structural parameters were incorporated to BV/TV, multiple regression analysis indicated that none of the μCT histomorphometric parameters could improve the prediction of mechanical stiffness and strength, while for UTTS, adding TTMP to BV/TV increased the prediction of mechanical stiffness to R 2 =0.711 and strength to R 2 =0.827. It is therefore envisaged that UTTS may have the ability to estimate BV/TV along with providing an improved prediction of osteoporotic fracture risk, within routine clinical practice in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

Price and utilisation differences for statins between four countries.

PubMed

Thai, Loc Phuoc; Vitry, Agnes Isabelle; Moss, John Robert

2018-02-01

Australia, England, France and New Zealand use different policies to regulate their medicines market, which can impact on utilisation and price. To compare the prices and utilisation of statins in Australia, England, France and New Zealand from 2011 to 2013. Utilisation of statins in the four countries was compared using Defined Daily Doses (DDD) per 1000 inhabitants per year. Pairwise Laspeyres and Paasche index comparisons were conducted comparing the price and utilisation of statins. The results showed that the price of statins in New Zealand was the cheapest. The price of statins in Australia was most expensive in 2011 and 2012 but France was more expensive in 2013. There were large differences between the Laspeyres index and Paasche index when comparing the price and utilisation of England with Australia and France. The policies that regulate the New Zealand and England medicines markets were more effective in reducing the price of expensive statins. The relative utilisation of cheaper statins was greatest in England and had a large effect on the differences between the two index results. The pricing policies in Australia have been only partly effective in reducing the price of statins compared to other countries.

Selective correlations in finite quantum systems and the Desargues property

NASA Astrophysics Data System (ADS)

Lei, C.; Vourdas, A.

2018-06-01

The Desargues property is well known in the context of projective geometry. An analogous property is presented in the context of both classical and Quantum Physics. In a classical context, the Desargues property implies that two logical circuits with the same input show in their outputs selective correlations. In general their outputs are uncorrelated, but if the output of one has a particular value, then the output of the other has another particular value. In a quantum context, the Desargues property implies that two experiments each of which involves two successive projective measurements have selective correlations. For a particular set of projectors, if in one experiment the second measurement does not change the output of the first measurement, then the same is true in the other experiment.

Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.

PubMed

Hone, Thomas; Lee, John Tayu; Majeed, Azeem; Conteh, Lesong; Millett, Christopher

2017-06-01

Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients. © 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.

Effects of coating thickness on high power metal coated fibre lasers

NASA Astrophysics Data System (ADS)

Daniel, Jae M. O.; Simakov, Nikita; Hemming, Alexander; Clarkson, W. Andrew; Haub, John

2017-03-01

We investigate the effects of coating thickness on the scattering losses of metal coated active fibre. A range of low numerical aperture metal coated optical fibres are placed in etchant solutions whilst measuring propagation loss as a function of time. By utilising concurrent coating diameter measurements, we are able to correlate propagation losses with coating thickness. Experimentally we find a monotonic dependence on coating thickness and scattering loss. We present the results of this work, providing useful parameters for high power metal coated fibre laser designs.

Sex Differences in Context Fear Generalization and Recruitment of Hippocampus and Amygdala during Retrieval

PubMed Central

Keiser, Ashley A; Turnbull, Lacie M; Darian, Mara A; Feldman, Dana E; Song, Iris; Tronson, Natalie C

2017-01-01

Anxiety disorders are commonly associated with increased generalization of fear from a stress- or trauma-associated environment to a neutral context or environment. Differences in context-associated memory in males and females may contribute to increased susceptibility to anxiety disorders in women. Here we examined sex differences in context fear generalization and its neural correlates. We observed stronger context fear conditioning and more generalization of fear to a similar context in females than males. In addition, context preexposure increased fear conditioning in males and decreased generalization in females. Accordingly, males showed stronger cFos activity in dorsal hippocampus during memory retrieval and context generalization, whereas females showed preferential recruitment of basal amygdala. Together, these findings are consistent with previous research showing that hippocampal activity correlates with reduced context fear generalization. Differential competition between hippocampus and amygdala-dependent processes may thus contribute to sex differences in retrieval of context fear and greater generalization of fear-associated memory. PMID:27577601

A Simple Geotracer Compositional Correlation Analysis Reveals Oil Charge and Migration Pathways

NASA Astrophysics Data System (ADS)

Yang, Yunlai; Arouri, Khaled

2016-03-01

A novel approach, based on geotracer compositional correlation analysis is reported, which reveals the oil charge sequence and migration pathways for five oil fields in Saudi Arabia. The geotracers utilised are carbazoles, a family of neutral pyrrolic nitrogen compounds known to occur naturally in crude oils. The approach is based on the concept that closely related fields, with respect to filling sequence, will show a higher carbazole compositional correlation, than those fields that are less related. That is, carbazole compositional correlation coefficients can quantify the charge and filling relationships among different fields. Consequently, oil migration pathways can be defined based on the established filling relationships. The compositional correlation coefficients of isomers of C1 and C2 carbazoles, and benzo[a]carbazole for all different combination pairs of the five fields were found to vary extremely widely (0.28 to 0.94). A wide range of compositional correlation coefficients allows adequate differentiation of separate filling relationships. Based on the established filling relationships, three distinct migration pathways were inferred, with each apparently being charged from a different part of a common source kitchen. The recognition of these charge and migration pathways will greatly aid the search for new accumulations.

A Simple Geotracer Compositional Correlation Analysis Reveals Oil Charge and Migration Pathways

PubMed Central

Yang, Yunlai; Arouri, Khaled

2016-01-01

A novel approach, based on geotracer compositional correlation analysis is reported, which reveals the oil charge sequence and migration pathways for five oil fields in Saudi Arabia. The geotracers utilised are carbazoles, a family of neutral pyrrolic nitrogen compounds known to occur naturally in crude oils. The approach is based on the concept that closely related fields, with respect to filling sequence, will show a higher carbazole compositional correlation, than those fields that are less related. That is, carbazole compositional correlation coefficients can quantify the charge and filling relationships among different fields. Consequently, oil migration pathways can be defined based on the established filling relationships. The compositional correlation coefficients of isomers of C1 and C2 carbazoles, and benzo[a]carbazole for all different combination pairs of the five fields were found to vary extremely widely (0.28 to 0.94). A wide range of compositional correlation coefficients allows adequate differentiation of separate filling relationships. Based on the established filling relationships, three distinct migration pathways were inferred, with each apparently being charged from a different part of a common source kitchen. The recognition of these charge and migration pathways will greatly aid the search for new accumulations. PMID:26965479

A Simple Geotracer Compositional Correlation Analysis Reveals Oil Charge and Migration Pathways.

PubMed

Yang, Yunlai; Arouri, Khaled

2016-03-11

A novel approach, based on geotracer compositional correlation analysis is reported, which reveals the oil charge sequence and migration pathways for five oil fields in Saudi Arabia. The geotracers utilised are carbazoles, a family of neutral pyrrolic nitrogen compounds known to occur naturally in crude oils. The approach is based on the concept that closely related fields, with respect to filling sequence, will show a higher carbazole compositional correlation, than those fields that are less related. That is, carbazole compositional correlation coefficients can quantify the charge and filling relationships among different fields. Consequently, oil migration pathways can be defined based on the established filling relationships. The compositional correlation coefficients of isomers of C1 and C2 carbazoles, and benzo[a]carbazole for all different combination pairs of the five fields were found to vary extremely widely (0.28 to 0.94). A wide range of compositional correlation coefficients allows adequate differentiation of separate filling relationships. Based on the established filling relationships, three distinct migration pathways were inferred, with each apparently being charged from a different part of a common source kitchen. The recognition of these charge and migration pathways will greatly aid the search for new accumulations.

Developing the practice context to enable more effective pain management with older people: an action research approach

PubMed Central

2011-01-01

Background This paper, which draws upon an Emancipatory Action Research (EAR) approach, unearths how the complexities of context influence the realities of nursing practice. While the intention of the project was to identify and change factors in the practice context that inhibit effective person-centred pain management practices with older people (65 years or older), reflective critical engagement with the findings identified that enhancing pain management practices with older people was dependent on cultural change in the unit as a whole. Methods An EAR approach was utilised. The project was undertaken in a surgical unit that conducted complex abdominal surgery. Eighty-five percent (n = 48) of nursing staff participated in the two-year project (05/NIR02/107). Data were obtained through the use of facilitated critical reflection with nursing staff. Results Three key themes (psychological safety, leadership, oppression) and four subthemes (power, horizontal violence, distorted perceptions, autonomy) were found to influence the way in which effective nursing practice was realised. Within the theme of 'context,' effective leadership and the creation of a psychologically safe environment were key elements in the enhancement of all aspects of nursing practice. Conclusions Whilst other research has identified the importance of 'practice context' and models and frameworks are emerging to address this issue, the theme of 'psychological safety' has been given little attention in the knowledge translation/implementation literature. Within the principles of EAR, facilitated reflective sessions were found to create 'psychologically safe spaces' that supported practitioners to develop effective person-centred nursing practices in complex clinical environments. PMID:21284857

Religious beliefs are factual beliefs: Content does not correlate with context sensitivity.

PubMed

Levy, Neil

2017-04-01

Neil Van Leeuwen argues that religious beliefs are not factual beliefs: typically, at least, they are attitudes of a different type. He argues that they exhibit much more sensitivity to context than factual beliefs: outside of contexts in which they are salient, they do not govern behaviour or inference, or provide background assumptions for cognition. This article surveys a large range of data to show that the kind of context sensitivity that Van Leeuwen thinks is the province of religious beliefs does not correlate with belief content. Beliefs about matters of fact beyond the theological realm exhibit this kind of sensitivity too. Conversely, theological and supernatural beliefs often guide behaviour across contexts. It is the intuitiveness of representations across contexts that predicts context (in)sensitivity, and intuitiveness is powerfully influenced by processing fluency. Fluency, in turn, is sensitive to cues that vary across contexts. Copyright © 2017 Elsevier B.V. All rights reserved.

Context-specific control and context selection in conflict tasks.

PubMed

Schouppe, Nathalie; Ridderinkhof, K Richard; Verguts, Tom; Notebaert, Wim

2014-02-01

This study investigated whether participants prefer contexts with relatively little cognitive conflict and whether this preference is related to context-specific control. A conflict selection task was administered in which participants had to choose between two categories that contained different levels of conflict. One category was associated with 80% congruent Stroop trials and 20% incongruent Stroop trials, while the other category was associated with only 20% congruent Stroop trials and 80% incongruent Stroop trials. As predicted, participants selected the low-conflict category more frequently, indicating that participants avoid contexts with high-conflict likelihood. Furthermore, we predicted a correlation between this preference for the low-conflict category and the control implementation associated with the categories (i.e., context-specific proportion congruency effect, CSPC effect). Results however did not show such a correlation, thereby failing to support a relationship between context control and context selection. Copyright © 2013 Elsevier B.V. All rights reserved.

Key Programme Science lessons from an HIV prevention 'Learning Site' for sex workers in Mombasa, Kenya.

PubMed

McClarty, Leigh M; Bhattacharjee, Parinita; Isac, Shajy; Emmanuel, Faran; Kioko, Japheth; Njiraini, Margaret; Gichangi, Peter; Okoth, Clifford Duncan; Musimbi-Mbole, Janet; Blanchard, James F; Moses, Stephen; Muysyoki, Helgar; Becker, Marissa L

2017-12-14

In 2013, Kenya's National AIDS and STI Control Programme established a Learning Site (LS) in Mombasa County to support and strengthen capacity for HIV prevention programming within organisations working with sex workers. A defining feature of LS was the use of a Programme Science approach throughout its development and implementation. We provide an overview of the key components of LS, present findings from 23 months of programme monitoring data, and highlight key Programme Science lessons from its implementation and monitoring. Routine monitoring data collected from September 2013 through July 2015 are presented. Individual-level service utilisation data were collected monthly and indicators of interest were analysed over time to illustrate trends in enrolment, programme coverage and service utilisation among sex workers in Mombasa County. Over the monitoring period, outreach programme enrolment occurred rapidly; condom distribution targets were met consistently; rates of STI screening remained high and diagnoses declined; and reporting of and response to violent incidents increased. At the same time, enrolment in LS clinics was relatively low among female sex workers, and HIV testing at LS was low among both female and male sex workers. Lessons learnt from operationalising the Programme Science framework through the Mombasa LS can inform the development and implementation of similar LS in different geographical and epidemiological contexts. Importantly, meaningful involvement of sex workers in the design, implementation and monitoring processes ensures that overall programme performance is optimised in the context of local, 'on-the-ground' realities. Additionally, learnings from LS highlight the importance of introducing enhanced monitoring and evaluations systems into complex programmes to better understand and explain programme dynamics over time. © 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.

Lifting and exertion injuries decrease after implementation of an integrated hospital-wide safe patient handling and mobilisation programme.

PubMed

Dennerlein, Jack T; O'Day, Elizabeth Tucker; Mulloy, Deborah F; Somerville, Jackie; Stoddard, Anne M; Kenwood, Christopher; Teeple, Erin; Boden, Leslie I; Sorensen, Glorian; Hashimoto, Dean

2017-05-01

With increasing emphasis on early and frequent mobilisation of patients in acute care, safe patient handling and mobilisation practices need to be integrated into these quality initiatives. We completed a programme evaluation of a safe patient handling and mobilisation programme within the context of a hospital-wide patient care improvement initiative that utilised a systems approach and integrated safe patient equipment and practices into patient care plans. Baseline and 12-month follow-up surveys of 1832 direct patient care workers assessed work practices and self-reported pain while an integrated employee payroll and injury database provided recordable injury rates collected concurrently at 2 hospitals: the study hospital with the programme and a comparison hospital. Safe and unsafe patient handling practice scales at the study hospital improved significantly (p<0.0001 and p=0.0031, respectively), with no differences observed at the comparison hospital. We observed significant decreases in recordable neck and shoulder (Relative Risk (RR)=0.68, 95% CI 0.46 to 1.00), lifting and exertion (RR=0.73, 95% CI 0.60 to 0.89) and pain and inflammation (RR=0.78, 95% CI 0.62 to 1.00) injury rates at the study hospital. Changes in rates at the comparison hospital were not statistically significant. Within the context of a patient mobilisation initiative, a safe patient handling and mobilisation programme was associated with improved work practices and a reduction in recordable worker injuries. This study demonstrates the potential impact of utilising a systems approach based on recommended best practices, including integration of these practices into the patient's plan for care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Evaluation of UK Integrated Care Pilots: research protocol

PubMed Central

Ling, Tom; Bardsley, Martin; Adams, John; Lewis, Richard; Roland, Martin

2010-01-01

Background In response to concerns that the needs of the aging population for well-integrated care were increasing, the English National Health Service (NHS) appointed 16 Integrated Care Pilots following a national competition. The pilots have a range of aims including development of new organisational structures to support integration, changes in staff roles, reducing unscheduled emergency hospital admissions, reduced length of hospital stay, increasing patient satisfaction, and reducing cost. This paper describes the evaluation of the initiative which has been commissioned. Study design and data collection methods A mixed methods approach has been adopted including interviews with staff and patients, non-participant observation of meetings, structured written feedback from sites, questionnaires to patients and staff, and analysis of routinely collected hospital utilisation data for patients/service users. The qualitative analysis aims to identify the approaches taken to integration by the sites, the benefits which result, the context in which benefits have resulted, and the mechanisms by which they occur. Methods of analysis The quantitative analysis adopts a ‘difference in differences’ approach comparing health care utilisation before and after the intervention with risk-matched controls. The qualitative data analysis adopts a ‘theory of change’ approach in which we triangulate data from the quantitative analysis with qualitative data in order to describe causal effects (what happens when an independent variable changes) and causal mechanisms (what connects causes to their effects). An economic analysis will identify what incremental resources are required to make integration succeed and how they can be combined efficiently to produce better outcomes for patients. Conclusion This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare. PMID:20922068

Evaluation of UK Integrated Care Pilots: research protocol.

PubMed

Ling, Tom; Bardsley, Martin; Adams, John; Lewis, Richard; Roland, Martin

2010-09-27

In response to concerns that the needs of the aging population for well-integrated care were increasing, the English National Health Service (NHS) appointed 16 Integrated Care Pilots following a national competition. The pilots have a range of aims including development of new organisational structures to support integration, changes in staff roles, reducing unscheduled emergency hospital admissions, reduced length of hospital stay, increasing patient satisfaction, and reducing cost. This paper describes the evaluation of the initiative which has been commissioned. A mixed methods approach has been adopted including interviews with staff and patients, non-participant observation of meetings, structured written feedback from sites, questionnaires to patients and staff, and analysis of routinely collected hospital utilisation data for patients/service users. The qualitative analysis aims to identify the approaches taken to integration by the sites, the benefits which result, the context in which benefits have resulted, and the mechanisms by which they occur. The quantitative analysis adopts a 'difference in differences' approach comparing health care utilisation before and after the intervention with risk-matched controls. The qualitative data analysis adopts a 'theory of change' approach in which we triangulate data from the quantitative analysis with qualitative data in order to describe causal effects (what happens when an independent variable changes) and causal mechanisms (what connects causes to their effects). An economic analysis will identify what incremental resources are required to make integration succeed and how they can be combined efficiently to produce better outcomes for patients. This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare.

Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study.

PubMed

Kohno, Ayako; Nik Farid, Nik Daliana; Musa, Ghazali; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-03-22

While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. We interviewed participants at Japan Clubs and their offices. 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia. 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/

Emotion Knowledge and Attentional Differences in Preschoolers Showing Context-Inappropriate Anger.

PubMed

Locke, Robin L; Lang, Nichole J

2016-08-01

Some children show anger inappropriate for the situation based on the predominant incentives, which is called context-inappropriate anger. Children need to attend to and interpret situational incentives for appropriate emotional responses. We examined associations of context-inappropriate anger with emotion recognition and attention problems in 43 preschoolers (42% male; M age = 55.1 months, SD = 4.1). Parents rated context-inappropriate anger across situations. Teachers rated attention problems using the Child Behavior Checklist-Teacher Report Form. Emotion recognition was ability to recognize emotional faces using the Emotion Matching Test. Anger perception bias was indicated by anger to non-anger situations using an adapted Affect Knowledge Test. 28% of children showed context-inappropriate anger, which correlated with lower emotion recognition (β = -.28) and higher attention problems (β = .36). Higher attention problems correlated with more anger perception bias (β = .32). This cross-sectional, correlational study provides preliminary findings that children with context-inappropriate anger showed more attention problems, which suggests that both "problems" tend to covary and associate with deficits or biases in emotion knowledge. © The Author(s) 2016.

'Where do I go from here'? A cultural perspective on challenges to the use of hospice services.

PubMed

Frey, Rosemary; Gott, Merryn; Raphael, Deborah; Black, Stella; Teleo-Hope, Linda; Lee, Hyeonjoo; Wang, Zonghua

2013-09-01

Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care services for patients and families and provide consultative services to primary healthcare providers in the community. © 2013 John Wiley & Sons Ltd.

The role of technology and telemetry medicine in the initial management of a ST-segment elevated myocardial infarction in a rural emergency department.

PubMed

Hood, Michael L

2018-05-01

The 12-lead electrocardiogram (ECG) is an integral part of the diagnostic tools available for recognising a patient who is experiencing an ST-segment elevated myocardial infarction (STEMI). Consequently, a great emphasis is placed on the rapid acquisition and expert interpretation of the 12-lead ECG so that the appropriate reperfusion management might be commenced to optimise patient outcomes by preventing further damage to the myocardium. With the advancement of telemetric and diagnostic abilities of the modern ECG machine, the role of frontline rural emergency clinicians is as important as ever. This clinical case report describes the presentation and management of a person experiencing a STEMI in a rural Australian hospital emergency department setting. The emanating point of interest from this case report is the early clinician recognition of significant ST-segment elevation in multiple leads of the initial ECG trace, indicating a STEMI. Despite the presence of significant acute ST-segment changes throughout the trace, the ECG's diagnostic analysis of the 12-lead ECG did not identify it as meeting STEMI criteria. Subsequently, the ECG was not recommended by the ECG machine for telemetric transmission to the remote on-call cardiologist for immediate STEMI management guidance. This article focuses on the telemetric technology utilised in the management of STEMIs in the rural emergency department, the diagnostic ability of the modern ECG and the role of the frontline rural emergency clinician in the utilisation of such technology. Competent utilisation of key technologies applied to the ECG machine require the clinician to be well trained in the technical use of the equipment, have a thorough understanding of how the technology interacts within the established clinical pathway and be ready to apply its use in a timely manner in order to prevent delays in treatment. Furthermore, an over-reliance on the diagnostic ability of the modern ECG machine in the rural or remote context may potentially lead to poor patient outcomes.

The use of organic and inorganic impurities found in MDMA police seizures in a drug intelligence perspective.

PubMed

Morelato, Marie; Beavis, Alison; Tahtouh, Mark; Ribaux, Olivier; Kirkbride, Paul; Roux, Claude

2014-01-01

Traditional forensic drug profiling involves numerous analytical techniques, and the whole process is typically costly and may be time consuming. The aim of this study was to investigate the possibility of prioritising techniques utilised at the Australian Federal Police (AFP) for the chemical profiling of 3,4-methylenedioxymethylamphetamine (MDMA). The outcome would provide the AFP with the ability to obtain more timely and valuable results that could be used in an intelligence perspective. Correlation coefficients were used to obtain a similarity degree between a population of linked samples (within seizures) and a population of unlinked samples (between different seizures) and discrimination between the two populations was ultimately achieved. The results showed that gas chromatography-mass spectrometry (GC-MS) was well suited as a single technique to detect links between seizures and could be used in priority for operational intelligence purposes. Furthermore, the method was applied to seizures known or suspected (through their case information) to be linked to each other to assess the chemical similarity between samples. It was found that half of the seizures previously linked by the case number were also linked by the chemical profile. This procedure was also able to highlight links between cases that were previously unsuspected and retrospectively confirmed by circumstantial information. The findings are finally discussed in the broader forensic intelligence context, with a focus on how they could be successfully incorporated into investigations and in an intelligence-led policing perspective in order to understand trafficking markets. © 2014.

Family context and externalizing correlates of childhood animal cruelty in adjudicated delinquents.

PubMed

Walters, Glenn D; Noon, Alexandria

2015-05-01

The purpose of this study was to determine whether childhood animal cruelty is primarily a feature of family context or of externalizing behavior. Twenty measures of family context and proactive (fearlessness) and reactive (disinhibition) externalizing behavior were correlated with the retrospective accounts of childhood animal cruelty provided by 1,354 adjudicated delinquents. A cross-sectional analysis revealed that all 20 family context, proactive externalizing, and reactive externalizing variables correlated significantly with animal cruelty. Prospective analyses showed that when the animal cruelty variable was included in a regression equation with the 10 family context variables (parental arguing and fighting, parental drug use, parental hostility, and parental knowledge and monitoring of offspring behavior) or in a regression equation with the five reactive externalizing variables (interpersonal hostility, secondary psychopathy, weak impulse control, weak suppression of aggression, and short time horizon), it continued to predict future violent and income (property + drug) offending. The animal cruelty variable no longer predicted offending, however, when included in a regression equation with the five proactive externalizing variables (early onset behavioral problems, primary psychopathy, moral disengagement, positive outcome expectancies for crime, and lack of consideration for others). These findings suggest that while animal cruelty correlates with a wide range of family context and externalizing variables, it may serve as a marker of violent and nonviolent offending by virtue of its position on the proactive subdimension of the externalizing spectrum. © The Author(s) 2014.

Suprathreshold stochastic resonance in neural processing tuned by correlation.

PubMed

Durrant, Simon; Kang, Yanmei; Stocks, Nigel; Feng, Jianfeng

2011-07-01

Suprathreshold stochastic resonance (SSR) is examined in the context of integrate-and-fire neurons, with an emphasis on the role of correlation in the neuronal firing. We employed a model based on a network of spiking neurons which received synaptic inputs modeled by Poisson processes stimulated by a stepped input signal. The smoothed ensemble firing rate provided an output signal, and the mutual information between this signal and the input was calculated for networks with different noise levels and different numbers of neurons. It was found that an SSR effect was present in this context. We then examined a more biophysically plausible scenario where the noise was not controlled directly, but instead was tuned by the correlation between the inputs. The SSR effect remained present in this scenario with nonzero noise providing improved information transmission, and it was found that negative correlation between the inputs was optimal. Finally, an examination of SSR in the context of this model revealed its connection with more traditional stochastic resonance and showed a trade-off between supratheshold and subthreshold components. We discuss these results in the context of existing empirical evidence concerning correlations in neuronal firing.

Suprathreshold stochastic resonance in neural processing tuned by correlation

NASA Astrophysics Data System (ADS)

Durrant, Simon; Kang, Yanmei; Stocks, Nigel; Feng, Jianfeng

2011-07-01

Suprathreshold stochastic resonance (SSR) is examined in the context of integrate-and-fire neurons, with an emphasis on the role of correlation in the neuronal firing. We employed a model based on a network of spiking neurons which received synaptic inputs modeled by Poisson processes stimulated by a stepped input signal. The smoothed ensemble firing rate provided an output signal, and the mutual information between this signal and the input was calculated for networks with different noise levels and different numbers of neurons. It was found that an SSR effect was present in this context. We then examined a more biophysically plausible scenario where the noise was not controlled directly, but instead was tuned by the correlation between the inputs. The SSR effect remained present in this scenario with nonzero noise providing improved information transmission, and it was found that negative correlation between the inputs was optimal. Finally, an examination of SSR in the context of this model revealed its connection with more traditional stochastic resonance and showed a trade-off between supratheshold and subthreshold components. We discuss these results in the context of existing empirical evidence concerning correlations in neuronal firing.

Health service utilisation amongst urban Aboriginal and Torres Strait Islander children aged younger than 5 years registered with a primary health-care service in South-East Queensland.

PubMed

Hall, Kerry K; Chang, Anne B; Anderson, Jennie; Arnold, Daniel; Otim, Michael; O'Grady, Kerry-Ann F

2018-06-01

The majority of Australia's Aboriginal and/or Torres Strait Islander children live in urban areas; however, little is known about their health service use. We aimed to describe health service utilisation amongst a cohort of urban Aboriginal and/or Torres Strait Islander children aged <5 years. We analysed health service utilisation data collected in an ongoing prospective cohort study of children aged <5 years registered with an Aboriginal-owned and operated primary health-care service. Enrolled children were followed monthly for 12 months, with data on health service utilisation collected at baseline and at each monthly follow-up. Health service utilisation rates, overall and by service provider and reason for presentation, were calculated and reported as incidence rates per 100 child-months with the corresponding 95% confidence intervals (CIs). Between February 2013 and November 2015, 180 children were enrolled, and 1541 child-months of observation were available for analysis. The overall incidence of health service utilisation was 52.5 per 100 child-months (95% CI 48.7-56.5); 81% of encounters were with general practitioners. Presentation rates were the highest for acute respiratory illnesses (30.7/100 child-months, 95% CI 27.8-33.9). In this community, acute respiratory illnesses are predominant causes of health service utilisation in young children. The health-care utilisation profile of these children presents important opportunities for health promotion and intervention. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

The experiences of culturally and linguistically diverse family caregivers in utilising dementia services in Australia

PubMed Central

2013-01-01

Background Older people from culturally and linguistically diverse groups are underrepresented in residential aged care but overrepresented in community aged care in Australia. However, little is known about culturally and linguistically diverse family caregivers in utilising dementia services in Australia because previous studies mainly focused on the majority cultural group. Experiences of caregivers from culturally and linguistically diverse groups who are eligible to utilise dementia services in Australia are needed in order to optimize the utilisation of dementia services for these caregivers. Methods The aim of the study was to explore the experiences of family caregivers from Chinese, Greek, Italian and Vietnamese groups in utilising dementia services. Gadamer's philosophical hermeneutics was used to interpret the experiences of the participants. Focus group discussions and in-depth individual interviews were used to collect data. Data collection was conducted over a six month period in 2011. In total, 46 family caregivers who were caring for 39 persons with dementia participated. Results Four themes were revealed: (1) negotiating services for the person with dementia; (2) the impact of acculturation on service utilisation; (3) the characteristics of satisfactory services; and (4) negative experiences in utilising services. The present study revealed that the participation of caregivers from culturally and linguistically diverse groups in planning and managing dementia services ranged markedly from limited participation to full participation. Conclusions The findings of this study suggest that caregivers from culturally and linguistically diverse groups need to be fully prepared so they can participate in the utilisation of dementia services available to them in Australia. PMID:24148155

The experiences of culturally and linguistically diverse family caregivers in utilising dementia services in Australia.

PubMed

Xiao, Lily Dongxia; De Bellis, Anita; Habel, Lesley; Kyriazopoulos, Helena

2013-10-22

Older people from culturally and linguistically diverse groups are underrepresented in residential aged care but overrepresented in community aged care in Australia. However, little is known about culturally and linguistically diverse family caregivers in utilising dementia services in Australia because previous studies mainly focused on the majority cultural group. Experiences of caregivers from culturally and linguistically diverse groups who are eligible to utilise dementia services in Australia are needed in order to optimize the utilisation of dementia services for these caregivers. The aim of the study was to explore the experiences of family caregivers from Chinese, Greek, Italian and Vietnamese groups in utilising dementia services. Gadamer's philosophical hermeneutics was used to interpret the experiences of the participants. Focus group discussions and in-depth individual interviews were used to collect data. Data collection was conducted over a six month period in 2011. In total, 46 family caregivers who were caring for 39 persons with dementia participated. Four themes were revealed: (1) negotiating services for the person with dementia; (2) the impact of acculturation on service utilisation; (3) the characteristics of satisfactory services; and (4) negative experiences in utilising services. The present study revealed that the participation of caregivers from culturally and linguistically diverse groups in planning and managing dementia services ranged markedly from limited participation to full participation. The findings of this study suggest that caregivers from culturally and linguistically diverse groups need to be fully prepared so they can participate in the utilisation of dementia services available to them in Australia.

The Efficacy of Blue-Green Infrastructure for Pluvial Flood Prevention under Conditions of Deep Uncertainty

NASA Astrophysics Data System (ADS)

Babovic, Filip; Mijic, Ana; Madani, Kaveh

2017-04-01

Urban areas around the world are growing in size and importance; however, cities experience elevated risks of pluvial flooding due to the prevalence of impermeable land surfaces within them. Urban planners and engineers encounter a great deal of uncertainty when planning adaptations to these flood risks, due to the interaction of multiple factors such as climate change and land use change. This leads to conditions of deep uncertainty. Blue-Green (BG) solutions utilise natural vegetation and processes to absorb and retain runoff while providing a host of other social, economic and environmental services. When utilised in conjunction with Decision Making under Deep Uncertainty (DMDU) methodologies, BG infrastructure provides a flexible and adaptable method of "no-regret" adaptation; resulting in a practical, economically efficient, and socially acceptable solution for flood risk mitigation. This work presents the methodology for analysing the impact of BG infrastructure in the context of the Adaptation Tipping Points approach to protect against pluvial flood risk in an iterative manner. An economic analysis of the adaptation pathways is also conducted in order to better inform decision-makers on the benefits and costs of the adaptation options presented. The methodology was applied to a case study in the Cranbrook Catchment in the North East of London. Our results show that BG infrastructure performs better under conditions of uncertainty than traditional grey infrastructure.

The exposure to and health effects of antimony

PubMed Central

Cooper, Ross G.; Harrison, Adrian P.

2009-01-01

Context: This minireview describes the health effects of antimony exposure in the workplace and the environment. Aim: To collate information on the consequences of occupational and environmental exposure to antimony on physiological function and well-being. Methods: The criteria used in the current minireview for selecting articles were adopted from proposed criteria in The International Classification of Functioning, Disability and Health. Articles were classified from an acute and chronic exposure and toxicity thrust. Results: The proportion of utilised and non-utilised articles was tabulated. Antimony toxicity is dependent on the exposure dose, duration, route (breathing, eating, drinking, or skin contact), other chemical exposures, age, sex, nutritional status, family traits, life style, and state of health. Chronic exposure to antimony in the air at levels of 9 mg/m3 may exacerbate irritation of the eyes, skin, and lungs. Long-term inhalation of antimony can potentiate pneumoconiosis, altered electrocardiograms, stomach pain, diarrhea, vomiting, and stomach ulcers, results which were confirmed in laboratory animals. Although there were investigations of the effect of antimony in sudden infant death syndrome, current findings suggest no link. Antimony trioxide exposure is predominant in smelters. Mining and exposure via glass working, soldering, and brazing are also important. Conclusion: Antimony has some useful but undoubtedly harmful effects on health and well-being and measures need to be taken to prevent hazardous exposure of the like. Its biological monitoring in the workplace is essential. PMID:20165605

Diffusion-weighted imaging and the skeletal system: a literature review.

PubMed

Yao, K; Troupis, J M

2016-11-01

Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) sequence that has a well-established role in neuroimaging, and is increasingly being utilised in other clinical contexts, including the assessment of various skeletal disorders. It utilises the variability of Brownian motion of water molecules; the differing patterns of water molecular diffusion in various biological tissues help determine the contrast obtained in DWI. Although early research on the clinical role of DWI focused mainly on the field of neuroimaging, there are now more studies demonstrating the promising role DWI has in the diagnosis and monitoring of various osseous diseases. DWI has been shown to be useful in assessing a patient's skeletal tumour burden, monitoring the post-chemotherapy response of various bony malignancies, detecting hip ischaemia in patients with Legg-Calvé-Perthes disease, as well as determining the quality of repaired articular cartilage. Despite its relative successes, DWI has several limitations, including its limited clinical value in differentiating chondrosarcomas from benign bone lesions, as well as osteoporotic vertebral compression fractures from compression fractures due to malignancy. This literature review aims to provide an overview of the recent developments in the use of DWI in imaging the skeletal system, and to clarify the role of DWI in assessing various osseous diseases. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Microfluidics and Raman microscopy: current applications and future challenges.

PubMed

Chrimes, Adam F; Khoshmanesh, Khashayar; Stoddart, Paul R; Mitchell, Arnan; Kalantar-Zadeh, Kourosh

2013-07-07

Raman microscopy systems are becoming increasingly widespread and accessible for characterising chemical species. Microfluidic systems are also progressively finding their way into real world applications. Therefore, it is anticipated that the integration of Raman systems with microfluidics will become increasingly attractive and practical. This review aims to provide an overview of Raman microscopy-microfluidics integrated systems for researchers who are actively interested in utilising these tools. The fundamental principles and application strengths of Raman microscopy are discussed in the context of microfluidics. Various configurations of microfluidics that incorporate Raman microscopy methods are presented, with applications highlighted. Data analysis methods are discussed, with a focus on assisting the interpretation of Raman-microfluidics data from complex samples. Finally, possible future directions of Raman-microfluidic systems are presented.

What variables should be considered in allocating Primary health care Pharmaceutical budgets to districts in Uganda?

PubMed

Mujasi, Paschal N; Puig-Junoy, Jaume

2015-01-01

A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P < 0.01). The percentage of health centre IIIs (HC III) among each district's health facilities is significantly correlated with per capita pharmaceutical expenditure (P < 0.05). OPD per capita utilisation has a relatively strong correlation with per capita pharmaceutical expenditure (r = 0.498); all the other significant factors are weakly correlated with per capita pharmaceutical expenditure (r < 0.5). From several iterations of an initially developed model, the proposed final model for explaining per capita pharmaceutical expenditure explains about 53% of the variation in pharmaceutical expenditure among districts in Uganda (Adjusted R(2) = 0.528). All variables in the model are significant (p < 0.01). From evaluation of the various models, proposed variables to consider in allocating prospective primary health care pharmaceutical budgets to districts in Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.

Coming to power: women's fake orgasms and best orgasm experiences illuminate the failures of (hetero)sex and the pleasures of connection.

PubMed

Fahs, Breanne

2014-01-01

While some literature has explored women's sexual satisfaction and, to a lesser degree, women's faking orgasm experiences, little research has examined the context and conditions around women's best and most memorable orgasms. This paper utilised thematic analysis of qualitative data from a community sample of 20 women in the USA (mean age = 34 years, SD = 13.35 years) from a wide range of racial, socioeconomic, and sexual identity backgrounds to illuminate their experiences with fake or pretend orgasms, and with their best orgasms. While faking orgasm narratives reflected themes of wanting to reinforce a partner's sexual skills, strategically ending sexual interactions, and suppressing feelings of abnormality and shame, best orgasm experiences showcased the power of interpersonal connection, the joys of masturbation and other non-penile-vaginal intercourse behaviours, and the significance of 'transformative embodiment'. Implications for the relative failures of (hetero)sex, particularly in the context of gendered power imbalances, along with the importance of deconstructing the sexually 'functional' or 'dysfunctional' woman are explored.

Integrated care networks and quality of life: linking research and practice

PubMed Central

Warner, Morton; Gould, Nicholas

2003-01-01

Abstract Purpose To report on the development of a project dedicated to improving the quality of life of older people through the creation of integrated networks. Context The project is set within a post-industrial community and against a backdrop of government re-organisation and devolution within Wales. The immediate research context is determined by utilising an approach to the structure of integration derived theoretically. Case description Project CHAIN (Community Health Alliances through Integrated Networks) adopts a network perspective as a means of addressing both the determinants of health and service delivery in health and social care. The Project partners are: healthcare commissioners and providers; local authority directorates including community services and transportation; the voluntary and private sectors; and a university institute. Co-opted participants include fora representing older people's interests. Data sources The Project incorporates an action research method. This paper highlights qualitative data elicited from interviews with health and social care managers and practitioners. Conclusions and discussion The Project is ongoing and we record progress in building five integrated networks. PMID:16896421

HIV in Harare: the role and relevance of social stigma.

PubMed

O'Brien, Stephen; Broom, Alex

2014-01-01

HIV is a significant social, political and economic problem in Zimbabwe. However, few researchers have explored peoples' experiences of living with HIV in that country. Drawing on 60 qualitative interviews conducted with Zimbabweans living in Harare in 2010, this paper focuses on how people from four different urban communities cope with HIV-related social stigma. To provide theoretical context to this issue, we utilised the ideas of Erving Goffman for exploring the individual experience of stigma and the concept of structural violence to understand stigma as a social phenomenon. This paper considers the relevance and role of stigma in the context of a country undergoing significant social, political and economic crisis. We investigated the strategies adopted by the Zimbabwean state and the influence of traditional and religious interpretations to appreciate the historical roots of HIV-related stigma. We took into account the ways in which the articulation of HIV with gender has caused women to experience stigma differently than men, and more intensely, and how grassroots activism and biomedical technologies have transformed the experience of stigma.

Process-Oriented Guided Inquiry Learning (POGIL) as a Culturally Relevant Pedagogy (CRP) in Qatar: a Perspective from Grade 10 Chemistry Classes

NASA Astrophysics Data System (ADS)

Treagust, David F.; Qureshi, Sheila S.; Vishnumolakala, Venkat Rao; Ojeil, Joseph; Mocerino, Mauro; Southam, Daniel C.

2018-04-01

Educational reforms in Qatar have seen the implementation of inquiry-based learning and other student-centred pedagogies. However, there have been few efforts to investigate how these adopted western pedagogies are aligned with the high context culture of Qatar. The study presented in this article highlights the implementation of a student-centred intervention called Process-Oriented Guided Inquiry Learning (POGIL) in selected independent Arabic government schools in Qatar. The study followed a theoretical framework composed of culturally relevant pedagogical practice and social constructivism in teaching and learning. A mixed method research design involving experimental and comparison groups was utilised. Carefully structured learning materials when implemented systematically in a POGIL intervention helped Grade 10 science students improve their perceptions of chemistry learning measured from pre- and post-tests as measured by the What Is Happening In this Class (WIHIC) questionnaire and school-administered achievement test. The study further provided school-based mentoring and professional development opportunities for teachers in the region. Significantly, POGIL was found to be adaptable in the Arabic context.

'You should build yourself up as a whole product': Transgender female identity in Lima, Peru.

PubMed

Pollock, Lealah; Silva-Santisteban, Alfonso; Sevelius, Jae; Salazar, Ximena

2016-01-01

Transgender women in Lima, Peru have, until recently, been grouped together with gay and bisexual men in the category MSM, or men who have sex with men, with little consideration of their unique situation and needs. Transgender women, self-identified in Peru as travesti, are a socially vulnerable population with many unmet health needs, including an HIV prevalence of 30%. Understanding specific transgender identities and their contexts will contribute to the improvement and development of HIV prevention programs. Through qualitative open-ended interviews with trans-identified women in Lima, Peru, this study found that the non-normative travesti identity is constructed within a conservative homophobic and heteronormative social context. Participants strive towards appearances and relationships perceived as feminine, seeking out silicone injections and abusive men as social markers of this femininity. Sex work is the primary economic activity available and travestis are often alienated from their families and communities. Work is needed to increase self-esteem and decrease violence, stigma, and discrimination. There is a need for multilevel HIV prevention campaigns prioritising travesti in Lima, utilising a human rights framework.

Engaging therapeutic citizenship and clientship: Untangling the reasons for therapeutic pacifism among people living with HIV in urban Zambia.

PubMed

Patterson, Amy S

2016-10-01

This article explores the reasons for therapeutic pacifism among people living with HIV (PLHIVs) in urban Zambia. It contributes to a growing ethnography on global health, biosociality, and patient-provider dynamics. Therapeutic citizenship is a biopolitical citizenship that includes claims and ethical projects that emerge from techniques to control and manage bodies. In some contexts, therapeutic citizenship has included activism and claims-making against local, national, and international power brokers. This article investigates therapeutic citizenship in the specific context of impoverished urban Zambian compounds, sites of food insecurity, unemployment, and political exclusion, as well as targets for donor, NGO, and faith-based organisation projects and PLHIV support group proliferation. The article utilises data from participant observations at two Lusaka AIDS clinics, interviews, and focused discussions with support groups of PLHIVs. It argues that PLHIVs continuously negotiate subjectivities related to kinship, clientship, religious belief, and political citizenship in processes that complicate therapeutic citizenship. Rather than fostering participation in PLHIV support groups or challenging 'politics as usual' through activist claims-making to institutions of biopower, these processes lead to therapeutic pacifism.

Utility of Fite-Faraco stain for both mast cell count and bacillary index in skin biopsies of leprosy patients.

PubMed

Chatura, K R; Sangeetha, S

2012-01-01

To assess the utility of a single stain for both mast cell count and bacillary index (BI), 50 skin-biopsie patients were stained with Fite-Faraco (FF) stain, viewed under oil immersion and BI calculated using the Ridley's logarithmic scale, and mast cells counted as the number of cells per mm2. Mean mast cell count per mm2 at the tuberculoid pole was lowest in TT 7.9 and highest in BT 14.23. At the lepromatous end, it was highest in BL 9.21, while in LL it was 8.23. Highest counts were seen in the borderline types overall. The correlation coefficient between histopathological diagnosis and BI is 0.822 which is a positive correlation to a significant degree. The correlation coefficient between histopathological diagnosis and mast cell count was found to be -0.17, which is a negative correlation but not to a significant degree. FF stain was utilised to visualise both bacilli for estimation of BI and mast cells for mast cell count, a seldom attempted feature in literature.

Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria

PubMed Central

Asuzu, Michael C.

2015-01-01

Background Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities. Aim To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria Settings A low-income community in Ibadan North West Local Government Area of Oyo State. Methods A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents' sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05. Results The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90% had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF. Conclusion The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation. PMID:26245600

Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?

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

Batumalai, Vikneswary, E-mail: vikneswary.batumalai@sswahs.nsw.gov.au; South Western Clinical School, University of New South Wales, Sydney, New South Wales; Quinn, Alexandra

Correct target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy. Planning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). Themore » mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast. The highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI. For breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account.« less

Surface Nutrient Utilisation and Productivity During Glacial-Interglacial Periods from the Equatorial Indian Ocean

NASA Astrophysics Data System (ADS)

R, C. K.; Bhushan, R.; Agnihotri, R.; Sawlani, R.; Jull, A. J. T.

2016-12-01

Seawaters and underlying sediments off Sri Lanka provide a unique marine realm affected by both branches of Northern Indian Ocean i.e. Arabian Sea (AS) and Bay of Bengal (BOB). AS and BOB are known for their distinct response to southwest monsoon. AS experiencing mainly winds and upwelling while BOB receives precipitation driven surface runoff from the Indian sub-continent. Multiple proxies were measured on a radiocarbon dated sediment core raised off Sri Lanka; their down core variations were used to understand oceanic history (nutrient utilisation, surface productivity, nature of organic matter) spanning last glacial-interglacial cycle ( 26 to 2.5 ka BP). Variations in CaCO3, biogenic silica (BSi) and δ15N from 26 ka to 12.5 ka BP indicate the region was experiencing high surface productivity with probably reduced surface nutrient utilisation efficiency. Sedimentary δ15N depth profile is decoupled from down core variations of major productivity indices (e.g. CaCO3, OC), hinting plausibly partial utilization of nutrients in the mixed layer (photic zone). δ13C of OC and C/N (wt. ratio) clearly reveal the terrestrial origin of organic matter at 15 ka BP, a period known for witnessing onset of deglaciation in northern hemisphere. δ13C minimum at 9 ka BP indicates intense monsoonal activity during this time coinciding well with solar insolation (June) maximum of the northern hemisphere. With the onset of Holocene ( 11 ka BP), δ15N variations appear to correlate with BSi and Ba/Ti indicating enhanced utilization of available nutrients at surface. Suggesting surface productivity over the region was probably micro-nutrient limited. The increased inventory of terrestrial runoff in Holocene probably demonstrates enhanced carbon sequestration capability of the region.

High-resolution label-free vascular imaging using a commercial, clinically approved dermatological OCT scanner

NASA Astrophysics Data System (ADS)

Byers, R. A.; Tozer, G.; Brown, N. J.; Matcher, S. J.

2016-02-01

Background and Aim: Recently developed decorrelative techniques such as speckle-variance optical coherence tomography (svOCT) have demonstrated non-invasive depth-resolved imaging of the microcirculation in-vivo. However, bulk tissue motion (BTM) originating from the subject's breathing or heartbeat remains problematic at low imaging speeds, often resulting in full frame decorrelation and a loss of vascular contrast. The aim of this study was to build upon existing svOCT techniques through utilisation of a commercially available, probe-based VivoSight OCT system running at 20 kHz Axial-scan rate. Methods and results: Custom four-dimensional scanning strategies were developed and utilised in order to maximise the interframe correlation during image acquisition. Volumes of structural OCT data were collected from various anatomical regions and processed using the aforementioned svOCT algorithm to reveal angiographic information. Following data collection, three dimensional image registration and novel filtering algorithms were applied to each volume in order to ensure that BTM artefacts were sufficiently suppressed. This enabled accurate visualisation of the microcirculation within the papillary dermis, to a depth of approximately 2mm. Applications of this technique, including quantitative capillary loop density measurement and visualisation of wound healing are demonstrated and enhanced through widefield mosaicing of the svOCT data. Conclusions: Non-invasive microcirculation imaging using an FDA 510(k) approved OCT scanner such as the VivoSight allows direct clinical utilisation of these techniques, in particular for the pathological analysis of skin diseases. This research was supported by BBSRC Doctoral Training Grant: BB/F016840/1. The authors also gratefully acknowledge the use of equipment funded by MRC grant: MR/L012669/1.

The uptake of dental services by elderly Germans.

PubMed

Nitschke, I; Müller, F; Hopfenmüller, W

2001-12-01

The aim of the study was to assess the uptake of dental services by the old and very old population within the scope of the Berlin Aging Study (Berliner Altersstudie BASE). A multi-disciplinary structured interview was performed on 928 subjects, aged from 70 to 103 years of whom 516 persons volunteered to take part in a 14-session intensive protocol. Six representative study groups were matched for age and gender. Subjects were asked to recall the timing of their most recent dental visit. Data were validated by sending for dental records and compared with all study participants from the multi-disciplinary intake assessment. Data were related to age group, dental state, dementia and education. Reported last contact with dental services ranged from 2 weeks to 52 years (median 18 months) with a higher time lapse in the study groups aged 85 and older. Dentate subjects had seen their dentist more recently than edentate subjects. Higher education correlated with an increased dental utilisation. Subjective memory on the time lapse since the last dental appointment coincided in 13% of the subjects with available dental records (n=84), was misjudged between one and six months in 55%, and by more than six months in the remainder. Moderately or severely demented subjects who remembered their last dental appointment (n=48 of 70) showed no consistently different utilisation to healthy or mildly demented study participants. Edentate old and very old subjects show the least frequent utilisation of dental services. Data on motivation and barriers to care are needed to develop strategies to improve the use of dental services and thus promote oral health in late life.

Stress-coping morbidity among family members of addiction patients in Singapore.

PubMed

Lee, Kae Meng Thomas; Manning, Victoria; Teoh, Hui Chin; Winslow, Munidasa; Lee, Arthur; Subramaniam, Mythily; Guo, Song; Wong, Kim Eng

2011-07-01

INTRODUCTIONS AND AIMS: Research from western countries indicates that family members of addiction patients report heightened stress and psychological morbidity. This current study aimed to examine stress, coping behaviours, related morbidity and subsequent resource utilisation among family members of patients attending a national treatment program in Singapore. The study used a matched case-control design. One hundred family members of addiction patients attending treatment and 100 matched controls completed a semi-structured interview with a researcher. This included the Beck Depression Inventory-II, Short-Form Health Survey-36, General Health Questionnaire-28, Perceived Stress Scale, Family Member Impact Scale and Coping Questionnaire, and also assessed service utilisation. T-tests revealed significantly greater depression, stress and psychiatric morbidity and poorer overall well-being (Short-Form Health Survey-36) among family members compared with controls. Despite the apparent negative impact on mental health, their physical morbidity did not differ from controls and services utilisation was low. Tolerant-inactive coping was found to be most strongly correlated with psychological well-being. Multivariate analysis indicated that perceived stress was the strongest predictor of overall strain (General Health Questionnaire), but this was not moderated by coping style. Subjective appraisal of stress and coping responses are essential factors affecting the morbidity of family members. Family members demonstrated a need and willingness to engage in formal treatment/counselling for their own problems that were attributed to living with an addiction patient. This provides an opportunity for stress management and brief interventions to modify coping styles, thereby minimizing the potential negative mental health impact on family members. © 2011 Australasian Professional Society on Alcohol and other Drugs.

Nutrient utilisation and particulate organic matter changes during summer in the upper mixed layer (Ross Sea, Antarctica)

NASA Astrophysics Data System (ADS)

Catalano, G.; Povero, P.; Fabiano, M.; Benedetti, F.; Goffart, A.

1997-01-01

The relationships among vertical stability, estimated nutrient utilisation and particulate organic matter in the Ross Sea are analysed from data collected during two cruises in the summers of 1987-1988 and 1989-1990. In the upper mixed layer (UML), identified through the vertical stability E( Z(UML)), nutrient consumption is calculated as the difference between the "diluted" nutrient value and the mean calculated from the integrated value in the UML. The nutrient utilisation ratio and E( Z(UML)) are linearly related for E( Z(UML))≤25, whereas for values > 25, the distribution pattern is more scattered and independent of E( Z(UML)). For E( Z(UML))≥25, utilisation values were ≥4, 0.4 and 10 mmol m -3 for nitrate, phosphate and silicate, respectively. Significant relationships between nutrient depletion and both particulate organic carbon (POC) and particulate protein/particulate carbohydrate ratios (PPRT/PCHO) are found. The analysis of particulate matter distribution vs nutrient utilisation shows that the stations could be divided into two groups having different characteristics. The first group includes coastal stations, where high nutrient utilisation, POC and PPRT/PCHO are typical of areas with high production. In the second group (pelagic stations), nutrient utilisation, POC and PPRT/PCHO are lower. The vertical stability can be used to discriminate among the factors that influence primary production.

Utilization of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria.

PubMed

Olaleye, Olubukola Adebisi; Lawal, Zainab Iyabo

2017-03-01

To investigate the pattern of referral for and utilisation of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria. Referral notes and medical records of patients admitted in the University College Hospital, Ibadan with a clinical diagnosis of stroke between January, 2009 and December, 2013 were retrospectively reviewed. Information on age, sex, type of stroke, length of hospital stay, referral for physiotherapy and utilisation of physiotherapy were retrieved. Data were summarised using descriptive statistics and analysed using Chi-square test. A total of 783 patients with stroke were admitted in the hospital during the period under study. The in-patient mortality rate was 37.2%. The mean Length of Hospital Stay (LoHS) was 16.17±12.34 days. Referral rate for physiotherapy was high (75.8%) and the mean time from admission to referral for physiotherapy was three days. Majority of patients referred utilised physiotherapy (63.4%) and mean number of physiotherapy sessions received during in-patient care was 8.69±6.45. There was a significant association between LoHS and utilisation of in-patientphysiotherapy (p=0.02). The referral rate of stroke patients for physiotherapy was relatively high. Utilisation of in-patient physiotherapy reduced length of hospital stay among patients with stroke. Utilisation of out-patient physiotherapy was low. Strategies to enhance out-patient utilisation should be explored.

RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates

PubMed Central

Chu, Kevin; Joseph, Anthony; Read, Catherine; Blecher, Gabriel; Furyk, Jeremy; Bharat, Chrianna; Velusamy, Karthik; Munro, Andrew; Baker, Kylie; Kinnear, Frances; Mukherjee, Ahses; Watkins, Gina; Buntine, Paul; Livesay, Georgia

2016-01-01

Introduction Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4–10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America. Aims To describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation. Methods A retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation. Results Fourteen radiology departments (15 ED) provided 7077 CTPA data (94% ≥64-slice CT); PE were reported in 1028 (yield 14.6% (95%CI 13.8–15.4%; range 9.3–25.3%; site variation p <0.0001) with four sites significantly below and one above the 15.3% target. Admissions, CTPA usage, PE diagnosis rates and size of PE were uncorrelated with yield. Large PE (≥lobar) were 55% (CI: 52.1–58.2%) and SSPE 8.8% (CI: 7.1–10.5%) of positive scans. CTPA usage (0.2–1.5% adult attendances) was correlated (p<0.006) with PE diagnosis but not SSPE: large PE proportions. Discussion/ Conclusions We found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5–3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE. PMID:27918576

Microgenerateurs electriques a base d'oscillateurs thermiques

NASA Astrophysics Data System (ADS)

Leveille, Etienne

Dans un contexte de developpement durable et d'automatisation de notre environnement, l'utilisation de capteurs sans-fil distribues est croissante. Hors l'usage et le remplacement de piles s'avere couteux. La consommation energetique de plus en plus faible de l'electronique rend l'extraction energetique de l'energie ambiante envisageable. La chaleur residuelle est une source d'energie interessante puisqu'elle est la forme finale de la majeure partie de l'energie utilisee par l'humain. Cependant, a petite echelle, seuls les elements thermoelectriques sont disponibles. Les presents travaux s'interessent donc a explorer et comparer des mecanismes de generation alternatifs. Puisque la majorite des mecanismes de transduction alternatifs sont dynamiques, leur utilisation requiert une transformation de l'energie thermique continue en oscillations. Les mecanismes etudies ont donc tous en commun de posseder un oscillateur thermique en plus d'un mecanisme de transduction vers la forme d'energie electrique. Parmi les divers mecanismes identifies, deux sont etudies en details pour comprendre leurs comportements ainsi que connaitre leur efficacite et leur puissance potentielle. Le premier generateur etudie theoriquement est base sur le changement de ferromagnetisme d'une masse suspendue par des ressorts au-dessus d'un aimant. Les comportements du modele developpe correspondent aux comportements reportes dans la litterature. Deux parametres de conception principaux ont ete identifies, permettant un controle de la frequence, de la plage de temperatures d'operation. De plus le mecanisme peut operer avec de faibles differences de temperature et des temperatures proches de l'ambiant, ouvrant la porte a des applications utilisant la chaleur du corps humain. L'utilisation de materiau pyroelectrique comme mecanisme de transduction pourrait offrir des densites de puissance electrique envisageables de l'ordre de 1mW/cm3. Le second generateur etudie experimentalement est base sur l'evaporation explosive d'un liquide surchauffe en absence de sites de nucleation. Un premier prototype a permis de demontrer, pour la premiere fois, le fonctionnement d'un tel cycle. Une etude de l'effet de la temperature de la source de chaleur et de l'effet du debit de liquide montre qu'une zone d'operation ideale est presente. La puissance de sortie maximale mesuree est de l'ordre de 1.6muW. Des ameliorations sont proposees pour faire croitre cette puissance de deux ordres de grandeur. Finalement, l'utilisation du pompage capillaire pour rendre le systeme autonome est demontre, mais reste sensible aux variations de conditions. Finalement, l'etude des dispositifs montre que les microgenerateurs a base d'oscillateurs thermiques peuvent presenter un interet, par rapport aux elements thermoelectriques, dans les applications ou les temperatures sont faibles ou incertaines. Cependant, ces mecanismes souffrent d'une tres faible efficacite causee par les multiples transformations energetiques a faible couplage. Mots-cles : microgenerateur, oscillateur thermique, cycle thermodynamique, thermoelectricite, microsystemes electromecaniques, MEMS

Thalamo-Sensorimotor Functional Connectivity Correlates with World Ranking of Olympic, Elite, and High Performance Athletes.

PubMed

Huang, Zirui; Davis, Henry Hap; Wolff, Annemarie; Northoff, Georg

2017-01-01

Brain plasticity studies have shown functional reorganization in participants with outstanding motor expertise. Little is known about neural plasticity associated with exceptionally long motor training or of its predictive value for motor performance excellence. The present study utilised resting-state functional magnetic resonance imaging (rs-fMRI) in a unique sample of world-class athletes: Olympic, elite, and internationally ranked swimmers ( n = 30). Their world ranking ranged from 1st to 250th: each had prepared for participation in the Olympic Games. Combining rs-fMRI graph-theoretical and seed-based functional connectivity analyses, it was discovered that the thalamus has its strongest connections with the sensorimotor network in elite swimmers with the highest world rankings (career best rank: 1-35). Strikingly, thalamo-sensorimotor functional connections were highly correlated with the swimmers' motor performance excellence, that is, accounting for 41% of the individual variance in best world ranking. Our findings shed light on neural correlates of long-term athletic performance involving thalamo-sensorimotor functional circuits.

Experimental study of droplet formation of dense suspensions

NASA Astrophysics Data System (ADS)

Martensson, Gustaf; Carson, Fabian

2017-11-01

As with the jet printing of dyes and other low-viscosity fluids, the jetting of dense fluid suspensions is dependent on the repeatable break-off of the fluid filament into well-formed droplets. It is well known that the break-off of dense suspensions is dependent on the volume fraction of the solid phase, particle size and morphology, fluid phase viscosity et cetera, see for example van Deen et al. (2013). The purpose of this study is to establish a deeper understanding of the formation process of droplets of dense suspensions. Previous experiments have utilised a filament break-off device (FilBO) developed in-house. These experiments utilise an ejection device based on rapid volumetric displacement of the fluid through a conical nozzle. The suspension samples consist of a resin-based flux and spherical particles with diameters of dp = 5 - 25 μ m. A droplet of of the suspension with a volume of Vdrop = 2 - 50 nl is ejected from the nozzle. Correlations between droplet speed and the temporal development of the volumetric displacement will be presented. Further results relating break-off length and rate versus particle diameter, volume fraction and probe speed will be presented.

Use of knowledge-sharing web-based portal in gross and microscopic anatomy.

PubMed

Durosaro, Olayemi; Lachman, Nirusha; Pawlina, Wojciech

2008-12-01

Changes in worldwide healthcare delivery require review of current medical school curricula structure to develop learning outcomes that ensures mastery of knowledge and clinical competency. In the last 3 years, Mayo Medical School implemented outcomes-based curriculum to encompass new graduate outcomes. Standard courses were replaced by 6-week clinically-integrated didactic blocks separated by student-self selected academic enrichment activities. Gross and microscopic anatomy was integrated with radiology and genetics respectively. Laboratory components include virtual microscopy and anatomical dissection. Students assigned to teams utilise computer portals to share learning experiences. High-resolution computed tomographic (CT) scans of cadavers prior to dissection were made available for correlative learning between the cadaveric material and radiologic images. Students work in teams on assigned presentations that include histology, cell and molecular biology, genetics and genomic using the Nexus Portal, based on DrupalEd, to share their observations, reflections and dissection findings. New generation of medical students are clearly comfortable utilising web-based programmes that maximise their learning potential of conceptually difficult and labor intensive courses. Team-based learning approach emphasising the use of knowledge-sharing computer portals maximises opportunities for students to master their knowledge and improve cognitive skills to ensure clinical competency.

Factors associated with postnatal care utilisation in Rwanda: A secondary analysis of 2010 Demographic and Health Survey data.

PubMed

Rwabufigiri, Bernard N; Mukamurigo, Judith; Thomson, Dana R; Hedt-Gautier, Bethany L; Semasaka, Jean Paul S

2016-05-31

Postnatal care (PNC) in the first seven days is important for preventing morbidity and mortality in mothers and new-borns. Sub-Saharan African countries, which account for 62 % of maternal deaths globally, have made major efforts to increase PNC utilisation, but utilisation rates remains low even in countries like Rwanda where PNC services are universally available for free. This study identifies key socio-economic and demographic factors associated with PNC utilisation in Rwanda to inform improved PNC policies and programs. This is a secondary analysis of the 2010 Demographic and Health Survey, a national multi-stage, cross-sectional survey. In bivariate analysis, we used chi-square tests to identify demographic and socio-economic factors associated with PNC utilisation at α = 0.1. Pearson's R statistic (r > 0.5) was used to identify collinear covariates, and to choose which covariate was more strongly associated with PNC utilisation. Manual backward stepwise logistic regression was performed on the remaining covariates to identify key factors associated with PNC utilisation at α = 0.05. All analyses were performed in Stata 13 adjusting for sampling weights, clustering, and stratification. Of the 2,748 women with a live birth in the last two years who answered question about PNC utilisation, 353 (12.8 %) returned for PNC services within seven days after birth. Three factors were positively associated with PNC use: delivering at a health facility (OR: 2.97; 95 % CI: 2.28-3.87), being married but not involved with one's own health care decision-making (OR: 1.69; 95 % CI: 1.17, 2.44) compared to being married and involved; and being in the second (OR: 1.46; 95 % CI: 1.01-2.09) or richest wealth quintile (OR: 2.04; 95 % CI: 1.27-3.29) compared to the poorest. Mother's older age at delivery was negatively associated with PNC use (20-29 - OR: 0.51, 95 % CI: 0.29-0.87; 30-39 - OR: 0.47, 95 % CI: 0.27-0.83; 40-49 - OR: 0.32, 95 % CI: 0.16-0.64). Low PNC utilisation in Rwanda appears to be a universal problem though older age and poverty are further barriers to PNC utilisation. A recent change in the provision of BCG vaccination to new-borns might promote widespread PNC utilisation. We further recommend targeted campaigns to older mothers and poorest mothers, focusing on perceptions of health system quality, cultural beliefs, and pregnancy risks.

Developing a PTEN-ERG Signature to Improve Molecular Risk Stratification in Prostate Cancer

DTIC Science & Technology

2017-10-01

that there exist distinctive molecular correlates of PTEN loss in the context of ETS-negative versus ETS-positive human prostate cancers and that...distinctive molecular correlates of PTEN loss in the context of ETS-negative versus ETS-positive human PCa and that these may drive prognosis...and MSKCC cohort, correlate these data with gene expression data from the same cohort to confirm ETS status and enable full gene expression analyses of

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

PubMed Central

2018-01-01

Background Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services. PMID:29420660

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis.

PubMed

Herkrath, Fernando José; Vettore, Mario Vianna; Werneck, Guilherme Loureiro

2018-01-01

Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen's behavioural model. Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Predisposing (OR = 0.89; 95% CI 0.81-0.97) and enabling (OR = 0.90; 95% CI 0.85-0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

Inequalities in utilisation of general practitioner and specialist services in 9 European countries.

PubMed

Stirbu, Irina; Kunst, Anton E; Mielck, Andreas; Mackenbach, Johan P

2011-10-31

The aim of this study is to describe the magnitude of educational inequalities in utilisation of general practitioner (GP) and specialist services in 9 European countries. In addition to West European countries, we have included 3 Eastern European countries: Hungary, Estonia and Latvia. To cover the gap in knowledge we pay a special attention to the magnitude of inequalities among patients with chronic conditions. Data on the use of GP and specialist services were derived from national health surveys of Belgium, Estonia, France, Germany, Hungary, Ireland, Latvia, the Netherlands and Norway. For each country and education level we calculated the absolute prevalence and relative inequalities in utilisation of GP and specialist services. In order to account for the need for care, the results were adjusted by the measure of self-assessed health. People with lower education used GP services equally often in most countries (except Belgium and Germany) compared with those with a higher level of education. At the same time people with a higher education used specialist care services significantly more often in all countries, except in the Netherlands. The general pattern of educational inequalities in utilisation of specialist care was similar for both men and women. Inequalities in utilisation of specialist care were equally large in Eastern European and in Western European countries, except for Latvia where the inequalities were somewhat larger. Similarly, large inequalities were found in the utilisation of specialist care among patients with chronic diseases, diabetes, and hypertension. We found large inequalities in the utilisation of specialist care. These inequalities were not compensated by utilisation of GP services. Of particular concern is the presence of inequalities among patients with a high need for specialist care, such as those with chronic diseases. © 2011 Stirbu et al; licensee BioMed Central Ltd.

[Utilisation of salivary markers in nephrology].

PubMed

Podracká, Ľudmila; Celec, Peter; Šebeková, Katarína

2016-01-01

Saliva has a broad diagnostic potential which can be used for detection many pathological conditions including renal dysfunction. In saliva can be measured concentration of urea and creatinine as well as the other uremic markers. Saliva urea nitrogen and creatinine and blood urea and creatinine highly correlated therefore might be used for screening in patients with CKD. Saliva collection is truly non-invasive and is especially suitable for small children and elderly patients. Recently, semiquantitative saliva urea test strip is available. Saliva might become promising dia-gnostic biofluid in nephrological practice.Key words: chronic kidney disease - renal failure - salivary dipstick - salivary markers.

Motivational Basis of Personality Traits: A Meta-Analysis of Value-Personality Correlations.

PubMed

Fischer, Ronald; Boer, Diana

2015-10-01

We investigated the relationships between personality traits and basic value dimensions. Furthermore, we developed novel country-level hypotheses predicting that contextual threat moderates value-personality trait relationships. We conducted a three-level v-known meta-analysis of correlations between Big Five traits and Schwartz's (1992) 10 values involving 9,935 participants from 14 countries. Variations in contextual threat (measured as resource threat, ecological threat, and restrictive social institutions) were used as country-level moderator variables. We found systematic relationships between Big Five traits and human values that varied across contexts. Overall, correlations between Openness traits and the Conservation value dimension and Agreeableness traits and the Transcendence value dimension were strongest across all samples. Correlations between values and all personality traits (except Extraversion) were weaker in contexts with greater financial, ecological, and social threats. In contrast, stronger personality-value links are typically found in contexts with low financial and ecological threats and more democratic institutions and permissive social context. These effects explained on average more than 10% of the variability in value-personality correlations. Our results provide strong support for systematic linkages between personality and broad value dimensions, but they also point out that these relations are shaped by contextual factors. © 2014 Wiley Periodicals, Inc.

A Descriptive Study on the Use of Materials in Vocabulary Lessons

ERIC Educational Resources Information Center

Holmes, Kerry; Holmes, Stacy V.; Watts, Karley

2012-01-01

Vocabulary knowledge is important because it is highly correlated with content area learning. Strategies for vocabulary instruction recommend using new words in multiple contexts as key to learning. To date, the term "multiple contexts" emphasizes written contexts, not three-dimensional concrete material contexts. This article describes the…

Understanding the Correlates of Face-to-Face and Cyberbullying Victimization Among U.S. Adolescents: A Social-Ecological Analysis.

PubMed

Hong, Jun Sung; Lee, Jungup; Espelage, Dorothy L; Hunter, Simon C; Patton, Desmond Upton; Rivers, Tyrone

2016-01-01

Using a national sample of 7,533 U.S. adolescents in grades 6-10, this study compares the social-ecological correlates of face-to-face and cyberbullying victimization. Results indicate that younger age, male sex, hours spent on social media, family socioeconomic status (SES; individual context), parental monitoring (family context), positive feelings about school, and perceived peer support in school (school context) were negatively associated with both forms of victimization. European American race, Hispanic/Latino race (individual), and family satisfaction (family context) were all significantly associated with less face-to-face victimization only, and school pressure (school context) was significantly associated with more face-to-face bullying. Peer groups accepted by parents (family context) were related to less cyberbullying victimization, and calling/texting friends were related to more cyberbullying victimization. Research and practice implications are discussed.

Percolation of secret correlations in a network

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

Leverrier, Anthony; Garcia-Patron, Raul; Research Laboratory of Electronics, MIT, Cambridge, MA 02139

In this work, we explore the analogy between entanglement and secret classical correlations in the context of large networks--more precisely, the question of percolation of secret correlations in a network. It is known that entanglement percolation in quantum networks can display a highly nontrivial behavior depending on the topology of the network and on the presence of entanglement between the nodes. Here we show that this behavior, thought to be of a genuine quantum nature, also occurs in a classical context.

Developing Organisational Knowledge Management Initiatives: A Collaborative Research Approach

NASA Astrophysics Data System (ADS)

Linger, Henry

The articulation of the knowledge management (KM) concept has occurred in the context of a radical shift away from goods and services to an information- based economy (Porter and Millar, 1985; Drucker, 1993 Boisot 1995; Boisot 1998) The organisational response to this shift has been a move towards global enterprises with very flat structures that, in principle, enable enterprises to react rapidly to changes in their operating environments (Drucker, 1988; Scott Morton, 1991; Galliers and Baets, 1998). Organisations that operate in the information economy require an ability to generate, access and utilise the volumes of information that are now readily available without the constraint of media, geography or time (Boisot, 1995). A critical factor is the speed at which they are able to productively process such information.

The role of information and communication technology in the transformation of the healthcare business model: a case study of Slovenia.

PubMed

Stanimirovic, Dalibor; Vintar, Mirko

The Slovenian healthcare business model (BM) has largely failed to integrate information and communication technologies (ICT) into its operational context, instead maintaining its rigid structure and traditional 'way of doing business'wo managers of public clinics). Findings present a roadmap for the redefinition of BM elements and the transformation of the Slovenian healthcare BM. It includes the specific reconfiguration of BM actors and their interactions, and the application of advanced ICT solutions, which could facilitate more effective utilisation of healthcare resources and promote an improved delivery of healthcare services and products. The presented development approach and derived conceptual solution could be transferable to other countries with similar socio-economic characteristics and comparable healthcare systems, subject to certain adjustments and inclusion of national specifics.

Information accountability and usability: are there any connections?

PubMed

Sahama, Tony; Kushniruk, Andre; Kuwata, Shigeki

2013-01-01

Availability of health information is rapidly increasing and the expansion and proliferation of health information is inevitable. The Electronic Healthcare Record, Electronic Medical Record and Personal Health Record are at the core of this trend and are required for appropriate and practicable exchange and sharing of health information. However, it is becoming increasingly recognized that it is essential to preserve patient privacy and information security when utilising sensitive information for clinical, management and administrative processes. Furthermore, the usability of emerging healthcare applications is also becoming a growing concern. This paper proposes a novel approach for integrating consideration of information accountability with a perspective from usability engineering that can be applied when developing healthcare information technology applications. A social networking user case in the healthcare information exchange will be presented in the context of our approach.

Interpreting and Utilising Intersubject Variability in Brain Function.

PubMed

Seghier, Mohamed L; Price, Cathy J

2018-06-01

We consider between-subject variance in brain function as data rather than noise. We describe variability as a natural output of a noisy plastic system (the brain) where each subject embodies a particular parameterisation of that system. In this context, variability becomes an opportunity to: (i) better characterise typical versus atypical brain functions; (ii) reveal the different cognitive strategies and processing networks that can sustain similar tasks; and (iii) predict recovery capacity after brain damage by taking into account both damaged and spared processing pathways. This has many ramifications for understanding individual learning preferences and explaining the wide differences in human abilities and disabilities. Understanding variability boosts the translational potential of neuroimaging findings, in particular in clinical and educational neuroscience. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Encryption and watermark-treated medical image against hacking disease-An immune convention in spatial and frequency domains.

PubMed

Lakshmi, C; Thenmozhi, K; Rayappan, John Bosco Balaguru; Amirtharajan, Rengarajan

2018-06-01

Digital Imaging and Communications in Medicine (DICOM) is one among the significant formats used worldwide for the representation of medical images. Undoubtedly, medical-image security plays a crucial role in telemedicine applications. Merging encryption and watermarking in medical-image protection paves the way for enhancing the authentication and safer transmission over open channels. In this context, the present work on DICOM image encryption has employed a fuzzy chaotic map for encryption and the Discrete Wavelet Transform (DWT) for watermarking. The proposed approach overcomes the limitation of the Arnold transform-one of the most utilised confusion mechanisms in image ciphering. Various metrics have substantiated the effectiveness of the proposed medical-image encryption algorithm. Copyright © 2018 Elsevier B.V. All rights reserved.

Management of cyanide toxicity in patients with burns.

PubMed

MacLennan, Louise; Moiemen, Naiem

2015-02-01

The importance of cyanide toxicity as a component of inhalational injury in patients with burns is increasingly being recognised, and its prompt recognition and management is vital for optimising burns survival. The evidence base for the use of cyanide antidotes is limited by a lack of randomised controlled trials in humans, and in addition consideration must be given to the concomitant pathophysiological processes in patients with burns when interpreting the literature. We present a literature review of the evidence base for cyanide antidotes with interpretation in the context of patients with burns. We conclude that hydroxycobalamin should be utilised as the first-line antidote of choice in patients with burns with inhalational injury where features consistent with cyanide toxicity are present. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Polymers from renewable materials.

PubMed

Rus, Anika Zafiah M

2010-01-01

With the world facing depletion of its oil reserves, attention is being focused on how the plastics industry will address shortages and price increases in its crucial raw materials. One renewable resource is that of vegetable oils and fats and about a dozen crop plants make up the main vegetable oil-seed market. The main constituents of these oils are saturated and unsaturated fatty acids that are unique to the plant in which they have been developed. Moreover, technological processes can produce more well-defined and pure oils, and the fatty acid contents in the vegetable oils can be altered with modern crop development techniques. This article describes recent advances in utilising such vegetable oils in sourcing new polymeric materials. It also gives the context for the development of polymers based on renewable materials in general.

An intelligent factory-wide optimal operation system for continuous production process

NASA Astrophysics Data System (ADS)

Ding, Jinliang; Chai, Tianyou; Wang, Hongfeng; Wang, Junwei; Zheng, Xiuping

2016-03-01

In this study, a novel intelligent factory-wide operation system for a continuous production process is designed to optimise the entire production process, which consists of multiple units; furthermore, this system is developed using process operational data to avoid the complexity of mathematical modelling of the continuous production process. The data-driven approach aims to specify the structure of the optimal operation system; in particular, the operational data of the process are used to formulate each part of the system. In this context, the domain knowledge of process engineers is utilised, and a closed-loop dynamic optimisation strategy, which combines feedback, performance prediction, feed-forward, and dynamic tuning schemes into a framework, is employed. The effectiveness of the proposed system has been verified using industrial experimental results.

Diagnostic Machine Learning Models for Acute Abdominal Pain: Towards an e-Learning Tool for Medical Students.

PubMed

Khumrin, Piyapong; Ryan, Anna; Judd, Terry; Verspoor, Karin

2017-01-01

Computer-aided learning systems (e-learning systems) can help medical students gain more experience with diagnostic reasoning and decision making. Within this context, providing feedback that matches students' needs (i.e. personalised feedback) is both critical and challenging. In this paper, we describe the development of a machine learning model to support medical students' diagnostic decisions. Machine learning models were trained on 208 clinical cases presenting with abdominal pain, to predict five diagnoses. We assessed which of these models are likely to be most effective for use in an e-learning tool that allows students to interact with a virtual patient. The broader goal is to utilise these models to generate personalised feedback based on the specific patient information requested by students and their active diagnostic hypotheses.

Correlates and Outcomes Associated with Aggression and Victimization among Elementary-School Children in a Low-Income Urban Context

ERIC Educational Resources Information Center

Pouwels, J. Loes; Cillessen, Antonius H. N.

2013-01-01

Previous research suggests that the prevalence of aggression is high among low-income urban youth who have to cope with a number of psychological stressors. Less is known about the early development and consequences of aggression and peer victimization prior to adolescence in these contexts. This study examined the correlates, interplay, and…

Utilisation of maternal health care in western rural China under a new rural health insurance system (New Co-operative Medical System).

PubMed

Long, Qian; Zhang, Tuohong; Xu, Ling; Tang, Shenglan; Hemminki, Elina

2010-10-01

To investigate factors influencing maternal health care utilisation in western rural China and its relation to income before (2002) and after (2007) introducing a new rural health insurance system (NCMS). Data from cross-sectional household-based health surveys carried out in ten western rural provinces of China in 2003 and 2008 were used in the study. The study population comprised women giving birth in 2002 or 2007, with 917 and 809 births, respectively. Correlations between outcomes and explanatory variables were studied by logistic regression models and a log-linear model. Between 2002 and 2007, having no any pre-natal visit decreased from 25% to 12% (difference 13%, 95% CI 10-17%); facility-based delivery increased from 45% to 80% (difference 35%, 95% CI 29-37%); and differences in using pre-natal and delivery care between the income groups narrowed. In a logistic regression analysis, women with lower education, from minority groups, or high parity were less likely to use pre-natal and delivery care in 2007. The expenditure for facility-based delivery increased over the period, but the out-of-pocket expenditure for delivery as a percentage of the annual household income decreased. In 2007, it was 14% in the low-income group. NCMS participation was found positively correlated with lower out-of-pocket expenditure for facility-based delivery (coefficient -1.14 P < 0.05) in 2007. Facility-based delivery greatly increased between 2002 and 2007, coinciding with the introduction of the NCMS. The rural poor were still facing substantial payment for facility-based delivery, although NCMS participation reduced the out-of-pocket expenditure on average. © 2010 Blackwell Publishing Ltd.

The electrolytic inferior vena cava model (EIM) to study thrombogenesis and thrombus resolution with continuous blood flow in the mouse

PubMed Central

Diaz, Jose A.; Alvarado, Christine M.; Wrobleski, Shirley K.; Slack, Dallas W.; Hawley, Angela E.; Farris, Diana M.; Henke, Peter K.; Wakefield, Thomas W.; Myers, Daniel D.

2016-01-01

Summary Previously, we presented the electrolytic inferior vena cava (IVC) model (EIM) during acute venous thrombosis (VT). Here, we present our evaluation of the EIM for chronic VT time points in order to determine whether this model allows for the study of thrombus resolution. C57BU6 mice (n=191) were utilised. In this model a copper-wire, inserted into a 25-gauge needle, is placed in the distal IVC and another subcutaneously. An electrical current (250 µAmp/15 minutes) activates the endothelial cells, inducing thrombogenesis. Ultrasound, thrombus weight (TW), vein wall leukocyte counts, vein wall thickness/fibrosis scoring, thrombus area and soluble P-selectin (sP-sel) were performed at baseline, days 1, 2, 4, 6, 9, 11 and 14, post EIM. A correlation between TW and sP-sel was also determined. A thrombus formed in each mouse undergoing EIM. Blood flow was documented by ultrasound at all time points. IVC thrombus size increased up to day 2 and then decreased over time, as shown by ultrasound, TW, and sP-sel levels. TW and sP-sel showed a strong positive correlation (r=0.48, p<0.0002). Vein wall neutrophils were the most common cell type present in acute VT (up to day 2) with monocytes becoming the most prevalent in chronic VT (from day 6 to day 14). Thrombus resolution was demonstrated by ultrasound, TW and thrombus area. In conclusion, the EIM produces a non-occlusive and consistent IVC thrombus, in the presence of constant blood flow, allowing for the study of VT at both acute and chronic time points. Thrombus resolution was demonstrated by all modalities utilised in this study. PMID:23571406

Drug utilisation profile in the neonatal unit of a university hospital: a prospective observational study in Brazil.

PubMed

Gonçalves, Adriana Cristina de Souza; Reis, Adriano Max Moreira; Gusmão, Ana Carolina Marçal; Bouzada, Maria Cândida Ferrarez

2015-08-01

Advances in neonatology have contributed to changes in the drug utilisation profile in neonates, both in the number of drugs and the pharmacotherapeutic groups. To analyse drug use in the neonatal care unit of a teaching hospital in Brazil and to evaluate the associations among perinatal, clinical care and drug use data. The neonatal care unit of a teaching hospital in Brazil. A prospective observational study was conducted. Perinatal, clinical care and pharmacotherapy data were collected from the patients' medical records. Labelling information regarding neonatal use was analysed for prescribed drugs. The data were analysed using univariate descriptive statistics and quasi-Poisson regression. Frequency of drug use by gestational age. The study included 187 patients; 157 (84.0 %) received drugs. The mean gestational age was 35.8 weeks. The mean number of drugs prescribed per patient was 6.4. The number of drugs used was inversely correlated to gestational age and birth weight. The most commonly prescribed drugs belonged to the following anatomical therapeutic chemical groups: nervous system drugs, anti-infectives for systemic use, and alimentary tract and metabolism drugs. Information regarding neonatal use was given in the labelling of only 20.5 % of the prescribed drugs. Of these, only 9.5 % had information specific for preterm infants. Drug administration to neonates is frequently and inversely correlated to gestational age and birth weight. Neonates are exposed to different therapeutic classes, reflecting scientific advances in neonatology. In Brazil, the percentage of drugs with neonate-specific labelling information is low. Consequently, there is an evident need for efforts to guarantee effective and safe pharmacotherapy for neonates.

Propionic and butyric acids, formed in the caecum of rats fed highly fermentable dietary fibre, are reflected in portal and aortic serum.

PubMed

Jakobsdottir, Greta; Jädert, Cecilia; Holm, Lena; Nyman, Margareta E

2013-11-14

SCFA are important end products formed during colonic fermentation of dietary fibre (DF). It has been suggested that propionic and butyric acids affect metabolic parameters, low-grade systemic inflammation, insulin resistance and obesity. The aim of the present study was to investigate whether the various SCFA profiles observed after fermentation in the caecum of rats fed pectin, guar gum and fructo-oligosaccharides (FOS) were also represented in hepatic portal and aortic serum. The SCFA in serum were extracted using hollow fibre-supported liquid membrane extraction before GLC analysis. The concentrations of acetic, propionic and butyric acids in caecal content correlated well with those in portal serum (P< 0·001) for all the three diets. A weaker correlation was found for propionic and butyric acids between the caecal content and aortic serum (P< 0·05). Butyric acid concentration in caecal content was also reflected in the aortic serum (P= 0·019) of rats fed FOS. FOS gave rather low amounts of the SCFA, especially butyric acid, but caecal tissue weight was higher with FOS than with the other two diets. This may be explained by rapid fermentation and quick utilisation/absorption of the SCFA. The present study also showed that propionic acid was metabolised/utilised to a higher extent than butyric acid by colonocytes before reaching the liver. We conclude that the formation of propionic and butyric acids in the caecum is reflected by increased concentrations in the aortic blood. This approach may therefore simplify the evaluation and study of SCFA from DF in human subjects.

The smartphone in the memory clinic: A study of patient and care partner's utilisation habits.

PubMed

Benge, Jared F; Dinh, Kara L; Logue, Erin; Phenis, Richard; Dasse, Michelle N; Scullin, Michael K

2018-04-16

Smartphones have potential as cognitive aids for adults with cognitive impairments. However, little is known about how patients and their care partners utilise smartphones in their day-to-day lives. We collected self-reported smartphone utilisation data from patients referred for neuropsychological evaluations (N = 53), their care partners (N = 44), and an Amazon Mechanical Turk control sample (N = 204). Patient participants were less likely to own a smartphone than controls, with increasing age associated with less utilisation of smartphone features in all groups. Of the patients who owned smartphones, spontaneous use of cognitive aid features (e.g., reminders and calendars) occurred on only a monthly-to-weekly basis; by comparison, patients reported utilising social/general features (e.g., email and internet) on a weekly-to-daily basis. Individuals referred for geriatric cognitive disorder evaluations were less likely to own and use smartphones than individuals referred for other reasons. Care partners reported using their smartphones more frequently than control group adults, with 55% of care partners endorsing utilising their device in caring for the patient. Building upon existing smartphone use habits to increase the use of cognitive aid features may be a feasible intervention for some patients, and including care partners in such interventions is encouraged.

Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey.

PubMed

Vikum, Eirik; Krokstad, Steinar; Westin, Steinar

2012-08-22

In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth. The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006-2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression. We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women. In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.

Impact of Nutritional Status and Sleep Quality on Hospital Utilisation in the Oldest Old with Heart Failure.

PubMed

Selan, S; Hellström, A; Fagerström, C

2016-02-01

To describe three-year trends in nutritional status and sleep quality and their impact on hospital utilisation in the oldest old (80 +) with heart failure (HF). Single-centred longitudinal observational study. South-eastern Sweden. 90 elderly (80+) with objectively verified HF. Baseline data from the Mini Nutritional Assessment (MNA) and on sleep quality were collected through structured interviews following the HF diagnosis (n=90) and at a three-year follow-up (n=41). Data on hospital utilisation during the three years following the HF diagnosis were also collected. Nineteen percent of the participants were found to have impaired nutritional status, a condition that increased hospital utilisation by four bed days per year. A majority (85%) had impaired sleep quality, but no impact on hospital utilisation was found. Nutritional status and sleep quality were stable over the three-year period. In the oldest old with HF, impaired nutritional status and impaired sleep quality are already common at HF diagnosis. Impaired nutritional status increases hospital utilisation significantly. Therefore, it is of supreme importance to systematically evaluate nutritional status and sleep quality in the oldest old when they are diagnosed with HF, as well as to take action if impairments are present.

Neural Correlates of Evaluations of Lying and Truth-Telling in Different Social Contexts

PubMed Central

Wu, Dingcheng; Loke, Ivy Chiu

2011-01-01

The present study examined the neural correlates of evaluations of both lying and truth-telling in different social contexts using fMRI methodology. The results demonstrated the differentiation between lying and truth-telling and between different types of lying in a network of brain regions. These regions included bilateral superior frontal gyrus (SFG), bilateral inferior parietal lobule (IPL), bilateral cuneus, right lingual gyrus (LG), right precuneus, and left postcentral gyrus (PoCG). Additionally, we found that activations in the right LG, the left IPL and the left PoCG were correlated with the off-line evaluations of truthful and untruthful communications about good and bad acts in different social contexts. These results suggest that the judgments of lying and truth-telling involving a third party might not be emotion-arousing but involve rational processing. This study is among the first to demonstrate that evaluations of truthful and untruthful communications in different social contexts can be differentiated in terms of brain BOLD (blood-oxygen-level dependent) activities. PMID:21382353

Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study

PubMed Central

Hu, Sung-Yuan; Hsieh, Ming-Shun; Lin, Meng-Yu; Hsu, Chiann-Yi; Lin, Tzu-Chieh; How, Chorng-Kuang; Wang, Chen-Yu; Tsai, Jeffrey Che-Hung; Wu, Yu-Hui; Chang, Yan-Zin

2016-01-01

Objectives To investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition. Setting A hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan. Participants Adult ED visits (aged ≥18 years) during 2009–2013, with or without receiving CT, were enrolled as the study participants. Main outcome measures For all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay. Results In all, 269 239 adult ED visits (148 613 male patients and 120 626 female patients) were collected during the 5-year study period, comprising 38 609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013). Conclusions ED CT utilisation rates increased significantly during 2009–2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective. PMID:27279477

COPD: Health Care Utilisation Patterns with Different Disease Management Interventions.

PubMed

Luk, Edwin K; Hutchinson, Anastasia F; Tacey, Mark; Irving, Louis; Khan, Fary

2017-08-01

The management of COPD is a significant and costly issue worldwide, with acute healthcare utilisation consisting of admissions and outpatient attendances being a major contributor to the cost. Pulmonary rehabilitation (PR) and integrated disease management (IDM) are often offered. Whilst there is strong evidence of physical and quality of life outcomes following IDM and PR, few studies have looked into healthcare utilisation. The aims of this study were to confirm whether IDM and PR reduce acute healthcare utilisation and to identify factors which contribute to acute health care utilisation or increased mortality. This was a retrospective cohort study of patients with COPD who were referred to IDM over a 10-year period. Patients were also offered an 8-week PR program. Data collected were matched with the hospital dataset to obtain information on inpatient, ED and outpatient attendances. 517 patients were enrolled to IDM. 315 (61%) also commenced PR and 220 (43%) completed PR. Patients who were referred to PR were younger and had less comorbidities (p < 0.001). Both groups (IDM only and IDM + PR referred) had reductions in healthcare utilisation but the IDM-only group had greater reductions. A survival benefit (HR 0.68, 95% CI 0.50-0.92) was seen in those who were PR completers compared to patients who received IDM only. Patients with COPD who successfully complete PR in addition to participating in IDM have improved survival. IDM alone was effective in the reduction of healthcare utilisation; however, the addition of PR did not reduce healthcare usage further.

Estimation of an optimal chemotherapy utilisation rate for cancer: setting an evidence-based benchmark for quality cancer care.

PubMed

Jacob, S A; Ng, W L; Do, V

2015-02-01

There is wide variation in the proportion of newly diagnosed cancer patients who receive chemotherapy, indicating the need for a benchmark rate of chemotherapy utilisation. This study describes an evidence-based model that estimates the proportion of new cancer patients in whom chemotherapy is indicated at least once (defined as the optimal chemotherapy utilisation rate). The optimal chemotherapy utilisation rate can act as a benchmark for measuring and improving the quality of care. Models of optimal chemotherapy utilisation were constructed for each cancer site based on indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient- and tumour-related attributes for which chemotherapy was indicated were obtained, using population-based data where possible. Treatment indications and epidemiological data were merged to calculate the optimal chemotherapy utilisation rate. Monte Carlo simulations and sensitivity analyses were used to assess the effect of controversial chemotherapy indications and variations in epidemiological data on our model. Chemotherapy is indicated at least once in 49.1% (95% confidence interval 48.8-49.6%) of all new cancer patients in Australia. The optimal chemotherapy utilisation rates for individual tumour sites ranged from a low of 13% in thyroid cancers to a high of 94% in myeloma. The optimal chemotherapy utilisation rate can serve as a benchmark for planning chemotherapy services on a population basis. The model can be used to evaluate service delivery by comparing the benchmark rate with patterns of care data. The overall estimate for other countries can be obtained by substituting the relevant distribution of cancer types. It can also be used to predict future chemotherapy workload and can be easily modified to take into account future changes in cancer incidence, presentation stage or chemotherapy indications. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Evaluation de l'intergiciel de communication DDS pour son utilisation dans le domaine avionique

NASA Astrophysics Data System (ADS)

Levesque-Landry, Kevin

Les aeronefs modernes doivent combler de plus en plus de fonctionnalites afin de satisfaire les besoins de la clientele. De ce fait, les besoins en communications des systemes avioniques sont grandissants. De plus, la portabilite et la reutilisabilite des applications sont des defis d'actualite dans le domaine avionique. De ce fait, ce projet de recherche vise a faire une evaluation de la technologie d'intergiciel de service de distribution de donnees (DDS) pour son utilisation dans le domaine avionique. Cette technologie permettrait de reduire la complexite des communications et faciliter la portabilite et reutilisabilite des applications grâce a son interface standardisee. Dans ce projet de recherche, la norme DDS est tout d'abord etudiee pour cibler les fonctionnalites qui sont utiles au domaine avionique. Les differentes polices de qualite de services sont ainsi etudiees et denotent la flexibilite de la technologie DDS. Un intergiciel DDS est egalement evalue dans un environnement de laboratoire afin de mesurer l'impact de l'utilisation de cette technologie sur les performances de latence ainsi que sur l'utilisation de la bande passante. Les resultats montrent une faible augmentation de la latence moyenne lorsque l'intergiciel DDS est utilise. L'intergiciel DDS est egalement utilise dans une etude de cas avec un AFCS (automatic flight control system) afin de quantifier les effets de son utilisation sur une application avionique. Les resultats montrent que l'utilisation de l'intergiciel DDS n'empeche pas l'AFCS d'atteindre la stabilite, mais qu'elle ralentit l'atteinte de cette derniere. Finalement, une etude de cas est effectuee afin de valider que la technologie DDS peut etre utilisee pour construire des systemes redondants. Les resultats montrent que l'intergiciel DDS permet de faire de la redondance de reserve sans avoir un impact visible sur les performances du systeme redondant.

[The Manifestation of the Anxiety during Fear Conditioning in Wistar Rats].

PubMed

Pavlova, I V; Rysakova, M P

2015-01-01

In order to identify the correlation between anxiety and conditioned fear, the behavior of the same male Wistar rats was compared in three anxiety tests (open field, light-dark box and elevated plus-maze) and in Pavlovian auditory fear conditioning paradigm using correlation, factor and variance analyses. The correlation between anxiety/bravery and locomotion indexes in different tests was not revealed. Positive correlations between grooming, urinations and defecations, rearing in three tests were revealed. These data suggest that animals reacted to various tests differently, resulting, apparently in the emergence of different anxiety levels, specific for each test. Vegetative reactions, inclination to exploration and substituting behavior were more stable characteristics of rats. Anxiety behavior in elevated plus-maze correlated to freezing response to context after fear conditioning, while high-anxiety rats had higher level of freezing to context than low-anxiety rats. The higher freezing response to sound after fear conditioning was found in rats with middle locomotor activity in open field. Conditioned fear to the context and to the sound was associated with different forms of rat anxiety during different tests.

The liberal arts and nursing programme at the University of Maine, 1939-1956. A study of leadership behaviours and organisational structure.

PubMed

Hart, V

2001-01-01

The trend for nursing programmes affiliated with universities in the US began in 1909 but did not gain momentum until the 1960s with the demise of hospital schools of nursing. During the period of time covered in this study, beginning in the 1930s, a hybrid of the present day university-based nursing programme began to appear. These 'cooperative' programmes often sandwiched traditional hospital experience between years of university course work and involved a five-year commitment on the part of students. In 1939 a liberal arts and nursing programme was established at the University of Maine. It continued to operate until 1956 and then ceased to exist. In this descriptive historical study the author investigates why this particular programme was initiated, of what it consisted, and why it had failed. Primary sources accessed included original correspondence, curriculum descriptions, faculty and students reports, and administrative policies. Leadership and organisational behaviour theory was utilised as well as identification of the historical nursing backdrop. Oral history was also utilised for the purpose of verification of written data. Analysis of the data suggests implications for nursing educators and administrators, as well as telling a story of the power of nursing when viewed in the context of constituency groups in a sociopolitical model of organisations. This paper was first presented at the History of Nursing Millennium Conference in Edinburgh in July 2000.

Utilising a multi-item questionnaire to assess household food security in Australia.

PubMed

Butcher, Lucy M; O'Sullivan, Therese A; Ryan, Maria M; Lo, Johnny; Devine, Amanda

2018-03-15

Currently, two food sufficiency questions are utilised as a proxy measure of national food security status in Australia. These questions do not capture all dimensions of food security and have been attributed to underreporting of the problem. The purpose of this study was to investigate food security using the short form of the US Household Food Security Survey Module (HFSSM) within an Australian context; and explore the relationship between food security status and multiple socio-demographic variables. Two online surveys were completed by 2334 Australian participants from November 2014 to February 2015. Surveys contained the short form of the HFSSM and twelve socio-demographic questions. Cross-tabulations chi-square tests and a multinomial logistic regression model were employed to analyse the survey data. Food security status of the respondents was classified accordingly: High or Marginal (64%, n = 1495), Low (20%, n = 460) or Very Low (16%, n = 379). Significant independent predictors of food security were age (P < .001), marital status (P = .005), household income (P < .001) and education (P < .001). Findings suggest food insecurity is an important issue across Australia and that certain groups, regardless of income, are particularly vulnerable. Government policy and health promotion interventions that specifically target "at risk" groups may assist to more effectively address the problem. Additionally, the use of a multi-item measure is worth considering as a national indicator of food security in Australia. © 2018 Australian Health Promotion Association.

A systematic review of integrated use of disease-management interventions in asthma and COPD.

PubMed

Lemmens, Karin M M; Nieboer, Anna P; Huijsman, Robbert

2009-05-01

The effectiveness of multiple interventions in asthma and chronic obstructive pulmonary disease (COPD) is unclear. To examine the effectiveness of multiple interventions as compared to single interventions or usual care on health outcomes and health care utilisation within the context of integrated disease management in asthma and COPD. MEDLINE and the Cochrane Library (1995-May 2008) were searched for controlled trials. Two reviewers independently extracted data and assessed study quality. Meta-analyses were performed on quality of life and health care utilisation data. Furthermore, the effects of multiple interventions versus single interventions and usual care were assessed qualitatively. Of the 36 studies included, 17 targeted double interventions (patient-related and organisational interventions); 19 studies performed triple interventions (patient-related, professional-directed and organisational interventions). They were heterogeneous in terms of (combinations of) interventions, outcomes measured, study design and setting. Pooled data showed that studied disease management programmes significantly improved quality of life on several domains. Patients within triple intervention programmes had less chance of at least one hospital admission compared with usual care. No significant effects were found in number of emergency department visits. Qualitative analyses revealed positive trends on process improvements and satisfaction. Inconclusive results were reported on symptoms; no effects were found in lung function. In spite of the heterogeneity of disease management studies in asthma and COPD care, this review showed promising improvements in quality of life and reductions in hospitalisations, especially for triple intervention programmes.

In vitro effect of Reiki treatment on bacterial cultures: Role of experimental context and practitioner well-being.

PubMed

Rubik, Beverly; Brooks, Audrey J; Schwartz, Gary E

2006-01-01

To measure effects of Reiki treatments on growth of heat-shocked bacteria, and to determine the influence of healing context and practitioner well-being. Overnight cultures of Escherichia coli K12 in fresh medium were used. Culture samples were paired with controls to minimize any ordering effects. Samples were heat-shocked prior to Reiki treatment, which was performed by Reiki practitioners for up to 15 minutes, with untreated controls. Plate-count assay using an automated colony counter determined the number of viable bacteria. Fourteen Reiki practitioners each completed 3 runs (n = 42 runs) without healing context, and another 2 runs (n = 28 runs) in which they first treated a pain patient for 30 minutes (healing context). Well-being questionnaires were administered to practitioners pre-post all sessions. No overall difference was found between the Reiki and control plates in the nonhealing context. In the healing context, the Reiki treated cultures overall exhibited significantly more bacteria than controls (p < 0.05). Practitioner social (p < 0.013) and emotional well-being (p < 0.021) correlated with Reiki treatment outcome on bacterial cultures in the nonhealing context. Practitioner social (p < 0.031), physical (p < 0.030), and emotional (p < 0.026) well-being correlated with Reiki treatment outcome on the bacterial cultures in the healing context. For practitioners starting with diminished well-being, control counts were likely to be higher than Reiki-treated bacterial counts. For practitioners starting with a higher level of well-being, Reiki counts were likely to be higher than control counts. Reiki improved growth of heat-shocked bacterial cultures in a healing context. The initial level of well-being of the Reiki practitioners correlates with the outcome of Reiki on bacterial culture growth and is key to the results obtained.

Antecedents of basic psychological need satisfaction of pharmacy students: The role of peers, family, lecturers and workload.

PubMed

Basson, Mariëtta J; Rothmann, Sebastiaan

2018-04-01

Self-determination theory (SDT) provides a model to improve pharmacy students' well-being or functioning in their study context. According to SDT, students need a context that satisfies their needs for autonomy, relatedness and competence in order to function optimally. Contextual factors that could have an impact on a student's functioning are lecturers, family, peers and workload. To investigate whether there is a difference between the contributions family, lecturers, peers and workload make towards the satisfaction of pharmacy students' basic psychological needs within a university context. An electronic survey was administered amongst students registered with the North-West University's School of Pharmacy. Registered pharmacy students, 779, completed said electronic survey comprised of a questionnaire on demographics, BMPN (Balanced Measure of Psychological Needs) and self-developed ANPNS (Antecedents of Psychological Need-satisfaction Scale). Data derived from the afore-going was analysed with the aid of structural equation modelling (SEM). Structural equation modelling explained 46%, 25% and 30% respectively of the total group's variances in autonomy, competence and relatedness satisfaction, and 26% of the variance in psychological need frustration. Peers and family played a significant role in the satisfaction of students' need for autonomy, relatedness and competence, whilst workload seemingly hampered satisfaction with regards to relatedness and autonomy. Workload contributed towards frustration with regards to psychological need satisfaction. The role played by lecturers in satisfying pharmacy students' need for autonomy, relatedness and competence will also be highlighted. This study added to the body of knowledge regarding contextual factors and the impact those factors have on pharmacy students' need satisfaction by illustrating that not all factors (family, lecturers, peers and workload) can be considered equal. Lecturers ought to recognise the important role family and peers play in the emotional and mental wellbeing of students and utilise those factors in their teaching. The mechanism of basic psychological need satisfaction as described in Self-determination theory provide insight into pharmacy students' optimal functioning. Hence the influence of contextual factors, (lecturers, peers, family and workload) on the need satisfaction was investigated by means of a survey. The structural model explained 46%, 25% and 30% of the variances in autonomy, competence and relatedness satisfaction and 26% of the variance in psychological need frustration. Family and Peer support contributed the most to the variance explained of the variables. Lecturers should acknowledge this important role of family and peers and utilise this premise when they design learning encounters. Copyright © 2017 Elsevier Inc. All rights reserved.

How lay health workers tailor in effective health behaviour change interventions: a protocol for a systematic review.

PubMed

Hodgins, Faith; Gnich, Wendy; Ross, Alastair J; Sherriff, Andrea; Worlledge-Andrew, Heather

2016-06-16

Lay health workers (LHWs) are utilised as a channel of delivery in many health interventions. While they have no formal professional training related to their role, they utilise their connections with the target group or community in order to reach individuals who would not normally readily engage with health services. Lay health worker programmes are often based on psychological theories of behaviour change that point to 'tailoring to individuals' needs or characteristics' as key to success. Although lay health workers have been shown to be effective in many contexts, there is, as yet, little clarity when it comes to how LHWs assess individuals' needs in order to tailor their interventions. This study aims to develop a better understanding of the effective implementation of tailoring in lay health worker interventions by appraising evidence and synthesising studies that report evaluations of tailored interventions. Health and psychology electronic databases (EMBASE, CINAHL, MEDLINE and PsycINFO) will be searched. Reference lists of included studies will also be searched. For articles that are deemed to be potentially relevant, we will employ a 'cluster searching' technique in order to identify all published papers related to a relevant intervention. Cluster searching will be undertaken in an effort to maximise the breadth and depth of description of the intervention. Quantitative studies will be assessed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project, ON, Canada. Qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Sythesising the data will enable the development of a taxonomy of strategies for the criteria used for individual assessment of recipients' needs and the ways in which messages or actions are tailored to these individual criteria by LHWs. This systematic review focuses specifically on how health promotion and support is individually tailored in effective programmes by LHWs. This study will be of value to those involved in the design and implementation of interventions that utilise a LHW. PROSPERO CRD42015030071.

Steering the conversation: A linguistic exploration of natural language interactions with a digital assistant during simulated driving.

PubMed

Large, David R; Clark, Leigh; Quandt, Annie; Burnett, Gary; Skrypchuk, Lee

2017-09-01

Given the proliferation of 'intelligent' and 'socially-aware' digital assistants embodying everyday mobile technology - and the undeniable logic that utilising voice-activated controls and interfaces in cars reduces the visual and manual distraction of interacting with in-vehicle devices - it appears inevitable that next generation vehicles will be embodied by digital assistants and utilise spoken language as a method of interaction. From a design perspective, defining the language and interaction style that a digital driving assistant should adopt is contingent on the role that they play within the social fabric and context in which they are situated. We therefore conducted a qualitative, Wizard-of-Oz study to explore how drivers might interact linguistically with a natural language digital driving assistant. Twenty-five participants drove for 10 min in a medium-fidelity driving simulator while interacting with a state-of-the-art, high-functioning, conversational digital driving assistant. All exchanges were transcribed and analysed using recognised linguistic techniques, such as discourse and conversation analysis, normally reserved for interpersonal investigation. Language usage patterns demonstrate that interactions with the digital assistant were fundamentally social in nature, with participants affording the assistant equal social status and high-level cognitive processing capability. For example, participants were polite, actively controlled turn-taking during the conversation, and used back-channelling, fillers and hesitation, as they might in human communication. Furthermore, participants expected the digital assistant to understand and process complex requests mitigated with hedging words and expressions, and peppered with vague language and deictic references requiring shared contextual information and mutual understanding. Findings are presented in six themes which emerged during the analysis - formulating responses; turn-taking; back-channelling, fillers and hesitation; vague language; mitigating requests and politeness and praise. The results can be used to inform the design of future in-vehicle natural language systems, in particular to help manage the tension between designing for an engaging dialogue (important for technology acceptance) and designing for an effective dialogue (important to minimise distraction in a driving context). Copyright © 2017 Elsevier Ltd. All rights reserved.

Development of a behaviour change intervention: a case study on the practical application of theory.

PubMed

Porcheret, Mark; Main, Chris; Croft, Peter; McKinley, Robert; Hassell, Andrew; Dziedzic, Krysia

2014-04-03

Use of theory in implementation of complex interventions is widely recommended. A complex trial intervention, to enhance self-management support for people with osteoarthritis (OA) in primary care, needed to be implemented in the Managing Osteoarthritis in Consultations (MOSAICS) trial. One component of the trial intervention was delivery by general practitioners (GPs) of an enhanced consultation for patients with OA. The aim of our case study is to describe the systematic selection and use of theory to develop a behaviour change intervention to implement GP delivery of the enhanced consultation. The development of the behaviour change intervention was guided by four theoretical models/frameworks: i) an implementation of change model to guide overall approach, ii) the Theoretical Domains Framework (TDF) to identify relevant determinants of change, iii) a model for the selection of behaviour change techniques to address identified determinants of behaviour change, and iv) the principles of adult learning. Methods and measures to evaluate impact of the behaviour change intervention were identified. The behaviour change intervention presented the GPs with a well-defined proposal for change; addressed seven of the TDF domains (e.g., knowledge, skills, motivation and goals); incorporated ten behaviour change techniques (e.g., information provision, skills rehearsal, persuasive communication); and was delivered in workshops that valued the expertise and professional values of GPs. The workshops used a mixture of interactive and didactic sessions, were facilitated by opinion leaders, and utilised 'context-bound communication skills training.' Methods and measures selected to evaluate the behaviour change intervention included: appraisal of satisfaction with workshops, GP report of intention to practise and an assessment of video-recorded consultations of GPs with patients with OA. A stepped approach to the development of a behaviour change intervention, with the utilisation of theoretical frameworks to identify determinants of change matched with behaviour change techniques, has enabled a systematic and theory-driven development of an intervention designed to enhance consultations by GPs for patients with OA. The success of the behaviour change intervention in practice will be evaluated in the context of the MOSAICS trial as a whole, and will inform understanding of practice level and patient outcomes in the trial.

Regional scale climatic trends derived from Younger Dryas glaciers in Britain.

NASA Astrophysics Data System (ADS)

Pearce, Danni; Pellitero, Ramon; Rea, Brice R.; Barr, Iestyn; Small, David; McDougall, Des

2016-04-01

In Britain, the glacial geomorphological record has been utilised to infer palaeo-glacier geometries and ice dynamics, with much of this work focussing on the Younger Dryas (YD; c. 12.9 - 11.7 ka BP). During the YD the West Highlands ice-cap covered the majority of the Scottish Highlands, which is thought to have affected accumulation rates beyond the ice-cap margins, resulting in a steep (c. 80%) easterly decline in precipitation and smaller ice-masses. We present multi-proxy data investigating YD glaciation in the Tweedsmuir Hills, Southern Uplands, Scotland (55°46' N, 03°34' W). The area forms the most easterly upland region in the Southern Uplands and south of the West Highlands ice-cap, reaching an altitude of 840 m and covering c. 300 km2. Results of air-photo interpretation and field mapping, which utilised a morphostratigraphic approach, have demonstrated a more extensive glaciation than previously mapped, suggesting conditions were less arid than previously thought. The reconstruction consists of two separate icefields covering an area c. 60 km2 and new 14C dates of basal contact organics place the ice-mass within the context of the YD but new Cosmogenic Nuclide Analysis (CNA) of bedrock and in situ boulders, imply limited erosion and resetting occurred during the YD. Equilibrium Line Altitudes are calculated to have ranged from c. 419 - 634 m. Palaeo-precipitation values were derived using two precipitation-temperature relationships and suggest slightly lower totals than YD ice-masses located on the west coast of Britain but do not support a significant easterly reduction in precipitation. Analysis of present-day (c. 30 year) meteorological data across Britain demonstrates a pronounced reduction in precipitation of c. 50% on the east coast. This disparity between present-day and glacier-based YD precipitation patterns is partly attributable to the methodology employed in glacier reconstruction and questions the steep precipitation gradients thought to have been present. This data is placed within a Europe-wide context to elucidate glacier-climate patterns during the YD.

Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol.

PubMed

Kyratsis, Yiannis; Ahmad, Raheelah; Holmes, Alison

2012-03-21

We know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UK's National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers' perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations. The study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems. Unlike most innovation studies, which involve single-level analysis, our study will explore the innovation-adoption process at multiple embedded levels: micro (individual), meso (organisational), and macro (interorganisational). By comparing and contrasting across the nine sites, each with different organisational contexts, local networks, leadership styles, and different innovations considered for adoption, the findings of the study will have wide relevance. The research will produce actionable findings responding to the political and economic need for healthcare organisations to be innovation-ready.

Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in healthcare. study protocol

PubMed Central

2012-01-01

Background We know that patient care can be improved by implementing evidence-based innovations and applying research findings linked to good practice. Successfully implementing innovations in complex organisations, such as the UK's National Health Service (NHS), is often challenging as multiple contextual dynamics mediate the process. Research studies have explored the challenges of introducing innovations into healthcare settings and have contributed to a better understanding of why potentially useful innovations are not always implemented in practice, even if backed by strong evidence. Mediating factors include health policy and health system influences, organisational factors, and individual and professional attitudes, including decision makers' perceptions of innovation evidence. There has been limited research on how different forms of evidence are accessed and utilised by organisational decision makers during innovation adoption. We also know little about how diverse healthcare professionals (clinicians, administrators) make sense of evidence and how this collective sensemaking mediates the uptake of innovations. Methods The study will involve nine comparative case study sites of acute care organisations grouped into three regional clusters across England. Each of the purposefully selected sites represents a variety of trust types and organisational contexts. We will use qualitative methods, in-depth interviews, observation of key meetings, and systematic analysis of relevant secondary data to understand the rationale and challenges involved in sourcing and utilising innovation evidence in the empirical setting of infection prevention and control. We will use theories of innovation adoption and sensemaking in organisations to interpret the data. The research will provide lessons for the uptake and continuous use of innovations in the English and international health systems. Discussion Unlike most innovation studies, which involve single-level analysis, our study will explore the innovation-adoption process at multiple embedded levels: micro (individual), meso (organisational), and macro (interorganisational). By comparing and contrasting across the nine sites, each with different organisational contexts, local networks, leadership styles, and different innovations considered for adoption, the findings of the study will have wide relevance. The research will produce actionable findings responding to the political and economic need for healthcare organisations to be innovation-ready. PMID:22436094

Improved sugar co-utilisation by encapsulation of a recombinant Saccharomyces cerevisiae strain in alginate-chitosan capsules

PubMed Central

2014-01-01

Background Two major hurdles for successful production of second-generation bioethanol are the presence of inhibitory compounds in lignocellulosic media, and the fact that Saccharomyces cerevisiae cannot naturally utilise pentoses. There are recombinant yeast strains that address both of these issues, but co-utilisation of glucose and xylose is still an issue that needs to be resolved. A non-recombinant way to increase yeast tolerance to hydrolysates is by encapsulation of the yeast. This can be explained by concentration gradients occuring in the cell pellet inside the capsule. In the current study, we hypothesised that encapsulation might also lead to improved simultaneous utilisation of hexoses and pentoses because of such sugar concentration gradients. Results In silico simulations of encapsulated yeast showed that the presence of concentration gradients of inhibitors can explain the improved inhibitor tolerance of encapsulated yeast. Simulations also showed pronounced concentration gradients of sugars, which resulted in simultaneous xylose and glucose consumption and a steady state xylose consumption rate up to 220-fold higher than that found in suspension culture. To validate the results experimentally, a xylose-utilising S. cerevisiae strain, CEN.PK XXX, was constructed and encapsulated in semi-permeable alginate-chitosan liquid core gel capsules. In defined media, encapsulation not only increased the tolerance of the yeast to inhibitors, but also promoted simultaneous utilisation of glucose and xylose. Encapsulation of the yeast resulted in consumption of at least 50% more xylose compared with suspended cells over 96-hour fermentations in medium containing both sugars. The higher consumption of xylose led to final ethanol titres that were approximately 15% higher. In an inhibitory dilute acid spruce hydrolysate, freely suspended yeast cells consumed the sugars in a sequential manner after a long lag phase, whereas no lag phase was observed for the encapsulated yeast, and glucose, mannose, galactose and xylose were utilised in parallel from the beginning of the cultivation. Conclusions Encapsulation of xylose-fermenting S. cerevisiae leads to improved simultaneous and efficient utilisation of several sugars, which are utilised sequentially by suspended cells. The greatest improvement is obtained in inhibitory media. These findings show that encapsulation is a promising option for production of second-generation bioethanol. PMID:25050138

Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study.

PubMed

Hu, Sung-Yuan; Hsieh, Ming-Shun; Lin, Meng-Yu; Hsu, Chiann-Yi; Lin, Tzu-Chieh; How, Chorng-Kuang; Wang, Chen-Yu; Tsai, Jeffrey Che-Hung; Wu, Yu-Hui; Chang, Yan-Zin

2016-06-08

To investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition. A hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan. Adult ED visits (aged ≥18 years) during 2009-2013, with or without receiving CT, were enrolled as the study participants. For all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay. In all, 269 239 adult ED visits (148 613 male patients and 120 626 female patients) were collected during the 5-year study period, comprising 38 609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013). ED CT utilisation rates increased significantly during 2009-2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective. 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/

Health services utilisation disparities between English speaking and non-English speaking background Australian infants

PubMed Central

2010-01-01

Background To examine the differences in health services utilisation and the associated risk factors between infants from non-English speaking background (NESB) and English speaking background (ESB) within Australia. Methods We analysed data from a national representative longitudinal study, the Longitudinal Study of Australian Children (LSAC) which started in 2004. We used survey logistic regression coupled with survey multiple linear regression to examine the factors associated with health services utilisation. Results Similar health status was observed between the two groups. In comparison to ESB infants, NESB infants were significantly less likely to use the following health services: maternal and child health centres or help lines (odds ratio [OR] 0.56; 95% confidence intervals [CI], 0.40-0.79); maternal and child health nurse visits (OR 0.68; 95% CI, 0.49-0.95); general practitioners (GPs) (OR 0.58; 95% CI, 0.40-0.83); and hospital outpatient clinics (OR 0.54; 95% CI, 0.31-0.93). Multivariate analysis results showed that the disparities could not be fully explained by the socioeconomic status and language barriers. The association between English proficiency and the service utilised was absent once the NESB was taken into account. Maternal characteristics, family size and income, private health insurance and region of residence were the key factors associated with health services utilisation. Conclusions NESB infants accessed significantly less of the four most frequently used health services compared with ESB infants. Maternal characteristics and family socioeconomic status were linked to health services utilisation. The gaps in health services utilisation between NESB and ESB infants with regard to the use of maternal and child health centres or phone help, maternal and child health nurse visits, GPs and paediatricians require appropriate policy attentions and interventions. PMID:20374663

Utilisation of primary total knee joint replacements across socioeconomic status in the Barwon Statistical Division, Australia, 2006-2007: a cross-sectional study.

PubMed

Brennan, Sharon Lee; Stanford, Tyman; Wluka, Anita E; Page, Richard S; Graves, Stephen E; Kotowicz, Mark A; Nicholson, Geoffrey C; Pasco, Julie A

2012-01-01

There are few Australian data that examine the association between total knee joint replacement (TKR) utilisation and socioeconomic status (SES). This study examined TKR surgeries with a diagnosis of osteoarthritis (OA) performed for residents of Barwon Statistical Division (BSD) for 2006-2007. Cross-sectional. BSD, South-eastern Victoria, Australia All patients who underwent a TKR for OA, 2006-2007, and whose residential postcode was identified as within the BSD of Australia, and for whom SES data were available, were eligible for inclusion. Primary TKR data ascertained from the Australian Orthopaedic Association National Joint Replacement Registry. Residential addresses were matched with the Australian Bureau of Statistics census data, and the Index of Relative Socioeconomic Disadvantage was used to determine SES, categorised into quintiles whereby quintile 1 indicated the most disadvantaged and quintile 5 the least disadvantaged. Age-specific and sex-specific rates of TKR utilisation per 1000 person-years were reported for 10-year age bands. Females accounted for 62.7% of the 691 primary TKR surgeries performed during 2006-2007. The greatest utilisation rates of TKR in males was 7.6 observed in those aged >79 years, and in 10.2 in females observed in those aged 70-79 years. An increase in TKR was observed for males in SES quintile four compared to quintile 1 in which the lowest utilisation which was observed (p=0.04). No differences were observed in females across SES quintiles. Further investigation is warranted on a larger scale to examine the role that SES may play in TKR utilisation, and to determine whether any social disparities in TKR utilisation reflect health system biases or geographic differences.

Cost-effectiveness of vildagliptin for people with type 2 diabetes mellitus in Brazil; findings and implications.

PubMed

De Oliveira, Gustavo Laine Araujo; Guerra Júnior, Augusto Afonso; Godman, Brian; Acurcio, Francisco de Assis

2017-04-01

Vildagliptin is an inhibitor of the enzyme dipeptidyl peptidase 4, indicated for the treatment of type 2 diabetes mellitus, combined or not with metformin. This study aims to evaluate the cost-effectiveness of vildagliptin in the Brazilian context. Areas covered: Using MEDLINE, Cochrane Library, Lilacs and CRD, six studies were selected for the economic models. This study utilised cost data in the Brazilian health system to provide the context. Expert commentary: Type 2 diabetes mellitus is an epidemic disease and represents a challenge for all health care systems. Although guidelines clearly define first-line treatment, there are several other promising treatments. Vildagliptin is one of them, resulting in a mean lifetime increase of 0.31 years compared to metformin alone and 1.19 more life years compared to other metformin combinations. Considering observational data, life years with dual vildagliptin-containing treatments were 0.37 more compared to other dual treatments. However, its high cost versus generic metformin and its unclear safety profile weakens its subsequent cost-effectiveness. Consequently, the incorporation of vildagliptin or its combination with metformin is currently not recommended for the Brazilian Health Care System. This may change as more data becomes available.

Context matters: Successes and challenges of intrapartum care scale-up in four districts of Afghanistan.

PubMed

Tappis, Hannah; Koblinsky, Marge; Winch, Peter J; Turkmani, Sabera; Bartlett, Linda

2016-01-01

Reducing preventable maternal mortality and achieving Sustainable Development Goal targets for 2030 will require increased investment in improving access to quality health services in fragile and conflict-affected states. This study explores the conditions that affect availability and utilisation of intrapartum care services in four districts of Afghanistan where mortality studies were conducted in 2002 and 2011. Information on changes in each district was collected through interviews with community members; service providers; and district, provincial and national officials. This information was then triangulated with programme and policy documentation to identify factors that affect the coverage of safe delivery and emergency obstetric care services. Comparison of barriers to maternal health service coverage across the four districts highlights the complexities of national health policy planning and resource allocation in Afghanistan, and provides examples of the types of challenges that must be addressed to extend the reach of life-saving maternal health interventions to women in fragile and conflict-affected states. Findings suggest that improvements in service coverage must be measured at a sub-national level, and context-specific service delivery models may be needed to effectively scale up intrapartum care services in extremely remote or insecure settings.

A transcultural study of Jordanian nursing students' care encounters within the context of clinical education.

PubMed

Nahas, V

2000-06-01

Clinical education is an integral part of nursing education. Clinical teachers are the vital link in this teaching-learning process. The quality and quantity of student-teacher interactions in the clinical area can either facilitate or hinder students' learning. This paper presents a part of a larger study that discovered, described, explained and compared Australian and Jordanian nursing students' caring and non-caring encounters with their clinical teachers within the context of clinical education. The study was guided by Leininger's theory of culture care universality and diversity and Leininger's ethnonursing research method was utilised. The informants consisted of 12 key informants and 35 general informants. Three major themes emerged from the analysis of the data: (1) clinical teacher's caring behaviours; (2) student-teacher caring encounters; and (3) caring encounter consequences. Under these themes, care constructs emerged which gave light to the Jordanian nursing students' care meanings, expressions and values within their cultural environment, social structures and world view. The overall findings revealed that Jordanian nursing students found their clinical experiences as beneficial when their encounters with the clinical teacher were conducted through mothering, translating, sustaining, negotiating and transforming processes.

Mechanism of failure of the Cabrol procedure: A computational fluid dynamic analysis.

PubMed

Poullis, M; Pullan, M

2015-12-01

Sudden failure of the Cabrol graft is common and frequently fatal. We utilised the technique of computational fluid dynamic (CFD) analysis to evaluate the mechanism of failure and potentially improve on the design of the Cabrol procedure. CFD analysis of the classic Cabrol procedure and a number of its variants was performed. Results from this analysis was utilised to generate further improved geometric options for the Cabrol procedure. These were also subjected to CFD analysis. All current Cabrol and variations of the Cabrol procedure are predicated by CFD analysis to be prone to graft thrombosis, secondary to stasis around the right coronary artery button. The right coronary artery flow characteristics were found to be the dominant reason for Cabrol graft failure. A simple modification of the Cabrol geometry is predicated to virtually eliminate any areas of blood stasis, and graft failure. Modification of the Cabrol graft geometry, due to CFD analysis may help reduce the incidence of graft thrombosis. A C shaped Cabrol graft with the right coronary button anastomosed to its side along its course from the aorta to the left coronary button is predicted to have the least thrombotic tendency. Clinical correlation is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

A correlation between macronutrient balancing and insect host-plant range: evidence from the specialist caterpillar Spodoptera exempta (Walker).

PubMed

Lee, Kwang Pum; Raubenheimer, David; Behmer, Spencer T; Simpson, Stephen J

2003-12-01

In an earlier study, we showed that the ingestive responses of the generalist caterpillar Spodoptera littoralis to foods imbalanced in their protein:carbohydrate content is similar to generalist locusts, but differs from that of specialist-feeding locusts. Here we further pursued the comparison by repeating the experiments using a closely related specialist caterpillar, Spodoptera exempta. First, caterpillars were allowed to self-compose a diet of preferred protein:carbohydrate balance by mixing between nutritionally complementary foods. Then, they were confined to one of five imbalanced foods, in which we measured the trade-off between over- and under-ingesting the two nutrients. On complementary foods, the caterpillars actively regulated their protein and carbohydrate intake. In the no-choice experiment, those fed excess-protein foods ingested small surpluses of protein compared with generalist feeders, thus showing a pattern of nutrient balancing similar to that observed in specialist locusts. Utilisation data indicated that ingested excesses and deficits were to some extent offset by differential utilisation. Evidence also showed that post-ingestive responses of the specialist S. exempta were less flexible than those observed in the generalist S. littoralis, a pattern which is again in accordance with comparisons of acridids differing in their host-plant range.

Factors affecting performance in an ultraendurance triathlon.

PubMed

Laursen, P B; Rhodes, E C

2001-01-01

In the recent past, researchers have found many key physiological variables that correlate highly with endurance performance. These include maximal oxygen uptake (VO2max), anaerobic threshold (AT), economy of motion and the fractional utilisation of oxygen uptake (VO2). However, beyond typical endurance events such as the marathon, termed 'ultraendurance' (i.e. >4 hours), performance becomes harder to predict. The ultraendurance triathlon (UET) is a 3-sport event consisting of a 3.8 km swim and a 180 km cycle, followed by a 42.2 km marathon run. It has been hypothesised that these triathletes ride at approximately their ventilatory threshold (Tvent) during the UET cycling phase. However, laboratory assessments of cycling time to exhaustion at a subject's AT peak at 255 minutes. This suggests that the AT is too great an intensity to be maintained during a UET, and that other factors cause detriments in prolonged performance. Potential defeating factors include the provision of fuels and fluids due to finite gastric emptying rates causing changes in substrate utilisation, as well as fluid and electrolyte imbalances. Thus, an optimum ultraendurance intensity that may be relative to the AT intensity is needed to establish ultraendurance intensity guidelines. This optimal UET intensity could be referred to as the ultraendurance threshold.

Space resource utilisation: a novel indicator to quantify species competitive ability for light.

PubMed

Zhang, Pengfei; Zhou, Xiaolong; Li, Junyong; Guo, Zhi; Du, Guozhen

2015-11-23

Species richness and productivity are two fundamental aspects of ecosystems. As a result, the relationship between species richness and productivity has been widely studied. A series of fertilisation experiments in an alpine meadow on the Tibetan Plateau were performed to study the relationship between species richness and productivity. In this paper, we present a novel indicator, i.e., space resource utilisation (SRU), which is calculated by a volume formula (V(i)  =  h(i) · S(i); h(i) = plant height of species i, S(i) = quadrat area × percent cover of species i). SRU more fully reflected species competitive ability for light in both horizontal and vertical dimensions compared with plant height and cover. We used this novel indicator to investigate the effects of SRU on the changes in species richness and productivity following fertilisation. We found that the SRU of the community was correlated with increasing productivity and decreasing species richness following fertilisation and was a better predictor of species richness than productivity. The changes in SRU following fertilisation vary among species. These results demonstrate that SRU can be a more useful tool in explaining plant biodiversity loss and predicting the fate of different species than each of height, cover and productivity.

Space resource utilisation: a novel indicator to quantify species competitive ability for light

PubMed Central

Zhang, Pengfei; Zhou, Xiaolong; Li, Junyong; Guo, Zhi; Du, Guozhen

2015-01-01

Species richness and productivity are two fundamental aspects of ecosystems. As a result, the relationship between species richness and productivity has been widely studied. A series of fertilisation experiments in an alpine meadow on the Tibetan Plateau were performed to study the relationship between species richness and productivity. In this paper, we present a novel indicator, i.e., space resource utilisation (SRU), which is calculated by a volume formula (Vi  =  hi · Si; hi = plant height of species i, Si = quadrat area × percent cover of species i). SRU more fully reflected species competitive ability for light in both horizontal and vertical dimensions compared with plant height and cover. We used this novel indicator to investigate the effects of SRU on the changes in species richness and productivity following fertilisation. We found that the SRU of the community was correlated with increasing productivity and decreasing species richness following fertilisation and was a better predictor of species richness than productivity. The changes in SRU following fertilisation vary among species. These results demonstrate that SRU can be a more useful tool in explaining plant biodiversity loss and predicting the fate of different species than each of height, cover and productivity. PMID:26593068

Modular operation of membrane bioreactors for higher hydraulic capacity utilisation.

PubMed

Veltmann, K; Palmowski, L M; Pinnekamp, J

2011-01-01

Using data from 6 full-scale municipal membrane bioreactors (MBR) in Germany the hydraulic capacity utilisation and specific energy consumption were studied and their connexion shown. The average hydraulic capacity utilisation lies between 14% and 45%. These low values are justified by the necessity to deal with intense rain events and cater for future flow increases. However, this low hydraulic capacity utilisation leads to high specific energy consumption. The optimisation of MBR operation requires a better utilisation of MBR hydraulic capacity, particularly under consideration of the energy-intensive membrane aeration. A first approach to respond to large influent flow fluctuations consists in adjusting the number of operating modules. This is practised by most MBR operators but so far mostly with variable flux and constant membrane aeration. A second approach is the real-time adjustment of membrane aeration in line with flux variations. This adjustment is not permitted under current manufacturers' warranty conditions. A further opportunity is a discontinuous operation, in which filtration takes place over short periods at high flux and energy for membrane aeration is saved during filtration pauses. The integration of a buffer volume is thereby indispensable. Overall a modular design with small units, which can be activated/ inactivated according to the influent flow and always operate under optimum conditions, enables a better utilisation of MBR hydraulic capacity and forms a solid base to reduce MBR energy demand.

African American women's preventative care usage: the role of social support and racial experiences and attitudes.

PubMed

Pullen, Erin; Perry, Brea; Oser, Carrie

2014-09-01

Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low-income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help-seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Metabolic specialisation on preferred prey and constraints in the utilisation of alternative prey in an ant-eating spider.

PubMed

Líznarová, Eva; Pekár, Stano

2016-10-01

Trophic specialists are expected to possess adaptations that increase the efficiency of handling preferred prey. Such adaptations may constrain the ability to utilise alternative prey. Here we tested whether the ant-eating spider Euryopis episinoides possesses metabolic specialisations with increased efficiency in utilising preferred prey and decreased efficiency in utilising alternative prey. In addition, we investigated the contribution of genetic variation via maternal effects. We reared E. episinoides spiders from the first instar on two different diets, either ants (preferred prey) or fruit flies (alternative prey). Spider survival rate and increases in body mass were significantly higher on the ant diet. The total development time did not differ between diet groups, nor did the number of egg sacs per female or the incubation period. However, the number of eggs per egg sac and hatching success were higher on the ant diet. There was a genetic variation in several offspring traits. Our data support the hypothesis that stenophagous ant-eating E. episinoides have a metabolic specialisation on ant utilisation indicated by higher efficiency in utilising ants than fruit flies. While most individuals of E. episinoides were able to capture fruit flies, only very few spiders were able to develop and reproduce on a pure fruit fly diet, suggesting the existence of within-species genetic variation regarding the tolerance to alternative prey. Copyright © 2016 Elsevier GmbH. All rights reserved.

Writing, self-reflection, and medical school performance: the Human Context of Health Care.

PubMed

Stephens, Mark B; Reamy, Brian V; Anderson, Denise; Olsen, Cara; Hemmer, Paul A; Durning, Steven J; Auster, Simon

2012-09-01

Finding ways to improve communication and self-reflection skills is an important element of medical education and continuing professional development. This study examines the relationship between self-reflection and educational outcomes. We correlate performance in a preclinical course that focuses on self-reflection as it relates to contextual elements of patient care (Human Context of Health Care), with educational measures such as overall grade point average, clinical clerkship scores, and Medical College Admission Test (MCAT) scores. Student performance in Human Context of Health Care correlated with MCAT-Verbal scores, MCAT-writing sample scores, clerkship grades, and overall medical school grade point average (R = 0.3; p < 0.001). Writing and self-reflection skills are often neglected in undergraduate medical curricula. Our findings suggest that these skills are important and correlate with recognized long-term educational outcomes.

An Analysis of Teaching Competence in Science Teachers Involved in the Design of Context-Based Curriculum Materials

ERIC Educational Resources Information Center

De Putter-Smits, Lesley G. A.; Taconis, Ruurd; Jochems, Wim; Van Driel, Jan

2012-01-01

The committees for the current Dutch context-based innovation in secondary science education employed teachers to design context-based curriculum materials. A study on the learning of science teachers in design teams for context-based curriculum materials is presented in this paper. In a correlation study, teachers with (n = 5 and 840 students)…

Effects of classification context on categorization in natural categories.

PubMed

Hampton, James A; Dubois, Danièle; Yeh, Wenchi

2006-10-01

The patterns of classification of borderline instances of eight common taxonomic categories were examined under three different instructional conditions to test two predictions: first, that lack of a specified context contributes to vagueness in categorization, and second, that altering the purpose of classification can lead to greater or lesser dependence on similarity in classification. The instructional conditions contrasted purely pragmatic with more technical/quasi-legal contexts as purposes for classification, and these were compared with a no-context control. The measures of category vagueness were between-subjects disagreement and within-subjects consistency, and the measures of similarity-based categorization were category breadth and the correlation of instance categorization probability with mean rated typicality, independently measured in a neutral context. Contrary to predictions, none of the measures of vagueness, reliability, category breadth, or correlation with typicality were generally affected by the instructional setting as a function of pragmatic versus technical purposes. Only one subcondition, in which a situational context was implied in addition to a purposive context, produced a significant change in categorization. Further experiments demonstrated that the effect of context was not increased when participants talked their way through the task, and that a technical context did not elicit more all-or-none categorization than did a pragmatic context. These findings place an important boundary condition on the effects of instructional context on conceptual categorization.

Stoichiometric modelling of assimilatory and dissimilatory biomass utilisation in a microbial community

PubMed Central

Hunt, Kristopher A.; Jennings, Ryan deM.; Inskeep, William P.; Carlson, Ross P.

2017-01-01

Summary Assimilatory and dissimilatory utilisation of autotroph biomass by heterotrophs is a fundamental mechanism for the transfer of nutrients and energy across trophic levels. Metagenome data from a tractable, thermoacidophilic microbial community in Yellowstone National Park was used to build an in silico model to study heterotrophic utilisation of autotroph biomass using elementary flux mode analysis and flux balance analysis. Assimilatory and dissimilatory biomass utilisation was investigated using 29 forms of biomass-derived dissolved organic carbon (DOC) including individual monomer pools, individual macromolecular pools and aggregate biomass. The simulations identified ecologically competitive strategies for utilizing DOC under conditions of varying electron donor, electron acceptor or enzyme limitation. The simulated growth environment affected which form of DOC was the most competitive use of nutrients; for instance, oxygen limitation favoured utilisation of less reduced and fermentable DOC while carbon-limited environments favoured more reduced DOC. Additionally, metabolism was studied considering two encompassing metabolic strategies: simultaneous versus sequential use of DOC. Results of this study bound the transfer of nutrients and energy through microbial food webs, providing a quantitative foundation relevant to most microbial ecosystems. PMID:27387069

Tactical and operational response to major incidents: feasibility and reliability of skills assessment using novel virtual environments.

PubMed

Cohen, Daniel; Sevdalis, Nick; Patel, Vishal; Taylor, Michael; Lee, Henry; Vokes, Mick; Heys, Mick; Taylor, David; Batrick, Nicola; Darzi, Ara

2013-07-01

To determine feasibility and reliability of skills assessment in a multi-agency, triple-site major incident response exercise carried out in a virtual world environment. Skills assessment was carried out across three scenarios. The pre-hospital scenario required paramedics to triage and treat casualties at the site of an explosion. Technical skills assessment forms were developed using training syllabus competencies and national guidelines identified by pre-hospital response experts. Non-technical skills were assessed using a seven-point scale previously developed for use by pre-hospital paramedics. The two in-hospital scenarios, focusing on a trauma team leader and a silver/clinical major incident co-ordinator, utilised the validated Trauma-NOTECHS scale to assess five domains of performance. Technical competencies were assessed using an ATLS-style competency scale for the trauma scenario. For the silver scenario, the assessment document was developed using competencies described from a similar role description in a real-life hospital major incident plan. The technical and non-technical performance of all participants was assessed live by two experts in each of the three scenarios and inter-assessor reliability was computed. Participants also self-assessed their performance using identical proformas immediately after the scenarios were completed. Self and expert assessments were correlated (assessment cross-validation). Twenty-three participants underwent all scenarios and assessments. Performance assessments were feasible for both experts as well as the participants. Non-technical performance was generally scored higher than technical performance. Very good inter-rater reliability was obtained between expert raters across all scenarios and both technical and non-technical aspects of performance (reliability range 0.59-0.90, Ps<0.01). Significant positive correlations were found between self and expert assessment in technical skills across all three scenarios (correlation range 0.52-0.84, Ps<0.05), although no such correlations were observed in non-technical skills. This study establishes feasibility and reliability of virtual environment technical and non-technical skills assessment in major incident scenarios for the first time. The development for further scenarios and validated assessment scales will enable major incident planners to utilise virtual technologies for improved major incident preparation and training. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Nurses in OR are more assertive than radiographers.

PubMed

Johnson, L

1993-01-01

This study investigated two hypotheses: that there is a positive correlation between assertiveness and self-esteem, and that nurses rate lower than non-nurses on the constructs. A self-report survey incorporating scales for general assertiveness, situationally-specific assertiveness, global self-esteem and differentiated self-esteem was utilised. For the sample of 83 operating room nurses and 81 radiographers, correlations significant at the p < .001 level between the respective scales supported the first hypothesis. Analysis of variance yielded no significant differences between the two groups on either self-esteem measures or general assertiveness, with the nurses scoring significantly higher than radiographers on the situationally-specific assertiveness scale. Findings challenge the stereotype of the 'shrinking violet' nurse. Additional analysis revealed that the power component of differentiated self-esteem had a higher correlation with global self-esteem and with both assertiveness measures than any other component. Further, the operating room nurses were significantly more power-oriented than radiographers. The pre-eminence of power in the findings suggests that assertiveness and self-esteem are issues relating to the empowerment of nurses.

Inter-individual differences in serotonin and glutamate co-transmission reflect differentiation in context-induced conditioned 50-kHz USVs response after morphine withdrawal.

PubMed

Hamed, Adam; Kursa, Miron Bartosz

2018-05-17

A growing body of research provides compelling evidence that in rats 50-kHz USVs are a form of expression of positive emotions. Context-induced 50-kHz USVs emission is variable among rats, indicating individual differences in contextual response bound up with pharmacological reward. The aims of this study were to: extract the most important neurotransmitters related to context-induced conditioned 50-kHz USVs response; find biological basis of existing inter-individual differences in context-induced conditioned 50-kHz USVs response; create a model of all-to-all neurotransmitters correlations. The data collected here confirms that re-exposure to the context of morphine administration after the withdrawal period increases the level of 50-kHz USVs and this contextual response is associated with elevated serotonin concentrations in amygdala, hippocampus and mPFC and with increased Glu/Gln ratio in nucleus accumbens. The concentration of serotonin increases simultaneously in amygdala, nucleus accumbens and hippocampus. Moreover, 5-HT concentration in amygdala is bound up with glutamate level in this structure as well as in hippocampus. Furthermore, Glu/Gln ratio in nucleus accumbens has strong associations with Glu/Gln ratio simultaneously in VTA, amygdala, striatum and hippocampus. All-to-all-analysis indicate that concentration of glutamate in hippocampus is proportional to glutamate in VTA and GABA concentration in the hippocampus. We have also demonstrated that Glu/GABA ratio in VTA and amygdala was elevated after post withdrawal re-exposure to the pharmacological reward paired context. Presented analysis indicates a strong correlation between serotonergic and glutamatergic systems in context-induced conditioned response. The strength of this co-transmission correlates with the number of 50-kHz USVs emitted in response to morphine-paired context.

Association between secure patient–clinician email and clinical services utilisation in a US integrated health system: a retrospective cohort study

PubMed Central

Meng, Di; Palen, Ted E; Tsai, Joanne; McLeod, Melanie; Garrido, Terhilda; Qian, Heather

2015-01-01

Objective To assess associations between secure patient–clinician email use and clinical services utilisation over time. Design Retrospective cohort study between July 2010 and December 2013. Controlling for a utilisation surge around first secure email use, we analysed difference of differences between propensity score-matched groups of secure patient–clinician email users and non-users for utilisation 1–12 months before and 7–18 months after first email (users) or a randomly assigned index date (non-users). Setting US integrated healthcare delivery system. Participants 9345 adults with first secure email use between July 2011 and July 2012 and continuous enrolment for ≥30 months and 9345 adults without secure email use between July 2010 and July 2012 matched to users on demographics, health status, and baseline utilisation. Primary Outcome Measures Rates of office visits, patient-initiated phone calls, scheduled telephone visits, after-hours clinic visits, emergency department visits, and hospitalisations. Results After controlling for multiple factors, no statistically significant differences in utilisation between secure email users and non-users occurred. Utilisation transiently increased by 88–237% around first email use. Annual rates of patient-initiated phone calls decreased among secure email users, 0.2 fewer calls per person (95% CI −0.3 to −0.1), from a mean of 4.1 calls per person 1–12 months before first use to a mean of 3.8 calls per person 7–18 months after first use. Rates of patient-initiated phone calls also decreased among non-users, 0.1 fewer calls per person (95% CI −0.2 to 0.0), from a mean of 4.2 calls per person 1–12 months before the index date to mean of 4.1 calls per person 7–18 months after the index date. Conclusions Compared with non-users, patient use of secure email with clinicians was not associated with statistically significant differences in clinical services utilisation 7–18 months after first use. PMID:26553841

Association between secure patient-clinician email and clinical services utilisation in a US integrated health system: a retrospective cohort study.

PubMed

Meng, Di; Palen, Ted E; Tsai, Joanne; McLeod, Melanie; Garrido, Terhilda; Qian, Heather

2015-11-09

To assess associations between secure patient-clinician email use and clinical services utilisation over time. Retrospective cohort study between July 2010 and December 2013. Controlling for a utilisation surge around first secure email use, we analysed difference of differences between propensity score-matched groups of secure patient-clinician email users and non-users for utilisation 1-12 months before and 7-18 months after first email (users) or a randomly assigned index date (non-users). US integrated healthcare delivery system. 9345 adults with first secure email use between July 2011 and July 2012 and continuous enrolment for ≥30 months and 9345 adults without secure email use between July 2010 and July 2012 matched to users on demographics, health status, and baseline utilisation. Rates of office visits, patient-initiated phone calls, scheduled telephone visits, after-hours clinic visits, emergency department visits, and hospitalisations. After controlling for multiple factors, no statistically significant differences in utilisation between secure email users and non-users occurred. Utilisation transiently increased by 88-237% around first email use. Annual rates of patient-initiated phone calls decreased among secure email users, 0.2 fewer calls per person (95% CI -0.3 to -0.1), from a mean of 4.1 calls per person 1-12 months before first use to a mean of 3.8 calls per person 7-18 months after first use. Rates of patient-initiated phone calls also decreased among non-users, 0.1 fewer calls per person (95% CI -0.2 to 0.0), from a mean of 4.2 calls per person 1-12 months before the index date to mean of 4.1 calls per person 7-18 months after the index date. Compared with non-users, patient use of secure email with clinicians was not associated with statistically significant differences in clinical services utilisation 7-18 months after first use. 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/

Can correlations among receptors affect the information about the stimulus?

NASA Astrophysics Data System (ADS)

Singh, Vijay; Tchernookov, Martin; Nemenman, Ilya

2014-03-01

In the context of neural information processing, it has been observed that, compared to the case of independent receptors, correlated receptors can often carry more information about the stimulus. We explore similar ideas in the context of molecular information processing, analyzing a cell with receptors whose activity is intrinsically negatively correlated because they compete for the same ligand molecules. We show analytically that, in case the involved biochemical interactions are linear, the information between the number of molecules captured by the receptors and the ligand concentration does not depend on correlations among the receptors. For a nonlinear kinetic network, correlations similarly do not change the amount of information for observation times much shorter or much longer than the characteristic time scale of ligand molecule binding and unbinding. However, at intermediate times, correlations can increase the amount of available information. This work has been supported by the James S McDonnell foundation.

Les conseils des cliniciens canadiens en matière de commotion dans le sport sont-ils cohérents?

PubMed Central

Carson, James D.; Rendely, Alexandra; Garel, Alisha; Meaney, Christopher; Stoller, Jacqueline; Kaicker, Jatin; Hayden, Leigh; Moineddin, Rahim; Frémont, Pierre

2016-01-01

Résumé Objectif Comparer les connaissances et l’utilisation des recommandations concernant la prise en charge de la commotion dans le sport (CDS) démontrées par les spécialistes de la médecine du sport et de l’exercice (SMSE) et les urgentologues afin d’évaluer la réussite du transfert des connaissances sur la CDS au Canada. Conception Un sondage à choix multiples envoyé par courriel et autoadministré par des SMSE et des urgentologues. La validité du contenu du sondage a fait l’objet d’une évaluation. Contexte Canada. Participants Le sondage a été complété entre mai et juillet 2012 par des SMSE qui ont réussi l’examen menant au diplôme de l’Académie canadienne de la médecine du sport et de l’exercice et des urgentologues qui n’avaient pas ce diplôme. Principaux paramètres à l’étude La connaissance et l’identification des sources d’information sur la prise en charge des commotions, l’utilisation des stratégies de diagnostic de la commotion et l’utilisation d’une terminologie courante et cohérente dans l’explication des stratégies de repos aux patients après une CDS. Résultats Le taux de réponse était de 28 % (305 sur 1085). Les taux de réponse par les SMSE et les urgentologues se situaient respectivement à 41 % (147 sur 360) et 22 % (158 sur 725). Parmi les répondants, 41 % des urgentologues et 3 % des SMSE n’étaient pas au courant de l’existence de déclarations consensuelles sur la commotion dans le sport; 74 % des SMSE utilisaient « habituellement ou toujours » la version 2 de l’Outil d’évaluation de la commotion dans le sport (SCAT2), tandis que 88 % des urgentologues n’utilisaient jamais le SCAT2. Aucune réponse uniforme n’a été documentée à la question visant à connaître les meilleurs modes de repos cognitif. Conclusion Nous avons cerné des différences et un manque d’uniformité chez les SMSE et les urgentologues dans la mise en application des recommandations concernant les patients ayant subi une CDS. Il semble que le SCAT2 soit davantage utilisé dans le milieu des SMSE que dans le contexte de l’urgence. Des efforts plus poussés de transfert des connaissances et en recherche devraient atténuer les obstacles à des conseils plus uniformes donnés par les médecins qui soignent des patients ayant subi une CDS.

Conception et calibration d'un sonoreacteur pour l'oxydation de la cellulose par le systeme TEMPO/NaOCl/NaBr

NASA Astrophysics Data System (ADS)

Paquin, Michel

Avec le contexte economique actuel dans le domaine des pates et papiers au Canada, l'industrie se doit de diversifier ses produits mis en marche. La fermeture de plus de 20 usines depuis 2005, une baisse du PIB de l'industrie de 1,4 milliard CAD entre 1999--2008, une baisse de la demande de 2,4 %, une diminution du prix de la pate de 20,9 % depuis juillet 2009. La delocalisation du secteur vers l'Asie et l'hemisphere sud sont autant de raisons pour laquelle l'industrie se doit d'etre a l'avant plan de nouvelle technologie a base de fibre de bois. Pour augmenter leur rentabilite, l'industrie se doit de diversifier ses produits dans d'autres secteurs que le simple fabricant de papier impression-ecriture. Sa diversification passe par l'elaboration de nouveaux papiers a valeur ajoutee (papier conducteur, papier bioactif, etc.), par l'utilisation de la biomasse forestiere pour la production d'energie, par l'utilisation de la biomasse forestiere pour l'elaboration d'une plateforme de chimie verte, par l'utilisation de la lignine pour le developpement de polymeres et par l'utilisation de la fibre cellulosique pour la fabrication de nanomateriaux. La fabrication de nanofibrille de cellulose peut devenir un des produits qui servira a diversifier la production des usines de pates et papiers. Les nanofibrilles de cellulose possedent des proprietes mecaniques et chimiques exceptionnelles. Les nanofibrilles de cellulose sont fabriquees a partir d'une oxydation selective de la pate kraft de feuillu avec le systeme TEMPO-NaOCl-NaBr. L'oxydation selective de l'alcool primaire en C6 du monomere de glucose sous forme de carboxylates engendre une modification chimique de la cellulose qui accroit l'hydrophilicite des fibrilles. Suite a cette oxydation, nous devons effectuer une desintegration mecanique de la fibre kraft de feuillu oxydee pour separer les fibrilles. Le processus d'oxydation de la fibre par le systeme TEMPO-NaOCl-NaBr et sa defibrillation par la suite engendre une grande consommation d'energie et de reactif qui rend le procede difficilement accessible au milieu industriel. L'utilisation des ultrasons lors de la reaction d'oxydation permet de reduire de 50% le temps de reaction et d'autant la consommation de produits chimiques. Actuellement le processus d'oxydation s'effectue en mode discontinu pour une quantite de 20 grammes de pate dans un reacteur en verre dans un bain a ultrason. L'objectif principal de ce travail est d'elaborer un sonoreacteur en mode semi-continu afin d'etre en mesure de transferer une reaction d'oxydation du mode discontinu en mode semi-continu. Le transfert de reaction sera effectue en realisant la calibration de l'activite acoustique des deux differents reacteurs, discontinu et semi-continu, par la methode de Weissler. La methode de Weissler quantifie le taux de production radicalaire en mesurant la formation d'iode moleculaire d'une solution aqueuse d'iodure de potassium sous ultrason. Suite a sa calibration, le sonoreacteur pilote (mode semi-continu) a demontre une augmentation de la production radicalaire de 683 % a 170 kHz en comparaison avec l'utilisation d'un bain a ultrason a la meme frequence. Lors de la reaction d'oxydation, la puissance optimale utilisee dans le bain a ultrason a 170 kHz est de 1000 W. La puissance utilisee selon les resultats de calibration obtenue dans le sonoreacteur pilote est de 125 W soit une diminution de l'energie appliquee de 87,5 %. Lors de la reaction d'oxydation, le taux de production des groupements carboxylates est de 2,6 mmol COOH kg/min dans le bain a ultrason et de 6,87 mmol COOH kg/min dans le sonoreacteur pilote soit une augmentation de 164% du taux de formation. Selon les resultats obtenus, l'utilisation d'un sonoreacteur en mode continu peut etre envisageable pour la reaction d'oxydation de la cellulose par le systeme TEMPO-NaOCl-NaBr en industrie au niveau industriel.

Emergency Braking of a Mine Hoist in the Context of the Braking System Selection

NASA Astrophysics Data System (ADS)

Wolny, Stanisław

2017-03-01

The paper addresses the selected aspects of the dynamic behaviour of mine hoists during the emergency braking phase. Basing on the model of the hoist and supported by theoretical backgrounds provided by the author (Wolny, 2016), analytical formulas are derived to determine the parameters of the braking system such that during an emergency braking it should guarantee that: - the maximal loading of the hoisting ropes should not exceed the rope breaking force, - deceleration of the conveyances being stopped should not exceed the admissible levels Results of the dynamic analysis of the mine hoist behaviour during an emergency braking phase summarised in this study can be utilised to support the design of conveyance and rope attachments by the fatigue endurance methods, with an aim to adapt it to the specified operational parameters of the hoisting installation (Eurokod 3).

An Auxiliary Gas Supply to Improve Safety During Aborted Dives with the Canadian Underwater Mine Countermeasures Apparatus (CUMA) (Un Systeme Auxiliaire D’approvisionnement en gaz Augmente la Securite des Plongeurs Utilisant L’appareil Canadien de Deminage Sous-marin (ACDSM) lors des Remontees D’urgence)

DTIC Science & Technology

2010-11-01

Des expériences de validation ont été menées de juin 2002 à novembre 2003, au cours de quatre séries de plongées. Les données consignées par...Eaton; A.J. Ward; D.J. Woodward; DRDC Toronto TR 2010-081; R & D pour la défense Canada – Toronto; Novembre 2010. Introduction ou contexte: L’appareil...semaines, qui ont eu lieu de juin 2002 à novembre 2003. Un contrôle Doppler des participants aux fins de décompression et l’analyse continue des gaz

The value of life in English law: revered but not sacred?

PubMed

Heywood, Rob; Mullock, Alexandra

2016-12-01

Terms such as sanctity and inviolability have failed to provide a legally coherent or ethically sound principle upon which to determine the scope of the intrinsic value of life against extrinsic , quality-of-life considerations in a medical context . In their recent work , Margaret Brazier and Suzanne Ost introduce a new term , reverence for life, which they suggest may be more appropriate when attempting to navigate the murky waters of the meaning of life and the value that should be attached to it . They suggest that reverence should be utilised as an alternative that better reflects the nuances and the realities of the dilemma . This paper explores the existing difficulties before considering how the principle of reverence might provide a principled compromise over when the presumption in favour of preserving life should be rebutted .

Complex clinical reasoning in the critical care unit - difficulties, pitfalls and adaptive strategies.

PubMed

Shaw, M; Singh, S

2015-04-01

Diagnostic error has implications for both clinical outcome and resource utilisation, and may often be traced to impaired data gathering, processing or synthesis because of the influence of cognitive bias. Factors inherent to the intensive/acute care environment afford multiple additional opportunities for such errors to occur. This article illustrates many of these with reference to a case encountered on our intensive care unit. Strategies to improve completeness of data gathering, processing and synthesis in the acute care environment are critically appraised in the context of early detection and amelioration of cognitive bias. These include reflection, targeted simulation training and the integration of social media and IT based aids in complex diagnostic processes. A framework which can be quickly and easily employed in a variety of clinical environments is then presented. © 2015 John Wiley & Sons Ltd.

La prévention des infections par le virus respiratoire syncytial

PubMed Central

Robinson, JL

2011-01-01

RÉSUMÉ L’infection par le virus respiratoire syncytial (VRS) est la principale cause d’infections des voies respiratoires inférieures chez les jeunes enfants. Le palivizumab, un anticorps monoclonal anti-VRS, réduit le taux d’hospitalisation des enfants à haut risque mais est très coûteux. Le présent document de principes remplace les trois précédents documents de principes de la Société canadienne de pédiatrie sur le sujet et est mis à jour principalement pour traiter des récentes modifications aux lignes directrices de l’American Academy of Pediatrics dans le contexte canadien. Il contient une analyse des publications ainsi que des recommandations au sujet de l’utilisation du palivizumab chez les enfants à haut risque

Morphogenesis and evolution of vertebrate appendicular muscle

PubMed Central

HAINES, LYNN; CURRIE, PETER D.

2001-01-01

Two different modes are utilised by vertebrate species to generate the appendicular muscle present within fins and limbs. Primitive Chondricthyan or cartilaginous fishes use a primitive mode of muscle formation to generate the muscle of the fins. Direct epithelial myotomal extensions invade the fin and generate the fin muscles while remaining in contact with the myotome. Embryos of amniotes such as chick and mouse use a similar mechanism to that deployed in the bony teleost species, zebrafish. Migratory mesenchymal myoblasts delaminate from fin/limb level somites, migrate to the fin/limb field and differentiate entirely within the context of the fin/limb bud. Migratory fin and limb myoblasts express identical genes suggesting that they possess both morphogenetic and molecular identity. We conclude that the mechanisms controlling tetrapod limb muscle formation arose prior to the Sarcopterygian or tetrapod radiation. PMID:11523824

Does hospital competition harm equity? Evidence from the English National Health Service.

PubMed

Cookson, Richard; Laudicella, Mauro; Li Donni, Paolo

2013-03-01

Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market competition and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity. Copyright © 2012 Elsevier B.V. All rights reserved.

Deep learning for staging liver fibrosis on CT: a pilot study.

PubMed

Yasaka, Koichiro; Akai, Hiroyuki; Kunimatsu, Akira; Abe, Osamu; Kiryu, Shigeru

2018-05-14

To investigate whether liver fibrosis can be staged by deep learning techniques based on CT images. This clinical retrospective study, approved by our institutional review board, included 496 CT examinations of 286 patients who underwent dynamic contrast-enhanced CT for evaluations of the liver and for whom histopathological information regarding liver fibrosis stage was available. The 396 portal phase images with age and sex data of patients (F0/F1/F2/F3/F4 = 113/36/56/66/125) were used for training a deep convolutional neural network (DCNN); the data for the other 100 (F0/F1/F2/F3/F4 = 29/9/14/16/32) were utilised for testing the trained network, with the histopathological fibrosis stage used as reference. To improve robustness, additional images for training data were generated by rotating or parallel shifting the images, or adding Gaussian noise. Supervised training was used to minimise the difference between the liver fibrosis stage and the fibrosis score obtained from deep learning based on CT images (F DLCT score) output by the model. Testing data were input into the trained DCNNs to evaluate their performance. The F DLCT scores showed a significant correlation with liver fibrosis stage (Spearman's correlation coefficient = 0.48, p < 0.001). The areas under the receiver operating characteristic curves (with 95% confidence intervals) for diagnosing significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4) by using F DLCT scores were 0.74 (0.64-0.85), 0.76 (0.66-0.85) and 0.73 (0.62-0.84), respectively. Liver fibrosis can be staged by using a deep learning model based on CT images, with moderate performance. • Liver fibrosis can be staged by a deep learning model based on magnified CT images including the liver surface, with moderate performance. • Scores from a trained deep learning model showed moderate correlation with histopathological liver fibrosis staging. • Further improvement are necessary before utilisation in clinical settings.

A comparison of the nature and correlates of panic attacks in the context of Panic Disorder and Social Anxiety Disorder.

PubMed

Brown, Lily A; LeBeau, Richard; Liao, Betty; Niles, Andrea N; Glenn, Daniel; Craske, Michelle G

2016-01-30

Panic attacks occurring outside of Panic Disorder are not well-understood despite their inclusion as a diagnostic specifier in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). This study compares panic attacks in the context of Panic Disorder compared to social anxiety in terms of their symptom frequency, severity, and clinical correlates. Participants (n=404) were interviewed using the Anxiety Disorders Interview Schedule (ADIS-IV-L; Brown et al., 1994), from which we analyzed interviewer ratings of panic attacks and panic attack symptoms, as well as other demographic and clinical characteristics. Panic attacks in the context of Panic Disorder were characterized by a greater number and severity of symptoms compared to panic attacks in the context of Social Anxiety Disorder, and were associated with a history of traumatization, inpatient psychiatric treatment, and benzodiazepine use. Social anxiety panic attacks were associated with reduced physical health concerns. Cognitive panic attack symptoms were more prevalent in Panic Disorder and were associated with a variety of poor clinical correlates. Panic attacks in the context of Panic Disorder are more severe than those in social anxiety, and this may be driven by cognitive disturbances during those attacks. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Mental health, social inclusion and the green agenda: an evaluation of a land based rehabilitation project designed to promote occupational access and inclusion of service users in North Somerset, UK.

PubMed

Stepney, Paul; Davis, Paul

2004-01-01

The current debate about social inclusion in the field of mental health reveals a tension between the political and economic objectives of social policy. The former utilises the language of citizen empowerment and rights, whilst the latter is concerned with reducing welfare dependency through labour market activation. A central question here is whether a suitable programme of therapeutic work, training and support will produce better outcomes than those predicted by either a clinical diagnostic assessment or indeed open employment in the labour market. This article evaluates a research project with mental health users designed to develop pathways towards inclusion. The principal means for achieving this was a programme of 'green' land-based activities, training and social support. The researchers employed a mixed method approach, utilising a quasi-experimental design with a hypothetical control and standardised testing. This was followed by interviews with users, staff and focus group discussion. The evaluation produced some unexpected findings; for example, it was found that no strong correlation existed between diagnosis and performance. Many users performed better than had been predicted by their diagnostic assessment. However, the reasons for this remained unclear until the qualitative interviews enabled users to give accounts of the problems they faced, explain what inclusion meant for them, and outline how the project had brought gains in confidence, motivation and self belief. The data gathered during the research derived from different epistemological positions. This can be seen as representing two ways of 'slicing the reality cake' rather than producing one complete view of mental health users reality. One construction related to how 'the system' diagnosed, processed, and 'objectively' managed them. The other was about how users' responded to their situation, utilised the opportunities available, and made 'subjective' sense of their experience.

Prevalence and predictors of female genital mutilation among infants in a semi urban community in northern Nigeria.

PubMed

Ashimi, Adewale O; Amole, Taiwo G; Iliyasu, Zubairu

2015-12-01

To determine the prevalence, predictors, of female genital mutilation (FGM) among infants and ascertain if their mothers knew what was done to them in Birnin Kudu northern Nigeria. Cross sectional study which utilised a pretested interviewer administered semi-structured questionnaire to assess occurrence of FGM with physical examination of the infants. Logistic regression analysis was used to assess the relative effect of determinants, after adjusting for other predictor variables. Of the 450 infants, 215(47.8%) (95% Confidence Interval [CI]: 43.1%-52.5%) had experienced one form of FGM. The ages at genital mutilation ranged from 1 to 50 days with a median of 4 days and interquartile range of 7 days. Maternal occupation, education and religion and type of facility accessed were significantly associated with occurrence of FGM in infants (p ≤ 0.05). After controlling for confounders, having a mother without formal education [AOR = 6.39 and 95% CI = 3.99-10.23] (p = 0.001) and one who was employed [Adjusted odds ratio (AOR) = 2.89 and 95% CI = 1.66-5.03] (p = 0.001) increased the likelihood of infant FGM remarkably while utilising tertiary institution for health care reduced the risk by about half [AOR = 0.49 and 95% CI = 0.26-0.92] (p = 0.03). Of the 215 infants that had undergone FGM, there was correlation between the reported and the observed forms of FGM in 16 (7.4%) of the cases. The prevalence of FGM is high with mothers' educational status, type of health facility utilised and occupational status being predictors of FGM among infants in Birnin Kudu. Majority of the mothers are not aware of what was done. Strategies aimed at discouraging this dangerous practice in the community should include female education, involvement of the men as husbands, fathers, traditional and religious leaders. Copyright © 2015 Elsevier B.V. All rights reserved.

Effective coverage of primary care services in eight high-mortality countries

PubMed Central

Malata, Address; Ndiaye, Youssoupha; Kruk, Margaret E

2017-01-01

Introduction Measurement of effective coverage (quality-corrected coverage) of essential health services is critical to monitoring progress towards the Sustainable Development Goal for health. We combine facility and household surveys from eight low-income and middle-income countries to examine effective coverage of maternal and child health services. Methods We developed indices of essential clinical actions for antenatal care, family planning and care for sick children from existing guidelines and used data from direct observations of clinical visits conducted in Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda between 2007 and 2015 to measure quality of care delivered. We calculated healthcare coverage for each service from nationally representative household surveys and combined quality with utilisation estimates at the subnational level to quantify effective coverage. Results Health facility and household surveys yielded over 40 000 direct clinical observations and over 100 000 individual reports of healthcare utilisation. Coverage varied between services, with much greater use of any antenatal care than family planning or sick-child care, as well as within countries. Quality of care was poor, with few regions demonstrating more than 60% average performance of basic clinical practices in any service. Effective coverage across all eight countries averaged 28% for antenatal care, 26% for family planning and 21% for sick-child care. Coverage and quality were not strongly correlated at the subnational level; effective coverage varied by as much as 20% between regions within a country. Conclusion Effective coverage of three primary care services for women and children in eight countries was substantially lower than crude service coverage due to major deficiencies in care quality. Better performing regions can serve as examples for improvement. Systematic increases in the quality of care delivered—not just utilisation gains—will be necessary to progress towards truly beneficial universal health coverage. PMID:29632704

L’investigation de la contusion myocardique pour la fracture sternale à l’urgence

PubMed Central

Audette, Jean-Sébastien; Émond, Marcel; Scott, Hugh; Lortie, Gilles

2014-01-01

Résumé Objectif Décrire la pratique d’acquisition d’un électrocardiogramme (ECG) initial, d’ECG de contrôle ou d’un monitoring équivalent et du dosage des troponines chez les patients avec une fracture sternale évalués au département d’urgence ou par un médecin de première ligne. Type d’étude Étude rétrospective descriptive multicentrique. Contexte Deux centres académiques de traumatologie de la région de Québec au Canada. Participants 54 patients ayant subi une fracture sternale traumatique. Interventions Évaluation de l’acquisition d’ECG initial et à 6 heures post-traumatisme ou un monitoring équivalent ainsi que le dosage des troponines sanguines. Principaux paramètres à l’étude En ce qui concerne l’ECG, les critères de comparaison de qualité furent sélectionnés à partir d’opinions d’experts rapportées dans quatre études. L’utilisation d’un ECG initial et de contrôle 6 heures post-traumatisme ou d’un monitoring cardiaque de 6 heures représente la pratique recommandée par la plupart de ceux-ci pour le diagnostic de la contusion myocardique dans la fracture sternale. L’utilisation des troponines I sanguines, 4 à 8 heures suivant un traumatisme thoracique, a également été proposée par certains auteurs comme méthode de détection efficace des arythmies significatives secondaires à la contusion myocardique. Des analyses descriptives univariées et des tests de chi-carré furent effectués. Une valeur P < ,05 fut considérée significative. Résultats Trente-neuf (72 %) patients ont été évalués initialement avec un ECG, tandis que 18 (33 %) de ces patients ont eu une évaluation par ECG ou monitoring cardiaque après 6 heures à l’urgence. Seize patients (30 %) ont été évalués à l’aide du dosage des troponines I. Deux patients (4 %) ont présenté des anomalies électrocardiographiques et un seul patient (2 %) a présenté des troponines I élevées. Conclusion Les urgentologues doivent augmenter leur utilisation de l’ECG comme outil diagnostic initial et de contrôle pour les patients ayant subi une fracture sternale traumatique afin de détecter la contusion myocardique et l’arythmie. L’utilisation de la troponinémie, de concert avec l’ECG, est également suggérée dans cette population pour l’identification des patients à risque de complications secondaires à leur contusion myocardique.

Utilisation of Used Palm Oil as an Alternative Fuel in Thailand

NASA Astrophysics Data System (ADS)

Permchart, W.; Tanatvanit, S.

2007-10-01

This paper summarises the overview of the current situation of alternative energies in Thailand. The utilisation of bio-diesel as an alternative energy in two economic sectors (i.e. transport and industrial sectors), which have the largest energy consumption in the country, is mainly presented because it has seemed to be the most promising project among various energy conservation projects of the Thai government. Actually, there is another bio-fuel project, namely, the ethanol project for blending with gasoline to produce gasohol (E10) used in gasoline engines, which has been developed and already become to an important policy for energy conservation of the country. Due to much more large number of diesel has been utilised, the bio-diesel project has been the first priority one to solve the petroleum crisis problems. However, it is remarked that the utilisation of bio-diesel as an alternative fuel seems to be unsatisfactory because of various reasons. Some issues in terms of both government policies and technical problems have not been clearly addressed. Therefore, this paper not only presents the utilisation of bio-diesel in these two sectors but also discusses the production processes, characterisations and some experimental testing results of bio-diesel.

ICT and OTs: a model of information and communication technology acceptance and utilisation by occupational therapists.

PubMed

Schaper, Louise K; Pervan, Graham P

2007-06-01

There is evidence to suggest that health professionals are reluctant to accept and utilise information and communication technologies (ICT) and concern is growing within health informatics research that this is contributing to the lag in adoption and utilisation of ICT across the health sector. Technology acceptance research within the field of information systems has been limited in its application to health and there is a concurrent need to develop and gain empirical support for models of technology acceptance within health and to examine acceptance and utilisation issues amongst health professionals to improve the success of information system implementation in this arena. This paper outlines a project that examines ICT acceptance and utilisation by Australian occupational therapists. It describes the theoretical basis behind the development of a research model and the methodology being employed to empirically validate the model using substantial quantitative, qualitative and longitudinal data. Preliminary results from Phase II of the study are presented. The theoretical significance of this work is that it uses a thoroughly constructed research model, with potentially the largest sample size ever tested, to extend technology acceptance research into the health sector.

[Day hospitals--predictors for utilisation and quality expectations from the perspective of family caregivers of dementia patients].

PubMed

Donath, Carolin; Bleich, Stefan; Grässel, Elmar

2009-05-01

To relieve the burden on family caregivers of dementia patients, the utilisation of day hospitals should be increased. Therefore, the predictive variables for utilisation as well as family caregivers' views regarding the quality of day hospitals must be investigated. The cross-sectional study was carried out as an anonymous, written survey of family caregivers of dementia patients in four regions of Germany. Quantitative and qualitative data from 404 family caregivers was analysed using binary logistic regression analysis and qualitative content analysis, respectively. In addition, 11 day hospital managers were interviewed concerning their quality concepts. The only significant predictor for the utilisation of day hospitals is the estimate of how helpful this support is for the family caregiver's situation. Those who have already had experiences with a day hospital expressed a wish for medical and psychiatric care by "well-trained" staff and a reasonable form of occupation for the dementia patient. In order to increase utilisation, family caregivers must be convinced of the advantages of using day hospitals. A day hospital that combines both activating occupational therapy and medical care by well-trained staff is what family caregivers wish most for their care-receivers.

Determinants of utilisation of intrapartum obstetric care services in Cambodia, and gaps in coverage.

PubMed

Chomat, Anne Marie; Grundy, John; Oum, Sophal; Bermudez, Odilia I

2011-01-01

Facility delivery and skilled birth attendance are two of the most effective strategies for decreasing maternal mortality. The objectives of this study were to further define utilisation of these services in Cambodia and to uncover socio-economic or location-specific coverage gaps that may exist. We performed a cross-sectional analysis of the 2005 Cambodia Demographic Health Survey (CDHS) to determine prevalence, and determinants, of service utilisation. Out of 6069 women aged 15-49 years, 77% delivered at home, three-fourths without a skilled birth attendant. Poverty, lower education and rural residence were associated with the highest likelihood of poor utilisation of services. Discussion. While there has been an overall increase in facility deliveries and skilled birth attendance since 2000, improvements have been spread unevenly across the population, benefiting mostly urban, wealthier and better educated women. While recent financing initiatives and health system developments appear to have further increased service utilisation since 2005, the extent of their reach to the most vulnerable populations, and their ultimate impact on maternal mortality reduction, remain to be elucidated. Further expanding successful initiatives, particularly among vulnerable populations, is essential. Longitudinal evaluation of ongoing strategies and their impact remains critical.

A MAD Explanation for the Correlation between Bulk Lorentz Factor and Minimum Variability Timescale

NASA Astrophysics Data System (ADS)

Lloyd-Ronning, Nicole; Lei, Wei-hua; Xie, Wei

2018-04-01

We offer an explanation for the anti-correlation between the minimum variability timescale (MTS) in the prompt emission light curve of gamma-ray bursts (GRBs) and the estimated bulk Lorentz factor of these GRBs, in the context of a magnetically arrested disk (MAD) model. In particular, we show that previously derived limits on the maximum available energy per baryon in a Blandford-Znajek jet leads to a relationship between the characteristic MAD timescale in GRBs and the maximum bulk Lorentz factor: tMAD∝Γ-6, somewhat steeper than (although within the error bars of) the fitted relationship found in the GRB data. Similarly, the MAD model also naturally accounts for the observed anti-correlation between MTS and gamma-ray luminosity L in the GRB data, and we estimate the accretion rates of the GRB disk (given these luminosities) in the context of this model. Both of these correlations (MTS - Γ and MTS - L) are also observed in the AGN data, and we discuss the implications of our results in the context of both GRB and blazar systems.

A model of the pre-assessment learning effects of assessment is operational in an undergraduate clinical context

PubMed Central

2012-01-01

Background No validated model exists to explain the learning effects of assessment, a problem when designing and researching assessment for learning. We recently developed a model explaining the pre-assessment learning effects of summative assessment in a theory teaching context. The challenge now is to validate this model. The purpose of this study was to explore whether the model was operational in a clinical context as a first step in this process. Methods Given the complexity of the model, we adopted a qualitative approach. Data from in-depth interviews with eighteen medical students were subject to content analysis. We utilised a code book developed previously using grounded theory. During analysis, we remained alert to data that might not conform to the coding framework and open to the possibility of deploying inductive coding. Ethical clearance and informed consent were obtained. Results The three components of the model i.e., assessment factors, mechanism factors and learning effects were all evident in the clinical context. Associations between these components could all be explained by the model. Interaction with preceptors was identified as a new subcomponent of assessment factors. The model could explain the interrelationships of the three facets of this subcomponent i.e., regular accountability, personal consequences and emotional valence of the learning environment, with previously described components of the model. Conclusions The model could be utilized to analyse and explain observations in an assessment context different to that from which it was derived. In the clinical setting, the (negative) influence of preceptors on student learning was particularly prominent. In this setting, learning effects resulted not only from the high-stakes nature of summative assessment but also from personal stakes, e.g. for esteem and agency. The results suggest that to influence student learning, consequences should accrue from assessment that are immediate, concrete and substantial. The model could have utility as a planning or diagnostic tool in practice and research settings. PMID:22420839

Antenatal Care Utilisation and Content between Low-Risk and High-Risk Pregnant Women

PubMed Central

Yeoh, Ping Ling; Hornetz, Klaus; Dahlui, Maznah

2016-01-01

Background The purpose of antenatal care is to monitor and improve the wellbeing of the mother and foetus. The World Health Organization recommends risk-oriented strategy that includes: (i) routine care to all women, (ii) additional care for women with moderately severe diseases and complications, (iii) specialised obstetrical and neonatal care for women with severe diseases and complications. Antenatal care is concerned with adequate care in order to be effective. Measurement for adequacy of antenatal care often applies indexes that assess initiation of care and number of visits. In addition, adequacy of care content should also be assessed. Results of studies in developed settings demonstrate that women without risk factors use antenatal services more frequently than recommended. Such over-utilisation is problematic for low-resourced settings. Moreover, studies show that a substantial proportion of high-risk women had utilisation or content of care below the recommended standard. Yet studies in developing countries have seldom included a comparison between low-risk and high-risk women. The purpose of the study was therefore to assess adequacy of care and pregnancy outcomes for the different risk groups. Methods A retrospective study using a multistage sampling technique, at public-funded primary health care clinics was conducted. Antenatal utilisation level was assessed using a modified Adequacy of Prenatal Care Utilisation index that measures the timing for initiation of care and observed-to-expected visits ratio. Adequacy of antenatal care content assessed compliance to routine care based on the local guidelines. Results Intensive or “adequate-plus” antenatal care utilisation as defined by the modified index was noted in over half of the low-risk women. On the other hand, there were 26% of the high-risk women without the expected intensive utilisation. Primary- or non-educated high-risk women were less likely to have a higher antenatal care utilisation level compared with tertiary educated ones (OR = 0.20, P = 0.003). Half of all women had <80% of the recommended antenatal care content. A higher proportion of high-risk than low-risk women scored <80% of the routine care content (p<0.015). The majority of the additional laboratory tests were performed on high-risk women. Provision of antenatal education showed comparatively poor compliance to guidelines, more than half of the antenatal advice topics assessed were rarely provided to the women. High-risk women were associated with a higher prevalence of adverse pregnancy outcome. Conclusions Disproportionate utilisation of antenatal care according to risk level of pregnancy indicates the need for better scheduling of care. The risk-oriented approach often results in a tendency to focus on the risk conditions of the women. Training interventions are recommended to improve communication and to help healthcare professionals understand the priorities of the women. Further studies are required to assess the reason for disproportionate utilisation of antenatal care according to risk level and how delivery of antenatal advice can be improved, reviewing both user and provider perspectives. PMID:27010482

Hospital emergency department utilisation rates among the immigrant population in Barcelona, Spain

PubMed Central

Buron, Andrea; Cots, Francesc; Garcia, Oscar; Vall, Oriol; Castells, Xavier

2008-01-01

Background The recent increase in the number of immigrants of Barcelona represents a challenge for the public healthcare system, the emergency department being the most used healthcare service by this group. However, utilisation rates in our environment have not yet been studied. We aimed to compare emergency department utilisation rates between Spanish-born and foreign-born residents in a public hospital of Barcelona. Methods The study population included all adults residing in the area of study and visiting the emergency department of Hospital del Mar in 2004. The emergency care episodes were selected from the Emergency Department register, and the population figures from the Statistics Department of Barcelona. Emergency care episodes were classified into five large clinical categories. Adjusted rate ratios (RR) of utilisation among foreign-born vs. Spanish-born residents were assessed through negative binomial regression. Results The overall utilisation rate was 382 emergency contacts per 1,000 persons-years. The RR for foreign-born versus Spanish-born residents was 0.62 (95% CI: 0.52; 0.74%). The RR was also significantly below one in surgery (0.51, 95% CI: 0.42; 0.63), traumatology (0.47, 95% CI: 0.38; 0.59), medicine (0.48, 95% CI: 0.38; 0.59) and psychiatry (0.42, 95% CI: 0.18; 0.97). No differences were found in utilisation of gynaecology and minor emergency services. Conclusion The overall lower utilisation rates obtained for foreign-born residents is consistent with previous studies and is probably due to the "healthy immigrant effect". Thus, the population increase due to immigration does not translate directly into a corresponding increase in the number of emergency contacts. The lack of differences in minor and gynaecological emergency care supports the hypothesis that immigrants overcome certain barriers by using the emergency department to access to health services. The issue of healthcare barriers should therefore be addressed, especially among immigrants. PMID:18315871

The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures.

PubMed

Page, Piers R J; Trickett, Ryan W; Rahman, Shakeel M; Walters, Angharad; Pinder, Leila M; Brooks, Caroline J; Hutchings, Hayley; Pallister, Ian

2015-07-01

Severe open fractures of the lower limbs are complex injuries requiring expert multidisciplinary management in appropriate orthoplastic centres. This study aimed to assess the impact of open fractures on healthcare utilisation and test the null hypotheses that there is no difference in healthcare utilisation between the year before and year after injury, and that there is no difference in healthcare utilisation in the year post-injury between patients admitted directly to an orthoplastic centre in keeping with the joint BOA/BAPRAS standards and those having initial surgery elsewhere. This retrospective cohort study utilising secure anonymised information linkage (SAIL), a novel databank of anonymised nationally pooled health records, recruited patients over 18 years of age sustaining severe open lower limb fractures managed primarily or secondarily at our centre and who had data available in the SAIL databank. 101 patients met inclusion criteria and 90 of these had records in the SAIL databank. The number of days in hospital, number of primary care attendances, number of outpatient attendances and number of emergency department attendances in the years prior and subsequent to injury were recorded. Patients sustaining open fractures had significantly different healthcare utilisation in the year after injury when compared with the year before, in terms of days spent in hospital (23.42 vs. 1.70, p=0.000), outpatient attendances (11.98 vs. 1.05, p=0.000), primary care attendances (29.48 vs. 11.99, p=0.000) and emergency department presentations (0.2 vs. 0.01, p=0.025). Patients admitted directly to orthoplastic centres had significantly fewer operations (1.78 vs. 3.31) and GP attendances (23.6 vs. 33.52) than those transferred in subsequent to initial management in other units. There is a significant increase in healthcare utilisation after open tibial fracture. Adherence to national standards minimises the impact of this on both patients and health services. Copyright © 2015 Elsevier Ltd. All rights reserved.

Utilisation of hepatocellular carcinoma screening in Australians at risk of hepatitis B virus-related carcinoma and prescribed anti-viral therapy.

PubMed

Sheppard-Law, Suzanne; Zablotska-Manos, Iryna; Kermeen, Melissa; Holdaway, Susan; Lee, Alice; George, Jacob; Zekry, Amany; Maher, Lisa

2018-07-01

To investigate hepatocellular carcinoma screening utilisation and factors associated with utilisation among patients prescribed hepatitis B virus anti-viral therapy and at risk of hepatocellular carcinoma. The incidence of hepatocellular carcinoma has increased in Australia over the past three decades with chronic hepatitis B virus infection a major contributor. hepatocellular carcinoma surveillance programs aim to detect cancers early enabling curative treatment options, longer survival and longer times to recurrence. Multi-site cross-sectional survey. An online study questionnaire was administered to eligible participants attending three Sydney tertiary hospitals. Data were grouped into six mutually exclusive hepatocellular carcinoma risk factor categories as per American Association for the Study of Liver Diseases guidelines. All analyses were undertaken in STATA. Logistic regression was used to assess the associations between covariates and screening utilisation. Multivariate models described were assessed using the Hosmer-Lemeshow goodness of fit. Of the 177 participants, 137 (77.4%) self-reported that US had been performed in the last six months. Awareness that screening should be performed and knowing the correct frequency of US screening were independently associated with screening utilisation. Participants who knew that screening should be undertaken were three times more likely to have had pretreatment education or were prescribed hepatitis B virus anti-viral treatment for >4 years. Participants reporting a family history of hepatocellular carcinoma were less likely to know that screening should be undertaken every 6 months. While utilisation of hepatocellular carcinoma surveillance programs was higher in this study than in previous reports, strategies to further improve surveillance remain necessary. Findings from this research form the basis for proposing strategies to improve utilisation of hepatocellular carcinoma screening, inform hepatitis B virus-related clinical practice and for the delivery of care and nursing education to people receiving hepatitis B virus anti-viral therapy and at risk of developing hepatocellular carcinoma. © 2018 John Wiley & Sons Ltd.

Maternal Tetanus Toxoid Vaccination and Neonatal Mortality in Rural North India

PubMed Central

Singh, Abhishek; Pallikadavath, Saseendran; Ogollah, Reuben; Stones, William

2012-01-01

Objectives Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India. Methods and Findings Using the third round of the Indian National Family Health Survey (NFHS) 2005–06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms. Conclusions Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose. PMID:23152814

Maternal tetanus toxoid vaccination and neonatal mortality in rural north India.

PubMed

Singh, Abhishek; Pallikadavath, Saseendran; Ogollah, Reuben; Stones, William

2012-01-01

Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India. Using the third round of the Indian National Family Health Survey (NFHS) 2005-06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms. Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose.

Barriers to Institutional Childbirth in Rumbek North County, South Sudan: A Qualitative Study.

PubMed

Wilunda, Calistus; Scanagatta, Chiara; Putoto, Giovanni; Takahashi, Risa; Montalbetti, Francesca; Segafredo, Giulia; Betrán, Ana Pilar

2016-01-01

South Sudan has one of the world's poorest health indicators due to a fragile health system and a combination of socio-cultural, economic and political factors. This study was conducted to identify barriers to utilisation of institutional childbirth services in Rumbek North County. Data were collected through 14 focus group discussions with 169 women and 45 men, and 18 key informant interviews with community leaders, staff working in health facilities, traditional birth attendants, and the staff of the County Health Department. Data were analysed using inductive content analysis. The barriers to institutional childbirth were categorised under four main themes: 1) Issues related to access and lack of resources: long distance to health facilities, lack of transportation means, referral problems, flooding and poor roads, and payments in health facilities; 2) Issues related to the socio-cultural context and conflict: insecurity, influence of the husband, lack of birth preparedness, domestic chores of women, influence of culture; 3) Perceptions about pregnancy and childbirth: perceived benefit of institutional childbirth, low childbirth risk perception, and medicalisation of childbirth including birth being perceived to be natural, undesirable birth practices, privacy concerns, and fear of caesarean section; and 4) Perceptions about the quality of care: inadequate health facility infrastructure and perceived neglect during admission. Multiple factors hinder institutional childbirth in Rumbek North. Some of the factors such as insecurity and poor roads are outside the scope of the health sector and will require a multi-sectoral approach if childbirth services are to be made accessible to women. Detailed recommendations to increase utilisation of childbirth services in the county have been suggested.

Regulation of metabolism by dietary carbohydrates in two lines of rainbow trout divergently selected for muscle fat content.

PubMed

Kamalam, Biju Sam; Medale, Françoise; Kaushik, Sadasivam; Polakof, Sergio; Skiba-Cassy, Sandrine; Panserat, Stephane

2012-08-01

Previous studies in two rainbow trout lines divergently selected for lean (L) or fat (F) muscle suggested that they differ in their ability to metabolise glucose. In this context, we investigated whether genetic selection for high muscle fat content led to a better capacity to metabolise dietary carbohydrates. Juvenile trout from the two lines were fed diets with or without gelatinised starch (17.1%) for 10 weeks, after which blood, liver, muscle and adipose tissues were sampled. Growth rate, feed efficiency and protein utilisation were lower in the F line than in the L line. In both lines, intake of carbohydrates was associated with a moderate post-prandial hyperglycaemia, a protein sparing effect, an enhancement of nutrient (TOR-S6) signalling cascade and a decrease of energy-sensing enzyme (AMPK). Gene expression of hepatic glycolytic enzymes was higher in the F line fed carbohydrates compared with the L line, but concurrently transcripts for the gluconeogenic enzymes was also higher in the F line, possibly impairing glucose homeostasis. However, the F line showed a higher gene expression of hepatic enzymes involved in lipogenesis and fatty acid bioconversion, in particular with an increased dietary carbohydrate intake. Enhanced lipogenic potential coupled with higher liver glycogen content in the F line suggests better glucose storage ability than the L line. Overall, the present study demonstrates the changes in hepatic intermediary metabolism resulting from genetic selection for high muscle fat content and dietary carbohydrate intake without, however, any interaction for an improved growth or glucose utilisation in the peripheral tissues.

Service utilisation by carers of people with dementia in rural Victoria.

PubMed

Ervin, Kaye; Reid, Carol

2015-12-01

To explore the use of community and dementia-specific services by informal carers caring for someone with dementia in a rural setting. Carers of people with dementia were recruited through a variety of rural community services and invited to complete a survey related to the utilisation of community services. A total of 39 carers completed surveys. Despite 84% reporting use of the Aged Care Assessment Service and 61% reporting provision of printed information on the services available, less than half of the carers utilised commonly available support services. Only 46% received financial compensation for their carer role. Rural carers of care recipients with behavioural and psychological symptoms of dementia underutilise community services. Services that may assist with carer stress and depression and services that provide advice on the management of distressing behavioural and psychological symptoms of dementia were utilised by less than half of the carers surveyed. © 2014 AJA Inc.

Relation of anosognosia to frontal lobe dysfunction in Alzheimer's disease.

PubMed

Michon, A; Deweer, B; Pillon, B; Agid, Y; Dubois, B

1994-07-01

A self-rating scale of memory functions was administered to 24 non-depressed patients with probable Alzheimer's disease, divided into two groups according to the overall severity of dementia (mild, mini-mental state (MMS) > 21; moderate, MMS between 10 and 20). These groups did not significantly differ in their self-rating of memory functions. The same questionnaire was submitted to a member of each patient's family, who had to rate the patient's memory. An "anosognosia score" was defined as the difference between patient's and family's ratings. This score was highly variable, and covered, in the two groups, the full range between complete awareness of deficits and total anosognosia. Correlations between the anosognosia score and several neuropsychological data were searched for. No significant correlation was found with either the Wechsler memory scale, the MMS, or linguistic abilities and gestures. In contrast, this score was highly correlated with the "frontal score", defined as the sum of scores on the Wisconsin card sorting test (WCST), verbal fluency, Luria's graphic series, and "frontal behaviours" (prehension, utilisation, imitation behaviours, inertia, indifference). Among these tests of executive functions, the highest correlation with the anosognosia score was obtained on the WCST. This suggests that anosognosia in Alzheimer's disease is not related to the degree of cognitive deterioration but results, at least in part, from frontal dysfunction.

Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits

PubMed Central

2013-01-01

Background The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income. Methods The study is based on register data years 2007 – 2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual’s age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform. Results Health care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29. Conclusions Reforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median. PMID:24171894

An interaural-correlation-based approach that accounts for a wide variety of binaural detection data.

PubMed

Bernstein, Leslie R; Trahiotis, Constantine

2017-02-01

Interaural cross-correlation-based models of binaural processing have accounted successfully for a wide variety of binaural phenomena, including binaural detection, binaural discrimination, and measures of extents of laterality based on interaural temporal disparities, interaural intensitive disparities, and their combination. This report focuses on quantitative accounts of data obtained from binaural detection experiments published over five decades. Particular emphasis is placed on stimulus contexts for which commonly used correlation-based approaches fail to provide adequate explanations of the data. One such context concerns binaural detection of signals masked by certain noises that are narrow-band and/or interaurally partially correlated. It is shown that a cross-correlation-based model that includes stages of peripheral auditory processing can, when coupled with an appropriate decision variable, account well for a wide variety of classic and recently published binaural detection data including those that have, heretofore, proven to be problematic.

Effect of active shortening on the rate of ATP utilisation by rabbit psoas muscle fibres

PubMed Central

Sun, Y-B; Hilber, K; Irving, M

2001-01-01

The rate of ATP utilisation during active shortening of single skinned fibres from rabbit psoas muscle at 10 °C was measured using an NADH-linked assay. Fibres were immersed in silicone oil and illuminated with 365 nm light. The amounts of NADH and carboxytetramethylrhodamine (CTMR) in the illuminated region of the fibre were measured simultaneously from fluorescence emission at 425–475 and 570–650 nm, respectively. The ratio of these two signals was used to determine the intracellular concentration of NADH, and thus the ATP utilisation, without interference from movements of the fibre with respect to the measuring light beam. The total extra ATP utilisation due to shortening (ΔATP) was determined by extrapolation of the steady isometric rates before and after shortening to the mid-point of the shortening period. ΔATP had a roughly linear dependence on the extent of shortening in the range 1–15% fibre length (L0) at a shortening velocity of 0.4 L0 s−1 from initial sarcomere length 2.7 μm. For shortening of 1%L0, ΔATP was 21 ± 1 μm (mean ±s.e.m., n = 3). The mean rate of ATP utilisation during ramp shortening of 10%L0 had a roughly linear dependence on shortening velocity in the range 0.05–1.2 L0 s−1. During unloaded shortening at 1.2 L0 s−1 the mean rate of ATP utilisation was 1.7 mm s−1, about 9 times the isometric rate. ΔATP was roughly independent of shortening velocity, and was 84 ± 9 μm (mean ±s.e.m., n = 6) for shortening of 10%L0. The implications of these results for mechanical-chemical coupling in muscle are discussed. The total ATP utilisation associated with shortening of 1%L0 is only about 17% of the concentration of the myosin heads in the fibre, suggesting that during isometric contraction either less than 17% of the myosin heads are attached to actin, or that heads can detach without commitment to ATP splitting. The fraction of myosin heads attached to actin during unloaded shortening is estimated from the rate of ATP utilisation to be less than 7%. PMID:11251058

Ethnic disparities in utilisation of maternal health care services in Ghana: evidence from the 2007 Ghana Maternal Health Survey.

PubMed

Ganle, John Kuumuori

2016-01-01

Disparities in utilisation of maternal health care remain a challenge to attainment of the maternal health-related Millennium Development Goals. The objective of this descriptive study was to examine disparities in utilisation of maternal health care among ethnic groups in Ghana. Data from the 2007 Ghana Maternal Health Survey were analysed for disparities in antenatal care (ANC) visit, utilisation of tetanus toxoid immunisation and iron tablets/syrup intake during pregnancy, place of delivery, skilled birth attendance, caesarean section (CS) and post-natal care (PNC) among different ethnic groups. Findings show that the proportion of women who received any form of skilled antenatal, delivery and PNC in the five years (2003-2007) preceding the survey was 96%, 55% and 55%, respectively. Despite the incremental progress Ghana made in improving access to skilled maternal health care services, large gradients of disparities exist. The ethnic difference in utilisation of institutional prenatal care was small; however, fewer births to women from majority ethnic groups such as the Akan (21%) took place at home compared with births to women from minority ethnic groups such as the Ewe (58.8%), Guan (42.7%), Grusi (53.4%), Mole-Dagbani (74.7%) and Gruma (58.8%). The rate of consultation of a skilled health care provider for delivery among the different ethnic groups also ranged from a low of 27% for births to Mole-Dagbani women to a high of 68.8% among births to Akan women. Minority ethnic groups reported lower utilisation levels for most of the components of skilled maternity care in Ghana. However, ethnic disparities in utilisation of all the components of ANC in Ghana were less compared to delivery in health facilities, skilled attendance at birth, use of CS and PNC. Therefore, efforts to promote universal access to skilled maternity care not only should target those sub-populations with significantly low utilisation levels but also must focus on those components of maternal health care such as skilled attendance at delivery that demonstrate the greatest disparities. There is also the need to further explore who continues to remain excluded from receiving needed care, and how to encourage such women, especially minority women, to seek skilled care.

Estimating consumer familiarity with health terminology: a context-based approach.

PubMed

Zeng-Treitler, Qing; Goryachev, Sergey; Tse, Tony; Keselman, Alla; Boxwala, Aziz

2008-01-01

Effective health communication is often hindered by a "vocabulary gap" between language familiar to consumers and jargon used in medical practice and research. To present health information to consumers in a comprehensible fashion, we need to develop a mechanism to quantify health terms as being more likely or less likely to be understood by typical members of the lay public. Prior research has used approaches including syllable count, easy word list, and frequency count, all of which have significant limitations. In this article, we present a new method that predicts consumer familiarity using contextual information. The method was applied to a large query log data set and validated using results from two previously conducted consumer surveys. We measured the correlation between the survey result and the context-based prediction, syllable count, frequency count, and log normalized frequency count. The correlation coefficient between the context-based prediction and the survey result was 0.773 (p < 0.001), which was higher than the correlation coefficients between the survey result and the syllable count, frequency count, and log normalized frequency count (p < or = 0.012). The context-based approach provides a good alternative to the existing term familiarity assessment methods.

Bioavailability and mobility of organic contaminants in soil: new three-step ecotoxicological evaluation.

PubMed

Prokop, Zbyněk; Nečasová, Anežka; Klánová, Jana; Čupr, Pavel

2016-03-01

A novel approach was developed for rapid assessment of bioavailability and potential mobility of contaminants in soil. The response of the same test organism to the organic extract, water extract and solid phase of soil was recorded and compared. This approach was designed to give an initial estimate of the total organic toxicity (response to organic extractable fraction), as well as the mobile (response to water extract) and bioavailable fraction (response to solid phase) of soil samples. Eighteen soil samples with different levels of pollution and content of organic carbon were selected to validate the novel three-step ecotoxicological evaluation approach. All samples were chemically analysed for priority contaminants, including aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), hexachlorocyclohexane (HCH) and dichlordiphenyltrichloroethane (DDT). The ecotoxicological evaluation involved determination of toxicity of the organic, mobile and bioavailable fractions of soil to the test organism, bacterium Bacillus cereus. We found a good correlation between the chemical analysis and the toxicity of organic extract. The low toxicity of water extracts indicated low water solubility, and thus, low potential mobility of toxic contaminants present in the soil samples. The toxicity of the bioavailable fraction was significantly greater than the toxicity of water-soluble (mobile) fraction of the contaminants as deduced from comparing untreated samples and water extracts. The bioavailability of the contaminants decreased with increasing concentrations of organic carbon in evaluated soil samples. In conclusion, the three-step ecotoxicological evaluation utilised in this study can give a quick insight into soil contamination in context with bioavailability and mobility of the contaminants present. This information can be useful for hazard identification and risk assessment of soil-associated contaminants. Graphical Abstract New three-step ecotoxicological evaluation by using the same organism.

General and gay-related racism experienced by Latino gay men.

PubMed

Ibañez, Gladys E; Van Oss Marin, Barbara; Flores, Stephen A; Millett, Gregorio; Diaz, Rafael M

2009-07-01

Latino gay men report experiences of racial discrimination within and outside the gay community. This study focused on correlates of racism within general and gay contexts. Racism was assessed in a probability sample of 911 Latino gay men recruited from 3 U.S. cities. Factor analysis of the 10-item scale produced 2 factors: (a) General Racism Experiences, and (b) Racism Experiences in Gay Contexts. The scale and each factor showed adequate reliability and validity. Latino gay men with darker skin, more Indian features, more time in the United States, and low self-esteem reported more racism in both general and gay contexts. The authors examine the psychometric properties of a measure that assesses interpersonal racism among Latinos, report correlates of racism within a gay context, and provide an assessment tool for understanding the role of racism in the lives of Latino gay men.

Application of wavelet filtering and Barker-coded pulse compression hybrid method to air-coupled ultrasonic testing

NASA Astrophysics Data System (ADS)

Zhou, Zhenggan; Ma, Baoquan; Jiang, Jingtao; Yu, Guang; Liu, Kui; Zhang, Dongmei; Liu, Weiping

2014-10-01

Air-coupled ultrasonic testing (ACUT) technique has been viewed as a viable solution in defect detection of advanced composites used in aerospace and aviation industries. However, the giant mismatch of acoustic impedance in air-solid interface makes the transmission efficiency of ultrasound low, and leads to poor signal-to-noise (SNR) ratio of received signal. The utilisation of signal-processing techniques in non-destructive testing is highly appreciated. This paper presents a wavelet filtering and phase-coded pulse compression hybrid method to improve the SNR and output power of received signal. The wavelet transform is utilised to filter insignificant components from noisy ultrasonic signal, and pulse compression process is used to improve the power of correlated signal based on cross-correction algorithm. For the purpose of reasonable parameter selection, different families of wavelets (Daubechies, Symlet and Coiflet) and decomposition level in discrete wavelet transform are analysed, different Barker codes (5-13 bits) are also analysed to acquire higher main-to-side lobe ratio. The performance of the hybrid method was verified in a honeycomb composite sample. Experimental results demonstrated that the proposed method is very efficient in improving the SNR and signal strength. The applicability of the proposed method seems to be a very promising tool to evaluate the integrity of high ultrasound attenuation composite materials using the ACUT.

Who benefits from public health financing in Zimbabwe? Towards universal health coverage.

PubMed

Shamu, Shepherd; January, James; Rusakaniko, Simbarashe

2017-09-01

Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of -0.13 [CI:-0.2 to -0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1-0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2-0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.

Socioeconomic inequalities in dental services utilisation in a Norwegian county: the third Nord-Trondelag Health Survey.

PubMed

Vikum, Eirik; Krokstad, Steinar; Holst, Dorthe; Westin, Steinar

2012-11-01

To assess the level of socioeconomic inequity in dental care utilisation in Norway and enable comparison with recent international comparative studies. We studied dental care utilisation among 17,136 men and 21,414 women in the third Nord-Trøndelag Health Survey (2006-08). Respondents aged 20 years and above were included in the study, and analyses were also performed within subgroups of age and gender (20-39, 40-59, and ≥60 years). Income-related horizontal inequity was estimated by means of concentration indices. Education-related inequity was estimated as relative risks. We found consistent pro-rich income inequity among men and women of all ages. The level of income inequity was highest among men and women ≥60 years, and in this group the income gradient was steepest between the poorest and the middle quintiles. Pro-educated inequity was found exclusively among men and women ≥60 years. General attendance was high (77%). The overall level of income-related inequity in dental services utilisation was low compared to other European countries as reported in two recent international studies of socioeconomic inequalities in dental care utilisation. Pro-rich and pro-educated inequity is a public health challenge mainly in the older part of the population.

Low use of contraceptives among rural women in Maitha, Uttar Pradesh, India.

PubMed

Saroha, Ekta; Altarac, Maja; Sibley, Lynn M

2013-05-01

Low contraceptive utilisation and high fertility in rural Uttar Pradesh (UP), India, is a major concern for the world's second most populous country. The association between reasons for low contraceptive utilisation and maternal factors has been inadequately researched. Data from the 'morbidity and performance assessment' study were analysed to explore reasons for low contraceptive utilisation and their association with maternal factors among 308 women in Maitha, rural UP, India. Chi-square, t-test, ANOVA, and logistic regression analyses were conducted. Majority (84.2%) of the rural women in Maitha, UP, India were not using any contraceptives. Upper caste, literate wives, and wives whose husbands were literate were more likely to use contraceptives. About one-third of the women did not want to use a contraceptive because they wanted another child. Large numbers (65.3%) of women wanted to use contraceptives but were unable to do so due to lack of knowledge (38.9%), fear of side-effects (15.5%), husband/family disapproval (15.5%), inconvenience (10.7%), and other reasons (19.1%). Maternal parity, wives' and husband's literacy were significantly associated with the reasons for low contraceptive utilisation (p < 0.05). Contraceptive utilisation can be Improved by taking into consideration such maternal characteristics. All state subsidised contraceptives should be more widely known, understood and made available.

Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries.

PubMed

Postolovska, Iryna; Helleringer, Stéphane; Kruk, Margaret E; Verguet, Stéphane

2018-01-01

Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services. We analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000-2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough). SIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country. The paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions.

Determination of the predictive factors of long-lasting insecticide-treated net ownership and utilisation in the Bamenda Health District of Cameroon.

PubMed

Fokam, Eric B; Kindzeka, Germaine F; Ngimuh, Leonard; Dzi, Kevin T J; Wanji, Samuel

2017-03-16

Malaria is a serious health concern in Africa. In Cameroon, an endemic country where malaria remains a major public health problem, several control measures have been put in place among which the use of insecticide-treated bednets (LLINs/ITNs) is considered one of the core vector control strategies. However, the greatest challenges include ownership and utilisation by individuals and households. Factors such as age, marital status, gender, education and occupation of the household head, household size, knowledge of bednets, socioeconomic status, and environmental factors have been suggested to have an impact on bednet ownership and utilisation in different settings. The present study sought to determine bednet ownership and utilisation rates and to assess the impact of predictive factors on bednet ownership and use in the Bamenda Health District (BHD) of Cameroon. A cross-sectional study involving 384 households was conducted in six health areas in the BHD. A structured and semi-structured questionnaire was used to collect data on demographic and household characteristics as well as information on their bednet ownership and utilisation. Descriptive statistics, bivariate and multivariate logistic regression analysis were performed. Frequency of bednet ownership was relatively high (63.5%) with LLINs being most abundant (91.9%); the majority of households (87.7%) obtained their bednets during the 2011 free distribution campaign. Utilisation was relatively high (69.3%), with negligence (29.3%) and heat discomfort (26.7%) accounting most for non-usage of bednets. Children less than 5 years (63%) and pregnant women (60%) most often used these nets. Households headed by a married couple, those with older household heads, household with smaller size (5-12 persons), and knowledge of bednets (good knowledge) had positive impacts on bednet ownership (p < 0.05). The gender of the household head (males), their educational level, environmental conditions (presence of suitable mosquito breeding sites), bednet number in households (greater number of bednets) and the prioritised groups (children < 5 and pregnant women) had positive impacts on bednet utilisation in households (p < 0.05). There was a negative association between bednet ownership and utilisation by households as bednet ownership was high and utilisation of these nets was low. Marital status and age of household head, household size, and knowledge of bednets had impacts on bednet ownership while gender and educational level of the household head, environmental suitability, the number of bednets and the two prioritised groups had an impact on bednet usage. These factors may be relevant for policy makers and in decision making for the intensification of campaign strategies to ensure more effective subsequent distribution campaigns in the BHD and beyond.

Refinement procedure for the image alignment in high-resolution electron tomography.

PubMed

Houben, L; Bar Sadan, M

2011-01-01

High-resolution electron tomography from a tilt series of transmission electron microscopy images requires an accurate image alignment procedure in order to maximise the resolution of the tomogram. This is the case in particular for ultra-high resolution where even very small misalignments between individual images can dramatically reduce the fidelity of the resultant reconstruction. A tomographic-reconstruction based and marker-free method is proposed, which uses an iterative optimisation of the tomogram resolution. The method utilises a search algorithm that maximises the contrast in tomogram sub-volumes. Unlike conventional cross-correlation analysis it provides the required correlation over a large tilt angle separation and guarantees a consistent alignment of images for the full range of object tilt angles. An assessment based on experimental reconstructions shows that the marker-free procedure is competitive to the reference of marker-based procedures at lower resolution and yields sub-pixel accuracy even for simulated high-resolution data. Copyright © 2011 Elsevier B.V. All rights reserved.

Two-electron spin correlations in precision placed donors in silicon.

PubMed

Broome, M A; Gorman, S K; House, M G; Hile, S J; Keizer, J G; Keith, D; Hill, C D; Watson, T F; Baker, W J; Hollenberg, L C L; Simmons, M Y

2018-03-07

Substitutional donor atoms in silicon are promising qubits for quantum computation with extremely long relaxation and dephasing times demonstrated. One of the critical challenges of scaling these systems is determining inter-donor distances to achieve controllable wavefunction overlap while at the same time performing high fidelity spin readout on each qubit. Here we achieve such a device by means of scanning tunnelling microscopy lithography. We measure anti-correlated spin states between two donor-based spin qubits in silicon separated by 16 ± 1 nm. By utilising an asymmetric system with two phosphorus donors at one qubit site and one on the other (2P-1P), we demonstrate that the exchange interaction can be turned on and off via electrical control of two in-plane phosphorus doped detuning gates. We determine the tunnel coupling between the 2P-1P system to be 200 MHz and provide a roadmap for the observation of two-electron coherent exchange oscillations.

Behavioural screening of zebrafish using neuroactive traditional Chinese medicine prescriptions and biological targets

NASA Astrophysics Data System (ADS)

Wang, Ya-Nan; Hou, Yuan-Yuan; Sun, Ming-Zhu; Zhang, Chun-Yang; Bai, Gang; Zhao, Xin; Feng, Xi-Zeng

2014-06-01

The mechanism of the therapeutic action of antidepressants remains uncertain in traditional Chinese medicine (TCM). In this study, we selected 7 classical TCM prescriptions and utilised an automatic video-tracking system to monitor the rest/wake behaviour of larval zebrafish at 4 days post-fertilisation (dpf) for 48 hours. We found that the curative effects of the prescriptions were dose-dependent. K-means clustering was performed according to the shared behavioural phenotypes of the zebrafish. The results revealed that the rest/wake behavioural profiles induced by the same class of prescriptions were similar. A correlation analysis was conducted between the TCM prescriptions and the known compounds. The results showed that the TCM prescriptions correlated well with some well-known compounds. Therefore, we predicted that they may share a similar mechanism of action. This paper describes the first study to combine TCM research with zebrafish rest/wake behaviour in vivo and presents a powerful approach for the discovery of the mechanism of action of TCM prescriptions.

Cortical activation during power grip task with pneumatic pressure gauge: an fMRI study

NASA Astrophysics Data System (ADS)

Mohamad, M.; Mardan, N. H.; Ismail, S. S.

2017-05-01

Aging is associated with a decline in cognitive and motor function. But, the relationships with motor performance are less well understood. In this study, functional magnetic resonance imaging (fMRI) was used to assess cortical activation in older adults. This study employed power grip task that utilised block paradigm consisted of alternate 30s rest and active. A visual cue was used to pace the hand grip movement that clenched a cylindrical rubber bulb connected with pressure pneumatic gauge that measure the pressure (Psi). The objective of this study is determined the brain areas activated during motor task and the correlation between percentage signal change of each motor area (BA 4 and 6) and hand grip pressure. Result showed there was a significant difference in mean percentage signal change in BA 4 and BA 6 in both hemispheres and negative correlation obtained in BA 4 and BA 6. These results indicate that a reduced ability in the motor networks contribute to age-related decline in motor performance.

Application of biospeckle phenomenon on monitoring of leavening process in breadmaking

NASA Astrophysics Data System (ADS)

da Silva, Emerson Rodrigo; da Silva Junior, Elieste; Júnior, Mauro Favoretto; da Silva Lannes, Suzana Caetano; Muramatsu, Mikiya

2008-04-01

Since the sixties, dynamic speckles have found a wide number of applications, covering fields from engineering to biomedicine. However, despite of this potential, its utilisation in food manufacture control is still incipient. In this work, our objective was to use the biospeckle phenomenon to monitoring the expansion of the dough during the leavening process. Our experiments consisted in the temporal evolution observation of speckle patterns scattered by samples prepared from two formulations: by yoghurt addition and without it. Every two minutes, it was constructed a 2-D image, recording the Time History Speckle Pattern (THSP). The full monitoring time was 50 minutes. A new estimator of activity index, proposed by some of the authors, was used in data analysis. This estimator is based on contrast of successive correlations of intensities recorded in THSP. It was found a strong correlation between the activities on the samples and the type of fermentative agents. These results reveal an interesting potential of the biospeckle to control in bread manufacture industries.

Overseas Chinese students in the UK: patterns and correlates of their use of Western and traditional Chinese medicine.

PubMed

Bishop, Felicity L; Lim, Chiw Yeh; Leydon, Geraldine M; Lewith, George T

2009-02-01

We explored the correlates of use of TCM and WM by ethnic Chinese students in the UK. A questionnaire assessed key theoretical determinants of health services use. One hundred and seventy ethnic Chinese participants (international students at one university in the South of England) completed this questionnaire (presented in English and Chinese) assessing their demographic characteristics, health status, attitudes towards and use of TCM and WM. Participants were more likely to use WM than TCM when they were in the UK. Different variables predicted use of WM and TCM. The statistical predictors (demographic characteristics, health status, past behaviour, attitudes) explained modest but important proportions of the variance in use of WM (37%) and TCM (29%). In conclusion, this small exploratory study suggests a need for further research on the health care utilisation of this growing body of international students. Improved language support is needed for international students in UK health care settings.

The relationship between the INTERMED patient complexity instrument and Level of Care Utilisation System (LOCUS).

PubMed

Thurber, Steven; Wilson, Ann; Realmuto, George; Specker, Sheila

2018-03-01

To investigate the concurrent and criterion validity of two independently developed measurement instruments, INTERMED and LOCUS, designed to improve the treatment and clinical management of patients with complex symptom manifestations. Participants (N = 66) were selected from hospital records based on the complexity of presenting symptoms, with tripartite diagnoses across biological, psychiatric and addiction domains. Biopsychosocial information from hospital records were submitted to INTERMED and LOCUS grids. In addition, Global Assessment of Functioning (GAF) ratings were gathered for statistical analyses. The product moment correlation between INTERMED and LOCUS was 0.609 (p = .01). Inverse zero-order correlations for INTERMED and LOCUS total score and GAF were obtained. However, only the beta weight for LOCUS and GAF was significant. An exploratory principal components analysis further illuminated areas of convergence between the instruments. INTERMED and LOCUS demonstrated shared variance. INTERMED appeared more sensitive to complex medical conditions and severe physiological reactions, whereas LOCUS findings are more strongly related to psychiatric symptoms. Implications are discussed.

Détermination assistée par ordinateur de la structure des molécules organiques

NASA Astrophysics Data System (ADS)

Nuzillard, J.-M.

1998-02-01

Nuclear Magnetic Resonance spectroscopy offers the unique possibility of accessing proximity relationships between atoms by means of chemical shift correlation experiments. Structure determination of small molecules has become thus much simpler. Computer programs can use directly correlation information for structure analysis. The use and operation mechanism of such a program, LSD (Logic for Structure Determination) are presented. The example compound is gibberellic acid, a natural product. La spectroscopie de Résonance Magnétique Nucléaire offre un moyen unique de déterminer des relations de proximité entre atomes par le biais des expériences de corrélation. L'analyse structurale de petites molécules organiques s'en trouve extrêmement facilitée. Des programmes informatiques peuvent utiliser directement les informations de corrélation pour déduire des structures. Le fonctionnement et l'usage d'un tel programme, LSD (Logic for Structure Determination), sont détaillés sur un exemple, l'acide gibberellique.

Perceiving emotions: Cueing social categorization processes and attentional control through facial expressions.

PubMed

Cañadas, Elena; Lupiáñez, Juan; Kawakami, Kerry; Niedenthal, Paula M; Rodríguez-Bailón, Rosa

2016-09-01

Individuals spontaneously categorise other people on the basis of their gender, ethnicity and age. But what about the emotions they express? In two studies we tested the hypothesis that facial expressions are similar to other social categories in that they can function as contextual cues to control attention. In Experiment 1 we associated expressions of anger and happiness with specific proportions of congruent/incongruent flanker trials. We also created consistent and inconsistent category members within each of these two general contexts. The results demonstrated that participants exhibited a larger congruency effect when presented with faces in the emotional group associated with a high proportion of congruent trials. Notably, this effect transferred to inconsistent members of the group. In Experiment 2 we replicated the effects with faces depicting true and false smiles. Together these findings provide consistent evidence that individuals spontaneously utilise emotions to categorise others and that such categories determine the allocation of attentional control.

The formation of professional identity in medical students: considerations for educators.

PubMed

Goldie, John

2012-01-01

Medical education is about more than acquiring an appropriate level of knowledge and developing relevant skills. To practice medicine students need to develop a professional identity--ways of being and relating in professional contexts. This article conceptualises the processes underlying the formation and maintenance of medical students' professional identity drawing on concepts from social psychology. A multi-dimensional model of identity and identity formation, along with the concepts of identity capital and multiple identities, are presented. The implications for educators are discussed. Identity formation is mainly social and relational in nature. Educators, and the wider medical society, need to utilise and maximise the opportunities that exist in the various relational settings students experience. Education in its broadest sense is about the transformation of the self into new ways of thinking and relating. Helping students form, and successfully integrate their professional selves into their multiple identities, is a fundamental of medical education.

Food (In)Security in Rapidly Urbanising, Low-Income Contexts.

PubMed

Tacoli, Cecilia

2017-12-11

Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space.

Dispensing history, art and mystery in the Medical History Museum of University of Melbourne.

PubMed

Brothers, Ann

2009-01-01

The installation of an 1849 Savory & Moore Pharmacy has been a popular attraction for visitors, yet under-utilised in the Museum as a means through which a deeper understanding of the making and taking of medication could be told. The opportunity to research and present these stories to a wider field of viewers in an online multimedia production is discussed here, and is set within the context of the challenges met by the Museum in terms of its relevance and sustainability within a University focused on the future as a graduate University. Under the radical reform of its curriculum, funding and students are more likely to be attracted to medical science than medical history, unless new questions are put to historical items and ways sought to draw on the curiosity and imagination of students who might gain a greater breadth of knowledge by learning through engagement with original objects.

Singapore Cancer Network (SCAN) Guidelines for Referral for Genetic Evaluation of Common Hereditary Cancer Syndromes.

PubMed

2015-10-01

The SCAN cancer genetics workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines for referral for genetic evaluation of common hereditary cancer syndromes. The workgroup utilised a modified ADAPTE process to calibrate high quality international evidence-based clinical practice guidelines to our local setting. To formulate referral guidelines for the 3 most commonly encountered hereditary cancer syndromes to guide healthcare providers in Singapore who care for cancer patients and/or their family members, 7, 5, and 3 sets of international guidelines respectively for hereditary breast and ovarian cancer (HBOC) syndrome, Lynch syndrome (LS), and familial adenomatous polyposis (FAP) were evaluated. For each syndrome, the most applicable one was selected, with modifications made such that they would be appropriate to the local context. These adapted guidelines form the SCAN Guidelines 2015 for referral for genetic evaluation of common hereditary cancer syndromes.

Patient identity management for secondary use of biomedical research data in a distributed computing environment.

PubMed

Nitzlnader, Michael; Schreier, Günter

2014-01-01

Dealing with data from different source domains is of increasing importance in today's large scale biomedical research endeavours. Within the European Network for Cancer research in Children and Adolescents (ENCCA) a solution to share such data for secondary use will be established. In this paper the solution arising from the aims of the ENCCA project and regulatory requirements concerning data protection and privacy is presented. Since the details of secondary biomedical dataset utilisation are often not known in advance, data protection regulations are met with an identity management concept that facilitates context-specific pseudonymisation and a way of data aggregation using a hidden reference table later on. Phonetic hashing is proposed to prevent duplicated patient registration and re-identification of patients is possible via a trusted third party only. Finally, the solution architecture allows for implementation in a distributed computing environment, including cloud-based elements.

Preferential vibrational excitation in microwave nitrogen plasma assessed by Raman scattering

NASA Astrophysics Data System (ADS)

Gatti, N.; Ponduri, S.; Peeters, F. J. J.; van den Bekerom, D. C. M.; Minea, T.; Tosi, P.; van de Sanden, M. C. M.; van Rooij, G. J.

2018-05-01

Vibrational activation of N2 molecules in a flowing microwave plasma is investigated in the context of utilising electrical energy for chemical conversion. Spatial profiles of rotational (T r ) and vibrational (T v ) temperatures are measured by Raman scattering. Maximum values of T r = 3500 K and T v = 6000 K were observed in the centre of the plasma at low pressure (50 mbar). A detailed quantification of the local energy content shows how the strong non-equilibrium character of low pressure discharges compares with a closer-to-equilibrium energy distribution at higher pressures. Measurements performed downstream of the plasma display the ability of the microwave flowing reactor to deliver up to 48% of the specific energy input (SEI) into internal degrees of freedom of the gas molecules. Specifically, 23% of the SEI is loaded into the vibrational mode, which is potentially available to enhance chemical reactivity of endothermic reactions.

Health financing to promote access in low income settings-how much do we know?

PubMed

Palmer, Natasha; Mueller, Dirk H; Gilson, Lucy; Mills, Anne; Haines, Andy

In this article we outline research since 1995 on the impact of various financing strategies on access to health services or health outcomes in low income countries. The limited evidence available suggests, in general, that user fees deterred utilisation. Prepayment or insurance schemes offered potential for improving access, but are very limited in scope. Conditional cash payments showed promise for improving uptake of interventions, but could also create a perverse incentive. The largely African origin of the reports of user fees, and the evidence from Latin America on conditional cash transfers, demonstrate the importance of the context in which studies are done. There is a need for improved quality of research in this area. Larger scale, upfront funding for evaluation of health financing initiatives is necessary to ensure an evidence base that corresponds to the importance of this issue for achieving development goals.

Food (In)Security in Rapidly Urbanising, Low-Income Contexts

PubMed Central

2017-01-01

Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space. PMID:29232936

The practice of terminal discharge.

PubMed

Radha Krishna, Lalit Kumar; Murugam, Vengadasalam; Quah, Daniel Song Chiek

2017-01-01

'Terminal discharges' are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided. It is hoped that this will provide a platform for professionals in palliative medicine to negotiate challenging issues when arranging a terminal discharge, so as to avoid the pitfall of committing euthanasia in a country such as Singapore where euthanasia is illegal. It is hoped that a set of guidelines for terminal discharges may someday be realised to assist professionals in Singapore and around the world.

Associating extreme precipitation events to parent cyclones in gridded data

NASA Astrophysics Data System (ADS)

Rhodes, Ruari; Shaffrey, Len; Gray, Sue

2015-04-01

When analysing the relationship of regional precipitation to its parent cyclone, it is insufficient to consider the cyclone's region of influence as a fixed radius from the centre due to the irregular shape of rain bands. A new method is therefore presented which allows the use of objective feature tracking data in the analysis of regional precipitation. Utilising the spatial extent of precipitation in gridded datasets, the most appropriate cyclone(s) may be associated with regional precipitation events. This method is applied in the context of an analysis of the influence of clustering and stalling of extra-tropical cyclones in the North Atlantic on total precipitation accumulations over England and Wales. Cyclone counts and residence times are presented for historical records (ERA-Interim) and future projections (HadGEM2-ES) of extreme (> 98th percentile) precipitation accumulations over England and Wales, for accumulation periods ranging from one day to one month.

Direct Estimation of Correlation as a Measure of Association Strength Using Multidimensional Item Response Models

ERIC Educational Resources Information Center

Wang, Wen-Chung

2004-01-01

The Pearson correlation is used to depict effect sizes in the context of item response theory. Amultidimensional Rasch model is used to directly estimate the correlation between latent traits. Monte Carlo simulations were conducted to investigate whether the population correlation could be accurately estimated and whether the bootstrap method…

Temporal context and the organisational impairment of memory search in schizophrenia.

PubMed

Polyn, Sean M; McCluey, Joshua D; Morton, Neal W; Woolard, Austin A; Luksik, Andrew S; Heckers, Stephan

2015-01-01

An influential theory of schizophrenic deficits in executive function suggests that patients have difficulty maintaining and utilising an internal contextual representation, whose function is to ensure that stimuli are processed in a task-appropriate manner. In basic research on episodic memory, retrieved-context theories propose that an internal contextual representation is critically involved in memory search, facilitating the retrieval of task-appropriate memories. This contextual machinery is thought to give rise to temporal organisation during free recall: the tendency for successive recall responses to correspond to items from nearby positions on the study list. If patients with schizophrenia have a generalised contextual deficit, then this leads to the prediction that these patients will exhibit reduced temporal organisation in free recall. Using a combination of classic and recently developed organisational measures, we characterised recall organisation in 75 patients with schizophrenia and 72 nondisordered control participants performing a multi-trial free-recall task. Patients with schizophrenia showed diminished temporal organisation, as well as diminished subjective organisation of their recall sequences relative to control participants. The two groups showed similar amounts of semantic organisation during recall. The observation of reduced temporal organisation in the patient group is consistent with the proposal that the memory deficit in schizophrenia can be characterised as a deficit in contextual processing.

Creativity and power: a qualitative, exploratory study of student learning acquired in a community nursing setting that is applied in future settings.

PubMed

Merritt, Alan; Boogaerts, Marina

2014-01-01

Nursing students undertake clinical placements in a wide range of clinical areas as part of their preparation for professional practice, offering students the opportunity to learn about the clinical context and the work that nurses do. This descriptive study explores the implicit learnings that occur for students in a community nursing placement and whether they transfer the knowledge they gain in the community setting into practice in other settings. Participants in this research study described implicit learning from a community nursing context which they were able to utilise in their current practice. Three major themes emerged. Firstly, participants recognised that power relationships manifest differently in a community based setting. This manifest in a recognition of patient autonomy and a creative approach to enhancing the patient's power. The second, related theme involved the enabling of self-determination through collaborative decision making between nurse and the person receiving care. The third theme was the development of an understanding of self-management which manifest in appropriate referrals and what the participants considered high quality discharge planning. This recognition of practice beyond technical, rationalist manifestations suggests that students grasped the unarticulated, implicit dimensions of the community nurse role through their experiences in a community nursing placement.

Developing a multi-method approach to data collection and analysis for explaining the learning during simulation in undergraduate nurse education.

PubMed

Bland, Andrew J; Tobbell, Jane

2015-11-01

Simulation has become an established feature of undergraduate nurse education and as such requires extensive investigation. Research limited to pre-constructed categories imposed by some questionnaire and interview methods may only provide partial understanding. This is problematic in understanding the mechanisms of learning in simulation-based education as contemporary distributed theories of learning posit that learning can be understood as the interaction of individual identity with context. This paper details a method of data collection and analysis that captures interaction of individuals within the simulation experience which can be analysed through multiple lenses, including context and through the lens of both researcher and learner. The study utilised a grounded theory approach involving 31 under-graduate third year student nurses. Data was collected and analysed through non-participant observation, digital recordings of simulation activity and focus group deconstruction of their recorded simulation by the participants and researcher. Focus group interviews enabled further clarification. The method revealed multiple levels of dynamic data, concluding that in order to better understand how students learn in social and active learning strategies, dynamic data is required enabling researchers and participants to unpack what is happening as it unfolds in action. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Schiff angular bremsstrahlung distribution from composite media

NASA Astrophysics Data System (ADS)

Taylor, M. L.; Dalton, B.; Franich, R. D.

2012-12-01

The Schiff differential for the angular distribution of bremsstrahlung is widely employed, but calculations involving composite materials (i.e. compounds and mixtures) are often undertaken in a somewhat ad hoc fashion. In this work, we suggest an alternative approach to power-law estimates of the effective atomic number utilising Seltzer and Berger's combined approach in order to generate single-valued effective atomic numbers applicable over a large energy range (in the worst case deviation from constancy of about 2% between 10 keV and 1 GeV). Differences with power-law estimates of Z for composites are potentially significant, particularly for low-Z media such as biological or surrogate materials as relevant within the context of medical physics. As an example, soft tissue differs by >70% and cortical bone differs by >85%, while for high-Z composites such as a tungsten-rhenium alloy the difference is of the order of 1%. Use of the normalised Schiff formula for shape only does not exhibit strong Z dependence. Consequently, in such contexts the differences are negligible - the power-law approach overestimates the magnitude by 1.05% in the case of water and underestimates it by <0.1% for the high-Z alloys. The differences in the distribution are most pronounced for small angles and where the bremsstrahlung quanta are low energy.

Hydrology and empire: the Nile, water imperialism and the partition of Africa.

PubMed

Tvedt, Terje

2011-01-01

Why did the British march up the Nile in the 1890s? The answers to this crucial question of imperial historiography have direct relevance for narratives and theories about imperialism, in general, and the partition of Africa in the nineteenth century, in particular. They will also influence our understanding of some of the main issues in the modern history of the whole region, including state developments and resource utilisation. This article presents an alternative to dominant interpretations of the partition of Africa and the role of British Nile policies in this context. It differs from mainstream diplomatic history, which dominates this research field, in its emphasis on how geographical factors and the hydrological characteristics of the Nile influenced and framed British thinking and actions in the region. Realising the importance of such factors and the specific character of the regional water system does not imply less attention to traditional diplomatic correspondence or to the role of individual imperial entrepreneurs. The strength of this analytical approach theoretically is that it makes it possible to locate the intentions and acts of historical subjects within specific geographical contexts. Empirically, it opens up a whole new set of source material, embedding the reconstruction of the British Nile discourse in a world of Nile plans, water works and hydrological discourses.

A regime-switching cointegration approach for removing environmental and operational variations in structural health monitoring

NASA Astrophysics Data System (ADS)

Shi, Haichen; Worden, Keith; Cross, Elizabeth J.

2018-03-01

Cointegration is now extensively used to model the long term common trends among economic variables in the field of econometrics. Recently, cointegration has been successfully implemented in the context of structural health monitoring (SHM), where it has been used to remove the confounding influences of environmental and operational variations (EOVs) that can often mask the signature of structural damage. However, restrained by its linear nature, the conventional cointegration approach has limited power in modelling systems where measurands are nonlinearly related; this occurs, for example, in the benchmark study of the Z24 Bridge, where nonlinear relationships between natural frequencies were induced during a period of very cold temperatures. To allow the removal of EOVs from SHM data with nonlinear relationships like this, this paper extends the well-established cointegration method to a nonlinear context, which is to allow a breakpoint in the cointegrating vector. In a novel approach, the augmented Dickey-Fuller (ADF) statistic is used to find which position is most appropriate for inserting a breakpoint, the Johansen procedure is then utilised for the estimation of cointegrating vectors. The proposed approach is examined with a simulated case and real SHM data from the Z24 Bridge, demonstrating that the EOVs can be neatly eliminated.

'They bring AIDS to us and say we give it to them': Socio-structural context of female sex workers' vulnerability to HIV infection in Ibadan, Nigeria.

PubMed

Muñoz, Jennifer; Adedimeji, Adebola; Alawode, Olayemi

2010-08-01

The aim of the study was to examine and describe the individual and structural-environmental factors that shape the vulnerability of brothel-based female sex workers (FSWs) in Ibadan, southwest Nigeria to HIV infection. A descriptive qualitative research design was utilised to elicit data, using in-depth interviews and focus group discussions, from 60 randomly selected participants in four brothels. A thematic analysis of data was undertaken following transcription and validation of interviews. Five themes emerged from the data: (i) flawed knowledge and fatalistic attitudes; (ii) the psychosocial and economic context of sex work; (iii) religious beliefs, stigma and risk taking; (iv) barriers to HIV testing; and (v) legal and policy constraints to sex work. We describe the complex interaction between these themes and how they combine to increase the risk of HIV infection among FSWs. The impact of previous interventions to reduce the risk of HIV infection among FSWs has been limited by personal and structural factors; hence we recommend that new strategies that recognise the practical constraints to HIV prevention among FSWs are urgently needed to make the environment of commercial work safer for FSWs, their clients, and by extension the general population.

Constitutive innate immunity is a component of the pace-of-life syndrome in tropical birds.

PubMed

Irene Tieleman, B; Williams, Joseph B; Ricklefs, Robert E; Klasing, Kirk C

2005-08-22

We studied the relationship between one component of immune function and basal metabolic rate (BMR), an indicator of the 'pace-of-life syndrome', among 12 tropical bird species and among individuals of the tropical house wren (Troglodytes aedon), to gain insights into functional connections between life history and physiology. To assess constitutive innate immunity we introduced a new technique in the field of ecological and evolutionary immunology that quantifies the bactericidal activity of whole blood. This in vitro assay utilises a single blood sample to provide a functional, integrated measure of constitutive innate immunity. We found that the bactericidal activity of whole blood varied considerably among species and among individuals within a species. This variation was not correlated with body mass or whole-organism BMR. However, among species, bacteria killing activity was negatively correlated with mass-adjusted BMR, suggesting that species with a slower pace-of-life have evolved a more robust constitutive innate immune capability. Among individuals of a single species, the house wren, bacteria killing activity was positively correlated with mass-adjusted BMR, pointing to physiological differences in individual quality on which natural selection potentially could act.

Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians.

PubMed

Dei, Vincent; Sebastian, Miguel San

2018-06-20

There is a lack of focused research on the older population in Ghana and about issues pertaining to their access to healthcare services. Furthermore, information is lacking regarding the fairness in the access to these services. This study aimed to ascertain whether horizontal and vertical equity requirements were being met in the healthcare utilisation among older adults aged 50 years and above. This study was based on a secondary cross-sectional data from the World Health Organization's Study on global AGEing (SAGE) and adult health wave 1 conducted from 2007 to 2008 in Ghana. Data on 4304 older adults aged 50 years-plus were analysed. Bivariate and multivariable analyses were carried out to analyse the association between outpatient/inpatient utilisation and (1) socioeconomic status (SES), controlling for need variables (horizontal equity) and (2) need variables, controlling for SES (vertical equity). Odds ratios with 95% confidence intervals were calculated to analyse the association between relevant variables. Horizontal and vertical inequities were found in the utilisation of outpatient services. Inpatient healthcare utilisation was both horizontally and vertically equitable. Women were found to be more likely to use outpatient services than men but had reduced odds of using inpatient services. Possessing a health insurance was also significantly associated with the use of both inpatient and outpatient services. Whilst equity exists in inpatient care utilisation, more needs to be done to achieve equity in the access to outpatient services. The study reaffirms the need to evaluate both the horizontal and vertical dimensions in the assessment of equity in healthcare access. It provides the basis for further research in bridging the healthcare access inequity gap among older adults in Ghana.

Cost and utilisation of healthcare resources during rehabilitation after ankle fracture are not linked to health insurance, income, gender, or pain: an observational study.

PubMed

Lin, Chung-Wei Christine; Haas, Marion; Moseley, Anne M; Herbert, Robert D; Refshauge, Kathryn M

2008-01-01

What are the costs and utilisation of healthcare resources, their determinants, and quality of life for people attending outpatient physiotherapy after ankle fracture? Longitudinal observational study. Ninety-four adults (2 dropouts) following cast removal after isolated ankle fracture attending outpatient physiotherapy at three hospitals in Sydney, Australia. Costs incurred (direct healthcare costs and out-of-pocket costs) and utilisation of healthcare system resources were measured at 4, 8, 12, 16, 20, and 24 weeks. Quality of life was measured shortly after cast removal and at 4, 12, and 24 weeks. Factors known to influence costs and utilisation in other conditions (private health insurance, income level, gender, and pain) were also measured. The total cost per person was AUD 735 (SD 876) over 24 weeks. Outpatient physiotherapy accounted for the highest costs in both direct healthcare (39%) and out-of-pocket (42%) costs. Less than 20% of participants sought private non-medical care in addition to receiving outpatient physiotherapy. None of the factors investigated had a significant influence on costs and utilisation. Quality of life score improved over the 24 weeks by a mean of 6.1 points out of 45 (95% CI 5.2 to 6.9), with most of the improvement occurring in the domain of independent living. Information on costs and utilisation of healthcare resources can be used to plan health services, eg, the number of physiotherapy sessions required after ankle fracture. Private health insurance, income level, gender, or pain did not influence the costs or the decision behind seeking care over and above publicly-provided physiotherapy.

Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain.

PubMed

Córdoba-Doña, Juan Antonio; Escolar-Pujolar, Antonio; San Sebastián, Miguel; Gustafsson, Per E

2018-01-01

Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011-2012 (crisis), using a composite income index as socioeconomic status (SES) indicator. Horizontal inequity indices (HII) were calculated to take differential healthcare needs into account, and a decomposition analysis of change in inequality between periods was performed. Results showed that before the crisis, the HII was positive (greater access for people with higher SES) for specialist visits but negative (greater access for people with lower SES) in the other three utilisation models. During the crisis no change was observed in inequalities in GP visits, but a pro-poor development was seen for the other types of utilisation, with hospital and emergency care showing significant inequality in favour of low income groups. Overall, the main contributors to pro-poor changes in utilisation were socio-economic variables and poor mental health, due to changes in their elasticities. Our findings show that inequalities in healthcare utilisation largely remained in favour of the less well-off, despite the cuts in welfare benefits and health services provision during the early years of the recession in Andalusia. Further research is needed to monitor the potential impact of such measures in subsequent years.

Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain

PubMed Central

2018-01-01

Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011–2012 (crisis), using a composite income index as socioeconomic status (SES) indicator. Horizontal inequity indices (HII) were calculated to take differential healthcare needs into account, and a decomposition analysis of change in inequality between periods was performed. Results showed that before the crisis, the HII was positive (greater access for people with higher SES) for specialist visits but negative (greater access for people with lower SES) in the other three utilisation models. During the crisis no change was observed in inequalities in GP visits, but a pro-poor development was seen for the other types of utilisation, with hospital and emergency care showing significant inequality in favour of low income groups. Overall, the main contributors to pro-poor changes in utilisation were socio-economic variables and poor mental health, due to changes in their elasticities. Our findings show that inequalities in healthcare utilisation largely remained in favour of the less well-off, despite the cuts in welfare benefits and health services provision during the early years of the recession in Andalusia. Further research is needed to monitor the potential impact of such measures in subsequent years. PMID:29601609

Sample entropy analysis for the estimating depth of anaesthesia through human EEG signal at different levels of unconsciousness during surgeries.

PubMed

Liu, Quan; Ma, Li; Fan, Shou-Zen; Abbod, Maysam F; Shieh, Jiann-Shing

2018-01-01

Estimating the depth of anaesthesia (DoA) in operations has always been a challenging issue due to the underlying complexity of the brain mechanisms. Electroencephalogram (EEG) signals are undoubtedly the most widely used signals for measuring DoA. In this paper, a novel EEG-based index is proposed to evaluate DoA for 24 patients receiving general anaesthesia with different levels of unconsciousness. Sample Entropy (SampEn) algorithm was utilised in order to acquire the chaotic features of the signals. After calculating the SampEn from the EEG signals, Random Forest was utilised for developing learning regression models with Bispectral index (BIS) as the target. Correlation coefficient, mean absolute error, and area under the curve (AUC) were used to verify the perioperative performance of the proposed method. Validation comparisons with typical nonstationary signal analysis methods (i.e., recurrence analysis and permutation entropy) and regression methods (i.e., neural network and support vector machine) were conducted. To further verify the accuracy and validity of the proposed methodology, the data is divided into four unconsciousness-level groups on the basis of BIS levels. Subsequently, analysis of variance (ANOVA) was applied to the corresponding index (i.e., regression output). Results indicate that the correlation coefficient improved to 0.72 ± 0.09 after filtering and to 0.90 ± 0.05 after regression from the initial values of 0.51 ± 0.17. Similarly, the final mean absolute error dramatically declined to 5.22 ± 2.12. In addition, the ultimate AUC increased to 0.98 ± 0.02, and the ANOVA analysis indicates that each of the four groups of different anaesthetic levels demonstrated significant difference from the nearest levels. Furthermore, the Random Forest output was extensively linear in relation to BIS, thus with better DoA prediction accuracy. In conclusion, the proposed method provides a concrete basis for monitoring patients' anaesthetic level during surgeries.

The role of non-need factors in individual GP utilisation analysis and their implications for the pursuance of equity: a cross-country comparison.

PubMed

McGregor, P; McKee, P; O'Neill, C

2008-05-01

A substantial amount of health care resources is allocated within the UK using formulae that relate funding to measures of population need. The aim of this paper is to demonstrate the importance of non-need factors in determining utilisation of services at an individual level and explore the implications inclusion of such factors has in the consideration of equity. In the paper we develop a utility model that accords a role to non-health factors in the determination of service use. A series of functions incorporating non-health factors as explanatory variables in GP utilisation functions are estimated using data from the British Household Panel Survey. The functions are decomposed to ascertain the role of service structure and examine the role of income across the four countries of the UK in explaining utilisation. The implications of our findings for the pursuance of equity in the NHS when individual choice has an explicit role are discussed.

Profiles and Correlates of Relational Aggression in Young Adults' Romantic Relationships

ERIC Educational Resources Information Center

Goldstein, Sara E.; Chesir-Teran, Daniel; McFaul, Adrienne

2008-01-01

The present study examines prevalence and correlates of experiencing and perpetrating relational aggression in the context of young adults' romantic relationships. We assess correlates of relational aggression in four domains of risk: (1) Social-cognitive, (2) Relationship, (3) Trait/dispositional, and (4) Mental health. Results indicate that…

Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design.

PubMed

Prashanth, N S; Elias, Maya Annie; Pati, Manoj Kumar; Aivalli, Praveenkumar; Munegowda, C M; Bhanuprakash, Srinath; Sadhana, S M; Criel, Bart; Bigdeli, Maryam; Devadasan, Narayanan

2016-08-22

India has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. Nearly 70 % of the expenditure is on medicines purchased at private pharmacies. Patients with chronic ailments are especially affected, as they often need lifelong medicines. Over the past years in India, there have been several efforts to improve drug availability at government primary health centres. In this study, we aim to understand health system factors that affect utilisation and access to generic medicines for people with non-communicable diseases. This study aims to understand if (and how) a package of interventions targeting primary health centres and community participation platforms affect utilisation and access to generic medicines for people with non-communicable diseases in the current district context in India. This study will employ a quasi-experimental design and a qualitative theory-driven approach. PHCs will be randomly assigned to one of three arms of the intervention. In one arm, PHCs will receive inputs to optimise service delivery for non-communicable diseases, while the second arm will receive an additional package of interventions to strengthen community participation platforms for improving non-communicable disease care. The third arm will be the control. We will conduct household and facility surveys, before and after the intervention and will estimate the effect of the intervention by difference-in-difference analysis. Sample size for measuring effects was calculated based on obtaining at least 30 households for each primary health centre spread across three distance-based clusters. Primary outcomes include availability and utilisation of medicines at primary health centres and out-of-pocket expenditure for medicines by non-communicable disease households. Focus group discussions with patients and in-depth interviews with health workers will also be conducted. Qualitative and process documentation data will be used to explain how the intervention could have worked. By taking into consideration several health system building blocks and trying to understand how they interact, our study aims to generate evidence for health planners on how to optimise health services to improve access to medicines. Protocol registered on Clinical Trials Registry of India with registration identifier number CTRI/2015/03/005640 on 17(th) March 2015.

The use of dental care facilities and oral health: a multilevel approach of schoolchildren in the Brazilian context.

PubMed

Antunes, José Leopoldo; Peres, Marco Aurélio; Jahn, Graciela Medeiros Jabôr; Levy, Bárbara Bianca da Silva

2006-01-01

To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children). A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus. Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus. This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies.

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion.

PubMed

van Niekerk, Ashley; Seedat, Mohamed; Kramer, Sherianne; Suffla, Shahnaaz; Bulbulia, Samed; Ismail, Ghouwa

2014-01-01

The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources. A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation. The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support. This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention.

The impact of a sugar-sweetened beverages tax on oral health and costs of dental care in Australia.

PubMed

Sowa, P Marcin; Keller, Elena; Stormon, Nicole; Lalloo, Ratilal; Ford, Pauline J

2018-05-22

Despite a clear causal link between frequent consumption of sugar-sweetened beverages (SSBs) and dental disease, little is known about the implications of a tax on SSBs in the context of oral health. The aim of our study was to estimate the impacts of a SSB tax on the Australian population in the context of oral health outcomes, dental care utilisation and associated costs. We designed a cohort model that accounted for the consequences of the tax through the mechanisms of consumer response to price increase, the effect on oral health due to change in sugar intake, and the implications for dental care use. Our results indicate that in the adult population an ad valorem tax of 20% would lead to a reduction in decayed, missing and filled teeth (DMFT) by 3.9 million units over 10 years, resulting in cost savings of A$666 million. Scenario analyses show that the outcomes are sensitive to the choice of the time horizon, tax rate, price elasticity of demand for SSBs, and the definition of target population. We found that the total and per-person consequences of SSB tax were considerable, both in terms of dental caries (tooth decay) averted and dental care avoided. These results have to be compounded with the implications of SSB tax for other aspects of health and health care, especially in the context of chronic diseases. On the other hand, the improved outcomes have to be weighted against a welfare loss associated with introducing a tax.

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion

PubMed Central

2014-01-01

Background The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources. Methods A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation. Results The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support. Conclusions This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention. PMID:25081088

Are healthcare aides underused in long-term care? A cross-sectional study on continuing care facilities in Canada.

PubMed

Arain, Mubashir A; Deutschlander, Siegrid; Charland, Paola

2017-05-17

Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities. From June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gathered solely from the prospective cross-sectional survey of continuing care facilities (long-term care (LTC) and supportive living (SL)) on HCA utilisation. We conducted this study in a Western Canadian province. The managers of the continuing care facilities (SL and LTC) were eligible to participate in the survey. The pattern of HCAs involvement in medication assistance and other care activities in SL and LTC facilities. We received 130 completed surveys (LTC=64 and SL=52). Our findings showed that approximately 81% of HCAs were fully certified. We found variations in how HCAs were used in SL and LTC facilities. Overall, HCAs in SL were more likely to be involved in medication management such as assisting with inhaled medication and oral medication delivery. A significantly larger proportion of survey respondents from SL facilities reported that medication assistance training was mandatory for their HCAs (86%) compared with the LTC facilities (50%) (p value <0.01). The utilisation of HCAs varies widely between SL and LTC facilities. HCAs in SL facilities may be considered better used according to their required educational training and competencies. Expanding the role of HCAs in LTC facilities may lead to a cost-effective and more efficient utilisation of workforce in continuing care facilities. © 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.

An Anthropometric Study of Cranio-Facial Measurements and Their Correlation with Vertical Dimension of Occlusion among Saudi Arabian Subpopulations.

PubMed

Majeed, Muhammed Irfan; Haralur, Satheesh B; Khan, Muhammed Farhan; Al Ahmari, Maram Awdah; Al Shahrani, Nourah Falah; Shaik, Sharaz

2018-04-15

Determining and restoring physiological vertical dimension of occlusion (VDO) is the critical step during complete mouth rehabilitation. The improper VDO compromises the aesthetics, phonetics and functional efficiency of the prosthesis. Various methods are suggested to determine the accurate VDO, including the facial measurements in the clinical situations with no pre-extraction records. The generalisation of correlation between the facial measurements to VDO is criticised due to gender dimorphism and racial differences. Hence, it is prudent to verify the hypothesis of facial proportion and correlation of lower third of the face to remaining craniofacial measurements in different ethnic groups. The objective of the study was to evaluate the correlation of craniofacial measurements and OVD in the Saudi-Arabian ethnic group. Total of 228 participants from Saudi-Arabian Ethnic group were randomly recruited in this cross-sectional study. Fifteen craniofacial measurements were recorded with modified digital Vernier callipers, and OVD was recorded at centric occlusion. The obtained data were analysed by using the Spearman's correlation and linear regression analysis. The Mean OVD in male participants was higher (69.25 ± 5.54) in comparison to female participants (57.41 ± 5.32). The craniofacial measurement of Exocanthion-right labial commissure and the Mesial wall of the right external auditory canal-orbitale lateral had a strong positive correlation with VDO. The strong correlation was recorded with a trichion-upper border of right eyebrow line and trichion-Nasion only in males. Meanwhile, the length of an auricle recorded the positive correlation in female participants. Being simple and non-invasive technique, craniofacial measurements and linear equations could be routinely utilised to determine VDO.

Regional scale climatic trends derived from Younger Dryas glaciers in the U.K.

NASA Astrophysics Data System (ADS)

Pearce, D.; Rea, B. R.; Barr, I.; Small, D.; McDougall, D.

2014-12-01

In the U.K., the glacial geomorphological record has been utilised to infer paleo-glacier geometries and ice dynamics, with much of this work focussing on the Scottish Highlands during the Younger Dryas (YD; c. 12.9 - 11.7 ka BP). During the YD the West Highlands Ice-cap covered the majority of the Scottish Highlands (c. 13,000 sq mi), which is thought to have affected accumulation rates beyond the ice-cap margins, resulting in a steep (c. 80%) easterly decline in precipitation and smaller ice-masses. We present multi-proxy data investigating YD glaciation in the Tweedsmuir Hills, Southern Uplands, Scotland (55°46' N, 03°34' W), suggesting conditions were less arid. The area forms the most easterly upland region in the Southern Uplands and south of the West Highlands Ice-cap, reaching an altitude of 840 m and covering c. 200 sq mi. Results of air-photo interpretation and field mapping, which utilised a morphostratigraphic approach, have demonstrated a more extensive glaciation than previously mapped. The reconstruction consists of two separate icefields covering an area c. 40 sq mi. and new 14C dates of basal contact organics place the ice-mass within the context of the YD but new Cosmogenic Nuclide Analysis (CNA) of bedrock and in situ boulders are inconclusive, implying limited erosion and limited resetting during the YD. Equilibrium Line Altitudes are calculated to have ranged from c. 419 - 634 m. Paleo-precipitation values were derived using two precipitation-temperature relationships and suggest slightly lower totals than YD ice-masses located on the west coast of the U.K. but do not support a significant easterly reduction in precipitation. Analysis of present-day (c. 30 year) meteorological data across the U.K. demonstrates a pronounced reduction in precipitation of c. 50% on the east coast. This disparity between present-day and glacier-based YD precipitation patterns is partly attributable to the methodology employed in glacier reconstruction and represents an avenue for future research. These results differ significantly from the traditional paradigm which due to low accumulation rates, only restricted ice-masses developed in the Tweedsmuir Hills. Within a wider context this data questions the steep precipitation gradients thought to have been present during the YD.

iMARS--mutation analysis reporting software: an analysis of spontaneous cII mutation spectra.

PubMed

Morgan, Claire; Lewis, Paul D

2006-01-31

The sensitivity of any mutational assay is determined by the level at which spontaneous mutations occur in the corresponding untreated controls. Establishing the type and frequency at which mutations occur naturally within a test system is essential if one is to draw scientifically sound conclusions regarding chemically induced mutations. Currently, mutation-spectra analysis is laborious and time-consuming. Thus, we have developed iMARS, a comprehensive mutation-spectrum analysis package that utilises routinely used methodologies and visualisation tools. To demonstrate the use and capabilities of iMARS, we have analysed the distribution, types and sequence context of spontaneous base substitutions derived from the cII gene mutation assay in transgenic animals. Analysis of spontaneous mutation spectra revealed variation both within and between the transgenic rodent test systems Big Blue Mouse, MutaMouse and Big Blue Rat. The most common spontaneous base substitutions were G:C-->A:T transitions and G:C-->T:A transversions. All Big Blue Mouse spectra were significantly different from each other by distribution and nearly all by mutation type, whereas the converse was true for the other test systems. Twenty-eight mutation hotspots were observed across all spectra generally occurring in CG, GA/TC, GG and GC dinucleotides. A mutation hotspot at nucleotide 212 occurred at a higher frequency in MutaMouse and Big Blue Rat. In addition, CG dinucleotides were the most mutable in all spectra except two Big Blue Mouse spectra. Thus, spontaneous base-substitution spectra showed more variation in distribution, type and sequence context in Big Blue Mouse relative to spectra derived from MutaMouse and Big Blue Rat. The results of our analysis provide a baseline reference for mutation studies utilising the cII gene in transgenic rodent models. The potential differences in spontaneous base-substitution spectra should be considered when making comparisons between these test systems. The ease at which iMARS has allowed us to carry out an exhaustive investigation to assess mutation distribution, mutation type, strand bias, target sequences and motifs, as well as predict mutation hotspots provides us with a valuable tool in helping to distinguish true chemically induced hotspots from background mutations and gives a true reflection of mutation frequency.

Development of a behaviour change intervention: a case study on the practical application of theory

PubMed Central

2014-01-01

Background Use of theory in implementation of complex interventions is widely recommended. A complex trial intervention, to enhance self-management support for people with osteoarthritis (OA) in primary care, needed to be implemented in the Managing Osteoarthritis in Consultations (MOSAICS) trial. One component of the trial intervention was delivery by general practitioners (GPs) of an enhanced consultation for patients with OA. The aim of our case study is to describe the systematic selection and use of theory to develop a behaviour change intervention to implement GP delivery of the enhanced consultation. Methods The development of the behaviour change intervention was guided by four theoretical models/frameworks: i) an implementation of change model to guide overall approach, ii) the Theoretical Domains Framework (TDF) to identify relevant determinants of change, iii) a model for the selection of behaviour change techniques to address identified determinants of behaviour change, and iv) the principles of adult learning. Methods and measures to evaluate impact of the behaviour change intervention were identified. Results The behaviour change intervention presented the GPs with a well-defined proposal for change; addressed seven of the TDF domains (e.g., knowledge, skills, motivation and goals); incorporated ten behaviour change techniques (e.g., information provision, skills rehearsal, persuasive communication); and was delivered in workshops that valued the expertise and professional values of GPs. The workshops used a mixture of interactive and didactic sessions, were facilitated by opinion leaders, and utilised ‘context-bound communication skills training.’ Methods and measures selected to evaluate the behaviour change intervention included: appraisal of satisfaction with workshops, GP report of intention to practise and an assessment of video-recorded consultations of GPs with patients with OA. Conclusions A stepped approach to the development of a behaviour change intervention, with the utilisation of theoretical frameworks to identify determinants of change matched with behaviour change techniques, has enabled a systematic and theory-driven development of an intervention designed to enhance consultations by GPs for patients with OA. The success of the behaviour change intervention in practice will be evaluated in the context of the MOSAICS trial as a whole, and will inform understanding of practice level and patient outcomes in the trial. PMID:24708880

Analysis of the barriers and enablers to implementing lifestyle management practices for women with PCOS in Singapore.

PubMed

Ko, Henry; Teede, Helena; Moran, Lisa

2016-06-16

Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and manifests with adverse reproductive, metabolic and psychological consequences. Evidence-based PCOS guidelines recommend lifestyle management first line for infertility. In Singapore women with PCOS can attend the PCOS Clinic at the Kandang Kerbau Women and Children's Hospital for infertility treatment. However lifestyle integration into infertility management is currently limited and barriers and enablers to progress remain unclear. All PCOS clinic staff undertook semi-structured interviews to investigate perceived barriers for staff and consumers for the integration of lifestyle into infertility management. This study utilised various tools including an 8P Ishikawa diagram model to identify and categorise barriers. A modified Hanlon method was then used to prioritise barriers within the Singaporean context considering organisational, cultural and financial constraints. Propriety, economics, acceptability, resources and legality (PEARL) criteria were also incorporated into this decision-making tool. In the 8P model, there were five factors contributing to the 'procedure (consultations and referral processes)' barrier, one 'policy (government and hospitals)' factor, five 'place' factors, two 'product (lifestyle management programme)' barriers, two 'people (programme capacity)' factors, four 'process (integration)' factors, three 'promotion' barriers and three 'price' factors. Of the prioritised barriers, two were identified across each of 'procedures', 'place', 'product' and 'people' and four related to 'processes'. There were no barriers identified that for 'policies', 'promotion' and 'price' that can be addressed. There is a clear need to integrate lifestyle into infertility management in PCOS, in line with current national and international evidence-based guidelines. The highest priority identified improvement opportunity was to develop a collaborative lifestyle management programme across hospital services. Reductions in variation of delivery and strengthening support within the lifestyle programme are other identified priorities. The strength of this study is that this is the first study to utilise a pragmatic quality improvement method for barriers identification and prioritisation in the area of lifestyle management for women with PCOS. This project identified factors that may provide easy improvements, but also identified some local factors that may be very difficult to change. The major limitation of this study is that it is only looking at the Singapore setting, so may have limited applicability to other countries. However, results from quality improvement projects are meant to be context specific.

Measuring self-regulation in a physically active context: Psychometric analyses of scores derived from an observer-rated measure of self-regulation.

PubMed

Lakes, Kimberley D

2013-10-01

The purpose of this study is to report psychometric properties of scores obtained using a novel observer-rated measure of children's self-regulation, the Response to Challenge Scale (RCS). The RCS was developed to rate children's self-regulatory abilities in a physically active context (e.g., while completing a physical challenge course). The RCS and other study measures were administered in a private school sample of 207 children. Analyses of score distributions indicated that the RCS was able to capture variance among children in self-regulatory abilities; the distribution was normal for the Affective, Cognitive, and Total Self-Regulation scales. Validity analyses revealed significant positive correlations between Cognitive, Affective, Motor, and Total Self-Regulation and executive function task performance; significant negative correlations between Cognitive Regulation and teacher-rated hyperactivity and inattention; significant negative correlations between Affective, Motor, and Total Self-Regulation and teacher ratings of peer problems; and significant positive correlations between Cognitive and Affective Regulation and parent ratings of prosocial behavior. Parent and teacher rated Total Difficulties scores were both negatively correlated with RCS Total Self-Regulation scores. Results suggest that it is possible for observers to rate self-regulatory abilities in the context of physical activities, and that these ratings correspond with performance on tasks requiring executive function as well as teacher and parent ratings of children's difficulties.

Mesophilic and thermophilic anaerobic digestion of sulphate-containing wastewaters.

PubMed

Colleran, E; Pender, S

2002-01-01

The effect of sulphate at an influent chemical oxygen demand (COD):sulphate ratio of 4 on the operational performance of anaerobic hybrid reactors treating molasses wastewater was investigated under mesophilic and thermophilic conditions in a long-term laboratory-scale study over a 1,081 day period. The presence of sulphate reduced the COD removal efficiency under both mesophilic and thermophilic conditions. At 55 degrees C, effluent acetate levels were consistently greater than 4000 mg l(-1) indicating that thermophilic acetate-utilising methane-producing bacteria (MPB) or sulphate-reducing bacteria (SRB) had not developed in the reactor under the conditions applied. At 37 degrees C, acetate was exclusively utilised by acetoclastic methanogens, whereas H2-utilising SRB predominated over H2-utilising MPB in the competition for hydrogen. By contrast, hydrogenotrophic MPB were shown to outcompete H2-utilising SRB during long-term thermophilic operation. 16SrDNA analysis of the seed sludge and reactor biomass on conclusion of the 37 degrees C and 55 degrees C trials illustrated that the dominant methanogen present on conclusion of the thermophilic trial in the absence of influent sulphate was related to Methanocorpusculum parvuum, and was capable of growth on both acetate and hydrogen. By contrast, an organism closely related to Methanobacterium thermoautotrophicum was the dominant methanogen present in the sulphate-fed reactor on completion of the thermophilic trial.

Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana Demographic and Health Surveillance data.

PubMed

Browne, Joyce L; Kayode, Gbenga A; Arhinful, Daniel; Fidder, Samuel A J; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin

2016-03-18

This study aims to evaluate the effect of maternal health insurance status on the utilisation of antenatal, skilled delivery and postnatal care. A population-based cross-sectional study. We utilised the 2008 Demographic and Health Survey data of Ghana, which included 2987 women who provided information on maternal health insurance status. Utilisation of antenatal, skilled delivery and postnatal care. Multivariable logistic regression was applied to determine the independent association between maternal health insurance and utilisation of antenatal, skilled delivery and postnatal care. After adjusting for socioeconomic, demographic and obstetric factors, we observed that among insured women the likelihood of having antenatal care increased by 96% (OR 1.96; 95% CI 1.52 to 2.52; p value<0.001) and of skilled delivery by 129% (OR 2.29; 95% CI 1.92 to 2.74; p value<0.001), while postnatal care among insured women increased by 61% (OR 1.61; 95% CI 1.17 to 2.21; p value<0.01). This study demonstrated that maternal health insurance status plays a significant role in the uptake of the maternal, neonatal and child health continuum of care service. 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/

Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries

PubMed Central

Postolovska, Iryna; Helleringer, Stéphane; Kruk, Margaret E; Verguet, Stéphane

2018-01-01

Background Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services. Methods We analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000–2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough). Results SIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country. Conclusion The paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions. PMID:29755760

Migrant female head porters' enrolment in and utilisation and renewal of the National Health Insurance Scheme in Kumasi, Ghana.

PubMed

Boateng, Simon; Amoako, Prince; Poku, Adjoa Afriyie; Baabereyir, Anthony; Gyasi, Razak Mohammed

2017-01-01

As a social protection policy, Ghana's National Health Insurance Scheme (NHIS) aims to improve access to healthcare, especially for the vulnerable. Migrant female head porters ( kayayoo ), who are part of the informal economic workforce, are underscored as an ethnic minority and vulnerable group in Ghana. This study aimed to analyse the factors associated with enrolment in and renewal and utilisation of the NHIS among migrant female head porters in the Kumasi Metropolis. We purposively sampled 392 migrant female head porters in the Kejetia, Asafo and Bantama markets. We used a binary logit regression model to estimate associations among baseline characteristics, convenience and benefit factors and enrolment in and renewal and utilisation of the NHIS. Age and income significantly increased the probability of NHIS enrolment, renewal and utilisation. Long waiting times at NHIS offices significantly reduced the likelihood of renewal, while provision of drugs highly significantly increased the tendency for migrant female head porters to enrol in, renew and use the NHIS. Consulting and surgery also significantly increased renewal and utilisation of the NHIS. Political commitment is imperative for effective implementation of the decentralisation policy of the NHIS through the National Health Insurance Authority in Kumasi. We argue that retail offices should be well equipped with logistic facilities to ensure convenience in NHIS initial enrolment and renewal processes by citizenry, and by vulnerable groups in particular.

Resource Utilisation and Curriculum Implementation in Community Colleges in Kenya

ERIC Educational Resources Information Center

Kigwilu, Peter Changilwa; Akala, Winston Jumba

2017-01-01

The study investigated how Catholic-sponsored community colleges in Nairobi utilise the existing physical facilities and teaching and learning resources for effective implementation of Artisan and Craft curricula. The study adopted a mixed methods research design. Proportional stratified random sampling was used to sample 172 students and 18…

Redirecting Under-Utilised Computer Laboratories into Cluster Computing Facilities

ERIC Educational Resources Information Center

Atkinson, John S.; Spenneman, Dirk H. R.; Cornforth, David

2005-01-01

Purpose: To provide administrators at an Australian university with data on the feasibility of redirecting under-utilised computer laboratories facilities into a distributed high performance computing facility. Design/methodology/approach: The individual log-in records for each computer located in the computer laboratories at the university were…

76 FR 82279 - Electronic Delivery of Search Results From the United States Patent and Trademark Office to the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... 141 EPC and new Rule 70b EPC--utilisation scheme, OJ EPO 2010, 410. To assist U.S. applicants who... exemption under Rule 141(2) EPC from filing a copy of the search results--utilisation scheme, OJ EPO 2011...

Beyond Problem-Based Learning: Using Dynamic PBL in Chemistry

ERIC Educational Resources Information Center

Overton, Tina L.; Randles, Christopher A.

2015-01-01

This paper describes the development and implementation of a novel pedagogy, dynamic problem-based learning. The pedagogy utilises real-world problems that evolve throughout the problem-based learning activity and provide students with choice and different data sets. This new dynamic problem-based learning approach was utilised to teach…

Doctor Competence and the Demand for Healthcare: Evidence from Rural China.

PubMed

Fe, Eduardo; Powell-Jackson, Timothy; Yip, Winnie

2017-10-01

The agency problem between patients and doctors has long been emphasised in the health economics literature, but the empirical evidence on whether patients can evaluate and respond to better quality care remains mixed and inconclusive. Using household data linked to an assessment of village doctors' clinical competence in rural China, we show that there is no correlation between doctor competence and patients' healthcare utilisation, with confidence intervals reasonably tight around zero. Household perceptions of quality are an important determinant of care-seeking behaviour, yet patients appear unable to recognise more competent doctors - there is no relationship between doctor competence and perceptions of quality. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

[Correlates of cyberbullying and bullying--first results of a self-report study].

PubMed

Wachs, Sebastian; Wolf, Karsten D

2011-01-01

If Li's assumption (2007) that the new phenomenon of cyberbullying is nothing else but "old wine in new old bottles" is true, cyberbullies (and cybervictims) will also be traditional bullies (and victims). Further aims of this study were to measure the prevalence of (cyber-bullying and to investigate the similarities and differences between both forms of bullying. An online-survey utilised the CAPI method with a sample of 838 students (11-17 years) who participated in whole classes. The data suggests that Li (2007) is right in principle, but there are also some important differences to traditional bullying: (1) cyberbullying seems to "level" the differences between gender; (2) cybervictims seem to be more ready to "strike back".

A multi-environmental study of recent breeding progress on nitrogen use efficiency in wheat (Triticum aestivum L.).

PubMed

Cormier, Fabien; Faure, Sébastien; Dubreuil, Pierre; Heumez, Emmanuel; Beauchêne, Katia; Lafarge, Stéphane; Praud, Sébastien; Le Gouis, Jacques

2013-12-01

By comparing 195 varieties in eight trials, this study assesses nitrogen use efficiency improvement in high and low nitrogen conditions in European winter wheat over the last 25 years. In a context where European agriculture practices have to deal with environmental concerns and nitrogen (N) fertiliser cost, nitrogen use efficiency (NUE) has to be improved. This study assessed genetic progress in winter wheat (Triticum aestivum L.) NUE. Two hundred and twenty-five European elite varieties were tested in four environments under two levels of N. Global genetic progress was assessed on additive genetic values and on genotype × N interaction, covering 25 years of European breeding. To avoid sampling bias, quality, precocity and plant height were added as covariates in the analyses when needed. Genotype × environment interactions were highly significant for all the traits studied to such an extent that no additive genetic effect was detected on N uptake. Genotype × N interactions were significant for yield, grain protein content (GPC), N concentration in straw, N utilisation, and NUE. Grain yield improvement (+0.45 % year(-1)) was independent of the N treatment. GPC was stable, thus grain nitrogen yield was improved (+0.39 % year(-1)). Genetic progress on N harvest index (+0.12 % year(-1)) and on N concentration in straw (-0.52 % year(-1)) possibly revealed improvement in N remobilisation. There has been an improvement of NUE additive genetic value (+0.33 % year(-1)) linked to better N utilisation (+0.20 % year(-1)). Improved yield stability was detected as a significant improvement of NUE in low compared to high N conditions. The application of these results to breeding programs is discussed.

Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study.

PubMed

Treacy, Laura; Bolkan, Håkon A; Sagbakken, Mette

2018-01-01

Sierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone. Data were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made. Pregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.

Caught between a rock and a hard place: An intrinsic single case study of nurse researchers' experiences of the presence of a nursing research culture in clinical practice.

PubMed

Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi

2018-04-01

To explore how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. Higher demands in the hospitals for increasing the quality of patient care engender a higher demand for the skills of health professionals and evidence-based practice. However, the utilisation of nursing research in clinical practice is still limited. Intrinsic single case study design underlined by a constructivist perspective. Data were produced through a focus group interview with seven nurse researchers employed in clinical practice in two university hospitals in Zealand, Denmark, to capture the intrinsic aspects of the concept of nursing research culture in the context of clinical practice. A thematic analysis was conducted based on Braun and Clarke's theoretical guideline. "Caught between a rock and a hard place" was constructed as the main theme describing how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. The main theme was supported by three subthemes: Minimal academic tradition affects nursing research; Minimal recognition from physicians affects nursing research; and Moving towards a research culture. The nurse researchers in this study did not experience the presence of a nursing research culture in clinical practice, however; they called for more attention on removing barriers against research utilisation, promotion of applied research and interdisciplinary research collaboration, and passionate management support. The results of this case study show the pressure which nurse researchers employed in clinical practice are exposed to, and give examples on how to accommodate the further development of a nursing research culture in clinical practice. © 2017 John Wiley & Sons Ltd.

Barriers to Institutional Childbirth in Rumbek North County, South Sudan: A Qualitative Study

PubMed Central

Wilunda, Calistus; Scanagatta, Chiara; Putoto, Giovanni; Takahashi, Risa; Montalbetti, Francesca; Segafredo, Giulia; Betrán, Ana Pilar

2016-01-01

Background South Sudan has one of the world’s poorest health indicators due to a fragile health system and a combination of socio-cultural, economic and political factors. This study was conducted to identify barriers to utilisation of institutional childbirth services in Rumbek North County. Methods Data were collected through 14 focus group discussions with 169 women and 45 men, and 18 key informant interviews with community leaders, staff working in health facilities, traditional birth attendants, and the staff of the County Health Department. Data were analysed using inductive content analysis. Results The barriers to institutional childbirth were categorised under four main themes: 1) Issues related to access and lack of resources: long distance to health facilities, lack of transportation means, referral problems, flooding and poor roads, and payments in health facilities; 2) Issues related to the socio-cultural context and conflict: insecurity, influence of the husband, lack of birth preparedness, domestic chores of women, influence of culture; 3) Perceptions about pregnancy and childbirth: perceived benefit of institutional childbirth, low childbirth risk perception, and medicalisation of childbirth including birth being perceived to be natural, undesirable birth practices, privacy concerns, and fear of caesarean section; and 4) Perceptions about the quality of care: inadequate health facility infrastructure and perceived neglect during admission. Conclusions Multiple factors hinder institutional childbirth in Rumbek North. Some of the factors such as insecurity and poor roads are outside the scope of the health sector and will require a multi-sectoral approach if childbirth services are to be made accessible to women. Detailed recommendations to increase utilisation of childbirth services in the county have been suggested. PMID:27977745

Experiences integrating autonomous components and legacy systems into tsunami early warning systems

NASA Astrophysics Data System (ADS)

Reißland, S.; Herrnkind, S.; Guenther, M.; Babeyko, A.; Comoglu, M.; Hammitzsch, M.

2012-04-01

Fostered by and embedded in the general development of Information and Communication Technology (ICT) the evolution of Tsunami Early Warning Systems (TEWS) shows a significant development from seismic-centred to multi-sensor system architectures using additional sensors, e.g. sea level stations for the detection of tsunami waves and GPS stations for the detection of ground displacements. Furthermore, the design and implementation of a robust and scalable service infrastructure supporting the integration and utilisation of existing resources serving near real-time data not only includes sensors but also other components and systems offering services such as the delivery of feasible simulations used for forecasting in an imminent tsunami threat. In the context of the development of the German Indonesian Tsunami Early Warning System (GITEWS) and the project Distant Early Warning System (DEWS) a service platform for both sensor integration and warning dissemination has been newly developed and demonstrated. In particular, standards of the Open Geospatial Consortium (OGC) and the Organization for the Advancement of Structured Information Standards (OASIS) have been successfully incorporated. In the project Collaborative, Complex, and Critical Decision-Support in Evolving Crises (TRIDEC) new developments are used to extend the existing platform to realise a component-based technology framework for building distributed TEWS. This talk will describe experiences made in GITEWS, DEWS and TRIDEC while integrating legacy stand-alone systems and newly developed special-purpose software components into TEWS using different software adapters and communication strategies to make the systems work together in a corporate infrastructure. The talk will also cover task management and data conversion between the different systems. Practical approaches and software solutions for the integration of sensors, e.g. providing seismic and sea level data, and utilisation of special-purpose components, such as simulation systems, in TEWS will be presented.

Effects of an air pollution personal alert system on health service usage in a high-risk general population: a quasi-experimental study using linked data.

PubMed

Lyons, R A; Rodgers, S E; Thomas, S; Bailey, R; Brunt, H; Thayer, D; Bidmead, J; Evans, B A; Harold, P; Hooper, M; Snooks, H

2016-05-23

There is no evidence to date on whether an intervention alerting people to high levels of pollution is effective in reducing health service utilisation. We evaluated alert accuracy and the effect of a targeted personal air pollution alert system, airAware, on emergency hospital admissions, emergency department attendances, general practitioner contacts and prescribed medications. Quasi-experimental study describing accuracy of alerts compared with pollution triggers; and comparing relative changes in healthcare utilisation in the intervention group to those who did not sign-up. Participants were people diagnosed with asthma, chronic obstructive pulmonary disease (COPD) or coronary heart disease, resident in an industrial area of south Wales and registered patients at 1 of 4 general practices. Longitudinal anonymised record linked data were modelled for participants and non-participants, adjusting for differences between groups. During the 2-year intervention period alerts were correctly issued on 208 of 248 occasions; sensitivity was 83.9% (95% CI 78.8% to 87.9%) and specificity 99.5% (95% CI 99.3% to 99.6%). The intervention was associated with a 4-fold increase in admissions for respiratory conditions (incidence rate ratio (IRR) 3.97; 95% CI 1.59 to 9.93) and a near doubling of emergency department attendance (IRR=1.89; 95% CI 1.34 to 2.68). The intervention was associated with increased emergency admissions for respiratory conditions. While findings may be context specific, evidence from this evaluation questions the benefits of implementing near real-time personal pollution alert systems for high-risk individuals. 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/

Ethnographic analysis on the use of the electronic medical record for clinical handoff.

PubMed

Nelson, Philippa; Bell, Anthony J; Nathanson, Larry; Sanchez, Leon D; Fisher, Jonathan; Anderson, Philip D

2017-12-01

The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase. This study uses an ethnographic qualitative research design incorporating semistructured interviews, participant observation on the ED floor and fieldwork notes. The setting for this research was in the ED at a tertiary University affiliated hospital. Triangulation was used to combine information obtained from multiple sources and information from fieldwork and interviews refined into useable chunks culminating in a thematic analysis. Thematic analysis yielded five central themes that reflected how the clinical staff utilised this IT system and why it had become embedded in the culture of clinical referral and handover. Efficient time management for improved patient flow was demonstrated, value added communication (at the interpersonal level), the building trust at the ED-inpatient interface, the maintenance of mutual respect across medical cultures and an overall enhancement of the quality of ED communication (in terms of the information available). A robust electronic handover process, resulted in an integrated approach to patient care by removing barriers to admission for medical inpatients, admitted via ED. The value proposition for patients was a more complete information transfer, both within the ED and between departments.

Narrative research in psychotherapy: a critical review.

PubMed

Avdi, Evrinomy; Georgaca, Eugenie

2007-09-01

This paper is a review of studies which utilise the notion of narrative to analyse psychotherapy. Its purpose is to systematically present this diverse field of research, to highlight common themes and divergences between different strands and to further the development and integration of narrative research in psychotherapy. The paper reviews studies which employ an applied textual analysis of narratives produced in the context of psychotherapy. Criteria for inclusion of studies are, firstly, the analysis of therapeutic and therapy-related texts and, secondly, the adoption of a narrative psychological perspective. The studies were examined on the basis of the notion of narrative they employ and the aspects of client narratives they focus on, and were grouped accordingly in the review. The majority of the studies reviewed assume a constructivist approach to narrative, adopt a representational view of language, focus primarily on client micro-narratives and relate to cognitive-constructivist and process-experiential psychotherapeutic approaches. A smaller group of studies assume a social constructionist approach to narrative and a functional view of language, focus on micro-narratives, highlight the interactional and wider social aspects of narrative and relate to postmodern trends in psychotherapy. The range of conceptualisations of narrative in the studies reviewed, from a representational psychological view to a constructionist social view, reflects tensions within narrative psychology itself. Moreover, two trends can be discerned in the field reviewed, narrative analysis of therapy, which draws from narrative theory and utilises the analytic approaches of narrative research to study psychotherapy, and analyses of narrative in therapy, which study client narratives using non-narrative qualitative methods. Finally, the paper highlights the need for integration of this diverse field of research and urges for the development of narrative studies of psychotherapy which employ a broader social understanding of narrative production and transformation.

Psycholinguistic Correlates of Progress in Literature of Students of Russian Vocational Training School

ERIC Educational Resources Information Center

Nuriakhmetov, Aidar

2012-01-01

The article describes psycholinguistic correlates of progress in literature, discovered on the basis of correlation analysis of grades, and results of several psychological and psycholinguistic tests were taken in the context of comprehensive psycholinguistic research based on one of Russian vocational training schools. Analysis revealed a list of…

A confluence of contexts: asymmetric versus global failures of selective attention to stroop dimensions.

PubMed

Sabri, M; Melara, R D; Algom, D

2001-06-01

In 6 experiments probing selective attention through Stroop classification, 4 factors of context were manipulated: (a) psychophysical context, the distinctiveness of values along the color and word dimensions; (b) set size context, the number of stimulus values tested; (c) production context, the mode used to respond; and (d) covariate context, the correlation between the dimensions. The psychophysical and production contexts mainly caused an asymmetry in selective attention failure between colors and words, whereas the set size and covariate contexts contributed primarily to the average or global magnitudes of attentional disruption across dimensions. The results suggest that (a) Stroop dimensions are perceptually separable, (b) J.R. Stroop's (1935) classic findings arose from his particular combination of contexts, and (c) stimulus uncertainty and dimensional imbalance are the primary sources of task and congruity effects in the Stroop paradigm.

Photonic correlator pattern recognition: Application to autonomous docking

NASA Technical Reports Server (NTRS)

Sjolander, Gary W.

1991-01-01

Optical correlators for real-time automatic pattern recognition applications have recently become feasible due to advances in high speed devices and filter formulation concepts. The devices are discussed in the context of their use in autonomous docking.

Brain oscillations track the formation of episodic memories in the real world.

PubMed

Griffiths, Benjamin; Mazaheri, Ali; Debener, Stefan; Hanslmayr, Simon

2016-12-01

Despite the well-known influence of environmental context on episodic memory, little has been done to increase contextual richness within the lab. This leaves a blind spot lingering over the neuronal correlates of episodic memory formation in day-to-day life. To address this, we presented participants with a series of words to memorise along a pre-designated route across campus while a mobile EEG system acquired ongoing neural activity. Replicating lab-based subsequent memory effects (SMEs), we identified significant low to mid frequency power decreases (<30Hz), including beta power decreases over the left inferior frontal gyrus. When investigating the oscillatory correlates of temporal and spatial context binding, we found that items strongly bound to spatial context exhibited significantly greater theta power decreases than items strongly bound to temporal context. These findings expand upon lab-based studies by demonstrating the influence of real world contextual factors that underpin memory formation. Copyright © 2016 Elsevier Inc. All rights reserved.

Wavelet-based image compression using shuffling and bit plane correlation

NASA Astrophysics Data System (ADS)

Kim, Seungjong; Jeong, Jechang

2000-12-01

In this paper, we propose a wavelet-based image compression method using shuffling and bit plane correlation. The proposed method improves coding performance in two steps: (1) removing the sign bit plane by shuffling process on quantized coefficients, (2) choosing the arithmetic coding context according to maximum correlation direction. The experimental results are comparable or superior for some images with low correlation, to existing coders.

Pleiotropy of cardiometabolic syndrome with obesity-related anthropometric traits determined using empirically derived kinships from the Busselton Health Study.

PubMed

Cadby, Gemma; Melton, Phillip E; McCarthy, Nina S; Almeida, Marcio; Williams-Blangero, Sarah; Curran, Joanne E; VandeBerg, John L; Hui, Jennie; Beilby, John; Musk, A W; James, Alan L; Hung, Joseph; Blangero, John; Moses, Eric K

2018-01-01

Over two billion adults are overweight or obese and therefore at an increased risk of cardiometabolic syndrome (CMS). Obesity-related anthropometric traits genetically correlated with CMS may provide insight into CMS aetiology. The aim of this study was to utilise an empirically derived genetic relatedness matrix to calculate heritabilities and genetic correlations between CMS and anthropometric traits to determine whether they share genetic risk factors (pleiotropy). We used genome-wide single nucleotide polymorphism (SNP) data on 4671 Busselton Health Study participants. Exploiting both known and unknown relatedness, empirical kinship probabilities were estimated using these SNP data. General linear mixed models implemented in SOLAR were used to estimate narrow-sense heritabilities (h 2 ) and genetic correlations (r g ) between 15 anthropometric and 9 CMS traits. Anthropometric traits were adjusted by body mass index (BMI) to determine whether the observed genetic correlation was independent of obesity. After adjustment for multiple testing, all CMS and anthropometric traits were significantly heritable (h 2 range 0.18-0.57). We identified 50 significant genetic correlations (r g range: - 0.37 to 0.75) between CMS and anthropometric traits. Five genetic correlations remained significant after adjustment for BMI [high density lipoprotein cholesterol (HDL-C) and waist-hip ratio; triglycerides and waist-hip ratio; triglycerides and waist-height ratio; non-HDL-C and waist-height ratio; insulin and iliac skinfold thickness]. This study provides evidence for the presence of potentially pleiotropic genes that affect both anthropometric and CMS traits, independently of obesity.

Tobacco cessation quitlines in North America: a descriptive study

PubMed Central

Cummins, Sharon E; Bailey, Linda; Campbell, Sharon; Koon‐Kirby, Carrie; Zhu, Shu‐Hong

2007-01-01

Background Quitlines have become an integral part of tobacco control efforts in the United States and Canada. The demonstrated efficacy and the convenience of telephone based counselling have led to the fast adoption of quitlines, to the point of near universal access in North America. However, information on how these quitlines operate in actual practice is not often readily available. Objectives This study describes quitline practice in North America and examines commonalities and differences across quitlines. It will serve as a source of reference for practitioners and researchers, with the aim of furthering service quality and promoting continued innovation. Design A self administered questionnaire survey of large, publicly funded quitlines in the United States and Canada. A total of 52 US quitlines and 10 Canadian quitlines participated. Descriptive statistics are provided regarding quitline operational structures, clinical services, quality assurance procedures, funding sources and utilisation rates. Results Clinical services for the 62 state/provincial quitlines are supplied by a total of 26 service providers. Nine providers operate multiple quitlines, creating greater consistency in operation than would otherwise be expected. Most quitlines offer services over extended hours (mean 96 hours/week) and have multiple language capabilities. Most (98%) use proactive multisession counselling—a key feature of protocols tested in previous experimental trials. Almost all quitlines have extensive training programmes (>60 hours) for counselling staff, and over 70% conduct regular evaluation of outcomes. About half of quitlines use the internet to provide cessation information. A little over a third of US quitlines distribute free cessation medications to eligible callers. The average utilisation rate of the US state quitlines in the 2004–5 fiscal year was about 1.0% across states, with a strong correlation between the funding level of the quitlines and the smokers' utilisation of them (r = 0.74, p<0.001). Conclusions Quitlines in North America display core commonalities: they have adopted the principles of multisession proactive counselling and they conduct regular outcome evaluation. Yet variations, tested and untested, exist. Standardised reporting procedures would be of benefit to the field. Shared discussion of the rationale behind variations can inform future decision making for all North American quitlines. PMID:18048639

[Analysis of the Association between Regional Deprivation and Utilization: An Assessment of Need for Physicians in Germany].

PubMed

Kopetsch, T; Maier, W

2018-01-01

A new strategy for planning outpatient medical care needs to be developed. The social and morbidity structure of the population should be considered in the planning of needs-based provision of medical care. This paper aims to examine the extent to which the degree of regional deprivation can be incorporated in the calculation of the regional requirements for specialists in Germany. To measure regional deprivation status at district level, we used the "German Index of Multiple Deprivation" (GIMD) developed in the Helmholtz Zentrum München - German Research Center for Environmental Health. Scores were calculated for the deprivation status of each rural and urban district in Germany. The methods used to compute the deprivation-adjusted medical need are linear regression analyses. The analyses were based on regionalized data for the number of office-based physicians and their billing data. The analyses were carried out with the SPSS software package, version 20. The analyses showed a clear positive correlation between regional deprivation and the utilisation of medical services both for outpatients and in-patients, on the one hand, and mortality and morbidity, as measured by the risk adjustment factor (RSA), on the other. At the district level, the analyses also revealed varying associations between the degree of deprivation and the utilisation of the 12 groups of specialists included in the needs assessment. On this basis, an algorithm was developed by which deprivation at district level can be used to calculate an increase or a decrease in the relative number of specialists needed. Using the GIMD and various determinants of medical utilisation, the model showed that medical need increased with the level of regional deprivation. However, regarding SHI medical specialist groups, the associations found in this analysis were statistically (R 2 ) insufficient to suggest a needs assessment planning system based only on the factors analysed, thereby restricting physicians' constitutional right of professional freedom. In particular cases, i. e. licenses to meet special needs, the developed instruments may be suitable for indicating a greater or lesser need for doctors at a regional level due to their relative ease of use and practicability. © Georg Thieme Verlag KG Stuttgart · New York.

Landscape context and scale differentially impact coffee leaf rust, coffee berry borer, and coffee root-knot nematodes.

PubMed

Avelino, Jacques; Romero-Gurdián, Alí; Cruz-Cuellar, Héctor F; Declerck, Fabrice A J

2012-03-01

Crop pest and disease incidences at plot scale vary as a result of landscape effects. Two main effects can be distinguished. First, landscape context provides habitats of variable quality for pests, pathogens, and beneficial and vector organisms. Second, the movements of these organisms are dependent on the connectivity status of the landscape. Most of the studies focus on indirect effects of landscape context on pest abundance through their predators and parasitoids, and only a few on direct effects on pests and pathogens. Here we studied three coffee pests and pathogens, with limited or no pressure from host-specific natural enemies, and with widely varying life histories, to test their relationships with landscape context: a fungus, Hemileia vastatrix, causal agent of coffee leaf rust; an insect, the coffee berry borer, Hypothenemus hampei (Coleoptera: Curculionidae); and root-knot nematodes, Meloidogyne spp. Their incidence was assessed in 29 coffee plots from Turrialba, Costa Rica. In addition, we characterized the landscape context around these coffee plots in 12 nested circular sectors ranging from 50 to 1500 m in radius. We then performed correlation analysis between proportions of different land uses at different scales and coffee pest and disease incidences. We obtained significant positive correlations, peaking at the 150 m radius, between coffee berry borer abundance and proportion of coffee in the landscape. We also found significant positive correlations between coffee leaf rust incidence and proportion of pasture, peaking at the 200 m radius. Even after accounting for plot level predictors of coffee leaf rust and coffee berry borer through covariance analysis, the significance of landscape structure was maintained. We hypothesized that connected coffee plots favored coffee berry borer movements and improved its survival. We also hypothesized that wind turbulence, produced by low-wind-resistance land uses such as pasture, favored removal of coffee leaf rust spore clusters from host surfaces, resulting in increased epidemics. In contrast, root-knot nematode population density was not correlated to landscape context, possibly because nematodes are almost immobile in the soil. We propose fragmenting coffee plots with forest corridors to control coffee berry borer movements between coffee plots without favoring coffee leaf rust dispersal.

Individual, Social, and Environmental Correlates of Active Transportation Patterns in French Women.

PubMed

Perchoux, Camille; Enaux, Christophe; Oppert, Jean-Michel; Menai, Mehdi; Charreire, Hélène; Salze, Paul; Weber, Christiane; Hercberg, Serge; Feuillet, Thierry; Hess, Franck; Roda, Célina; Simon, Chantal; Nazare, Julie-Anne

2017-01-01

The objectives were (1) to define physical activity (PA) and sedentary behaviors (SB) patterns in daily life contexts (work, leisure, and transportation) in French working women from NutriNet-Santé web-cohort and (2) to identify pattern(s) of active transportation and their individual, social, and environmental correlates. 23,432 participants completed two questionnaires to evaluate PA and SB in daily life contexts and individual representations of residential neighborhood and transportation modes. Hierarchical cluster analysis was performed which identified 6 distinct movement behavior patterns: (i) active occupation, high sedentary leisure, (ii) sedentary occupation, low leisure, (iii) sedentary transportation, (iv) sedentary occupation and leisure, (v) active transportation, and (vi) active leisure. Multinomial logistic regressions were performed to identify correlates of the "active transportation" cluster. The perceived environmental characteristics positively associated with "active transportation" included "high availability of destinations around home," "presence of bicycle paths," and "low traffic." A "positive image of walking/cycling," the "individual feeling of being physically active," and a "high use of active transport modes by relatives/friends" were positively related to "active transportation," identified as a unique pattern regarding individual and environmental correlates. Identification of PA and SB context-specific patterns will help to understand movement behaviors' complexity and to design interventions to promote active transportation in specific subgroups.

Application of the differentiation process into the correlation-based leak detection in urban pipeline networks

NASA Astrophysics Data System (ADS)

Gao, Yan; Liu, Yuyou; Ma, Yifan; Cheng, Xiaobin; Yang, Jun

2018-11-01

One major challenge currently facing pipeline networks across the world is the improvement of leak detection technologies in urban environments. There is an imperative to locate accurately leaks in buried water pipes to avoid serious environmental, social and economic consequences. Much attention has been paid to time delay estimation (TDE) in determining the position of a leak by utilising cross-correlation, which has been proven to be effective with varying degrees of success over the past half century. Previous research in published literature has demonstrated the effectiveness of the pre-whitening process for accentuating the peak in the cross-correlation associated with the time delay. This paper is concerned with the implementation of the differentiation process for TDE, with particular focus on the problem of determining a leak in pipelines by means of pipe pressure measurements. Rather than the pre-whitening operation, the proposed cross-correlation via the differentiation process, termed here DIF, changes the characteristics of the pipe system so that the pipe effectively acts as a band-pass filter. This method has the potential to eliminate some ambiguity caused by the interference at low frequencies and to allow more high frequency information to pass. Given an appropriate differentiation order, a more pronounced and reliable peak is obtained in the cross-correlation result. The use of differentiation process may provide a viable cross-correlation method suited to water leak detection. Its performance in relation to leak detection is further compared to the basic cross-correlation and pre-whitening methods for TDE in detecting a leak from actual PVC water pipes. Experimental results are presented to show an additional property of the DIF compensating for the resonance effects that may exist in cross-spectral density measurements, and hence better performance for TDE.

Fostering Effective Leadership in Foreign Contexts through Study of Cultural Values

ERIC Educational Resources Information Center

Schenck, Andrew D.

2016-01-01

While leadership styles have been extensively examined, cultural biases implicit within research methodologies often preclude application of results in foreign contexts. To more holistically comprehend the impact of culture on leadership, belief systems were empirically correlated to both transactional and transformational tendencies in public…

Temporal Context, Preference, and Resistance to Change

ERIC Educational Resources Information Center

Podlesnik, Christopher A.; Jimenez-Gomez, Corina; Thrailkill, Eric A.; Shahan, Timothy A.

2011-01-01

According to behavioral momentum theory, preference and relative resistance to change in concurrent chains schedules are correlated and reflect the relative conditioned value of discriminative stimuli. In the present study, we explore the generality of this relation by manipulating the temporal context within a concurrent-chains procedure through…

Socialization in Context: Exploring Longitudinal Correlates of Mothers’ Value Messages of Compassion and Caution

PubMed Central

Wray-Lake, Laura; Flanagan, Constance A.; Maggs, Jennifer L.

2012-01-01

This study examined correlates of mothers’ value messages using mother and adolescent reports across three years (N =1638 dyads). Two fundamental socialization dimensions were assessed: compassion messages (e.g., caring for others) and caution messages (e.g., being wary of others). Multilevel models revealed distinct between-person and within-person correlates for mothers’ compassion and caution messages. Individual differences in compassion messages were predicted by family context (e.g., mothers’ knowledge of friends and concerns for their child’s future) and neighborhood cohesion. Within-person effects demonstrated that compassion declined in concert with adolescents’ experiences of being bullied. Caution messages were predicted by mothers’ education levels, race/ethnicity, and marital status, and increased in relation to mothers’ concerns and perceptions that illegal substances were easily attainable in the community. Tests of age, period, and cohort effects unexpectedly revealed that longitudinal changes in compassion and caution were best explained by period effects. Consistent with new developments in value socialization theory, results suggest that mothers place emphasis on certain values based on their backgrounds, their children’s characteristics, and the broader social context. PMID:22059448

Teaching Harmonic Motion in Trigonometry: Inductive Inquiry Supported by Physics Simulations

ERIC Educational Resources Information Center

Sokolowski, Andrzej; Rackley, Robin

2011-01-01

In this article, the authors present a lesson whose goal is to utilise a scientific environment to immerse a trigonometry student in the process of mathematical modelling. The scientific environment utilised during this activity is a physics simulation called "Wave on a String" created by the PhET Interactive Simulations Project at…

Extent of ESL Teachers' Access To, Utilisation and Production of Research

ERIC Educational Resources Information Center

Sibanda, Jabulani; Begede, Martin P.

2015-01-01

This study employed the survey design on a purposive sample of 100 English Second Language (ESL) teachers from Swaziland and South Africa's Eastern Cape Province, to investigate the extent to which they accessed, utilised and conducted research to better their practice. A survey questionnaire and follow-up structured interviews generated…

Enhancing Student Employability through Ethics-Based Outreach Activities and Open Educational Resources

ERIC Educational Resources Information Center

Lewis, David I.

2011-01-01

This paper reports on how science communication final year undergraduate research projects and educational internships can be utilised to provide opportunities for students to develop and utilise key employability skills. In the current difficult economic climate, the report "Working towards your future: Making the most of your time in higher…

The Nature and Significance of Listening Skills in Accounting Practice

ERIC Educational Resources Information Center

Stone, Gerard; Lightbody, Margaret

2012-01-01

While surveys of the employers of accountancy graduates highlight the significance of listening skills, relatively little is known about how such skills are utilised in accounting practice. The present study attempts to address the above lacuna by utilising the findings of in-depth interviews with Australian public accountants about the nature of…

Utilising Planning and Financing Strategies in the Management of Community Development Projects in Enugu State, Nigeria

ERIC Educational Resources Information Center

Obetta, Chukwuemeka K.; Oreh, Catherine I.

2017-01-01

Utilisation of community management strategies is an approach to governance that is based on community and organisational involvement. Communities with development projects have formed community projects management committees (CPMCs) that are encouraged to adopt the community management strategy in the planning and financing of community…

Utilisation of Local Inputs in the Funding and Administration of Education in Nigeria

ERIC Educational Resources Information Center

Akiri, Agharuwhe A.

2014-01-01

The article discussed how, why and who is in charge of administering and funding schools in Nigeria. The author utilised the relevant statistical approach which examined and discussed various political and historical trends affecting education. Besides this, relevant documented statistical data were used to both buttress and substantiate related…

A Qualitative Exploration of Primary School Students' Experience and Utilisation of Mindfulness

ERIC Educational Resources Information Center

Bannirchelvam, Bavani; Bell, Karen L.; Costello, Shane

2017-01-01

Despite the increasing utilisation of mindfulness-based interventions in children, research investigating the impact of these interventions in children is still in its infancy. One significant gap in the literature is the general omission of the child's voice in how they experience and benefit from mindfulness-based intervention. Therefore, the…

Utilisation and Satisfaction with Rehabilitation Services in Children with Primary Language Impairment Transitioning to School: Parents' Perspective

ERIC Educational Resources Information Center

Mazer, Barbara; Dion, Karyne; Moryoussef, Aguy

2017-01-01

Children with disabilities require coordinated services to optimise transition into school. This study compared type, frequency and approach to service utilisation for children with primary language impairment transitioning from rehabilitation to the educational system, and examined parent satisfaction. Parents responded to a telephone…

Improving the Utilisation of Management Information Systems in Secondary Schools

ERIC Educational Resources Information Center

Bosker, R. J.; Branderhorst, E. M.; Visscher, A. J.

2007-01-01

Although most secondary schools do use management information systems (MISs), these systems tend not to be used to support higher order managerial activities but are currently primarily used for clerical purposes. This situation is unsatisfactory as MISs fully utilised could offer invaluable support to schools, which are increasingly being granted…

Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses' Perceived Barriers to Research Utilisation

ERIC Educational Resources Information Center

Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla

2016-01-01

Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…

Ethnic Variation in Service Utilisation among Children with Intellectual Disability

ERIC Educational Resources Information Center

Dura-Vila, G.; Hodes, M.

2009-01-01

Background: This study examined whether service utilisation among children with intellectual disability (ID) varied by ethnic cultural group. Method: Survey carried out in four special schools in London. Information was provided by school teachers using case files, and 242 children aged 7 to 17 years with mild and moderate ID were identified.…

Linking Bacillus cereus Genotypes and Carbohydrate Utilization Capacity.

PubMed

Warda, Alicja K; Siezen, Roland J; Boekhorst, Jos; Wells-Bennik, Marjon H J; de Jong, Anne; Kuipers, Oscar P; Nierop Groot, Masja N; Abee, Tjakko

2016-01-01

We characterised carbohydrate utilisation of 20 newly sequenced Bacillus cereus strains isolated from food products and food processing environments and two laboratory strains, B. cereus ATCC 10987 and B. cereus ATCC 14579. Subsequently, genome sequences of these strains were analysed together with 11 additional B. cereus reference genomes to provide an overview of the different types of carbohydrate transporters and utilization systems found in B. cereus strains. The combined application of API tests, defined growth media experiments and comparative genomics enabled us to link the carbohydrate utilisation capacity of 22 B. cereus strains with their genome content and in some cases to the panC phylogenetic grouping. A core set of carbohydrates including glucose, fructose, maltose, trehalose, N-acetyl-glucosamine, and ribose could be used by all strains, whereas utilisation of other carbohydrates like xylose, galactose, and lactose, and typical host-derived carbohydrates such as fucose, mannose, N-acetyl-galactosamine and inositol is limited to a subset of strains. Finally, the roles of selected carbohydrate transporters and utilisation systems in specific niches such as soil, foods and the human host are discussed.

Linking Bacillus cereus Genotypes and Carbohydrate Utilization Capacity

PubMed Central

Warda, Alicja K.; Siezen, Roland J.; Boekhorst, Jos; Wells-Bennik, Marjon H. J.; de Jong, Anne; Kuipers, Oscar P.; Nierop Groot, Masja N.; Abee, Tjakko

2016-01-01

We characterised carbohydrate utilisation of 20 newly sequenced Bacillus cereus strains isolated from food products and food processing environments and two laboratory strains, B. cereus ATCC 10987 and B. cereus ATCC 14579. Subsequently, genome sequences of these strains were analysed together with 11 additional B. cereus reference genomes to provide an overview of the different types of carbohydrate transporters and utilization systems found in B. cereus strains. The combined application of API tests, defined growth media experiments and comparative genomics enabled us to link the carbohydrate utilisation capacity of 22 B. cereus strains with their genome content and in some cases to the panC phylogenetic grouping. A core set of carbohydrates including glucose, fructose, maltose, trehalose, N-acetyl-glucosamine, and ribose could be used by all strains, whereas utilisation of other carbohydrates like xylose, galactose, and lactose, and typical host-derived carbohydrates such as fucose, mannose, N-acetyl-galactosamine and inositol is limited to a subset of strains. Finally, the roles of selected carbohydrate transporters and utilisation systems in specific niches such as soil, foods and the human host are discussed. PMID:27272929

[TANDEM (TAsk force oN long Duration unemployment of Elderly People and Mental health) implementation of a cross-institutional pilot project for elderly long-term unemployed persons - presentation of the project procedure and the utilisation].

PubMed

Steil, C; Meiler, B; Wiesten, I; Wiltfang, J; Kis, B

2013-08-01

The aim of this study is to implement and examine the feasibility of a cross-institutional mental health intervention to comprehend and advance mental health of elderly long-term unemployed persons. Report on the procedure and on the observational study utilisation in a 14-month period. The structure and processes chosen could be implemented into practice successfully. Utilisation was high but 30% dropped out during the procedure. Of the unemployed persons surveyed, 96% received a psychiatric diagnosis. 85% were not having psychiatric treatment. The method chosen is feasible and was accepted by the target group. Project structure and processes proved to be applicable for the implementation of the project aims. The method chosen reaches an up to now "psychiatry-inexperienced" target group characterised by frequent incidence of mental disorders and low utilisation of psychiatric care. Thus, vocational reintegration programmes should be supported by psychiatric services. © Georg Thieme Verlag KG Stuttgart · New York.

To fractionate municipal solid waste incineration bottom ash: Key for utilisation?

PubMed

Sormunen, Laura Annika; Rantsi, Riina

2015-11-01

For the past decade, the Finnish waste sector has increasingly moved from the landfilling of municipal solid waste towards waste incineration. New challenges are faced with the growing amounts of municipal solid waste incineration bottom ash, which are mainly landfilled at the moment. Since this is not a sustainable or a profitable solution, finding different utilisation applications for the municipal solid waste incineration bottom ash is crucial. This study reports a comprehensive analysis of bottom ash properties from one waste incineration plant in Finland, which was first treated with a Dutch bottom ash recovery technique called advanced dry recovery. This novel process separates non-ferrous and ferrous metals from bottom ash, generating mineral fractions of different grain sizes (0-2 mm, 2-5 mm, 5-12 mm and 12-50 mm). The main aim of the study was to assess, whether the advanced bottom ash treatment technique, producing mineral fractions of different grain sizes and therefore properties, facilitates the utilisation of municipal solid waste incineration bottom ash in Finland. The results were encouraging; the bottom ash mineral fractions have favourable behaviour against the frost action, which is especially useful in the Finnish conditions. In addition, the leaching of most hazardous substances did not restrict the utilisation of bottom ash, especially for the larger fractions (>5 mm). Overall, this study has shown that the advanced bottom ash recovering technique can be one solution to increase the utilisation of bottom ash and furthermore decrease its landfilling in Finland. © The Author(s) 2015.

Identifying patterns of general practitioner service utilisation and their relationship with potentially preventable hospitalisations in people with diabetes: The utility of a cluster analysis approach.

PubMed

Ha, Ninh Thi; Harris, Mark; Preen, David; Robinson, Suzanne; Moorin, Rachael

2018-04-01

We aimed to characterise use of general practitioners (GP) simultaneously across multiple attributes in people with diabetes and examine its impact on diabetes related potentially preventable hospitalisations (PPHs). Five-years of panel data from 40,625 adults with diabetes were sourced from Western Australian administrative health records. Cluster analysis (CA) was used to group individuals with similar patterns of GP utilisation characterised by frequency and recency of services. The relationship between GP utilisation cluster and the risk of PPHs was examined using multivariable random-effects negative binomial regression. CA categorised GP utilisation into three clusters: moderate; high and very high usage, having distinct patient characteristics. After adjusting for potential confounders, the rate of PPHs was significantly lower across all GP usage clusters compared with those with no GP usage; IRR = 0.67 (95%CI: 0.62-0.71) among the moderate, IRR = 0.70 (95%CI 0.66-0.73) high and IRR = 0.76 (95%CI 0.72-0.80) very high GP usage clusters. Combination of temporal factors with measures of frequency of use of GP services revealed patterns of primary health care utilisation associated with different underlying patient characteristics. Incorporation of multiple attributes, that go beyond frequency-based approaches may better characterise the complex relationship between use of GP services and diabetes-related hospitalisation. Copyright © 2018 Elsevier B.V. All rights reserved.

Drug safety and the impact of drug warnings: An interrupted time series analysis of diabetes drug prescriptions in Germany and Denmark.

PubMed

Hostenkamp, Gisela; Fischer, Katharina Elisabeth; Borch-Johnsen, Knut

2016-12-01

To analyse the impact of drug safety warnings from the European Medicines Agency (EMA) on drug utilisation and their interaction with information released through national reimbursement bodies. Insurance claims data on anti-diabetic drug prescriptions in primary care in Germany and Denmark were analysed using interrupted time series analysis, with EMA drug warnings for thiazolidinediones (TZDs) in 2007 and 2011 as the intervention. Monthly drug utilisation data per substance in defined daily dosages (DDD) consumed per 1000 insurees were retrieved from the Danish national drug prescriptions register and one large statutory sickness fund in Germany. TZDs were generally reimbursed in Germany but restricted to individual reimbursement in Denmark. Consequently, utilisation of TZDs was much higher in Germany in 2007 compared with Denmark. For rosiglitazone, the drug warning had a significant impact on utilisation, reducing the number of DDD per 1000 insurees per day by -0.0105 in Denmark and -0.0312 in Germany (p-values<0.05). For pioglitazone, neither of the drug warnings had a significant effect on utilisation. The impact of EMA drug warnings differed across countries and might be mediated by information released through national reimbursement bodies and physician associations. Increasing complexity of new drugs and modified approval procedures require a strengthening of information exchange between drug regulation bodies and physicians to ensure patient safety. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Etude de faisabilite d'un systeme eolien diesel avec stockage d'air comprime

NASA Astrophysics Data System (ADS)

Benchaabane, Youssef

Le Systeme Hybride Eolien-Diesel avec Stockage d'Air Comprime (SHEDAC) utilise l'hybridation pneumatique pour remplacer la consommation des combustibles fossiles par de l'energie renouvelable, plus particulierement de l'energie eolienne. Le surplus de l'energie eolienne est utilise pour comprimer et stocker de l'air qui est utilise ensuite pour suralimenter le moteur diesel. Le memoire de maitrise est constitue de deux articles scientifiques. Le premier article presente le developpement d'un logiciel dedie a l'etude de faisabilite d'un systeme eolien-diesel avec stockage d'air comprime. Cette etude est basee sur l'analyse des couts et des revenus, des couts des equipements (eolienne, moteur diesel, systeme de stockage d'air). Elle est completee par une analyse de sensibilite aux differents parametres, une analyse des risques et des emissions des gaz a effet de serre (GES). Le deuxieme article est une application de ce logiciel pour l'installation d'un systeme SHEDAC au camp minier Esker au Quebec en remplacement des sources actuelles de production d'energie. L'utilisation du stockage d'air comprime a l'aide d'un systeme SHEDAC est le plus rentable par rapport a l'utilisation de l'energie eolienne seule ou d'une centrale thermique au diesel seule ou des deux combinees. Avec une valeur actuelle nette et un taux de rendement interne plus eleves, cette solution permet d'obtenir le plus bas cout de l'energie pour cette region eloignee. None None None

Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data.

PubMed

Atun, Rifat; Gurol-Urganci, Ipek; Hone, Thomas; Pell, Lisa; Stokes, Jonathan; Habicht, Triin; Lukka, Kaija; Raaper, Elin; Habicht, Jarno

2016-12-01

Following independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system. Using routinely collected health billing records for 2005-2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co-morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply-side variables, and PHC use. Over the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow-up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services. Our findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions.

The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda.

PubMed

Dhillon, Ranu S; Bonds, Matthew H; Fraden, Max; Ndahiro, Donald; Ruxin, Josh

2012-01-01

This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five 'imidugudu' or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights.

Modelling job support, job fit, job role and job satisfaction for school of nursing sessional academic staff.

PubMed

Cowin, Leanne S; Moroney, Robyn

2018-01-01

Sessional academic staff are an important part of nursing education. Increases in casualisation of the academic workforce continue and satisfaction with the job role is an important bench mark for quality curricula delivery and influences recruitment and retention. This study examined relations between four job constructs - organisation fit, organisation support, staff role and job satisfaction for Sessional Academic Staff at a School of Nursing by creating two path analysis models. A cross-sectional correlational survey design was utilised. Participants who were currently working as sessional or casual teaching staff members were invited to complete an online anonymous survey. The data represents a convenience sample of Sessional Academic Staff in 2016 at a large school of Nursing and Midwifery in Australia. After psychometric evaluation of each of the job construct measures in this study we utilised Structural Equation Modelling to better understand the relations of the variables. The measures used in this study were found to be both valid and reliable for this sample. Job support and job fit are positively linked to job satisfaction. Although the hypothesised model did not meet model fit standards, a new 'nested' model made substantive sense. This small study explored a new scale for measuring academic job role, and demonstrated how it promotes the constructs of job fit and job supports. All four job constructs are important in providing job satisfaction - an outcome that in turn supports staffing stability, retention, and motivation.

Use of Online Machine Translation for Nursing Literature: A Questionnaire-Based Survey

PubMed Central

Anazawa, Ryoko; Ishikawa, Hirono; Takahiro, Kiuchi

2013-01-01

Background: The language barrier is a significant obstacle for nurses who are not native English speakers to obtain information from international journals. Freely accessible online machine translation (MT) offers a possible solution to this problem. Aim: To explore how Japanese nursing professionals use online MT and perceive its usability in reading English articles and to discuss what should be considered for better utilisation of online MT lessening the language barrier. Method: In total, 250 randomly selected assistants and research associates at nursing colleges across Japan answered a questionnaire examining the current use of online MT and perceived usability among Japanese nurses, along with the number of articles read in English and the perceived language barrier. The items were rated on Likert scales, and t-test, ANOVA, chi-square test, and Spearman’s correlation were used for analyses. Results: Of the participants, 73.8% had used online MT. More than half of them felt it was usable. The language barrier was strongly felt, and academic degrees and English proficiency level were associated factors. The perceived language barrier was related to the frequency of online MT use. No associated factor was found for the perceived usability of online MT. Conclusion: Language proficiency is an important factor for optimum utilisation of MT. A need for education in the English language, reading scientific papers, and online MT training was indicated. Cooperation with developers and providers of MT for the improvement of their systems is required. PMID:23459140

Pregnancy and oral health: utilisation of dental services during pregnancy in northern Greece.

PubMed

Dinas, Konstantinos; Achyropoulos, Vassilios; Hatzipantelis, Emmanouel; Mavromatidis, Georgios; Zepiridis, Leonidas; Theodoridis, Theodoros; Dovas, Dimitrios; Tantanasis, Theoharis; Goutzioulis, Fotios; Bontis, John

2007-01-01

Recent studies have shown that gingivitis and periodontal infection during pregnancy represent an independent risk factor for pre-term birth. However, little is known about the prevalence and correlates of dental attendance during pregnancy. During the first 3 days postpartum, an anonymous questionnaire was administered to 425 women in order to explore their dental condition and utilisation of dental health services during pregnancy, as well as their perceptions on the potential associations between dental care during pregnancy and pregnancy outcomes. Almost half of the respondents (46.8%) reported symptoms of gingivitis during their pregnancy. Pregnancy gingivitis was independently associated with non-Greek ethnicity (p=0.008), multiparity versus primiparity (p<0.005), lower economic class versus middle and upper classes (p=0.001), and the lack of routine primary dental care (p=0.005). Some 27.3% reported a visit to the dentist during their pregnancy. The majority (72.2%) believed that dental treatment during pregnancy might have a negative affect on pregnancy outcome. The presence of pregnancy gingivitis and the belief that dental treatment during pregnancy is safe were both independently associated with visiting a dentist during pregnancy (p<0.0005 for both). Despite the increased prevalence of dental problems among pregnant women, few women seek dental services in this population, which can be primarily attributed to women's erroneous beliefs regarding the safety of dental examination. Therefore, there is an imperative need to offer oral health education and develop preventive programs for women of reproductive age.

[Dialin: infection surveillance network for haemodialysis patients. First results].

PubMed

Ayzac, Louis; Béruard, Michel; Girard, Raphaële; Hannoun, Jacques; Kuentz, François; Marc, Jean-Michel; Moreau-Gaudry, Xavier; Roche, Catherine; Tressières, Benoît; Uzan, Marc

2009-02-01

To show results of the first year of an infection surveillance network for haemodialysis patients (Dialin). In order to improve the security and quality of care, six haemodialysis centers have organized an infection watching network. The purpose of the network is to compare of the watching results between centers. This comparison includes vascular access infection (VAI), bacteraemia and C viral hepatitis. The heterogeneous pattern has been also taken into account. SURVEY TYPE: Multicenter prospective permanent survey. Six hundred and sixty-four haemodialyzed chronic patients, followed during one year (2005), in six voluntary haemodialysis centers. This survey has based on 71,688 treatment sessions corresponding to 6257.5 months of haemodialysis (HM). As with the heterogeneity among centers, the acquired infection standardized ratios (observed/expected) (AISR) and 95% confidence interval are computed with Cox model which includes confounding factors found in literature or in the preliminary stage of the survey. VAI crude rate was 0.47 per 100HM, 0.10 per 1000 native fistulae utilisation days, 0.45 per 1000 days of prosthetic graft utilisation and 0.44 per 1000 days of catheter utilisation. Bacteraemia crude incidence rate was 0.69 per 100HM, 0.02 per 1000 days of native fistulae utilisation, 0.00 per 1000 days of prosthetic graft utilisation and 0.39 per 1000 days of catheter utilisation. No new case of C viral hepatitis was found. Prevalence rate at the beginning of the survey was 5.3% (35 over 664). Two centers had a significantly high AISR for VAI and two centers had a significantly low AISR for VAI. One center had a significantly high AISR for bacteraemia and one center had a significantly low AISR for bacteraemia. The first year of Dialin running demonstrates the importance of standardised surveillance method in VAI and bacteraemia surveillance but not for viral hepatitis.

The association of smoking status with healthcare utilisation, productivity loss and resulting costs: results from the population-based KORA F4 study.

PubMed

Wacker, Margarethe; Holle, Rolf; Heinrich, Joachim; Ladwig, Karl-Heinz; Peters, Annette; Leidl, Reiner; Menn, Petra

2013-07-17

Smoking is seen as the most important single risk to health today, and is responsible for a high financial burden on healthcare systems and society. This population-based cross-sectional study compares healthcare utilisation, direct medical costs, and costs of productivity losses for different smoking groups: current smokers, former smokers, and never smokers. Using a bottom-up approach, data were taken from the German KORA F4 study (2006/2008) on self-reported healthcare utilisation and work absence due to illness for 3,071 adults aged 32-81 years. Unit costs from a societal perspective were applied to utilisation. Utilisation and resulting costs were compared across different smoking groups using generalised linear models to adjust for age, sex, education, alcohol consumption and physical activity. Average annual total costs per survey participant were estimated as €3,844 [95% confidence interval: 3,447-4,233], and differed considerably between smoking groups with never smokers showing €3,237 [2,802-3,735] and former smokers causing €4,398 [3,796-5,058]. There was a positive effect of current and former smoking on the utilisation of healthcare services and on direct and indirect costs. Total annual costs were more than 20% higher (p<0.05) for current smokers and 35% higher (p<0.01) for former smokers compared with never smokers, which corresponds to annual excess costs of €743 and €1,108 per current and former smoker, respectively. Results indicate that excess costs for current and former smokers impose a large burden on society, and that previous top-down cost approaches produced lower estimates for the costs of care for smoking-related diseases. Efforts must be focused on prevention of smoking to achieve sustainable containment on behalf of the public interest.

Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales

NASA Astrophysics Data System (ADS)

Jegasothy, Edward; McGuire, Rhydwyn; Nairn, John; Fawcett, Robert; Scalley, Benjamin

2017-08-01

Periods of successive extreme heat and cold temperature have major effects on human health and increase rates of health service utilisation. The severity of these events varies between geographic locations and populations. This study aimed to estimate the effects of heat waves and cold waves on health service utilisation across urban, regional and remote areas in New South Wales (NSW), Australia, during the 10-year study period 2005-2015. We divided the state into three regions and used 24 over-dispersed or zero-inflated Poisson time-series regression models to estimate the effect of heat waves and cold waves, of three levels of severity, on the rates of ambulance call-outs, emergency department (ED) presentations and mortality. We defined heat waves and cold waves using excess heat factor (EHF) and excess cold factor (ECF) metrics, respectively. Heat waves generally resulted in increased rates of ambulance call-outs, ED presentations and mortality across the three regions and the entire state. For all of NSW, very intense heat waves resulted in an increase of 10.8% (95% confidence interval (CI) 4.5, 17.4%) in mortality, 3.4% (95% CI 0.8, 7.8%) in ED presentations and 10.9% (95% CI 7.7, 14.2%) in ambulance call-outs. Cold waves were shown to have significant effects on ED presentations (9.3% increase for intense events, 95% CI 8.0-10.6%) and mortality (8.8% increase for intense events, 95% CI 2.1-15.9%) in outer regional and remote areas. There was little evidence for an effect from cold waves on health service utilisation in major cities and inner regional areas. Heat waves have a large impact on health service utilisation in NSW in both urban and rural settings. Cold waves also have significant effects in outer regional and remote areas. EHF is a good predictor of health service utilisation for heat waves, although service needs may differ between urban and rural areas.

[Frequency of use of school cafeterias in middle and high schools in 3 French districts].

PubMed

Michaud, C; Feur, E; Gerbouin-Rérolle, P; Leynaud-Rouaud, C; Chateil, S; Gourdon, M

2000-09-01

Reports from the French Ministry of Education warn of a decrease in the use of school food services, especially in sensitive urban areas. They also suggest that this decline has led to cases of malnutrition. This article describes the characteristics of the current supply of school meals and measures the evolution of demand observed between 1992 and 1996 in relation to the economic situation of students' families. The study was carried out in 3 departments in France: Doubs, Herault, and Val de Marne. The administrators of all public and private middle and high schools in the 3 departments received a questionnaire asking them to describe the services offered in their cafeterias and to provide the corresponding statistical and accounting data. External food services near the schools were also taken into account. Seventy-nine percent of schools responded to the survey. Concerning the services offered, 91% of schools have their own cafeterias, of which 81% are managed by the schools. Concerning the evolution of utilisation, a significant decrease in the number of meals served in seen in middle schools. On the other hand, high schools have observed stable utilisation. The positive changes in utilisation are linked, in middle schools, to characteristics of the schools' internal food services (self-service, choice of main courses, modulation of seats). In high schools, positive changes in the utilisation of school services are linked to the lack of external food services near the schools. As middle schools and high schools control the logistics and management of food services offered to students, they are potentially in a position to influence a policy on this issue. The evolution in utilisation is very different among departments and between middle and high schools. While economic precariousness has a negative structural effect on utilisation, it doesn't seem to be a major factor in the evolution of the decrease observed over the past few years.

Simulation d'ecoulements internes compressibles laminaires et turbulents par une methode d'elements finis

NASA Astrophysics Data System (ADS)

Rebaine, Ali

1997-08-01

Ce travail consiste en la simulation numerique des ecoulements internes compressibles bidimensionnels laminaires et turbulents. On s'interesse, particulierement, aux ecoulements dans les ejecteurs supersoniques. Les equations de Navier-Stokes sont formulees sous forme conservative et utilisent, comme variables independantes, les variables dites enthalpiques a savoir: la pression statique, la quantite de mouvement et l'enthalpie totale specifique. Une formulation variationnelle stable des equations de Navier-Stokes est utilisee. Elle est base sur la methode SUPG (Streamline Upwinding Petrov Galerkin) et utilise un operateur de capture des forts gradients. Un modele de turbulence, pour la simulation des ecoulements dans les ejecteurs, est mis au point. Il consiste a separer deux regions distinctes: une region proche de la paroi solide, ou le modele de Baldwin et Lomax est utilise et l'autre, loin de la paroi, ou une formulation nouvelle, basee sur le modele de Schlichting pour les jets, est proposee. Une technique de calcul de la viscosite turbulente, sur un maillage non structure, est implementee. La discretisation dans l'espace de la forme variationnelle est faite a l'aide de la methode des elements finis en utilisant une approximation mixte: quadratique pour les composantes de la quantite de mouvement et de la vitesse et lineaire pour le reste des variables. La discretisation temporelle est effectuee par une methode de differences finies en utilisant le schema d'Euler implicite. Le systeme matriciel, resultant de la discretisation spatio-temporelle, est resolu a l'aide de l'algorithme GMRES en utilisant un preconditionneur diagonal. Les validations numeriques ont ete menees sur plusieurs types de tuyeres et ejecteurs. La principale validation consiste en la simulation de l'ecoulement dans l'ejecteur teste au centre de recherche NASA Lewis. Les resultats obtenus sont tres comparables avec ceux des travaux anterieurs et sont nettement superieurs concernant les ecoulements turbulents dans les ejecteurs.

Caries experience, dental health behaviour and social status--three comparative surveys among Danish military recruits in 1972, 1982 and 1993.

PubMed

Antoft, P; Rambusch, E; Antoft, B; Christensen, H W

1999-06-01

To compare caries experience among young Danish men in 1972, 1982 and 1993; and on the same occasions to describe relationship between their utilisation of regular dental care and social status, as well as the relationship between their caries experience, utilisation of dental services and social status. During their routine health examinations in 1972, 1982 and 1993 all recruits enlisted in the Danish Air Force were subjected to an additional oral examination combined with a structured socio-dental questionnaire. Identical methods were applied in each of the three surveys. Dental clinics at air bases in Denmark. 4,103 male military recruits, aged 18 to 25 years. Caries was registered in accordance with the WHO Basic Methods 1971. The questionnaire provided information on age, place of residence during childhood, social origin, and patterns of utilisation of dental services. The findings indicated a considerable decrease in average caries experience from 16.6 DMFT in 1972 to 11.8 in 1982 and 6.2 in 1993. The results further documented markedly increased availability of public school dental health services, the coverage rising from 33% in 1972 to 65% in 1982 and 100% in 1993, as well as moderately increased utilisation of regular dental care with private practitioners, rising from 71% in 1972 to 86% in 1982 and 84% in 1993. In 1993 as in 1982 and 1972, recruits who used the public school dental health services and also received regular dental care after their school leaving age showed the lowest average caries experience. The findings indicate a marked decrease in average caries experience and an increased utilisation of dental services among Danish young men from 1972 to 1993. However, in 1993 the least privileged social group continued to maintain the highest average caries experience and the lowest rate of utilisation of regular dental care.

Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana.

PubMed

van der Wielen, Nele; Channon, Andrew Amos; Falkingham, Jane

2018-01-01

This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed. Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over. The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled. The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.

Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana

PubMed Central

van der Wielen, Nele; Channon, Andrew Amos; Falkingham, Jane

2018-01-01

Introduction This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed. Methods Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over. Results The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled. Conclusion The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments. PMID:29527348

[Sustainable Implementation of Evidence-Based Programmes in Health Promotion: A Theoretical Framework and Concept of Interactive Knowledge to Action].

PubMed

Rütten, A; Wolff, A; Streber, A

2016-03-01

This article discusses 2 current issues in the field of public health research: (i) transfer of scientific knowledge into practice and (ii) sustainable implementation of good practice projects. It also supports integration of scientific and practice-based evidence production. Furthermore, it supports utilisation of interactive models that transcend deductive approaches to the process of knowledge transfer. Existing theoretical approaches, pilot studies and thoughtful conceptual considerations are incorporated into a framework showing the interplay of science, politics and prevention practice, which fosters a more sustainable implementation of health promotion programmes. The framework depicts 4 key processes of interaction between science and prevention practice: interactive knowledge to action, capacity building, programme adaptation and adaptation of the implementation context. Ensuring sustainability of health promotion programmes requires a concentrated process of integrating scientific and practice-based evidence production in the context of implementation. Central to the integration process is the approach of interactive knowledge to action, which especially benefits from capacity building processes that facilitate participation and systematic interaction between relevant stakeholders. Intense cooperation also induces a dynamic interaction between multiple actors and components such as health promotion programmes, target groups, relevant organisations and social, cultural and political contexts. The reciprocal adaptation of programmes and key components of the implementation context can foster effectiveness and sustainability of programmes. Sustainable implementation of evidence-based health promotion programmes requires alternatives to recent deductive models of knowledge transfer. Interactive approaches prove to be promising alternatives. Simultaneously, they change the responsibilities of science, policy and public health practice. Existing boundaries within disciplines and sectors are overcome by arranging transdisciplinary teams as well as by developing common agendas and procedures. Such approaches also require adaptations of the structure of research projects such as extending the length of funding. © Georg Thieme Verlag KG Stuttgart · New York.

Hippocampal Contribution to Context Encoding across Development Is Disrupted following Early-Life Adversity.

PubMed

Lambert, Hilary K; Sheridan, Margaret A; Sambrook, Kelly A; Rosen, Maya L; Askren, Mary K; McLaughlin, Katie A

2017-02-15

Context can drastically influence responses to environmental stimuli. For example, a gunshot should provoke a different response at a public park than a shooting range. Little is known about how contextual processing and neural correlates change across human development or about individual differences related to early environmental experiences. Children ( N = 60; 8-19 years, 24 exposed to interpersonal violence) completed a context encoding task during fMRI scanning using a delayed match-to-sample design with neutral, happy, and angry facial cues embedded in realistic background scenes. Outside the scanner, participants completed a memory test for context-face pairings. Context memory and neural correlates of context encoding did not vary with age. Larger hippocampal volume was associated with better context memory. Posterior hippocampus was recruited during context encoding, and greater activation in this region predicted better memory for contexts paired with angry faces. Children exposed to violence had poor memory of contexts paired with angry faces, reduced hippocampal volume, and atypical neural recruitment on encoding trials with angry faces, including reduced hippocampal activation and greater functional connectivity between hippocampus and ventrolateral prefrontal cortex (vlPFC). Greater hippocampus-vlPFC connectivity was associated with worse memory for contexts paired with angry faces. Posterior hippocampus appears to support context encoding, a process that does not exhibit age-related variation from middle childhood to late adolescence. Exposure to dangerous environments in childhood is associated with poor context encoding in the presence of threat, likely due to greater vlPFC-dependent attentional narrowing on threat cues at the expense of hippocampus-dependent processing of the broader context. SIGNIFICANCE STATEMENT The ability to use context to guide reactions to environmental stimuli promotes flexible behavior. Remarkably little research has examined how contextual processing changes across development or about influences of the early environment. We provide evidence for posterior hippocampus involvement in context encoding in youth and lack of age-related variation from middle childhood to late adolescence. Children exposed to interpersonal violence exhibited poor memory of contexts paired with angry faces and atypical neural recruitment during context encoding in the presence of threatening facial cues. Heightened attention to threat following violence exposure may come at the expense of encoding contextual information, which may ultimately contribute to pathological fear expressed in safe contexts. Copyright © 2017 the authors 0270-6474/17/371925-10$15.00/0.

Leader-member exchange (LMX) and culture: a meta-analysis of correlates of LMX across 23 countries.

PubMed

Rockstuhl, Thomas; Dulebohn, James H; Ang, Soon; Shore, Lynn M

2012-11-01

This study extends leader-member exchange (LMX) research by meta-analyzing the role of national culture in moderating relationships between LMX and its correlates. Results based on 282 independent samples (N = 68,587) from 23 countries and controlling for extreme response style differences indicate that (a) relationships of LMX with organizational citizenship behavior, justice perceptions, job satisfaction, turnover intentions, and leader trust are stronger in horizontal-individualistic (e.g., Western) contexts than in vertical-collectivistic (e.g., Asian) contexts; and (b) national culture does not affect relationships of LMX with task performance, organizational commitment, and transformational leadership. These findings highlight that although members are universally sensitive to how their leaders treat them, members' responses in Asian contexts may also be influenced by collective interests and role-based obligations. (c) 2012 APA, all rights reserved.

Modelling Pasture-based Automatic Milking System Herds: The Impact of Large Herd on Milk Yield and Economics.

PubMed

Islam, M R; Clark, C E F; Garcia, S C; Kerrisk, K L

2015-07-01

The aim of this modelling study was to investigate the effect of large herd size (and land areas) on walking distances and milking interval (MI), and their impact on milk yield and economic penalties when 50% of the total diets were provided from home grown feed either as pasture or grazeable complementary forage rotation (CFR) in an automatic milking system (AMS). Twelve scenarios consisting of 3 AMS herds (400, 600, 800 cows), 2 levels of pasture utilisation (current AMS utilisation of 15.0 t dry matter [DM]/ha, termed as 'moderate'; optimum pasture utilisation of 19.7 t DM/ha, termed as 'high') and 2 rates of incorporation of grazeable complementary forage system (CFS: 0, 30%; CFS = 65% farm is CFR and 35% of farm is pasture) were investigated. Walking distances, energy loss due to walking, MI, reduction in milk yield and income loss were calculated for each treatment based on information available in the literature. With moderate pasture utilisation and 0% CFR, increasing the herd size from 400 to 800 cows resulted in an increase in total walking distances between the parlour and the paddock from 3.5 to 6.3 km. Consequently, MI increased from 15.2 to 16.4 h with increased herd size from 400 to 800 cows. High pasture utilisation (allowing for an increased stocking density) reduced the total walking distances up to 1 km, thus reduced the MI by up to 0.5 h compared to the moderate pasture, 800 cow herd combination. The high pasture utilisation combined with 30% of the farm in CFR in the farm reduced the total walking distances by up to 1.7 km and MI by up to 0.8 h compared to the moderate pasture and 800 cow herd combination. For moderate pasture utilisation, increasing the herd size from 400 to 800 cows resulted in more dramatic milk yield penalty as yield increasing from c.f. 2.6 and 5.1 kg/cow/d respectively, which incurred a loss of up to $AU 1.9/cow/d. Milk yield losses of 0.61 kg and 0.25 kg for every km increase in total walking distance (voluntary return trip from parlour to paddock) and every one hour increase in MI, respectively. The high pasture utilisation combined with 30% of the farm in CFR in the farm increased milk yield by up to 1.5 kg/cow/d, thereby reducing loss by up to $0.5/cow/d (c.f. the moderate pasture and 800 cow herd scenario). Thus, it was concluded that the successful integration of grazeable CFS with pasture has the potential to improve financial performance compared to the pasture only, large herd, AMS.

Neural Correlates of Affective Influence on Choice

ERIC Educational Resources Information Center

Piech, Richard M.; Lewis, Jade; Parkinson, Caroline H.; Owen, Adrian M.; Roberts, Angela C.; Downing, Paul E.; Parkinson, John A.

2010-01-01

Making the right choice depends crucially on the accurate valuation of the available options in the light of current needs and goals of an individual. Thus, the valuation of identical options can vary considerably with motivational context. The present study investigated the neural structures underlying context dependent evaluation. We instructed…

On Direction of Dependence in Latent Variable Contexts

ERIC Educational Resources Information Center

von Eye, Alexander; Wiedermann, Wolfgang

2014-01-01

Approaches to determining direction of dependence in nonexperimental data are based on the relation between higher-than second-order moments on one side and correlation and regression models on the other. These approaches have experienced rapid development and are being applied in contexts such as research on partner violence, attention deficit…

Pseudocontingencies and Choice Behavior in Probabilistic Environments with Context-Dependent Outcomes

ERIC Educational Resources Information Center

Meiser, Thorsten; Rummel, Jan; Fleig, Hanna

2018-01-01

Pseudocontingencies are inferences about correlations in the environment that are formed on the basis of statistical regularities like skewed base rates or varying base rates across environmental contexts. Previous research has demonstrated that pseudocontingencies provide a pervasive mechanism of inductive inference in numerous social judgment…

Teachers' Emotional Labour, Discrete Emotions, and Classroom Management Self-Efficacy

ERIC Educational Resources Information Center

Lee, Mikyoung; van Vlack, Stephen

2018-01-01

Extending research on teachers' emotions beyond general educational contexts and Western samples, we examined how teachers' emotions correlated with their emotional labour strategies and classroom management self-efficacy with an East-Asian sample in an English teaching context (127 Korean English teachers). Surface acting (emotional expressions…

A Meta-Analysis of the Correlation between Heritage Language and Ethnic Identity

ERIC Educational Resources Information Center

Mu, Guanglun Michael

2015-01-01

The interaction between heritage language (HL) and ethnic identity has gained increasing scholarly attention over the past decades. Numerous quantitative studies have investigated and vindicated this interaction within certain contexts. Nevertheless, quantitative evidence on this interaction across contexts is absent to date. The current…

Evolution from Packet Utilisation to Mission Operation Services

NASA Astrophysics Data System (ADS)

Cooper, Sam; Forwell, Stuart D.

2012-08-01

The ECSS Packet Utilisation Standard (PUS) and the forthcoming CCSDS Mission Operations (MO) Services occupy a very similar domain. This paper discusses the history of the two standards, their relationship and how the two can co-exist in the near term and long terms. It also covers implications with implementing MO services in current and future on-board architectures.

Understanding Teachers' Perspectives of Factors That Influence Parental Involvement Practices in Special Education in Barbados

ERIC Educational Resources Information Center

Blackman, Stacey; Mahon, Erin

2016-01-01

Parental involvement has been defined in various ways by researchers and is reported to have many advantages for children's education. The research utilises a case study strategy to investigate teachers' perspectives of parental involvement at four case sites in Barbados. In-depth interviews were done with teachers and analysis utilised content…

Public Health Knowledge Utilisation by Policy Actors: An Evaluation Study in Midden-Holland, the Netherlands

ERIC Educational Resources Information Center

de Goede, Joyce; Steenkamer, Betty; Treurniet, Henriëtte; Putters, Kim; van Oers, Hans

2011-01-01

A comprehensive report has been prepared on the state of public health and healthcare in the Midden-Holland region of the Netherlands. This study describes the development of the report and the mechanisms behind public health knowledge utilisation by three groups of health policy actors: local authorities, public health professionals and regional…

Experiences in the Dissemination and Utilisation of Information and Communication Technology (ICT) Research Findings from Three Southern African Universities

ERIC Educational Resources Information Center

Kaino, Luckson M.; Mtetwa, David; Kasanda, Choshi

2014-01-01

The dissemination and utilisation of research knowledge produced at universities has been debated in recent times. Recent changes and developments at universities suggest an entrepreneurial model of academic research production in which universities have the responsibility not only to carry out research and teaching but also to disseminate…

The Pivotal Position of 'Liaison People': Facilitating a Research Utilisation Intervention in Policy Agencies

ERIC Educational Resources Information Center

Haynes, Abby; Butow, Phyllis; Brennan, Sue; Williamson, Anna; Redman, Sally; Carter, Stacy; Gallego, Gisselle; Rudge, Sian

2018-01-01

This paper explores the enormous variation in views, championing behaviours and impacts of liaison people: staff nominated to facilitate, tailor and promote SPIRIT (a research utilisation intervention trial in six Australian health policy agencies). Liaison people made cost/benefit analyses: they weighed the value of participation against its…

Ethnic Factors in Mental Health Service Utilisation among People with Intellectual Disability in High-Income Countries: Systematic Review

ERIC Educational Resources Information Center

Dura-Vila, G.; Hodes, M.

2012-01-01

Background: An emerging literature suggests that ethnic and cultural factors influence service utilisation among people with intellectual disability (ID), but this has not previously been reviewed. Aims: To investigate possible ethnic variation in uptake of mental health services in children, adolescents and adults with ID in high-income…

Télèmetre utilisant une diode laser à balayage continu en fréquence et un double interférométre

NASA Astrophysics Data System (ADS)

Hafidi, Abdeslam; Pfeiffer, Pierre; Meyrueis, Patrick

2018-04-01

This paper, "Télèmetre utilisant une diode laser à balayage continu en fréquence et un double interférométre," was presented as part of International Conference on Space Optics—ICSO 1997, held in Toulouse, France.

Exploring the Extent to Which ELT Students Utilise Smartphones for Language Learning Purposes

ERIC Educational Resources Information Center

Yaman, Ismail; Senel, Müfit; Yesilel, Deren Basak Akman

2015-01-01

The advent of smartphones has had dramatic influences on our daily lives and has rendered human beings "walking computers." This holds important reflections in the realm of language learning, as well as in many other areas. This study aimed to explore the extent to which English Language Teaching (ELT) students utilise smartphones for…

Utilising Benchmarking to Inform Decision-Making at the Institutional Level: A Research-Informed Process

ERIC Educational Resources Information Center

Booth, Sara

2013-01-01

Benchmarking has traditionally been viewed as a way to compare data only; however, its utilisation as a more investigative, research-informed process to add rigor to decision-making processes at the institutional level is gaining momentum in the higher education sector. Indeed, with recent changes in the Australian quality environment from the…

Impediments to Effective Utilisation of Information and Communication Technology Tools in Selected Universities in the North-Eastern Nigeria

ERIC Educational Resources Information Center

Momoh, Mustapha

2010-01-01

This study examined the impediments to effective use of Information and Communication Technology (ICT) tools in Nigerian universities. Series of research conducted on the factors militating against computerisation indicated that, there were impediments to effective utilisation of ICT tools in most developing countries. In the light of this, the…

Science Teachers' Utilisation of Innovative Strategies for Teaching Senior School Science in Ilorin, Nigeria

ERIC Educational Resources Information Center

Oyelekan, Oloyede Solomon; Igbokwe, Emoyoke Faith; Olorundare, Adekunle Solomon

2017-01-01

Efforts have been made to improve science teaching in secondary schools in Nigeria, yet, students continue to perform poorly in science subjects. Many innovative teaching strategies have been developed by educators and found to impact significantly on students' academic performance when utilised. Hence, this study was aimed at examining science…

The Schooling Experience of Adolescent Boys with AD/HD: An Australian Case Study

ERIC Educational Resources Information Center

Gibbs, Kathryn; Mercer, K. Louise; Carrington, Suzanne

2016-01-01

This study explored the experience of schooling of six adolescent boys diagnosed with AD/HD from the perspectives of the boys, their mothers and their teachers. The study utilised social constructionism as the theoretical orientation and the Dynamic Developmental Theory (DDT) of AD/HD as the explanatory framework. Utilising a multiple,…

VO2 thermochromic smart window for energy savings and generation

PubMed Central

Zhou, Jiadong; Gao, Yanfeng; Zhang, Zongtao; Luo, Hongjie; Cao, Chuanxiang; Chen, Zhang; Dai, Lei; Liu, Xinling

2013-01-01

The ability to achieve energy saving in architectures and optimal solar energy utilisation affects the sustainable development of the human race. Traditional smart windows and solar cells cannot be combined into one device for energy saving and electricity generation. A VO2 film can respond to the environmental temperature to intelligently regulate infrared transmittance while maintaining visible transparency, and can be applied as a thermochromic smart window. Herein, we report for the first time a novel VO2-based smart window that partially utilises light scattering to solar cells around the glass panel for electricity generation. This smart window combines energy-saving and generation in one device, and offers potential to intelligently regulate and utilise solar radiation in an efficient manner. PMID:24157625